[Quality assessment indictors and benchmarks for pancreatic surgery].

Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.

[Diagnosis and treatment of blunt high-grade pancreatic trauma].

The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.

[Summary of the 2021 Annual Academic Conference of the Chinese Burn Association].

Organized by the Chinese Medical Association and the Chinese Burn Association, hosted by the Hainan Medical Association and Hainan Provincial People's Hospital, and co-sponsored by the Chinese Journal of Burns (Chinese Journal of Burns and Wounds), Chinese Journal of Injury Repair and Wound Healing (Electronic Edition), and Burns & Trauma, the 2021 Annual Academic Conference of the Chinese Burn Association was held in beautiful Haikou from December 14 to 16, 2021. The conference continued to focus on the guiding principle of "One China, One Standard" and followed the tenet of "precise, homogeneous, and comfortable treatment" for burns. The conference received a total of 1 638 submissions, 296 electronic posters, 891 online and offline registered delegates, and nearly 750 offline attendees. The conference focused on the theme, adopting a variety of novel forms to discuss the key issues in burn field, including academician and committee director forum, doctor-nurse-rehabilitation therapist combined case competition, discipline development forum, and workshop, recording and broadcasting of surgical operations. The atmosphere was warm in the conference site.

[Application experience of integrated nursing mode for extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident].

Objective: To explore the application experience of integrated nursing mode in the treatment of extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 35 extremely severe burn patients involved in the August 2nd Kunshan factory aluminum dust explosion accident were admitted to Wuxi Third People's Hospital, including 18 males and 17 females, aged 21-50 years. According to the characteristics of the wounded, the situation of the nursing staff, and the characteristics of the nursing work, the integrated nursing mode was constructed and implemented to improve overall nursing quality. The standardized management measures such as cluster management of facilities and equipments in wards, improving and unifying nursing system, standardized training, drawing up " Nurses Compulsory Reading" , optimizing nursing shift handover and so on were taken. Professional quality control groups such as continuous renal replacement therapy (CRRT) group, static therapy group, airway group, and burn group were established, and standardized writing nursing group, wound nursing group, psychological nursing group, and enteral nutrition nursing group were set up under burn group. The treatment outcomes of patients and effects of nursing management, nursing methods, and specialty nursing were recorded. Results: Twenty-seven patients survived the shock period, infection period, and recovery period smoothly. The success rate of rescue was 77.14%. During the treatment, the ward was in good order. The implementation rate of disinfection and isolation system, the completion rate of shift handover, the standard rate of intravenous therapy, the implementation rate of bed head elevation, the correct rate of posture placement, and the success rate of CRRT were all 100%. Successful turn over of rotating bed without interruption of CRRT for 24 hours was implemented in two patients. In many cases, the single filter for hemodialysis continuously run for more than 72 hours. The airway mucosa of patients healed around 20 days after injury. No adverse nursing events such as tracheal cannula detachment/blockage, respiratory distress, atelectasis, lung consolidation, aspiration by mistake, rotating bed rollover, ear chondritis, nasal septal pressure ulcer, vacuum sealing drainage (VSD) catheter blockage, VSD dressing leakage, severe abdominal distension/diarrhea, non-planned extubation/blockage of various intravenous treatment catheters implanted into deep veins and arteries were observed. Conclusions: The integrated nursing mode significantly optimizes the nursing work process in the treatment of extremely severe mass burns, clarifies the duties of nursing staff, and improves the quality of nursing. This mode is worthy of taking reference by other burn treatment units.

[Nursing human resource management in the early phase of treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident].

In August 2nd Kunshan factory aluminum dust explosion accident 2014, 35 severe mass burn patients were admitted to our hospital, including 18 men and 17 women, aged 21 to 50 (38±9) years. Their severe injuries caused much difficulty to the treatment. In the early period of treatment, a series of measures of nursing human resource management were implemented, such as carrying out training program for non-burn speciality nurses of different levels and origin, grouping and task-dividing, organizing work schedule and assigning in a unified way, and establishing monitoring team of speciality quality. Except for 2 cases of deaths in the early period, the other 33 patients were treated and nursed timely and effectively in the early period. The rescue rate arrived at 94.3% (33/35) on the 17th day post burn. In this period, no such nursing adverse event and complication occurred as bed-dropping, unplanned extubation, coagulation in veins of lower limb, catheter-related infection, or cross infection.

[Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury].

