Objective To investigate the clinical diagnostic value of plasma serine protease inhibitor Ka-zal-type 4(SPINK4)expression in colorectal adenocarcinoma(CRC)and progressive adenoma(AA).Methods A total of 62 patients with CRC(CRC group)and 15 patients with AA(AA group)diagnosed by colonoscopy and pathological examination in this hospital from June 2020 to December 2021 were selected,and 22 healthy people undergoing physical examination during the same period were selected as the HC group.The expression of SPINK4 in plasma was detected by ELISA,and the expression of CEA in plasma was detected by electrochemiluminescence,and the correlation was analyzed.The diagnostic efficiency was analyzed by re-ceiver operating characteristic(ROC)curve,and the expression of p53 in CRC tissues was detected by immu-nohistochemistry.Results The expression of plasma SPINK4 in the CRC group and AA group was lower than that in the HC group(Z=3.72,-0.41,P＜0.05),and the expression of CEA in the CRC group was higher than that in the HC group(Z=-3.63,P＜0.05).The area under the curve(AUC),accuracy,sensi-tivity and specificity of SPINK4 combined with CEA in the diagnosis of CRC and AA were higher than those of SPINK4 and CEA alone.The positive rate of mutant type p53 in SPINK4 low expression group and CEA high ex-pression group was significantly increased in CRC patients(72.55％,75.00％,P＜0.05).Conclusion The expression of plasma SPINK4 is decreased in CRC and AA,and the combined detection of SPINK4 and CEA has a good di-agnostic efficiency in CRC and AA.

Objective:To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies.Methods:In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT.Results:In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant ( P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively ( OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions:In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.

Objective:To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies.Methods:In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT.Results:In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant ( P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively ( OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions:In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.

Objective:To explore the effect of hanging electronic baking lamp on the quality and progress of flap recovery in patients with hand injury flap repair.Methods:A total of 180 patients undergoing hand injury flap repair in Yantaishan Hospital in Yantai City from January 2019 to May 2022 were selected as the research objects by the convenient sampling method. They were divided into the control group and the observation group, with 90 cases in each group. The control group was treated with routine nursing combined with ordinary baking lamp nursing, while the observation group was treated with routine nursing combined with hanging electronic baking lamp nursing. The postoperative flap recovery quality (survival rate, healing grade) and recovery process (exudation drying time, the regression time of swelling , the healing time of flap wound) were compared between the two groups.Results:In the control group, 85 flaps survived, with a survival rate of 94.44% (85/90) ; in the observation group, 87 flaps survived, with a survival rate of 96.67% (87/90) ; there was no statistically significant difference in the results between the two groups ( P>0.05) . In the control group, there were 43 cases of grade A skin flap healing, 26 cases of grade B skin flap healing and 21 cases of grade C skin flap healing; in the observation group, 63 cases had grade A healing, 16 cases had grade B healing and 11 cases had grade C healing; there was statistically significant difference in the level of skin flap healing between the two groups of patients ( P<0.05) . The exudation drying time were (3.79±1.22) d in the observation group and (3.21±1.38) d in the control group; the regression time of swelling were (5.23±1.06) d in the observation group and (3.89±1.19) d in the control group; the healing time of the flap wound in the observation group was (12.36±2.58) d, while in the control group it was (8.98±1.47) d; the differences were all statistically significant ( P<0.05) . Conclusions:The use of a hanging electronic baking lamp after surgery can improve the quality of skin flap recovery for patients undergoing hand injury flap repair and accelerate their recovery progress.

