Objective    To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application. Methods    Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years. Results    All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning. Conclusion    Pre-operative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.

Objective:To evaluate the effect of early enteral nutrition supplemented with synbiotics on the levels of C reactive protein (CRP) and Procalcitonin(PCT)level of patients with severe brain injury.The clinical outcomes were also observed.Methods:Forty-seven patients with identified severe brain injury were randomized into study group (n =24) and control group (n =23).All patients received enteral nutrition via nasogastric tube within 24 to 48 h following admission.Patients in the study group were also given synbiotics.Fasting blood samples were collected for detecting the levels of CRP,PCT on day 1,4,7 and 15,respectively.The incidence of lung infection,the length of ICU stay,the cost,the GCS score,the APACHE Ⅱ score,and the mortality in 30 days after administration were collected and compared between 2 groups.Results:Patients in the study group had a lower level of PCT than control group on day 7 and 15 (P ＜0.05,P ＜0.05),and a lower level of CRP on day 15 (P ＜0.01)was also found in the study group.The incidence of lung infection of the study group was also significantly lower than the control group (P ＜ 0.05).A reduced length of hospital stay and a lower cost were found in the study group (P ＜0.05).The GCS scores in the study group was higher on day 15 when compared with that in the control group (P ＜ 0.05).However,There was no significant change in APACHE Ⅱ score and mortality in 30 days(P ＞ 0.05).Conclusion:Nutrition supplemented with synbiotics leads to a lower rate of infection,a shorter length of ICU stay,a reduced the cost,and a better outcome in patients with severe brain injury.

Objective To explore the occurrence of enteral feeding intolerance and its influencing factors in patients with severe acute pancreatitis. Methods A retrospective analysis of severe acute pancreatitis patients undergoing enteral nutrition therapy admitted to a tertiary hospital from October 2012 to October 2015 was performed. The occurrence of enteral feeding intolerance was analyzed,and its influencing factors were evaluated by single factor analysis and multivariate logistic regression analysis. Results There were 54 patients suffered from enteral feeding intolerance among 92 patients. The results of single factor analysis and multivariate regression analysis showed that higher APACHE II score,intra-abdominal pressure and central venous pressure were independent risk factors of feeding intolerance,while adding dietary fiber was a protective factor. Conclusion Severe acute pancreatitis patients with higher APACHE II score,intra-abdominal pressure and central venous pressure can aggravate the risk of feeding intolerance,while adding dietary fiber is beneficial for reducing the incidence.

Objective To understand the reasons that relatives refused to give up treatment for ICU end-of-life patients. Methods A depth interview was conducted to analyze themes with 10 relatives of end-of-life patients from level three classes A hospitals by using phenomenological method. Results Four themes were abstracted including economic conditions, death place, cognition of death, opinions of family members. Conclusions Giving-up treatment for end-of-life patients in ICU should be legalized and standardized as soon as possible in order to reduce the patients′dying suffering and provide a theoretical basis for the development of hospice care in ICU.

Objective To probe into the nursing experts' perspectives on the clinical training of master of nursing specialist which was newly set up in our country,and to provide reference for the clinical training model of the master of nursing specialist.Methods In-depth interviews were conducted with thirteen nursing experts from five universities and three affiliated hospitals in our country.The data were analyzed by phenomenological procedures.Results Nursing experts proposed some suggestions on the clinical training of master of nursing specialist from the following aspects:clinical training goal,training content,training mode.Conclusions It is important to explore suitable clinical training pattern for the master of nursing specialist from the national education policy,the different requirements for enrollment,the development requirement of students' clinical competence and the effective operation of cultivating mode,in order to promote the further development of master of nursing specialist education.

Objective To probe into learning experience of master of nursing specialist students during clinical practice,so as to provide some educational references for their clinical practice training.Methods Thirteen master of nursing specialist students from two universities in Chongqing were selected by homogenous sampling.The data were collected by focus group interview and analyzed by phenomenological procedures.Results The learning experience of master of nursing specialist students during clinical practice were obtained via evaluation on clinical learning and teaching.Conclusions It is important to explore appropriate teaching strategies,strengthen clinical teacher teams and establish a scientific clinical teaching management system during clinical practice of master of nursing specialist students.

Objective To build model of intestinal motility disorders (IMD) in mice after severe craniocerebral trauma by using modified free fall impact method so as to lay the foundation for further study on development mechanism of postinjury IMD.Methods Severe craniocerebral trauma in mice was induced by a cylindrical sleeve rod impactor.Pathological changes of cerebral and intestinal tissue in mice were observed at 1,6 hours and 1,3,7 days after severe craniocerebral trauma.Brain water content and intestinal propulsion percentage were detected in each time point as well.Results Acute inflammation and congestion of the intestine were observed in phase of cerebral hemorrhage and edema after severe craniocerebral trauma in mice.Brain water content was increased at 6 hours and reached the peak at 24 hours.Intestine propulsion percentage showed a fall at one hour and dropped to the lowest level at 6 hours.Conclusions IMD exists in mice with severe craniocerebral trauma.The device involving modified Feeney free fall impact method can successfully establish animal model of IMD in mice with severe craniocerebral trauma.

