Χ2 Values Research Articles

Topographic lymph node staging system shows prognostic superiority compared to the 8th edition of AJCC TNM in gastric cancer. A western monocentric experience

IntroductionThe current Tumor Node Metastasis staging system (TNM) for gastric cancer classifies the extent of lymph node metastasis based upon the number of lymph nodes involved. Choi et al. have recently proposed a new anatomical classification based upon the regionality of the involved nodes. This new classification seems to have a better predictive prognostic value than the traditional one. We investigated the prognostic role of the new anatomical based classification, reviewing our institutional gastric cancer database. MethodsWe performed a retrospective chart review of 329 patients who underwent gastrectomy at our Institution from 2003 to 2017. We excluded from data analysis any patient with distant metastases at the time of first diagnosis and or surgery, pathology other than adenocarcinoma, lymphadenectomy less than D2, impossibility to identify location of lymph nodes (LNs) on pathological report and neoadjuvant chemotherapy. The extent of D2 lymphadenectomy was defined according to Japanese Gastric Cancer Association criteria. LN metastasis were reclassified into three topographic groups (lesser, greater curvature, and extraperigastric nodes) and staged according to Choi. The new N stage was combined with the current pT according to the 8th edition of TNM and a new hybrid TNM stage was established. All patients were followed up until June 2019. The prognostic performance of the new stage and of the current anatomical numeric based system (TNM) was analyzed and assessed by the C-index, AIC and likelihood ratio χ2 value. ResultsIn predicting both Overall Survival (OS) and Disease free Survival (DFS) the new N stage and the new TNM staging system had the highest C-index and likelihood ratio χ2 value and the lowest Akaike Information Criterion (AIC), showing a better accuracy and displaying a better prognostic performance. ConclusionsOur study is the first from the Western world to compare the new hybrid classification, based on the anatomical location of metastatic nodes, to the 8th of American Joint Committee on Cancer (AJCC) TNM staging system. Our findings on a small, monocentric sample suggest that hybrid topographic lymph node staging system is more accurate than TNM.

A LIP Abdominal Tuberculosis Classification System for Surgery

Tubercular infection can occur in various organs and tissues; however, abdominal tuberculosis is a common form of extrapulmonary tuberculosis after tubercular lymphadenitis. The treatment strategies and surgical indications for different types of abdominal tuberculosis are also not illustrated. This study aimed to create a classification scheme to guide the treatment strategy. The data of abdominal tuberculosis patients admitted to Shaanxi Tuberculosis Hospital from December 2012 to December 2016 were reviewed. All diagnosed abdominal tuberculosis cases were classified into the following 4 types, according to the LIP classification system: lymphatic type (type-L), intestinal type (type-I), peritoneum type (type-P), and mixed type. The differences in medical cure rate, surgical cure rate, postoperative complication rate, and mortality between the patients were compared. The medical cure rate of type-P was the highest of all 4 types (91.7%). The intra-abdominal adhesion of type-I abdominal tuberculosis was milder than those of the other types; hence, laparoscopic surgery can be considered. The incidence of postoperative complications of the mixed type was the highest of the 4 types at 22.7%. The mortality rate of type-L was the highest of the 4 types at 20%. In total, 3 of the 4 deceased mixed patients were found to have L-type abdominal tuberculosis. There were significant differences in the cure rate, complication rate, and mortality rate among the 4 types. The χ2 values were 38.895, 8.253, and 8.601, respectively. The P values were < 0.001, 0.023, and 0.013, respectively. The LIP classification can guide the treatment of abdominal tuberculosis.

