Objective:To explore the application effect of the forgetting curve combined with blended learning in extracorporeal membrane oxygenation (ECMO) nursing training for ICU nurses.Methods:A randomized controlled trial was conducted from June to November 2022. Sixty-three ICU nurses from the First Hospital of Quanzhou City were selected using cluster sampling and divided into an observation group ( n=30) and a control group ( n=33). The control group received traditional teaching methods for training, while the observation group received training using the forgetting curve combined with blended learning. Compared the ECMO theoretical scores and skill operation scores of two groups of nurses after 1 day, 1 month, and 3 months of training; observed the core competencies and training satisfaction of ECMO nurses before and after training in two groups of nurses. Results:In the control group, there were 7 males and 26 females with an average age of (27.88 ± 4.36) years old; in the observation group, there were 6 males and 24 females with an average age of (28.67 ± 4.24) years old.Prior to training, there were no statistically significant differences in theoretical scores, skill operation scores, and core competencies between the two groups (all P>0.05). After 1 day, 1 month, and 3 months of training, the observation group′s ECMO theoretical scores were (80.33 ± 3.11), (78.13 ± 3.70), (76.73 ± 3.30) points respectively, higher than those of the control group which were (75.18 ± 3.30), (73.88 ± 2.75), (70.48 ± 2.96) points, with statistically significant differences ( t=6.36, 5.21, 7.92, all P<0.01); the observation group′s ECMO skill operation scores were (84.10 ± 4.16), (82.73 ± 3.71), (81.50 ± 3.40) points respectively, higher than the control group′s (78.09 ± 4.30), (74.97 ± 4.17), (71.85 ± 4.03) points, with statistically significant differences ( t=5.63, 7.77, 10.22, all P<0.01). There were statistically significant differences between two groups of nurses in terms of ECMO theory score and skill operation score, as well as time and interactive effect after training ( Finteraction=11.16, 84.76, both P<0.05). After training, the observation group′s total score for ECMO nurse core competency was (280.23 ± 9.23) points, superior to the control group′s (245.39 ± 14.90) points, with a statistically significant difference ( t=11.26, P<0.01). The observation group′s satisfaction total score and the scores in various dimensions were (99.17 ± 10.79), (4.43 ± 0.50), (4.30 ± 0.53), (4.57 ± 0.68), (4.37 ± 0.67), (4.23 ± 0.57) points, all higher than those of the control group which were (84.30 ± 12.61), (3.67 ± 0.96), (3.48 ± 0.71), (3.67 ± 0.74), (3.73 ± 0.72), (3.82 ± 0.77) points, with statistically significant differences ( t values were 2.42 to 5.09, all P<0.05). Conclusions:The application of the forgetting curve combined with blended learning in ECMO nursing training for ICU nurses is scientifically feasible. It helps nurses master ECMO theory and skill operations, improve ECMO nurse core competencies, enhance training satisfaction, and provides a new method for ECMO nursing training.

Humans ; Nitric Oxide ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms ; Lung ; Nitric Oxide Synthase ; Macrophages, Alveolar ; Pulmonary Alveoli

Objective:To determine the prevalence of sarcopenia and explore related influencing factors of sarcopenia in maintenance hemodialysis (MHD) patients.Methods:MHD patients aged ≥18 years old and receiving therapies of ≥3 months from March 2019 to December 2019 in Blood Purification Centre of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively enrolled in this study. General data of the patients were collected. Grip strength was measured by the Jamar dynamometer and the chair stand was measured by a chair of standard height to assess skeletal muscle strength and appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry. Baseline data between MHD patients with and without myasthenia were compared. Logistic regression analysis method was used to analyze the influencing factors for sarcopenia in MHD patients.Results:A total of 125 MHD patients were enrolled, with 68 males (54.4%), age of (59.4±14.9) years and median dialysis age of 51.0(23.5, 101.0) months. Sarcopenia was diagnosed in 39 cases (31.2%). Compared with MHD patients without sarcopenia, age, tumor necrosis factor-α, von Willebrand factor (vWF) and proportion of using α ketones were higher, and serum carbondioxide combining power (CO 2CP), prealbumin, albumin and proportion of regular exercise were lower in MHD patients with sarcopenia (all P<0.05). Multivariable logistic regression analysis results showed that low CO 2CP ( OR=0.717, 95% CI 0.576-0.892, P=0.003), high vWF ( OR=1.037, 95% CI 1.016-1.058, P<0.001) and no regular exercise ( OR=0.309, 95% CI 0.118-0.810, P=0.017) were independent influencing factors of sarcopenia in MHD patients. Conclusions:The prevalence of sarcopenia in MHD patients is high. Low CO 2CP, high vWF and no regular exercise are independent influencing factors for sarcopenia in MHD patients.

