Objective To explore the effect of respiratory care bundle combined with management by objectives(MBO)on postoperative pulmonary function,pulmonary complications and postoperative quality of recovery of respiratory risky patients undergone gastrointestinal surgeries.Methods A total of 80 patients with respiratory risk underwent elective surgery in a ward of gastrointestinal surgery from April to November 2021 were selected.Based on the order of the surgery,48 patients with surgeries between April to July were selected into control group and received routine respiratory care,while 32 patients with surgeries between August to November were selected into trial group and received the respiratory care bundle combined with MBO.The pulmonary function,postoperative pulmonary complications and postoperative quality of recovery were analyzed and compared on the 7th postoperative day.Results There was no significant difference between two groups in preoperative general data,preoperative lung function,preoperative quality of recovery(QoR-15)and other baseline data,as well as the surgery data.On the 7th postoperative day,the decrease of pulmonary function indexes,FVC(t=3.173,P=0.002)and FEV1(t=2.883,P=0.005)in the trial group was less than that in the control group,and the degree of percutaneous oxygen saturation in the trial group was higher than that in the control group(Z=-2.454,P=0.014).There was no significant difference in the incidence of postoperative pulmonary complications.As with the QoR-15,the score of trial group was higher than that in the control group in 3 items including"moderate pain"(Z=-2.738,P=0.006),"feeling nervous or anxious"(Z=-2.593,P=0.010)and"feeling sad and depressed"(Z=-2.945,P=0.003).There was no significant difference in other items between the two groups.Conclusion The respiratory care bundle combined with MBO is beneficial to the recovery of postoperative pulmonary function and postoperative quality of recovery of gastrointestinal surgical patients with respiratory risk.

Objective To explore the effect of respiratory care bundle combined with management by objectives(MBO)on postoperative pulmonary function,pulmonary complications and postoperative quality of recovery of respiratory risky patients undergone gastrointestinal surgeries.Methods A total of 80 patients with respiratory risk underwent elective surgery in a ward of gastrointestinal surgery from April to November 2021 were selected.Based on the order of the surgery,48 patients with surgeries between April to July were selected into control group and received routine respiratory care,while 32 patients with surgeries between August to November were selected into trial group and received the respiratory care bundle combined with MBO.The pulmonary function,postoperative pulmonary complications and postoperative quality of recovery were analyzed and compared on the 7th postoperative day.Results There was no significant difference between two groups in preoperative general data,preoperative lung function,preoperative quality of recovery(QoR-15)and other baseline data,as well as the surgery data.On the 7th postoperative day,the decrease of pulmonary function indexes,FVC(t=3.173,P=0.002)and FEV1(t=2.883,P=0.005)in the trial group was less than that in the control group,and the degree of percutaneous oxygen saturation in the trial group was higher than that in the control group(Z=-2.454,P=0.014).There was no significant difference in the incidence of postoperative pulmonary complications.As with the QoR-15,the score of trial group was higher than that in the control group in 3 items including"moderate pain"(Z=-2.738,P=0.006),"feeling nervous or anxious"(Z=-2.593,P=0.010)and"feeling sad and depressed"(Z=-2.945,P=0.003).There was no significant difference in other items between the two groups.Conclusion The respiratory care bundle combined with MBO is beneficial to the recovery of postoperative pulmonary function and postoperative quality of recovery of gastrointestinal surgical patients with respiratory risk.

ObjectiveTo analyze the epidemic characteristics of foodborne disease outbreaks in Mengla County， Yunnan Province， so as to provide basis for formulating corresponding prevention and control measures. MethodsThe data of foodborne disease outbreaks in Mengla County， Yunnan Province from 2017 to 2021 in the national "foodborne disease outbreak monitoring system" were collected. The time， population， region， place， pathogenic factors and inducing links of the events were statistically analyzed. ResultsFrom 2017 to 2021， a total of 68 incidents were reported， including 526 cases and 5 deaths. The total incidence rate was 23.40% and the case fatality rate was 0.95%. The peak period was from May to July， with the largest number of reported events in July. The reporting areas were mainly Mengla Town （35.29%）， Guanlei Town （11.76%） and Mengpeng Town （10.29%）. The main place of the incident was family （76.47%）. The main pathogenic factors were plant toxins （79.41%）， mainly through the ingestion of wild mushrooms （68.52%）， improper processing of green beans （12.96%） and aconitum （9.26%）. ConclusionAccording to the epidemiological characteristics of Mengla County， we should focus on the public education of health knowledge in key areas and places， especially on the identification of wild mushrooms， to prevent accidental eating. At the same time， we should strengthen the monitoring and risk assessment of foodborne diseases， find potential risks as soon as possible， issue early warning and forecast in time， and constantly improve the clinical treatment ability of poisoned patients.

