OBJECTIVE: To investigate the mutation characteristics of common deafness gene from 127 non-syndromic hearing loss patients in Guangxi province. METHOD: Deafness-related gene mutations detection kit was used to detect 15 mutation sites in four deafness-associated genes, and a total of 127 hearing impaired patients were tested. The samples that could not be diagnosed with DNA microarray were subjected to PCR and sequenced to detect other mutations. RESULT Among the 127 patients with non-syndromic deafness, the total mutation rate is 8.66% (11/127), including GJB2 235delC homozygous in 3 cases (2.36%), 235delC single heterozygous mutation in 2 cases (1.57%), GJB2 235delC and 109 A > G mutations in 2 cases (1.57%); SLC26A4 1229C > T homozygous in 1 case (0.79%), IVS7-2A > G, IVS11 + 47T > C and 15448insC mutaion in 2 cases (1.57%); mitochondrial 12S rRNA gene mutations were not detected. The result indicates that GJB2 and SLC26A4 were the main genes in this study, and the mutation rate is significantly lower than the national average level. Three new mutations (SLC26A4 IVS11 + 47T > C,1548insC and GJB2 109A > G) were found. There may be rare mutations among sites or genes associated with deafness in Guangxi.
China ; Connexin 26 ; Connexins ; genetics ; DNA Mutational Analysis ; Deafness ; genetics ; Heterozygote ; Homozygote ; Humans ; Membrane Transport Proteins ; genetics ; Mutation ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction ; RNA, Ribosomal ; genetics ; Sulfate Transporters

Objective To investigate the characteristics of common deafness genes mutation from 222 sensori-neural hearing loss patients in Guangxi province.Methods A deafness-related gene mutations detection kit was used to detect 15 mutation sites in four deafness-associated genes.A total of 222 hearing impaired patients,who were selected from January 2015 to April 2016,were tested.The samples that could not be diagnosed with DNA mi-croarray were subjected to PCR and sequenced to detect other mutations.Results Among the 222 patients with sen-sorineural deafness,the total mutation rate was 10.36% (23/222),including GJB2 235delC homozygous in 3 cases (1.35%),235delC single heterozygous mutation in 8 cases (3.60%),35delG single heterozygous mutation in 2 cases (0.90%),GJB2 235delC and 109 A>G mutations in 2 cases (0.90%),SLC26A4 1229C>T homozygous in 2 case (0.90%),IVS7-2 A>G heterozygous mutation in 2 cases (0.90%);IVS7-2A>G,IVS11+47T>C and 1548 insC mutations in 2 cases (0.90%);GJB3 538C>T heterozygous mutation in 1 cases (0.45%);Mitochondrial 12S rRNA gene heterogeneous mutations in 1 case (0.45%).One of them carry both two mutations:GJB2 235 del C and SLC26A4 1226 G>A.Conclusion The results indicate that GJB2 and SLC26A4 were the main genes in this study,and in Guangxi province the mutation rate is significantly lower than the national average level.3 new muta-tions (SLC26A4 IVS11+47T ! C,1548insC and GJB2 109A>G)were found.There may be some rare mutations among sites or genes caused deafness in Guangxi.

