Objective To investigate MRI characteristics of subacute combined degeneration(SCD)with secondary spinal canal stenosis.Methods The clinical and MRI imaging data of 56 patients with SCD were collected to analyze the performance characteristics between spinal cord lesions and spinal canal stenosis,which depended on the synergism of lumbar disc bluge or herniation,degenerative thickening of the ligament flavum and posterior longitudinal ligament.Results Among 56 SCD cases underwent MRI scan,45 cases were combined with spinal cord lesions which showed typical signs of SCD.37 patients were secondary spinal canal stenosis with typical signs,but 2 showed no typical signs.8 patients were no secondary spinal canal stenosis and showed typical.9 cases showed neither spinal cord lesions nor secondary spinal canal stenosis.There was significant difference (P <0.05)between relative secondary spinal canal stenosis and spinal anomaly signal.The course of 1 5 cases were shortened after treated by physical in 37 cases of SCD with secondary spinal canal. Conclusion The secondary spinal canal stenosis can cause microcirculation dysfunction of the spinal cord,which is a key factor contributing to the imaging manifestation.

Objective:To understand the needs of end-stage cancer patients for hospice care, so as to provide a basis for the development of human-centered quality nursing services in hospice care.Methods:13 patients with end-stage cancer in tumor ward were interviewed by personal in-depth interview, and the data were sorted and analyzed by Colaizzi's seven-step analysis method.Results:A total of four themes of hospice care needs of patients with end-stage cancer were extracted. The need to maintain self-subject: the desire to maintain self-efficacy and self-image of dignity in life; the need to relieve the symptoms of self-discomfort. The need to relieve the physical symptoms and psychological discomfort. Meet the needs of self-determination: participate in medical care decisions and choose comfortable social relationships. Express their own emotional needs: the past farewell and remembrance and future wish to achieve the expectationsConclusions:Patients with end-stage cancer have diverse needs for hospice care. In clinical work, medical staff should adhere to the people-oriented concept, explore patients' needs and preferences, and implement individualized quality nursing measures to meet patients' needs for hospice care.

Objective The application of flash glucose monitoring ( FGM) in type 1 diabetes could diminish the frequency of hypoglycaemia, however, how FGM improving the glycaemic control target (e.g. HbA1C) is waited to be investigated. Methods Seventy type 1 diabetic patients were recruited from December 2017 to July 2018 in the First Affiliated Hospital of Nanjing Medical University. Their demographic data, use of FGM and HbA1C level were collected. Results We observed that type 1 diabetic patients wearing the FGM showed lower insulin dose [(0.562± 0.059)U/kg vs (0.772±0.049)U/kg, P=0.008)], shorter diabetic duration[2.0(0.8-6.0) vs 6.0(2.5-10), P=0.013], lower HbA1C value [6.8％(6.2％-7.7％) vs 8.0％(6.9％-9.4％), P=0.001]. Nevertheless, after adjusting the potential confounders, the level of HbA1C in patients wearing FGM was significantly lower than those without FGM. Moreover, it was independent of other factors, such as the dose of insulin and the insulin delivery method. Conclusion Type 1 diabetic patients wearing FGM had lower HbA1C value but it needs further follow-up to confirm the improvement of glycaemic control in type 1 diabetes with the use of FGM.

