Objective To investigate the correlation between the psychological capital and humanistic practice ability in ICU nurses. Methods In this convenience study, a total of 168 nurses from ICU were enrolled. The self-designed basic information questionnaire, psychological capital questionnaire and nurse humanistic practice ability scale were used in the study. Results The total score on psychological capital and the score on the humanistic practice ability were (4.23 ± 0.41), was (3.68 ± 0.65). The psychological capital was positively correlated with humanistic practice ability in ICU nurses (P<0.01, r=0.498). Conclusions The psychological capital and humanistic practice ability of the nurses in ICU are both in the medium level. Nursing managers should take measures to improve the psychological capital of ICU nurses and create a good cultural practice environment to enhance the humanistic practice ability.

Objective To observe the biomechanieal properties of tendons repaired by five suture techniques in different stage of healing process.Methods After establishing the zone Ⅱ FDP transection model in 2nd,3rd,4th too of both feet in female fowls,the ruptured tendons were repaired with Modified Kessler ( M K ),Kessler plus running ( K +R ),double-strand Kessler ( DK ),double loop (DT) and modified double loop (MT) methods,respectively.Passive and active mobilizations were applied on the 3rd day and 21st day postoperatively.Animals were executed postoperatively,on the 14th,21st and 35th days,respectively and both feet were harvested for biomechanical test.Results Anatomical findings included: The breakage incidence of K+R group was smaller than that of MK group.The excellent and good results of K+R and DK groups were higher compared with that of MK group.Biomechanical results showed: The MK group had the poorest biomechanical results in every stage of tendon healing (P＜0.05) except that the results from MK group on the 35th showed no statistical difference compared with that of MT and DT in extreme load;K+R group exbited the greatest extreme load and tensile strength (P＜0.05);Biomechanical test results from all groups showed significant differences on different testing point: 35th day＞21st day＞14th day(P＜0.05 );No significant differences were found in all groups between the immediate postoperative results onlst day and that from 14th day.ConclusionDuring the recovery of tendon,biomechanical properties returned to the immediate postoperative level on the 14th day and increased along with time.K+R group shows the superiority to the other methods in biomechanical properties as well as low breaking incidence ratein every stage of tendon healing.Kessler plus running is an effective method with high strength against breakage and great resistance to adhesion formation.

Objective To compare the biomechanical effect of several commonly used internal fixators in treating the femoral neck fractures so as to provide clinical basis for the selection of ideal internal fixation.Methods Twelve artificial PMMA femoral models were selected,and the central neck of the specimens was sawn with an electric saw at Pauwels angle of 70° to form adduction type femoral neck fracture models.After anatomic reduction,the specimens were fixed with dynamic hip screw ( DHS),three hollow screws,proximal femoral nail (PFN) and dynamic sleeve three-wing screw according to the operative approach,respectively.Instron-8874 servo-hydraulic mechanical testing machine was used to fix the specimens which simulated uniped standing.Fifteen key points on proximal femur were selected as test points and were given gradation loading at speed of 10 mm/min with linear load 0-1 200 N.The strain of each point under 1200 N load,head sink displacement under different loads and the strain of eight points on principal pressure side were measured.Results There was a peak at the eight resistance strain gage at 1200 N load and the strain values of the DHS,three hollow screws,PFN and dynamic sleeve three-wing screw were (700 ±35) μεz,(756 ± 14) με,( 1362 ± 136) με and (3024 ± 127) με,with statistical significance (P ＜ 0.01 ).Under the same load,the head sink displacement in the group of dynamic sleeve three-wing screw was greater than that of the hollow screws group and the PFN group ( P ＜0.01 ),but smaller thau that of the DHS group ( P ＜ 0.01 ).The strain values at the eight resistance strain gage in the group of dynamic sleeve three-wing screw was larger than that of the other three groups under the same load (P ＜ 0.01 ),and the strain values increased with the increase of load at the same fixation group.Conclusion Dynamic sleeve three-wing screw has good biomechanical stability for treatment of femoral neck fracture,which can be applied in the clinical practice.

