ObjectiveTo explore the points of nursing cooperation during hand-assisted thoracoscopic surgery for simultaneous operation of bilateral lung metastasectomy.Methods The preoperative preparation,nursing cooperation during the surgery,the cleaning and maintenance of surgical instruments and equipment after operation were retrospectively summarized in 72 patients who underwent hand-assisted thoracoscopic surgery for simultaneous treatment of bilateral pulmonary metastases. ResultsAll the procedures of surgery were smooth.No patients were converted to thoracotomy or died of surgery. Conclusions It is an important challenge for nursing quality in the operation room and the cleaning and maintenance of surgical instruments and equipment in carrying out hand-assisted thoracoscopic surgery.The skilled nursing cooperation and standardized operating procedures could improve the quality of intraoperative nursing cooperation.It could ensure the smooth process of simultaneous operation of bilateral lung metastasectomy.

OBJECTIVE To evaluate the efficacy of plasma sterilization system,observe and comprehend the(methods) and mechanisms of plasma sterilization.METHODS In application of plasma(sterilization) system,the(sterilization) processes were observed.The efficacy of this new system was shown by a biological test and chemical test.Comparative observation was conducted on the effective use time of wire of high-frequency electrode that had been sterilized in plasma sterilization system and Formalin smoke respectively.RESULTS The instrument that had been sterilized in plasma sterilization system all passed the tests and could be used immediately,manipulation of(plasma)(sterilization) system was easy,the effective use times of electrode′s wire were extended.CONCLUSIONS Plasma sterilization system can achieve effective sterilization with low(humidity),and no-toxicity.With shorter sterilization cycle time and lesser damage to surgery instruments,this new system improves the margin of safety and reduces(processing) costs.

Objective To analyze the relationship between clinical and pathological features in children with Henoche-Sch?nelin purpura nephritis (HSPN). Methods Clinical and pathological data of 89 children with HSPN from April 2009 to April 2013 in our hospital were retrospectively analyzed. Results A majority of patients (94.83%) suffered nephritis within two month after purpura. Clinically, hematuria and proteinuria (41.6%), nephrotic syndrome (27.0%), and isolated protein-uria (21.3%) are the most common type in children with HSPN. The majority of pathological changes of these three types HSPN are gradeⅢ, which accounts for 67.6%, 70.8%, and 73.7%, respectively. The clinical manifestations are closely associated with pathologic classiifcation (H=26.88, P=0.000). IgA plus IgM deposit was the most common type (40.45%) in histological and immunopathologic changes.There was no statistical difference between the pathologic classification and immunopathologic types. Gastrointestinal bleeding was associated with pathologic classiifcation. Conclusions The pathological changes of HPSN patients are mainly of gradesⅡandⅢ, and the clinical manifestations, gastrointestinal bleeding in particular, are closely associated with pathological classiifcation.

OBJECTIVE:To discuss the median effective concentration(EC50)of ropivacaine caudal motor block. METHODS: The EC50 of ropivacaine caudal epidural block was determined with sequential experimental method. RESULTS:The EC50 of ropivacaine caudal block was 0.22%(95%CI ranged from 0.216% to 0.235%). CONCLUSION:Canales sacralis injected with 0.20%～ 0.22% ropivacaine is suitable for bladder endoscopic examination in out-patient.

Objectives To investigate the clinical effect of hemoperfusion in severe juvenile dermatomyositis. Meth-ods Two patients with severe juvenile dermatomyositis, who accepted hemoperfusion treatment, were retrospectively analyzed. Results In these 2 patients, the hemoperfusion process were smooth. The muscle pain was reduced and the muscle enzymes were decreased. After hemoperfusion, one patient refused to continue treatment and the disease recurrent. The other patient con-tinued to accept the immunosuppressive therapy and eventually improved. Conclusions For juvenile dermatomyositis, hemo-perfusion was a safe and effective auxiliary treatment. It could be applied when the general treatment was invalid.

