Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To construct nursing quality evaluation indicator system for comprehensive stroke center, so as to provide reference for standardized nursing quality evaluation of comprehensive stroke center.Methods:From September 2018 to December 2019, based on the theory of Donabedian′s structure-process-outcome quality model, literature review, semi-structured interview, Delphi method and analytic hierarchy process were used to determine nursing quality evaluation index system and index weight for comprehensive stroke center.Results:A total of 16 experts from comprehensive stroke center were consulted for two rounds. The clinical working time was 24.63±10.08 years, and the effective recovery rates of two rounds were 100%. The authority coefficient of experts was 0.888, and the coordination coefficients W of two rounds were 0.229 and 0.283 respectively.Finally, a nursing quality evaluation indicator system for comprehensive stroke center was constructed, including 3 first-level indicators, 13 second-level indicators and 46 third-level indicators. Conclusions:The established nursing quality evaluation indicator system for comprehensive stroke center covers the whole process of stroke emergency, stroke unit, and follow-up, which is scientific and reliable, and provides an evaluation tool for daily nursing quality monitoring and continuous quality improvement in comprehensive stroke centers.

Objective To understand the nutrition status in elderly patients with hip fracture, and clarify its effects on postoperative functional recovery,complications and mortality based on literature analysis of the past 10 years. Methods PubMed,Medline,Embase Database,Wanfang Database,Chinese National Knowledge Infrastructure(CNKI)and China Biology Medicine disc(CBMdisc)were searched,and relevant researches published from 1st January,2010 to 31th May,2019 were collected. Single rate Meta-analysis was used to integrate the prevalence and mortality of malnutrition. A qualitative systematic review was used to analyze the relationship between nutritional status and prognosis after surgery. Results A total of 11 articles was included,including 21791 patients. Meta-analysis showed that the mean prevalence of malnutrition during hospitalization in elderly patients with hip fracture was 46％(95％CI:45％-47％)using serum albumin(ALB),and was 17％(95％CI:12％-22％)assessing by the Mini Nutritional Assessment (MNA),and the risk of malnutrition prevalence was 42％(95％CI:45％-47％). The results of qualitative evaluation showed that compared with the well-nutrition group(Short-form MNA 12-14 points),the malnutrition risk group(Short-form MNA 8-11 points)had lower activity ability 4 months after the operation (OR=2.03,95％CI:1.24-3.31),and the MNA score decreased by 1 point,the risk of death increased by 15％(HR=0.869,95％CI:0.757-0.998). The malnutrition group(ALB<3.5 g/dl)had a higher incidence of sepsis (P< 0.001)and pulmonary infection(P=0.019),with every 1 g/dl reduction in ALB and 0.59-fold increased risk of death(RR=0.59,95％CI:0.53-0.65). Conclusions The incidence of hip fracture malnutrition or malnutrition risk is very high in the elderly patients with hip fracture. Both malnutrition and malnutrition risk have negative effects on postoperative functional recovery,complications and death rates,and the worse the nutritional status,the worse the prognosis. So,both ALB and MNA are recommended to be included in the care plan of elderly patients with hip fracture. When ALB is failed to diagnose malnutrition,the MNA evaluation method should be adopted to find the problems of nutrition and offer nutritional intervention in advance.

Training and improving the clinical skills of specialist nurses is an important part of nursing education in Operating Room. The objective structured clinical examination is currently recognized as an objective assessment method to evaluate the clinical practice skills of medical students. Its assessment model is still in its infancy in the field of clinical nursing education in China. This article reviews the connotation of clinical skills,the design of objective structured clinical examination and the application status of clinical skills training of specialist nurses in Operating Room.

Objective? To explore the medical staff's recognition of the nursing quality evaluation of a comprehensive stroke center,so as to provide reference for constructing the nursing quality evaluation index system in the comprehensive stroke center. Methods? By descriptive qualitative method, 11 doctors and nurses from comprehensive stroke center were enrolled to have semi-structured in-depth interviews from February to April of 2019. The data were analyzed using a directed content analysis method. Results? A total of 2 subjects related to structured nursing quality evaluation were extracted: nursing staff allocation,organizational structure configuration; 6 subjects related to process nursing quality evaluation:disease condition observation and assessment,specialist nursing practice,complications management,rehabilitation nursing,health education, effective communicationand coordination; 3 subjects related to outcome nursing quality evaluation: incidence of complications,physical and mental status,patient benefits. Conclusions? The relevant topics of comprehensive stroke center nursing quality evaluation extracted based on the perspective of medical staff, can provide a reference for constructing a comprehensive, scientific and applicable index system to improve the quality of care in the comprehensive stroke center.