Objective:To investigate the clinical practice of chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis patients in Shanghai, and to better understand the changes of clinical practice for CKD-MBD.Methods:Sixty-four hospitals with qualified dialysis center in Shanghai were selected for questionnaire survey as of March 2019. The survey questionnaire included the number of hemodialysis and peritoneal dialysis patients, the implementation of CKD-MBD guidelines, the learning of CKD-MBD guidelines, the detection and distribution of CKD-MBD biochemical indicators, the treatment of hyperphosphatemia, the treatment of secondary heperparathyroidism (SHPT) and renal bone disease, and the concentration of calcium ion in dialysate. The results were compared with previous survey data in 2011.Results:There were sixty-three hospitals included in this study, with 10 168 maintenance hemodialysis patients and 4 610 maintenance peritoneal dialysis patients in Shanghai. 84.1%(53/63) hospitals implemented the guidelines smoothly, which increased by 28.5% compared with the rate (55.6%) of 2011. The successful implementation rates for guidelines in secondary and tertiary hospitals were 83.3%(25/30) and 84.8%(28/33) , which increased by 44.0% and 11.7% respectively (39.3% of secondary hospitals and 73.1% of tertiary hospitals in 2011). All hospitals carried out the detection for serum calcium and phosphorus. The rate for parathyroid hormone (PTH), total alkaline phosphatase (AKP), bone specific alkaline phosphatase (BAP), 25-hydroxy vitamin D[25(OH)D], and other bone metabolism-related biomarkers were 98.4%(62/63), 90.5%(57/63), 19.0%(12/63), 90.5%(57/63) and 42.9%(27/63), respectively; coronary artery CT, lumbar lateral X-ray plain, echocardiography, bone mineral density, and vascular ultrasound were carried out in 68.3%(43/63), 74.6%(47/63), 100.0%(63/63), 68.3%(43/63)and 69.8%(44/63), respectively. Compared with 2011, the proportion of detection for PTH, AKP, BAP, 25(OH)D, coronary artery CT, lumbar lateral film and echocardiography increased by 2.1%, 1.6%, 0.5%, 47.9%, 14.6%, 20.9% and 1.9%, respectively. The proportion of patients with serum phosphorus ranging in 0.80-1.45 mmol/L(KDIGO guideline), serum phosphorus ranging in 0.80-1.78 mmol/L(KDOQI guideline), calcium ranging in 2.10-2.54 mmol/L, and PTH ranging in 150-600 ng/L were 37.0%(3 323/8 969), 50.7%(4 571/9 018), 60.2%(5 568/9 244) and 33.2%(3 018/9 087). Compared with 2011(39.6%, 53.5% and 34.1%), the proportion of patients with ideal serum phosphorus (0.80-1.78 mmol/L) and calcium (2.10-2.54 mmol/L) levels increased by 11.1% and 6.7% respectively, and the proportion with PTH 150-300 ng/L decreased by 0.9%. The proportion of hospitals for using non-calcium phosphate binders (lanthanum carbonate from 1.9% to 87.3% and sevelamer carbonate from 14.8% to 63.5%) and surgical treatment (from 38.9% to 68.3%) for SHPT dramatically increased.Conclusions:Through the availability of medicine increases, and nephrologists gain deeper understanding in management and treatment of CKD-MBD, the detection rate for CKD-MBD indicators and the eligible rate have significantly improved compared with those in 2011. However, the comprehensive management of CKD-MBD in Shanghai still faces great challenges. It is still necessary to further improve eligible rate for serum phosphorus and iPTH, so as to provide more evidences and management strategies for integrated management of end-stage renal disease and prevention of abnormal calcium and phosphorus metabolism in patients.

