Objective:To analyze the predictive value of combined detection of serum tumor abnormal protein (TAP), cytokeratin 19 fragment antigen (CYFRA21-1), and endothelial cell specific molecule 1 (ESM1) for postoperative recurrence and metastasis of colorectal cancer patients.Methods:Seventy-five patients with colorectal cancer(colorectal cancer group) admitted to Jinhua Guangfu Cancer Hospital from June 2021 to May 2023 and 60 healthy subjects (control group) during the same period were retrospectively selected as the study objects. The levels of serum TAP, CYFRA21-1 and ESM1 were compared between the two groups. The levels of serum TAP, CYFRA21-1 and ESM1 in colorectal cancer patients with different clinicopathological features were compared. All patients with colorectal cancer were followed up for 1 year, and 5 cases were lost to follow-up, including 40 cases in the non-recurrence and metastasis group and 35 cases in the recurrence and metastasis group. The levels of serum TAP, CYFRA21-1, and ESM1 were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of three indexes for postoperative recurrence and metastasis of colorectal cancer.Results:The levels of serum TAP, CYFRA21-1 and ESM1 in the colorectal cancer group were higher than those in the control group: (134.52 ± 26.18) μm 2 vs. (95.52 ± 10.03) μm 2, (6.96 ± 0.73) μg/L vs. (3.15 ± 0.42) μg/L, (36.78 ± 4.97) μg/L vs. (421 ± 0.35) μg/L, there were statistical differences ( P<0.01). There were significant differences in serum TAP, CYFRA21-1, and ESM1 levels among patients with different clinical stages, tissue differentiation, and lymph node metastasis ( P<0.01). The levels of serum TAP, CYFRA21-1 and ESM1 in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group: (155.25 ± 28.02) μm 2 vs. (121.05 ± 21.03) μm 2, (8.58 ± 0.93) μg/L vs. (5.25 ± 0.62) μg/L, (42.05 ± 5.23) μg/L vs. (34.62 ± 5.01) μg/L, there were statistical differences ( P<0.01). ROC curve analysis results showed that the combined detection of serum TAP, CYFRA21-1 and ESM1 levels predicted postoperative recurrence and metastasis of colorectal cancer patients with the largest of the area under the curve (AUC), which was 0.811, and was higher than any single index. Conclusions:The levels of TAP, CYFRA21-1 and ESM1 are increased in colorectal cancer patients, and combined detection of serum TAP, CYFRA21-1 and ESM1 levels has high predictive value for postoperative recurrence and metastasis.