Corrigendum

European Management ReviewVolume 17, Issue 2 p. 593-593 CorrigendumFree Access Corrigendum This article corrects the following: Managers’ Corruption Prevention Efforts in Small and Medium-Sized Enterprises: An Exploration of Determinants Anna Werner, Tanja Rabl, Henning Best, Volume 16Issue 3European Management Review pages: 741-759 First Published online: March 25, 2018 First published: 07 May 2020 https://doi.org/10.1111/emre.12403AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In Werner et al. (2019), we regret to advise two errors that occurred in reporting our findings. First, the correct χ2 value for our alternative model 2 in Table 3 (page 751) should be 1279.18. Hence, the corrected Table 3 reads: Table 3. Structural models Model χ2 df χ2/df RMSEA CFI IFI Hypothesized model 4038.29 1841 2.19 0.06 0.76 0.77 Alternative model 1: No controls model 807.77 476 1.70 0.05 0.96 0.96 Alternative model 2: Only significant controls 1279.18 695 1.84 0.05 0.92 0.92 N = 339; RMSEA = root mean square error of approximation; CFI = comparative fit index; IFI = incremental fit index. Consequently, the results of the χ2 difference tests reported on page 749 in the section “Structural model” in the paragraph “Alternative model testing” also need correcting. Thus, the respective corrected paragraph on page 749 reads as follows: “We conducted χ2 difference tests for all models. The model with no control variables (Δ χ2 = 3230.52, Δ df = 1365, p < 0.01) and the model including only significant controls (Δ χ2 = 2759.11, Δ df = 1146, p < .01) both had a significantly better fit than the hypothesized model with all control variables.” Second, on page 749 in the section “Structural model” in the paragraph “Alternative model testing”, the model with significant controls was incorrectly reported as showing a better fit than the model without controls. However, the model without controls had the better fit. The reasoning for using the model including only significant controls to test the hypotheses lies in the theoretical relevance of the controls. Thus, the respective corrected paragraph on page 749 reads as follows: “The significant χ2 difference test contrasting the models without controls and with significant controls showed that the model without controls had the better fit (Δ χ2 = 471.41, Δ df = 219, p < 0.01). Nevertheless, the model including only significant controls (χ2 = 1279.18, df = 695, RMSEA = 0.05, CFI = 0.92, IFI = 0.92) was used to test the hypotheses due to the strong theoretical rational for assuming a relationship between the included controls and the study's variables (Bernerth and Aguinis, 2016) and since the model had an adequate fit. Following the recommendations of Becker et al. (2016), we also tested the model without controls as a robustness check, which showed no changes in the pattern and significance levels of the results”. To allow for maximum transparency, we would be willing to provide the raw data and our calculations to whomever requests them. The authors would like to apologize for the errors. References Becker, T. E., G. Atinc, J. A. Breaugh, K. D. Carlson, J. R. Edwards and P. E. Spector, 2016, “Statistical control in correlation studies: 10 essential recommendations for organizational researchers”. Journal of Organizational Behavior, 37: 157– 167. Bernerth, J. B. and H. Aguinis, 2016, “A critical review and best-practice recommendations for control variable usage”. Personnel Psychology, 69: 229– 283. Werner, A., T. Rabl, and H. Best, 2019, “Managers’ corruption prevention efforts in small and medium-sized enterprises: An exploration of determinants”. European Management Review, 16: 741– 759. https://doi.org/10.1111/emre.12165 Volume17, Issue2Summer 2020Pages 593-593 ReferencesRelatedInformation

Ultra-sonicated vacuum drying's effect on antioxidant activity, TPC, TFC and color of elephant apple slices

The use of ultrasound and vacuum to shorten the processing time and to improve the quality of elephant apple (Dillenia indica) slices during drying was investigated. Preliminary studies were done on the application of ultrasonic vacuum energy with elephant apple slices at different temperatures (40, 50, 60, 70 and 80 °C). The best results were obtained at 60 ± 12 °C. The values for DPPH radical scavenging activity, total phenolic content and total flavonoid content of dried samples were found as 50 ± 2 μ mol of TE/g, 31 ± 1 mg GAE/g and 12 ± 1 mg quercetin/g, respectively. The effect of ultrasonic vacuum drying (UVD) was compared with the slices dried using vacuum drying (VD) and tray drying (TD). The time required to dry elephant apple slices to final moisture content of ~8.5 ± 1% (db) was 930, 870 and 690 min for TD, VD and UVD, respectively. The drying kinetics of the elephant apple slices was tested using 9 thin-layer drying models. Among the mathematical models investigated, the two term exponential model satisfactorily described the drying behavior of elephant apple slices with high R2 (0.9971–0.9989) and low χ2 (0.00039–0.00056) values. UVD may be a useful non-thermal technology for drying elephant apple slices, which accelerates drying kinetics as well as improves the quality of the final product.

Harvest of at least 18 lymph nodes is associated with improved survival in patients with pN0 colon cancer: a retrospective cohort study.

