Objective: To investigate the trends in mortality and life loss of gastric cancer in Wenzhou City, Zhejiang Province from 2014 to 2023, so as to provide the evidence for formulating the prevention and control strategy for gastric cancer. Methods: The surveillance on causes of death data of permanent residents in Wenzhou City were collected through the Wenzhou Chronic Disease Monitoring and Management Information System from 2014 to 2023. The crude mortality of gastric cancer was calculated, and standardized by the data from the Sixth Chinese National Population Census in 2010. The life loss were measured using potential years of life lost (PYLL) and rate of potential years of life lost (PYLLR). The characteristics of mortality and life loss of gastric cancer in different genders and age groups were described. The trends in mortality and PYLLR of gastric cancer were analyzed using the average annual percent change (AAPC). Results: Totally 17 080 deaths were reported due to gastric cancer in Wenzhou City from 2014 to 2023, accounting for 12.58% and ranking third in the order of malignant tumor deaths. The crude mortality of gastric cancer was 20.73/105, and the standardized mortality was 15.22/105, showing decreasing trends (AAPC=-3.311%, -6.470%, both P<0.05). The crude mortality of gastric cancer was 29.22/105 in men and 11.61/105 in women, with standardized mortality rates of 20.81/105 and 8.74/105 (both P<0.05). The crude mortality of gastric cancer appeared a tendency towards a rise with increasing age (P<0.05), reaching the highest rate of 225.88/105 in the group aged 80 to <85 years. The PYLL and PYLLR of gastric cancer were 107 607.50 person-years and 1.37‰. The PYLLR appeared a tendency towards a decline from 2014 to 2023, with AAPC of -6.667% (P<0.05). Conclusions The mortality and PYLLR of gastric cancer in Wenzhou City appeared a tendency towards a decline from 2014 to 2023. Men and the elderly populations were the key groups for the prevention and treatment of gastric cancer.

Objective To evaluate the effect of remimazolam combined with desflurane and flumazenil antagonism for anesthesia during ophthalmic day surgery.Methods This is a prospective randomized controlled trial.A total of 64 patients undergoing elective general anesthesia with laryngeal mask during ophthalmic day surgery were selected and randomly assigned to propofol group(n = 32)and remimazolam group(n = 32).The propofol group was given propofol anesthesia induction and propofol combined with diflurane anesthesia maintenance;the remazolam group was given remazolam anesthesia induction and remazolam combined with diflurane anesthesia maintenance,and flumazenil antagonism was given intravenously at the end of the operation.Continuous intravenous infusion of remifentanil was administered during surgery in both groups.The primary outcome was emergence time.The secondary outcome included changes in intraoperative hemodynamic parameters,extubation time,time to leaving the operating room,duration of postoperative recovery room(PACU)stay,and the occurrence of other perioperative adverse reactions.Results Emergence time,extubation time,and time to leaving the operating room in remimazolam group were significantly shorter than those in group propofol(P<0.05)[(4.11±1.17)vs.(8.64±2.77)min,(4.61±1.11)vs.(9.90±2.81)min and(6.60±2.01)vs.(11.74±3.11)min,respectively].The incidences of intraopera-tive hypotension and bradycardia in the remimazolam group were significantly lower than that in the propofol group(P<0.05);There was no statistically difference in the duration of PACU stay and the incidence of postoperative complications between the two groups(P>0.05).Conclusion Remimazolam combined with desflurane general anesthesia and flumazenil antagonism for anesthesia management in ophthalmic day surgery could significantly shorten the time of emergence and extubation,help to maintain hemodynamic stability with fewer adverse reactions,and improve the safety of ophthalmic daytime surgery,which is worthy of clinical promotion and application.

