Objective In order to reduce neonatal missing and obstetric malpractice,design and application of a new neonatal hand ring was proposed in this paper.Methods Positive stop button,positive stop knot,positive stop cannula,rope,double sandwich tag set were included in the structure of new neonatal hand ring.Results The new neonatal hand ring has been experimentally applied by some departments in Nanjing Maternity and Child Health Care Hospital.The result showed the new neonatal hand ring effectively reduced the incidence of hand ring falling off,arm erythema and beds error.Conclusions Application of the new neonatal hand ring can guarantee the legal rights of newnates,avoid the disputes caused by misunderstanding and increase the automatic management level of hospitals.

Objective To evaluate the effect of isoflurane preconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and isoflurane preconditioning group (group IP).Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion followed by 24 reperfusion.Group IP inhaled 1.5％ isoflurane for 1 h per day for 5 consecutive days,the other two groups only inhaled 30％ oxygen,and focal cerebral I/R was induced at 24 h after the last inhalation.At 24 h of reperfusion,neurologic deficit was assessed and scored,the rats were then sacrificed,and brains were removed for determination of cerebral infarct size (using triphenyl tetrazolium chloride staining) and expression of microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 (by Western blot).Results Compared with group S,the neurologic deficit scores and cerebral infarct size were significantly increased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly up-regulated in I/R and IP groups (P＜0.05).Compared with group I/R,the neurologic deficit scores and cerebral infarct size were significantly decreased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly upregulated in group IP (P ＜ 0.05).Conclusion The mechanism by which isoflurane preconditioning ameliorates focal cerebral I/R injury is related to enhancement of autophagy in the rats.

Objective To evaluate the effect of electroacupuncture (EA) on postoperative outcome in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-four patients of both sexes,aged 18-55 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅲ,with New York Heart Association Ⅱ[or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =22 each) using a random number table:control group (group C) and group EA.In group EA,patients received EA stimulation with needles at bilateral Neiguan,Ximen,Shenmen and Baihui acupoints (disperse-dense waves,frequency 2 Hz,intensity 1.0-1.2 mA) from 20 min before anesthesia induction to the end of surgery.After induction of general anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia.Quality of Recovery 9 and Minimum Mental State Examination scores were assessed on the day before surgery and 1 and 3 days after surgery.The development of nausea and vomiting,postoperative cognitive dysfunction,requirement for rescue analgesics and ventricular arrhythmia was recorded within 3 days after surgery.The consumption of sufentanil in surgery,extubation time,the first flatus time,the first postoperative off-bed time,duration of stay in the intensive care unit and length of hospital stay after sugery were recorded.Results Compared with group C,the consumption of sufentanil in surgery was significantly decreased,Quality of Recovery 9 scores were increased at 1 and 3 days after surgery,the incidence of nausea and vomiting,postoperative cognitive dysfunction and ventricular arrhythmia was decreased within 3 days after surgery,and the extubation time,the first flatus time,the first postoperative off-bed time and length of hospital stay after surgery were significantly shortened in group EA (P＜0.05).Conclusion EA can promote postoperative outcome in the patients undergoing cardiac valve replacement with CPB.

Objective To compare the efficacy of continuous lumbar plexus block (LPB) with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups (n =30 each) using a random number table:0.5 μg/ml dexmedetomidine+0.1％ ropivacaine group (group D1) and 1.0 μg/ml dexmedetomidine + 0.1％ ropivacaine group (group D2).Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia (PCIA) pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9％ sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score ＞3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 (P＜ 0.05).No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1％ ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.

To improve the clinical teaching work, the objective structured clinical examination (OSCE) was first introduced into the periodontal clinical assessment held by Departments of Periodon-titis and Mucosal Disease. With the OSCE exam station and item pool established, standardized pa-tients tralned, the examination form reformed, the knowledge, skill, and attitude of the examinee were assessed comprehensively. Compared with traditional exam,the OSCE evaluated the examinee's skills on clinical admissions, history collection, treatment plan development better. Most examinee have got satisfactory result (pass rate: 86.4 %, 19/22; good rate: 36.4%, 8/22; excellent rate: 9.1%, 2/22). The feedback of the following questionnalre also showed that most of the candidates thought the OSCE helpful to promoting the learning of theoretical knowledge (87.5%, 14/16) and good for converting the learned knowledge and skills into occupation ability (87.5%, 14/16).