To investigate the correlation between number of retrieved lymph nodes (rLNs) and prognosis and further ascertain the optimal number of rLNs with a beneficial survival impact in patients with pN0 colon cancer. The Surveillance, Epidemiology, and End Results (SEER) database was searched for pN0 colon cancer cases. X-Tile software and Kaplan-Meier survival analysis were applied to determine the optimal number of rLNs based on the minimal probability (P) value and the largest χ2 value. Univariate analyses and Cox proportional hazard regression model were used to investigate the relationship between rLN number and overall survival. Multiple analyses were conducted to assess the prognostic predictive ability of the identified optimal rLN cut-off value under different stratifications. Nomograms were established based on the independent prognostic factors selected by the multivariate analysis to predict 3- and 5-year overall survival rates of pN0 patients. A total of 6269 pN0 colon cancer patients who underwent surgical therapy were finally included for analysis. Harvest of at least 18 lymph nodes was determined as the optimal rLN number. This cut-off rLN value (< 18 versus ≥ 18) was identified as an independent prognostic factor (P < 0.001) of overall survival via multivariate analysis. Similar findings were obtained in patients with retrieval of at least 12 lymph nodes (18 > rLNs ≥ 12 versus rLNs ≥ 18) stratified into several groups. The number of rLNs was identified as an independent prognostic factor for pN0 colon cancer. Retrieval of at least 18 lymph nodes was associated with favorable prognosis in patients with pN0 colon cancer, and should, therefore, be regarded as an alternative cut-off value for survival analysis.

Nurse-led evidence-based nursing practice of reducing pulmonary complications among patients after thoracic surgery

Objective To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery. Methods A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 (χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant (t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence (χ2 value was 16.834-64.000, P<0.01). Patients′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant (χ2 value was 22.823, P<0.01). Patients′ satisfaction improved. Conclusions By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery. Key words: Nurse-led; Multidisciplinary team; Evidence-based nursing; Pulmonary complications

Application of Six Sigma management in reducing the misdiagnosis rate of acute abdomen pre-examination in emergency department

Objective To explore the effect of the Six Sigma management in reducing the pre-examination and triage error rate of emergency acute abdominal diseases. Methods Data of 367 misdiagnosed patients in Emergency Department of Shanxi Bethune Hospital from January to June 2018 were collected. Six Sigma management method was applied to the management of emergency acute abdomen triage. After analyzing the causes of errors, improvement measures were formulated and implemented.A total of 118 patients who were triaged from September 2018 to February 2019 were taken as the intervention group to evaluate the effect. Results After the implementation of Six Sigma management, the errors of acute abdomen diagnosis were significantly reduced from 9.92%(367/3 698) to 2.80%(118/4 219), and there was a significant difference before and after the implementation (χ2 value was 174.082, P < 0.05). Conclusions The application of Six Sigma management method can effectively reduce the misdiagnosis rate of emergency acute abdomen triage and realize standardized management of acute abdomen triage, which has the value of popularization and application. Key words: Six Sigma theory; Acute abdominal diseases; Emergency pre-examination and triage; Error rate

Intervention effect of three-line relaxation method on the fear of childbirth and pregnancy outcome in primipara

Objective To investigate the effect of three-line relaxation method on the fear of childbirth and pregnancy outcome in primipara, to explore the useful method to prevent childbirth fear of primipara. Methods A total of 94 cases of primipara who had regular prenatal care at Rizhao Maternal and Child Health Care Hospital from June 2017 to June 2018 were divided into study group and control group with 47 cases each by random number table method. Participants in the control group received routine nursing, while the study group carried out Lamaze respiratory delivery-based three-line relaxation method. The fear of childbirth was investigated by Wijma Delivery Expectancy Questionnaire (W-DEQ-A) before intervention, 4 weeks of intervention and before delivery, the anxiety was assessed by Pregnancy-Related Anxiety Questionnaire (PAQ). Meanwhile, the pregnancy and neonatal outcome was also compared between two groups. Results After 4 weeks of intervention and before delivery, the W-DEQ-A scores were (74.73±7.48) and (80.32±9.25) points in the study group, lower than in the control group (83.11±12.19) and (87.11±10.22) pionts; the PAQ scores were (20.79±4.04) and (18.68±4.09) points, also lower than in the control group (24.74±4.69) and (23.22±4.11) points, the difference was statistically significant (t value was 3.301-5.246, P<0.01). The duration of labor and the rate of caesarean section were (11.66±3.71) h, 6.82% (3/44) and (15.39±4.27) h, 21.74% (10/46) in the study group and control group, respectively, the difference was statistically significant (t value was 4.417, χ2 value was 4.051, P<0.01 or 0.05). Conclusions Lamaze respiratory delivery-based three-line relaxation method can reduce anxiety and childbirth fear and improve pregnancy outcome of primipara, which is worthy of popularization and application. Key words: Three-line relaxation method; Lamaze respiratory care; Fear of childbirth; Pregnancy outcome; Primipara

