Abstract Background and Purpose The tumour-node metastasis (TNM) classification is a common model for evaluating the prognostic value of tumour patients. However, few models have been used to predict the survival outcomes of patients with colorectal cancer liver metastasis (CRLM) with unresectable metastases who received the primary local surgery. Thus, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to establish novel nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) of these patients. Methods Extracted primary data on CRLM patients by local surgery from SEER database. All prognostic factors of OS and CSS were determined by Cox regression analysis. The concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves were used to further evaluate the accuracy and discrimination of these nomograms. Decision curve analysis (DCA) was executed to evaluate the nomograms for the clinical net benefit. Risk stratification analysis (RSA) was used to evaluate the reliability of them in clinical. Results 3622 eligible patients were screened and assigned to training cohort (1812) or validation cohort (1810). The age, chemotherapy, tumour grade, primary tumour site, tumour size, lymph node positive rate (LNR), marital status, and carcinoembryonic antigen (CEA) were independent prognostic factors of OS. Additionally, the age, chemotherapy, tumour grade, primary tumour site, tumour size, LNR, and CEA were independent prognostic factors of CSS. The results of C-indexes and ROC curves indicated that the established nomograms exhibited better discrimination power than TNM classification. The calibration curves demonstrated excellent agreement between the predicted and actual survival rates for 1-, 3-, and 5 year OS and CSS. Meanwhile, the validation cohort demonstrated similar results. Background the clinic context, the DCA showed that these nomograms have higher net benefits, and the RSA showed that patients were further divided into low risk, medium risk, and high risk groups according to the predicted scores from nomograms. And, the Kaplan–Meier curve and log-rank test showed that the survival differences among the three groups are statistically significant. Conclusions The prognostic nomograms showed very high accuracy, identifiability, and clinical practicality in predicting the OS and CSS of CRLM patients with unresectable metastases treated by local surgery at 1-, 3-, and 5 years, which might improve individualized predictions of survival risks and help clinicians formulate treatment plans.

Background:Secreted frizzled-related protein (SFRP) is a crucial regulator of Wnt signaling, involved in multiple biological processes including cell proliferation and metastasis. Despite the accumulation of evidence that indicated that SFRPs are differentially expressed and play a key role in various malignancies, the function of different SFRPs in colorectal cancer (CRC) remains insufficiently studied.Methods:Multicenter databases, including GEPIA, cBioPortal, UALCAN, Pathway Commons, STRING, TIMER, CCLE, and LinkedOmics, comprehensively analyzed differential expression, prognostic value, genetic alterations, signaling pathways, immune cell infiltration, and associated genes of the SFRP family in CRC patients. Colony formation, wound healing, and transwell assays were performed to further validate in vitro.Results:SFRP family members were differentially expressed in CRC, with each member showing varying degrees of genetic alterations. Except for SFRP5, the remaining members show a significant correlation with immune cells. Interestingly, only SFRP2 significantly correlated with CRC prognosis and stage. Additionally, SFRP2 participated in a number of critical biological processes, including metastasis and cell proliferation. Moreover, cell function assays suggested the elimination of SFRP2 inhibits the proliferation, migration, and invasion of HCT116 cells.Conclusions:The differential expression of SFRP2 is closely associated with the prognosis of CRC patients. In addition, abnormal expression of SFRP2 has a significant impact on the progression of CRC, including proliferation, migration, and invasion. SFRP2 may become a novel prognostic factor for CRC.

