Objective To investigate the current status and influencing factors of anticipatory grief of main caregivers of young and middle-aged patients with advanced liver cancer by cross-sectional survey.Methods A total of 330 caregivers of young and middle-aged patients with advanced liver cancer who were admitted to The Third Affiliated Hospital of Naval Medical University from January 2023 to May 2023 were enrolled as research objects by convenience sampling.A questionnaire survey on general information,anticipatory grief and simple coping style was conducted on these caregivers one day before discharge.Results The score of anticipatory grief of the caregivers was 94.10±22.33.Multiple linear stepwise regression analysis was performed with statistically significant data from the characteristics of the research objects as independent variables and anticipatory grief as the dependent variable,and the result showed that gender,monthly income,educational level,personality self-assessment and coping were main factors affecting anticipatory grief of main caregivers of young and middle-aged patients with advanced liver cancer(all P<0.05).The mean score for positive response was 2.23±0.14,which was negatively associated with anticipatory grief(P=0.041).The mean score for negative response was 1.31±0.24,which was positively associated with anticipatory grief(P<0.001).Conclusion The anticipatory grief of main caregivers of young and middle-aged patients with advanced liver cancer is at a high level.The anticipatory grief is negatively related to positive coping,and positively related to negative coping.The main factors affecting anticipatory grief of main caregivers of young and middle-aged patients with advanced liver cancer are gender,family economic status,educational level,and introverted personality.

Objective To summarize the best evidence concerning the prevention and management of indwelling line complications in patients with hepatocellular carcinoma(HCC)receiving hepatic artery infusion chemotherapy(HAIC),and to standardize the key contents of clinical observation of complications during HAIC treatment.Methods By using the"6S"pyramid model system,the relevant literature was searched in the order from high to low.Two professionals evaluated the quality of the literature,summarized the evidence and conducted the analysis and summarization.Results Ten literature articles were finally enrolled in this study,including one article of guideline,one article of systematic review,five articles of expert consensus,one article of meta-analysis,and two articles of randomized controlled trials.Six complications(catheter displacement or falling off,catheter obstruction,unplanned extubation,arterial spasm or occlusion,infection,puncture site bleeding/local hematoma)and 22 pieces of best evidence for prevention management were summarized.Conclusion This study systematically summarizes 6 complications and their prevention and treatment in patients with HCC receiving HAIC,providing a reliable basis for clinical practice.

Objective To investigate psychological resilience levels and influencing factors of civilian nurses stationed in islands and reefs.Methods From January to August 2022,an online questionnaire survey was conducted on 39 civilian nurses from 3 affiliated hospitals of Naval Medical University who participated in the island mission.The questionnaire included baseline data of the civilian nurses,tasks,and psychological resilience level.Logistic multivariate linear regression analysis was used to assess the survey.Results The average psychological resilience score of the civilian nurses was 99.42±10.01.The highest score was working competence(3.88±0.45),and the lowest score was self-control(3.15±0.71).In terms of family support,married status scored the highest and unmarried status scored the lowest.In the future expectations,the nurses with bachelor degree or above had higher scores than those with junior college degree.In the dimension of tolerance,urban nurses had higher scores than those from rural areas.In the working competence,deputy chief nurse and above had the highest score,followed by nurse-in-charge,senior nurse,and nurse below.There was no significant difference in the scores of self-control,social support,or total psychological resilience among civilian nurses(P>0.05).Logistic analysis showed that professional title(nurse-in-charge and above)and married status were positively related to psychological resilience(P<0.05).Conclusion In this survey,the nurses have a high level of psychological resilience,especially those with higher professional title,higher nursing age and married status.When selecting rescue and nursing staff,civilian nurses with high professional titles and long clinical working years should be recommended as the first choice.Well-trained civilian nurses with high level of psychological resilience and comprehensive quality can more efficiently complete island tasks.

Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.

