Objective:To evaluate the early predictive value of serum procalcitonin (PCT) , C-reactive protein (CRP) , and white blood cell count (WBC) levels for pancreatic fistula after pancreaticoduodenectomy (PD) .Methods:Data of 93 patients undergoing PD in Department of Pancreatic Surgery at the First Affiliated Hospital of Xinjiang Medical University from Jan. 2017 to Nov. 2019 were retrospectively analyzed. The general information of patients before surgery and postoperative pancreatic fistula were recorded. The levels of serum PCT, CRP, and WBC before surgery and 1st, 3rd, and 5th days after operation were recorded. Patients were divided into pancreatic fistula group (63 cases) and non-pancreatic fistula group (30 cases) . The preoperative data were compared between the two groups. Box plot and the receiver operating characteristic curve (ROC) were drawn. The area under the ROC curve (AUC) was calculated. The sensitivity and specificity of PCT, CRP, and WBC levels in predicting pancreatic fistula alone and jointly were calculated.Results:There were no statistically significant differences in the age, gender, presence or absence of diabetes, total bilirubin, preoperative albumin, surgical time, or intraoperative bleeding in the general information of the pancreatic fistula group and the non-pancreatic fistula group. The difference in index (BMI) was statistically significant. The value of PCT, CRP, and WBC before operation and the value of PCT on the first day after operation were not statistically significant between the two groups ( P=0.424, 0.819, 0.484, and 0.072, respectively) . The PCT values on the 3rd and 5th days after surgery, the values of CRP and WBC on the 1st, 3rd, and 5th days after surgery were all statistically significant (all P values were<0.05) . The area under the ROC curve was jointly predicted by the three at the 3rd and 5th days after operation (AUC=0.792, 0.812) , and the sensitivity (62.9%, 71.4%) and specificity (83.3%, 80%) were better than the three alone. Conclusion:PCT, CRP, and WBC values on the 1st, 3rd, and 5th days after surgery alone have certain limitations in predicting pancreatic fistula, and the combined prediction of the three is more valuable.

Objective To understand and evaluate the quality of life of patients after heart transplantation and analyzing its influence factors, so as to provide reference for improving the quality of life of patients after heart transplantation. Methods A total of 63 patients 3 months after heart transplant were investigated by concise health examination survey scale (SF-36).Results Patients after heart transplantation mainly concentrated in 30-60 years old ( 80%) , male ( 60%) , 60% with complications. Compared with norm, patients after heart transplantation in physiological function (PF), physiological function (RF), body pain (BP), social function ( SF), emotional function ( RE) had low scores ( P<0. 05); single factor variance analysis found that the differences in the different educational degree, family income, ways of medical payment and whether the complications influenced the quality of life of heart transplantation patients significantly had statistical significance. Conclusions The main influencing factors of quality of life include family income, whether happen complication and ways of medical pay.