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Objective:To investigate the expressions and clinical significance of tetraspanin CO-029 and integrin αv in intrahepatic cholangiocarcinoma (ICC ).Methods:Tissue microarray (TMA) was used to detect the expression of CO-029 and αv in 254 cases of intrahepatic cholangiocarcinoma. The relationship between the two factors and clinicopathological features, recurrence, metastasis and prognosis was analyzed.Spearman method was used to analyze their correlation.Relationship between αv and CO-029 was studied by mass spectrometry and database search,immunoprecipitation and Western blot were used to detect the coexistence.Results:Tissue microarray analysis showed that the positive expression rate of CO-029 was 51.6% (131/254), and the positive expression rate of αv was 61.4% (156/254). The expression of CO-029 and αv were closely correlated with tumor envelope, size, number and TNM stage ( P<0.05). According to the time of recurrence (TTR), the expressions of CO-029 and αv in early postoperative recurrence group (TTR <1 year) were significantly higher than those in non recurrence group (TTR ≥ 1 year). The patients with high CO-029 expression were more likely to relapse ( HR=2.01, 95% CI=1.45-2.79; P<0.001) and had shorter survival time ( HR=2.03, 95% CI=1.46-2.81; P<0.001). The patients with high expression of αv had shorter recurrence time ( HR=1.85, 95% CI=1.38-2.47; P<0.001) and shorter survival time ( HR=1.95, 95% CI=1.40-2.71; P<0.001). Co immunoprecipitation and Western blot confirmed that αv and CO-029 formed a complex. There was a positive correlation between CO-029 and αv in intrahepatic cholangiocarcinoma ( r=0.401, P<0.01). Conclusions:The differential expression of CO-029 and αv were closely related to the recurrence, metastasis and prognosis of intrahepatic cholangiocarcinoma, and CO-029 may couple with αv to form a complex to promote the invasion and metastasis of intrahepatic cholangiocarcinoma.

Objective To investigate the effect of occult HBV infection (OBI) on carcinogenesis of cryptogenic hepatocellular carcinoma.Methods Samples of hepatocellular carcinoma (HCC) and pericarcinomatous tissues obtained after hepatectomy from January 2011 to November 2013 at the Third Affiliated Hospital of Sun Yat-Sen University were collected.They were divided into two groups:the cryptogenic HCC group (the CH group,n =26) and the HBV related HCC group (the HH group,n =40).These samples were compared with the normal liver tissues obtained in 30 patients.HBV DNA was identified by the nested polymerase chain reaction and the immunohistochemical method was taken to examine the hepatitis B virus X protein (HBx) and Yes-associated protein (YAP) expressions.Results OBI was identified in 20 (77.8％) cryptogenic HCC patients and 8 (26.7％) in the control group.There was a significant difference between the two groups (x2 =14.072,P ＜ 0.05).HBV DNA was detected in all the HBV-related HCC patients.The HBx protein expression was mainly located in the cytoplasm of liver cells and liver cancer cells,but YAP was expressed in the nucleus.Both of them showed diffuse brown or tan particles.In the HH group and the CH group,the positive expression rates of HBx protein in the tumorous tissues were 80.0％ and 90.0％,respectively,and 85.0％ and 82.5％ in the nontumorous tissues,but only in 40.0％ in the control group.The positive expression rates of YAP in the tumorous tissues were 65.0％ and 67.5％,respectively,15.0％ and 20.0％ in the nontumorous tissues,respectively,but only in 12.5％ in the control group.The HBx expression in the cancerous tissues and para-cancerous tissues of the HH group and the CH group showed no significant difference (P ＞ 0.05),but the YAP expression in the tumor tissues was significantly higher than that in the nontumorous tissues (P ＜ 0.05).The HBx and YAP expressions in the HH group were comparable to the CH group (P ＞ 0.05).However,their expressions in the cancerous tissue of the HH group and the CH group were significantly higher than in the normal liver tissues (P ＜ 0.05).Conclusion A high prevalence of HBV infection was observed in HBsAg-negative HCC and the high expressions of HBx and YAP might be involved in the process of cryptogenic hepatocellular carcinoma.