Objective To investigate the chanegs and correla iton between IL-17 and MMP-9 in c hildren of henoch-schonlein purpura,and to explore the pathogenesis of teh IL-17 and MMP-9 in henoch-schonlein pur-pura /henoch-schonlein purpura nephritis.Methods The level of serum IL-17 andMMP-9 in 74 henoch-schon-lein purpura childr en in initial stage and 30 cases of healthy children( control group) were detetced by ELISA. Results (1) The level of plasma IL-17 was significantly higher in children of henoch-schonlein purpura thna tha t foh ealthy control group (86.59 ±35.50) fg/L vs.(62.38 ±14.65)fg/L,P<0.01].(2) The level of plasma MMP-9 was significantly higher in children of henoch-schonlein pupru ar than that o fhealt hy control group [(201.82 ±105.87) fg/L vs(89.27 ±27.99)fg/L,P <0.01].(3) Henoch-schonlein purpura children were followed up for6 months,dependin g on whether the kidney was involved,they were devided into non-he-noch-schonlein purpura nephritsi grou p nad henoch-s chonlein purpura nephritis group.In initial phase of HSP,the level of plasma IL-17 was significant lyhigher in henoch-schonlein purpura nephritis group than non-henoch-schonlein purpura nephrits group [(101.67 ±39.55) fg/L vs.(101.67 ±39.55)fg/L,P<0.05].The level of p lasma MMP-9 was significantly higher in henoch-schonlein purpura nephritsi group than no n-henoc h-schon-lein purpura nephritis group [(249.63 ±97.57) Pg/L vs.(185.30 ±104.39) pg/L,P<0.05 ].(4) IL-17 and MMP-9 correlation aanlysis didn't show sign ificant correlation(r=0.184,P>0.05).Conclusion IL -17 and MMP-9 are involved in the pathogenesis of henohc-schonlein purpura/henoch-schonlein pur pura nephritis.

The purpose of this study was to prepare dabigatran etexilate nanoemulsion to improve bioavailability of dabigatran etexilate, a poorly water-soluble drug. The physicochemical properties and the stability of dabigatran etexilate nanoemulsion were investigated. Equilibrium solubility of dabigatran etexilate in commonly used oil materials for nanoemulsion were determined for selection. Then, surfactant and co-surfactant were chosen based upon the plooted pseudo-ternary diagrams. The formulation and preparation process were further optimized with orthogonal design. As a result, the dabigatran etexilate nanoemulsion was formulated based on the system consisting of Oil Acid/Labrafac Lipophile WL1394/Cremophor RH40/Transcutol P/H2O. The dabigatran etexilate nanoemulsion was found to have a mean diameter of(57. 5±0. 2)nm, Zeta potential of -(20. 9±1. 4)mV, and the drug encapsulation efficiency of(85. 2±1. 0)%. Besides, the droplet size, stability constant and drug content of the nanoemulsion was found to have no significant changes in at least 3 months under room temperature. In conclusion, the uniform and stable dabigatran etexilate nanoemulsion with a clear and translucent appearance was obtained after the optimization of formulation and preparation process. Thus nanoemulsion could be a promising way for the improvement of bioavailability of dabigatran etexilate and other poorly water-soluble drugs.

Objective:To analyze and summarize the efficacy and safety of thalidomide in the treatment of refractory systemic juvenile idiopathic arthritis（sJIA）.Methods:The clinical data of ten patients with refractory sJIA admitted to Department of Nephrology and Immunology in Children's Hospital of Hebei Province from January 2015 to March 2022 were collected，and the clinical manifestations，efficacy and safety of thalidomide in the treatment of refractory sJIA were analyzed retrospectively. Systemic juvenile arthritis disease activity score（sJADAS）was used to evaluate the efficacy of the treatment. Statistical analysis was performed by repeated measurements using general linear models.Results:Among the 10 children（4 males and 6 females）with refractory sJIA，the average age of onset was（7.5±3.3）years. Seven patients were complicated with macrophage activation syndrome at an early stage of disease.The average course of disease was（4.4±1.7）years，and the longest course of disease was 8.3 years. Before the application of thalidomide，all the 10 children experienced relapses（ranging from 2 to 10 times）. The indices of 10 children treated with thalidomide at 6 months and 12 months were compared with those before treatment. Peripheral blood leukocytes［（10.19±3.67）×10 9/L，（8.53±2.83）×10 9/L vs.（16.11±7.81）×10 9/L， F=7.918，11.084， P=0.020，0.009］，C-reactive protein［19.13（0.38，35.21）mg/L，8.05（0.10，18.00）mg/L vs. 59.34（24.20，131.90）mg/L， F=7.030，12.731， P=0.026，0.006］，sJADAS scores［6.00（1.50，12.50）scores，3.00（0，12.50）scores vs. 20.00（11.50，28.00）scores， F=14.710，17.870， P=0.004，0.002］were decreased significantly. The doses of prednisone［0.13（0，0.45）mg/（kg·d），0.02（0，0.06）mg/（kg·d）vs. 0.42（0.16，1.47）mg/（kg·d）， F=5.890，7.623， P=0.041，0.022］were significantly decreased.All the differences were statistically significant. Prednisone was successfully discontinued in 7 cases. Tocilizumab was gradually withdrawn in 3 cases，and tocilizumab administration interval was prolonged in 1 case. None of the 10 children had serious adverse reactions. Conclusion:Thalidomide is clinically effective in the treatment of sJIA，and can reduce the required dose of prednisone and prolong the tocilizumab free remission.