Objective To investigate the clinical characteristics,distribution and drug sensitivity of pathogens causing intravenous catheter-related bloodstream infections (CRBSIs) in pediatric intensive care unit (PICU) so as to use antibiotics reasonably.Methods All patients with CRBSIs in PICU of Guangdong General Hospital from September 2009 to September 2014 were investigated and the drug resistance profiles of pathogens causing CRBSIs were also analyzed retrospectively.Results Between 2009 and 2014,there were totally 10 834 catheter days and 23 episodes of CRBSIs with an incidence of 2.1 infections per 1 000 catheter days.Catheter indwell time ＜ 7 days in 9 cases (39.1％),8 to 14 days in 10 cases (43.5％),14 to 21 days in 4 cases (17.4％).There were 13 strains (56.6％) of gram-positive bacteria,5 strains (21.7％) of gram-negative bacteria and 5 strains (21.7％) of fungi.The main pathogens causing CRBSIs were coagulase negative Staphylococci (7 strains,30.4％),Staphylococcus aureus (3 strains,13.0％),Candida albicans(3 strains,13.0％),Candida parapsilosis(2 strains,8.7％),and Enterobacter cloacae (2 strains,8.7 ％).The susceptibility to Vancomycin,Linezolid and Teicoplanin of coagulase negative Staphylococ cus such as S.epidermidis and to Imipenem,Piperacillin/Tazobactam,Cefoperazone/ Sulbactam and Amikacin of gram-positive bacteria arrived at 100.0％,respectively.The candida were 100％ susceptible to Amphotericin B,5-Flucytosine,Fluconazole and Voriconazole.Twenty-one cases (91.3％) received antibiotic treatment versus no antibiotic in 2 cases (8.7％).The average number of antibiotic kinds administered on the patients with fungal infection was 4.4,bacteria were 1.4.Ten cases (43.5％) treatment with 1 kind of antibiotic,4 cases (17.4％) with 2,4 cases (17.4％) with 3,5 cases (21.7％) with more than 3.Twenty-two cases (95.7％) cured and 1 case died (4.3％).Conclusions The major species of pathogen causing CRBSIs was coagulase negative staphylococci in PICU.It is critical for clinicians to guard against fungal infection because of prolonged catheter indwelling time and more antibiotics administered before indwelling catheter.It is effective way to prevent the CRBSIs by reasonably using antibiotics and shortening the time of catheter indwelling.Monitoring CRBSIs pathogenic bacteria distribution and drug susceptibility helps reasonable administration of antibiotics in the earlier time.

BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.

Objective To study the correlation of posttraumatic growth with psychological resilience,social support and self-efficacy in breast cancer patients.Methods The questionnaires of Posttraumatic Growth Inventory (PTGI),Connor-Davidson Resilience Scale (CD-RISC),Perceived Social Support Scale (PSSS),General Self-Efficacy Scale (GSES) were used to measure 170 patients with breast cancer.Finally 159 questionnaires were returned.The investigation results were analyzed.Results Among 159 patients,the score of PTGI was (56.41±17.19) scores.The dimension score from high to low order were the relationships with others,personal strength,appreciation of life,new possibilities:(3.29±0.99),(3.19±1.00),(2.94±1.15),(2.36± 1.15) scores.The score of CD-RISC was (63.36± 14.43) scores,PSSS was (69.28±8.59) scores.The score of support from family was (24.45±3.67) scores,which was in the high level.The score of support out of family was (33.51±5.60) scores,which was in the medium level.The posttraumatic growth in breast cancer was positively correlated with the psychological resilience,perceived social support,support out of family,and general self-efficacy,P＜0.05.Conclusions The posttraumatic growth of patients with breast cancer is in the medium level,which still should be improved.The measures which can improve psychological resilience,social support,general self-efficacy of patients would also improve the posttraumatic growth in patients with breast cancer.

Objective To evaluate the effect of the collaboration care model on posttraumatic growth and resilience in patients with breast cancer.Methods 70 patients who were diagnosed with breast cancer in department of Breast Surgery of the First Affiliated Hospital of Dalian Medical University were assigned into two groups by random number table.32 patients who completed the research in the experimental group received collaboration care while 31 patients who completed the research in the control group received routine care both for there months.The patients were investigated with the Posttraumatic Growth Inventory (PTGI) and Connor-Davidson Resilience Scale (CD-RISC) before and after intervention.Results After the intervention,there were significant differences in scores of posttraumatic growth [(63.83±11.87) scores vs.(60.33±10.09) scores,t=2.384] and resilience [(66.52±15.23) scores vs.(61.33±10.09) scores,t=2.472] between the two groups (P＜0.05).And also there were significant differences of posttraumatic growth scores before and after intervention in the experimental group [(56.24±10.01) scores vs.(63.83±11.87) scores,t=-3.988,P＜ 0.01] and the control group [(56.68±10.32) scores vs.(60.33±10.09) scores,t=-2.426,P＜0.05].Differences of resilience also existed in the experimental group [(61.28±14.40) scores vs.(66.52±15.25) scores,t=-3.225,P＜0.01] and the control group [(63.97±17.66) scores vs.(61.33±10.09) scores,t=-2.370,P＜0.05].Conclusions Collaboration care model can significantly improve the level of patients' posttraumatic growth and resilience.