Effect of acupoint massage combined with high frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life

Objective To investigate the effects of acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life. Methods A total of 169 patients with post-stroke depression who were admitted to the Department of Neurological Intensive Care Unit of Zhengzhou University First Affiliated Hospital from June 2017 to June 2019 were selected as the research subjects. The patients were divided into observation group (85 cases) and control group (84 cases) by random number table method. The control group was treated with high frequency repetitive transcranial magnetic stimulation, and the observation group was treated with high frequency repetitive transcranial magnetic stimulation combined with acupoint massage, high frequency repetitive transcranial magnetic stimulation 5 times a week, 28 minutes each time, 8 weeks of intervention, acupoint massage once a day, 1-2 minutes each acupoint, 8 weeks of intervention. The state of depression and the improvement of quality of life were observed, and the adverse reactions were recorded. Results The total effective rate of depressive symptoms improvement in the observation group was 83.53% (71/85), which was higher than that of the control group 70.24% (59/84), the difference was statistically significant (χ2 value was 4.204, P 0.05). Conclusions Acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation has a effective in the treatment of post-stroke depression, which can significantly improve the depression status and quality of life. Key words: Acupoint massage; High frequency repetitive transcranial magnetic needling; Stroke; Depression; Quality of life

Effects of warming carbon dioxide pneumoperitoneum on the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot

Objective To study the effect of heated carbon dioxide pneumoperitoneum on the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot. Methods A total of 307 patients who underwent pancreaticoduodenectomy by Da Vinci robot from January 2016 to December 2018 were selected as subjects. 140 patients who underwent pancreaticoduodenectomy from January 2016 to April 2017 were selected as the control group, and room temperature carbon dioxide pneumoperitoneum was used. From May 2017 to December 2018, 167 patients were set as the intervention group, and heated carbon dioxide pneumoperitoneum was used. Body temperature, heart rate and blood oxygen saturation of the two groups were compared after entering the operating room, before anesthesia, before the establishment of carbon dioxide pneumoperitoneum and after the closure of carbon dioxide pneumoperitoneum, and the duration of operation, intraoperative blood loss, postoperative anesthesia recovery time, hospitalization time and postoperative complication rate were recorded. Results There was no significant difference in body temperature after entering the operating room, before the establishment of carbon dioxide pneumoperitoneum between the two groups (P>0.05). After the closure of carbon dioxide pneumoperitoneum, the decline range of the body temperature of the control group was(1.24±2.36) ℃, which was significantly higher than that of the intervention group (0.60±0.25) ℃, and the difference was statistically significant (t value was 6.892, P 0.05). The intraoperative blood loss, resuscitation time, drainage time was (291.08±265.42) ml, (27.04±10.89) min, (8.69±6.64) d in the intervention group and (364.29±309.28) ml, (32.60±12.17) min, (10.76±6.25) d in the control group, and the difference was statistically significant (t value was 2.232, 7.294, 2.789, P<0.05 or 0.01). There was statistically significant difference in The incidence of pancreatic fistula and biliary fistula, and length of hospital stay was 20 cases, 7 cases, (27.62±17.30) d in the intervention group, and 31 cases, 15 cases, (32.38±12.22) d in the control group, and the difference was statistically significant (χ2 value was 4.653, 4.870, t value was 6.284, P<0.05). Conclusions Warming carbon dioxide pneumoperitoneum can reduce the incidence of perioperative hypothermia and improve the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot. Key words: Warming carbon dioxide pneumoperitoneum; Da Vinci robot; Pancreaticod-uodenectomy; Prognosis; Hypothermia

