Objective:To analyze the risk factors of Intensive Care Unit-Acquired Weakness, and to develop and verify the model.Methods:A total of 247 patients admitted to ICU patients from November 2018 to October 2019 were selected, and risk factors between ICU acquired weakness group ( n=106) and non-ICU acquired weakness group( n=141)were compared using logistic regression for model construction.The Hosmer-Lemeshow test was used to verify the goodness of fit of the model. The area under the ROC curve was used to test the model to predict the effects. From November 2019 to May 2020, 106 patients were recruited for application of the model. Results:The incidence of ICU acquired weakness in this study was 42.91%(106/247), and 44.34%(47/106),the study finally included age ( OR=1.043) ,mechanical ventilation time ( OR=1.140) , APACHE II score ( OR=1.081) , blood sugar ( OR=1.117) , lactic acid( OR=1.459) ,and neuromuscular blockers ( OR=3.499) to construct the risk prediction. The model formula was P=1/1+exp (- Z) =1/1+exp (8.808-0.042×age -1.252×neuromuscular blockers-0.078×APACHE II score -0.110×blood sugar -0.378×lactic acid -0.131×mechanical ventilation time. The area under the ROC curve of this model was 0.896 (95% CI: 0.824-0.914) , the maximum value of the Youden index was 0.577, and the corresponding sensitivity was 0.754,the specificity was 0.823,the cutoff value was 0.503. The model verification results the sensibility of 70.2%, the specificity of 88.1%, and the accuracy of 80.2%. Conclusion:The predictic model of ICU acquired weakness couducted in this study has satisfactory prediction effect, which can provide a reference for clinical screening of high-risk patients.

Objective:To evaluate the effect of continuing health management on type 2 diabetes mellitus based on WeChat platform by Meta-analysis.Methods:Clinical randomized controlled trials connected with WeChat continuing health management for type 2 diabetes was searched by database including China Knowledge Network, Wanfang, Weipu, PubMed, Elsevier Science Direct, CINAHL, Web of Science, Cochrane Library. Cochrane bias risk assessment tool was used for evaluating the methodological quality of the included literatures. Meta-analysis of the data extracted from the included literature was performed by RevMan5.2 statistical software to assess heterogeneity of the outcome indicators and extract value of mean difference ( MD) and odds ratio ( OR). Results:A total of 1 133 patients with type 2 diabetes from 9 researches were enrolled in the study. The results showed that the WeChat continuing health management group had statistically significant differences in levels of fasting blood glucose ( MD value was -0.98, 95% CI -1.14 - -0.83, P<0.01), postprandial blood glucose ( MD value was -1.27, 95% CI -1.56 - -0.97, P<0.01), glycated hemoglobin ( MD value was -0.69, 95% CI -0.82 - -0.56, P<0.01), total cholesterol ( MD value was -0.54, 95% CI -0.65 - -0.44, P<0.01), triglyceride ( MD value was -0.50,95% CI -0.67 - -0.32, P<0.01) and low-density lipoprotein ( MD value was -0.52, 95% CI -0.74 - -0.30, P<0.01) compared with the control group. Conclusions:WeChat continuing health management intervention can effectively control the blood sugar and blood lipid levels of patients with type 2 diabetes mellitus and improve their self-management ability. For the deficiencies of little included references, the result still required a large-sample and high-quality randomized controlled trials to enhance accuracy.

Objective To explore the nursing experience of spinal disease patients with postoperative delirium.Methods From January 2014 to December 2017,we selected 116 elderly spinal disease patients with postoperative delirium of Department of Orthopedics in China-Japan Union Hospital of Jilin University.All of the patients were randomly divided into control group and observation group,58 cases in each group.Patients of control group received routine nursing.On this basis of nursing in control group,patients of observation group were treated with specific nursing on neck brace preventing rotation and pressed bellyband in back.We compared the status of oozing of blood around incision and integrity of dressing among patients in two groups.Results Among patients in observation group,the incidence of oozing of blood around incision was 13.8％lower than that(44.8％)in control group;the integrity of dressing was 91.4％better than that(75.9％)in control group all with significant differences(χ2=13.481,5.098;P < 0.05).Conclusions Specific nursing intervention for elderly spinal disease patients with postoperative delirium can reduce the incidence of oozing of blood around incision and improve the integrity of dressing.