Objective:To compare the effect of systematic nursing in operating room and routine nursing in reducing intraoperative stress injury in patients with spinal fracture and spinal cord injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 285 patients with cervical or thoracolumbar fracture associated with spinal cord injury admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2019, including 168 males and 127 females, with the age of 38-59 years [(47.8±8.5)years]. All patients underwent posterior decompression and fusion with internal fixation. Of all, 138 patients received systematic nursing in operating room including systematic evaluation and management before, during and after operation (observation group), and 147 patients received routine nursing including only intraoperative preventive care of pressure ulcer (control group). The incidence of pressure injury on the day after operation, degree of injury and location of injury at postoperative 3 days, and area of injury on the day after operation and at postoperative 3 days were compared between the two groups. The degree of injury was evaluated using the new stress injury staging assessment published by the American National Pressure Ulcer Advisory Panel (NPUAP).Results:The incidence of pressure injury in observation group [5.1% (7/138)] was lower than that in control group [12.2% (18/147)] on the day after operation ( P<0.05). The incidence of stage I, stage II, and stage III pressure injury in observation group [2.9% (4/138), 2.2% (3/138), 0.0%] was also lower than that in control group [8.2% (12/147), 3.4% (5/147), 0.6% (1/147)] at postoperative 3 days ( P<0.05). There was no significant difference in the incidence of pressure injury in the knee, chest, face and anterior superior iliac spine between the two groups ( P>0.05). The total proportion of pressure injury in the face and anterior superior iliac spine was 71% (5/7) in observation group, showing no significant difference from that in control group [83% (15/18)] ( P>0.05). The area of injury was (3.2±1.2)cm 2 and (3.2±1.1)cm 2 in observation group on the day after operation and at postoperative 3 days, lower than that in in control group [(5.1±1.5)cm 2 and (5.1±1.4)cm 2] ( P<0.01). Conclusion:Compared with the routine nursing, systematic nursing in operating room can significantly reduce the incidence, degree and area of intraoperative pressure injury in patients with spinal fracture accompanied by spinal cord injury, and deserves clinical promotion.

Objective:To compare the effects of enhanced heat preservation strategies and conventional heat preservation strategies in the operation room on body temperature, coagulation function, and myocardial injury in patients with cervical spinal cord injuries.Methods:A retrospective cohort study was conducted to analyze the clinical data of 160 patients with cervical spinal cord injuries admitted to Second Affiliated Hospital of Xi′an Jiaotong University and Affiliated Honghui Hospital of Xi′an Jiaotong University from February to October 2022, including 82 males and 78 females, aged 38-64 years [(50.6±8.7)years]. Injured segments included C 3 in 19 patients, C 4 in 33, C 5 in 39, C 6 in 38, and C 7 in 31. According to American Spinal Injury Association (ASIA) classification, 10 patients were classified into grade A, 83 grade B, 39 grade C, and 28 grade D. All the patients underwent cervical laminoplasty, decompression and bone graft fusion surgery. According to different heat preservation strategies intraoperatively, the patients were divided into conventional heat preservation group ( n=80) and enhanced heat preservation group ( n=80). The body temperature changes before surgery, at 2 hours during surgery, immediately after surgery, at 2 and 24 hours after surgery were compared between the two groups. The changes of coagulation function before surgery and at 4 hours after surgery were compared between the two groups, including the prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (APTT). The incidence of myocardial injury and the number of patients with myocardial injury measured by the indicators of cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) at 48 hours after surgery. Before surgery and at 14 days after surgery, ASIA classification was used to evaluate the neurological functions, including sensory and motor functions between the two groups. The incidence of cardiovascular events at 12 months after surgery were compared between the two groups. Results:A total of 145 patients were followed up for 12-18 months [(15.7±1.6)months]. At 12 months after operation, there were 7 patients in the enhanced heat preservation group were lost to follow-up, compared to 8 patients in the conventional heat preserration group. There was no statistically significant difference in body temperature between the two groups before surgery or at 24 hours after surgery ( P>0.05). At 2 hours during surgery, immediately after surgery and at 2 hours after surgery, the body temperature was (36.90±0.12)℃, (37.00±0.06)℃, and (37.16±0.06)℃ in the enhanced heat preservation group, which were significantly higher than those in the conventional heat preservation group [(36.56±0.03)℃, (36.74±0.08)℃, and (36.84±0.08)℃] ( P<0.01). The serum levels of PT, TT and APTT were not significantly different between the two groups before surgery ( P>0.05), while they were (13.1±1.2)seconds, (19.2±1.1)seconds, and (36.2±3.3)seconds in the enhanced heat preservation group at 4 hours after surgery, which were significantly lower than those in the conventional heat preservation group [(14.3±1.0)seconds, (20.2±1.1)seconds, and (38.7±3.4)seconds] ( P<0.01). The incidence of myocardial injury in the enhanced heat preservation group was 5.0% (4/80) at 48 hours after surgery, which was lower than 12.5% (12/80) in the conventional heat preservation group ( P<0.05). With cTnI as the indicator of myocardial injury, there were 2 patients [2.6%(2/76)] with myocardial injury in the enhanced heat preservation group, which was much lower than 8 patients [11.8%(8/68)] in the conventional heat preservation group ( P<0.05). With hs-cTnT as the indicator of myocardial injury, 8 patients [10.5%(8/76)] in the enhanced heat preservation group experienced myocardial injury, similar with 10 patients [14.7%(10/68)] in the conventional heat preservation group ( P>0.05). There were no statistically significant differences in the ASIA scores of the sensory and motor functions between the two groups before surgery and at 14 days after surgery ( P>0.05). The incidence of cardiovascular events at 12 months after surgery in the conventional heat preservation group was 27.8% (20/72), which was significantly higher than 9.6% (7/73) in the enhanced heat preservation group ( P<0.01). Conclusion:For patients with cervical spinal cord injuries, compared with conventional heat preservation strategies, the enhanced heat preservation strategies in the operating room can improve the patients′ core body temperature and coagulation function, and significantly reduce the incidence of myocardial injury and cardiovascular events.

