Objective:To explore the self-care experience of arteriovenous fistula in elderly maintenance hemodialysis patients, and to provide reference for intervention and management.Methods:The descriptive phenomenological research method was used to select elderly patients as subjects who underwent hemodialysis and used arteriovenous fistula as vascular access in the blood purification center of The First Affiliated Hospital of Zhejiang University School of Medicine from November 2022 to May 2023 through objective sampling, and semi-structured in-depth interviews were conducted on them, and the data were analyzed by Colaizzi 7-step analysis method.Results:Finally, 15 interviewees were included. There were 6 males and 9 females, aged (73.53±8.59) years old. A total of 4 themes and 12 sub-themes were summarized: multiple burdens (comorbidities management burden, psychological burden, financial burden), self-care dilemmas (affected by physical decline, inadequate self-coping, inadequate counseling channels), driven by social factors (motivated by social feedback, influenced by peer behavior, promoted by extended medical services) and understanding of life philosophy (actively coping with life changes, replanning life order, appreciating life value).Conclusions:Elderly maintenance hemodialysis patients have complicated burden experience, multi-dimensional problems and needs in the process of self-care for internal arteriovenous fistula, and self-care behavior is greatly affected by social factors. Future intervention should focus on strengthening multidisciplinary collaboration, providing professional and convenient continuous nursing services, improving social support paths and giving accurate psychological intervention, so as to reduce the burden of disease management of patients, meet their self-care needs, enhance the internal motivation of self-care behavior and improve self-care ability.

Objective:To understand the symptom clusters of patients with indwelling tracheal cannula after head and neck cancer surgery, and to identify the sentinel symptoms of different symptom clusters.Methods:A total of 197 patients with head and neck cancer who underwent surgical treatment in Department of Head, Neck and Thyroid Surgery in Cancer Hospital Affiliated to Zhengzhou University (Henan Cancer Hospital) from June 2020 to December 2021 were selected as the research objects by the convenient sampling method. On the 7th day after surgery, general information questionnaire and Anderson Symptom Inventory, Head and Neck Module were used, and exploratory factor analysis was used to extract symptom clusters. Apriori association analysis was used to identify sentinel symptoms in the symptom clusters.Results:There were 4 symptom clusters in patients with indwelling tracheal cannula after head and neck cancer surgery, including head and neck cancer-specific symptom cluster, pain-digestive tract symptom cluster, voice/swallowing disorder symptom cluster and fatigue-sleep-emotional symptom cluster. Oral and throat mucus was the sentinel symptom of head and neck cancer-specific symptom cluster, nausea was the sentinel symptom of pain-digestive tract symptom cluster, numbness and needling sensation were the sentinel symptom of voice/swallowing disorder symptom cluster, sadness was the sentinel symptom of fatigue-sleep-emotional symptom cluster.Conclusions:Patients with indwelling tracheal cannula after head and neck cancer surgery have more symptoms, which are combined into symptom clusters, and sentinel symptoms exist in each symptom cluster, suggesting that medical workers should take sentinel symptoms as the entry point for symptom cluster management to achieve effective management of symptoms.

Objective:To explore the symptom cluster characteristics of early postoperative patients with head and neck cancer and analyze its influencing factors.Methods:From June 2020 to June 2022, convenience sampling was used to select 230 head and neck cancer patients who underwent surgery in the Head and Neck Thyroid Surgery of Henan Cancer Hospital as the research subject. The questionnaire survey was conducted using the Demographic and Disease Characteristics Questionnaire, Chinese version of M.D. Anderson Symptom Inventory-Head & Neck, Self-perceived Burden Scale for Cancer Patient, and Medical Outcome Study Social Support Scale. Exploratory factor analysis and multiple linear regression analysis were used for statistics.Results:A total of 230 questionnaires were distributed, and 215 qualified questionnaires were collected, with an effective rate of 93.48%. Postoperative patients with head and neck cancer had four symptom clusters, including pain-gastrointestinal symptom cluster, fatigue-sleep-emotional symptom cluster, head and neck cancer-specific symptom cluster, and vocal/swallowing disorders symptom cluster. Medical social support, per capita monthly income of families, type of head and neck cancer, self-perceived burden and complications were the influencing factors of pain-gastrointestinal symptom cluster ( P<0.05). Medical social support, disease staging, complications, self-perceived burden, and per capita monthly income of families were the influencing factors of fatigue-sleep-emotional symptom cluster ( P<0.05). Medical social support, complications, treatment methods, and type of head and neck cancer were the influencing factors of head and neck cancer-specific symptom cluster ( P<0.05). Medical social support, complications, treatment methods, course of disease, and per capita monthly income of families were the influencing factors of vocal/swallowing disorders symptom cluster ( P<0.05) . Conclusions:Postoperative patients with head and neck cancer have multiple symptom clusters and are influenced by psychological, social, and disease factors. Medical and nursing staffs should pay attention to the symptom cluster of postoperative head and neck cancer patients with low levels of social support, heavy self-perceived burden, and complications, and scientifically formulate interventions to reduce the burden of patient symptom cluster and promote rehabilitation.

