Peripherally inserted central catheters (PICC) in patients with mediastinal tumor under upper limb

Objective:To analyse the various surgery programs on patients with mediastinal tumor who accept PICC catheter under upper limb, and disscussing the methods of nursing care.Methods:A total of 10 cases, including the surgery programs, postoperative nursing and complications prevention, were retrospectively analyzed that patients with mediastinum tumor accept PICC catheter in upper limbs.Results: 10 cases of PICC catheter, including 4 cases of left upper limb and 6 cases of right upper limb with PICC, were completed successfully with complete preoperative assessment, preoperative discussion and preparation, closely monitoring patients during operation, good doctor-nurse cooperation, and seasoned operators. After careful nursing, all patients have completed chemotherapy successfully, whose tube indwelling time from 3 to 12 months,without unscheduled extubation.Conclution: Patients with mediastinum tumor should be comprehensively assessed by colour-Doppler ultrasound in upper limbs and the chest CT, which helping to check the size and compression degree of tumors, in addition to the regular preoperative evaluation of PICC. The PICC operations in upper limbs should be made by seasoned operators as well as good doctor-nurse cooperation, closely monitoring patients during operation and careful postoperative nursing.

Effect of modified puncture method on catheter-related bloodstream infection after PICC catheterization in patients with tumor

Objective: To explore the preventive effect of modified puncture method on catheter-related bloodstream infection after PICC catheterization in patients with tumor. Methods: A total of 95 cases of tumor admitted to our hospital from February 2015 to February 2017 were selected according to the order of admission, divided into the study group (n=47) and the control group (n=48). In the control group, the traditional blind catheterization was carried out, and the research group improved the puncture method. The rate of puncture success (onetime puncture success rate, total success rate), puncture time and complication rate were compared between the two groups. Results: The total success rate (77.1%) of the study group (97.9%) was significantly higher than control group, The puncture time of the study group was significantly shorter than control group. Incidence of complications in the study group (4.3%) was significantly lower than that in the control group (22.9%). Conclusions: The improved puncture method can significantly reduce the incidence of complications after PICC catheterization, shorten the puncture time and improve the success rate of puncture, which is worthy of reference and promotion.

Correlation of tumor-associated macrophage density and proportion of M2 subtypes with the pathological stage of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent global malignancy with complex prognostic factors.Tumor-associated macrophages(TAMs)have shown paradoxical associations with CRC survival,particularly concerning the M2 subset.AIM We aimed to establish a simplified protocol for quantifying M2-like TAMs and explore their correlation with clinicopathological factors.METHODS A cross-sectional study included histopathological assessment of paraffinembedded tissue blocks obtained from 43 CRC patients.Using CD68 and CD163 immunohistochemistry,we quantified TAMs in tumor stroma and front,focusing on M2 proportion.Demographic,histopathological,and clinical parameters were collected.RESULTS TAM density was significantly higher at the tumor front,with the M2 proportion three times greater in both zones.The tumor front had a higher M2 proportion,which correlated significantly with advanced tumor stage(P=0.04),pathological nodal involvement(P=0.04),and lymphovascular invasion(LVI,P=0.01).However,no significant association was found between the M2 proportion in the tumor stroma and clinicopathological factors.CONCLUSION Our study introduces a simplified protocol for quantifying M2-like TAMs in CRC tissue samples.We demonstrated a significant correlation between an increased M2 proportion at the tumor front and advanced tumor stage,nodal involvement,and LVI.This suggests that M2-like TAMs might serve as potential indicators of disease progression in CRC,warranting further investigation and potential clinical application.