Objective To explore the effect of dexmedetomidine combined with ropivacaine for continuous lumbar plexus block on the quality of early recovery in patients undergoing total hip ar-throplasty.Methods Sixty patients (35 males and 25 females)with ASA physical status Ⅱ or Ⅲ, aged 65-84 years,undergoing total hip replacement were randomly assigned to dexmedetomidine com-bined with ropivacaine group (group D)or ropivacaine group (group C).All patients received ropiva-caine which was administered via continuous lumbar plexus block as patient-controlled analgesia (PCA)after surgery.The PCA were programmed with a background infusion 8 ml/h of ropivacaine, bolus dose was 4 m1 and the block time was 30 min;the patients in group C received 0.2% ropiva-caine,and the patients in group D received 0.1% ropivaciane combined with 1 μg/ml of dexmedeto-midine by the way of intravenous infusion.In addition,all patients received another patient-controlled intravenous analgesia (PCIA)with 1 mg/ml of morphine for relieving the explosive pain.The PCIA was programmed with a lobus dose of morphine 1 mg without background dose,the block time was 5 min.Consumption of morphine and visual analog scale (VAS)score,muscle strength and maximum flexion and abduction of hip joint were recorded at the time points of 6,12,24 and 48 h after opera-tion.The side-effect reactions such as nausea,vomiting,drowsiness and itching were recorded.The sleep quality was assessed with Pittsburgh sleep quality index (PSQI)on day 1 before operation,day 1 and day 7 after operation.Results The consumption of morphine in group D was significantly fewer than group C (P <0.05).Compared with group C,muscle strength and maximum flexion and abduc-tion of hip joint in group D were increased at 6,12,24 and 48 h after operation (P <0.05 ).PSQI scores were decreased on the day 1 and day 7 after operation.The incidence of delirium,nausea and vomiting,drowsiness and itching in group D were decreased (P <0.05).Conclusion 0.1% ropiva-ciane continuous lumbar plexus block combined with 1 μg/ml of dexmedetomidine by the way of in-travenous infusion could provide satisfied analgesia for the operation of total hip arthroplasty;the sleep quality is improved,the functional exercise of hip joint is promoted.

Objective To determine the median effective concentration (EC50) of ropivacaine blocking the motor nerve in aged patients of different age stratification.Methods Ninety-six patients of both sexes,aged 66-85 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with body mass index of 20-27 kg/m2,scheduled for elective hip replacement,were divided into 4 groups (n=24 each) according to the age:group Ⅰ 66-70 yr,group Ⅱ 71-75 yr,group Ⅲ 76-80 yr and group Ⅳ 81-85 yr.The concentration of ropivacaine was determined by up-and-down sequential trial.In each group,0.2％ ropivacaine 10 ml was epidurally injected in the first patient,and the difference between two successive concentrations was 0.025％.Each time the concentration of ropivacaine increased or decreased in the next patient depending on whether or not the Bromage score was 0 at 30 min after epidural injection.The EC50 and 95％ confidence interval of epidurally administered ropivacaine blocking the motor nerve were determined using probit analysis.The sensory block level and development of intraoperative hypotension and nausea and vomiting were recorded.Results The EC50 (95％ confidence interval) of ropivacaine was 0.24％ (0.19％-0.29％),0.22％ (0.17％-0.26％),0.19％ (0.15％-0.24％) and 0.17％(0.14％-0.22％) in Ⅰ,Ⅱ,Ⅲ and Ⅳ groups,respectively,and the EC50 of epidurally administered ropivacaine blocking the motor nerve was gradually decreased with increasing age stratification (P＜0.05).The sensory block level was all at T7.8-S1 in the four groups.There were no significant differences between the four groups in the incidence of intraoperative hypotension or nausea and vomiting (P＞0.05).Conclusion For aged patients of different age stratification,the EC50 of epidurally administered ropivacaine blocking the motor nerve is as follows:0.24％ in patients aged 66-70 yr;0.22％ in patients aged 71-75 yr;0.19％ in patients aged 76-80 yr;0.17％ in patients aged 81-85 yr.

