Objective:To investigate the effect of oral administration of vitamin D3 on intestinal barrier function in patients after gastric cancer surgery,and to provide a reference for perioperative nutritional therapy in patients with gastric cancer.Methods:The conve-nience sampling method was used to select 80 patients with gastric cancer who were admitted to Department of Gastrointestinal Surgery in a grade A tertiary hospital in Xiamen,China,from June 2021 to May 2023,and the patients were divided into intervention group and control group using a random number table.The patients in the intervention group were given oral administration of vitamin D3 800 IU/d for 14 consecutive days before surgery.ELISA was used to measure the serum levels of 25-hydroxyvitamin D3[25(OH)D3],intestinal barrier indicators(D-lactate,Zonulin),and inflammatory indicators(C-reactive protein,interleukin-6)within 24 hours after admis-sion and on days 1,4,and 7 after surgery,and the changes in these indicators were compared between the two groups.Results:A total of 71 patients were enrolled finally,with 34 in the intervention group and 37 in the control group.On days 1,4,and 7 after surgery,the intervention group had a significantly lower level of D-lactate than the control group(F=3.978,P=0.026;F=9.649,P=0.005;F=4.389,P=0.021).On day 4 after surgery,the intervention group had a significantly lower level of Zonulin than the control group(F=3.198,P=0.035).Conclusion:Oral administration of vitamin D3 before surgery may accelerate the recovery of intestinal barrier function in pa-tients with gastric cancer.

OBJECTIVE To explore the risk factors for postoperative surgical site infection(SSI)in the neurosur-gery department patients undergoing craniocerebral surgeries and establish Nomogram prediction model and verify it.METHODS A total of 1 265 patients who underwent craniocerebral surgeries in neurosurgery department of the First Hospital of Quanzhou City from Jan.2021 to Dec.2022 were recruited as the research subjects.The risk factors for the postoperative SSI were explored by logistic regression model.The Nomogram prediction model was established based on the independent risk factors that were screened by logistic regression analysis,and the model was verified.RESULTS Among 1 265 patients who underwent the craniocerebral surgeries,68 had SSI,with the infection rate of 5.38％.Diabetes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days were the independent risk factors for the postoperative SSI in the patients undergoing craniocerebral surgeries(P＜0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the established Nomogram pre-diction model was 0.842 in the training group,0.863 in the verification group.the calibration curves were drawn,the goodness of fit of the established Nomogram risk prediction model was assessed by means of Hosmer-Leme-show test;the predicted probability of SSI was highly consistent with the actual probability of infection,with the modeling group(P=0.851),the validation group(P=0.893).CONCLUSIONS The postoperative SSI in the neurosurgery department patients undergoing craniocerebral surgeries is closely associated with the diabe-tes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days.The established Nomogram prediction model has high prediction capability and can accurately assess the risk of SSI in the patients.

OBJECTIVE To explore the risk factors for postoperative surgical site infection(SSI)in the neurosur-gery department patients undergoing craniocerebral surgeries and establish Nomogram prediction model and verify it.METHODS A total of 1 265 patients who underwent craniocerebral surgeries in neurosurgery department of the First Hospital of Quanzhou City from Jan.2021 to Dec.2022 were recruited as the research subjects.The risk factors for the postoperative SSI were explored by logistic regression model.The Nomogram prediction model was established based on the independent risk factors that were screened by logistic regression analysis,and the model was verified.RESULTS Among 1 265 patients who underwent the craniocerebral surgeries,68 had SSI,with the infection rate of 5.38％.Diabetes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days were the independent risk factors for the postoperative SSI in the patients undergoing craniocerebral surgeries(P＜0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the established Nomogram pre-diction model was 0.842 in the training group,0.863 in the verification group.the calibration curves were drawn,the goodness of fit of the established Nomogram risk prediction model was assessed by means of Hosmer-Leme-show test;the predicted probability of SSI was highly consistent with the actual probability of infection,with the modeling group(P=0.851),the validation group(P=0.893).CONCLUSIONS The postoperative SSI in the neurosurgery department patients undergoing craniocerebral surgeries is closely associated with the diabe-tes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days.The established Nomogram prediction model has high prediction capability and can accurately assess the risk of SSI in the patients.