Modeling Non‐Force‐Free and Deformed Flux Ropes in Titan's Ionosphere

AbstractPrevious work at Titan presented a set of 85 flux ropes detected during Cassini flybys of Titan from 2005 to 2017. In that study a force‐free model was used to determine the radii and axial magnetic field of the flux ropes. In this work we apply non‐force‐free models. The non‐force‐free model shows an improvement in the number of flux ropes that can be fitted with a model, along with improved uncertainties and χ2 values. A number of asymmetries and features in the magnetometer data cannot be reproduced by either model; therefore, we deform the force‐free model to show that small deformations can replicate these features. One such deformation is to use an elliptical cross section, which replicates a plateau in magnetic field strength along with asymmetries on either side of the center of the flux ropes. Additionally, we explore the properties of bending a flux rope, where we find that minimum variance analysis becomes increasingly degenerate with bending, along with a slight bend causing the switching of the axial field direction from intermediate to maximum variance direction. We conclude that the flux ropes at Titan show aspects of developing flux ropes, compared to other planetary bodies, which exhibit more agreement to the force‐free assumptions of mature flux ropes.

The impact of paediatric dose range checking software

ObjectiveDosing errors can cause significant harm in paediatric healthcare settings. Our objective was to investigate the effects of paediatric dose range checking (DRC) clinical decision support (CDS) software on overdosing-related...

Prognostic value of 18F-FDG PET/CT imaging and related factors for patients with classic Hodgkin lymphoma before or after autologous stem cell transplantation

Objective To assess the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and relevant factors in the prognosis of patients with classic Hodgkin lymphoma (cHL) before or after autologous stem cell transplantation (ASCT). Methods From January 2008 to June 2017, 55 cHL patients (28 males, 27 females; age: (28.8±9.6) years) confirmed by pathology in Shanghai General Hospital were retrospectively included. 18F-FDG PET/CT imaging was performed before ASCT in 43 cases and after ASCT in 34 cases (22 patients underwent the imaging both before and after ASCT). Patients were divided into positive group (≥4) and negative group (<4) according to 18F-FDG PET/CT imaging results using Deauville 5-point scale. The predictive value of relevant factors in the prognosis was evaluated with progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis and log-rank test. Hazard ratio (HR) was calculated by Cox regression model. Results Of 55 cHL patients, 29 (53%) had a progression of disease after a median follow-up of 8 months, and 11 (20%) patients died after a median follow-up of 29.5 months, with the 3-year PFS rate of 46.4% and OS rate of 84.5%. Significant differences of PFS rate were found between patients with or without B symptoms, between patients with or without large mediastinal mass, between patients with international prognostic score (IPS) of 0-2 and those with IPS of 3-7, among patients with different effect of salvage chemotherapy (complete remission (CR), partial remission (PR) + stable disease (SD), progressive disease (PD)), and between patients with negative or positive PET/CT imaging results before or after ASCT (χ2 values: 5.52-20.01, HR: 2.21(95% CI: 1.56-3.12)-5.51(95% CI: 1.86-16.33), all P<0.05). B symptoms and large mediastinal mass were also prognostic factors for OS rate (HR: 5.28(95% CI: 1.14-24.51) and 4.27(95% CI: 1.24-14.79), both P<0.05). The combination of 18F-FDG PET/CT imaging before and after ASCT was statistically significant for predicting PFS (χ2=11.28, P<0.01). Multivariate survival analysis showed that the risk of progression in patients with positive PET/CT results after ASCT was significantly higher than those with negative results (HR=6.20, P<0.01), and the risk of death in patients with B symptoms was significantly higher than those without B symptoms (HR=5.28, P<0.05). Conclusion 18F-FDG PET/CT imaging results after ASCT have important values for predicting PFS in cHL patients after ASCT, and B symptoms can be used as an important prognostic indicator of OS after ASCT. Key words: Lymphoma; Stem Cells; Transplantation, autologous; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Kinetic and thermodynamic studies on biosorption of Cr(VI) on raw and chemically modified Datura stramonium fruit.

Biosorption of Cr(VI) on sulfuric and phosphoric acid-treated Datura stramonium fruit was investigated in batch mode. The various parameters that influence the biosorption process such as Cr(VI) initial concentration, biosorbent dosage, contact time, temperature, and pH value were optimized. Both linear and non-linear regression analysis of isotherm data suggest that Langmuir isotherm model mimics the behavior of Cr(VI) ion biosorption onto Datura stramonium fruit biosorbent. The maximum Cr(VI) ions adsorption capacity of 138.074mg/g at pH 2 is achieved with phosphoric acid treated Datura stramonium (PDSF). The kinetics of adsorption process is well described by pseudo-second-order model with high R2 and low χ2 value. The estimated activation energy of < 8kJ/mol obtained for both raw and chemically modified adsorbents suggests that the adsorption occurs mainly via physisorption. Besides, thermodynamic results reveal that biosorption of Cr(VI) on both treated and untreated Datura stramonium was endothermic, spontaneous, and randomness in nature.