Objective: To analyze the trends in mortality of liver cancer in Wenzhou City, Zhejiang Province from 2014 to 2022, so as to provide the evidence for improving liver cancer control measures. Methods: Data of liver cancer mortality in Wenzhou City from 2014 to 2022 were collected from Wenzhou Chronic Disease Monitoring Information System. The crude mortality were estimated and standardized by the national population census data in China in 2010, and the trends in mortality of liver cancer were analyzed with average annual percent change (AAPC). Results: There were 22 033 liver cancer deaths from 2014 to 2022, accounting for 18.08% of malignant tumor deaths and ranking the second in malignant tumor deaths. The crude mortality of liver cancer was 30.00/105 and the standardized mortality was 24.32/105, both showing decreasing trends (AAPC=-2.812% and -5.742%, both P<0.05). The standardized mortality of liver cancer were higher in men than in women (36.66/105 vs. 11.21/105, P<0.05), both showing decreasing trends (AAPC=-5.702% and -5.521%, both P<0.05). The crude mortality of liver cancer appeared a tendency towards a rise with age (P<0.05), with the highest crude mortality in the group aged 80 to 84 years, reaching 145.12/105. The crude mortality of liver cancer showed a tendency towards a decline among residents aged under 15 years, 15 to 44 years, 45 to 64 years and 65 years and above (AAPC=-20.311%, -6.569%, -7.408% and -3.177%, all P<0.05). Conclusions The mortality of liver cancer showed a tendency towards a decline in Wenzhou City from 2014 to 2022. Men and the elderly were high-risk groups for liver cancer deaths, and prevention should be strengthened based on risk factors.

Objective:To investigate the risk factors and their warning effectiveness for postoperative intestinal barrier dysfunction (IBD) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 101 patients with sTBI admitted to Wuxi Branch of Zhongda Hospital Affiliated to Southeast University from May 2020 to February 2023, including 63 males and 38 females, aged 21-81 years [(53.4±14.2)years]. All the patients underwent emergency surgery. The patients were divided into IBD group ( n=67) and non-IBD group ( n=34) according to whether or not they had IBD after surgery. The gender, age, basic diseases (hypertension and diabetes), types of intracranial hematoma (subdural, epidural, and intracerebral hematoma), preoperative Glasgow Coma Scale (GCS), cerebral hernia, intraoperative initial intracranial pressure (iICP), operation time, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were recorded in the two groups. Univariate and multivariate binary Logistic regression analyses were conducted to assess the correlations between above-mentioned indicators and incidence of postoperative IBD in sTBI patients and determine the independent risk factors for sTBI. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the warning effectiveness of each risk factor for IBD. Results:The results of the univariate analysis showed that preoperative GCS, cerebral hernia, intraoperative iICP, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were significantly correlated with the incidence of IBD in sTBI patients ( P<0.05 or 0.01), while there were no correlations of IBD with gender, age, basic diseases, types of intracranial hematoma and operation time ( P>0.05). The results of the multivariate binary Logistic regression analysis showed that preoperative GCS≤5 points ( OR=2.49, 95% CI 1.17, 5.32, P<0.05), intraoperative iICP>23 mmHg (1 mmHg=0.133 kPa)( OR=1.20, 95% CI 1.03, 1.39, P<0.05), and initiation time of enteral nutrition>24 hours ( OR=10.03, 95% CI 1.26, 80.21, P<0.05) were highly correlated with postoperative IBD in sTBI patients. The results of the ROC curve analysis showed that intraoperative iICP had the highest warning value (AUC=0.91, 95% CI 0.85, 0.96), followed by preoperative GCS (AUC=0.88, 95% CI 0.82, 0.95), and initiation time of enteral nutrition had the lowest warning value (AUC=0.78, 95% CI 0.69, 0.87). Conclusions:Preoperative GCS≤5 points, intraoperative iICP>23 mmHg, and initiation time of enteral nutrition>24 hours are independent risk factors for postoperative IBD in sTBI patients. The warning value of intraoperative iICP ranks the highest for postoperative IBD in sTBI patients, followed by preoperative GCS, with initiation time of enteral nutrition having the lowest warning value.

