ObjectiveTo investigate the safety and efficacy of puncture cyanoacrylate selective seal （PCSS） under endoscopic ultrasound in the treatment of gastroesophageal varices （GOV）. MethodsA total of 100 patients with liver cirrhosis who underwent endoscopic therapy for the secondary prevention of GOV bleeding in Beijing Ditan Hospital， Capital Medical University， from March 1 to December 31， 2023 were enrolled and randomly divided into PCSS group and traditional endoscopy group. The patients were followed up for 6 months after surgery， and the two groups were compared in terms of clinical outcome and complications. The primary outcome measure was the rate of alleviation or disappearance of GOV， and the secondary outcome measure was variceal rebleeding and death. The independent-samples t test was used for comparison of normally distributed or approximately normally distributed quantitative data between two groups， and the Wilcoxon non-parametric test was used for comparison of non-normally distributed quantitative data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of qualitative data between two groups. ResultsThere were 50 patients in the PCSS group， among whom 1 patient was lost to follow-up， and there were 50 patients in the traditional endoscopy group， among whom 3 patients were lost to follow-up. There were no significant differences between the two groups in baseline data such as age， sex， Child-Pugh class， varices grade， and GOV typing （all P>0.05）. Compared with the traditional endoscopy group， the PCSS group had significantly better results of the number of endoscopic treatment sessions （t=-15.671， P=0.001）， the total amount of tissue adhesive used （t=-2.830， P=0.006）， and the rate of alleviation or eradication of varices sclerosis （χ²=7.078， P=0.029）. Both groups had low rates of postoperative rebleeding， adverse reactions， and complications， and there were no significant differences between the two groups （all P>0.05）. ConclusionCompared with traditional endoscopy， PCSS can significantly enhance treatment outcome while maintaining safety standards.

ObjectiveTo investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. MethodsThe patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. ResultsA total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. ConclusionEndoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS.

Objective To analyze the rebleeding rate in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) after endoscopic treatment of esophagogastric variceal bleeding and then assessed the risk factors of the rebleeding in the patients. Methods This study retrospectively recruited 169 hepatitis B-associated HCC patients complicated with PVTT and esophagogastric variceal bleeding treated by endoscopy in Department of Gastroenterology, Beijing Ditan Hospital from September 2008 to December 2016. Among them, 47 patients had PVTT Ⅱ, 67 patients had PVTT Ⅲ, and 55 patients had PVTT Ⅳ. Their clinicopathological and follow-up data were retrieved from the medical records and statistically analyzed. Continuous data were compared among groups using ANOVA or Kruskal-Wallis H test. Categorial data were compared among groups using Chi-square test or corrected Fisher test. The Kaplan-Meier curves and Log-rank test were performed to analyze the rebleeding rate and cumulative survival rates after treatment. The univariate multivariate Cox regression analyses were used to identify the risk factors affecting the rebleeding of patients. Results Compared with PVTT Ⅱ and Ⅲ, PVTT Ⅳ patients had a higher serum level of the direct bilirubin ( Z =6.153, P =0.046). The endoscopy treatment successfully blocked esophagogastric variceal bleeding in all patients. There was no significant difference in the rebleeding rates within six months and a year after the treatment (all P > 0.05). It was also no statistically significant difference in cumulative survival rates in six months and l-, 2-, and 3-year after the treatment in PVTT Ⅱ, Ⅲ, and Ⅳ patients (all P > 0.05). Cox multivariate regression analysis showed that hepatic encephalopathy ( HR =3.643, 95% CI : 2.099-6.325, P < 0.001), γ-glutamyltransferase ( HR =1.002, 95% CI : 1.000-1.005, P =0.029), AFP ( HR =1.000, 95% CI : 1.000-1.000, P =0.002) and numbers of tumor lesions ( HR =1.647, 95% CI : 1.011-2.684, P =0.045) were all independent risk factors for 1-year rebleeding in these PVTT patients with esophagogastric variceal bleeding after endoscopic treatment. Conclusion Endoscopic hemostasis is a feasible treatment option for HCC patients with PVTT and esophagogastric variceal bleeding. However, there was no significant difference in the rebleeding and cumulative survival rates in these patients. Furthermore, hepatic encephalopathy, γ-glutamyltransferase, AFP and numbers of tumor lesions were all independent risk factors for 1-year rebleeding in these patients.

Objective:To construct a management plan for postoperative paralytic ileus (PI) in spinal surgery patients and explore its effect.Methods:The management plan for PI in spinal surgery patients was constructed based on literature retrieval and expert consultation. From July 2020 to June 2021, 295 patients with spinal surgery of Spine Surgery Department in Yancheng Third People's Hospital were selected by convenience sampling. The patients from January to June 2021 were in the experimental group ( n=152) , and the patients from July to December 2020 were in the control group ( n=143) . The control group adopted routine nursing, while the experimental group received PI management plan of spinal surgery on the basis of routine nursing. We compared the abdominal distension grading, first exhaust time, defecation time, PI incidence, anal exhaust utilization rate, average hospitalization day and patient satisfaction between the two groups at 12, 24, 36, 48, 72 hours after surgery. Results:After intervention, there was no statistical difference in the level of abdominal distension between the two groups at 12, 24 and 36 hours ( P>0.05) . The level of abdominal distension in the experimental group at 48 hours and 72 hours were both lower than that in the control group, and the differences were statistically significant ( P<0.05) . The time of first exhaust and defecation of patients in the experimental group were shorter than that in the control group, and the differences were statistically significant ( P<0.01) . The incidence of PI in the experimental group was lower than that in the control group, with a statistically significant difference ( P<0.05) . The satisfaction of patients in the experimental group was higher than that in the control group, with a statistically significant difference ( P<0.05) . The utilization rate of anal exhaust in the experimental group was higher than that in the control group, with a statistically significant difference ( P<0.05) . There was no statistical difference in average hospitalization days between the two groups ( P>0.05) . Conclusions:PI management plan for patients with spinal surgery can reduce the first exhaust time, defecation time, PI incidence, and improve patient satisfaction, which can provide a basis for standardizing the management of PI for patients with spinal surgery.

