OBJECTIVE To study the effects of enteral immune microecological nutrition combined with ω-3 fish oil fat emulsion on postoperative recovery， immune function， liver function and inflammation level in patients with hepatocellular carcinoma resection， as well as the safety of the medication. METHODS A total of 106 patients with hepatocellular carcinoma admitted to our Hospital from June 2020 to December 2023 were selected and divided into control group and study group according to the random number table method， with 53 cases in each group. After undergoing hepatocellular carcinoma resection， control group was given Intacted protein enteral nutrition solution+Enhanced enteral immune microecological nutrition， and the study group was given ω-3 fish oil fat emulsion injection based on the control group. The clinical indicators （postoperative exhaust time， defecation time， postoperative ambulation， and hospital stay）， liver function indicators [alanine transaminase （ALT）， lactate dehydrogenase （LDH）， aspartate transaminase （AST）]， immune function indexes （CD3+ ， CD4+ ， CD8+ ， CD4+/CD8+）， inflammatory factor indexes [tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， IL-6， IL-8]， and indicators of intestinal mucosal barrier [D-lactic acid， intestinal fatty acid binding protein （I-FABP）] were compared between 2 groups， and the occurrence of ADR was recorded. RESULTS Compared with the control group， the postoperative exhaust time， postoperative defecation time， and hospital stay of the study group were shortened significantly， and postoperative ambulation increased significantly （P＜0.05）. After treatment， ALT， LDH， AST， CD8+， inflammatory factors， D-lactic acid and I-FABP of 2 groups were significantly lower than before treatment， and the study group was significantly lower than the control group （P＜0.05）； CD4+， CD3+， and CD4+/CD8+ of two groups were significantly higher than before treatment， and the study group was significantly higher than the control group （P＜0.05）. There was no significant difference in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS Enteral immune microecological nutrition combined with ω-3 fish oil fat emulsion injection can shorten the recovery time of patients after hepatocellular carcinoma resection， improve immune function， reduce inflammatory response， and improve liver function with good safety.

Objective This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials(RCTs)assessing the clinical efficacy of acupuncture for chronic stable angina(CSA).Methods PubMed,The Cochrane Library,Embase,CNKI,VIP,WanFang Data,CBM databases,ClinicalTrial.gov and Chinese Clinical Trial Registry were electronically searched to collect randomized controlled trials(RCTs)of acupuncture for CSA and only RCTs that included acupuncture as the sole or combination of acupuncture in the treatment of CSA.The retrieval period was from the establishment of the database to May 19,2022.The primary outcome measure was the frequency of angina attacks,and the secondary outcome measures were angina efficacy,total effective rate of ECG improvement,nitroglycerin use after treatment,patient-perceived overall effectiveness,performance on the Six-Minute Walk Test(6-MWT),depression as measured by the anxiety as measured by the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),adverse effects.Results Twelve studies with a total of 1605 case subjects were included and grade quality of evidence reviews had 1 outcomes as medium quality evidence,5 outcomes as low quality evidence and 4 outcomes as very low quality evidence.Acupuncture treatment resulted in significantly greater reductions in angina attacks,visual analog scale(VAS),6-minute walk test,angina efficacy,electrocardiogram improvement rate,angina efficacy,total clinical response rate.Conclusion The efficacy of acupuncture combined with western medicine in treating CSA is better than that of Western medicine alone,thanks to restricted by the number and quality of included researchs,higher quality studies are required to prove above conclusions.

