Objective To develop a rehabilitation nursing model for knee osteoarthritis(KOA)of external treatment in traditional Chinese medicine(TCM).Methods Between February and June 2023,a preliminary KOA rehabilitation nursing model was developed through literature search and semi-structured interview method.Two rounds of Delphi consultations were conducted with the selected experts,to establish a rehabilitation nursing model for KOA of TCM external treatment.Results A total of 24 experts from different regions participated in the consultation.The final rehabilitation nursing model of TCM external treatment for KOA included 3 primary indicators,16 secondary indicators and 91 tertiary indicators.The response rates from the two rounds of expert consultation were 96.00%and 100.00%,respectively,and the rates of expert opinion proposal were 58.33%and 8.33%,respectively.The expert authority coefficient were 0.906 and 0.923.The two rounds of expert consultation were 0.137 and 0.236 in Kendall's coefficient of concordance(W),with statistically significant differences(both P<0.001).The importance scores of each item in the second inquiry ranged from 3.75 to 4.88,and the coefficient of variation ranged from 0.07 to 0.30,and the full score ratio ranged from 20.83%to 87.50%.Conclusion The rehabilitation nursing model for KOA of TCM external treatment developed in this study is significant,scientific and feasible.It provides a guidance for medical professionals.

Objective To develop a rehabilitation nursing model for knee osteoarthritis(KOA)of external treatment in traditional Chinese medicine(TCM).Methods Between February and June 2023,a preliminary KOA rehabilitation nursing model was developed through literature search and semi-structured interview method.Two rounds of Delphi consultations were conducted with the selected experts,to establish a rehabilitation nursing model for KOA of TCM external treatment.Results A total of 24 experts from different regions participated in the consultation.The final rehabilitation nursing model of TCM external treatment for KOA included 3 primary indicators,16 secondary indicators and 91 tertiary indicators.The response rates from the two rounds of expert consultation were 96.00%and 100.00%,respectively,and the rates of expert opinion proposal were 58.33%and 8.33%,respectively.The expert authority coefficient were 0.906 and 0.923.The two rounds of expert consultation were 0.137 and 0.236 in Kendall's coefficient of concordance(W),with statistically significant differences(both P<0.001).The importance scores of each item in the second inquiry ranged from 3.75 to 4.88,and the coefficient of variation ranged from 0.07 to 0.30,and the full score ratio ranged from 20.83%to 87.50%.Conclusion The rehabilitation nursing model for KOA of TCM external treatment developed in this study is significant,scientific and feasible.It provides a guidance for medical professionals.

Objective:To investigate the prevalence and potential classification of symptoms after total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA), and to analyze the differences in demographic characteristics and surgical data, compare the different potential subgroups, in order to provide a basis for clinical symptom management plans.Methods:This study was a multicenter cross-sectional survey. Through convenience sampling, patients with KOA undergoing TKA in the orthopaedic wards of four tertiary hospitals in Urumqi were selected as the study from November 2023 to February 2024. The study subjects were surveyed using a general information questionnaire, the Visual Analogue Scale (VAS) for pain, the Hospital Anxiety and Depression Scale (HADS), and the Pitts Burgh Sleep Quality Index (PSQI), and the degree of postoperative joint swelling and size of ecchymosis were measured. Latent class analysis was performed using Mplus 8.3 software, and Logistic regression analysis was conducted using SPSS 26.0 software to explore the influencing factors of the latent classes.Results:Totally 337 effective questionnaires were collected, and the recovery rate was 94.7% (337/356), and the age distribution ranged from 47 to 85 (65.19 ± 6.99) years old, with 90 (26.7%) males and 247 (73.3%) females. There were 92.3% (311/337) of TKA patients with postoperative symptom cluster. The symptom cluster of patients with TKA were identified as 3 classes. They were named as "high level pain-psychological disorder group"(12.5%, 39/311), "high bruises-moderate psychological disorders group"(25.4%, 79/311) and "low symptom burden group" (62.1%, 193/311). The results of the unordered multi-class logistic regression analysis showed that age 45-59 years ( OR = 2.367), body mass index 24.0-27.9 kg/m 2 ( OR = 0.207), living with children/parents ( OR = 6.473), and this being the second joint surgery ( OR = 0.040) were the factors influencing the "high level pain-psychological disorders group" (all P<0.05). The factors influencing the "high bruises-moderate psychological disorders group" were living with children/parents ( OR = 4.023), comorbid chronic diseases ( OR = 1.979, 3.842), and intraoperative blood loss ≤100 ml ( OR = 2.342) (all P<0.05). Conclusions:The postoperative symptom cluster of TKA patients have a relatively high incidence, and there is heterogeneity within the symptom cluster, so nurses need to identify at-risk patients early according to the characteristics of different categories and give interventions.