目的:研究国内应用皮下持续负压引流术对结直肠癌病人术后腹部切口愈合的影响.方法:检索2010年—2020年间中国知网、万方数据库、中国生物医学文献数据库和维普数据库中有关皮下持续负压引流术与传统常规换药术对结直肠癌病人术后切口恢复影响的文献,按照标准严格筛选并纳入合格的文献,利用RevMan 5.3软件做统计学分析.结果:共纳入10篇文献,Meta分析结果显示:与实施传统常规换药术病人比较,实施皮下持续负压引流术病人的切口感染[OR=0.17,95％CI(0.09,0.30),P<0.01]、切口裂开[OR=0.19,95％CI(0.06,0.54),P<0.01]、切口脂肪液化[OR=0.19,95％CI(0.12,0.32),P<0.01]发生率较低,切口平均换药次数[WMD=-2.18,95％CI(-2.89,-1.47),P<0.01]、术后住院时间[WMD=-1.72,95％CI(-2.71,-0.73),P<0.01]以及切口愈合时间[WMD=-2.95,95％CI(-3.56,-2.33),P<0.01]较短,且病人术后切口的甲级愈合率[OR=4.35,95％CI(2.87,6.59),P<0.01]较高.结论:现有证据表明,皮下持续负压引流术在结直肠癌病人术后切口愈合并发症发生率低,切口愈合时间短,本结论受纳入研究数量和质量的影响,仍然需要更大样本的临床随机对照研究进一步验证

目的 探讨贴敷治疗仪联合肠通膏穴位贴敷治疗腹部手术后患者胃肠功能障碍的临床疗效.方法 选取2020年4月至2021年3月在我院接受腹部手术的患者100例,按照随机数字表法分为对照组和试验组各50例,对照组予以常规护理,试验组在对照组基础上予以贴敷治疗仪联合肠通膏穴位贴敷,比较两组患者第一次排气排便时间、肠鸣音修复时间、开始进餐时间和生活质量评分以及患者满意度.结果 试验组总有效率高于对照组,首次排气排便时间、肠鸣音修复时间、开始进餐时间均优于对照组,患者生活质量评分高于对照组,满意度也高于对照组,差异均有统计学意义(P＜0.05).结论 贴敷治疗仪联合肠通膏穴位贴敷能促进腹部手术后胃肠功能修复,满意率高,值得临床推广应用.

外渗是指液体意外地注入或泄漏到皮下或血管周围组织中[1].外渗多发生在血管较细且无法表达疼痛的儿童或血管、皮肤脆弱的老年人中.高渗、强酸强碱、血管刺激、化疗类药物常引起药物渗漏损伤,损伤程度可以从非常轻微的皮肤反应到严重的皮肤坏死[2-3].长春地辛(vindesine sulfate)是恶性淋巴瘤、小细胞肺癌等肿瘤常用的化疗药物,该药属于发泡剂,长期化疗且血管条件较差的病人,在静脉输注该药时易发生外渗性损伤[1].一旦病人发生外渗应立即进行外科清创以去除可能引发感染的坏死组织;若未及时清创则会使坏死继续进展,导致皮肤出现厚厚的皮革状焦痂且周围皮肤有红肿热痛等表现,最终延长病人住院时间,增加医疗费用[4].目前国内少见将新型敷料用于长春地辛外渗损伤的伤口护理.2019 年 5 月,我院积极采取多项措施护理长春地辛外渗致残病人 1 例,疗效满意.现将护理报告如下.

本文以规培护士作为职业认同评价的主体,基于三甲教学医院平台对其职业认同指标进行综合评价,得出结论,在规培护士的职业认同评价中,自我把握感和对患者的影响力、对组织的影响力、工作的意义感以及自我效能感等方面是护士职业认同更加重要的影响因素,而其中自我把握感和对患者的影响感是最重要的影响因素.

目的:观察肠通膏联合多源频谱治疗仪在促进结直肠癌患者根治术后肠道功能恢复情况的临床效果.方法:按数字表法,将160例结直肠癌根治术的患者随机分为治疗组和对照组,治疗组术后采取肠通膏+多源频谱治疗仪来促进肠道功能恢复,对照组术后仅用多源频谱治疗仪来促进肠道功能恢复,比较两组患者术后肠道功能恢复情况.结果:术后24 h、48 h和72 h,在肠鸣音恢复情况、腹胀情况、伴随症状情况和肛门排气情况等方面比较,治疗组均优于对照组,差异有统计学意义(P<0.05);术后48 h和72 h,治疗组的肛门排便、进流质饮食情况优于对照组(P<0.05),但术后24 h两组比较,差异无统计学意义.结论:肠通膏联合多源频谱治疗仪能够快速、有效减轻腹胀,促进结直肠癌根治术后肠道功能的恢复,值得在临床推广应用.