Objective:To investigate the perioperative risk factors of surgical site infection (SSI) of subaxial cervical spine injury after anterior surgery and provide a basis for the development of nursing measures.Methods:A retrospective case-control study was conducted to analyze the clinical data of 754 patients with subaxial cervical spine injury who underwent anterior surgery from January 2014 to January 2018, including 511 males and 243 females, aged 44-61 years [(50.2±5.1)years]. The fracture segment was C 3 in 60 patients, C 4 in 159, C 5 in 197, C 6 in 236 patients, and C 7 in 102. The patients were divided into two groups according to SSI occurrence. There were 28 patients in infected group and 726 patients in non-infected group. Data of the two groups were recorded, such as demographic data, American Spinal Injury Association (ASIA) scale, comorbidity, time interval from skin preparation to operation, preoperative urinary catheterization or not, consecutive operation or not, total number of staff involved in the operation, layer flow level of operating room, operating room temperature, relative humidity, operation duration, intern nurse involved in the operation or not and surgical methods. Univariate analysis was used to screen the indicators with statistically significant differences between the two groups. Multivariate Logistic regression analysis was further used to identify the risk factors of SSI. Results:The occurrence rate of SSI was 3.71% (28/754). The univariate analysis showed that there were significant differences between the two groups in ASIA scale, diabetes, dietary nursing, time interval from skin preparation to operation, preoperative urinary catheterization, consecutive operation, total number of staff involved in the operation, layer flow level of operating room and operation duration( P<0.01). The multivariate Logistic regression analysis showed that the ASIA scale (grade A: OR= 84.421, grade B: OR=27.200, P<0.01), diabetes ( OR=3.234, P<0.05), without diet nursing ( OR=2.375, P<0.05), time interval from skin preparation to operation ≥ 6 h ( OR=2.542, P<0.05), preoperative urinary catheterization ( OR=4.085, P<0.01), consecutive operation ( OR=2.894, P<0.05), total number of staff in the operating room ≥ 8 ( OR=3.137, P<0.01), layer flow level of operating room is grade 10, 000 or above ( OR=5.380, P<0.01) and operation duration≥ 3 h ( OR=2.405, P<0.05) were positively correlated with perioperative SSI. Conclusions:The factors associated with SSI of subaxial cervical spine injury after anterior surgery are the ASIA scale (grade A and B), diabetes, without diet nursing, time interval from skin preparation to operation ≥ 6 h, preoperative urinary catheterization, consecutive operation, total number of staff in the operating room ≥ 8, layer flow level of operating room (grade 10, 000 or above) and operation duration ≥3 h. For patients with subaxial cervical spine injury, attention should be paid to diet care, blood glucose monitoring should be strengthened, and operating room management should be optimized.

