Objective:To evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) during the perioperative period and early postoperative recurrence in patients with advanced gastric cancer.Methods:In this prospective study, 188 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-75 yr, with a body mass index of 20-30 kg/m 2, with radiological staging of T 2-4N xM 0, underwent elective gastric cancer radical surgery under general anesthesia at the Fourth Hospital of Hebei Medical University from January 2018 to April 2022, were selected. The NLR was measured at 1 day before operation and postoperative days 1, 3 and 5. The difference between postoperative and preoperative NLR (ΔNLR) was calculated. Based on the presence or absence of tumor recurrence and/or metastasis within 2 yr after surgery, the patients were divided into recurrence group and non-recurrence group. The Cox proportional hazards regression model was employed to evaluate the early postoperative recurrence and perioperative NLR in patients with advanced gastric cancer. Results:A total of 171 patients ultimately completed the follow-up. There were 77 cases in recurrence group and 94 in non-recurrence group. Compared to non-recurrence group, NLR and ΔNLR were significantly increased on the 5th day after operation in recurrence group ( P<0.05). The elevated NLR and ΔNLR at postoperative day 5 were independent risk factors for recurrence within 2 yr in patients with advanced gastric cancer ( HR=1.026, P<0.05). Conclusions:NLR may not be associated with the risk of early postoperative recurrence in the patients with advanced gastric cancer, and further evaluation with large-scale studies is needed.

The patient was admitted to the hospital with a diagnosis of diffuse large B-cell lymphoma for one month,accompanied by limb numbness for one week.Upon admission,the patient was initially prescribed vitamin B,and mecobalamin for symptomatic relief,which led to an improvement in the symptoms of limb numbness.Subsequently,the patient was administered chemotherapy consisting of rituximab,lenalidomide,and prednisone.However,following the initiation of chemotherapy,the symptoms of limb numbness became more severe.After review of the patient's medication history and analysis of relevant data,the clinical pharmacist suggested that the patient's limb numbness was caused by lenalidomide-induced peripheral neuropathy.

Objective:To evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) during the perioperative period and early postoperative recurrence in patients with advanced gastric cancer.Methods:In this prospective study, 188 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-75 yr, with a body mass index of 20-30 kg/m 2, with radiological staging of T 2-4N xM 0, underwent elective gastric cancer radical surgery under general anesthesia at the Fourth Hospital of Hebei Medical University from January 2018 to April 2022, were selected. The NLR was measured at 1 day before operation and postoperative days 1, 3 and 5. The difference between postoperative and preoperative NLR (ΔNLR) was calculated. Based on the presence or absence of tumor recurrence and/or metastasis within 2 yr after surgery, the patients were divided into recurrence group and non-recurrence group. The Cox proportional hazards regression model was employed to evaluate the early postoperative recurrence and perioperative NLR in patients with advanced gastric cancer. Results:A total of 171 patients ultimately completed the follow-up. There were 77 cases in recurrence group and 94 in non-recurrence group. Compared to non-recurrence group, NLR and ΔNLR were significantly increased on the 5th day after operation in recurrence group ( P<0.05). The elevated NLR and ΔNLR at postoperative day 5 were independent risk factors for recurrence within 2 yr in patients with advanced gastric cancer ( HR=1.026, P<0.05). Conclusions:NLR may not be associated with the risk of early postoperative recurrence in the patients with advanced gastric cancer, and further evaluation with large-scale studies is needed.

The patient was admitted to the hospital with a diagnosis of diffuse large B-cell lymphoma for one month,accompanied by limb numbness for one week.Upon admission,the patient was initially prescribed vitamin B,and mecobalamin for symptomatic relief,which led to an improvement in the symptoms of limb numbness.Subsequently,the patient was administered chemotherapy consisting of rituximab,lenalidomide,and prednisone.However,following the initiation of chemotherapy,the symptoms of limb numbness became more severe.After review of the patient's medication history and analysis of relevant data,the clinical pharmacist suggested that the patient's limb numbness was caused by lenalidomide-induced peripheral neuropathy.

Postoperative pulmonary complications are common in thoracic surgery, which are the main influencing factors of poor prognosis, prolonged hospital stay, increased medical burden and increased postoperative mortality. Therefore, effective early diagnosis, early diagnosis and timely treatment of postoperative pulmonary complications after thoracic surgery is of great significance to improve the prognosis of patients. This article will review the definition, mechanism, risk factors and preventive measures of pulmonary complications after thoracic surgery.