Objective To observe the effects of comprehensive treatment of aerobic exercise and medicine on the levels of serum immunoglobulins and cytokines in rats with chronic abacterial prostatitis (CAP).Methods Forty healthy adult male SD rats were randomly divided into the normal control group,CAP model control group,exercise treatment group,medicine treatment group and exercise and medicine comprehensive treatment group,8 cases in each group.The CAP rat model was prepared by the injection of Xiaozhiling,and after 7 d of rat model construction,the exercise treatment group and exercise and medicine comprehensive treat ment group conducted once swimming exercise at fixed time every day,6 d per week for 4 continuous weeks;the medicine treatment group and exercise and medicine comprehensive treatment group were given Qianlieshutong Capsule aqueous solution for gavage treatment every day;the normal control group,model control group and exercise treatment group performed gastric gavage with sterile normal saline.On 14,28 d of the treatment process the rats in each group were sacrificed.The indicators such as serum immunoglobulins and cytokines in rats were detected by using ELISA.Results On 14 d,compared with the normal control group,the levels of serum IgG,IgA,IgM,TNF-α,IL-1β and IL-6 in each experimental group were increased significantly (P＜ 0.05),while which had no statistically significant difference between the exercise treatment group and model control group and between the comprehensive treatment group and medicine treatment group(P＞0.05);on 28 d,the levels of IgG,IgM,TNF-α,IL-1β and IL-6 in the exercise treatment group were significantly lower than those in the model control group(P＜0.05),the levels of IgG,IgA,TNF-α,IL-1β and IL-6 in the comprehensive treatment group were significantly lower than those in the medicine treatment group (P＜0.05),moreover were close to those in the normal control group(P＞0.05).Conclusion Aerobic exercise can reduce the levels of serum immunoglobulins and cytokines in CAP rats,and the effect is more obviousin CAP rats treated by comprehensive therapy combined with medicine.

Objective To investigate the effects of structured triglyceride and long chain triglyceride/medium chain triglyceride (LCT/MCT) on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinical data of 42 elderly patients who underwent total gastrectomy for gastric cancer in the Jiangsu Cancer Hospital between Sepember 2014 and September 2015 were collected.Twenty-two patients using structured triglyceride in postoperative parenteral nutrition and 20 using LCT/MCT in postoperative parenteral nutrition were allocated into the case and control groups,respectively.All the patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy.Patients in the case and control groups received respectively 20％ structured triglyceride and 20％ LCT/MCT.Observation indicators:(1) postoperative recovery situation:time of gut exsufflation,changes of body mass at postoperative 5 days,postoperative anastomotic leakage and abdominal infection;(2) test of liver function indexes:aspartate transaminase (AST),alanine transaminase (ALT),total bilirubin (TBil),direct bilirubin (DBil) of liver function in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(3) test of nutritional indexes:serum total protein (TP),albumin (Alb) and prealbumin in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(4) test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD3/CD8 in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5.Measurement data with normal distribution were represented as x ±s.Repeated measures data were evaluated with the repeated measures ANOVA.Count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Postoperative recovery situation:there was no special adverse reaction during support treatment of parenteral nutrition.Time of gut exsufflation,changes of body mass at postoperative 5 days,incidences of postoperative anastomotic leakage and abdominal infection were (46 ± 12)hours,(60±8) kg,0,0 in the case group and (50 ±14) hours,(58±9)kg,0,1 in the control group,respectively,with no statistically significant difference between the 2 groups (t =0.86,0.65,P＞0.05).(2) Test of liver function indexes:levels of AST and ALT from preoperation to postoperative day 5 were respectively from (24±9) U/L to (22±6)U/L,from (31±12)U/L to (20±8)U/L in the case group and from (23±8) U/L to (30± 10) U/L,from (30 ± 9) U/L to (32 ± 7) U/L in the control group,respectively,with statistically significant differences between the 2 groups (F =92.87,87.92,P＜0.05).Levels of TBil and DBil from postoperative day 1 to postoperative day 5 were respectively from (21±4) μmol/L to (19±4) μmol/L,from (7.0±2.0) μmol/L to (6.0±2.0)μmol/L in the case group and from (19±3) μmol/L to (20±4)μmol/L,from (7.0±2.0)μmol/L to (8.0±3.0)μmol/L in the control group,respectively,with no statistically significant difference between the 2 groups (F =1.48,0.81,P ＞ 0.05).(3) Test of nutritional indexes:levels of serum TP and Alb from postoperative day 1 to postoperative day 5 were respectively from (52±6)g/L to (56±5)g/L,from (34±3)g/L to (37±4) g/L in the case group and from (53±7)g/L to (52±4)g/L,from (33±3) g/L to (31± 3)g/L in the control group,respectively,with no statistically significant difference in changing trends between the 2 groups (F=0.47,0.54,P ＞ 0.05).Levels of prealbumin from postoperative day 1 to postoperative day 5 were respectively from (230±32)mg/L to (245±30)mg/L in the case group and from (228±28)mg/L to (222±26) mg/L in the control group,respectively,with a statistically significant difference in changing trend between the 2 groups (F=16.81,P＜0.05).(4) Test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD4/CD8 from postoperative day 1 to postoperative day 5 were respectively from (12±4) g/L,(2.20±0.20)g/L,52％±4％,30％±4％,1.30±0.20 to (18±5)g/L,(2.80±0.30)g/L,59％±4％,33％±4％,1.50±0.20 in the case group and from (12±3)g/L,(2.10±0.10)g/L,52％±4％,27％±4％,1.30±0.10 to (13±4)g/L,(2.30±0.20) g/L,51％±4％,26％ ±4％,1.20±0.20 in the control group,respectively,with statistically significant differences in changing trends between the 2 groups (F=25.07,29.42,33.53,22.19,33.47,P＜0.05).Conclusions The short-term usage of structured triglyceride or LCT/MCT in early period after operation can effectively improve postoperative recovery of elderly patients with gastric cancer,with a small impact on liver function.Structured triglyceride can improve immunologic function and nutrition status more effectively.

