BACKGROUND:For dislocation of acromioclavicular joint induced by coracoclavicular ligament fracture,single EndoButton Plate reconstruction and double EndoButton Plates reconstruction are common repair methods.Further study on the stress distribution and fracture risk of the two repair methods is of great significance. OBJECTIVE:To study the biomechanical properties of the coracoclavicular ligament,and compare the fixation effect,stress distribution and failure mode of single and double EndoButton Plates reconstruction. METHODS:(1)Finite element simulation analysis:Mimics,Wrap and SolidWorks were used to establish normal coracoclavicular ligament,single EndoButton Plate reconstruction and double EndoButton Plates reconstruction.Ansys software was used to analyze the stress and deformation of the scapula and clavicle of each model under vertical load.(2)Sample experiment:Fifteen intact scapular-clavicle specimens were randomly grouped into five groups,with three specimens in each group.In group A,the acromioclavicular ligament was severed and the coracoclavicular ligament remained intact.In group B,acromioclavicular ligaments and trapeoid ligaments were severed,leaving intact conical ligaments.In group C,acromioclavicular ligaments and conical ligaments were cut off,and the intact traprex ligaments were retained.In group D,acromioclavicular and coracoclavicular ligaments were severed,and coracoclavicular ligaments were repaired by single EndoButton Plate reconstruction.In group E,acromioclavicular and coracoclavicular ligaments were severed,and the coracoclavicular ligaments were repaired by double EndoButton Plates reconstruction.The mechanical experiment was carried out by a mechanical testing machine to analyze the biomechanical status,stress distribution and failure patterns of the scapular-clavicle and clavicle. RESULTS AND CONCLUSION:(1)Finite element simulation analysis:The average stress of coracoclavicular ligament attached specimens was the lowest,and the risk of coracoclavicular fracture was less than that of single and double EndoButton Plates reconstruction.The mean stress of the coracoid process was similar in single and double EndoButton Plates reconstruction,and the fracture risk was similar.(2)Sample experiment:In groups A,B,C,D and E,the stiffness of specimens was(26.4±3.5),(19.8±2.8),(21.3±3.2),(57.7±4.1),and(46.2±2.8)N/mm,respectively;the ultimate loads were(545.5±53.7),(360.1±42.1),(250.9±44.4),(643.5±39.1),and(511.9±31.7)N,respectively;global stiffness in groups D and E was higher than that in group A(P=0.000 06,0.000 3);ultimate load in group D was higher than that in group A(P<0.05);the ultimate load was not significantly different between the group E and group A(P>0.05).Ligament fracture was observed in groups A,B and C and coracoid process fracture was found in groups D and E.(3)These results suggest that from the biomechanical analysis,Single EndoButton Plate reconstruction and double EndoButton Plates reconstruction are effective treatment techniques for coracoclavicular ligament fracture in acromioclavicular joint dislocation,but increase the risk of fracture.The double EndoButton Plates reconstruction dispersed the stress of the steel plate and reduced the contact force between the steel plate and bone,but slightly reduced the ultimate bearing capacity.Single and double EndoButton Plates reconstruction should be selected according to the actual clinical situation.

Objective:To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation (LT) recipients to provide rationales for early identification of delirium and constructing the related models.Methods:The authors used the "肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and "liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords, searching Wanfang data, China Biomedical Literature Database, CNKI, PubMed, Embase, Web of Science, Cochrane Library, BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients. The researchers independently performed literature screening, methodological evaluation and data extraction. And RevMan 5.4 and State16.0 software were employed for data processing.Results:A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies. Meta-analysis showed that the incidence of POD was 23%(1151/5003). The statistically significant risk factors included preoperative blood ammonia concentration >46 mmol/L ( OR=3.51, 95% CI: 1.53-8.09, P<0.001), model for end-stage liver disease (MELD) score >15 points ( OR=4.24, 95% CI: 2.51-7.16, P<0.001), preoperative hepatic encephalopathy ( OR=3.00, 95% CI: 2.09-4.31, P<0.001), preoperative dosing of diuretics ( OR=2.36, 95% CI: 1.38-4.04, P<0.001), history of alcoholism ( OR=3.16, 95% CI: 1.06-9.40, P=0.040), longer anhepatic period ( OR=1.04, 95% CI: 1.03-1.06, P<0.001) and elevated aspartate transaminase concentration at Day 1 post-operation ( OR=1.33, 95% CI: 1.15-1.53, P<0.001). Conclusions:Preoperative blood ammonia concentration >46 mmol/L, MELD score >15, hepatic encephalopathy, dosing of diuretic, a history of alcoholism, longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT. Postoperative reintubation is not a risk factor for postoperative delirium.

