Objective To understand the current situation and characteristics of occupational exposure(OE)among health care workers(HCWs),and provide basis for making preventive measures.Methods Self-designed question-naire about OE was adopted,OE among all HCWs in a hospital in January-December 2015 were surveyed and statis-tically analyzed.Results A total of 1888 HCWs were surveyed,there were 304 cases of OE,the mean OE rate in the whole hospital was 16.10%;OE occurred 370 times(19.60%).Doctors,trainees,and HCWs who worked for≤1 year had relatively higher OE rates,which were 23.18%(102/440),17.88%(49/274),and 18.34%(95/518) respectively.Sharp injury is the main OE mode,accounting for 83.24%(n=308),sharp injuries mainly occurred before disposing the used devices and during the process of use,accounting for 37.99%(n=117)and 36.69%(n=113)respectively.Among 370 times of OE,315 could be traced to the sources of exposure.Among the known ex-posure sources,OE of bloodborne pathogens accounted for 24.13% (n=76).59 of 370 times of OE implemented complete local treatment and reporting procedures,reporting rate of OE was 15.95%.Conclusion Hospital should take comprehensive measures to promote occupational safety precaution,and reduce the incidence of OE.

Objective To integrate the best available evidence of preoperative care for ophthalmic patients undergoing day surgery into clinical practice,so as to improve the quality of nursing.Methods This project was performed in an ophthalmic day surgery ward,guided by the Joanna Briggs Institute(JBI)Practice Application of Clinical Evidence System (PACES) program which includes 3 procedures:baseline audit,evidence implementation,and re-audit.Eight audit criteria were made based on evidences from JBI.Twelve nurses and 267 patients were enrolled in baseline audit,and 12 nurses and 234 patients were recruited for re-audit after evidence implementation.Results Six of the audit criteria that nurses showed poor compliance in the baseline audit(0％～28.5％),such as providing preoperative telephone screening and reducing preoperative waiting time through better preparation and planning,were significantly improved in the re-audit(71.43％～100％).The preoperative waiting time was shortened from 109.70±18.34 minutes to 88.22±9.91 minutes;the correct rates of operation-related knowledge in patients increased from 63.0％ to 85.09％;the patients' satisfaction scored 84.23±17.01 in baseline audit and 95.02±7.32 in the re-audit(P＜0.001).Conclusion Application of evidence-based preoperative care of ophthalmic patients undergoing day surgery can improve nurse's behavior and compliance with the implementation of evidence into clinical practice,and increase patient satisfaction.Continuous audits are needed to continuously improve clinical nursing quality.

Objective:To explore the role of navigation-assisted valgus stress method in avoiding excessive correction of lower limb mechanical axis after high tibial osteotomy (HTO).Methods:A retrospective study was carried out on osteoarthritis (OA) patients who were treated with HTO for medial compartment pain of knee from January 2020 to March 2022 in the Department of Joint Surgery, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Medical University. According to the different ways of confirming alignment during operation, they were divided into computer navigation assisted valgus stress HTO group (referred to as navigation group) and traditional rod fluoroscopy HTO group (referred to as traditional group). There were 28 patients in the navigation group, 10 males and 18 females, with age of 54.4±9.1 years (range, 41-73 years) and body mass index of 26.1±3.3 kg/m 2 (range, 19.8-35.2 kg/m 2); There were 30 patients in the traditional group, 13 males and 17 females, aged 56.9±8.5 years (range, 40-70 years), with a body mass index of 25.7±4.0 kg/m 2 (range, 19.2-32.9 kg/m 2). Measuring the mechanical femoral tibial angle (mFTA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), Lysholm score and Hospital for Special Surgery (HSS) score before operation and at the last follow-up of the two groups, and conduct statistical analysis. Results:Both groups were followed up. The follow-up time of navigation group and traditional group was 21.3±8.7 months and 22.5±7.6 months, respectively, with no significant difference ( t=0.53, P=0.596). There were significant differences between the two groups in the amount of mechanical axis correction (ΔmFTA) and the amount of bone correction (ΔMPTA) ( t=2.09, P=0.041; t=2.58, P=0.012), while there was no significant difference in ΔJLCA ( t=0.32, P=0.753). In the navigation group, there were 9 cases (32%) of undercorrection, 17 cases (61%) with acceptable alignment, and 2 cases (7%) with over correction, while in the traditional group, there were 5 cases (17%) with under correction, 13 cases (43%) with acceptable alignment, and 12 cases (40%) with over correction. There was significant difference in the distribution rate of alignment between the two groups ( P=0.012), and the rate of overcorrection in the navigation group was significantly lower than that in the control group (7% vs. 40%, P=0.005). The intra group correlation coefficient between the navigation correction mechanical axis and ΔmFTA was 0.787. There was no significant difference in Lysholm score and HSS score between the two groups before and after surgery (all P>0.05), and they were significantly improved after operation (all P<0.05). Conclusion:Navigation-assisted valgus stress method HTO is reliable, which can accurately achieve the target alignment, reduce the incidence of over correction, and obtain good clinical results.

Acute skin failure (ASF) is an inevitable damage to the skin and subcutaneous tissue caused by hemodynamic instability and/or low perfusion. At present, there are some understandings and reports about adult ASF at home and abroad, but there are few reports about children's ASF. This article reviewed the definition, pathophysiological changes, risk factors, clinical manifestations, and management of children's ASF, and put forward suggestions in order to provide ideas for clinical diagnosis and treatment of children's ASF, and promote the further study of children's ASF.

Objective To investigate the possible brain diffusion changes in different sites of the brain,particularly in areas associated with vision function,of patients with proliferative and nonproliferative retinopathy by using diffusion-weighted imaging (DWI).Methods Forty-five type 2 diabetic patients,admitted to our hospital from March 2012 to March 2013,were chosen in our study;according to the fundus examination,they were divided into group of proliferative retinopathy (n=15) group of non-proliferative retinopathy (n=15) and group of no retinopathy (n=15); another 15 healthy controls were chosen.T2WI and DWI with 3.0T magnetic resonance imaging (MRI) were performed; the apparent diffusion coefficient (ADC) values in the orbitofrontal cortex,cingulated gyrus,thalamus,dorsomedial and dorsolateral frontal cortex,and corona radiate were calculated; and then,Spearman's correlation analysis was performed between ADC values and both course of disease and glycosylated hemoglobin level.Results The ADC values of orbitofrontal cortex,cingulated gyrus and visual cortex in groups of proliferative and non-proliferative retinopathy were significantly increased as compared with group of no retinopathy and control group (F=95.268,P＜0.05); the ADC values of orbitofrontal cortex,cingulated gyrus and visual cortex in group of proliferative retinopathy were significantly increased as compared with those in group of non-proliferative retinopathy (P=0.004,0.001 and 0.009,respectively);no significant difference of them was noted between group of no retinopathy and control group (P＞0.05).The mean ADC values of orbitofiontal cortex,cingulated gyrus and visual cortex was positively correlated to the duration of disease (r=0.567 and P=0.001; r=0.491 and P=0.01; r=0.428 and P=0.003) and glycosylated hemoglobin level (r=0.336 and P=0.014; r=0.296 and P=0.049; r=0.370 and P=0.012).Conclusion Increased ADC values of visual center (orbitofrontal cortex,cingulated gyrus and visual cortex) conform the association between diabetic retinopathy and brain functioning impairment; DWI may serve to assess subclinical neurogical involvement in diabetic retinopathy,even when brain structural changes are absent.