Objective:To evaluate the efficacy of modified splenic arteriovenous shunt surgery at the distal pancreatic tail in combined pancreas-kidney transplantation.Methods:A retrospective analysis was conducted on 24 recipients who underwent combined pancreas-kidney transplantation with the modified splenic arteriovenous shunt at the pancreatic tail from November 2023 to October 2024 (shunt group) and 231 recipients who received conventional splenic artery and vein ligation since 2016 (ligation group). The incidence of perioperative thrombosis and severe adverse events was compared between the two groups using the chi-square test or Fisher's exact test. Independent sample t-tests were performed to assess postoperative pancreatic and renal function recovery as well as blood perfusion in 15 recipients from the shunt group and 20 from the ligation group who underwent CT perfusion imaging (CTP).Results:The incidence of perioperative splenic arteriovenous thrombosis was lower in the shunt group (0) compared to the ligation group (4.76%, 11/231), though the difference was not statistically significant ( P=0.606). One month postoperatively, the shunt group demonstrated significantly lower serum amylase levels than the ligation group (99.61±19.62 vs. 148.20±70.67 U/L, P=0.018). However, at the time of CTP examination, serum lipase (67.87±32.35 vs. 45.11±17.94 U/L, P=0.014) and creatinine levels (131.79±26.41 vs. 112.1±24.98 μmol/L, P=0.034) were significantly higher in the shunt group. Urea nitrogen levels were also significantly higher in the shunt group both one month postoperatively (11.24±4.64 vs. 8.51±3.01 mmol/L, P=0.043) and at the CTP examination (10.41±1.78 vs. 6.87±1.91 mmol/L, P=0.001). Regarding pancreatic perfusion, blood volume in both the pancreatic head (15.99 ± 3.51 vs. 20.67 ± 5.47 ml/100 g, P = 0.024) and tail (17.19±4.24 vs. 27.40±19.80 ml/100 g, P=0.039) was significantly lower in the shunt group. After one minute of splenic artery perfusion, the shunt group exhibited significantly higher splenic artery blood flow (755.85±101.50 vs. 574.00 ± 142.06 ml·min -1· (100 g) -1, P<0.001) and blood volume (58.90 ±19.93 vs. 23.21±17.02 ml/100 g, P=0.007) compared to the ligation group. These differences persisted after two minutes of perfusion (blood flow: 793.83±68.57 vs. 503.78 ± 130.80 ml·min -1· (100 g) -1, P<0.001; blood volume: 64.22±15.74 vs. 34.32±20.39 ml/100 g, P=0.002). For the transplanted kidney, the shunt group had significantly lower blood flow (113.10±28.55 vs. 232.76±113.37 ml·min -1· (100 g) -1, P<0.001), blood volume (28.95±10.79 vs. 38.36±12.38 ml/100 g, P=0.047), and capillary surface permeability (PS) (26.49±16.57 vs. 43.02±20.37, P = 0.042) in the upper pole. Similar reductions in blood flow, blood volume, and PS were observed in the middle dorsal region ( P=0.018, 0.021, and 0.048, respectively) and lower pole ( P<0.001, P=0.048, and P=0.012, respectively). Conclusion:The modified splenic arteriovenous shunt at the pancreatic tail appears to be a safe and effective approach to reducing the risk of pancreatic graft thrombosis. This technique facilitates effective diversion of pancreatic parenchymal blood flow into the splenic vein, alleviating hyperperfusion of the transplanted pancreas. While renal blood perfusion was reduced postoperatively, it did not adversely affect renal function.