Objective To understand the proficiency level and sources of Traditional Chinese Medicine(TCM)health education among hemodialysis patients,in order to provide the basis for promoting the application of TCM nursing in hemodialysis patients.Methods Utilizing a convenience sampling approach,we conducted a survey from April to May 2023 involving hemodialysis patients from 7 tertiary TCM hospitals across Beijing,Hebei Province,Sichuan Province,and other regions.Custom-made questionnaires were utilized,gathering general information,respons-es conceming the level of mastery on TCM health education,and their primary sources of such knowledge.Results A total of 413 questionnaires were disseminated,and 392 proved valid,yielding a valid response rate of 94.92％.The score of patient's knowledge on TCM health education averaged(8.25±3.73),and an average score rate of 48.53％was obtained.In the patients undergoing hemodialysis,a relatively larger number of people possess knowl-edge of TCM health knowledge about relieving symptoms(50.8％～55.9％)and traditional Chinese daily life routines(56.4％～90.1％).However,fewer people are aware of how to use the five-tone therapy method for emotional inter-vention(40.8％)and principle of taking restorative Traditional Chinese Medicine(24.5％～36.7％),the dietary prin-ciples of"nurturing yang in spring and summer,and nurturing yin in autumn and winter"(14.3％),and theories of TCM kidney functions(9.9％).Approximately 23.0％of the patients sourced their TCM health education knowledge from new media platforms.Compared with new media method alone,patients who utilized only traditional education-al platforms(P=0.020),and those who combined both new media and traditional methods(P=0.018)demonstrated higher proficiency in TCM health education.Conclusion Hemodialysis caregivers are urged to develop a TCM health education framework that emphasizes emotional well-being and traditional wellness concepts,thereby fostering patient-centric TCM health ideologies.Hemodialysis education personnel are encouraged to leverage new media whilst ensuring education quality and effective outcomes.

Objective To describe the status of the post-discharge coping difficulties in women with hypertensive disorders of pregnancy(HDP),and to explore its influencing factors.Methods A total of 280 women with HDP from a tertiary A maternity hospital in Nanjing City were investigated with the general information questionnaire,the post-discharge coping difficulty scale-new mother form,the readiness for hospital discharge study-new mother form,the family APGAR index.The factors influencing post-discharge coping difficulties in women with HDP were analyzed using univariate analysis and multiple linear regression.Results 238 valid questionnaires were collected,with a response rate of 85.0%.The score of the post-discharge coping difficulties in women with HDP was 5.07±1.69,which is at a middle level.The results of multiple linear regression analysis showed that parity,primary caregiver during the postpartum period,HDP type,readiness for hospital discharge,family APGAR index were influencing factors of post-discharge coping difficulties in women with HDP(P＜0.05).Conclusion Post-discharge coping difficulties in women with HDP remains to be further improved,and it is affected by many factors.Medical staff should pay more attention to post-discharge coping difficulties of such parturients,formulate targeted continuation care programs according to relevant influencing factors,comprehensively improve their coping ability,and reduce their coping difficulties after discharge.

Objective:To explore the status quo and influencing factors of postnatal sense of security in patients with hypertensive disorder complicating pregnancy.Methods:This study was a cross-sectional study. Using the convenience sampling method, a total of 215 patients with hypertensive disorder complicating pregnancy and their spouses who gave birth in Women's Hospital of Nanjing Medical University from December 2022 to May 2023 were selected as the research objects. The general data questionnaire, Parents' Postnatal Sense of Security (PPSS), Ego-Resiliency Scale (ERS) and Perceived Social Support Scale (PSSS) were used to investigate them. Multiple linear regression analyses were used to explore the factors influencing postpartum security in patients with hypertensive disorders complicating pregnancy.Results:A total of 215 questionnaires were sent out in this study, and 202 were effectively collected, with an effective recovery rate of 94.0%. The total score of PPSS maternal version for 202 patients with hypertensive disorder complicating pregnancy was (59.32±6.81), while the total score of PPSS paternal version for spouses was (41.28±5.24). The results of multiple linear regression analysis showed that the number of antenatal examinations accompanied by family members, the effect of postpartum blood pressure control, the current state of mother and child, postnatal sense of security of spouse, ego-resiliency and perceived social support were the influencing factors of postnatal sense of security in patients with hypertensive disorder complicating pregnancy ( P<0.05) . Conclusions:The postnatal sense of security in patients with hypertensive disorder complicating pregnancy is at a medium high level. Medical personnel should focus on patients with hypertensive disorder complicating pregnancy who are accompanied by their family members less times, poor postpartum blood pressure control and postpartum separation from mother and child, providing them with targeted clinical care to improve their postnatal sense of security.