Objective:To explore the mediating effect of perceived professional benefits between the humanistic literacy and spiritual care competence among oncology nurses.Methods:From September to October 2022, convenience sampling was used to select 354 oncology nurses from 11 ClassⅢ Grade A hospitals in Sichuan Province, Guangdong Province, and Hubei Province as the research subject. A survey was conducted on oncology nurses using the General Information Questionnaire, Nurses' Perceived Professional Benefit Questionnaire, Nurses' Humanistic Literacy Scale, and the Chinese version of the Spiritual Care Competence Scale (SCCS) . Pearson correlation was used to analyze the relationship between nurses' humanistic literacy, perceived professional benefits, and spiritual care competence. AMOS 26.0 software was used to analyze mediating effects. A total of 354 questionnaires were distributed, and after excluding 7 unqualified questionnaires, 347 valid questionnaires were collected, with a valid response rate of 98.02%.Results:Among 347 oncology nurses, the score of the Chinese version of SCCS was (77.60±19.04) . The total score of the SCCS was positively correlated with the total scores of the Nurses' Humanistic Literacy Scale, the Nurses' Perceived Professional Benefit Questionnaire, and scores of all dimensions, with statistically significant differences ( P<0.01) . Bootstrap test showed that the mediating effect of perceived professional benefits among oncology nurses between humanistic literacy and spiritual care competence was 0.284 [95% CI (0.408, 0.860) ] , accounting for 50.90% of the total effect. Conclusions:The perceived professional benefits of oncology nurses play a partial mediating role between humanistic literacy and spiritual care competence. We should strengthen training on the humanistic literacy of oncology nurses, enhance their perceived professional benefits, form a virtuous cycle of employment, and thereby improve their spiritual care competence.

AIM: To investigate the expression of glucose metabolism genes associated with tacrolimus-induced post-transplant diabetes in the mouse kidney and the mechanisms involved in the regulation of glucose metabolism by farnesylate X (FXR) receptor activator. METHODS: The gene expression levels of FXR, small heterodimeric partner-1 (SHP-1), phosphoenolpyruvate carboxykinase (PEPCK), and glucose transporter protein-2 (GLUT2) were measured after 72 h in HK-2 cell lines treated with tacrolimus and tacrolimus+FXR agonist (GW4064) and control groups, respectively. C57BL/6J male mice were gavaged with tacrolimus and tacrolimus+FXR agonist for 12 weeks, respectively, and the control group was given saline to observe the changes in body weight and blood glucose; after the animals were treated, the gene expression levels of FXR, SHP-1, PEPCK, and GLUT2 were detected, respectively. RESULTS: In cellular experiments, the expression of FXR, SHP-1 and GLUT2 genes was decreased in the tacrolimus-treated group (P< 0.05) and the expression of the PEPCK gene was significantly upregulated compared with the control group (P< 0.05). In animal experiments, compared with the control group, the blood glucose values were significantly increased in the tacrolimus-treated group and significantly decreased in the tacrolimus+FXR agonist combination intervention group (P< 0.05), and the expression of FXR, SHP-1 and GLUT2 genes were upregulated (P< 0.05) and the expression of PEPCK genes was significantly decreased in the mice kidney (P< 0.05).CONCLUSION: FXR agonists can improve tacrolimus-induced abnormal glucose metabolism after transplantation. Therefore, FXR may be a potential new target for the prevention and treatment of post-transplant diabetes.