Objective To investigate effect of early enteral nutrition supplemented with probiotics on gastrointestinal motility disturbance and nutritional status in patients with severe craniocerebral trauma.Methods Forty patients with severe craniocerebral trauma were randomized into study group (18patients) and control group (22 patients).Patients of both groups received enteral nutrition via nasogastric tube at 24-72 hours after admission,but the patients of study group were also supplemented with probiotics simultaneously.Rate of abdominal distention,vomiting,gastro-oesophageal reflux,gastric retention,constipation and diarrhea were recorded during the whole study.Time to first defecation and time to targeted nutritional goals were also recorded.Prealbumin and transferrin in serum were detected at days 0,4,7,and 15 after the beginning of enteral nutrition.Length of ICU stay was compared between groups.Results There were no significant differences of the two groups in terms of rate of abdominal distention,vomiting,gastric retention and diarrhea.However,less gastro-oesophageal reflux or constipation patients were observed in study group,as compared with control group (P ＜ 0.05).Time to first defecation and time to targeted nutritional goals were shorter in study group,as compared with control group (P ＜ 0.05).Levels of prealbumin and transferrin had no significant differences between the two groups at days 0,4,and 7,but study group showed both were higher than control group at day 15 (P＜0.05).Moreover,length of ICU stay showed no significant difference between the two groups.Conclusions Compared with simple enteral nutrition,early enteral nutrition with probiotics improves gastrointestinal motility,facilitates the delivery of enteral nutrition,and further ameliorates nutritional status in patients with severe craniocerebral trauma.

Objective To investigate the effect of early enteral nutrition combined with probiotics on the nutritional status of patients with severe head injury. Methods Thirty-five patients with severe head injury were randomized into early enteral nutrition group ( control group, n = 18 ) and early enteral nutrition combined with probiotics group (observational group, n = 17). All the patients received enteral nutrition via nasogastric tube within 24-48 hours following admission. Hemoglobin, lymphocyte count,plasma concentrations of total protein, albumin, prealbumin, cholinesterase, and fasting blood glucose were determined before enteral nutrition and at days 8, 15, 21 after enteral nutrition. Arm circumference (AC), triceps skinfold thickness (TSF) and ann muscle circumference ( AMC ) were measured at the same time points. Gastrointestinal reactions as well as the time to first defecation were recorded. Glasgow coma scale (GCS) was assessed. Results There was no difference in terms of hemoglobin, lymphocyte count, plasma concentrations of total protein, prealbumin, and GCS score at each time point between the two groups ( P ＞ 0. 05 ). At day 8 after enteral nutrition, the patients in the observational group exhibited significantly lower level of fasting blood glucose than those in the control group (P ＜ 0.05 ). At day 15,the concentration of plasma cholinesterase in the observational group was significantly higher than that in the control group ( P ＜ 0. 05 ). At day 21, the observational group showed a tendency in increase of plasma albumin level in comparison with the control group( P = 0. 054), and the decrease of AC and AMC was obviously lower than that in the control group ( P ＜0. 05 ) compared with pre-enteral nutrition. The observational group showed less gastro-oesophageal reflux and constipation as well as earlier time to first defecation compared with the control group ( P ＜ 0. 05,0. 01 ). Conclusion Compared with the ordinary enteral nutrition, the enteral nutrition combined with probiotics can attenuate metabolic disorders and improve the nutritional status of the patients with severe head injury.

Objective To probe into the effect of the enteral nutrition added with lactobacillus on gastric bacteria of rats with severe brain injury. Methods Severe brain injury was made in rats that were then fed with enteral nutrition (3-9 entire nutrients), lactobacillus (3-9 entire nutrients + lactobacillus) and synbiotics (3-9 entire nutrients + lactobacillus + fiber) respectively. Gastric body and gastric antrum mucosa were collected at day 1, 3 and 7 after injury to detect the change of the gastric bacteria. Results DCCE analysis showed less bacteria in sham operation group. On the first day after severe brain injury, the flora bands were increased remarkably but the number of bacteria was decreased in three groups. The similarity of denaturing gradient gel electrophoresis ( DGGE) map patterns was 65% , 64% and 53% respectively in the enteral nutrition group, lactobacillus group and synbiotics group, with no significant difference in regard of the diversity index. On the third day after severe brain injury, the flora bands showed a tendency of decrease, with the similarity of denaturing gradient gel electrophoresis (DGGE) map patterns for 72% , 58% and 62% respectively. The richness and diversity of total bacteria in the lactobacillus group was remarkably lower than that in the enteral nutrition group and synbiotics group (P＜0.01). On the seventh day after SHI, the flora bands were decreased in three groups, with the minimum number of the bacteria. The similarity of denaturing gradient gel electrophoresis ( DGGE) map patterns was 61% , 51% and 58% respectively, with higher richness and diversity of total bacteria in the synbiotics group compared with the other groups. Conclusion Lactobacillus can help improve gastric bacteria disturbance of rats with severe brain injury. In the meantime, addition of the lactobacillus is better than addition of the synbiotics.