Objective:To compare the safety and efficacy of laparoscopy and laparotomy for 5-10 cm intermediate-risk gastric stromal tumor, and to evaluate whether there was evident benefits of postoperative adjuvant treatment with imatinib.Methods:A retrospective study was conducted on 72 patients with moderate risk gastric stromal tumors (5-10 cm in diameter) who received operation in Nanjing Drum Tower Hospital from January 2010 to July 2020. There were 28 cases in the laparoscopy group and 44 cases in the laparotomy group. The clinical features, pathological data, perioperative results and hospitalization costs were compared between the two groups. The survival rates of postoperative adjuvant therapy with or without imatinib were analyzed and compared.Results:There was no significant difference in clinicopathological features between the two groups ( P>0.05). The incidences of postoperative complications in the laparoscopy group and the laparotomy group were 32.1% (9/28) and 52.3% (23/44) respectively, showing no significant difference ( P=0.094). Compared with the laparotomy group, both the hospital stay (12.5±3.2 days VS 15.0±3.5 days, P=0.004) and the median postoperative hospital stay (7.5 days VS 9.0 days, P=0.006) in the laparoscopy group were significantly shorter, and the first exhaust time was significantly shorter ( P=0.003). During the median follow-up period of 58 months (13-129 months), there was no tumor-related death. Two cases died of breast cancer and heart disease in the laparotomy group, and 1 case died irrelevant to gastric stromal tumor in the laparoscopy group. Of the 72 patients, 40 received postoperative imatinib adjuvant therapy, 22 cases (50.0%) in the laparotomy group and 18 cases (64.3%) in the laparoscopy group, with no significant difference in the proportion ( χ2=1.414, P=0.234). There was significant difference in the overall survival rate between the group treated with imatinib and the group without imatinib ( P=0.015). Conclusion:Laparoscopic resection is safe and effective for intermediate-risk gastric stromal tumor of 5-10 cm. Taking imatinib adjuvant treatment does not increase overall survival rate of patients with intermediate-risk gastric stromal tumors (5-10 cm), and there is no tumor-related death, recurrence or metastasis for those who did not accept imatinib adjuvant treatment after R0 resection.

Objective:To understand the symptom clusters and quality of life of patients with laryngeal cancer at different times, and to explore the correlation between the two.Methods:From June 2020 to June 2021, convenience sampling was used to select 155 laryngeal cancer patients with operation in the Head and Neck Thyroid Surgery of Affiliated Cancer Hospital of Zhengzhou University as the research object. The General Information Questionnaire, the Chinese version of Anderson Symptom Inventory-Head and Neck, and Functional Assessment of Cancer Therapy Generic Scale (FACT-G) were used to investigate on the day of admission, 3 days after operation, and 30 days after operation. Symptom clusters were extracted using exploratory factor analysis. Spearman correlation analysis was used to analyze the correlation between the severity of symptom clusters and quality of life in patients with laryngeal cancer.Results:A total of 4 symptom clusters were extracted, namely pain-gastrointestinal symptom cluster, fatigue-sleep-mood symptom cluster, laryngeal cancer-specific symptom cluster, and vocalization-dysphagia symptom cluster. The number and composition of symptom clusters were different on the day of admission, 3 days after operation and 30 days after operation. There were statistically significant differences in FACT-G scores on the day of admission, 3 days after operation and 30 days after operation in patients with laryngeal cancer ( P<0.01) . The FACT-G total score and physiological dimension score on the day of admission, 3 days after operation and30 days after operation of laryngeal cancer patients were negatively correlated with the severity of different symptom clusters ( P<0.05) . Conclusions:The number and composition of symptom clusters in patients with laryngeal cancer at different times are different. The more severe the symptom clusters, the worse the quality of life. Medical and nursing staff should manage patients' symptom clusters to improve the quality of life.