目的:评估术后皮下放置医用硅橡胶引流管在预防再次胆道手术合并肥胖患者切口感染的有效性.方法:本研究采用回顾性分析80例再次开腹胆道手术合并肥胖患者的临床资料,其中引流组39例,对照组41例,比较术后放置医用硅橡胶引流管与未放置患者术后切口的感染率.结果:与对照组相比,引流组患者术后切口感染率明显降低(5.4％vs.32.3％P=0.036).相关性分析显示,术后皮下放置医用硅橡胶引流管,性别、是否合并糖尿病、手术时间、皮下脂肪厚度(TSF)、术后第1天白蛋白水平与再次开腹胆道手术合并肥胖患者切口感染有关(P<0.05).多因素分析显示,女性、合并糖尿病、手术时间≥3 h、TSF≥25.3 mm为术后切口感染危险因素,术后皮下放置医用硅橡胶引流管是保护性因素(P<0.05).结论:术后皮下放置医用硅橡胶引流管能很好预防再次胆道手术合并肥胖患者的切口感染,当合并有多种危险因素,尤其是合并肥胖患者,术后切口皮下放置医用硅橡胶引流管是必要的.

Objective To identify the risk factors for postoperative complications after radical resection of rectal cancer, and study the influence of high ligation of the inferior mesenteric artery on postoperative complications of rectal cancer. Methods Clinical data of the patients who underwent radical resection of rectal cancer in the Affiliated Hospital of North Sichuan Medical College from January 2011 to December 2015 were analyzed. The χ 2test and t test were used for all the data. Results A total of 431 patients with rectal cancer were included, of which 80 cases were excluded, and finally 351 cases met the standard. Among them, 196 cases were in high ligation group, and 155 cases were in low ligation group. The total incidence of postoperative complications was 20.4 %(40/196) in the high ligation group and 27.1 %(42/155)in the low ligation group respectively,the difference of which was not statistically significant(χ2=1.336, P= 0.245). The incidence of anastomotic leakage was 10.2 % (20/196) in the high ligation group and 7.7 % (12/155) in the low ligation group respectively, and there was no significant difference between them (χ2=0.529, P= 0.467). Logistic regression analysis revealed that gender (OR= 2.102, 95 % CI 1.278-3.459, P=0.003), body mass index (OR= 2.492, 95 % CI 1.070-5.800, P= 0.027), with or without anemia before surgery(OR=2.203,95 % CI 1.085-4.472,P=0.029), and location of tumor(OR=2.861, 95 % CI 1.288-16.007,P=0.019) were independent risk factors for postoperative complications. Conclusions High ligation of the inferior mesenteric artery does not increase the incidence of postoperative complications after radical resection of rectal cancer. Anastomotic leakage after rectal cancer resection is related to gender, body mass index,with or without anemia before surgery,and location of tumor.

Objective To evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) in laparoscopic radical gastrectomy for gastric cancer.Methods From May 2015 to July 2017,149 patients with gastric cancer in our department were prospectively enrolled and randomly divided into the ERAS group (n =75) and control group (n =74).Results In ERAS group compared to control group,the time to first passage of flatus was (51 ± 11)vs.(62 ± 11)h,first feeding time (46 ± 12) vs.(68 ±20)h,gastric tube removal time (13 ± 12)h vs.(70 ± 16) h,pain score on the first day after surgery (3.9 ±1.3) vs.(5.2 ±0.9),C-reaction protein level (8.5 ±2.6) mg/L vs.(10.1 ±3.0)mg/L,post-op hospital stay (6.9 ± 2.9) d vs.(11.2 ± 3.5) d,were all significantly different (all P ＜ 0.05).The postoperative complication rates was 25％ vs.28％ respectively,(x2 =0.101,P =0.750).Conclusions Enhanced recovery after surgery can promote the postoperative recovery and shorten the time of hospitalization in laparoscopic-assisted radical gastrectomy for gastric cancer.