Objective:To explore the application value of computed tomography angiography(CTA)combined with neuron-specific enolase(NSE)and insulin-like growth factor-1(IGF-1)in the disease assessment of progressive cerebral infarction.Methods:A total of 110 patients with suspected progressive cerebral infarction admitted to Shanghai Changzheng Hospital from May 2022 to May 2023 were selected as the study subjects,all of them were tested by CTA.According to the deterioration status,63 cases with progressive cerebral infarction were divided into in the study group(progressive cerebral infarction),and then they were further divided into mild degree(19 cases),moderate degree(25 cases)and severe degree(16 cases)according to the condition of neurological deficit of the score of National Institutes of Health Stroke Scale(NIHSS).Other 47 patients with non-progressive cerebral infarction were divided into the control group.The degree of vascular stenosis,the changes of NSE and IGF-1 levels of each group were analyzed,as well as the changes of NSE and IGF-1 levels of neurological deficit with different degrees.The relationship between CTA,NSE and IGF-1 was further explored,and the assessment value of the combined examination of CTA,NSE and IGF-1 on progressive cerebral infarction also was explored.Results:Compared with the control group,the degree of vascular stenosis and NSE levels of the study group increased,while IGF-1 levels of that decreased,and the differences of them between two groups were statistical significance(t=20.893,24.156,40.209,P＜0.05),respectively.Compared with mild patients,IGF-1 levels decreased and NSE levels increased in moderate and severe patients,and the differences were statistical significance(t=4.689,9.103,18.464,23.672,P＜0.05),respectively.Compared with moderate patients,NSE levels increased and IGF-1 levels decreased in severe patients,and the differences were statistical significance(t=5.408,8.118,P＜0.05),respectively.NSE level was positively correlated with the degree of vascular stenosis(r=0.651,P＜0.05),while IGF-1 level was negatively correlated with it(r=-0.617,P＜0.05).Vascular stenosis and NSE were positively correlated with progressive cerebral infarction(r=0.672,P＜0.05),while IGF-1 level was negatively correlated with it(r=-0.629,P＜0.05),respectively.The area under curve(AUC)values of receiver operating characteristic(ROC)curves of CTA,NSE,IGF-1 and the combination of them were respectively 0.688(95%CI:0.594-0.786),0.710(95%CI:0.609-0.811),0.676(95%CI:0.578-0.775)and 0.822(95%CI:0.734-0.910),and the value of the combination of the three indicators was higher in assessing progressive cerebral infarction.Conclusion:The NSE level is higher in patients with progressive cerebral infarction,and the IGF-1 level is lower.The combination of NSE,IGF-1 and CTA can help to enhance the clinical assessment for progressive cerebral infarction,which can provide beneficial basis for clinical diagnosis and treatment of this disease.

Objective:To gain a deeper understanding of the cognitive differences between lactating women and obstetric nurses regarding their breastfeeding counselling abilities.Methods:This study was a descriptive phenomenology qualitative study. From October 2021 to June 2022, purposive sampling was used to select 11 lactating women who received breastfeeding counselling and 13 obstetric nurses who provided breastfeeding counselling services in Department of Obstetrics at Peking Union Medical College Hospital for semi-structured interviews. Giorgi analysis method was used to extract and analyze data.Results:The cognitive differences between lactating women and obstetric nurses regarding breastfeeding counselling abilities were mainly manifested in four aspects, namely breastfeeding knowledge and skills, counselling practice ability, improving counselling ability, and personality traits.Conclusions:Lactating women and obstetric nurses have cognitive differences in breastfeeding counselling abilities. Obstetric nurses should improve their breastfeeding counselling skills based on the needs of lactating women and provide personalized breastfeeding counselling services.