Objective:To explore the effect of probiotics on the cognitive function of patients with schizophrenia.Methods:100 schizophrenic patients admitted to Shanghai Jinshan District Mental Health Center from January 2019 to January 2021 were randomly divided into the conventional group (treated with atypical antipsychotics combined with placebo, 50 cases) and the intervention group (treated with atypical antipsychotics combined with probiotics, 50 cases). Before treatment and 3 months after treatment, the feces of the patients were taken for DNA detection to compare the composition of intestinal flora. The cognitive function of the patients was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the mental state of the patients was assessed by the Positive and Negative Symptom Scale(PANSS). The incidence of adverse drug reactions was compared between the two groups.Results:Before treatment, the relative abundance of Fusobacteria, Proteus and Actinobacteria in the two groups had no statistical significant difference (all P>0.05); After 3 months of treatment, the relative abundance of Fusobacteria, Proteus and Actinobacteria in the two groups decreased compared with that before treatment, and the decline was more significant in the intervention group (all P<0.05). Before treatment, there was no significant difference in immediate memory, visual span, speech function, attention function, delayed memory and RBANS between the two groups (all P>0.05); After 3 months of treatment, the scores of immediate memory, visual span, speech function, attention function, delayed memory and RBANS in the two groups were higher than those before treatment, and the increase was more significant in the intervention group (all P<0.05). Before treatment, there was no significant difference in PANSS scores between the two groups ( P>0.05); After 3 months of treatment, PANSS scores in both groups decreased compared with those before treatment, and the decrease degree in the intervention group was higher than that in the conventional group (all P<0.05). During the three months of treatment, there was no significant difference in the incidence of adverse drug reactions between the two groups ( P>0.05). Conclusions:Probiotics are used in adjuvant therapy for patients with schizophrenia, which can regulate the patients′ intestinal flora, improve patients′ cognitive function and mental disorders, and do not increase the incidence of adverse drug reactions. They have significant clinical efficacy and high treatment safety.

Objective:To retrieve, evaluate and summarize the relevant evidence of mechanical prevention of venous thromboembolism (VTE) in adult patients undergoing abdominal and pelvic surgery, so as to provide a scientific basis for clinical practice.Methods:We systematically retrieved and screened the guide network and database for evidence on mechanical prevention of VTE in adult patients undergoing abdominal and pelvic surgery, including guidelines, evidence summary, clinical decision-making, systematic review, and expert consensus. The search time limit was to build the database until January 19, 2020. Two researchers who had undergone evidence-based training selected appropriate evaluation tools according to different types of literature to evaluate the quality of the literature, and to extract, translate and integrate recommendations.Results:A total of 24 articles were included, including 7 guidelines, 2 evidence summaries, 1 recommended practice, 12 systematic reviews, and 2 expert consensus. The evidence was summarized from 6 aspects, namely admission assessment, contraindications, applicable population, starting time, duration and patient education, and a total of 10 recommendations were formed.Conclusions:This study summarizes the best evidence for mechanical prevention of VTE in adult patients undergoing abdominal and pelvic surgery, and provides evidence-based evidence for standardizing clinical mechanical prevention.

Objective:To evaluate the effect of implementation of prevention from mother-to-child transmission of syphilis in Minhang district of Shanghai from 2013 to 2019.Methods:The data of 284 pregnant women with syphilis infection diagnosed by 6 midwifery medical institutions in Minhang District from January 2013 to December 2019, were collected from the database of national management information system for prevention of mother to child transmission of AIDS, syphilis and hepatitis B. Among them there were 1 case of spontaneous abortion, 4 cases of ectopic pregnancy, 42 cases of lost follow-up; the remaining 237 parturients were included in this study. The Implementation Program of prevention of mother-to-child transmission of AIDS, syphilis and hepatitis B (2015 edition) has been implemented since 2015 in Minhang district. The maternal and neonatal outcomes between the period of 2013-2015 (before program implemented, 123 cases) and the period of 2016-2019 (after program implemented, 114 cases) were compared. Results:Between 2013 and 2019, the syphilis detection rate of pregnant women remained 100.00% (100 761/100 761). The detection rates during pregnancy before and after program implementation were 95.92% (51 855/54 288) and 98.87% (45 949/46 473); the prevalence rate of syphilis was 2.93‰ (159/54 288) and 2.69‰ (125/46 473), respectively. The rate of anti-syphilis treatment was 62.60% (77/123) and 85.96% (98/114), the standard treatment rate was 20.33% (25/123) and 49.12% (56/114), the neonatal preventive treatment proportion/rate was 1/12 and 94.74% (72/76). The detection rate during pregnancy, anti-syphilis treatment rate, standardized treatment rate and neonatal preventive treatment rate after program implementation were significantly higher than those of before implementation (χ 2=988.88, 16.72, 21.81, 54.72, all P<0.01). The rate of non- Treponema pallidum antigen titer ≥ 1∶8 was 36.89% (38/103) and 17.48% (18/103), respectively in two periods; the incidence of neonatal adverse health problems was 21.49% (26/121) and 6.03% (7/116); congenital syphilis report incidence rate was 152.12/100 000 live births (83/54 562) and 23.46/100 000 live births (11/46 890), respectively. All these indicators showed a significant reduction (χ 2=9.81, 11.80, 45.10, all P<0.01). The treatment rate of pregnant women with previously diagnosed syphilis infection was 63.27% (62/98), which was lower than that of those with initially diagnosed (81.29%, 113/139) ( cOR=2.52, 95 %CI: 1.40-4.56, χ 2=9.672, P<0.01). Among whose with lost follow-up, the floating pregnant women accounted for 92.86% (39/42), 57.14% (24/42) of whom were unable to contact and 30.95% (13/42) refused to be followed up. Conclusions:After the implementation of prevention program, the rates of detection and diagnosis, standardized treatment, neonatal preventive treatment, as well as the maternal and neonatal outcomes of pregnant women with syphilis infection have been significantly improved in Minhang district of Shanghai.

