Objective To explore the application of propofol combined with small dose fentanyl in manual reduction anesthesia in orthopedics.MethodsOctober 2014 to August 2016 in Huzhou central hospital treated 120 cases of acute long bone closed fracture and ankle, shoulder dislocation and other patients, efficient analysis anesthesia, surgery time, patient recovery time, propofol is added volume and total volume, and detection 3min, 1min, 3min, 5min and waking SpO2, HR, MAP, RR values.After administration before it is administered.ResultsAnesthetic effect experimental group total efficiency is higher, the difference was statistically significant (P<0.05);after simultaneous administration of all patients 1min, 3min, 5min signs were lower than prodrug 3min signs, the difference statistically significant (P<0.05), after clear signs of its former administration 3min with no significant difference;experimental group recovery time, propofol bolus of propofol than with total control were lower, the difference was statistically significant (P<0.05);and the two groups were similar to the operation time, the difference was not statistically significant.ConclusionIn summary, propofol combined with entanyl anesthesia for patients to take the treatment of orthopedic manual reduction obviously.

Objective To assess the length of stay,early complication and cost of treatment in radical cystectomy (RC) patients with different Charlson Comorbidity Index Score (CCI).Methods A prospective study of a total of 102 patients who underwent RC between March 2012 and August 2014 in Center for Research of Urology in Yunnan Province,China.They were divided into three groups:69 cases in CCI=0 or 1group,19 cases in CCI=2 group,14 cases in CCI≥3 group.Comorbidities were graded according to CCI,and each patient was followed-up for 3 months after RC.Length of stay,early complications and treatment cost were analyzed by statistics.Results A total of 102 patients were analyzed.There were obvious differences with respect to length of stay,early complication and cost of treatment comparing patients in each CCI group,H=20.722,6.025,and 7.047,P＜0.05.The incidence of diversion-related early complications in patients with different CCI showed significant difference,H=7.100,P＜0.05,however,the non diversionrelated early complications did not show significant difference between patients with different CCI,H=2.590,P＞0.05.Conclusions Patients with different CCI showed difference in the length of stay,early complication and cost of treatment in RC patients with different CCI.CCI≥3 might help to identify patients at risk for early complications after RC,especially in the orthotopic urinary diversion operation.Patients' complication should be evaluated standardized before operation and these should be included in patients' consideration.

Objective:To explore the analysis of staging alteration and prognosis of 8th edition of the American Joint Committee on Cancer (AJCC) staging update for breast cancer with different molecular subtypes.Methods:The clinical data of 965 breast cancer patients treated in Xijing Hospital from January 2011 to December 2017 were retrospectively collected, and 103 patients met the inclusion criteria. The staging results between all the patients and patients with 4 different molecular subtypes were compared according to the 7th and 8th edition of the AJCC. Fisher's exact test was used for staging differences, Kaplan-Meier was used for survival analysis, log-rank test was used to compare survival rates of different groups, the prognostic judgement efficacy and staging alteration for all patients and cases with different molecular subtypes in the 8th edition was also compared.Results:Compared with the 7th edition, a total of 52 cases (50.5%) had staging declined and 8 cases (7.8%) had staging risen in the 8th edition, and there was a statistically significant difference in composition change ( P < 0.05). There was no rise in staging for Luminal subtype patients, but the decline in 34 cases, with the decline rate of 87.2% (34/39); no rise in staging for patients of HER2 + subtype, but the decline in4 cases, with the decline rate of 19.0% (4/21). No rise in staging for triple positive subtype patients, but the decline in 14 cases, with the decline rate of 82.4% (14/17). Oppositely, for the patients with previous subtypes, no decline in staging of patients with triple negative subtypes, but the rise in 8 cases with the rise rate of 30.8% (8/26). The difference in all the above staging changes was statistically significant ( P = 0.001). According to the 7th edition of the AJCC, the disease-free survival (DFS) time of all the cases and Luminal subtype patients had no statistical differences among different staging groups ( P > 0.05), but according to the 8th edition of the AJCC, the differences were statistically significant ( P < 0.05). DFS time was shorten with the increase of staging, indicating that the 8th edition of staging could more accurately assess the prognosis of patients. Conclusions:Compared with the 7th edition of the AJCC, for the staging changes determined by the 8th edition of the AJCC, the proportion of staging declined in all the cases is significantly higher than that of staging risen, and patients with different molecular subtypes has different staging changes, among which the patients with the triple negative subtypes have staging risen and the rest have staging declined. The DFS analysis for all the patients and patients with Luminal subtypes indicates that the 8th edition of the AJCC staging is a more accurate predictor of prognosis compared with the 7th edition of the AJCC.

