Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.

Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.

Postoperative nausea and vomiting (PONV) is a common complication after aesthesia, which may cause dehydration, electrolyte imbalance and even aspiration. Although anesthesia technology has made great progress, the incidence of PONV is still high. Non-pharmacological intervention is an important way to manage PONV, but it has not attracted enough attention. This paper reviews the adverse effects, risk prediction and severity assessment tools of PONV, and non-drug intervention methods, so that nurses can better understand the management status of PONV, and then provide reference for improving the management strategy of PONV.

With the traffic accident, sudden disaster and safety accidents occur year after year, the injured patients often complicated with multiple injuries, how to maximize the treatment of the injury to improve the survival rate, is an important problem faced by orthopedic surgeons.In recent years, damage control orthopaedics (DCO) technology has been gradually developed, DCO aims to control the patients' primary injury, to prevent further deterioration of the disease, compared with the traditional treatment, it can effectively reduce the second strike and complications, is conducive to the recovery of patients.In this paper, the development of DCO concept, the theoretical basis of DCO, the adaptation of DCO, the implementation steps of DCO and the best time, the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed.

Objective To investigate the constitutional types of Chinese medicine of primary bile reflux gastritis among different seasons. Methods Data of gastroscopy center during August 2015 to July 2016 were analyzed. A total of 603 patients were diagnosed as primary bile reflux gastritis. After gastroscopy, the standardized constitution in Chinese medicine questionnaire was used to evaluation the scores of all kinds of constitutional types. The Constitutional types of Chinese medicine of primary bile reflux gastritis among different seasons were analyzed. Results Among all seasons, the positive detection rate showed significant difference (χ2=13.041, P=0.005), and summer group showed the highest among the four seasons (23.38% vs. 17.63%,χ2=12.414, P<0.001). Among all seasons, constitutional types of Chinese medicine of primary bile reflux gastritis had significant difference (χ2=37.441, P<0.001). Damp-heated type had significant difference among seasons (χ2=8.472, P=0.037), especially during the summer (χ2=5.847, P=0.016). Conclusions The summer may have more primary bile reflux gastritis chance to be diagnosed as primary bile reflux gastritis. Yang-deficiency type, Gentleness type, Qi-deficiency type and damp-heat type were more common in primary bile reflux gastritis patients.

Objective To investigate the relationship between uncertainty in illness and recovery quality. Methods A cross sectional study was conducted from June to December 2015. The Chinese version Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness of 168 patients with unconfirmed breast tumor undergoing general anesthesia. The following datarecovery time, time stay in postanesthesiacar unit, modified Observer′s Assessment of Alertness/Sedation Scale score etc were recorded. Results The breast tumor patients had a medium degree of illness uncertainty (81.11 ± 12.57) points. Educational background, marital status, family medical history, the severity of disease affect scores of illness uncertainty (P<0.05 or 0.01). Uncertainty in illnesswas negative correlated with recovery quality (P<0.05 or 0.01). Conclusions Uncertainty in illness of patients isrelated to recovery quality. Nursesshould instruct breast tumor patients to manage symptoms to decrease uncertainty in illness.

Objective To observe the association between ambulatory blood pressure levels and blood pressure variability (BPV) with myocardial performance index (MPI) in untreated hypertensive patients.Methods From January to September 2013,a total of 81 untreated hypertensive patients were included in this study.All patients received ambulatory blood pressure monitoring and echocardiography measurements.MPI was determined in all patients by the following formula:MPI =(isovolumic contraction time + isovolumic relaxation time)/ejection time.The patients were divided into two groups according to left ventricular MPI:patients with MPI ＞ 0.47 (n =39) and patients with MPI ≤ 0.47 (n =42).The mean levels and standard deviation (SD) of 24 h,daytime and nighttime blood pressures were compared between the two groups.SD was used to express BPV.Determinants of MPI were identified by multivariate regression analysis.Results 24 h and daytime systolic blood pressure,24 h,daytime and nighttime diastolic blood pressure,as well as SD of 24 h and daytime systolic blood pressure ((130.1 ± 8.7),(134.0 ± 8.2),(89.1 ±6.3),(90.9 ±6.4),(83.1 ±9.9),(13.7 ± 3.3) and(14.2 ± 3.5) mmHg(1 mmHg =0.133 kPa),respectively) were significantly higher in patients with MPI ＞ 0.47 than those ((124.8 ± 8.7),(126.7 ±8.8),(84.5 ±7.1),(86.2 ± 7.4),(76.4 ± 7.5),(11.8 ±2.1) and(10.4 ± 1.9) mmHg,respectively) in patients with MPI≤0.47 (all P ＜ 0.05).Multivariate regression analysis showed that 24 h diastolic blood pressure (β =0.239,P =0.007) and SD of 24 h systolic blood pressure (β =0.333,P ＜0.001),left ventricular mass index and early diastolic mitral annular velocity were independently associated with MPI.Conclusion The increase of diastolic blood pressure and systolic BPV are associated with the deterioration of left ventricular function.