Objective To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB). Methods The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding. Results The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [ HR ]=0.504, 95% confidence interval [ CI ]: 0.357-0.711, P < 0.001) and ascites ( HR =1.424, 95% CI : 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding. Conclusion ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.

Objective:To construct a continuous nursing program for stroke patients with disability, so as to provide guidance for continuous nursing after discharge.Methods:The service program was initially developed based on the literature analysis by retrieving China National Knowledge Infrastructure (CNKI) , WanFang Data, VIP, PubMed, Cochrane Library and Ovid Database, and the retrieval time limit was as of October 31, 2019. On the basis of literature search and analysis, an expert consultation questionnaire was initially drawn up. Following the principles of informed consent and voluntariness, a total of 18 experts were finally selected for two rounds of expert consultation to construct the continuous nursing program for stroke patients with disability.Results:In the first round of expert consultation, a total of 18 expert consultation questionnaires were issued and 17 valid questionnaires were returned with the coefficient of expert motivation of 94.44%. In the second round of expert consultation, a total of 18 expert consultation questionnaires were issued and 18 valid questionnaires were returned with the coefficient of expert motivation of 100.00%. The mean value of the coefficient of motivation for the two rounds of expert consultation was 97.22%. The judgment basis coefficient of two rounds of expert was 0.80, the familiarity coefficient was all 0.79, and the authority coefficient of this study was 0.80. After two rounds of expert consultation, a three-level linkage management continuous nursing program for stroke patients with disability was finally formed, with 4 key time points and a total of 61 items.Conclusions:The results of this study are reliable, and the formed program can provide a reference for the development of continuous nursing research and practice for stroke patients with disability.

We constructed bicistronic expression system containing AH6 promoter, 5' UTR and its fore 38 bp sequence from Corynebacterium glutamicum, followed by a conserved Shine-Dalgarno (SD) sequence for xylanase expression. The two major secretory pathways signal peptide in C. glutamicum, Tat (CgR0949) and Sec (CspB) dependent signal peptide were added before xylanase for its secretion. Fed-batch cultivation was done in a 5 L jar for high-level xylanase secretion. The enzyme properties of the purified xylanase were then studied, including the effect of temperature and pH on its activity. The xylanase could be secreted into the culture supernatant when the Sec-dependent signal peptide CspB was used, but none was detected when CgR0949 was used. The secretory production level of xylanase in a flask was 486.2 U/mL and become 1 648.7 U/mL when in a 5 L jar, which was 3.4 fold as in the flask. The optimal pH and temperature of xylanase were pH 4.5 and 45 ℃, respectively. Its activity was 80% of initial activity after pretreatment at 4 ℃ for 24 h at pH 4-11, 95% after incubation below 50 ℃ for 15 min, and 20% when the temperature above 60 ℃. The xylanase could be efficiently secreted into the culture medium by C. glutamicum using its own genetic elements, and the secretion level could be improved through large-scale fed-batch cultivation. This bicistronic expression system can provide a useful tool for heterologous proteins secretion in C. glutamicum. In addition, the catalyze activity of xylanase could be further improved by enzyme properties study.
Corynebacterium glutamicum ; Promoter Regions, Genetic ; Protein Sorting Signals ; Protein Transport

Objective: To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways. Methods: PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study. Results: A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%). Conclusions The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.

Objective To explore the intervention effect of liaison nurses on the follow-up care of patients transferred out of the intensive care unit. Methods Totally 156 ICU patients from January to December 2016 were selected as the research object by convenient sampling, with 71 patients from January to June as the control group and 85 patients from July to December as the treatment group. Patients in the control group received conventional transfer, while a team of ICU liaison nurses was established to provide continuing nursing services to the patients transferred from ICU into general wards in terms of the treatment group so that potential risks could be found and intervened as early as possible. The average length of stays, rate of unexpected return to ICU within 48 hours, and incidence of nursing complications were compared between the two groups. The State Anxiety Inventory and Chinese Version of Critical Care Family Satisfaction Survey were used to compare the level of transfer anxiety and family satisfaction of the patients in the two groups. Results The patients in the treatment group showed a shorter average length of stays and a lower rate of unexpected return to ICU within 48 hours and incidence of nursing complications than the patients in the control group (P<0.05). The patients in the treatment group had a lower score in transfer anxiety (P< 0.05). The score in any dimension of family satisfaction and the total score of the patients in the treatment group were higher than those of the patients in the control group (P<0.05). Conclusions Liaison nurses have showed a good effect on the follow-up care of patients transferred out of ICU, which is significant to some extent.

Objective To explore the needs and expectations of the transitional care services in ICU of a tertiary hospital in Zhejiang province, and to provide evidence for further implementation of ICU transitional care. Methods Three semi-structured focus group interviews were conducted among nurses from ICU and wards by using a purposive sampling during January and July in 2015. Another semi-structured in-depth interview was conducted in three ICU referral patients and their family members during the study period. The data were analyzed by content analysis method. Results The data had two main topics including: improving the connection and consistency between ICU and ward; promoting the rapid transition and the coordination between ICU and ward. Conclusions A clear need and expectation for ICU transitional care services is good for its further implementation.