Objective:To evaluate the efficacy of modified splenic arteriovenous shunt surgery at the distal pancreatic tail in combined pancreas-kidney transplantation.Methods:A retrospective analysis was conducted on 24 recipients who underwent combined pancreas-kidney transplantation with the modified splenic arteriovenous shunt at the pancreatic tail from November 2023 to October 2024 (shunt group) and 231 recipients who received conventional splenic artery and vein ligation since 2016 (ligation group). The incidence of perioperative thrombosis and severe adverse events was compared between the two groups using the chi-square test or Fisher's exact test. Independent sample t-tests were performed to assess postoperative pancreatic and renal function recovery as well as blood perfusion in 15 recipients from the shunt group and 20 from the ligation group who underwent CT perfusion imaging (CTP).Results:The incidence of perioperative splenic arteriovenous thrombosis was lower in the shunt group (0) compared to the ligation group (4.76%, 11/231), though the difference was not statistically significant ( P=0.606). One month postoperatively, the shunt group demonstrated significantly lower serum amylase levels than the ligation group (99.61±19.62 vs. 148.20±70.67 U/L, P=0.018). However, at the time of CTP examination, serum lipase (67.87±32.35 vs. 45.11±17.94 U/L, P=0.014) and creatinine levels (131.79±26.41 vs. 112.1±24.98 μmol/L, P=0.034) were significantly higher in the shunt group. Urea nitrogen levels were also significantly higher in the shunt group both one month postoperatively (11.24±4.64 vs. 8.51±3.01 mmol/L, P=0.043) and at the CTP examination (10.41±1.78 vs. 6.87±1.91 mmol/L, P=0.001). Regarding pancreatic perfusion, blood volume in both the pancreatic head (15.99 ± 3.51 vs. 20.67 ± 5.47 ml/100 g, P = 0.024) and tail (17.19±4.24 vs. 27.40±19.80 ml/100 g, P=0.039) was significantly lower in the shunt group. After one minute of splenic artery perfusion, the shunt group exhibited significantly higher splenic artery blood flow (755.85±101.50 vs. 574.00 ± 142.06 ml·min -1· (100 g) -1, P<0.001) and blood volume (58.90 ±19.93 vs. 23.21±17.02 ml/100 g, P=0.007) compared to the ligation group. These differences persisted after two minutes of perfusion (blood flow: 793.83±68.57 vs. 503.78 ± 130.80 ml·min -1· (100 g) -1, P<0.001; blood volume: 64.22±15.74 vs. 34.32±20.39 ml/100 g, P=0.002). For the transplanted kidney, the shunt group had significantly lower blood flow (113.10±28.55 vs. 232.76±113.37 ml·min -1· (100 g) -1, P<0.001), blood volume (28.95±10.79 vs. 38.36±12.38 ml/100 g, P=0.047), and capillary surface permeability (PS) (26.49±16.57 vs. 43.02±20.37, P = 0.042) in the upper pole. Similar reductions in blood flow, blood volume, and PS were observed in the middle dorsal region ( P=0.018, 0.021, and 0.048, respectively) and lower pole ( P<0.001, P=0.048, and P=0.012, respectively). Conclusion:The modified splenic arteriovenous shunt at the pancreatic tail appears to be a safe and effective approach to reducing the risk of pancreatic graft thrombosis. This technique facilitates effective diversion of pancreatic parenchymal blood flow into the splenic vein, alleviating hyperperfusion of the transplanted pancreas. While renal blood perfusion was reduced postoperatively, it did not adversely affect renal function.

Objective To systematically review and synthesize the psychological experience of kinesiophobia in patients with cardiac rehabilitation.Methods PubMed,Web of science,Journals@Ovid,Embase,CINAHL,PsycINFO,Cochrane Library,CNKI,SinoMed,WanFang Database,Vip Database,American Heart Association,European Society of Cardiology and American Association of Cardiovascular and Pulmonary Rehabilitation were searched to collect qualitative research on the psychological experience of cardiac rehabilitation patients with kinesiophobia.The retrieval time was from the establishment of the databases to Jun 2023.The literature was evaluated using the Australian JBI Quality Evaluation Criteria for Qualitative Research in Evidence-based Health Care Centres(2016),and the results were consolidated using an aggregative integration approach.Results A total of 45 results were extracted from 14 studies.Similar results were summarized into 10 groups,and 3 integrated results were synthesized as followed.Kinesiophobia was influenced by many factors;kinesiophobia affects the life experience of patients;strategies to reduce the level of kinesiophobia.Conclusion Nurses should pay more attention to psychological experience of kinesiophobia,and take the corresponding intervention measures to help patients overcome the psychological barriers of kinesiophobia,perfect personalized exercise programs,and improve the level of physical activity.

Objective:To systematically evaluate and integrate the qualitative study of healthcare workers' cognition and experience in frailty management, providing reference for promoting clinical practice of frailty management in China.Methods:Qualitative studies on the cognition and experience of healthcare workers in implementing frailty management were searched on PubMed, Web of Science, CINAHL, Embase, Cochrane Library, PsycINFO, Ovid, China Biology Medicine disc, China National Knowledge Infrastructure, WanFang Data, and VIP. The search period was from database establishment to July 1, 2023. The quality of literature was evaluated according to the quality evaluation criteria for qualitative study of the Joanna Briggs Institute Evidence-based Health Care Center (2016). The aggregation integration method was used for Meta-synthesis.Results:A total of 13 articles were included, 42 research results were extracted, categorized into nine categories, and finally summarized into four integrated results of healthcare workers' cognition, benefit perception, practical difficulties, and educational and training needs in implementing frailty management.Conclusions:Medical institution managers should pay attention to the many difficulties and needs of implementing frailty management among healthcare workers, actively implement medical policies, strengthen awareness, conduct standardized training, and ensure the smooth implementation of frailty management.