Extragastrointestinal stromal tumors with diffuse membranous distribution with bleeding:A case report

BACKGROUND Extragastrointestinal stromal tumors(EGIST)and gastrointestinal stromal tumors are of similar pathological type and form.Here we report a rare case of EGIST diffusely distributed in membranous tissue in abdominal cavity,the feature of which included diffuse tumors at membranous tissue in entire abdominal cavity and spontaneous bleeding of the tumors.CASE SUMMARY The patient was a 71-year man and hospitalized due to continuous pain at lower abdomen for more than 10 days.Upon physical examination,the patient had flat and tough abdomen with mild pressing pain at lower abdomen,no obvious abdominal mass was touchable,and shifting dullness was positive.Positron emission tomography-computed tomography(CT)showed that in his peritoneal cavity,there were multiple nodules of various sizes,seroperitoneum,multiple enlarged lymph nodes in abdominal/pelvic cavity and right external ilium as well as pulmonary nodules.Plain CT scanning at epigastrium/hypogastrium/pelvic cavity+enhanced three-dimensional reconstruction revealed multiple soft tissue nodules in abdominal/pelvic cavity,peritoneum and right groin.Tumor marker of carbohydrate antigen 125 was 808 U/mL,diffuse tuberous tumor was seen in abdominal/pelvic cavity during operation with hematocelia,and postoperative pathological examination confirmed EGIST.Imatinib was administered with better therapeutic effect.CONCLUSION Gene testing showed breast cancer susceptibility gene 1 interacting protein C-terminal helicase 1 and KIT genovariation,and the patient was treated with imatinib follow-up visit found that his clinical symptoms disappeared and the tumor load alleviated obviously via imageological examination.

课程思政在PICC专业技术培训中的应用

目的探究课程思政在经外周静脉穿刺中心静脉置管(PICC)专业技术培训中的应用效果。方法以2022年初级PICC国际认证培训班两期的80位学员为研究对象,其中第1期5-8月学员应用传统教学模式;第2期9-12月学员应用课程思政教学模式,在传统教学模式的基础上,将收集到的课程思政素材融入各个教学环节中,培训结束后进行教学评价。结果观察组考核成绩得分(86.58±2.61)分、自我导向学习能力得分(223.83±6.74)分、教学效果评价和满意度均优于对照组,差异有统计学意义(P<0.05)。结论在PICC专业技术培训中,课程思政教学模式优于传统教学模式,课程思政提高了PICC专科护士的学习效率、职业素养及学习满意度,促进了知识传授与价值引领的有机统一。

New roles of tumor-derived exosomes in tumor microenvironment

Throughout tumorigenesis, the co-evolution of tumor cells and their surrounding microenvironment leads to the development of malignant phenotypes. Cellular communication within the tumor microenvironment(TME) plays a critical role in influencing various aspects of tumor progression, including invasion and metastasis. The release of exosomes, a type of extracellular vesicle, by most cell types in the body, is an essential mediator of intercellular communication. A growing body of research indicates that tumor-derived exosomes(TDEs) significantly expedite tumor progression through multiple mechanisms, inducing epithelial-mesenchymal transition and macrophage polarization, enhancing angiogenesis, and aiding in the immune evasion of tumor cells. Herein, we describe the formation and characteristics of the TME, and summarize the contents of TDEs and their diverse functions in modulating tumor development. Furthermore, we explore potential applications of TDEs in tumor diagnosis and treatment.

Tumor microenvironment reprogramming by nanomedicine to enhance the effect of tumor immunotherapy