Objective:To investigate the nutritional risk, incidence of malnutrition, and intake of three major energy-supplying nutrients, analyze changes in their body composition and the possible influencing factors in patients with stomach neoplasms during perioperative period in order to provide a theoretical basis for the nutritional management of patients with stomach neoplasms during perioperative period.Methods:This was a cross-sectional study. A total of 105 patients who underwent gastric cancer radical surgery in the Gastrointestinal Department of Zhongshan Hospital Affiliated to Xiamen University from June 2021 to May 2023 were taken as the research subjects using fixed-point continuous sampling method. They were recruited for screening and assessment using Nutritional Risk Screening 2002 (NRS 2002) and Patient-Generated Subjective Global Assessment (PG-SGA). Nutrients intake during the perioperative period were investigated using the 24-h recall method and dietary diary method, etc. Body compositions were measured using the bioelectrical resistance method.Results:Among the 105 patients, there were 78 males and 27 females, with an average age of (61.5 ± 10.3) years. About 83.8% (88/105) gastric cancer patients were at nutritional risk and 82.9% (87/105) were malnourished. The preoperative and postoperative energy intake were (1 646.1 ± 321.5) and (1 317.2 ± 365.8) kcal (1 kcal=4.184 kJ), respectively, which were significantly lower than the target amount of (1 896.7 ± 262.9) kcal, the difference was statistically significant ( t=6.23, 8.29, both P<0.05).The preoperative body mass, muscle mass, skeletal muscle, fat mass, and skeletal muscle index were (51.5 ± 9.6), (40.8 ± 6.0), (23.6 ± 4.0), (8.3 ± 4.9) kg, and 6.7 ± 0.8 respectively, while the postoperative values were (50.0 ± 9.1), (39.8 ± 6.0), (22.8 ± 3.6), (7.8 ± 5.2) kg, and 6.5 ± 0.8 respectively, with statistically significant differences between the two groups ( t values were 2.89-10.61, all P<0.05). Logistic multivariate regression analysis showed that the operation time ( OR=3.984, 95% CI 1.433-11.080, P<0.05) and energy satisfaction ( OR=0.053, 95% CI 0.005-0.610, P<0.05) were independent influencing factors for the degree of skeletal muscle loss. Conclusions:During perioperative period, the gastric cancer patients had poor nutritional status with insufficient nutrient intake and accelerated loss of body muscle and fat. Therefore, it was necessary to conduct a comprehensive nutritional evaluation for patients with stomach neoplasms during perioperative period in time and take steps to promote recovery by providing individualized nutritional therapy.

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Objective:To explore the effect of online and offline blended teaching in gynecology and obstetrics nursing.Methods:From February to July 2021, 139 second-year nursing undergraduates from the Chinese Academy of Medical Sciences & Peking Union Medical College in 2019 were selected as the research subject by the convenience sampling. The online and offline blended teaching was applied in the course of gynecology and obstetrics nursing. A self-designed questionnaire was used to investigate the evaluation of undergraduate nursing students on teaching preparation, teaching implementation and teaching effect.Results:A total of 87.05% of the students had a very good/good experience of using the online learning platform. 99.28% of students could watch online videos before class. 97.84% of the students were very satisfied/satisfied with the teaching.Conclusions:The online and offline blended teaching is conducive to improving students' autonomous learning ability, promoting the understanding and mastery of obstetrics and gynecology nursing knowledge, and improving learning interest.

Objective:To explore the breastfeeding guidance experience of international board certified lactation consultants (IBCLC) in China, so as to provide reference for promoting breastfeeding guidance in China.Methods:This study adopted a descriptive phenomenological approach. From October 2021 to June 2022, purposive sampling was used to select 15 IBCLC from 8 provinces and cities who provided breastfeeding support. The semi-structured in-depth interview was used for data collection, and the Giorgi method was used to analyze the data and extract themes.Results:A total of 4 themes were extracted, namely, a sense of need, a sense of meaning and value, a sense of resistance at work and a sense of expectation for the future.Conclusions:The needs of the public and the improvement of IBCLC guidance capabilities are the foundation for providing breastfeeding guidance. The realization of self-worth and the attention and support of family, society, and hospital managers are conducive to the development of breastfeeding guidance.

Objective To explore the effects of different flushing and sealing procedures on blood pressure fluc-tuation in patients receiving norepinephrine(NE) via micro-pump. Methods A total of 40 cases of critically ill pa-tients receiving intravenous infusion of NE via micro-pump,were randomly divided into two groups(20 cases in each group) from March to September,2016. For the experimental group,the liquid medicine in central venous catheter was sucked out,followed by flushing or sealing the tube according to conventional operation method. For the control group,conventional operation method was used to flush or seal the tube. The effects of two methods on arterial blood pressure were compared. Results Overall 423 flushing and sealing events were recorded among 40 cases in this study (209 in the experimental group and 214 in the control group). The fluctuation of blood pressure was small in the experimental group,while patients in the control group had significant fluctuation of blood pressure(P<0.05). Conclusion The new method that sucking liquid medicine out of the central venous catheter before flush-ing or sealing the tube followed by flushing or sealing using conventional operation method can reduce the risk of sudden increase in blood pressure for patients receiving small dose infusion with micro-pump.