OBJECTIVES: To investigate the effect of a variety of kidney-tonifying Chinese medicines on thymus regeneration after acute degeneration in mice. METHODS: Forty-eight 8-week-old male BALB/c mice were randomly divided into normal control group, model control group, negative control group, positive control group, the fructus of Cnidium monnieri (L.) Cuss. group, the fructus of Psoralea corylifolia (L.) group, the fructus of Rubus chingii Hu group, and the tuber onion seed group, with 6 mice in each group. Except for the normal control group, mice in the other groups received intraperitoneal injections of rapamycin (1 mg·kg^－1·d^－1) for 5 consecutive days followed by 14 h of starvation to induce acute thymus degeneration. After successful modeling, in treatment groups ethanol extract of the fructus of Cnidium monnieri (L.) Cuss. (0.78 g·kg^－1·d^－1), fructus of Psoralea corylifolia (L.) (0.39 g·kg^－1·d^－1), fructus of Rubus chingii Hu (0.78 g·kg^－1·d^－1) or the tuber onion seed(0.39 g·kg^－1·d^－1) was intraperitoneally injected once a day for 5 days; while the negative control group was given equal volume of normal saline, and the positive control group was given metformin (300 mg·kg^－1·d^－1). The grip strength was measured with a grip tester 2 h after the last administration. The pathological changes of thymus were observed by hematoxylin and eosin (HE) staining. The structure and distribution of thymic epithelial cells were observed by multiple immunofluorescence method. The proportion of T cell subsets in thymus and peripheral blood was analyzed by flow cytometry. The level of T cell receptor excision circles (TREC) in the genomic DNA of mouse spleen mononuclear cells was detected by quantitative polymerase chain reaction (PCR) for evaluation of thymic output function. The expression of thymus aging- and function-related factors in the thymus tissue were detected by quantitative reverse transcription PCR. The expression of cyclin-dependent kinase inhibitor 1A (p21) and tumor protein 53 (p53) were verified by immunohistochemistry. RESULTS: Rapamycin induced thymic atrophy and significantly reduced limb grip strength in mice (P<0.01). Compared with the negative control group, the limb grip strength of mice in the fructus of Psoralea corylifolia (L.) group, the fructus of Rubus chingii Hu group and the tuber onion seed group was significantly enhanced (all P<0.05), and the level of TREC in spleen of the mice in each administration group was reduced (all P<0.05). Among Chinese herb medicine-treatment groups, the recovery of thymus function and tissue structure in the tuber onion seed group was most obvious. Further study showed that compared with the negative control group, the proportion of CD4 single positive cells (CD3⁺TCR-β⁺CD4⁺CD8^－) in the thymus of the tuber onion seed group was significantly increased (P<0.01), and the proportion of CD3⁺CD28⁺ T cell and CD3⁺CD8⁺CD28⁺ T cell in peripheral blood was significantly increased (all P<0.01). The mRNA levels of IL-1α, IL-6, p21 and p53 in thymocytes were decreased (all P<0.05). The results of immunohistochemistry further confirmed the decrease in p21 and p53 expression. In normal mice, tuber onion seed was observed to enhance limb grip strength (P<0.01), while suppressing thymus output and change the distribution of T cell subsets, and there was no significant effect on thymus weight and the expression of Foxn1, SIRT1, p21, CXCL2 and PTMα. CONCLUSIONS The tuber onion seed and other kidney-tonifying traditional Chinese medicines can accelerate the regeneration process of mouse thymus after acute degeneration induced by rapamycin in mice, and the tuber onion seed exhibits the most pronounced therapeutic effect.
Animals ; Mice ; Male ; Mice, Inbred BALB C ; Thymus Gland/physiology* ; Drugs, Chinese Herbal/pharmacology* ; Sirolimus/adverse effects* ; Regeneration/drug effects*

Objective:To analyze the predictive value of combined detection of serum tumor abnormal protein (TAP), cytokeratin 19 fragment antigen (CYFRA21-1), and endothelial cell specific molecule 1 (ESM1) for postoperative recurrence and metastasis of colorectal cancer patients.Methods:Seventy-five patients with colorectal cancer(colorectal cancer group) admitted to Jinhua Guangfu Cancer Hospital from June 2021 to May 2023 and 60 healthy subjects (control group) during the same period were retrospectively selected as the study objects. The levels of serum TAP, CYFRA21-1 and ESM1 were compared between the two groups. The levels of serum TAP, CYFRA21-1 and ESM1 in colorectal cancer patients with different clinicopathological features were compared. All patients with colorectal cancer were followed up for 1 year, and 5 cases were lost to follow-up, including 40 cases in the non-recurrence and metastasis group and 35 cases in the recurrence and metastasis group. The levels of serum TAP, CYFRA21-1, and ESM1 were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of three indexes for postoperative recurrence and metastasis of colorectal cancer.Results:The levels of serum TAP, CYFRA21-1 and ESM1 in the colorectal cancer group were higher than those in the control group: (134.52 ± 26.18) μm 2 vs. (95.52 ± 10.03) μm 2, (6.96 ± 0.73) μg/L vs. (3.15 ± 0.42) μg/L, (36.78 ± 4.97) μg/L vs. (421 ± 0.35) μg/L, there were statistical differences ( P<0.01). There were significant differences in serum TAP, CYFRA21-1, and ESM1 levels among patients with different clinical stages, tissue differentiation, and lymph node metastasis ( P<0.01). The levels of serum TAP, CYFRA21-1 and ESM1 in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group: (155.25 ± 28.02) μm 2 vs. (121.05 ± 21.03) μm 2, (8.58 ± 0.93) μg/L vs. (5.25 ± 0.62) μg/L, (42.05 ± 5.23) μg/L vs. (34.62 ± 5.01) μg/L, there were statistical differences ( P<0.01). ROC curve analysis results showed that the combined detection of serum TAP, CYFRA21-1 and ESM1 levels predicted postoperative recurrence and metastasis of colorectal cancer patients with the largest of the area under the curve (AUC), which was 0.811, and was higher than any single index. Conclusions:The levels of TAP, CYFRA21-1 and ESM1 are increased in colorectal cancer patients, and combined detection of serum TAP, CYFRA21-1 and ESM1 levels has high predictive value for postoperative recurrence and metastasis.