With the rapid development of the fields of tumor biology and immunology, tumor immunotherapy has been used in clinical practice and has demonstrated significant therapeutic potential, particularly for treating tumors that do not respond to standard treatment options. Despite its advances, immunotherapy still has limitations, such as poor clinical response rates and differences in individual patient responses, largely because tumor tissues have strong immunosuppressive microenvironments. Many tumors have a tumor microenvironment (TME) that is characterized by hypoxia, low pH, and substantial numbers of immunosuppressive cells, and these are the main factors limiting the efficacy of antitumor immunotherapy. The TME is crucial to the occurrence, growth, and metastasis of tumors. Therefore, numerous studies have been devoted to improving the effects of immunotherapy by remodeling the TME. Effective regulation of the TME and reversal of immunosuppressive conditions are effective strategies for improving tumor immunotherapy. The use of multidrug combinations to improve the TME is an efficient way to enhance antitumor immune efficacy. However, the inability to effectively target drugs decreases therapeutic effects and causes toxic side effects. Nanodrug delivery carriers have the advantageous ability to enhance drug bioavailability and improve drug targeting. Importantly, they can also regulate the TME and deliver large or small therapeutic molecules to decrease the inhibitory effect of the TME on immune cells. Therefore, nanomedicine has great potential for reprogramming immunosuppressive microenvironments and represents a new immunotherapeutic strategy. Therefore, this article reviews strategies for improving the TME and summarizes research on synergistic nanomedicine approaches that enhance the efficacy of tumor immunotherapy.

Two different mutational types of familial gastrointestinal stromal tumors:Two case reports

BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal(GI)tract,and cases of GISTs tend to be of the disseminated type,with a global incidence of 10 to 15 cases/million each year.The rarer familial GISTs,which often represent a population,differ in screening,diagnosis,and treatment.Familial GISTs include primary familial GISTs with predominantly KIT/PDGFRA mutations and wild-type GISTs.However,whether the same genetic family has different phenotypes has not been reported.CASE SUMMARY We report two cases of rare GISTs in the same family:A male patient with the V561D mutation in exon 12 of the PDGFRA gene,who has been taking the targeted drug imatinib since undergoing surgery,and a female patient diagnosed with wild-type GIST,who has been taking imatinib for 3 years since undergoing surgery.The favorable prognosis of these patients during the 7-year follow-up period validates the accuracy of our treatment strategy,and we have refined the entire process of diagnosis and treatment of familial GISTs in order to better manage this rare familial disease.CONCLUSION Different mutation types of familial GISTs in the same family are very rare,thus it is very important to make the correct diagnosis and treatment strategies according to the results of molecular detection for the management of familial GISTs.

Nanomaterials for refining tumor microenvironment and enhancing therapy in head and neck squamous cell carcinoma: a review

Head and neck squamous cell carcinoma (HNSCC) is a prevalent and lethal solid tumor with a high mortality rate. Conventional cancertreatments, including surgery, radiotherapy, and chemotherapy, primarily target cancer cell eradication. However, uncontrolled proliferation and metabolic activities of these cells result in abnormalities in nutrient levels, hypoxia, and immunosuppression within the tumor microenvironment (TME). These factors constrain the efficacy of traditional treatments by promoting drug resistance, recurrence, and metastasis. Nanomaterials (NMs), such as nanozymes, can exhibit enzymatic activity similar to that of natural enzymes and offer a promising avenuefor the direct modification of the TME through catalytic oxidation-reduction processes. Moreover, they can serve as sensitizers or drug deliverycarriers, enhancing the efficacy of traditional treatment methods. Recently, NMs have garnered significant attention from oncologists. Thisreview begins with an overview of the composition and unique characteristics of the TME. Subsequently, we comprehensively exploredthe application of NMs in the treatment of HNSCC. Finally, we discuss the potential prospects and challenges associated with usingNMs in biomedical research.

超声联合影像学调整双腔耐高压PICC原发性异位的临床实践效果

目的:探讨双腔耐高压注射型经外周静脉穿刺中心静脉置管术(PICC)导管原发性异位借助超声引导+影像学资料复位的临床实践效果。方法:选取2020年3月—2023年3月我院724例双腔耐高压PICC置管病人,51例病人置管完成后24 h内通过胸部影像学检查确诊导管发生原发性异位,发生率为7.04%。异位后分析其原因,结合胸部影像学资料,通过实时B超影像、腔内心电图P波形态,多种手法及体位综合复位的处理措施。结果:41例病人成功复位,成功率为80.3%。10例病人多因病人血管因素或错过调管时机导致导管复位失败。结论:置管护士要有扎实的理论基础以及丰富的实践经验,在临床实际操作过程中,应该灵活应用,多方法结合,具体问题具体分析,尽可能保证PICC导管尖端处于最佳位置,减少并发症的发生。