Objective:To investigate the surgical technology and clinical efficacy of using the all-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ.Methods:The clinical data of 33 patients (33 feet) with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from March 2017 to March 2019 at Department of Orthopedics,Xuzhou Central Hospital were retrospectively analyzed.There were 19 male patients,and 14 female patients,aged (32.6±11.3) years(range:20 to 55 years). According to the Sanders classification,there were 12 cases of type Ⅱ and 21 cases of type Ⅲ. The duration from injury to surgery was (101.2±32.1) hours(range:6 to 140 hours).The preoperative visual analogue scale (VAS) was 6.4±2.9 (range: 4 to 8); The preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the SF-36 score was 63.3±11.8 (range:50 to 75) and 94.8±9.1 (range:70 to 105) respectively.All the patients were managed with the all-side subtalar arthroscopy through three portals combined with rafting screws technique.The incision healing,reduction of fracture,and fracture healing were recorded.The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were used to assess the pain and functional outcomes.Repeated-measurement was used to compare the scores before and after surgery.Results:The time of operation was (69.7±10.4) minutes (range:40 to 110 minutes). All patients did not undergo bone grafting.The incision healed in one stage without complications of skin sensory and peroneal tendon injury.All patients were followed up for 24 months.At the last follow-up,all the patients were satisfied with the hindfoot alignment,function,and hindfoot appearance.Postoperative calcaneal imaging indicators (calcaneal length,calcaneal width,calcaneal height,Bohler angle and Gissane angle) were significantly improved compared with those before surgery ( P<0.01).There was no statistically significant difference in the imaging indexes of calcaneus at 1 day,1 year and 2 years after surgery,indicating no loss of fracture reduction (all P>0.05).The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were 1.5±0.4 (range: 0 to 2),94.0±6.5 (range:90 to 100),and 119.1±7.2 (range:105 to 130),respectively,which were better than those before surgery (all P>0.05).According to the AOFAS scoring system,27 cases were excellent,4 cases were good, 2 cases were fair,and the excellent and good rate was 94.0%. Conclusion:All-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ provides precise reduction,reliable fixation,satisfactory function and limited complications,which is an alternative method.

Objective:To investigate the surgical technology and clinical efficacy of using the all-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ.Methods:The clinical data of 33 patients (33 feet) with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from March 2017 to March 2019 at Department of Orthopedics,Xuzhou Central Hospital were retrospectively analyzed.There were 19 male patients,and 14 female patients,aged (32.6±11.3) years(range:20 to 55 years). According to the Sanders classification,there were 12 cases of type Ⅱ and 21 cases of type Ⅲ. The duration from injury to surgery was (101.2±32.1) hours(range:6 to 140 hours).The preoperative visual analogue scale (VAS) was 6.4±2.9 (range: 4 to 8); The preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the SF-36 score was 63.3±11.8 (range:50 to 75) and 94.8±9.1 (range:70 to 105) respectively.All the patients were managed with the all-side subtalar arthroscopy through three portals combined with rafting screws technique.The incision healing,reduction of fracture,and fracture healing were recorded.The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were used to assess the pain and functional outcomes.Repeated-measurement was used to compare the scores before and after surgery.Results:The time of operation was (69.7±10.4) minutes (range:40 to 110 minutes). All patients did not undergo bone grafting.The incision healed in one stage without complications of skin sensory and peroneal tendon injury.All patients were followed up for 24 months.At the last follow-up,all the patients were satisfied with the hindfoot alignment,function,and hindfoot appearance.Postoperative calcaneal imaging indicators (calcaneal length,calcaneal width,calcaneal height,Bohler angle and Gissane angle) were significantly improved compared with those before surgery ( P<0.01).There was no statistically significant difference in the imaging indexes of calcaneus at 1 day,1 year and 2 years after surgery,indicating no loss of fracture reduction (all P>0.05).The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were 1.5±0.4 (range: 0 to 2),94.0±6.5 (range:90 to 100),and 119.1±7.2 (range:105 to 130),respectively,which were better than those before surgery (all P>0.05).According to the AOFAS scoring system,27 cases were excellent,4 cases were good, 2 cases were fair,and the excellent and good rate was 94.0%. Conclusion:All-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ provides precise reduction,reliable fixation,satisfactory function and limited complications,which is an alternative method.