OBJECTIVE: To systematically assess the efficacy of traditional Chinese therapy in the treatment of ICU-acquired weakness (ICU-AW). METHODS: PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP were retrieved by computer and were used to collect a randomized controlled trials (RCT) of traditional Chinese therapy for ICU-AW. The retrieval time was from databases establishment to December 2021. After 2 researchers independently screened the literature, extracted data and evaluated the risk of bias included in the study, and RevMan 5.4 software was used for Meta-analysis. RESULTS: 334 articles were selected, totally 13 clinical studies and 982 patients were included, including 562 in the trial group and 420 in the control group. Meta-analysis results showed that traditional Chinese therapy could improve clinical efficacy of ICU-AW patients [relative risk (RR) = 1.35, 95% confidence interval (95%CI) was 1.20 to 1.52, P < 0.000 01], improve the muscle strength [Medical Research Council score (MRC score); standardized mean difference (SMD) = 1.00, 95%CI was 0.67 to 1.33, P < 0.000 01], improve daily life ability [modified Barthel index score (MBI score); SMD = 1.67, 95%CI was 1.20 to 2.14, P < 0.000 01], shorten mechanical ventilation time (SMD = -1.47, 95%CI was -1.84 to -1.09, P < 0.000 01), reduce the length of intensive care unit (ICU) stay [mean difference (MD) = -3.28, 95%CI was -3.89 to -2.68, P < 0.000 01], reduce the total hospitalization time (MD = -4.71, 95%CI was -5.90 to -3.53, P < 0.000 01), reduce tumor necrosis factor-α (TNF-α; MD = -4.55, 95%CI was -6.39 to -2.70, P < 0.000 01) and interleukin-6 (IL-6; MD = -5.07, 95%CI was -6.36 to -3.77, P < 0.000 01). There was no obvious advantage in reducing the severity of the disease [acute physiology and chronic health evaluation II (APACHE II; SMD = -0.45, 95%CI was -0.92 to 0.03, P = 0.07). CONCLUSIONS Based on the current research, traditional Chinese therapy can improve the clinical efficacy of ICU-AW, improve muscle strength and daily life ability, shorten mechanical ventilation, the length of ICU stay and total hospitalization time, reduce TNF-α and IL-6. But traditional Chinese therapy can not reduce the overall disease severity.
Humans ; APACHE ; East Asian People ; Intensive Care Units ; Interleukin-6 ; Tumor Necrosis Factor-alpha ; Medicine, Chinese Traditional ; Muscle Weakness/therapy*

With the rapid development of computing methods and computing power, the ability of artificial intelligence in problem modelling and analysis has been improved rapidly. Artificial intelligence has been gradually introduced into the field of medical care and nursing, and played an important role in assisting medical care and nursing. This paper mainly discusses the progress of artificial intelligence technology in nursing, and analyzes the existing problems and challenges, in order to provide new ideas for artificial intelligence in supporting the development of nursing more effectively.