Objective:To evaluate the effect of hydrogen on activation of A1 astrocytes in the hippocampus of mice with sepsis-associated encephalopathy (SAE).Methods:A total of 164 clean-grade healthy male C57BL/6J mice, aged 6-8 weeks, weighing 20-25 g, were divided into 4 groups ( n=41 each) using a random number table method: sham operation group (group Sham), sham operation plus hydrogen group (group Sham+ H 2), group SAE and SAE plus hydrogen group (group SAE+ H 2). The SAE model was established by cecal ligation and perforation.Group Sham+ H 2 and group SAE+ H 2 inhaled 2% hydrogen starting from 1 and 6 h after operation, respectively.Twenty mice in each group were selected to observe the 7-day survival rate after operation.The remaining mice were sacrificed at 12 h after operation, and brain tissues were removed for examination of the pathological changes in hippocampal CA1 region (with a light microscope) and for determination of the apoptosis in neurons (by TUNEL), co-expression of hippocampal glial fibrillary acidic protein (GFAP) and complement C3 (by immunofluorescence staining), expression of A1 astrocyte marker C3 (by Western blot), and contents of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and high-mobility group box 1 protein (HMGB1) (by enzyme-linked immunosorbent assay). The abnormal cell ratio and apoptosis rate were calculated.Six mice in each group were selected at 7 days after operation to perform Y-Maze paradigm. Results:Compared with group Sham, the 7-day survival rate after operation was significantly decreased, the abnormal cell ratio and apoptosis rate of hippocampal neurons were increased, the contents of TNF-α, IL-6 and HMGB1 were increased, the expression of C3 was up-regulated, the number of cells coexpressing GFAP and C3 was increased, the exploration time spent in the novel arm in Y-Maze paradigm was shortened, and the preference index was decreased in group SAE ( P<0.05). Compared with group SAE, the 7-day survival rate after operation was significantly increased, the abnormal cell ratio and apoptosis rate of hippocampal neurons were decreased, the contents of TNF-α, IL-6 and HMGB1 were decreased, the expression of C3 was down-regulated, the number of cells coexpressing GFAP and C3 was decreased, the exploration time spent in the novel arm in Y-Maze paradigm was prolonged, and the preference index was increased in group SAE+ H 2 ( P<0.05). There was no significant difference in each parameter mentioned above between Sham group and Sham+ H 2 group ( P>0.05). Conclusion:The mechanism by which hydrogen improves SAE may be related to inhibiting activation of A1 type astrocytes in mice.

Objective:To investigate the effect of nurse-led multiple disciplinary team-based intervention in the prevention of venous thromboembolism in paitents undergoing general surgery.Methods:A total of 118 patients who underwent general surgery in the Tianjin First Central Hospital from May 2017 to October 2018 were divided into study group and control group by random digits table method, with 59 cases in each group. The control group received routine thrombosis prevention nursing, the study group carried out nurse-led multiple disciplinary team-based intervention. The condition of lower limbs deep venous hemodynamic was detected by color Doppler ultrasonography at 3 days after surgery, the levels of D-dimer, thrombelastograph coagulation analyzer (TEG) coagulation parameters were also measured at after 24 hours of admission and postoperative day 3, respectively.Results:The vein blood stasis rate was 94.9% (3/59) in the study group, 79.7% (12/59) in the control group, the venous blood flow of the lower 1imbs in the study group was better than that in the control group ( Z value was 2.477, P<0.05). At 3 days after surgery, the levels of D-dimer were (5.26±1.42) mg/L in the study group, (6.36±1.58) mg/L in the control group, D-dimer was decreased in study group compared to the control group, the difference was statistically significant ( t value was 3.991, P<0.05). Coagulation reaction time(R) value and solidification angle(Angel), maximum thrombus intensity(MA), composite coagulation index(CI) levels were (5.30±0.91) min, (69.64±21.93) deg, (65.40±13.76) mm and (1.23±0.20) in the study group, those index were (4.41±0.75) min, (76.64±16.02) deg, (70.98±13.39) mm, (2.09±0.36) in the control group, R value were increased and Angel, MA, CI levels were decreased in the study group compared to the control group ( t value was 2.001-15.997, P<0.05). Conclusions:Nurse-led multiple disciplinary team-based intervention improves the lower limbs deep venous hemodynamic and coagulation function, as well as reduce the incidence of venous thromboembolism.

