Objective To explore the wound healing of semi-toe nail flap donor site after transplantation. Methods To repair small wounds,on 13 toes the first metatarsal dorsal flaps were applied,and on 7 toes the second toe digital flaps were applied.While,to repair large wounds,free flaps were applied,including foot inside flaps on 3 toes,peroneal artery perforator flaps on 5 toes,tarsal lateral artery flaps on 2 toes,and phil bowel artery inside branch flaps on 3 toes.Wounds remaining on semi-toe nail flaps of 7 toes were all covered with fibular island flaps of the first toes. Results Twenty cases were followed up,and the rang between 6 months to 5 years.The nail margin was exposed out of the lateral flaps in 2 cases.The first toes and the second toes appeared nearly normal in the other 18 cases.The flaps appeared smooth,flexible appearance with nice color and no ulceration.Seven cases applied with free flaps recovered protective sensibility with no complaint. Conclusion To cover wounds on semi-toe nail flaps of the first toes and the second toes with flaps is an ideal treatment method.The method of free flap transplantation is superior to vascular pedicle flap graft.

Objective:To investigate the relationship between problem behaviorand father-child relationship in 4-6-year-oldchildren. Methods:Totally 102 children were recruited in a kindergarten in Beijing,with 36 aged four,36 aged five,30 aged six and 55 being boys and 47 being girls. Child Behavior Checklist (CBCL)was used to measure preschoolers'problem behaviors,and Family Relations Index (FRI)was adopted to assess children's rela-tionship with their fathers. Results:There were 41,49,and 12 children being classified as negative,neutral and posi-tive father-child relation respectively. Kruskal-Wallis Test revealed that there was no significant difference in scores of 3 CBCL subtests and 8 factors (P>0. 05 )among 4-,5-,and 6-year-old children. Children with negative father-child relationship scored higher on CBCL problem behavior subtests than those with neutral father-child relationship[30. 5 (7. 0,58. 0)vs. 16. 0 (0. 0,69. 0),P<0. 05 ]. They alsoscored higher on withdrawn behavior than children with neutralor positive father-child relationship [3. 0 (0. 0,4. 0)vs. 1. 0 (0. 0,6. 0),1. 0 (0. 0,4. 0),P<0. 05] . Mann-Whitney U Test manifested that boys scored higher in attention problem than girls (P<0. 0 1 ),but no gen-der difference was found in the other problem behaviors. Kruskal-Wallis Test showed that boys with negative father-child relationship scored higher than those with neutral father-child relationship on problem behavior subtest,anxie-ty-depression,attention problem,and internalized problem (Ps<0. 05 ). Boys with negative father-child relationship scored higher than those with neutraland positivefather-child relationship on withdrawn behavior (Ps <0. 05 ). No difference was found whether in CBCL subtests or problem behavior factors for girls with different types of father-child relationship. Conclusion:It suggests that the children with negative father-child relationship display more problem behavior and withdrawn symptoms;boys have more attention problems than girls;compared with girls, boys'problem behavior may be more closely related to therelationship with their father.

Objective To discuss the treatment of half hallux toenail flap transplantation for reconstruction of the distal segment finger defect. Methods Based on using the first plantar/dorsal metatarsal artery, or toe artery as pedicle to cut off partial toenail together with toe abdomen flap or partial toenail to repair 64 cases which include 69 fingers with distal segment complete and partial defect,the distal skin avulsion,skin tube in postoperative plastic,replantation failure and so on.Depending on the size of the donor foot wound use the first dorsal metatarsal artery,second toe artery,the perforating branch of peroneal artery or plantar metatarsal artery flap to cover the wound, and then observe the appearance of the finger and foot donor site after operation. Results The finger pulp was full and elastic,nail bed of the toe was well healing,nail groove which originated from the reconstructed nail fold was shallow,the appearance wos realistic,all feelings were recover,two-point discrimination was 4 to 5 millimeter,the donor toe was plump like the original one in appearance,patients were all satisfied with the reconstructed finger and the toe shape,after a follow-up from 3 month to 4 years. Conclusion Half hallux toenail flap transplantation is an effective way to repair the distal segment finger defect.

Objective To investigate the effect of vascularized fibula with fibular flap to repair limb bones and soft tissue defects.Methods Transpositional fibulas were used to repair tibiae defects in 4 cases.Free fibular transplantation was used in 6 cases,including folded fibular transplantation in 3 cases distal femur repair in 2 cases,calcaneus repair in I case.Hole fibular transplantation was used in 11 cases to repair tibia radius and metatarsal bones.Semi-fibular transplantation was used to repair metacarpal bone defects in 2 cases.All transplanted bones were together with the flap to repair bones and soft tissue defects.Results Twenty cases were all survived,with bone healing time of 6 to 10 weeks,and weight bearing time of 3 to 6 months,fifteen cases were followed up for 6 months to 4 years,and the results showed that their transplanted bones became thicker,their lower limbs recovered to normal walking,hand grip function recovered,the transplanted flaps were elastic.Conclusion Vascularized fibula and fibular flaps transplantation was an effective way to repair limb bones and soft tissue defects.

Objective To explore the effect of combined aerobic and resistance exercise training on the quality of life, pain degree and hospital stay of spinal scoliosis patients. Methods A total of 112 patients were selected from January 2016 to March 2018, thereby assigning two groups randomly (56 cases). Patients in the control group was nursed by conventional training methods and traditional health education. The experimental group was added combined aerobic and resistance exercise training. The quality of life, pain degree on the first day of admission, 1 week, 1 month and 3 months after operation was evaluated by Scoliosis Research Society-22(SRS-22) and Visual Analogue Scale(VAS),the hospital stay was observed and compared between the two groups. Results There was no significant difference of SRS-22 score and VAS score on the first day of admission between the two groups (P>0.05). The score of VAS was 7(6.25,8.75), 4(3.25,5.00) points in 1 week, 1 month after operation in the experimental group, 8(7.00, 9.00), 5(3.00, 6.00) points in the control group, and there was significant difference between the two groups (Z=4.380, 3.318, P<0.01). The score of SRS-22 was (71.32±10.31), (65.96±6.01), (50.40±7.82) points in 1 week, 1 month, 3 months after operation in the experimental group, (74.64 ± 6.86), (68.16 ± 5.43), (66.42±7.65) points in the control group,and there was significant difference between the two groups (t=2.312, 1.286, 4.508, P<0.01 or 0.05). The hospital stay was (19.30±7.21) d in the control group, (16.70± 5.43) d in the experimental group, and there was significant difference between the two groups (t=1.321, P<0.05).Conclusions Combined aerobic and resistance exercise training is effective at decreasing the degree of pain in post operation, improving quality of life and shorting average of length of stay.

The electronic nursing clinical pathway was fully applied, and the evidence-based practice achievements of cancer patient symptom management was integrated into the electronic nursing clinical pathway in Fudan University Shanghai Cancer Center. Taking " comprehensive evaluation before chemotherapy" , " chemotherapy-related nausea and vomiting" , " chemotherapy-related diarrhea" as examples, the authors introduced the application of evidence-based practice project in nursing clinical pathway. Through the implementation of the project, a standardized operation flow of electronic nursing clinical pathway was formed; The nurses introduced new nursing tools, new processes and new technologies in the process of project implementation; Meanwhile, the project reduced the incidence of adverse symptoms and shortened the hospitalization time of patients. The project achieved the goal of " win-win" to reduce the burden of patients′ disease and improve the efficiency of tumor care.