Objective:To summarize the nursing experience in 2 patients with cardiogenic shock combined with acute respiratory distress syndrome(ARDS) treated by extracorporeal membrane oxygenation (ECMO) and transferred outer-hospital in long distance.Methods:There were many risk factors in this transport: high parameters of ECMO included V-A mode, 100% oxygen, and a flow of oxygen from 6 L/min to 10 L/min. High ventilator parameters included oxygen concentration of 100% and positive end-expiratory pressure of 15-17 cmH 2O(1 cmH 2O=0.098 kPa). Transport distance was up to 196 km. And the transport time was up to 2 h 36 min. In this regard, we carried out adequate preparations before transport and professional cares during transport. The main points were as follows: setted up a professional transport team; prepared adequate power and oxygen supply; reduced the number of interruption of ECMO and ventilator support during transport; provided the reasonable remedial actions when ECMO and ventilator support were interrupted. Results:Two patients arrived at the destination safely.Conclusions:Adequate preparations before transport and professional cares during transport could effectively avoid and respond to the occurrence of adverse events, and it is feasible and safe to patients supported by ECMO for long distance outer-hospital transport.

Objective:To investigate the current situation of knowledge, attitude and practice level of ICU nurses in the prevention of medical device-related pressure injuries (MDRPI) in critically ill patients and analyze its influencing factors.Methods:From May to August 2019, 540 ICU nurses in 8 Class Ⅲ general hospitals in Zhejiang province were surveyed by using "MDRPI Prevention Knowledge, Attitude and Practice Questionnaire for ICU Nurses". Current situation and influencing factors of knowledge, attitude and practice of ICU nurses in the prevention of MDRPI were analyzed and relationships among prevention knowledge, attitude and practice were explored.Results:The overall average score of knowledge, attitude and practice level of ICU nurses in the prevention of MDRPI was (3.87±0.46) . Of which, the average score of knowledge dimension items was (3.43±0.69) , the average score of attitude dimension items was (4.13±0.51) , and the average score of practice dimension items was (4.06±0.56) . There were statistically significant differences in the overall average scores of knowledge, attitude and practice in the prevention of MDRPI in ICU nurses with different genders, marital status, years of work, titles, duties, whether they are members of the wound stoma or pressure ulcer group, whether they have cared for MDRPI patients, whether they have received MDRPI training ( P<0.05) . Multiple linear regression analysis showed that years of work, whether they had cared for MDRPI patients and whether they had received training in MDRPI were influencing factors of knowledge, attitude and practice level of ICU nurses in the prevention of MDRPI ( P<0.05) . ICU nurses MDRPI prevention knowledge, attitude and practice were positively correlated ( P<0.05) . Conclusions:ICU nurses have a more positive attitude and behavior towards MDRPI prevention, but their knowledge of MDRPI prevention is relatively lacking. Nursing managers should attach importance to training on ICU nurses' knowledge of MDRPI prevention so as to improve their MDRPI recognition and nursing ability.

Objective:To discuss the relationship between supracapsular secretion drainage of tracheal intubation before percutaneous dilational tracheotomy (PDT) and the incidence of early-onset VAP (within 5 days) after PDT.Methods:By the convenient sampling method, a total of 160 patients who underwent PDT in ICU of Shaoxing People's Hospital from March 2013 to March 2019 were selected as the research objects and they were divided into group A and group B according to the random number table method, 80 cases in each group. In group A, the research team intervened to drain supracapsular secretion before PDT and bedside nurses cooperated with the doctor to complete other operations on the PDT. In group B, the PDT operation was entirely completed by the bedside nurses and the research team did not intervene. The drainage volume of supracapsular secretion in group A was recorded and the proportion of patients who underwent supracapsular secretion drainage in group B was calculated. The incidence of VAP, ICU mechanical ventilation time, ICU hospitalization time and ICU hospitalization cost within 5 d after PDT were compared between the two groups.Results:Before PDT, patients in group A drained (3.88±2.34) ml of supracapsular secretion. The proportion of bedside nurses in group B who drained secretions before PDT was 53.75% (43/80) . The incidence of VAP within 5 d after PDT in group A was 6.25% (5/80) , which was lower than 17.50% (14/80) in group B, and the difference was statistically significant ( P<0.05) . The ICU mechanical ventilation time and hospital stay of patients in group A were respectively (28.75±8.59) d and (30.91±9.12) d, which were lower than (32.91±8.53) d and (34.28±9.54) d in group B, and the differences were statistically significant ( P<0.05) . The ICU hospitalization cost of group A was (14.98±4.54) ten thousand yuan, which was lower than (16.93±5.37) ten thousand yuan in group B, and the difference was statistically significant ( P<0.05) . Conclusions:Supracapsular secretion drainage of tracheal intubation before PDT can reduce intraoperative aspiration of supracapsular secretion, reduce the incidence of early-onset VAP after PDT and improve prognosis of patients.