Objective To investigate the status and risk factors of surgical site infection (SSI)in hospitals in Chi-na,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries (colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery)in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1 .60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hys-terectomy,femoral neck repair surgery,and vascular surgery were 4.47%(74/1 655 ),1 .03%(22/2 139),0.21 %(5/2 372),and 0.00% (0/143 )respectively.The incidences of SSI were different among different regions (χ2 =114.213,P <0.05).The most common SSI was superficial incisional infection,the next was deep incisional infec-tion.The major pathogens causing SSI were Escherichia coli ,Enterococcus spp .,coagulase negative staphylococ-cus ,Staphylococcus aureus ,and Klebsiella pneumoniae .The independent risk factors for SSI were male patients, long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surger-ies.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.

Objective To explore the incidence of surgical site infection (SSI)and compliance to bundled interven-tion measures,and evaluate the effect of bundled interventions on controlling SSI.Methods From October 2013 to September 2014,three types of surgeries (colorectal surgery,abdominal hysterectomy,and femoral neck repair sur-gery)in 29 hospitals in China were monitored,October 2013 to March 2014 was baseline investigated stage,April 2014 to September 2014 was intervention stage.Results A total of 6 166 episodes of surgeries were monitored,the incidence of SSI was 1 .64%,incidence of SSI following colorectal surgery,abdominal hysterectomy,and femoral neck repair surgery were 4.47%,1 .03%,and 0.21 % respectively.The P 75 time of three types of surgeries were 3,2,and 2 hours respectively.Compared with the baseline stage,the compliance to most intervention measures im-proved after intervention,the largest increase in the compliance to interventions was disinfection with chlorhexidine-containing disinfectant at surgical sites of colorectal surgery (increased by 29.09%),followed by preoperative shower of femoral neck repair surgery (increased by 26.24%),preoperative shower of colorectal surgery(increased by 22.95%),and skin preparation on the day of operation (increased by 20.75%).Incidences of SSI in three types of surgeries were not significantly different before and after intervention(all P >0.05).Conclusion The incidences of SSI are different among different types of surgeries,the compliance to most bundled intervention measures has im-proved to some extent after intervention,but effectiveness of intervention measures needs to be further observed.

Objective To explore the effect of postoperative progressive resistance training (PRT) on the upper limb function in breast cancer patients. Methods 66 breast cancer patients were randomly divided into intervention group (n=33) and control group (n=33). The intervention group accepted a 12-week PRT and the control group accepted the routine training since 4-6 weeks postoperative as they admitted to hospital for their first chemotherapy. All the patients received a same content of health education. Results The grip strength, range of motion of abduction and flexion of shoulder were more in the intervention group than in the control group after intervention (P<0.01). Conclusion PRT can effectively improve the function of upper limbs in breast cancer patients.

Objective To observe the condition and relevant danger factors of patients with acute poisoning combined infection in EICU. Methods A total of 80 patients with acute poisoning received by EICU were chosen, among which 30 cases were complicated by infection and 50 cases were not. By reference of clinical data of patients, infection condi-tion and relevant danger factors were analyzed. Results Among 30 cases of acute poisoning, heavy metal(66.67%), poi-sonous gas (55.56%), opioid (45.45%), pesticide (45.45%), acid and alkali (42.86%), hypnotics (33.33%), alcohol (16.67%); respiratory tract infection (46.67%), urinary tract infection (30.00%), digestive tract infection (16.67%), skin and soft tissue infection (6.67%);Complication of coma, gastric intubation, trachea cannula were high risk factors of pa-tients with acute poisoning combined with infection (P<0.01). Conclusion Acute poisoning of strong acid and alkali, poisonous gas and heavy metal are more common among patients with acute poisoning received by EICU, and the infec-tions are mainly respiratory tract and urinary tract infection, and high risk factors of patients with acute poisoning com-bined infection were coma, gastric intubation, trachea cannula.