Application effect of an ultrasound probe fixation bracket assisted ultrasound-guided venipuncture in difficult intravenous access

Objective To observe the effect of ultrasound probe fixation bracket assisted ultrasound-guided venipuncture in difficult intravenous access. Methods A total of 105 inpatients with difficult intravenous access from November 2017 to May 2019 were selected by convenient sampling method. From November 2017 to May 2018, 39 patients as the control group were treated with ultrasound-guided peripheral venous indwelling needle puncture technique. From June 2018 to May 2019, 66 patients as the experimental group were treated with ultrasound probe fixation bracket assisted ultrasound-guided peripheral vein indwelling needle puncture technique. The success rate of one needle puncture, the times of puncture and the degree of pain were compared between the two groups. Results The success rate of one needle puncture was 92.4% (61/66) in the experimental group and 66.7% (26/39) in the control group (χ2 value was 11.450, P<0.01); The puncture times in the experimental group and the control group were 1.08±0.27 and 1.44 ±0.72, and the difference was statistically significant (Z value was -3.435, P<0.01). The pain scores of the experimental group and the control group were 2.00 ± 0.95 and 3.08±1.37, and the difference was statistically significant (Z value was -4.159, P<0.01). Conclusions The application of ultrasound probe fixation bracket assisted ultrasound-guided peripheral venipuncture technique in patients with difficult intravenous access can improve the success rate of one needle puncture, reduce the number of puncture and reduce the degree of pain. Key words: Ultrasound-guided; Peripheral vein; Indwelling needle; Vascular grading; Difficult intravenous access

Nursing effect of central venous catheter combined with empathy nursing on AIDS patients

Objective To analyze the nursing effect of central venous catheter (CVC) infusion combined with empathy nursing on AIDS patients. Methods A total of 129 AIDS patients who were hospitalized for infusion at Beijing You'an Hospital, Capital Medical University from June 2014 to June 2016 were selected as the control group. Another 129 AIDS patients from August 2016 to August 2018 were selected as the observation group. The control group was given ordinary infusion needle infusion and conventional psychological nursing, and the observation group was given CVC infusion combined with empathic nursing. The clinical nursing effect of the two groups of patients was analyzed. Results The infusion fluency rate, vascular damage rate, nurse puncture rate, and occupational exposure rate in the observation group were 91.47% (118/129), 10.85% (14/129), 0, 0, and the control group was 82.94% (107/129), 20.93% (27/129), 6.20% (8/129), 6.20% (8/129), the difference between the two groups was statistically significant (χ2 values were 4.188-8.224, P <0.05 or 0.01). After 3 months of intervention, the anxiety and depression (Self-rating Anxiely Scale/Self-rating Depression Scale) scores of the observation group were 47.87 ± 5.43 and 45.02 ± 5.61, which were significantly lower than the control group, which were 51.15 ±6.97 and 49.11 ± 6.48. The difference was statistically significant (t values were 3.320, 4.268, P <0.01). After 3 months of intervention, the treatment compliance rate in the observation group was 92.24% (119/129), which was significantly higher than 83.72% (108/129) in the control group, and the difference was statistically significant (t value was 4.419, P <0.05). After 3 months of intervention, the CD4+ T lymph count and HIV viral load in the observation group were (378.25 ± 49.04)/μl, (2.86 ± 0.53) igIU/ml, and the control group were (342.17 ± 43.47)/μl, (3.13 ± 0.66) igIU/ml, the improvement effect of the observation group was significantly better than that of the control group (t values were 3.559, 2.853, P <0.01). Conclusion CVC infusion combined with empathic nursing can significantly improve the anxiety and depression of AIDS patients, improve treatment compliance and infusion fluency, reduce vascular damage rate, related infection rate, nurse puncture rate and occupational exposure rate, and good nursing effect. Key words: AIDS; Empathy care; Central venous catheter; Compliance; Anxiety depression