费曼式学习法在低年资护士儿童PICC维护培训中的应用

目的:探讨费曼式学习法在低年资护士儿童经外周静脉置入中心静脉导管(PICC)维护培训中的应用。方法:2022年3月—12月选取无锡市儿童医院80名低年资护士参与儿童PICC导管维护培训,采用随机数字表法将其分为观察组及对照组,每组40人。对照组行规范性培训,观察组应用费曼式学习法,比较两组护士规范化培训参与率、PICC置管知识及技能考核评分、护士自主学习能力及PICC知信行评分。结果:观察组护士第4次~第6次培训参与率明显高于对照组(P<0.05);观察组培训结束时PICC置管知识评分、技能考核评分、护士自主学习能力评分及PICC知信行评分高于对照组(P<0.05)。结论:费曼式学习法可提升低年资护士参与儿童PICC维护培训参与率,改善低年资护士自主学习能力及PICC维护知信行水平,有助于护士PICC维护知识及维护技能的提升。

隧道式置管方式在降低肿瘤病人PICC非计划性拔管率的效果研究

目的:观察肿瘤病人在经外周置入中心静脉导管(PICC)治疗期间应用隧道式置管方式对降低非计划性拔管率的效果。方法:选取2023年1月—11月南昌大学第二附属医院肿瘤科初次行PICC置管治疗的80例肿瘤病人为研究对象,随机分为对照组、试验组,每组40例。对照组行传统置管方式,试验组行隧道式置管方式,比较两组病人一次穿刺成功率、非计划性拔管率、并发症发生率及生活质量[生活质量评定量表(QOL)评分]。结果:试验组病人一次穿刺成功率为90.00%,高于对照组的72.50%(P<0.05);试验组病人置管后90、120 d非计划性拔管率低于对照组(P<0.05);试验组并发症总发生率为5.00%,低于对照组的25.00%(P<0.05);干预后试验组病人QOL评分高于对照组(P<0.05)。结论:隧道式置管方式可提高肿瘤病人PICC一次穿刺成功率,减少并发症,降低非计划性拔管率,改善生活质量。

耐高压PICC影像检查质量开展现状调查与分析

目的调查全国二级以上医院和科室耐高压经外周静脉置入中心导管(peripherally inserted central venous catheters,PICC)影像检查开展现状,为耐高压PICC影像检查规范制定与推广提供依据。方法2023年2月19日至11月7日期间,通过便利抽样法对全国25个省、自治区、直辖市的70所二级以上医院使用造影剂科室的护理负责人进行问卷调查。应用SPSS 27.0进行数据统计分析。结果来自68所医院的100份问卷被纳入,其中42所医院(61.76%)46个科室(46.00%)开展了耐高压PICC影像检查。不同等级的医院与耐高压PICC患者数量呈显著正相关(r=0.417,P<0.05),即随着医院等级升高,耐高压PICC患者数量呈增加趋势。但不同类型(r=-0.149,P>0.05)与地理区域(r=-0.130,P>0.05)的医院与耐高压PICC影像检查开展数量之间不具备相关性。耐高压PICC影像检查操作标准并不统一,且开展受限的主要原因是缺乏耐高压PICC患者(62.96%)和医患担心耐高压PICC检查潜在风险(18.52%)。结论耐高压PICC影像检查开展范围小,发展较缓慢,流程欠规范,亟待指南规范操作流程,完善专业培训,推动耐高压PICC影像检查规范化管理。