Background and objective Pembrolizumab(PEM)has been shown to be effective in clinical trials for the treatment of advanced non-small cell lung cancer(NSCLC),but clinical trials were based on cohorts of patients selected on specific criteria,and whether the findings are consistent with real-world patients is debatable.The aim of this study is to evaluate the efficacy and safety of PEM in the treatment of advanced NSCLC based on real-world data.Methods A retro-spective collection of real-world data from patients with advanced NSCLC receiving PEM was conducted.Propensity score matching was used to eliminate inter-group differences and assess the efficacy and safety of PEM compared to chemotherapy.Results Among 450 matched patients,the incidence rates of any-grade adverse events were 79.87％in the PEM group and86.71％inthe chemotherapy group,while the incidence rates of grade＞3 adverse events were 4.03％and 7.31％,respectively.The objective response rates were 48.63％for PEM and 36.00％for chemotherapy(P=0.011).The median progression-free survival was 15.5 months for PEM and 8.8 months for chemotherapy(P＜0.001),and the median overall survival was not reached for PEM and 26.2 months for chemotherapy(P＜0.001).Conclusion PEM treatment for advanced NSCLC demonstrates favorable survival outcomes and acceptable safety in real-world clinical practice.

Objective: To understand the status quo of sleep quality of nurses in emergency department and explore its influencing factors, so as to provide reference for relevant departments to formulate corresponding policies and ensure the health of nurses. Methods: From July to September 2018, 257 nurses in emergency department of 5 tertiary hospitals in a city were investigated by cluster sampling. Results: The detection rate of sleep among 257 nurses was 63.42%. Logistic regression model showed that having children or not (OR=1.063) , self-rated health (OR=1.639) , stress (OR=1.728) and coping style (OR=1.055) were independent influencing factors of sleep quality of nurses in emergency department. Conclusion Sleep problems are common among nurses in emergency department. It is helpful to improve sleep quality to ensure physical and mental health, actively cope with work and family stress.

Objective To explore the epidemiological features of medical adhesive related skin injury (MARSI) in elderly inpatients, such as incidence, predilection sites and common types, and to determine the risk factors of MARSI and to put forward nursing countermeasures. Methods From April 2018 to August 2018, we selected all the elderly patients at a Class Ⅲ Grade A hospital in Shandong Province by cluster sampling. The investigation was carried out with the self-designed MARSI related factors questionnaire and the information collection questionnaire. The single factor analysis and multiple Logistic regression were used to analyze the risk factors of MARSI. Results A total of 2 263 elderly inpatients were included. There were 218 of them with MARSI along with 9.63% for the incidence, and the contact dermatitis is the most common (43.95%). Logistic regression showed that the independent risk factors of MARSI included the ages, smoking history, serum albumin, skin edema, MARSI history, dry skin and skin allergies. Conclusions Elderly patients are the high risk group of MARSI. Nursing intervention should be strengthened the in clinical work based on risk factors to reduce the skin injury caused by medical factors.

ObjectiveTo investigate the effect of microencapsules cells transfected with nerve growth factor (NGF) gene to the sciatic nerve regeneration following sciatic nerve injury in rats.MethodsMicroencapsules containing cells transfected with NGF gene were prepared using drop generative technique and cells were cultured in vitro. Animal model of sciatic nerve cut and sutured was established with Sprague-Dawely rats, and ninety-six animals were randomly divided into group A (in vivo implantation of microencapsules cells transfected with NGF gene), group B (in vivo implantation of microencapsule), group C (in vivo implantation of cells transfected with NGF gene), and group D (negative control group). The nerve conductive velocity (NCV), nerve action potential (NAP), sciatic nerve function index (SFI) were detected in the 4th, 8th and 12th week postimplantation.ResultsThe microencapsules cells transfected with NGF gene in microencapsules retained reliable cell viability and function. The expanded cells formed cell aggregates, with confocal laser scanning microscopy (CLSM), exhibited green fluorescence material in the cell. The NGF concentration in supernatant were arriving at 269 pg/ml when cultured for 10 days. The results of NCV, NAP and SFI tests in group A were higher than those in the other groups (P<0.05).ConclusionAfter implantation, microencapsules cells transfected with NGF gene may secrete NGF continuously in vivo, and has significant improvement effect on nerve regeneration following sciatic nerve injury.