Objective To observe the impact of enhancing perioperative care on the clinical efficacy of the patients with intravascular intervention for treatment of patients with acute lower extremity deep venous thrombosis (LEDVT) complicated with pulmonary embolism (PE). Methods Twenty-nine patients with LEDVT complicated with PE admitted to the Tianjin First Center Hospital from May 2015 to February 2019 were enrolled, the pulmonary angiography + pulmonary thrombolysis was applied for all the patients, and 25 cases used inferior vena cava filter implantation, 1 patient underwent catheter-directed thrombolysis (CDT), 4 patients underwent mechanical endovascular aspiration of thromboembolism (PTM), etc intravascular interventional treatment, the peri-operative care was strengthened, including closely observation on the patient's condition, correct use of anticoagulant and thrombolytic drugs, in the mean time, after operation, the nursing care and observation on thrombolysis catheters, involved limbs, complications should be well performed, and health education and discharge guidance ought to be carried out. Before the patient was discharged from the hospital, the improvement of clinical symptoms and the changes of coagulation indexes D-dimer, fibrinogen (Fib), prothrombin time (PT), and activated partial thromboplastin time (APTT) were observed; the Bartel index evaluation quantitative scale was used to assess the patient's activity of daily living (ADL) score; WeChat was used to investigate patient's satisfaction. Results In this group of 29 patients, postoperative chest tightness, shortness of breath symptoms were improved significantly, no fatal PE etc complications occurred. The pulmonary artery computed tomographic angiography (CTA) showed that the pulmonary artery and its branches PE basically disappeared or the measured range or area was obviously decreased. Re-examination of blood gas analysis showed that the arterial oxygen partial pressure (PaO2) was increased. Echocardiography revealed the improvement in pulmonary hypertension. 12 patients with pulmonary infection were improved after anti-inflammatory treatment, the swelling of the affected limb was significantly relieved, and the patients had no distending pain after activities on the ground. After treatment, the coagulation indexes D-dimer and fibrinogen (Fib) were significantly lower than those before treatment [D-dimer (μg/L):2 389.45±2 061.02 vs. 6 093.45±2 586.99, Fib (g/L): 3.18±0.91 vs. 4.07±1.49, both P < 0.01], there were no significant differences in PT and APTT before and after treatment [PT (s): 13.12±2.27 vs. 12.33±2.06, APTT (s):34.51±11.79 vs. 31.84±3.05, both P > 0.05]. After treatment, the ADL score of patients was obviously higher than that before treatment (scores: 79.66±6.26 vs. 17.24±8.30, P < 0.01). WeChat was used to investigate the patients' satisfaction, the nursing score was 95-100 points with an average of (97.38±1.37) points. Conclusion High quality nursing care can minimize the suffering to the largest extent in the patients with pulmonary thrombosis, elevate the quality of life, and reduce the disability and recurrence rates.

Objective To explore the influence of perioperative nursing for interventional open operation of patients with symptomatic internal carotid artery occlusion under the guidance of the Joint Commission International(JCI) concept. Methods The clinical data of 90 patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation from January 2016 to February 2018 were retrospectively analyzed, of which 40 patients receiving routine nursing from January 2016 to January 2017 were set as control group, of which 50 patients receiving nursing guided by JCI concept from February 2017 to February 2018 were set as observation group. The Hamilton Depression Scale (HAMD) was used to evaluate the anxiety of patients at preoperative 1 h and postoperative 48 h, and the extubation time and hospitalization time were compared, as well as the incidence of complications and the patient's coordination degree. Results The HAMD scores of preoperative 1 h and postoperative 48 h of the observation group respectively was (26.58 ± 5.79) and (17.41 ± 4.18) points, of which the control group respectively was (29.75 ± 5.21) points and (22.26 ± 4.64) points, and the HAMD scores between the postoperative 48 h and preoperative 1 h in the 2 groups were statistically significant differences (t=9.080, 6.790, all P < 0.01), of which between the 2 groups were statistically significant differences (t=2.697, 5.208, all P < 0.01). The extubation time and hospitalization time of the observation group respectively was (3.81 ± 0.62) and (12.97 ± 3.65) d, of which the control group respectively was (4.39 ± 0.71) and (16.18±3.54) d, with statistically significant differences (t=4.134, 4.201, all P<0.01). The total incidence rate of complications of the observation group was 18.00％(9/50), of which the control group was 40.00％(16/40), with statistically significant differences (χ2=5.361, P<0.05). The good rate of coordination of the observation group was 76.00％(38/50), of which the control group was 55.00％(22/40), with statistically significant differences (χ2=4.410, P < 0.05). Conclusions The perioperative nursing based on the JCI concept guidance can relieve the anxiety of patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation, shorten the postoperative recovery time, reduce the incidence of complications and improve the nursing coordination.