Objective To construct the male and female rat model of fluorosis and to explore the gender difference in fluorosis. Methods A total of 48 clean-grade SD rats with the body weight of about 150 g (male∶female=1∶1) were equally divided into the control group and fluorosis model group. Rats in the fluorosis model group were fed with fluorine-containing (100 mg/kg) feedstuff. The general condition, changes in body weight and dental fluorosis of the rats were observed every three days. A batch of female and male rats were sacrificed by femoral artery bleeding on the 70th and 110th day of experiment, respectively, when all rats showed dental fluorosis. The levels of urinary fluoride and bone fluoride of the rats were measured by a fluoride ion-selective electrode. Results All the male and female rats in the control group did not show dental fluorosis during the entire experiment. The female and male rats in the fluorosis group showed dental fluorosis visible to naked eye began approximately on the 60th and 80th day, respectively, indicating that the appearance of dental fluorosis of the male rats was about 20 days later than the female rats. After 30 days or so, the male and female rats went into a rapid growth period, and there were significant differences between the body weights of the male and female rats (P＜ 0. 01). The body weight of the male and female rats in the fluorosis group was higher than that of the control group on the 110th day. With the progression of fluorosis, the levels of urinary fluoride and bone fluoride of the rats were gradually increased, and finally significantly higher than those of the control group (P＜ 0. 01). There was a positive correlation between the levels of urinary and bone fluoride and the time of fluorosis. The levels of urinary and bone fluoride of the male rats were significantly higher than those of the female rats (P＜ 0. 01), indicating that they are affected by gender. Conclusions The body weight of the rat model of fluorosis, the starting time when dental fluorosis occurs and the levels of urinary and bone fluorine are all different between male and female rats.

Objective To determine the risk factors of urinary tract infection (UTI) after renal transplantation,so as to provide a theoretical basis of reducing the rate of postoperative UTI effectively.Method Such databases as CNKI,VIP,Wanfang,Pubmed,Embase,Ovid,and EBSCO were searched from January 1995 to December 2015 for collecting the studies about UTI after renal transplantation.The search keywords were renal transplantation,kidney transplantation,urinary tract infection and risk factors.Meta-analysis was performed by using the RevMan 5.2 software.Result Fifteen studies were identified,including 1 236 patients in UTI group and 2 729 patients in the control group (non UTI group).The two groups had no significant differences in recipient age,diabetes mellitus history,peritoneal dialysis,cytomegaovirus infection,acute rejection,usage of MMF,usage of Tacrolimus,usage of CsA and retransplantation.The incidence of UTI after renal transplantation was significantly higher in female patients than male patients (OR:2.69;95％ CI:1.92-3.77;P＜0.000 01).The incidence of UTI of cadaveric renal transplantation was higher than living donor renal transplantation (OR:1.51;95％ CI:1.71-1.95;P=0.002).Using D-J tube for urinary reconstruction significantly increased the incidence of UTI (OR:1.51;95 ％ CI:1.07-2.13;P =0.02).Patients in the UTI group had a significantly longer preoperative dialysis time (WMD:1.48;95％ CI:0.22-2.74;P =0.02).Conclusion The female recipients,cadaveric renal transplantation,using D-J tube and prolonged preoperative dialysis time were factors affecting the risk of UTI.UTI after renal transplantation had no relationship with recipient age,diabetes mellitus history,peritoneal dialysis,cytomegaovirus infection,acute rejection,usage of MMF,Tacrolimus and CsA,and retransplantation.

Liver transplantation is a standard life-saving procedure for end-stage liver diseases.The therapeutic potential of this procedure may be limited by post-operative infectious complications.A better understanding on the common important infectious complications may improve the life quality and survival rate after liver transplantation.In this article,we review the progress on infectious complications after liver transplantation,with particular emphasis on risk factors,clinical manifestations,diagnostic methods,prevention measures and specific treatments for bacterial,fungal,cytomegalovirus infections.

Auto liver transplantation (ALT) has been tremendously popular in hepatic surgery for the liver masses due to lack of enough donor for allogeneic transplantation of liver.But ALT remains stagnant because it is technically more difficult than liver transplantation.Much difficulties in this field lying ahead.Related surgical technical requirements for surgeons operating ALT,complications,difficult liver resection,hypothermic liver perfusion,veno-venous bypass,ex vivo ECMO perfusion and liver trim,assess the quality and volume of autoplast,autoplast implant and vascular anastomosis.On the other hand,the therapeutic effect largely depends on the intraoperative vascular separating range,the location and size of the tumor,the scope of lymphoid infiltrates by neoplast,the intubation site for perfusion and the sequence of opening the occlusion vessel.Thus,it's necessary to set up a scientific,normative ALT procedure to improve the therapeutic effect and prognosis.

