This report summarizes the nursing experience of a patient with acute myocardial infarction complicated by cardiogenic shock and frequent electrical storms.The key nursing interventions are outlined as follows.Formation of a multidisciplinary management team:a collaborative treatment plan was developed by assembling a multidisciplinary team of healthcare professionals.Activation of the hospital emergency response system:the hospital's emergency response protocols were promptly activated to ensure efficient emergency nursing care.Dynamic hemodynamic monitoring:circulatory support strategy guided by hemodynamic monitoring.Establish-ment of a malignant arrhythmia warning system:a warning system for malignant arrhythmias was implemented to standardize the emergency procedures for electrical cardioversion and defibrillation,thereby maximizing the time available for life support.Sequential antiplatelet and anticoagulation management:a sequential approach to antiplatelet and anticoagulation therapy was employed to effectively prevent the risks of thrombosis and bleeding.Focus on psychological care and rehabilitation training:emphasis was placed on psychological support and rehabilitation exercises to enhance the patient's comfort and exercise tolerance.The patient was hospitalized for 33 days and was discharged in improved condition.This translation is structured to reflect the conventions of academic writing,making it suitable for inclusion in a clinical report or research paper.

This report summarizes the nursing experience of a patient with acute myocardial infarction complicated by cardiogenic shock and frequent electrical storms.The key nursing interventions are outlined as follows.Formation of a multidisciplinary management team:a collaborative treatment plan was developed by assembling a multidisciplinary team of healthcare professionals.Activation of the hospital emergency response system:the hospital's emergency response protocols were promptly activated to ensure efficient emergency nursing care.Dynamic hemodynamic monitoring:circulatory support strategy guided by hemodynamic monitoring.Establish-ment of a malignant arrhythmia warning system:a warning system for malignant arrhythmias was implemented to standardize the emergency procedures for electrical cardioversion and defibrillation,thereby maximizing the time available for life support.Sequential antiplatelet and anticoagulation management:a sequential approach to antiplatelet and anticoagulation therapy was employed to effectively prevent the risks of thrombosis and bleeding.Focus on psychological care and rehabilitation training:emphasis was placed on psychological support and rehabilitation exercises to enhance the patient's comfort and exercise tolerance.The patient was hospitalized for 33 days and was discharged in improved condition.This translation is structured to reflect the conventions of academic writing,making it suitable for inclusion in a clinical report or research paper.

Objective To investigate the epidemiological characteristics and clinic symptoms of an outbreak of infectious diarrhea caused by Sapovirus,in CT community,Zhaoqing,Guangdong province.Methods Retrospective study of field epidemiology investigation was carried out and Chi-square test was used enteroviruses were detected by RT-PCR in swab,fecal specimens and water samples.Results A total of 422 cases were identified in this outbreak,with the prevalence as 11.95％.Cases mainly concentrated between 21 and 24,December,with curves noticed by pointsource and peaked on the 22nd.Symptoms mainly appeared as vomiting,with watery stool.Patients were founded in every village,with the highest prevalence appeared in the elderly (25.20％) but involved in every age group.Sapovirus infection was most frequently seen in the population under 25 years of age,with overall prevalence as 16.41％.People older than 50 years of age took the second place (12.05％),and the lowest was seen between 25 to 49 years age group (8.42％).Sapovirus was detected in both swab and fecal specimens,with the positive rate as 38.78％.Both general and heatresistant coliformed-bacteria were detected in the 24 monitored water samples,with the qualification rates as 95.83％,45.83％ and 50.00％,respectively.However,Sapovirus was not detected in any of the water samples.Conclusions Our findings confirmed that an outbreak,caused by sapovirus infection in CT community was most likely related to the central water supply.The surveillance system for infectious diarrheal diseases should be improved and both public health awareness and surveillance programs on drinking water should be strengthened.

Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.

Objective To investigate the diagnosis and treatment of hashimoto′s disease(HD) complicated with thyroid adenomas(TA).Methods Clinical data of 50 cases of HD complicated with TA were analysed retrospectively. Results 8 patients were diagnosed before operation ,misdiagnosis rate was 84.0%.Intra operation frozen section diagnosis rate was 81.4% (35/43).All patients were diagnosed as HD complicated with TA by pathology after operation.Various extension thyroidectomies were performed according to the patients conditions. After operation,27 cases were given small dosage of thyroxine and 2 cases were given small dosage of prednisone. All the 50 patients were followed up for 3 months to 1 year, none presented hypothyroidism.Conclusions Complete serum immunologic examinations,ultrasonography and fine needle aspiration biopsy are helpful for the diagnosis of HD with TA. HD with TA should be treated surgically,and the intraoperation frozen section for the diagnosis is important.The operation procedures,extension of excision and medication after operation should be individulization to avoid the occurrence of postoperative hypothyroidism as possible.

Objective To summarize our experience in the prevention and treatment of iatrogenic vascular(trauma).Methods The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed.Results The 24 cases included 7 cases of superior mesenteric(arteriovenous) trauma,3 cases of portal venous trauma,4 cases of carotid arterial trauma,6 cases of iliac and femoral arterial trauma,and each one of trauma of popliteal artery,axillary artery,renal artery,left gastric artery,respectively.Treated method: Six cases underwent vascular repair,5 cases had vascular anastomosis,2 cases had vascular replacement,3 cases had vascular ligation,2 cases had covered stent implantation under intervention,and other methods included thrombectomy,thrombolysis and packing.Among the 24 cases,22 were cured completely,one patient died from massive hemorrhage 24 hours after operation,and the other died 5 days after operation.Conclusions Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance,clear identification of the anatomy,and accurate and careful operation.Once iatrogenic vascular trauma has occurred,its cause must be determined and then different treatment methods can be(chosen),based on the cicumstaces. When effective treatment technique is not at hand,one should promptly seek outside support or transfer the patient to an advanced hostipal.

Objective To discuss the diagnosis and treatment of insulinoma.Methods The clinical data of 30 patients with insulinoma were reviewed.Results All patients had Whipple′s triad.Accurate preoperative localization rate of B ultrasonography, CT and MRI was 34.8 %(8/23),58.3 %(7/12) and 71.4 %(5/7),respectively. Localization rate of intraoperative ultrasonography (IOUS) was 87.5 %(7/8). The tumors were single in 27 cases,and multiple in 3 cases. In the location of single tumor,8 of them were in the head,7 in the body, and 12 in the tail; while for multiple tumors, 2 tumors were both located in the body in 1 patient,and 2 tumors were separately located in the body and tail respectively in 2 patients. Local enucleation was performed in 21 cases, distal pancreatectomy in 6 cases,distal pancreatectomy plus splenectomy in 2 cases,and duodenopancreatectomy in 1 case. The tumor was benign in 29 cases, and malignant in 1 case.Pancreatic fistula developed after operation in 4 cases, and in all cases, it healed after drainage. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 27 cases, 1 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor; the malignant tumor case, recurred and died of metastasis of abdominal cavity 3 years after operation.Conclusions Whipple′s triad, and the ratio of immunoreactive insulin to blood glucose (IRI/G)are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Enucleation is the main mode of surgical treatment of insulinoma.