Objective:To explore the predictive value of renal resistive index (RRI) joint with semiquantitative power Doppler ultrasound (PDU) score to acute kidney injury (AKI) in non-septic critically ill patients.Methods:This prospective observational study enrolled non-septic critically ill patients admitted to the Emergency Intensive Care Unit of Cangzhou Central Hospital from January 2018 to August 2019. In addition to general data, RRI and PDU scores were measured with medical ultrasonic instrument within 6 h after admission. Renal function was assessed on the 5th day in accordance with kidney disease: Improving Global Outcomes criteria. The patients who progressed to AKI stage 3 within 5 days after admission were classified into the AKI 3 group, and the rest were classified into the AKI 0-2 group. The difference of each index was compared between the two groups in non-septic critically ill patients and patients with acute heart failure (AHF). Normal distributed continuous variables were compared using independent sample t-tests, whereas Mann-Whitney U tests were used to examine the differences in variables without a normal distribution. Categorical data were compared with the Chi-square test. Receiver operator characteristic curves were plotted to examine the values of RRI, PDU score, RRI-RDU/10 (subtraction of RRI and 1/10 of PDU score), RRI/PDU (the ratio of RRI to PDU score), and RRI+PDU (the prediction probability of the combination of RRI and PDU score for AKI stage 3 obtained by logistic regression analysis) in predicting AKI 3. Delong's test was used to compare the area under the curve (AUC) between predictors. Results:A total of 110 non-septic critically ill patients (51 patients with no AKI, 21 with AKI stage 1, 11 with AKI stage 2, and 27 with AKI stage 3) were recruited. Among them, there were 63 patients with AHF (21 patients with no AKI, 15 with AKI stage 1, 7 with AKI stage 2, and 20 with AKI stage 3). Among the non-septic critically ill patients as well as its subgroup of AHF, compared with the AKI 0-2 group, acute physiology and chronic health evaluation-Ⅱ score, sequential organ failure assessment score, arterial lactate concentration, mechanical ventilation rate, proportion of vasoactive drugs, 28-day mortality, serum creatinine, RRI, RRI-RDU/10, RRI/PDU, RRI+PDU, and rate of continuous renal replacement therapy were higher in the AKI 3 group, and urine output and PDU score were lower ( all P<0.05). As for non-septic critically ill patients, RRI/PDU [AUC=0.915, 95% confidence interval ( CI): 0.846-0.959, P<0.01] and RRI+PDU (AUC=0.914, 95% CI: 0.845-0.959, P<0.01) performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.804, 95% CI: 0.718-0.874, P<0.01) and PDU score (AUC=0.868, 95% CI: 0.791-0.925, P<0.01). The optimal cutoff for RRI/PDU was > 0.355 (sensitivity 92.6%, specificity 81.9%, Youden index 0.745). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.899, 95% CI: 0.827-0.948, P<0.01) was also better than RRI and PDU scores, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). As for patients with AHF, RRI/PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) and RRI+PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) also performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.845, 95% CI: 0.731-0.924, P<0.01) and PDU score (AUC=0.913, 95% CI: 0.814-0.969, P<0.01) with statistically differences (all P<0.05). The optimal cutoff for RRI/PDU was > 0.360 (sensitivity 95.0%, specificity 90.7%, Youden index 0.857). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.950, 95% CI: 0.864-0.989, P<0.01) was also better than RRI and PDU score, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). Conclusions:The combination of RRI and PDU score could effectively predict AKI 3 in non-septic critically ill patients, especially in patients with AHF. The ratio of RRI to PDU score is recommended for clinical application because of its excellent predictive value for AKI and its practicability.

his article expounds the concept, theory and mechanism of laughter therapy, introduces the process of laughter therapy, and analyzes and summarizes the effects of laughter therapy on elderly patients in other countries in order to provide a reference for studies on laughter therapy in China and to improve elderly people's physical and mental health as well as their quality of life.

Objective To optimize and compare four in vitro cytotoxicity assays in order to find a relatively rapid assay that can replace the traditional 51Cr release assay to evaluate the cytotoxicity of immune cells prepared for immunotherapy.Methods Four assays including BATDA, CAM (calcein acetoxymethyl ester), CytoTox-Glo and PKH were optimized and used to measure the in vitro cytotoxicity of NK-92 cells to K562 cell line.Intra-and inter-assay reproducibility of these assays and their correlation with 51Cr release assay were analyzed.Results After optimization, all of the four cytotoxicity assays showed good correlation with effector to target (E/T) ratio in a certain range.Compared with the other three assays, CytoTox-Glo assay showed obvious hook effect at a high E/T ratio of 40∶1.BATDA assay could detect the significant cytotoxicity of NK-92 cells to K562 cells after incubating them for one hour and that was the shortest time taken by the four assays to detect in vitro cytotoxicity.Both CAM and PKH assays took about four hours and CytoTox-Glo assay took six to eight hours to detect the significant cytotoxic potency.All of the four assays, especially BATDA and CAM assays, showed good intra-and inter-assay reproducibility.Among these assays, BATDA assay showed the best correlation with the traditional 51Cr release assay.BATDA assay, as compared with the other three assays, could be used to detect the cytotoxicity of Caov3 cells, an adherent cell line, and showed good results in evaluating the cytotoxic potency of autologous primary NK cells and CD19-CAR T cells.Conclusion Compared with the other three assays, BATDA assay shows the best linear correlation with 51Cr release assay and has the advantages of time-saving and good reproducibility.Besides, it is a better assay for detecting the cytotoxicity of adherent cells.BATDA assay is a promising substitute for 51Cr release assay in evaluating the in vitro cytotoxic potency of NK cells and other immune cells.