Objective To investigate the therapeutic effect of intravenous bloodletting combined with low molecular weight heparin in the treatment of chronic pulmonary heart disease and hyperviscosity in plateau area. Methods 84 patients with chronic pulmonary heart disease complicated with hyperviscosity from plateau area were randomly divided into the control group (40 patients) and the observation group (44 patients). In the two groups, on the basis of routine treatment (anti-infection, anti -asthma, oxygen inhalation, and correction of heart failure), the observation group was further given intravenous bloodletting combined with low molecular weight heparin calcium. The changes of respiratory rate, content of venous hemoglobin, hematocrit and arterial partial pressure of oxygen before and after treatment were monitored and statistically analyzed. Results After treatment, the respiratory rate, content of hemoglobin, hematocrit and PaO2 in the observation group were significantly better than those in the control group (P＜0. 0l). Conclusion Intra-venous bloodletting combined with low molecular weight heparin is more effective than conventional treatment method in the treatment of chronic pulmonary heart disease and hyperviscosity in plateau area.

Objective To compare the biomechanical property of original and new dynamic sleeve three-wing screws.Methods Twelve artificial polymethylmethacrylate (PMMA) femoral models and twelve adult cadaver femurs were selected,and then adduction-type femoral neck fracture models were prepared.The specimens were divided randomly into 2 groups,and each group had 6 specimens.According to the operative approach,the fractures were fixed with original dynamic sleeve three-wing screw (DSTS) or new DSTS after anatomic reduction.Then the specimens were fixed in simulated uniped standing position with an instron-8874 servo-hydraulic mechanical testing machine.Ten key points at the proximal femurs and two key points at the femoral shaft were selected to be the positions at which the strain was recorded.The continuous load (PMMA group:0-1200 N; cadaver femur group:0-800 N) was put to the specimens at the rate of 10 mm/min.The strain values under the maximum load,the femoral head sinking displacement and the strain values of No.8 gauge under different loads were recorded.Results There was a peak at the No.8 resistance strain gauge under 1200 N in PMMA group,and the strain values of original and new DSTS were (-2744±35) and (-718±14) με,respectively.There was a peak at the No.8 resistance gauge under 800N in cadaver femur group,and the strain values of original and new DSTS were (-2813±38) and (-2032±22) με,respectively.The differences of strain values above were significant.The femoral head sinking displacement of the new DSTS was much less than that of original DSTS under the same load.Conclusion The new DSTS has better biomechanical properties,using which the femoral neck fracture can be fixed more stably.

Objective To collect domestic and foreign literatures on mini-invasive total hiparthroplasty (THA) and conventional THA so as to assay the clinical outcomes of the two treatments usingMeta analysis.Methods Randomized controlled trials (RCTs) of mini-invasive THA and conventionalTHA that met the inclusion criteria were collected in the computer-based retrieval combined with manualretrieval of databases such as MEDLINE,EMBASE,OVID,and ScienceDirect.Methodological qualityassessment of the included literatures was performed using Cochrane risk evaluation tool and Meta analysisof those literatures was made by employing RevMan 5.1 software.Two surgical approaches were comparedin regard of indices including postoperative Harris hip score,operation time,intraoperative blood loss andcomplications.Results The study involved 17 related articles (18 RCTs containing 1 560 patients),including 774 patients treated by mini-invasive THA and 786 by conventional THA.The study showedsignificant differences between mini-invasive THA and conventional THA in aspects of incision length[WMD=-5.93,95％ CI (-7.29,-4.57)],blood loss [SMD =-0.45,95％ CI (-0.77,-0.13)] and postoperative visual analog scale (VAS) [MD =-19.58,95％ CI (-26.38,-12.78)],whereas there were no significant differences regarding the postoperative Harris score [WMD =0.85,95％ CI (-3.50,5.20)],operation time [WMD=-0.99,95％ CI (-5.36,3.39)],blood transfusion volume [WMD =-66.29,95％ CI (-241.31,108.72)] and complication incidence rate [RR =1.01,95％ CI (0.61,1.66)].Conclusions Mini-invasive THA offers advantages of smaller incision,less intraoperative blood loss and milder postoperative pain over conventional THA but has similar effect with conventional THA in aspects of Harris hip score,operation duration,blood transfusion volume and complications.Moreover,high quality,multicenter and large scale RCTs are required to confirm the outcomes.

