Objective To explore the effect of transcranial magnetic stimulation (TMS) on gross motor function for children with cerebralpalsy. Methods 80 children with cerebral palsy treated in our hospital during July 2009 to January 2010 were divided into control group(n=40) and observation group (n=40). The control group received conventional treatment, including physical therapy, massage, scalp acupuncture,body acupuncture, point injection, physiotherapy and medication. The observation group received TMS in addition. The therapeuticeffects were compared using the Gross Motor Function Measure-88 (GMFM-88) after 3 months. Results The percent scores of all the domainssignificantly increased in both groups (P<0.05) after treatment, the increased percent scores of observation group in B domain, D domain,E domain and total were higher in the observation group than in the control group (P<0.05). Conclusion TMS can further improve thegross motor function of children with cerebral palsy.

Objective:To evaluate the effect of position change and pneumoperitoneum pressure on the respiratory system of patients undergoing DaVinci assisted laparoscopic prostate cancer surgery.Methods:Peak airway pressure, lung compliance and airway resistance were recorded by ventilator as the basic values to evaluate the change of respiratory function. When the artificial pneumoperitoneum pressure was 10 mmHg or 15 mmHg, the changes of respiratory function were recorded in five different positions: trendelenburg position (head low foot height) 30°, 15°, supine position, anti-trendelenburg position (head high foot height) 15° and 30°, peak airway pressure, lung compliance, airway resistance and so on.Results:At 10 mmHg and 30° trendelenburg, peak airway pressure, lung compliance and airway resistance were 28.13 cmH 2O, 23.33 ml/cmH 2O,16.06 cmH 2O·L -1·Sec -1, respectively. When the pneumoperitoneum pressure was adjusted to 15 mmHg, peak airway pressure increased to 32.03 cmH 2O, lung compliance decreased to 20.14 ml / cmH 2O, and airway resistance increased to 117.24 cmH 2O·L -1·Sec -1( P<0.01). At 10 mmHg and trendelenburg returned to 15°, peak airway pressure, lung compliance and airway resistance were 26.66 cmH 2O, 24.95 ml/cmH 2O,15.50 cmH 2O·L -1·Sec -1, peak airway pressure increased to 30.61 cmH 2O, the lung compliance decreased to 20.89 ml/cmH 2O and airway resistance increased to 16.66 cmH 2O·L -1·Sec -1 ( t value was -43.81, 24.638, -12.812, P<0.01). Conclusion:With the increase of trendelenburg position angle and artificial pneumoperitoneum pressure, the peak airway pressure and airway resistance are increased, while the lung compliance decreases gradually. Compared with trendelenburg position, the change of artificial pneumoperitoneum pressure has more influence on respiratory function.

Objective:To investigate the effect of hybrid intensity modulated radiotherapy (Hy-IMRT) on immune function in patients with locally advanced breast cancer surgery and the treatment efficacy.Methods:A total of 94 patients with locally advanced breast cancer who underwent modified radical mastectomy for breast cancer and required postoperative radiotherapy in Changzhou Cancer Hospital in Jiangsu Province from January 2015 to January 2017 were selected. The patients were divided into Hy-IMRT group (observation group, 47 cases) and three-dimensional conformal radiotherapy (3DCRT) group (control group, 47 cases) according to the random number table method. The dose and related radiophysical parameters of the respective target areas of the two groups, adverse reactions during and after radiotherapy, cytokines and T lymphocyte subsets before and after radiotherapy, 3-year local recurrence rate, distant metastasis rate and mortality were observed and compared between the two groups.Results:The dose obtained by 95% (D 95%) [(4 945.6±36.1) Gy vs. (4 754.0±35.6) Gy] and target area conformity (CI) of the target volume (0.7±0.1 vs. 0.5±0.1) in the observation group were greater than those in the control group, and the differences were statistically significant (both P<0.05); the target volume of 110% of the prescription dose (V 110%) [(1.6±0.5) cm 3 vs. (8.4±1.2) cm 3], the target volume of more than 105% of the prescription dose (V 105%) [(19.3±3.5) cm 3 vs. (26.6±5.6) cm 3] and the heterogeneity index (HI) (1.1±0.1 vs. 1.3±0.1) in the observation group were all smaller than those of the control group, and the differences were statistically significant (all P < 0.05). The incidence of acute skin adverse reactions [53.2% (25/47) vs. 74.5% (35/47)] and the incidence of bone marrow suppression [40.4% (19/47) vs. 70.2% (33/47)] in the observation group were lower than those in the control group, and the differences were statistically significant (both P < 0.05). There were no significant differences in levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), CD4 +, CD8 +, and CD4 +/CD8 + between the two groups before radiotherapy (all P > 0.05). At the end of radiotherapy, the levels of IL-6, TNF-α and CD8 + were higher in both groups than before radiotherapy (all P < 0.05), and CD4 + and CD4 +/CD8 + were lower than before radiotherapy (both P < 0.05). The levels of IL-6, TNF-α and CD8 + in the observation group were lower than those in the control group, while the CD4 + and CD4 +/CD8 + were higher than those in the control group (all P < 0.05). The 3-year local recurrence rate [34.04% (16/47) vs. 42.55% (20/47)], distant metastasis rate [25.53% (12/47) vs. 38.30% (18/47)] and mortality rate [14.89% (7/47) vs. 19.15% (9/47)] in the observation group were lower than those in the control group, but the differences were not statistically significant (all P > 0.05). Conclusion:Compared with 3DCRT, the Hy-IMRT has less effect on the immune function of locally advanced breast cancer patients after modified radical resection, and the incidences of acute skin reaction and bone marrow adverse reaction are low.

Objective:To construct the evaluation index system of pediatric specialized nurses' core competence, so as to provide a basis for accurate measurement of pediatric specialized nurses' core competence.Methods:A research group was established in August 2021. Based on the quality onion model and literature analysis, a qualitative interview was conducted in September 2021 with 10 provincial and above hospitals pediatric specialist nurses, 5 pediatric nursing managers, 5 pediatric chief physicians and 5 primary caregivers for children selected by objective sampling. From September 2021 to February 2022, questionnaires were sent to 16 experts via email or WeChat for three rounds of Delphi expert consultation. The evaluation indexes of pediatric specialized nurses' core competence were determined according to the authority coefficient, Kendall coordination coefficient, coefficient of variation and other factors.Results:Among three rounds of expert consultation, the effective recovery rates of the questionnaire were all 100.00% (16/16) , and the authority coefficients were 0.813, 0.888 and 0.895, respectively, and the Kendall coordination coefficients were 0.175 (χ 2=289.348, P<0.01) , 0.239 (χ 2=408.131, P<0.01) and 0.288 (χ 2=467.280, P<0.01) , respectively. The final evaluation index system of pediatric specialized nurses' core competence included 6 first level indicators, 18 second level indicators and 84 third level indicators. Conclusions:The evaluation index system of pediatric specialized nurses' core competence is scientific and reliable, which can be used as an effective tool to measure the core competence of pediatric specialized nurses.