Objective To establish an assay for the detection of Torque teno sus virus ( TTSuV) strains and to analyze its preliminary application to biologics.Methods Primers and probe were designed according to the conserved sequences.A fluorescent PCR assay for the detection of TTSuV strains was estab-lished.Several parameters including the specificity, linearity, accuracy, sensitivity and anti-interference of the established assay were verified.The fluorescent PCR assay was performed to detect the samples of por-cine blood, cell substrate and rotavirus vaccine.The porcine blood samples positive for TTSuV strains were further genotyped.Results The established fluorescent PCR assay was confirmed to have high specificity as no cross-reactions with parvovirus virus of various species, SV40 and porcine circovirus strains were detec-ted.The linear range of the assay was 1×109-1×103 copies/μl for TTSuV1 genotype and 1×109-1×102 cop-ies/μl for TTSuV2 genotype with a R2 value more than 0.993.The sensitivity of the fluorescent PCR assay was 1×103 copies/μl for TTSuV1 genotype and 1×102 copies/μl for TTSuV2 genotype.The intra-and inter-CVs were both less than 7%in Ct values and less than 25% and 45% respectively in copies.No interfer-ence was found in the detection of TTSuV nucleic acids from cell samples.8 out of 20 porcine blood samples were positive for TTSuV strains, among which one sample was positive for TTSuV1 genotype, four samples were positive for TTSuV2 genotype and the rest were positive for both TTSuV1 and TTSuV2 genotypes.Com-pared with the reference strain, strains genotyped as TTSuV1 and TTSuV2 were respectively shared 98%-99%and 98%homologies in sequences.All of the cell substrate and rotavirus vaccine samples detected by the fluorescent PCR assay were negative for TTSuV strains.Conclusion The fluorescent PCR assay for the detection of TTSuV was established successfully, the application of which would further improve the safety of biologics.

Abstract] Objective To establish an assay for the detection of porcine parvovirus ( PPV) and to verify its application for monitoring cells used for production.Methods A pair of primers and one probe were designed according to the conserved sequence encoding non-structural protein 1 (NS1).Based on the designed primers, a real-time fluorescent quantitative PCR assay for the detection of PPV was developed. Several parameters including the linearity, precision, minimum detection limit and anti-interference of the established assay were evaluated.A stock of PPV strains was prepared by infecting swine testicle ( ST) cells with PPV strains.An assay for the detection of PPV infection was developed by using ST cells as sensitive cells.A combined ST cell infection-PCR test was developed by combining the ST cell infection assay with the real-time fluorescent quantitative PCR assay.The sensitivity of ST cell infection-PCR test was analyzed.The cell samples used for production of biological products were detected by using the established assay.Results The real-time fluorescent quantitative PCR assay was specific for the detection of PPV without cross-reaction to other species of parvovirus virus, SV40 virus and other porcine viruses.The linear range of the assay was 1×109-1×104 copies/μl with a R2 value more than 0.98.The sensitivity of the real-time quantitative PCR assay was 1×104 copies/μl.Both of the intra-and inter-coefficient of variation (CV) were less than 5%in Ct values.The intra-and inter-CV in copies of detection were 5%-15% and 30%-40% respectively.The minimum detection limit of the real-time fluorescent quantitative PCR assay was 1CCID50/ml.The PPV strains were detected in cell samples with no interference.The sensitivity of ST cells infection-PCR test was 0.01CCID50/ml.All of the 22 cell samples were negative for PPV by using the real-time fluorescent quanti-tative PCR assay.Conclusion The real-time fluorescent quantitative PCR and the ST cell infection-PCR test for the detection of PPV in cells were established successfully.The application of the two assays was conducive to further enhance the safety of using cells for production and therapy.