Objective:To evaluate the value of systematic education for primiparas undergoing epidural labor analgesia.Methods:A total of 240 primiparas who were suitable and voluntarily requested epidural labor analgesia, aged 20-35 yr, at 37-41 + 6 weeks gestation, with a singleton fetus, in vertex presentation without fetal abnormality, were selected.According to whether the primiparas and their accompanying family members had received systematic education on epidural labor analgesia during pregnancy, the primiparas were divided into 2 groups ( n=120 each): education group and control group.When the uterine contraction was regular and the diameter of the uterine orifice reached 2 cm or more, epidural labor analgesia was carried out.Before the begining of epidural puncture, the degree of anxiety of pregnant women was evaluated using the self-rating anxiety scale.The time of communication before analgesia, time of placing body position, and satisfaction of puerperae and their family members with labor analgesia were observed and recorded. Results:Compared with control group, the self-rating anxiety scale score was significantly decreased, the time of communication before analgesia and time of placing body position were shortened, and the rate of satisfaction of puerperae and their family members with labor analgesia was increased in education group ( P<0.05). Conclusions:Systematic education is helpful in relieving the anxiety of primiparas during epidural labor analgesia, increasing the efficiency of analgesia implementation and improving the delivery experience of puerperae.

Objective:To explore the behavior and influencing factors of mobile health (m-Health) information searching among patients with cancer, aiming to provide evidence for the provision of medical health information.Methods:A cross-sectional survey was conducted.A total of 535 patients with cancer were recruited from a cancer hospital in Zhejiang Province from September to December 2017.Measurement tools included the demographic information questionnaire, mobile health information search behavior questionnaire, mobile health information search environment questionnaire, cancer needs questionnaires-short form and ehealth literacy scale.SPSS 26.0 was used for descriptive statistical analysis, one-way analysis of variance, Pearson correlation analysis and multiple linear regression analysis.Results:The total score of mobile health information search behavior of cancer patients was (60.84±9.60), and 66.5% of participants reported that they "never" or "occasionally" searched health information via mobile.The total score of information needs was (80.99±27.86), electronic health literacy was (26.54±7.85), mobile health information search environment was (8.00±2.86). m-Health information search behavior was positively correlated with information needs ( r=0.251, P<0.01), ehealth literacy ( r=0.538, P<0.01), and m-Health information search environment ( r=0.267, P<0.01). The stepwise regression analysis revealed that the place of residence, working status, income level, ehealth literacy, mobile health information search environment and information needs were statistically significant associated with the m-Health information searching behavior among cancer patients, which accounted for 39.3% of the total variance ( F=12.151, P<0.01). Compared with patients living in the central cities, those living in the small and medium-sized cities( β=0.092, P=0.031) had higher score in m-Health information behavior.Compared with patients working on normal schedule, those took sick days ( β=0.156, P=0.017) and working fewer hours ( β=0.138, P=0.002) had higher score m-Health information behavior.Compared with patients with monthly income of 1 000-3 000 yuan ( β=-0.194, P=0.002), those with monthly income less than 1 000 yuan had higher score in m-Health information behavior.The ehealth literacy ( β=0.425, P=0.000), mobile health information search environment ( β=0.179, P=0.000) and information needs ( β=0.091, P=0.027) were positive influencing factors of m-Health information search behavior. Conclusion:Patients with cancer did not report high m-Health information search behavior.Place of residence, working status, income level, ehealth literacy, m-Health information search environment and information demand were the influencing factors of m-Health information search behavior among patients with cancer.