目的 分析腹腔镜直肠癌根治术后的并发症及其相关影响因素.方法 回顾性分析2013年2月至2016年12月期间符合纳入标准的343例接受腹腔镜直肠癌根治术患者的临床病理资料,分析术后并发症发生情况并用logisitic回归分析其危险因素.结果 343例接受腹腔镜直肠癌根治术患者中97例(28.3％)术后发生了并发症.单因素分析结果显示,患者的年龄、性别、体质量指数、术前贫血、术前合并疾病、肿瘤位置、肿瘤直径、手术时间及手术者经验与腹腔镜直肠癌根治术后并发症的发生有关(均P＜0.050);logisitic回归分析结果显示,患者的年龄、性别、体质量指数、术前贫血、术前合并疾病、肿瘤位置、手术时间和手术者经验是术后并发症发生的独立危险因素(均P＜0.050).结论 腹腔镜直肠癌根治术后并发症发生的独立危险因素为患者的年龄、性别、体质量指数、术前贫血、术前合并疾病、肿瘤位置、手术时间和手术者经验.

目的 总结肠造口患者28例粪水性皮炎发生的原因,探讨护理对策,为造口专科护理提供经验.方法 对每例患者发生粪水性皮炎的具体原因进行分析和总结,同时给予一对一的专科指导与护理,不定期电话回访,给予延续性护理.结果 两周后回访或复诊28例均痊愈,且熟练掌握造口护理技巧.结论 加强专科及延续性护理,可让造口患者真正掌握造口护理的要领,避免造口并发症的发生,减轻造口患者的痛苦.

目的 调查临床实习护生人文关怀品质和人文关怀能力的现状以及两者之间的相关性.方法 采用人文关怀品质和人文关怀能力问卷对90名临床实习护生进行调查.结果 临床实习护生人文关怀能力得分62.95±8.27,人文关怀品质得分163.11±14.54,两者之间呈正相关(r=0.338,P＜0.01).人文关怀理念、知识、能力和感知与人道利他价值观、促进情感交流、灌输信念与希望呈正相关(P＜0.05,P＜0.01),人文关怀知识与提供良好环境呈负相关(r=-0.223,P＜0.05).结论 临床实习护生的人文关怀品质呈中等偏上水平,能力呈较低水平,两者之间相互影响.临床教师应根据临床环境,引导护生体验关爱,使其认同和内化人文关怀价值取向,形成良好的人文关怀品质.

Objective To study the sujectect evalution of living quality,analysis of relevant factors,improve the living quality of the patients with low rectal concer after anus preservation. Methods Adopted purposive sampling method to select 9 low rectal cancer patients in our hospital with postoperative semi-structured interviews ,Colaizzi method to analysis data. Re-sults The subjective experience on living quality of the patients with low rectal cancer after anus preservation,incontinence,the change of the demand of self-care knowledge,self-efficacy,self feelings of burden,anxiety,and pessimistic. Conclusion Fecal incontinence brought great distress on life and psychological to the patients with low rectal cancer after anus preservation ,seri-ously affected the living quality of patients,in order to improve living quality of the patients, nursing intervention should be giv-en in time to help patients gradually to return normal defecation.