Application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis

Objective To explore the application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis. Methods From October 2017 to February 2019, 53 patients with hepatic cystic echinococcosis who met the inclusion criteria were selected as the control group. Another 53 patients from June 2018 to January 2019 were collected as the experimental group, the nutritional index, liver function, complication rate and postoperative recovery were compared between the two groups. Results The levels of retinol-binding protein, prealbumin and transferrin were (24.32 ± 3.76) μg/L, (167.00 ± 24.12) mg/L, (2.08 ± 0.43) μg/L on the day of admission in the experimental group, and one day before the operation were (27.78± 4.98) μg/L, (245.00 ± 22.02) mg/L,(2.47 ± 0.54)μ g/L, there was no significant difference (t=0.576-3.552, P < 0.05). The incidence of infection, biliary leakage and hemorrhage in the experimental group were 0, 1.89% (1/53) and 0 respectively, which were lower than 9.43% (5/53), 13.21% (7/53), 11.32% (6/53) in the control group (χ2 value was 4.867, P < 0.05). The aspartate aminotransferase and alanine aminotransferase of the experimental group on the 7th day after operation were (51.50 ± 6.30), (29.54 ± 2.03) U/L, which were significantly different from (69.53 ± 7.07), (43.72±3.67) U/L of the control group (t value was 2.032, 2.015, P<0.05). Anal exhaust, defecation time, hospitalization time and expenses in the experimental group were (15.89±8.34) h, (49.12±10.56) h, (8.69 ± 1.69) d, (2.84±1.37) thousand yuan, which were significantly different from (34.13±7.13) h, (63.45±11.03) h, (11.51±4.18) d, (3.76±1.53) thousand yuan in the control group. There was statistical significance (t values were 3.372-12.592, P<0.05). Conclusions The application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis can improve the nutritional status of patients during perioperative period, promote the recovery of liver function and reduce the occurrence of postoperative complications. Key words: Hepatic cystic echinococcosis; Perioperative period; Nutrition management

Prospective cohort study of the effects of motor cognitive risk syndrome on fractures after falls

Objective To investigate the risk factors of elderly, sports cognitive risk syndrome falling, repeated falls and fractures after falls. Methods A total of 3 552 people were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from April 2015 to April 2016. The demographics of each selected individual were recorded. The selected individuals were assessed by MMSE for the presence of Subjective Cognitive Complaint (SCC), and the pace was used to assess whether there was slow walking and whether there was MCR (SCC + slow walking). All individuals were divided into MCR group and non-MCR group according to the evaluation results. The non-MCR group was subdivided into SCC subgroup, slow speed walking subgroup and healthy subgroup. Baseline variables were compared between the two groups, and demographics between subgroups, subgroups, and MCR groups were compared. Follow-up was followed every 4 months for a total of 2 years. The number of people who fell during the follow-up period, repeated falls, and fractures were recorded. With all demographics and SCC, walking at a slower pace, MCR was an independent variable, with a fall during follow-up, repeated falls and post-fall fractures as dependent variables, and a COX proportional hazard regression model of independent and dependent variables. Results The proportions of the MCR group in higher education, depression, the use of crutches were 10.2% (36/352), 22.4% (79/352), 44.9% (158/352), the BMI, number of medications in the MCR group were (27.0 ± 4.3) kg/m2, (6.8±3.2), the proportions of non-MCR group in higher education, depression, using crutches ratio were 22.9% (732/3 200), 12.8% (409/3 200), 22.8% (729 /3 200), the BMI, number of medications of non-MCR group were (24.8 ± 3.8) kg/m2, (5.2 ± 3.1), the two groups showed statistical significant difference(χ2 values were 29.93, 3.45, 24.98, t values were 12.34, 82.71, P<0.05). The proportions of higher education, depression and crutches were 18.9% (289/1531), 13.2% (202 /1531) and 22.5% (344/1531) in SCC subgroup. The difference between MCR group and SCC subgroup was statistically significant (χ2 values were 14.99, 19.28, 73.56, P<0.05). The higher education level of the slow walking group was 16.6% (34/205), which was significantly different from that of the MCR group (χ2 value was 4.77, P<0.05). The proportions of higher education level, arthritis, depression and crutches in the healthy subgroup were 27.9% (409/1 464), 12.9 (190/1 464), 11.2% (164/1 464) and 19.7% (288/1 464), while that in the SCC subgroup were 18.9% (289/1 531), 16.2 (248/1 531), 13.2% (202/1 531) and 22.5% (344/1 531), and that in the slow walking subgroup were 16.6% (34/205), 21.5% (44/205), 20.9 (43/205) and 47.3% (97/205). There were significant differences among the three subgroups (χ2 values were 13.08-78.28, P<0.05). BMI and number of drugs in healthy subgroups were (23.4±4.4) kg/m2 and (4.7±2.8) , SCC group was (25.2±4.3) kg/m2 and (5.1±2.9) kinds, and slow walking subgroup were (25.1±3.8) kg/m2 and (6.7±3.1) kinds. The differences among the three subgroups were statistically significant (t values were 2.68,7.21, P<0.05). The risks of falling, repeated falling and fracture after falling in MCR patients were 1.22, 1.47 and 2.54 (P<0.05). Conclusions Age, MCR is a high risk factor for falls in the elderly, repeated falls and fractures after falls. In clinical care, MCR needs to be evaluated and attention should be payed to the elderly. Key words: Cognitive impairment; Fall; Post-fall fracture; Cohort study; Elderly