Objective:To investigate the changes in total radioactivity in patient body with differentiated thyroid carcinoma (DTC) after 131I treatment and the factors influencing its metabolism. Methods:The clinical data from 218 patients after DTC treatment in the Department of Nuclear Medicine, the Second Affiliated Hospital of Air Force Medical University from September 2021 to April 2022 were retrospectively analyzed. Based on administrated 131I dose, 171 patients were divided into low-dose group (≤ 3.7 GBq) and 47 into high-dose group (>3.7 GBq) . A whole body dynamic radiation monitoring system was used to measure the in vivo residual activity of 131I 24, 48 and 72 h after 131I administration and to explore their influencing factors. Results:24, 48 and 72 h after adimination of 131I, the residual activity of 131I in the low-dose group patients was significantly lower than in the high-dose group patients ( t= -7.46, -3.31, -2.01, P<0.05) . The discharge compliance rate at 24 and 48 h in the low-dose group was significantly higher than that in the high-dose group (21.0% vs. 4.3%, 98.2% vs. 89.4%, χ2 = 7.23, 5.91, P<0.05) , and all patients could meet the discharge criteria at 72 h. Univariate analysis showed that the residual 131I activity at 24 and 48 h was dependent on age, body mass index (BMI) , basal metabolism rate (BMR) and thyroid stimulating hormone (TSH) . As have been shown by multiple linear regression analysis, in the low-dose group, the older age, the higher BMR and the higher TSH level at 24 h tended to the higher 131I residual activity in the body. At 48 h, the higher BMI and the higher TSH level lead to the higher 131I residual activity in patient body. Meanwhile, in the high-dose group, the higher age and BMR at 24 h, tended to the higher in vivo131I residual activity. The influencing factors were analyzed in terms that 131I residual activity reaching 400 MBq in patient body at 24 and 36 h. The result showed that at 24 h the lower TSH level leaded to the lower 131I residual activity in patient body. At 36 h, the younger age, the lower TSH level, and the smaller 131I treatment dose tended to the lower in vivo131I residual activity. Conclusions:Age, BMI, BMR and TSH levels are the influencing factors for the change in total activity in patient body after 131I treatment of DTC. Radiation dose assessment based on the above indicators can provide a reference for adjusting the length of hospitalization time.

With the development of critical care ultrasound technology, clinics begins to pay attention to the role of critical care ultrasound in nursing of critically ill patients. The increasingly extensive application of ultrasound in the field of critical care provides a visual tool for clinical nursing work, which can qualitatively and quantitatively evaluate nursing indicators, help to solve the existing nursing problems and nursing difficulties and promote the improvement of critical care quality and the development of nursing academics. To this end, experts formulates this consensus based on years of experience and application of intensive care ultrasound practice.

Objective:To formulate the Nursing standards of clinical practice of critical care ultrasonography (referred to as the Standards), so as to provide recommendations for the application of ultrasound in intensive care nursing practice. Methods:Based on the experience of intensive care ultrasound nursing practice and literature research, combined with the consensus recommendations of intensive care ultrasound, the critical care ultrasound study group formed the first draft of the Standards. After expert interview, consensus discussion, two rounds of Delphi expert letter consultation and other methods, the content of the Standards was revised and improved, and the final draft of the Standards was formed. Results:The Standards included four parts, such as basic application of intensive care ultrasound, nursing evaluation standard of intensive care ultrasound guidance, nursing operation process guided by ultrasound and intensive care ultrasound training. Conclusions:The establishment of Standards is scientific and practical, which can provide guidance for nursing practice of clinical operation technology of critical care ultrasonography.

Objective:To explore the characteristics of parental emotional regulation(ER)and its influence on the ER of children with attention deficit hyperactivity disorder(ADHD).Methods:A total of 140 children with ADHD meeting the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)criteria and their parents,68 normal controls and their parents were recruited.ER was assessed using the Difficulties in Emotion Regulation Scale(DERS),Emotion Regulation Questionnaire(ERQ)and Emotion Regulation Checklist(ERC).Re-sults:Higher scores of DERS in emotion regulation strategies,impulse control and goal-directed behavior were found in parents of children with ADHD compared with parents of normal controls(Ps＜0.05).The higher emo-tional lability(EL)of ERC and lower ER of ERC detected in children with ADHD were correlated with the emo-tion regulation strategies,impulse control and goal-directed behavior of their parents(Ps＜0.01).The mediation an-alyses suggested that ER in children with ADHD may mediate the relationship of parental emotion regulation strate-gies and parental impulse control with children's EL.Conclusion:Parents of children with ADHD may exhibit emo-tional dysregulation in multiple subdimensions which might affect emotional regulation and aggravate the emotional lability of children with ADHD.

Objective To understand the driver gene mutation status in patients with non-small cell lung cancer (NSCLC) in Xi'an City, and to analyze the association with environmental exposure factors. Methods A total of 305 NSCLC patients admitted to the First Affiliated Hospital of the Air Force Medical University from January 2019 to December 2023 were included. The driver gene mutation status was observed, and the relationship with environmental exposure factors was analyzed. Results The driver gene mutation rate of 305 patients was 46.89%, with EGFR gene mutation accounting for the highest proportion, and 4 cases of gene co-mutations were detected. There was a difference in gender among patients with different single drive gene mutations (P<0.05), and the proportion of EGFR in women was significantly higher (P<0.05). Univariate analysis showed that there were statistical differences in family history, smoking history, long-term cooking history, and fried smoked food intake between patients with driver gene mutation and patients without driver gene mutation (P<0.05). Logistic regression analysis suggested that long-term cooking history (OR=2.392), and fried smoked food intake (OR=2.849) were the environmental exposure factors affecting EGFR gene mutation (P<0.05), and smoking history (OR=1.377) was an environmental exposure factor of KRAS gene mutation (P<0.05). Conclusion EGFR gene mutation accounts for the highest proportion of NSCLC patients in Xi'an City, and is mainly female. Long-term cooking history, and fried smoked food intake are related to EGFR gene mutation. There is a certain association between smoking history and KRAS gene mutation.

POEMS syndrome is a rare condition associated with plasma cell disorders， and it often involves multiple systems and has diverse clinical manifestations. This article reports two cases of POEMS syndrome with hepatosplenomegaly as the initial manifestation. During the course of the disease， the patients presented with lower limb weakness， hepatosplenomegaly， lymph node enlargement， ascites， hypothyroidism， positive M protein， and skin hyperpigmentation， and ¹⁸F-FDG PET-CT imaging revealed bone lesions mainly characterized by osteolytic changes and plasma cell tumors. There was an increase in the serum level of vascular endothelial growth factor. The patients were finally diagnosed with POEMS syndrome， and the symptoms were relieved after immunomodulatory treatment.