Objective:To investigate the effect of pirfenidone (PFD) on the proliferation of human glomerular mesangial cells (HMC) stimulated by serum IgA1 in patients with IgA nephropathy (IgAN) and its possible mechanism.Methods:Serum IgA1 of IgAN patients was purified by Jacalin affinity chromatography combined with Sephacryl S-200 gel filtration, and then heated to aggregated form (aIgA1). CCK8 method was used to confirm the concentration and time of PFD. The cells were divided into blank control group, IgA1 (0.5 mg/ml) group and IgA1 (0.5 mg/ml)+PFD (2 mmol/L) group. The CCK8 method was used to detect proliferation of mesangial cells. The cell cycle was detected by flow cytometry, and the proliferation index of mesangial cells was calculated. The expression levels of transforming growth factor β1 (TGF-β1), Smad4, Smad7, fibronectin (FN) and collagen Ⅳ protein and mRNA were detected through Western blotting and real-time PCR.Results:Compared with blank control group, the proliferation of HMC was promoted significantly by aIgA1 ( P<0.05). After PFD treatment, the proliferation of HMC was significantly inhibited ( P<0.01). Compared with the blank control group, the number of G1 phase cells decreased, the number of S phase cells and cell proliferation index increased in IgA1 group (all P<0.05). Compared with IgA1 group, the number of cells in G1 phase increased significantly, the number of cells in S phase and G2/M phase decreased significantly, and the cell proliferation index decreased in IgA1+PFD group (all P<0.05). Western blotting and real-time PCR results showed that compared with the blank control group, the protein and mRNA expressions of collagen Ⅳ, FN and Smad4 in HMC stimulated by aIgA1 were significantly increased, while TGF-β1 protein expression was increased and Smad7 protein expression was decreased (all P<0.05). After PFD treatment, the protein and mRNA expression of collagen Ⅳ, FN and Smad4 in HMC was significantly decreased, while TGF-β1 protein expression was obviously decreased, and Smad7 protein was up-regulated (all P<0.05). There was no significant difference in the mRNA expression of TGF-β1 and Smad7 in each group before and after PFD treatment (all P>0.05). Conclusions:PFD can increase the arrest of HMC in G1 phase, inhibit the proliferation of HMC induced by aIgA1 of IgAN patients, and reduce the production of extracellular matrix. The mechanism may be related to up-regulation of Smad7 expression and down-regulation of TGF-β1/Smad4 pathway.

Objective To analyze the clinical features and risk factors of urinary tract infection in patients with gestational diabetes mellitus ( GDM).Methods A total of 1 068 patients with GDM were enrolled from Nanshan People's Hospital between January and December 2014.The incidence of urinary tract infection, pathogens distribution and drug resistance rate were retrospectively analyzed.Multivariate Logistic regression was performed to analyze the risk factors of urinary tract infection in GDM patients . Results Among 1 068 patients with GDM, 130 (12.17%) were compliacated with urinary tract infection One hundred of forty-two strains of pathogens were detected in the middle urine culture sample from urinary tract infection patients, Escherichia coli (67.61%,96/142) and Klebsiella pneumonia (11.97%,17/142) were the most frequent strains.Escherichia coli has high resistance to semi-synthetic penicillins, quinolones and sulfonamides, and relatively low resistance rate to carbapenems , aminoglycoside antibiotics and nitrofurantoin.Klebsiella pneumoniae was completely resistant to ampicillin , while was completely sensitive to carbapenems, aminoglycoside antibiotics , piperacillin/tazobactam, aztreonam.Logistic regression analysis showed that glycated hemoglobin ＞6.5%(OR＝8.631, 95%CI 2.969-25.090, P＜0.01), fasting blood glucose＞5.3 mmol/L(OR＝3.116, 95%CI 2.040-4.761,P＜0.01), low density lipoprotein ＞2.6 mmol/L (OR＝1.649, 95%CI 1.083-2.511, P＜0.05), triglyceride＞1.7 mmol/L(OR＝2.986, 95%CI 1.256-7.112, P＜0.05), history of urinary tract infection (OR＝5.561,95%CI 1.315-23.519, P＜0.05) and history of maternity(OR＝1.631, 95%CI 1.018-2.614, P＜0.05) were the independent risk factors for urinary tract infection in GDM.Conclusion The incidence of urinary tract infection in patients with GDM is high.The control of blood glucose and blood lipids , enhanced health education for pregnant women with history of urinary tract infection and history of childbirth may reduce the occurrence of urinary tract infection in GDM patients.

Objective To evaluate the effects of fentanyl transdermal combined with morphine subcutaneous injection in the management of advanced liver cancer pain after intervention .Methods 166 patients who suffered from advanced liver canc-er and received intervention therapy in our hospital were divided into two groups .89 patients belong to the fentanyl transdermal combined with morphine subcutaneous injection treatment group .77 patients belong to the morphine subcutaneous injection treatment group .The pain score and the remission rate of the two groups were compared and analyzed statistically .Mean-while ,the side effects of each group were recorded .Results Pain score in the group with fentanyl transdermal and morphine treatment was significantly lower than morphine mono therapy .12 hours after intervention therapy ,(1 .97 ± 0 .56 for combina-tion treatment vs 3 .23 ± 1 .49 for morphine only group ,P<0 .05) .24 hours after intervention therapy ,(1 .63 ± 0 .44 for com-bination vs 4 .19 ± 1 .68 for morphine only group ,P<0 .01) .Similarly ,the remission rate of the fentanyl transdermal combined with morphine subcutaneous injection group improved significantly ,(92 .1% vs 76 .6% P<0 .05) 12 hours after intervention therapy ,and(97 .8% vs 70 .1% ,P<0 .05) 24 hours after intervention therapy .Conclusions The addition of fentanyl trans-dermal to morphine subcutaneous injection treatment significantly improve the pain remission rate for the patients with advanced liver cancer pain 72 hours after intervention therapy .