Objective:To explore the effect of cluster nursing in robot-assisted surgery for the treatment of reducible atlantoaxial dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 41 patients with reducible atlantoaxial dislocation treated by robot-assisted surgery in Honghui Hospital affiliated to Xi′an Jiaotong University from January 2019 to December 2021, including 28 males and 13 females; aged 18-79 years [(45.2±10.3)years]. Ninteen patients received cluster nursing (cluster nursing group), with operating room nursing team set up on the basis of routine nursing and performed cluster nursing in line with evidence-based medicine. Twenty-two patients received routine nursing (routine nursing group). The operation time, intraoperative blood loss, frequency of intraoperative C-arm fluoroscopy, time of drainage tube placement and chief surgeon′s satisfaction for nursing were compared between the two groups. The degree of pain was evaluated by pain numerical score (NRS) at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up. The neck disability index (NDI) was assessed at 1 day before operation, 1 month after operation, 3 months after operation and at the last follow-up. The complications were observed.Results:All patients were followed up for 12-18 months [(16.7±3.7)months]. The operation time, intraoperative blood loss, frequency of C-arm fluoroscopy and time of drainage tube placement in cluster nursing group were (82.9±10.4)minutes, (105.9±11.8)ml, (3.8±0.6)times and (1.5±0.4)days, while those in routine nursing group were (125.7±12.8)minutes, (208.4±13.8)ml, (9.7±2.3)times and (3.6±0.6)days, respectively (all P<0.01). The chief surgeon′s satisfaction for nursing was 94.7% (18/19) in cluster nursing group and was 68.2% (15/22) in routine nursing group ( P<0.05). The NRS in cluster nursing group was (6.2±0.4)points, (6.0±0.7)points, (4.9±1.1)points, (2.7±0.5)points, (1.9±0.4)points, (1.8±0.4)points and (1.5±0.3)points at 12 hours, 24 hours, 48 hours, 72 hours, 1 month and 3 months after operation and at the last follow-up, while it was (7.6±0.6)points, (6.8±1.2)points, (5.8±1.5)points, (4.2±0.8)points, (3.4±0.7)points, (2.6±0.5)points and (2.2±0.5)points in routine nursing group ( P<0.05 or 0.01). There was no significant difference in the NDI between the two groups at 1 day before operation, but the NDI in cluster nursing group was 20.6±4.5, 14.6±2.8 and 10.7±2.5 at 1 month and 3 months after operation and at the last follow-up, while it was 26.9±4.1, 18.7±3.3 and 13.7±1.7 in routine nursing group (all P<0.01). There was no hematoma, infection or implant-related complications in both groups .Conclusion:For robot-assisted surgery in the treatment of reducible atlantoaxial dislocation, cluster nursing is associated with shortened operation time and time of drainage tube placement, decreased intraoperative blood loss and frequency of intraoperative fluoroscopy, increased chief surgeon′s satisfaction for nursing, reduced pain and accelerated functional recovery.

Objective:To explore the application effect of centralized propaganda of ward nurses combined with preoperative visit of full-time nurses in the operating room in patients undergoing knee arthroscopic surgery.Methods:A total of 208 patients who were hospitalized and underwent knee arthroscopic surgery in Sports Medicine Center of Xi'an Honghui Hospital affiliated to Xi'an Jiaotong University from May to June 2019 were selected as research objects. In chronological order, 104 patients admitted in May 2019 were set as the control group and 104 patients admitted in June 2019 were set as the intervention group. The control group received routine surgery-related propaganda and routine preoperative visit, while the intervention group received centralized propaganda of ward nurses combined with preoperative visit of full-time nurses in the operating room. The completion degree of preoperative preparation, awareness rate of health education knowledge of knee arthroscopic surgery, compliance of rehabilitation exercise and the anxiety level before and after visit were compared between the two groups.Results:The completion degree of preoperative preparation and compliance of rehabilitation exercise of the intervention group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The awareness rate of health education knowledge of knee arthroscopic surgery in the intervention group was 96.1% (100/104) and that in the control group was 81.7% (85/104) , and the difference between the two groups was statistically significant ( P <0.01) . After intervention, the anxiety scores after visit of patients in two groups were lower than those before visit, and that of the intervention group was lower than that of the control group, and the difference was statistically significant ( P<0.01) . Conclusions:Application of ward centralized propaganda combined with preoperative visit in patients undergoing knee arthroscopic surgery can help patients successfully pass the perioperative period, improve the awareness rate of disease knowledge and enhance compliance of rehabilitation exercise, which is worthy of clinical promotion and application.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.