Objective: To investigate the mortality and life loss of female breast cancer in Wenzhou City, Zhejiang Province from 2014 to 2022, so as to provide the evidence for prevention and control of breast cancer. Methods: Data of female breast cancer deaths in Wenzhou City were collected through the Wenzhou Chronic Disease Monitoring and Management information System from 2014 to 2012. The mortality of breast cancer was calculated, and standardized by the data from the Sixth Chinese National Population Census in 2010 (Chinese-standardized rate) and the world standard population first introduced by Segi (world-standardized rate). The life loss were measured using potential years of life lost (PYLL), rate of potential years of life lost (PYLLR) and average years of life lost (AYLL). The trends in mortality, PYLLR and AYLL were analyzed using the average annual percent change (AAPC). Results: Totally 2 523 deaths were reported due to breast cancer from 2014 to 2022, ranking fifth in the order of female malignant tumor deaths. The crude mortality of female breast cancer was 7.13/105, showing an increasing trend with AAPC of 2.186% (P<0.05). The Chinese population-standardized mortality and global population-standardized mortality were 5.93/105 and 4.39/105, showing no significant trend with AAPC of -0.617% and -0.602% (both P>0.05), respectively. The crude mortality of female breast cancer appeared a tendency towards a rise with age (P<0.05). The crude mortality of breast cancer in females aged 65 years and older showed an increasing trend (AAPC=3.283%, P<0.05), but there were no significant tendency aged 15 to <45 years and 45 to <65 years (AAPC=-1.011% and -1.850%, both P>0.05). The PYLL, PYLLR and AYLL of breast cancer were 41 227.50 person-years, 1.23‰ and 19.44 years per person, respectively. AYLL showed a decreasing trend (AAPC=-1.969%, P<0.05), and PYLLR showed no significant trend (AAPC=-0.527%, P>0.05). Conclusions The mortality of female breast cancer in Wenzhou City appeared a tendency towards a rise from 2014 to 2022, and AYLL appeared a downward trend. Females aged 65 years and older were the key groups for the prevention and control of breast cancer.

Objective:To determine the training direction, training program and to promote management of endoscopy nurses by understanding the role delineations and professional practice competencies of gastrointestinal endoscopy nurses in China through a questionnaire survey.Methods:A questionnaire of " role delineations and professional practice competencies for gastrointestinal endoscopy nurses in China" was designed, based on the overseas profile or standards of role delineations and the professional practice competencies. Cross-cultural factors were taken into consideration for a higher content validity, and comments from endoscopic experts were consulted. Questionnaires were sent to participants from 52 medical institutions in 30 provinces, autonomous regions, municipalities.Results:A total of 252 respondents returned questionnaires, whom from 47 medical institutions in 28 provinces, autonomous regions, municipalities. The respondents included 144 endoscopy nurses, aged 35.87±7.43, 53.5% with a junior professional title and 68.8% with a bachelor degree; 65 endoscopy physicians, aged 39.66±5.62, 46.2% with a junior professional title and 40.0% with a doctoral degree; 43 endoscopic-nurse managers, aged 43.12±5.78, 46.5% with a senior professional title and 90.7% with a bachelor degree. The mean score of respondents of the consistency of 12 role delineations and 10 professional practice competencies was over 3.5. The role delineations with the highest score of consistency were " technical assistance" (4.58±0.57), " hygiene and infection control" (4.54±0.62) and " care of endoscopic equipment" (4.47±0.65). The three future role delineations with the highest scores were " hygiene and infection control" (4.58±0.55), " technical assistance " (4.52± 0.62), and " health safety" (4.52±0.58). There was no significant difference in the scores among endoscopy nurses, endoscopy physicians and endoscopic-nurse managers of the consistency of 12 role delineations ( P>0.05). The most consistent professional practice competencies were " cooperation" (4.32±0.61) and " communication" (4.25±0.63), which were also the required professional practice competencies for future development (4.48±0.58, 4.46±0.58, respectively). There was a significant defference between the coincidence on status and the recognition on development of " evidence-based practice and research" competency (3.80±0.77 VS 4.20±0.73, P<0.001). There was no significant difference in the scores of 10 professional practice competencies for future development among endoscopy nurses, endoscopy physicians and endoscopic-nurse managers( P>0.05). Conclusion:There is a consensus among endoscopy nurses, endoscopy physicians and endoscopic chief-nurse managers on the status of the role delineations and the professional practice competencies, as those for future development of gastrointestinal endoscopy nurses in China. " Cooperation" and " communication" are two professional practice competencies that are acknowledged by all types of participants." Evidence-based practice and research" is the professional practice competencies that all the respondents believe that endoscopy nurses need to develop in the future.