Objective: To investigate the effect of occupational exposure on job burnout in nurses, and to analyze the mediating effect of negative emotion between occupational exposure and job burnout and the regulatory effect of supervisor support on occupational exposure and negative emotion. Methods: From September to December, 2015, simple random sampling was used to select 543 nurses from six tertiary hospitals in Zhejiang Province, China. The questionnaires consisted of occupational exposure risk questionnaire, negative emotion questionnaire, supervisor support questionnaire, and job burnout questionnaire. Results: The total score of occupational exposure risk in nurses was 11.43±7.19; the score of emotional exhaustion was 3.19±1.24, the score of low sense of personal accomplishment was 3.02±1.21, and the score of sense of working indifference was 2.24±1.06. There were significant differences in occupational exposure score between nurses with different sexes (t=2.61, P<0.01) and working years (F=4.49, P<0.01) . There were significant differences in the scores of emotional exhaustion and low sense of personal accomplishment in nurses with different sexes (t=5.25, P<0.001) and working years (t=-3.48, P<0.01) . Occupational exposure had positive effects on negative emotion (β=0.41, P<0.05) , emotional exhaustion (β=0.47, P<0.05) , sense of working indifference (β=0.42, P<0.05) , and low sense of personal accomplishment (β=0.17, P<0.05) . Negative emotion had a partial mediating effect between occupational exposure and emotional exhaustion (total effect size 30.5%, P<0.05) and between occupational exposure and sense of working indifference (total effect size 37.1%, P<0.05) . Negative emotion had a complete mediating effect between occupational exposure and low sense of personal accomplishment (β=0.08, P>0.05) . Supervisor support negatively regulate the effects of occupational exposure and negative emotion (F=21.73, P<0.001) . Conclusion In nurses, occupational exposure has a direct positive effect on job burnout and indirectly influences job burnout via negative emotion. Supervisor support can reduce the negative impact of occupational exposure on negative emotion.

Objective: To investigate the effect of leader-member exchange on nurses’sense of calling in workplace based on self-determination theory. Methods: A total of 381 nurses were randomly selected from five tertiary general hospitals in Zhejiang province, China from October to December, 2016. They were subjected to a survey using the Leader-Member Exchange Scale, Job Autonomy Scale, Core Self-Evaluation Scale, and Calling Scale. The mediating effect was used to test the procedures and the data were subjected to hierarchical regression analysis. Results: The leader-member exchange was positively correlated with job autonomy, core self-evaluation, and sense of calling (r=0.471, P<0.001; r=0.373, P<0.001; r=0.475, P<0.001) ; the leader-member exchange had a positive predictive effect on job autonomy and sense of calling (β= 0.47, P<0.001; β=0.48, P<0.001) ; the job autonomy had a partial mediating effect on the relationship between leader-member exchange and sense of calling (F=66.50, P<0.001) ; the core self-evaluation negatively adjusted the positive relationship between leader-member exchange and job autonomy (F=27.81, P<0.001) . Conclusion High-quality leader-member exchange enhances the sense of calling by improving staffs’ job autonomy and the core self-evaluation reduces the positive relationship between leader-member exchange and job autonomy.