Objective To investigate the impact of 1,25(OH)2D3 on histological changes and activation of STAT3 in BLM?induced pulmonary fibrosis mice. Methods 30 male C57BL/6 mice were randomly divided into control group ,BLM group and BLM+VD group. Mice in BLM group and BLM+VD group received intratracheal injection of BLM(3 U/kg). Control group were intratracheally injected equal volume of sterile saline. From the first day after the surgery,mice in BLM+VD group received intraperitoneal injection of VD (5μg/kg·d). After 21 days, H&E and Masson′s trichrome staining were carried out. Aschroft score were used to evaluate histological changes in lungs. IL?6,IL?4 and INF?γin BALF were assessed by Elisa. p?STAT3,α?SMA and Collagen I were detected by western blot (WB) and immunohistochemistry. Results Fibrosis score and level of α?SMA,Collagen I in BLM group were significantly higher than that in control group (P < 0.05). However ,treatment with VD effectively at?tenuated fibrosis (P<0.05). IL?6 and IL?4 increased while INF?γwas decreased in BALF of BLM group (P<0.05). VD could ameliorate these changes. Upregulation and neuclear translocation of p?STAT3 were observed in BLM group,while VD intervention could inhibit phosphorylation of STAT3. Conclusions VD attenuate BLM?induced pulmonary fibrosis and regulate inflammatory cytokines probably by blocking STAT3 activation.

Objective Intradialytic hypotension (IDH) is one of the common complications during hemodialysis,however its diagnostic criteria are highly controversial at present.In order to fully understand the prevalence of IDH in our center and figure out which diagnostic criteria is better for Chinese maintenance hemodialysis (MHD) patients,we choose several IDH definitions by reviewing published literatures and analyze their association with mortality.Methods The patients were recruited from Blood Purification Center of Ruijin Hospital undergoing hemodialysis during July 2012.Pre-,intra-and post-dialysis blood pressure were recorded.Patients' clinical characteristics,laboratory results and cardiac ultrasound results were collected.Based on several IDH definitions,we investigated the prevalence rate of IDH and its frequency among MHD patients.SPSS 23.0 was used to analyze data and conduct survival analysis.Results Totally 219 MHD patients underwent 16084 hemodialysis in 6 months.The prevalence rate,overall and individual frequency of IDH fluctuated between 45.21％-100.00％,4.64％-37.60％ and 0.00％-33.00％ respectively.For every IDH criteria,the patients were recruited into the group IDH(+) if they ever met the corresponding definition,otherwise the group IDH(-).Survival analysis found that IDH (the criteria of an absolute systolic blood pressure (SBP) ＜ 90 mmHg or with a decrease of SBP≥ 20 mmHg) could decrease the risk of patients' cardiovascular mortality but was not relevant to all-cause mortality.Further analysis showed these patients had better cardiac functions mainly reflecting in lower Pro-BNP (2880 ng/L vs 6909 ng/L),lower prevalence rate of left ventricular hypertrophy (52％ vs 83％) and higher left ventricular ejection fraction (65.0％ vs 62.5％) than IDH(-) patients.No correlation was found between other IDH criteria and mortality.Conclusions The prevalence rate,overall and individual IDH frequency of IDH are of high variability when diagnosed by different IDH criteria.All IDH episodes defined by our selected definitions are of no association with all-cause mortality.An absolute SBP ＜ 90 mmHg or with a decrease of SBP≥20 mmHg can decrease the risk of cardiovascular mortality due to their better cardiac function.Large scale researches should be conducted to find optimal IDH definition and explore the association of IDH and mortality.