Objective From the perspective of health economics, to evaluate 23 pneumococcal polysaccharide vaccination programme among chronic obstructive pulmonary disease (COPD) patient. Methods In the pilot counties of the project of integrated care pathway for COPD patient (Hanbin district of Hanzhong city in Shanxi Province, Qianjian district of Qingqing city, Huandao district of Qindao city in Shangdong Province, Wen county of Jiaozuo city in Henan Province), information of insurance participants of New Rural Cooperative Medical System (NRCS) was collected by local NRCM information system, which included general information as well as records of medical care and medical fee. Nonprobability sampling method was applied to select a total of 860 objects, who were over 60 years old with local household registration, hospitalized within one recent year due to COPD acute exacerbation, and without vaccination of 23 voluntary pneumococcal polysaccharide vaccine within 3 years. A quasi-experimental design without control group was adopted. Objects were vaccinated with 23-valent pneumococcal polysaccharide vaccine from January to December in 2013, then were followed up from January in 2014 for one year. Data of effectiveness and medical cost was collected by self-designed questionnaire and (Chinese version). Paired rank sum test applied to test the difference of quality of life, number and direct medical cost of treatment (including outpatient treatment and hospitalization) due to COPD acute exacerbation, one year before and after intervention. The incremental cost-effectiveness ratio (ICER) and cost-benefit ratio (CBR) of the programme were calculated. Results By January 2014, eight hundred sixty objects were vaccinated. By January 2015, seven hundred eighty eight objects were followed up, with 72 cases withdrawed (8.4%). On average, COPD patients reduced 1.12±2.51 treatments due to acute exacerbation, including 0.28±2.09 outpatient treatments and 0.85±1.15 hospitalizations. Total medical cost was saved by 3 610.21 per capita yuan, including outpatient cost of 241.41 yuan and hospitalization cost of 269.82 yuan; Quality of life was gained by 0.03 QALY gain per capita. The ICER was dominant and CBR was 12.00. Conclusion COPD patients vaccinated with 23-valent pneumococcal polysaccharide vaccine within one year reduced treatments due to acute exacerbation. The vaccination was cost effective and cost saving , and we suggest the vaccine should be covered in the public health program or health insurance scheme in conditional region.

Objective From the perspective of health economics, to evaluate 23 pneumococcal polysaccharide vaccination programme among chronic obstructive pulmonary disease (COPD) patient. Methods In the pilot counties of the project of integrated care pathway for COPD patient (Hanbin district of Hanzhong city in Shanxi Province, Qianjian district of Qingqing city, Huandao district of Qindao city in Shangdong Province, Wen county of Jiaozuo city in Henan Province), information of insurance participants of New Rural Cooperative Medical System (NRCS) was collected by local NRCM information system, which included general information as well as records of medical care and medical fee. Nonprobability sampling method was applied to select a total of 860 objects, who were over 60 years old with local household registration, hospitalized within one recent year due to COPD acute exacerbation, and without vaccination of 23 voluntary pneumococcal polysaccharide vaccine within 3 years. A quasi-experimental design without control group was adopted. Objects were vaccinated with 23-valent pneumococcal polysaccharide vaccine from January to December in 2013, then were followed up from January in 2014 for one year. Data of effectiveness and medical cost was collected by self-designed questionnaire and (Chinese version). Paired rank sum test applied to test the difference of quality of life, number and direct medical cost of treatment (including outpatient treatment and hospitalization) due to COPD acute exacerbation, one year before and after intervention. The incremental cost-effectiveness ratio (ICER) and cost-benefit ratio (CBR) of the programme were calculated. Results By January 2014, eight hundred sixty objects were vaccinated. By January 2015, seven hundred eighty eight objects were followed up, with 72 cases withdrawed (8.4%). On average, COPD patients reduced 1.12±2.51 treatments due to acute exacerbation, including 0.28±2.09 outpatient treatments and 0.85±1.15 hospitalizations. Total medical cost was saved by 3 610.21 per capita yuan, including outpatient cost of 241.41 yuan and hospitalization cost of 269.82 yuan; Quality of life was gained by 0.03 QALY gain per capita. The ICER was dominant and CBR was 12.00. Conclusion COPD patients vaccinated with 23-valent pneumococcal polysaccharide vaccine within one year reduced treatments due to acute exacerbation. The vaccination was cost effective and cost saving , and we suggest the vaccine should be covered in the public health program or health insurance scheme in conditional region.