Objective:To analyze the relationship between homology of Kleber pathogen pneumoniae (KP) in patients with neurocritical infections and the Genomics.Method:Five non-multidrug resistant pathogen KP were identified in 2015 to 2018, including the same cloning strain of P90 and P91, the same popular cloning system of P66,P90 and P91, and there is no homology between P20,P39 and other strains, which makes a second generation full genome sequencing. A variety of bioinformatics software were used for genomic analysis to understand the basic genomic information, chromosomal and plasmid distribution, single nucleotide polymorphism (SNP) differences and gene family clustering characteristics, meanwhile with the National Center for Biotechnology Information (NCBI) website registered 18 KP strains (2013--2016) to analyze the evolutionary affinity between strains.Results:The total genome sizes of P20, P39, P66, P90 and P91 were 5 469 543 bp, 5 480 332 bp, 5 768 352 bp, 5 745 666 bp, 5 722 999 bp. The GC contents were 57.07% (1 559 929+1 561 432)/5 469 543, 57.27% (1 566 970+1 571 424)/5 480 322, 56.96% (1 640 438+1 645 432)/5 768 352, 56.88% (1 634 285+1 634 038)/5 745 666, and 56.95% (1 627 360+1 631 781)/5 722 999, respectively. Compared with P20 reference strains, the total number of SNP in P39, P66, P90 and P91 were 32 682, 34 226, 34 292, 34 375, and the total mutation rates of gene coding region sequences were87.18% (28 491/32 682), 86.71% (29 679/34 226), 85.26% (29 238/34 292), 86.22% (29 638/34 375), respectively. Nonsynonymous mutations accounted for some advantages, and the rates were 44.57% (14 566/32 682), 44.01% (15 063/34 226), 48.01% (16 465/34 292), 48.75% (16 758/34 375), and synonymous mutations were 42.61% (13 925/32 682), 42.70% (14 616/34 226), 37.25% (12 773/34 292), 37.47% (12 880/34 375), respectively. P90 and P91 have 6 specific gene families, and P66 has 4 specific gene families. The same popular clone lines P66, P90 and P99 are on the same evolutionary branch of the phylogenetic tree. The same clone P90 and P99 are on the same subbranch. P20 and P39 without homology are on different evolutionary branches respectively. P20, P39, P66, P90 and P91 on the evolutionary branches of phylogenetic tree are closely related to the evolutionary grade of strain KP52-145 from France and strain ED23 from Taiwan, China submitted on NCBI website.Conclusion:Klebsiella pneumoniae in patients with neurocritical infection has the same clone, and the number of unique gene families among strains is the same. There are small differences in the number of unique gene families and the total number of SNPs among the same epidemic clone lines, and they are characteristic of the same evolutionary branch of the phylogenetic tree. The number of unique gene families and the total number of SNPs of non homologous strains are quite different, and they are in different evolutionary branches of the phylogenetic tree.

Objective:To evaluate the accuracy of surgical pleth index (SPI) in monitoring the depth of anesthesia in elderly patients undergoing general anesthesia.Methods:Thirty-five patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 65-80 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery, were studied.Combined intravenous-inhalational anesthesia was used to maintain bispectral index value at 45-60.SPI was recorded within 2 min before and after skin incision, before and after pneumoperitoneum, and before and after the most intense stimulation of skin incision.The maximum value (SPI max) within 2 min after noxious stimulation was recorded, and the difference between SPI max and baseline value (ΔSPI) was calculated.The receiver operating characteristic curve (ROC) was used to evaluate the accuracy of the above indicators in monitoring the depth of anesthesia. Results:Thirty patients were finally included in this study.The area under the curve of SPI max was 0.887, the diagnostic threshold was 57, the sensitivity was 68.9%, and the specificity was 92.9%.The area under the curve of ΔSPI was 0.988, diagnostic threshold was 12, the sensitivity was 88.0%, and the specificity was 98.7%. Conclusion:SPI can accurately determine the depth of anesthesia in elderly patients with general anesthesia, and using ΔSPI has more clinical significance.

Objective:To explore the current status and influencing factors of knowledge, attitude and practice of drug clinical trials among ovarian cancer patients.Methods:We selected 268 ovarian cancer patients from a ClassⅢ Grade A cancer hospital in Zhejiang Province from January to December 2018 by convenience sampling. The mature Knowledge, Attitude and Practice Questionnaire was used to investigate the current status of knowledge, attitude and practice in drug clinical trials. According to the survey results, patients were divided into the high cognition group and the low cognition group. Univariate and multivariate Logistic regression were used to analyze the influencing factors.Results:Among 268 patients, the scores of knowledge, attitude and practice were (31.67±3.59) , (16.35±2.71) and (10.56±1.43) respectively. Univariate analysis showed that there were statistical differences in knowledge, attitude and practice among patients with different education levels, residence places, medical insurance, occupation, fertility, medical attention, medical relatives and friends, and annual income ( P<0.05) . Multivariate analysis indicated that the influencing factors of knowledge, attitude and practice in drug clinical trials of ovarian patients included education levels, medical insurance, medication attention and annual income. Conclusions:Patients with ovarian cancer are not optimistic about the level of knowledge, attitude and practice in drug clinical trials, which clinical nurses should pay great attention to. We should carry out individualized health education for patients with different backgrounds and characteristics.