Effect of chin-down-plus-larynx-tightening maneuver on improving choking cough and swallowing function in patients after esophageal cancer surgery

Objective To explore the effect of Chin-down-plus-larynx-tightening maneuver on improving choking cough and swallowing function in patients after esophageal cancer surgery. Methods A total of 121 patients with esophageal cancer surgery had been randomly divided into control group and observation group from November 2018 to September 2019. Starting from feeding after surgery, the head and neck were in normal habits when swallowing in the control group, and the observation group used Chin-down-plus-larynx-tightening maneuver to perform swallowing training. The feeding process of two groups was observed and recorded for one week. One week after eating, the water swallowing test and M. D. Anderson Symptom Inventory for Gastrointestinal cancer (MDASI-GI) were used to evaluate the difference of swallowing function and gastrointestinal symptoms between the two groups. Results During one week period of feeding, the incidence of choking cough in observation group was 3.39%, (2/59), which was significantly lower than that in the control group (14.52%, 9/62)(χ2 value was 4.53, P=0.033). After one week of feeding, the swallowing function showed significant difference (Z value was 6.07, P=0.014), the gastrointestinal symptoms and the degree of life interference caused by gastrointestinal symptoms of observation group scored 2.57 ± 0.81, 1.76 ± 0.84, lower than those of the control group (4.25 ± 1.54, 2.18 ± 1.24), and the difference was statistically significant(t values were -7.56, -2.17, P<0.05). Conclusions The Chin-down-plus-larynx-tightening maneuver can promote recovery of postoperative swallowing function in patients with esophageal cancer, reduce the incidence of choking cough, and help reduce the symptoms of digestive tract, and then raise the level of patient′s clinical prognosis. Key words: Chin-down-plus-larynx-tightening maneuver; Esophageal cancer; Choking cough; Swallowing function

The effect of different green alkali modification processes on the clinoptilolite surface as adsorbent for ammonium ions; characterization and application

Abstract Clinoptilolite natural zeolite was modified by different alkali bearing salts (K, Na, Ca, and Mg) by a green process in the presence of green tea extract as promising green adsorbents for ammonium ions. The modified products displayed significant enhancement in the ion exchange capacities, the surface area, and the morphological properties which was supported by different characterization techniques. The novel modified products achieved stunning adsorption capacities for ammonium ions with experimental qmax of 162 mg/g, 190 mg/g, 230 mg/g and 296 mg/g for K/clinoptilolite, Na/clinoptilolite, Ca/clinoptilolite, and Mg/clinoptilolite, respectively. The theoretical values which were obtained from the equilibrium model are 197.5 mg/g, 219.7 mg/g, 256.2 mg/g, and 340 mg/g for the same products in the order. The adsorption systems of all the prepared adsorbents are highly fitted with both the Pseudo-First order and Pseudo-Second order model with preferences for the first model. Additionally, the uptake of ammonium ions by them is of a monolayer form and of higher fitting with the Langmuir model than the other models considering the correlation coefficient and Chi-squared (χ2) values. The theoretical adsorption energies of K/Clinoptilolite (0.64 kJ/mol), Na/Clinoptilolite (0.76 kJ/mol), Ca/Clinoptilolite (0.9 kJ/mol), and Mg/Clinoptilolite (0.81 kJ/mol) signify physisorption mechanism close to the values of zeolite ion exchange process or coulumbic attractive forces. The modified clinoptilolite products are of high reusability values and applied effectively in the purification of real groundwater and sewage water.