Objective To investigate the portal vein embolization (PVE) and portal vein ligation (PVL) in liver regeneration of rats with hepatic fibrosis.Methods Fifty rats with liver fibrosis were prepared,including 10 rats were randomly chosen as pre-operative control group.The other 40 rats were divided into two groups:PVE group (A1,n =20) and PVL group (A2,n =20).We chose to embolize and ligate the right portal vein,respectively.The blood samples were obtained at different end points for measuring ALT and AST levels.Each liver lobes and whole liver were weighed,and non-embolized liver lobe/whole liver weight ratio,non-ligated liver lobe/whole liver weight were caculated at different end points.The samples from liver with/without embolization or ligation were were stained with hematoxylin-eosin,and the changes of microstructure of liver were observed.Immunostained for PCNA and Ki-67 were performed.Results Transient elevation of postoperative ALT and AST levels were noted in each group.Serum ALT and AST reached the peak on the first day in both of PVE and PVL groups [ALT,A1 (66.5 ±6.3) U/L vs(491.5 ± 48.0) U/L,A2 group(62.8 ±5.7) U/L vs(433.7 ±41.0) U/L;AST,A1group (113.4 ± 12.5) U/L vs (685.2 ±65.7) U/L,A2 group (110.4 ± 11.1) U/L vs(623.9 ±75.2) U/L,P＜0.05),and started to decrease on the third day,recovered to the pre-operative level on the fourteenth day (P ＞ 0.05).The weight percentage of non-embolized and non-ligated liver lobes/whole liver after PVE and PVL increased.There was no significant difference between the first day and pre-operative levels (P ＞ 0.05).Nevertheless,there were significant differences observed from the third,seventh,fourteenth days (A1 group,50.2 ± 5.0,57.7 ±5.7,61.8 ±6.6;A2group,49.6 ±3.5,55.7 ±6.9,63.0±5.1,respectively)compared with preoperative groups (A1 group,34.4 ± 4.0;A2 group,34.4 ± 4.0) (P ＜ 0.05).There was no significant difference between group A1 and A2 in each time point (P ＞0.05).The PCNA and Ki-67 were positive in hepatocytes and increased after operation,reached the peak in the third day (P ＜ 0.05),decreased slowly and restored to the normal level in the fourteenth day after operation,meanwhile,there was no significant difference between group A1 and A2 (P ＞ 0.05).Conclusions Fibrosis rats had the ability of regeneration in the contralateral part of the liver after selective PVE and PVL and there was no significant difference on the proliferative degree.Therefore,the safety and reliability of PVE and PVL in inducing liver regeneration in rats with liver fibrosis were confirmed.

Objective To evaluate the application of nursing quality indicators in gastrointestinal surgery department. Methods The indicator system was established by use of the Delphi method, applied in nursing quality control in gastrointestinal surgery department, and was used to analyze and improve nursing quality continuously according to the routine data collection. Results After the application of quality indicators for 6 months, the complications′ observation and prevention awareness rate of the patients increased from 75.00% to 92.00%(x2=4.200, P<0.05), and most of the process indicators had improved. Conclusions The nursing quality indicators provide basis for nursing quality management,and provide standards and guidance for clinical works.

Objective To evaluate the efficacy of auricular-plaster therapy indiabetes patients with insomnia, and provide suggestions for treatment.Methods The relevant randomized controlled trials and quasi-randomized controlled trials about using auricular-plaster therapy in diabetes patients with insomnia were searched in Cochrane Library, JBI, EMbase, Chinese Biological Medical Database ( CBM ) , Wanfang Data, VIP, China National Knowledge Internet(CNKI) and Pub Med. Information was selected. Retrieval time was limited from the foundation of those database to January 1st 2016. We use the Review manager 5. 3 analysis software to conduct Meta-analysis.Results 10 primary studies were included, which involved in 1 315 patients. Meta-analysis was processed based on different intervention methods and various outcome indicators. ①Different intervention methods:the effective rate of the auricular-plaster therapy group were higher than the control group, with significant differences [ OR= 7. 56, 95%CI ( 3. 92, 14. 58 ) , P<0. 000 01 ]; The effective rate of the comprehensive group ( including auricular-plaster therapy) were higher than the control group, with significant differences [OR=3.45, 95%CI(2.60,4.57), P=0.009];②Different results of outcome indicators, comprehensive interventionhas significant improvementonthe sleep quality of patients [MD=-1.96,95%CI(-2.33,-1.59),P<0.000 01];Moreover, comprehensive intervention could control postprandial blood glucose within twohours,with significant differences [MD=-1.86,95%CI(-1.94,-1.78),P<0.000 01].Conclusions Theauricular-plaster therapy can improve the sleep quality and sleep effect of diabetes patients with insomnia. However, because of the large literature difference, the results of the meta-analysis should be critical treated.

Objective To evaluate the effect of problem-based learning (PBL)versus tradi-tional methods in medical statistics. Methods Computer retrieval was conducted to search for con-trolled studies comparing PBL and traditional methods. The quality of included studies was critically evaluated and data were analyzed by using the Cochrane Collaboration's RevMan 5.0 software. Results A total of 21 articles were retrieved,but only 7 were included. The results of Meta analysis showed that there was no significant difference between PBL and traditional methods in both the passing rate of student's score (RR=1.09,95%CI=0.98-1.23,P=0.12>0.05)and the exact score (WMD=0.30, 95%CI=-0.06 -0.67,P=0.10>0.05). Conclusion PBL showed no better learning results in medical statistics compared with traditional methods.