Objective To reproduce a stable animal model of brain death in pigs, observe the change regularity of cerebral oxygen metabolism during the process of brain death, and to evaluate the significance and value of cerebral oxygen metabolism parameters for the diagnosis of brain death. Methods Twelve landrace pigs were used to create the brain death models using modified method of increasing epidural intracranial pressure (ICP). The mean arterial pressure (MAP) and ICP were monitored continuously during the process. The pigs were divided into four groups according to cerebral perfusion pressure (CPP) decreasing degree during brain death, namely CPP normal group and CPP decreasing 0%-30%, 30%-70%, and 70%-100% groups. Blood gas analysis of the external carotid artery and internal jugular vein were monitored discontinuously. The changes in cerebral oxygen metabolism parameters, including external carotid artery-internal jugular vein bulb oxygen content difference (AJDO2), internal jugular bulb-external carotid artery carbon dioxide partial pressure difference (DPCO2) and DPCO2/AJDO2 ratio, were observed. Results Brain death model were successfully reproduced in 12 experimental pigs. With MAP and ICP monitoring, the models at different stages of CPP could be repeatedly induced. The levels of AJDO2 and DPCO2 were increased gradually and then decreased, while the ratio of DPCO2/AJDO2 was constantly increased with the decrease of CPP. The level of AJDO2 in CPP decreasing 0%-30%group was significantly higher than that in CPP normal group [(5.86±1.21)% vs. (3.92±0.64)%], the levels of DPCO2 in CPP decreasing 0%-30% and CPP decreasing 30%-70% groups were significantly higher than those in CPP normal group [mmHg (1 mmHg = 0.133 kPa): 10.33±1.83, 11.48±2.32 vs. 6.11±1.43], and the ratios of DPCO2/AJDO2 in CPP decreasing 30%-70% and CPP decreasing 70%-100% groups were significantly higher than those in CPP normal group and CPP decreasing 0%-30% group (2.81±0.53, 4.12±1.07 vs. 1.57±0.64, 1.62±0.81). All the differences above were statistically significant (all P < 0.05). Conclusions With the decrease of CPP, cerebral oxygen metabolism showed a regular change during brain death. DPCO2 combined with DPCO2/AJDO2 is a reliable blood gas analysis index indicating intracranial hypoperfusion, which has certain reference value for the determination of brain death.

Objective To investigate changes in the number and function of endothelial progenitor cells (EPCs) in elderly patients with permanent atrial fibrillation(AF).Methods This prospective study included 35 elderly patients in each the permanent atrial fibrillation group and the control group.The numbers of circulating CD34+/KDR+ cells in the two groups were determined by flow cytometry.After two sets of peripheral blood samples were taken,mononuclear cells were isolated through density gradient centrifugation and cultured in vitro.EPC colonies were identified by the methylthiazolyldipheny-tetrazolium(MTT) assay and adhesion assay.The proliferation,adhesion and vasculogenesis of EPC colonies were determined by Matrigel culture.Enzyme-linked immunosorbent assay and nitric acid reductase assay were used to measure the secretion of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in EPCs.Results The numbers of CD34+/KDR+ cells were lower in the AF group than in the control group (20.0±12.7)/104 vs.(77.9±58.9)/104 (P＜0.05).The number of EPC colonies in the atrial fibrillation group was significantly lower than that in the control group (1.8 ± 0.6) CFU vs.(3.5 ± 0.8) CFU (P ＜ 0.01).The proliferation,adhesion and vasculogenesis of EPC colonies in the AF group decreased,compared with the control group (each P＜0.01 or 0.05).Paracrine secretion of VEGF in the AF group (27.4±9.9)ng/L was lower than that in the control group (41.9±7.3)ng/L (P＜0.01) and paracrine production of NO in the AF group also decreased (P＜0.05).Conclusions EPCs In elderly patients with permanent atrial fibrillation show decreased numbers and reduced proliferation,adhesion and vasculogenesis.Paracrine VEGF and NO secretion is down as well.

The disease of critically ill patients was with rapid changes, and at any time faced the risk of emergency. The current commonly used rescue vehicles were larger and bulky implementation, which were not conducive to the operation, therefore the design of a portable rescue vehicle was needed. This new type of rescue vehicle is multi-layer folding structure, with small footprint, large storage space, so a variety of first aid things can be classified and put, easy to be cleaned and disinfected. In the rescue process, the portable rescue vehicles can be placed in the required position; box of various emergency items can be found at a glance with easy access; the height of the infusion stand can adjust freely according to the user height; the rescue vehicle handle can be easy to pull and adjust accord with human body mechanics principle. The portable rescue vehicle facilitates the operation of medical staff, and is worthy of clinical application.

Objective To understand the current situation and level of clinical laboratory about the analysis of cellular morphology in Tibet region .Methods Authors investigated the information about the staff of clinical laboratory testing the patient′s blood smear under microscope ,executing the rules and regulations by using standard questionnaires .Results Some of the clinical laboratory didn′t founded the rule and standardization of rechecking about abnormal blood routine (5/15 ,33 .3% ) .Some of the divi-sion leadership didn′t pay enough attention to the staff′s basic operation (2/15 ,13 .3% ) .Most of the staff didn′t being trained about cellular morphology in special purpose workshop (6/43 ,88 .8% ) .Some of the hospital didn′t carried out the chemistry stai-ning about blood cells(10/15 ,66 .7% ) .Conclusion It′s important to promote the quality and level about the analysis of cellular morphology in Tibet region .