Objective To compare the diagnostic value of two different types of puncture needles guided by endoscopic ultrasonography for pancreatic solid masses.Methods The clinical data of 176 pancreatic solid tumor patients who received endoscopic fine needle aspiration (EUS-FNA) in Shanghai Changhai Hospital from January 2018 to December 2018 was retrospectively analyzed.The acquired specimens were analyzed by cytology and histology.The patients were divided into 25G acupuncture needle group (25G group,63 cases) and 22G acupuncture needle group (22G group,113 cases) according to the type of acupuncture needle.The satisfaction score of specimen,the positive rate of puncture and diagnostic accuracy of malignant masses were compared between the two groups.Results The satisfaction of specimen in 25G group (44.6 ± 18.8) was higher than 22G group (20.5 ± 18.1),and the differences were statistically significant (P =0.047).The positive rates of puncture were 79.3％ and 85.8％,respectively,and the differences were not statistically significant (P =0.267).Thirty nine of 176 patients underwent surgical resection.Thirty three cases of malignant were diagnosed pathologically.The accuracy of 25G and 22G group was 81.3％ and 86.9％,respectively,and the differences were not statistically significant.Conclusions The accuracy and positive rate of 25G and 22G needle in the diagnosis of pancreatic solid masses are comparable,but compared with 25G needle,22G needle can obtain more tissue specimen.

Objective To check the nursing interns′ knowledge about emergency medications. Methods A self-designed questionnaire was used to investigate the knowledge of emergency medications (including dosage, indications and usage) and learning demands in 258 nursing interns. Results The mean score of all students was 18.06 ± 3.35,accounting for 82.2%(212/258)nursing interns expected to obtain the knowledge by the clinical teachers.Both different education backgrounds and training periods didn′t have significant influence on the scores of emergency medications. There were significant differences in total scores among practice nurses from different areas (F=2.87, P<0.05). Conclusion Generally,the nursing interns are not qualified enough to know emergency medications.We should focus on training nursing interns in pharmacological knowledge and the ability of their knowledge management cognition.

Objective To evaluate the application effect of nursing management in the follow-up of patients with recurrent acute pancreatitis (RAP).Methods During January 2016 and January 2017,the clinical data of RAP patients admitted in Changhai Hospital of Navy Medical University was collected.Selfcontrol method was used to establish a prospective cohort study.Meticulous nursing management mode was applied to follow up the patients for 12 months.Patients' compliance,symptom improvement,patients' satisfaction and other markers are evaluated using questionnaires to assess the effect of meticulous nursing management once every 3 months.The data over 12 months were collected.Results Sixty-four RAP patients were finally included.The average follow-up period was 19.7 ±3.4 months.Before admission,the average disease course was(4.21 ± 3.95) years.30 patients (46.9％)had a history of drinking;33 patients (51.6％)had a history of smoking.25 patients (39.1％) had abnormal blood lipid and 40 patients (62.5％) had the dietary habit of high lipid and high protein.The etiology included alcohol (n =10,15.6％),high lipid (n =7,10.9％),biliary diseases (n =1,1.6％),idiopathic causes (n =46,71.9％) and abnormal BMI (n =49,76.6％).After the meticulous nursing management,the frequency of pancreatitis,VAS score of pain and alcohol intake situation was obviously lower than before intervention [(0.50 ±0.85) times/year vs(2.77 ±2.52)times/year;(1.84 ±2.54)vs(6.47 ±2.15);2 cases vs 30 cases].The number of patients who took medicine on time and BMI were obviously decreased[(52 cases vs 13 cases;(23.26 ± 3.85) kg/m2 vs (21.92 ± 4.27)kg/m2)],and the differences were statistically significant (P ＜0.01).Patients' satisfaction with this nursing model was 4.90 ± 0.56.Conclusions The implementation of the new meticulous nursing management model can effectively alleviate patient's symptom condition and improve the compliance behavior and life quality of the patients.

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.