Objective:To investigate the risk factors and treatment of postpancreatico-duodenectomy hemorrhage(PPH).Methods:The retrospective case-control study was conducted. The clinical data of 712 patients who underwent pancreaticoduodenectomy in Peking University First Hospital from January 2012 to November 2021 were collected. There were 392 males and 320 females, aged from 16 to 89 years, with a median age of 62 years. Observation indicators: (1) diagnosis of PPH; (2) analysis of influencing factors for PPH; (3) treatment of PPH. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability, and multivariate analysis was performed using the Logistic regression model. Results:(1) Diagnosis of PPH. Of the 712 patients, 72 cases had PPH and 7 cases died. The incidence of PPH was 10.11%(72/712), and PPH related mortality was 9.72%(7/72). There were 7 cases of early PPH and 65 cases of delayed PPH. There were 23 cases of mild PPH and 49 cases of severe PPH. (2) Analysis of influencing factors for PPH. Results of univariate analysis showed that preoperative serum total bilirubin (TBil), extended surgery, postoperative pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were related factors for delayed PPH ( χ2=13.17, 3.93, 87.89, 22.77, 36.13, P<0.05). Results of multivariate analysis showed that preoperative serum TBil ≥171 μmol/L, postoperative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were independent risk factors for delayed PPH ( odds ratio=1.91, 8.10, 2.11, 2.42, 95% confidence interval as 1.09-3.33, 4.62-14.20, 1.06-4.23,1.35-4.31, P<0.05). (3) Treatment of PPH. ① Treatment of early PPH. Of the 7 cases with early PPH, 4 cases had mild PPH and 3 cases had severe PPH. The 4 cases with mild PPH were stanched by conservative treatment. The bleeding location of the 3 cases with severe PPH were the posterior wall of pancreatoenteric anastomosis, the pancreatic uncinate stump and the unintentional puncture of the jejunostomy tube of the left upper abdominal wall vessels and the 3 cases were stanched by reoperation. All the 7 cases were discharged without other complications. ② Treatment of delayed PPH. Of the 65 cases with delayed PPH, 19 cases had mild PPH and 46 cases had severe PPH. Of the 19 cases with mild PPH, 18 cases were stanched by conservative treatment including 2 cases died of pancreatic fistula and abdominal infection, 1 case were stanched by endoscope therapy. Of the 46 cases with severe PPH, 18 cases with stable vital signs and slow bleeding were stanched by conservative treatment including 1 case died of infectious toxic shock and the other 28 cases underwent invasive treatment, including 2 cases undergoing gastroscopy, 20 cases undergoing interventional treatment and 6 cases under-going reoperation as the initial treatment. Of the 22 cases taking endoscope or interventional treatment as the initial treatment, 5 cases underwent rebleeding and 2 cases died, with the reblee-ding rate and mortality as 22.7%(5/22) and 9.1%(2/22), respectively. Of the 6 cases taking reopera-tion as the initial treatment, 3 cases underwent rebleeding and 2 cases died, with the rebleeding rate and mortality as 3/6 and 2/6, respectively. There was no significant difference in the rebleeding rate and mortality in patients taking endoscope or interventional treatment as the initial treatment and patients taking reoperation as the initial treatment ( P>0.05). Of the 28 cases undergoing invasive treatment, 10 cases underwent secondary surgical treatment, including 6 cases taking reoperation and 4 cases taking interventional treatment as the initial treatment for hemorrhage, and 4 cases died with the mortality as 4/10, and the other 18 cases who did not receive secondary surgical treatment survived. There was a significant difference in the mortality between patients with or without secondary surgical treatment ( P<0.05). Conclusions:Preoperative serum TBil ≥171 μmol/L, post-operative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection are independent risk factors for delayed PPH. Surgical treatment should be performed decisively for early severe PPH. For delayed severe PPH patients who undergoing conservative treat-ment without effect, endoscope therapy and interventional treatment should be the first choice, and surgical treatment should be performed if those above procedures not working.

Pancreatic cancer is the fourth leading cause of cancer-related death in the world.Most patients are diagnosed as locally advanced or metastatic disease at initial visit,losing the opportunity of surgery.Conversion therapy aims to give unresectable tumors the opportunity to receive radical surgery through comprehensive treatment.For unresectable pancreatic cancer,chemotherapy based on AG(abraxane+gemcitabine)or FOLFIRINOX(5-fluorouracil+leucovorin+irinotecan+oxaliplatin),radiotherapy combined with chemotherapy as well as other regimens have shown conversion potential.Targeted therapy and immunotherapy have also become new frontiers of conversion therapy for pancreatic cancer.Focusing on new drugs and new regimens,this review has summarized the latest research progress of conversion therapy for pancreatic cancer.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.