Objective To investigate the change of umbilical cord blood gas from early-stage neonates with pregnancy-induced hypertension syndrome (PHIS) affected mothers and its influence upon internal environment of body,and to evaluate the significance of postpartum umbilical cord blood gas analysis.Methods Retrospective study of 101 neonates(born of 97 PHIS-affected mothers),41 cases of mild group,34 cases of moderate group,26 cases of severe group,and enrolled 52 neonates born of non-PHIS mothers as the control group.Prior to neonate's first breath,umbilical cord artery blood gas analysis was performedimmediately to determine the values of pH,arterial carbon dioxide partial pressure (PaCO2),arterial oxygen tension (PaO2),HCO3-,base excess (BE),and Apgar score was completed within 1 min after birth.Results The pH,PaO2,HCO3-,BE in severe group was significantly lower than those in mild group,moderate group,and control group [7.16 ± 0.18 vs.7.25 ± 0.09,7.22 ± 0.11,7.29 ± 0.08 ; (12.01 ± 2.75) mmHg (1 mmHg =0.133 kPa) vs.(18.35 ± 1.75),(14.21 ± 2.01),(22.23 ± 1.45) mmHg; (17.11 ± 2.42) mmoFL vs.(19.82 ±3.85),(17.32 ± 3.21),(22.56 ± 3.38) mmol/L; (-9.15 ± 0.32) mmol/L vs.(-7.95 ± 0.60),(-7.21 ± 0.08),(-6.76 ± 0.03) mmol/L] (P ＜ 0.05),the PaCO2 in severe group was significantly higher than that in mild group,moderate group,and control group [(61.84 ± 32.93) mmHg vs.(54.48 ± 12.82),(58.38 ± 15.32),(51.66 ± 10.52) mmHg] (P ＜ 0.05),Apgar score 1 min after birth was positively correlated with umbilical arterial pH (P ＜ 0.05),the lower Apgar score,the lower pH.Among 65 cases of Apgar score ≤ 7 scores,37 cases of acidosis (pH ＜ 7.20),the incidence rate was 56.92％ (37/65) ; among 88 cases of Apgar score ≥ 8 scores,11 cases of acidosis,the incidence rate was 12.50％ (11/88),the difference was statistically significant (P ＜ 0.01).Conclusions Umbilical cord blood gas analysis is more objective than Apgar score,which could reflect neonate's hypoxia-ischemia degree bore of PIHS mothers,as well as contributed to the assessment of neonate' s prognosis.Conventional umbilical cord blood gas analysis is necessary for neonates bore of PIHS-affected mothers.Enhanced monitoring should be performed in a timely manner on those neonates born after intrauterine distress signs or with low Apgar score,the prevention and therapy as early as possible can improve the quality of birth.

This study was aimed to investigate effects of electroacupunture on PC6-Ne iguan and PC5-Jians hi points on heart rate and heart rate variability (HRV) in fear emotion. A total of 120 healthy volunteers were randomly allo-cated into the acupuncture group and control group, with 60 cases in each group. After 20 min frightening audio stimulation, volunteers in the acupuncture group received electroacupunture on PC6 and PC5 of both sides for 20 min and continued to repose for 20 min after needles were removed. Volunteers in the control group reposed for 40 min in the waking state. The heart rate and HRV of each subject was recorded during the whole process through Actiheart. The results showed that the experiment data was divided into two parts, rate rise and decreased or un-changed parts, after listening to audio and analyzed, respectively. Compared to the period of listening for 20 min, there were significant differences on average heart rate, HF, LF/HF of the post listening period between the acupunc-ture group and the control group (P < 0.05). There were significant differences on average heart rate, RMSSD, HF under the condition of heart rate decreasing or unchanging after 20 min (P < 0.05). It was concluded that elec-troacupunture on PC6 and PC5 had immediate regulating and post effects on autonomic nerve and bidirectional regu-lations of the plant nerve function disorder caused by fear, which can treat diseases through excitatory or inhibitory vagus nerve function.