Objective To analyze the clinical features and pulmonary radiological findings of primary anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis (AAV).Methods Clinical data of 271 ANCA positive primary AAV patients admitted in Shanghai Ruijin Hospital from January 2003 to November 2015 were retrospectively analyzed.Among 271 patients,there were 211 myeloperoxidase (MPO)-ANCA positive cases (MPO subgroup),52 proteinase 3 (PR3)-ANCA positive cases (PR3 subgroup),and 8 dual positive cases (dual subgroup) according to ANCA classification.The demography,clinical characteristics,pulmonary radiological manifestation and renal function were compared among three subgroups.Results MPO subgroup had more renal (x2 =4.968,P =0.026) and constitutional symptoms (x2.=8.901,P =0.003) than PR3 group,while PR3 group had more ENT symptoms (x2 =19.843,P ＜ 0.001),cough (x2 =6.623,P =0.010),hemoptysis (x2 =8.656,P =0.003),dyspnea (x2 =5.127,P =0.024),buccal and ocular mucosal symptoms (x2 =4.818,P =0.028) than MPO group.In lung radiology,interstitial manifestations were displayed more frequently in MPO than PR3 group (x2 =4.237,P =0.040),while pulmonary nodules was more frequent in PR3 than MPO group (x2 =4.503,P =0.034).Dual subgroup tended to have more nervous,respiratory and renal impairment.Renal function showed that MPO subgroup had higher creatinine (Z =-5.529,P ＜ 0.001),urea (Z =-4.646,P ＜ 0.001) and uric acid levels (Z =-2.331,P =0.020) than PR3 subgroup.Dual subgroup had higher creatinine (Z =-3.251,P =0.001) and urea (Z =-2.882,P =0.004) levels than PR3 subgroup,but there was no difference with MPO subgroup.Conclusion There are significant differences in both clinical and pulmonary radiological manifestations between the MPO and PR3-ANCA subgroup of primary AAV.

Objective To evaluate the safety and short‐term efficacy of delta‐shaped anastomosis in the Billroth‐I reconstruc‐tion of totally laparoscopic distal gastric cancer radical operation (TLDG) .Methods The clinical data in 35 patients with TLDG Delta anastomosis(TLDG group) and 35 patients with laparoscopic assisted distal gastric cancer radical operation (LADG) extraper‐itoneal anastomosis (LADG group) in the gastroenterology department of our hospital from January to December 2014 were ana‐lyzed retrospectively .The intraoperative bleeding volume ,operative time ,gastroenterological function recovery time ,hospitalization duration ,postoperative pathological examination results and hospitalization total cost were compared between the two groups .Re‐sults Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death .The TLDG group had no anastomotic leakage ,bleeding and stenosis after operation ;while the LADG group had 1 case of gastroparesis ,1 case of anastomotic bleeding and 2 cases of anastomotic leakage .The introperative bleeding volume ,tumor size ,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups (P>0 .05);the operation time ,digestive tract reconstruction time ,first exhaustion time ,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group (P< 0 .05) ,but the hospitalization cost was higher than that in the LADG group ,the differences were statistically significant (P<0 .05) .Conclusion The delta‐shaped anasto‐mosis technique is safe and feasible for using in LADG ,moreover has better short‐term effect .

Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

OBJECTIVETo investigate the clinical value of three-dimensional (3D) high-definition (HD) laparoscope in laparoscopic radical resection of gastric cancer.

METHODSFrom January to December, 2013, 40 patients underwent radical resection of gastric cancer with 3D HD laparoscopy (3D group) and another 40 patients received 2D HD laparoscopy (2D group). The duration of surgery, intra-operative blood loss, learning curve, and costs during hospitalization were compared between the two groups.

RESULTSThe average operation duration of 3D group was 2.8=0.6 h, significantly shorter that in the 2D group (3.2=0.8 h, P<0.05); the intraoperative blood loss in the 3D group was significantly less than that in the 2D group (110=18 ml vs 120=21 ml, P>0.05). The mean hospitalization cost was 75 000=16 000 RMB Yuan in 3D group, similar to significantly lower than that of 71 000=13 000 RMB Yuan in 2D group (P>0.05).

CONCLUSION3D HD laparoscopy can provide three-dimensional vision and better sense of depth to facilitate precise operation and shorten the operation time. The high-definition 3D vision also allows surgeons to quickly improve surgical skills and shorten the learning curve.

Adult ; Aged ; Aged, 80 and over ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; methods ; Middle Aged ; Stomach Neoplasms ; surgery