Objective:To summarize the methods and effects of utilizing the ilioinguinal flap in repairing the defect after the extended resection of the middle and lower abdominal wall or the groin region’s dermatofibrosarcoma protuberans.Methods:From November 2011 to October 2018, nine patients (including five males) with the middle and lower abdominal wall or groin region’s dermatofibrosarcoma protuberans received extended resection procedures in the Department of Plastic and Reconstructive Surgery of Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The age distribution of patients was 27-60 years old with a mean age of 44.3 years old. The defect area following the extended resection of the tumor ranged from 9.5 cm × 10.5 cm to 15.0 cm × 18.0 cm, and the size of the ilioinguinal flap ranged from 6.0 cm × 11.0 cm to 8.0 cm × 15.0 cm. Either an axial flap or a V-Y advancement flap was used to repair the defect. Five patients were treated with the unilateral ilioinguinal flap, two with the bilateral ilioinguinal flap combination flap, one with the ilioinguinal flap combined with the tensor fascia lata myocutaneous flap, and one with the ilioinguinal flap combined with the anterolateral thigh flap.Results:All defects were covered by flaps completely, and all donor sites were closed directly. Eight flaps survived completely without necrosis, while one case of ilioinguinal flap faced the distal necrosis, which was debrided and repaired with full-thickness skin grafting in the second stage. The postoperative follow-up period ranged from 1.0 to 8.5 years. No local recurrence or other distant metastases occurred. All reconstructed regions had a good outline and ordinary sense function.Conclusions:Almost all defects after the extended resection of dermatofibrosarcoma protuberans in the middle and lower abdominal wall or the groin region could be repaired with a unilateral or bilateral ilioinguinal flap, whose blood supply is stable and reliable. Moreover, the operation presented is simple, less time-consuming, safe, reliable, and with a satisfactory postoperative appearance.

Objective:To summarize the methods and effects of utilizing the ilioinguinal flap in repairing the defect after the extended resection of the middle and lower abdominal wall or the groin region’s dermatofibrosarcoma protuberans.Methods:From November 2011 to October 2018, nine patients (including five males) with the middle and lower abdominal wall or groin region’s dermatofibrosarcoma protuberans received extended resection procedures in the Department of Plastic and Reconstructive Surgery of Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The age distribution of patients was 27-60 years old with a mean age of 44.3 years old. The defect area following the extended resection of the tumor ranged from 9.5 cm × 10.5 cm to 15.0 cm × 18.0 cm, and the size of the ilioinguinal flap ranged from 6.0 cm × 11.0 cm to 8.0 cm × 15.0 cm. Either an axial flap or a V-Y advancement flap was used to repair the defect. Five patients were treated with the unilateral ilioinguinal flap, two with the bilateral ilioinguinal flap combination flap, one with the ilioinguinal flap combined with the tensor fascia lata myocutaneous flap, and one with the ilioinguinal flap combined with the anterolateral thigh flap.Results:All defects were covered by flaps completely, and all donor sites were closed directly. Eight flaps survived completely without necrosis, while one case of ilioinguinal flap faced the distal necrosis, which was debrided and repaired with full-thickness skin grafting in the second stage. The postoperative follow-up period ranged from 1.0 to 8.5 years. No local recurrence or other distant metastases occurred. All reconstructed regions had a good outline and ordinary sense function.Conclusions:Almost all defects after the extended resection of dermatofibrosarcoma protuberans in the middle and lower abdominal wall or the groin region could be repaired with a unilateral or bilateral ilioinguinal flap, whose blood supply is stable and reliable. Moreover, the operation presented is simple, less time-consuming, safe, reliable, and with a satisfactory postoperative appearance.

Frailty is a clinical syndrome characterized by the gradual decline of multiple organ func-tion and the emergence of vulnerable phenotype.Patients with frailty exhibit diminished resistance to stress,which often leads to unfavorable outcomes following surgery,including cognitive decline,prolonged hospital-ization,and increased rates of complications and mortality.Given that frailty is a dynamic and reversible process,it is recommended to implement appropriate optimization measures during the perioperative period in order to improve patient outcomes.Recent studies have revealed that abnormal energy metabolism plays a crucial role in the development and occurrence of frailty.This article will primarily focus on abnormalities in glucose metabolism,lipid metabolism,and amino acid metabolism among frail patients,and emphasize the significance of correcting these metabolic irregularities during the perioperative period in order to reduce complications and improving surgical safety.

Nursing staff plays a crucial role in the end-stage of a patient′s life, and it is inevitable for nursing staff to face and handle problems about death. The ability to cope with death is of vital importance, which can reduce the risk of emotional distress in nurses, and assist nurses to better participate in patients' end-stage care, and improve the quality of care. This paper summarizes the definition, components, theoretical frameworks and models, assessment tools, status quo, influencing factors of the coping with death competence, and propose the corresponding intervention strategy according to the situation of our country, provide references for the future research.