Objective To study the effect of back-pressurized corset in incision pressure dressing after posterior lumbar surgery. Methods Seventy-eight patients who received posterior lumbar surgery during December 2013 to December 2014 in our hospital, were set as the control group and treated by incision dressing using common corset. Another 80 patients receiving the same posterior lumber surgery during January to December 2015 were set as the experiment group and treated with incision pressure dressing using the pressured-corset. After surgery, the two groups were compared in terms of incisive bleeding, completeness of the dresses and waist comfort level at day 7. Results The rate of incisive bleeding in the experiment groups was significantly lower and the comfort level at the lumbar was significantly higher than that of the control group (P < 0.001). There was no significant difference in the completeness of incisive dresses (P>0.05). Conclusion The incision pressure dressing for the patients after posterior lumbar surgery can remarkably improve the effect of compression fixation on the incision and increase comfort level.

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate, as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence, we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery, and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.
Colon ; Colorectal Surgery ; Elective Surgical Procedures ; Humans ; Laparoscopy ; Preoperative Care

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate , as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence , we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery , and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate , as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence , we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery , and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.

The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.
Gastroenterostomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Stomach Neoplasms ; blood supply ; pathology ; surgery

Objective To investigate the location and expression of hypoxia inducible factor (HIF) subunits in the remnant kidney of 5/6 nephrectomy rats. Methods Remnant kidneys were produced in adult male SD rats by 5/6 nephrectomy. The renal function and histopathological changes were evaluated at week 1, 2, 4, 6, 8 and 12 after operation. Tissues of remnant kidneys were collected to detect the location and expression of HIF-1α and HIF-2α by immunohistochemistry staining and Western blotting. The mRNA levels of HIF targeted genes vascular endothelial growth factor (VEGF) and heme oxygenase-1 (HO-1) were determined by RTPCR. Results (1) 5/6 nephrectomy rats underwent one week of acute renal failure at first[Scr (122.8±22.1) μmol/L] and then developed compensative chronic renal failure [(66.0±3.7)-(66.4±8.4) μmol/L], but the level of Scr increased quickly after week 6 [(66.4±8.4)-(127.8±22.7) μmol/L],concomitantly with progressive tubulointerstitial fibrosis in remnant kidney cortex. (2) In cortex, HIF-1α was expressed only in the atrophic and dilated tubular cells while HIF-2α was located in endothelial, interstitial fibroblasts, and vascular smooth muscle cells. The semiquantitative results of imunohistochemistry and Western blotting revealed that HIF-1α and HIF-2α were both gradually up-regulated during the early stage of remnant kidney, peaked at week 4 and 6, and then gradually down-regulated. (3) The mRNA levels of HIF targeted genes VEGF and HO-1 transiently peeked at week 4 and 6, and then decreased gradually. Conclusions The increased stabilization of HIF-αprotein and transcription of HIF targeted genes at the early stage of this model is a compensation reaction towards hypoxia. The mechanism of decreased expression of HIF-α at the end stage of chronic kidney disease deserves further investigation.

By studying the developmental strategy of the revonal medical science and technology and implementation condition from 2001 to 2004 as well as systematically studying the national policy of the scientific and technical field,we proposed the developmental strategy of medical science and technology in Shanghai that the priority for the introduction,the application and the popularization of new or suitable technology should be given,also continuous advancement in technology should be kept.As a result,it is possible to provide the people a safer,more effective,convenient and moderately priced public health and basic medical service.During the past 5 years.we made an experimental work in selected Pudong in Shanghai.It Was proved that the strategy tallies with the actual situation of Pudong and is effectual in practice.