Objective:To optimize the Manchester needs tool for injured children (MANTIC) scale , and evaluate its reliability and validity among injured children. Methods:The MANTIC scale was optimized through Delphi expert consultation and pre-tests. From March 2023 to June 2023 , a total of 317 injured children admitted in 7 level A tertiary hospitals in Zhejiang and Shandong provinces and their families were surveyed with general data, optimized MANTIC scale, and EuroQol 5-dimension health questionnaire for youth (EQ-5D-Y). Item analysis was conducted on the data of the 317 patients collected with optimized MANTIC scale through the test for homogeneity and value-based decision-making method and the content validity test of the scale was evaluated with item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). It was evaluated with KMO test values and Bartlett′s test of sphericity to determine whether the scale was suitable for exploratory factors. The number of common factors was determined based on the K1 criterion and scree plot to further obtain the structural validity of the scale of the item load value. The correlation validity of the scale was evaluated with the correlation coefficient of the optimized MANTIC scale and EQ-5D-Y. The reliability of the scale was tested with Cronbach alpha coefficient and Guttman split-half reliability coefficient. Results:A total of 332 questionnaires were distributed, among which 317 valid ones were collected, with a response rate of 95.6%. The test of homogeneity in the item analysis showed that the correlation coefficient between each item and the total score of the scale was 0.40-0.80. The results of the value-based decision-making method showed that the critical ratio of high-and low-scored groups was 6.08-28.01. The quality of all the items met the retention requirements so that the reliability and validity tests could be continued. Validity test found that I-CVI was 0.83-1.00, consistent S-CVI was 0.83, and mean S-CVI was 0.95. In structural validity analysis, the KMO value was 0.96, and the Chi-square value of Bartlett′s test of sphericity was 10755.76 ( P<0.01). A total of 9 common factors were extracted with the K1 criterion (eigen value>1), and the scree plot indicated 9 common factors with a cumulative variance contribution rate of 73.46%. Factor extraction and rotation showed that the load value of each item of the scale ranged from 0.589 to 0.874. The correlation coefficient of the optimized MANTIC scale and EQ-5D-Y was r= 0.55 ( P<0.01).Reliability test showed that the Cronbach alpha coefficient of the total scale and all dimensions was 0.96 and 0.77-0.98, and the Guttman split-half reliability coefficient was 0.76 and 0.73-0.98. Conclusion:The optimized MANTIC scale can attain good reliability, validity, consistency and stability, and can reflect the concept to be expressed and the content to be evaluated, indicating that it can be used to evaluate the injury rehabilitation needs of injured children and their families throughout the entire treatment process.

Objective:To investigate the effect of treatment of spinal meningioma with microsurgical procedures.Methods:From January 2003 to March 2022, there were 120 patients who had spinal meningioma and treated in the Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University. Their clinical data were retrospectively analysed. Of the 120 patients, there were 90 females and 30 males, aged from 14 to 85 (average, 54) years old. According to McCormick Classification, 29 cases were in grade I, 59 cases were in grade II, 25 cases were in grade III, and 7 cases were in grade IV. They were all underwent microsurgery. Patients were followed up by outpatient service within 3 months after surgery, then reviewed by outpatient visits and telephone interviews. McCormick's classification method and MRI examination were used to analyse the neurological and imaging changes of the patients before and after the surgery.Results:A total of 113 patients had complete resection and 7 had the resection of most part of the spinal meningioma. No infection, cerebrospinal fluid leakage, other complications and death occurred. Three months after surgery, 95 patients achieved the improvement or even completely disappearance of symptoms (such as numbness, pain, limited movement, etc.). There were 23 patients who had the symptoms unchanged as what before the surgery. Two patients had the symptoms worsened after the surgery. At 3 months after surgery, 95 cases (79.2%) improved, 23 cases (19.2%) were stable, and 2 cases (1.6%) aggravated. According to McCormick classification method, 92 cases were in grade Ⅰ, 15 cases were in gradeⅡ, 10 cases were in grade Ⅲ, and 3 cases were in grade Ⅳ. MRI scans showed that the dural sac were well refluxed, and no recurrence was found.Conclusion:Microsurgery is safe and effective for removal of spinal meningioma, with significant improvement in symptoms with fewer complications.