Objective:To retrieve and obtain relevant evidence of compression stockings to prevent deep vein thrombosis (DVT) of the lower extremities in adult surgical patients, and to provide a reference for clinical nursing practice.Methods:The relevant evidence of compression stockings to prevent DVT of the lower extremities in adult surgical patients was retrieved from BMJ Best Practice, UpToDate, library of the Center for Evidence Based Healthcare at Joanna Briggs Institute (JBI) , National Institute for Health and Care Excellence clinical guidelines, Registered Nurses' Association of Ontario, Scottish Intercollegiate Guidelines Network, official websites of American College of Chest Physicians and International Union of Angiology, Cochrane library, PubMed, EMbase, China Biomedical Literature Database (CBM) , Wanfang, and CNKI, including guidelines, evidence summary, clinical decisions, systematic review, and expert consensus, which was published up to October 14, 2019. Two researchers evaluated the quality of the literature and extracted data.Results:A total of 29 articles were included, including 8 guidelines, 4 evidence summaries, 2 clinical decisions, 12 systematic reviews, and 3 expert consensuses. The evidence was summarized from contraindications, applicable population, application timing, selection of duration, and methods, and 12 recommendations were summarized.Conclusions:For adult surgical patients who are at risk of DVT of the lower extremities, stepwise compression stockings are recommended as one of the mechanical prevention methods, and it is recommended to wear them for as long as possible during the prevention cycle; nursing staff should choose the type of stepwise compression stockings based on the patient's wishes and ensure proper wearing and regular evaluation.

Objective To analyze the features and diagnostic value of 3.0T multiparametric MRI for prostate cancer(PCa).Methods The clinical and MRI data of 48 patients with PCa and 52 patients with benign prostatic hyperplasia (BPH)were analyzed retrospectively. All patients underwent plain MRI,DWI,DCE-MRI and MRS.Results The PCa were hyperintensity on DWI and hypointensity on ADC,respectively.There was significant difference in the ADC values between the benign and malignant lesions.DWI using the high b-value was sensitivitive to diagnosing the PCa.The distribution of the S-I T was significant difference between the two groups.The SI-T curves of the PCa were type Ⅲ in 40 cases,type Ⅱ in 5 cases and type Ⅰ in 3 cases.The SI-T curves of the BPH were type Ⅰ in 27 cases,type Ⅱ in 23 cases and type Ⅲ in 2 cases.The peak value of choline (Cho)increased and citrate (Cit)decreased on MRS.The ratio of (Cho+Cre)value/Cit value of the PCa was increased.Conclusion DWI,DCE-MRI and MRS can present the specific findings of PCa.The combining application of the three technics could increase the accuracy in diagnosing PCa.

Objective To assess and summary the guideline best evidence on malnutrition risk screening in adult inpatients so as to provide a reference for malnutrition risk screening of adult inpatients. MethodsGuidelines on malnutrition risk screening in adult inpatients were systematically retrieved in nutrition association official website, guideline website and database and were screened. All of the guidelines were assessed by 4 trained researchers with the Appraisal of Guidelines for Research and Evaluation (AGREEⅡ). Guidelines with level C were excluded, and guidelines with level A and B were selected to extract, translate and summary the recommendations. ResultsA total of 213 guidelines were retrieved and 140 were selected after eliminating repetitive guidelines. Finally, 13 guidelines were included after eliminating 128 guidelines by reading titles and abstracts. AGREE Ⅱ evaluation results showed that there were 3 guidelines with level A and 10 guidelines with level B. Analysis and summary showed that a total of 16 items of 3 classes best evidence on malnutrition risk screening in adult inpatients were selected including screening qualification, population, time and tools. ConclusionsIn this study, guidelines best evidence on malnutrition risk screening in adult inpatients provides a credible reference for clinical practice. Population with high risk of malnutrition should be assessed in comprehensive nutrition and should be treated in nutritional department when necessary.