PICC 护理安全管理评价指标体系的构建

目的基于“Vincent患者安全因素框架”,构建一套适合我国PICC护理安全管理评价指标体系,为PICC护理安全管理提供可量化的参考工具。方法以“Vincent患者安全因素框架”为基础,根据文献资料分析结果和临床实践经验,分别从指标体系的临床意义、可行性和有效性等方面,初步拟定PICC护理安全管理评价指标条目。采用德尔菲专家咨询法对28名专家进行三轮专家函询,采用SPSS24.0、Yaahp软件进行统计分析,形成PICC护理安全管理评价指标条目最终版。结果根据文献资料分析结果和临床实践经验,经过2次小组会议讨论和汇总意见,初步拟定PICC护理安全管理评价指标条目,包括一级指标5个,二级指标18个,三级指标43个。本研究选取山东、北京、上海、天津四个省市的28名专家进行三轮专家函询。专家函询问卷的回收率分别是100%、92.86%和89.29%,专家权威系数分别是0.831、0.862、0.895;专家函询意见协调程度分别是0.272、0.414、0.483。经专家函询意见与小组成员讨论相结合,最终构建的PICC护理安全管理评价指标体系包含4个一级指标(组织管理因素、环境设施因素、护理人员因素、患者因素),13个二级指标,44个三级指标。结论指标构建过程科学,函询专家积极性和权威性较好,指标内容合理,可为PICC护理安全管理提供可量化的评价工具。

综合护理在行PICC置管术的消化道恶性肿瘤患者中的应用

目的 分析综合护理对消化道恶性肿瘤患者PICC置管术后负面情绪、遵医行为、并发症的影响。方法 260例行PICC置管术的消化道恶性肿瘤患者随机分为两组,常规护理组予以常规护理,综合护理组在常规护理基础上予以综合护理,比较两组的负面情绪、遵医行为、并发症。结果 护理后,综合护理组的HAMA、 HAMD评分均低于常规护理组,患肢功能锻炼、置管肢体无负重、洗澡时良好防护比例均高于常规护理组(P <0.05)。综合护理组的并发症总发生率为3.85%,低于常规护理组的10.77%(P <0.05)。结论 综合护理可缓解行PICC置管术的消化道恶性肿瘤患者的负面情绪,改善遵医行为,减少并发症的发生。

Association of tumor budding with clinicopathological features and prognostic value in stage III-IV colorectal cancer

BACKGROUND Tumor budding(TB)has emerged as a promising independent prognostic biomarker in colorectal cancer(CRC).The prognostic role of TB has been extensively studied and currently affects clinical decision making in patients with stage I and II CRC.However,existing prognostic studies on TB in stage III CRC have been confined to small retrospective cohort studies.Consequently,this study investigated the correlation among TB categories,clinicopathological features,and prognosis in stage III-IV CRC to further enhance the precision and individualization of treatment through refined prognostic risk stratification.AIM To analyze the relationship between TB categories and clinicopathological characteristics and assess their prognostic value in stage III-IV CRC to further refine the prognostic risk stratification of stage III-IV CRC.METHODS The clinical data of 547 CRC patients were collected for this retrospective study.Infiltration at the front edge of the tumor buds was counted according to the 2016 International Tumor Budding Consensus Conference guidelines.RESULTS Multivariate Cox proportional hazards regression analysis demonstrated that chemotherapy(P=0.004),clinical stage IV(P<0.001),≥4 regional lymph node metastases(P=0.004),left-sided colonic cancer(P=0.040),and Bd 2-3(P=0.002)were independent prognostic factors in patients with stage III-IV CRC.Moreover,the density of tumor infiltrating lymphocytes was higher in Bd 1 than in Bd 2-3,both in the tumor stroma and its invasive margin.CONCLUSION TB has an independent predictive prognostic value in patients with stage III-IV CRC.It is recommended to complete the TB report of stage III-IV CRC cases in the standardized pathological report to further refine risk stratification.