Objective To investigate effect of visualized health education on the adaptation of patients with enterostomy in rural areas.Methods A total of 78 patients with enterostomy in rural areas were divided into experimental and control groups according to the parity of the hospital number mantissa.The patients in experimental group received visualized health education,and the patients in control group received routine health education.The patients satisfaction and adaptation level of enterostomy between the two groups were compared.Results The score of adaptation level of enterostomy in the experimental group patients (74.6 ± 2.43) was higher than that in control group patients (63.8 ± 5.22),the difference was statistically significant (t =-4.27,P =0.00) ; the patient satisfaction in experimental group (97％) was higher than that in the control group (62％),the difference was statistically significant (x2 =15.41,P =0.014).Conclusions The adoption of visualized health education can improve the basic knowledge level,self-care ability and enterostomy adaptation level of patients with enterostomy in rural areas,thereby to improve the patients quality of life and patients satisfaction with the quality of care.

Objective To discuss the effect of grouping delamination scheduling model on the quality of nursing. Methods Grouping delamination scheduling model was implemented in our surgery department from November 2011 to August 2012. The level of nursing quality and patient satisfactions of the two groups were compared. Results After the implemented of grouping delamination scheduling model, the situation of nursing operation technique, basic nursing, first class nursing, holistic nursing, nursing records, safety management, health education, synthesize nursing quality and patients' satisfaction degrees were all better in the experimental group; the difference between the two groups was of statistical significance (P0.01). Conclusions Grouping delamination scheduling model can optimize the arrangement of labor resources, fully inspire the enthusiasm of the nurses and enhance the level of nursing quality.

Objective: To investigate the Quality of patients in rural with rectal carcinoma a after colostomy. Methods: Data were col ected on 54 patients with the self-designed questionnaire and analyzed by statistical methods. Results:The patients in rural with colostomy in this research showed low level with Quality. Conclusions:Medical staf should be provided more welfare policy and specialty support for the patients in rural to promote their Quality of Life.

The paper discusses the application and outcome of three-level teaching mode in nursing students' clinical practice.It points out that the new mode has changed the traditional mode,standardized the order of clinical teaching,upgraded the quality of clinical teaching,and improved nursing students' professional skills and satisfaction about clinical teaching.

[目的]探讨胃转流术治疗2型糖尿病病人的护理干预及效果。[方法]选择在我科行胃转流术治疗的2型糖尿病病人36例,按照住院号奇偶数将其分为两组,干预组采取多种形式的护理干预,对照组进行常规的围术期护理,比较两组病人围术期心理焦虑、护理质量满意率、并发症的发生率及自我管理能力。[结果]干预组病人焦虑、护理质量满意率、自我管理能力得分与对照组比较差异有统计学意义(P<0.05),两组术后并发症的发生率比较差异有统计学意义(P<0.05)。[结论]围术期综合护理干预保证了胃转流术病人充分的术前准备,提高了病人围术期的自我管理能力,减少了术后并发症的发生,提高了护理质量满意度。

Objective:To detect 5-Fu concentration in serum,peritoneal fluid and pericancerous tissues between intra-operational regional chemotherapy(RC) and intraluminal chemotherapy for colon cancer.Methods: Twenty colon cancer patients received intra-operational RC with 5-Fu(15 mg/kg).Another twenty colon cancer patients received intraluminal chemotherapy with 5-Fu(15 mg/kg).On 2,5,10,20,30 and 60 minutes after administration,portal vein blood,peripheral circulation blood,peritoneal fluid and pericancerous tissue were sampled to analyze the 5-Fu concentration by high performance liquid chromatography(HPLC) method.Results: Peak concentration appeared two minutes after treatment,and lowered gradually in the RC group.The drug level in peritoneal fluid was the highest,and that in the peripheral vein was lower than that in portal vein.5-Fu was detected in the portal vein blood,peritoneal fluid,and pericancer tissues in the intraluminal,chemotherapy group at two minutes,and were significantly lower than that of the RC group(P0.01).The concentration in portal vein upgrade slowly reaching its maximum concentration at 60 minutes and exceed that of the RC group(P0.01).5-Fu was not detected in the peripheral circulation blood.Conclusion:The intra-operational RC for colon cancer maintains a higher concentration of chemotherapy in portal vein blood and peritoneal fluid.This has significance in prophylaxis for cancer intra-operational spreading and forestalls the recurrence post-operation.