BACKGROUND: Parkinson disease(PD) is a series of clinical symptom induced by decreased dopamine (DA) in the striatum due to nigral dopaminergic neuronal degeneration. The intracerebral transplantation of secretory DA can reverse or improve the symptoms to a certain extent, but immunologic rejection is still existed.OBJECTIVE: To probe into cell transplantation with immunoisolation in treatment of in rats without application of immunosuppress and observe its mechanical intensity and the biocompatibility of microcapsule .DESIGN: Randomized controlled experiment was designed.SETTING: Biomedical Material Engineering Group, Dalian Institute of ChemicalPhysics , Chinese Academy of Sciences, and Department of Neurology, Second Hospital of Jilin University.MATERIALS: The experiment was performed in Animal Experimental Center of Second Hospital of Jilin University from August 2003 to February 2004, in which, 40 male Wistar rats were employed. PC12 cell was provided from Shanghai Institute of Cellular Biology of Chinese Academy of Sciences.METHODS: 6-hydroxydopamine solution was infused in the striatum to prepare animal model of Parkinson disease. Twenty-five rats of those had been prepared successfully and were randomized into microencapsulated cell transplantation group (12 rats), in which, 25 μL cell-loading sodium alginate-chitosan-solium alginate(ACA)microencapsul suspension (equal to 2.5×104 cells) was injected stereotaxically on two points of the right (affected side) striatum of animal model; non-microencapsulated cell transplantation group (7 rats), in which, 25 μL PC12 cell suspension (equal to 5×104cells) was injected; and empty microcapsul transplantation group (6 rats),in which, 25 μL empty microcapsules suspension was injected . On the 7th day after transplantation, in every group, apomorphine (APO) prepared with saline solution was injected (0.05 mg/kg) subcutaneously in the neck; afterwards, the revolving behavior was recorded for each rat, once per week,totally for 12 weeks. In the 12th week after operation, the rats were sacrificed with anesthesia. The brain tissue was collected for pathological observation and microcapsule were retrieved to evaluation of biocompatibility and immunoisolation.numbers before and after transplantation of each group.RESULTS:Twenty-five rats entered result analysis and the rest was sule: the retrieved ACA microcapsule was integrative in morphology,munoisolation of microcapsule: microencapsuled PC12 cells were prolifercycles before and after transplantation of each group: the records of lateral revolving of rats in every group before transplantation were not significantly different (P ＞ 0.05). In microencapsuled cell transplantation group, 2weeks later, the average number of revolving was significantly lower than that before the transplantation, or even the revolving stopped; the improved symptoms were maintained till the 12th week after transplantation. In nonmicroencapsulated cell transplantation group, the average revolving number was also significantly lower than that before the transplantation, but that on the 8th and 12th weeks was in tendency of increase, without obvious change compared with that before the transplantation (P ＞ 0.05). The revolving number before and after transplantation in non-microencapsulated transplantation group was similar[(10.5±1.4), (10.5±1.3) cyclos/min, P ＞ 0.05].microcapsule provides immune protection. The grafted encapsulated PC12cells survive for along term in the brain of rats with PD, maintain continuously the normal physiological function and improve the symptoms of PD by synthesizing and releasing DA.

By using decapitating, intravenous injection of saturated MgCl2 and legation of bilateral carotid arteries with vagi, the effects of 1-(2,6-dimethylphenoxy)-2-(3,4-dimethoxyphenylethyl- amino) propane hydrochloride(DDPH) on survival time in mice were studied. With the model of cerebral ischemia for 20 min and reperfusion for 10 min, effects of DDPH on the superoxide dismutases(SOD) activity and malondialdehyde (MDA) content in brain tissue and pathological changes were studied. The results indicated that DDPH at dosages of 3,6,12,24 mg*kg-1 ip 30 min before ischemia prolonged the survival time significantly. Meanwhile, DDPH was found to increase the activity of SOD and reduce the content of MDA, as well as mitigate pathological damage of neuron after cerebral ischemia and reperfusion in mice. The results suggest that DDPH has protective effects on brain ischemia.