Calculus bovis inhibits M2 tumor-associated macrophage polarization via Wnt/β-catenin pathway modulation to suppress liver cancer

BACKGROUND Calculus bovis(CB),used in traditional Chinese medicine,exhibits anti-tumor effects in various cancer models.It also constitutes an integral component of a compound formulation known as Pien Tze Huang,which is indicated for the treatment of liver cancer.However,its impact on the liver cancer tumor microenvironment,particularly on tumor-associated macrophages(TAMs),is not well understood.AIM To elucidate the anti-liver cancer effect of CB by inhibiting M2-TAM polarization via Wnt/β-catenin pathway modulation.METHODS This study identified the active components of CB using UPLC-Q-TOF-MS,evaluated its anti-neoplastic effects in a nude mouse model,and elucidated the underlying mechanisms via network pharmacology,transcriptomics,and molecular docking.In vitro assays were used to investigate the effects of CB-containing serum on HepG2 cells and M2-TAMs,and Wnt pathway modulation was validated by real-time reverse transcriptase-polymerase chain reaction and Western blot analysis.RESULTS This study identified 22 active components in CB,11 of which were detected in the bloodstream.Preclinical investigations have demonstrated the ability of CB to effectively inhibit liver tumor growth.An integrated approach employing network pharmacology,transcriptomics,and molecular docking implicated the Wnt signaling pathway as a target of the antineoplastic activity of CB by suppressing M2-TAM polarization.In vitro and in vivo experiments further confirmed that CB significantly hinders M2-TAM polarization and suppresses Wnt/β-catenin pathway activation.The inhibitory effect of CB on M2-TAMs was reversed when treated with the Wnt agonist SKL2001,confirming its pathway specificity.CONCLUSION This study demonstrated that CB mediates inhibition of M2-TAM polarization through the Wnt/β-catenin pathway,contributing to the suppression of liver cancer growth.

基于FOCUS-PDCA模式安全管理策略对早产儿PICC置管并发症及皮肤损伤的影响

目的探讨基于FOCUS-PDCA模式安全管理策略对早产儿PICC置管并发症及皮肤损伤的影响。方法选择2022年1月至2023年12月期间在扬州市妇幼保健院扬州大学附属医院接受PICC置管治疗的82例早产儿,采用随机数表法分为观察组与对照组。对照组采用标准护理,观察组在此基础上应用基于FOCUS-PDCA模式的安全管理策略。比较两组PICC置管并发症与皮肤损伤情况。结果观察组PICC置管并发症总发生率为7.14%,显著低于对照组19.05%,差异有统计学意义(P<0.05)。干预后第1 d、第7 d、第14 d,观察组皮肤损伤评分均较对照组低,差异有统计学意义(P<0.05)。结论基于FOCUS-PDCA模式的安全管理策略可有效减少早产儿PICC置管并发症,保护患儿置管部位皮肤健康。

81例PICC患者拔管困难的原因分析及拔管策略

回顾血管外科81例PICC拔管困难患者的临床资料,分析导致PICC拔管困难的原因并进行临床分级。其中,拔管困难Ⅰ级7例(8.6%),采用普通方式拔管;Ⅱ级18例(22.2%),采取湿热敷和X线透视辅助下拔管;Ⅲ级40例(49.4%),采用X线透视下导管内置入支撑导丝拔管;Ⅳ级16例(19.8%),5例采用穿刺股静脉建立全轨道方法松解粘连拔管,7例通过外科手术拔管,4例PICC导管断裂患者采用“鹅颈式”抓捕器取出。不同级别PICC拔管困难的原因受多种因素影响,其中以血栓形成及纤维蛋白鞘为主要因素,采取个体化拔管策略后所有患者PICC均安全拔除。

1例外周T细胞淋巴瘤患者PICC术后CRBSI的案例分析

通过回顾性分析我科收治的1例外周T细胞淋巴瘤患者PICC术后发生导管相关血液感染(CRBSI)的护理过程,并阅读相关文献报道,总结经验,为皮肤型淋巴瘤患者选择血管通路时提供一定的参考依据,从而提高护理质量安全。