Objective To assess the differences in carotid artery stiffness properties and endothelium-independent dilation (EID)between elderly and young patients,and evaluate the echotracking (ET)system for vascular stiffness at different ages.Methods A total of 79 outpatients with multiple cardiovascular risks were recruited.Clinical data including medical history,height,weight,blood pressure,fasting blood glucose and blood lipid were collected.We evaluated the arterial stiffness parameters of carotid artery and EID using an ultrasonic ET system in 46 elderly subjects,compared with 33 sex-matched non-elderly subjects.The impaired EID function was defined as brachial artery nitroglycerin mediated dilation (NMD)below 4％.Results All stiffness parameters including pressure-strain elasticity modulus stiffness index β (Ep),pulse wave velocity β (PWVβ)and augmentation index (AI)were significantly increased in elderly group compared with the non-elderly group [(138.9±64.7)kPa vs.(100.6±30.8)kPa,(10.9±4.7)vs.(8.2±2.3),and (6.9±1.4)m/s vs.(6.1±0.9)m/s,P＜0.05 respectively],while the exception of arterial compliance (AC)was reduced (0.9±0.3)mm2/kPa vs.(1.0±0.5)mm2/kPa(P＜0.05).The incidence of impaired EID in elderly group was higher than in non-elderly group [56.5％ (26 cases) vs.33.3％ (11 cases),P＜0.05].ET parameters including Ep,stiffness index β,PWVβ,AC and AI were related to age (r=-0.44,-0.45,-0.40,-0.40,0.34,all P＜0.01)； Ep,stiffness index β,PWVβ and AC were also related to impaired EDI (r=-0.38,-0.40,-0.34,-0.29,all P＜0.01).Conclusions Arterial stiffness properties and EID measured by ET system was more serious in elderly with multiple cardiovascular risks than in non-elderly subjects.As a convenient and accurate assessment of stiffness parameters,ET system is optimal option for measuring arterial stiffness and EID in elderly people.

OBJECTIVETo observe the toxicity of hyperoside in rat embryo-fetal development, in order to provide preference for safe use of drugs during gestation period.

METHODHealthy pregnant rats were randomly divided into hyperosid groups (30, 175, 1000 mg x kg(-1) x d(-1)), the positive control group (cyclophosphamide, 7 mg x kg(-1) x d(-1)) and the solvent control group (1% aqueous carboxymethylcellulose). These rats were orally administered with hyperosid or vehicle during 6-15 d after gestation and subcutaneously injected with cyclophosphamide during 11-13 d. Maternal clinical sign, abortions, premature deliveries and body weight were monitored throughout gestation. At termination (gestation days 20), pregnant females were evaluated for clinical symposiums, weight change, corpora lutea count, existence and death of embryos; live fetuses were examined for gender, external, visceral and skeletal malformation and variations.

RESULTAll pregnant rats showed no significant abnormality in appearance, viscera and skeletal development. However, there was a difference between the high-dose group of hyperoside and negative control group in the fetus body weight, the length of the embryos and the length of tail (P < 0.05).

CONCLUSIONPregnant women are suggested to cautiously use hyperoside because it shows certain impact on development of fetal rats under the experimental conditions.

Abelmoschus ; chemistry ; Animals ; Drugs, Chinese Herbal ; toxicity ; Embryonic Development ; drug effects ; Female ; Fetal Development ; drug effects ; Litter Size ; drug effects ; Male ; Pregnancy ; Quercetin ; analogs & derivatives ; toxicity ; Rats ; Rats, Wistar

Objective:To explore the related factors of ventricular arrhythmia (VA) complicating acute phase of myocardial infarction and their effects on short term prognosis. Methods:A total of 161 subjects with acute myocardial infarction (AMI) were divided into 5 groups according to VA types: frequent single ventricular premature beat group(n=10),bigeminy or paired ventricular premature beat group (n=21),non-sus- tained ventricular tachycardia group (n=31),ventricular tachycardia and fibrillation group (n=11) and control group (n=88). The characteristics of coronary artery and left ventricular ejection fraction were determined. Results:The incidence of left main coronary occlusion was more frequent in ventricular tachycardia and fibrillation group than in control group (P