Objective: To explore and analyze the effects of airway management team (AMT) in the treatment of severely mass burn patients combined with inhalation injury. Methods: The clinical data of 58 severely burned patients combined with inhalation injury hospitalized in our unit from January 2012 to August 2014, conforming to the inclusion criteria, were retrospectively analyzed. According to whether airway management was implemented by AMT or not, patients hospitalized from January 2012 to July 2014 were divided into control group (n=27), while patients in Kunshan factory aluminum dust explosion accident hospitalized on 2nd August 2014 were divided into observation group (n=31). Patients in control group received regular airway nursing carried out by nurses on duty, while patients in observation group received specialized airway concentration nursing implemented by AMT. The concrete implementation included overall assessment of patients' airway, elaborate airway care, and controlled management of mechanical ventilation. Arterial blood gas indexes and oxygenation index of patients in the two groups on post injury day (PID) 1, 7, and 14 were compared. Sputum viscosity, ventilator-associated pneumonia (VAP) occurrence rate, and ventilation time of patients in the two groups in post injury week(s) 1, 2, and 3 after admission were monitored and recorded. Survival rates of patients in the two groups were compared. Data were processed with analysis of variance for repeated measurement, t test and Bonferroni correction, chi-square test, and Wilcoxon rank sum test. Results: (1) There were no statistically significant differences in pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), and oxygenation index of patients in the two groups on PID 1 (t=0.595, -0.166, 1.518, -0.828, 0.458, P>0.05). The pH values of patients in observation group on PID 7 and 14 were 7.327±0.050 and 7.367±0.043, respectively, significantly better than those in control group (7.304±0.021 and 7.390±0.029, respectively, t=-2.385, 2.391, P<0.05). The PaO(2) values of patients in observation group on PID 7 and 14 were (95.1±6.7) and (106.3±7.8) mmHg (1 mmHg=0.133 kPa), respectively, significantly higher than those in control group [(91.6±5.7) and (102.0±8.3) mmHg, respectively, t=-2.109, -2.059, P<0.05]. The PaCO(2) values of patients in observation group on PID 7 and 14 were (41±4) and (40±4) mmHg, respectively, significantly lower than those in control group [(43±5) and (43±4) mmHg, respectively, t=2.220, 2.304, P<0.05]. The SaO(2) values of patients in observation group on PID 7 and 14 were 0.95±0.04 and 0.96±0.04, respectively, significantly higher than those in control group (0.93±0.05 and 0.94±0.05, respectively, t=-2.201, -2.016, P<0.05). The oxygenation indexes of patients in observation group on PID 7 and 14 were (286±18) and (329±20) mmHg, significantly higher than those in control group [(277±14) and (306±58) mmHg, respectively, t=-2.263, -2.022, P<0.05]. (2) Sputum viscosity of patients in observation group in post injury week(s) 1, 2, and 3 were superior to that in control group (Z=-2.096, -2.076, -2.033, P<0.05). (3) VAP occurrence rate of patients in observation group was lower than that in control group, and time of mechanical ventilation of patients in observation group was shorter than that in control group (χ(2)=4.244, t=2.425, P<0.05). (4) Survival rate of patients in observation group was higher than that in control group (χ(2)=4.244, P<0.05). Conclusions: The special intensive care of airway management by AMT can effectively improve the oxygenation status of severely burned patients combined with inhalation injury, alleviate the sputum viscosity, reduce the occurrence of VAP, and shorten the time of mechanical ventilation, thus benefits the treatment of severely mass burn patients combined with inhalation injury.

The polymorphism analysis of CD169 and CD163 related with the risk of porcine reproductive and respiratory syndrome virus (PRRSV) infection.

Porcine reproductive and respiratory syndrome virus (PRRSV) could infect porcine alveolar macrophages (PAM), and the CD169 and CD163 are identified as critical receptors on the surface of PAM, but whether the single nucleotide polymorphisms (SNPs) of these genes could influence the infection is remain unclear. In this study, we identified totally 6 SNPs for CD169 (G1640T, C1654A, C4175T) and CD163 (G2277A, A2552G and C2700A), and evaluated their associations with PRRSV infection using two classified methods in a 524 pig population to investigate the effects of mutations on the PRRSV receptors. The pigs with genotypes of AA of CD169-C1654A, CT of CD169-C4175T and AA of CD163-A2552G appeared to resistant to the PRRSV infection by the combination of two classified results. The results provided fundamental molecular investigation to promote pig breeding with disease resistance. However, the identification of functional changes induced by SNPs and molecular mechanism were need further research.