ObjectiveTo explore the effect of mindfulness-based childbirth on pregnant women's anxiety and depression， and to provide references for related psychological intervention. MethodsA total of 80 pregnant women who attended the obstetrics department of the Third People's Hospital of Mianyang from October 2018 to March 2019 and met the diagnostic criteria of mild to moderate anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were selected， and they were divided into two groups by random number table method， each with 40 cases. Both groups received regular mental health education. On this basis， experimental group received mindfulness-based childbirth training for 8 times， once a week. Meantime， all pregnant women were assessed using Patient Health Questionnaire-9 item （PHQ-9） and Generalized Anxiety Disorder Scale （GAD-7） at the baseline and after intervention. ResultsAt the baseline and after intervention， the scores of PHQ-9 ［（6.95±1.40） vs. （2.10±1.34）， P<0.05］ and GAD-7 ［（7.23±1.29） vs. （2.08±1.51）， P<0.05］ in the experimental group had statistical significance， and the scores of PHQ-9 ［（7.00±1.43） vs. （3.65±1.35）， P<0.05］ and GAD-7 ［（7.18±1.57） vs. （3.38±1.66）， P<0.05］ in the control group had statistical significance. Moreover， the post-intervention scores of PHQ-9 and GAD-7 were significantly lower in experimental group than in control group （t=5.161， 3.666， P<0.01）. ConclusionCompared with mental health education alone， its combination with mindfulness-based childbirth achieves better effect in alleviating the anxiety and depression status of pregnant women.

Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture.Methods From January,2012 to March,2017,surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture.Five patients underwent sural neurovascular flap in the first stage of repair,2 patients were treated with peroneal perforator propeller flap,and 1 patient was treated with posterior tibial artery perforator propeller flap.The donor sites of 3 flaps were directly closed,and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly.The size of flap was 5.0 cm× 3.0 cm-7.0 cm × 5.0 cm.Through postoperative outpatient and WeChat follow-up.The patient's flap survival,infection,flap shape,sensation and ankle function were evaluated.Results All flaps and skin grafts survived post-operatively.All patients were followed-up for 6-12 (mean,8.4) months.All patients had good flap survival and no complications such as soft tissue and calcaneal infection.The flaps were good in texture,shape and function of ankle.At the last follow-up,according to the British Medical Research Institute (BMRI),the sensory function was divided into 6 levels.The flap sensory function recovered to S2 in 3 cases,and the remaining 5 cases was S1.According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS),the results were excellent in 5 cases,and good in 3 cases.All patients had good clinical results and satisfaction at the last followedup.Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps,which avoided the occurrence of calcaneal osteomyelitis.It is easy to perform early rehabilitation exercise and the ankle function is well restored.

Objective: To investigate the clinical value of endoscopic ultrasonography (EUS) and Multi-slice Spiral CT (MSCT) in the preoperativestaging of tumor(T) and lymph node (N) metastasis in patients with SiewertⅡand Ⅲ typeadenocarcinoma of esophagogastric junction(AEG). Methods: Clinical data of 145 Siewert Ⅱ and Ⅲ type AEG patientswithout preoperative chemoradiotherapy were retrospectively reviewed. Theyall received preoperative EUS and MSCT examination and underwent surgical resection, and the results of EUS and MSCT were compared with their postoperative pathologic staging. Results: The sensitivity, specificity, and accuracy of EUS for T stage in Siewert Ⅱ and Ⅲ type AEG were higher than those of MSCT. The total accuracy of EUS and MSCT were 90.3% and 63.5%, respectively, and the difference was statistically significant (χ²=29.52, P<0.01). The sensitivity of EUS for T1, T2 and T3 were 89.5%, 91.1% and 85.2%, respectively, which were significantly higher than 42.1%, 66.7% and 29.6% of MSCT (χ²=9.47, P<0.01 for T1; χ²=8.07, P<0.01 for T2; χ²=17.40, P<0.01 for T3). In addition, the total accuracy of EUS and MSCT for lymph node metastasis status of Siewert Ⅱ and Ⅲ type AEG were 75.9% and 64.8%, respectively, showing a statistically significant difference(χ²=4.23, P=0.04). The sensitivity of EUS for N1 and N2 were 82.1% and 79.2%, respectively, which were significantly higher than 53.6% and 60.4% of MSCT (χ²=5.24, P=0.02; χ²=4.48, P=0.03). There was no statistical significance for sensitivity of EUS and MSCT in N0 and N3 (P>0.05). Conclusion EUS diagnosis of T and N staging in Siewert Ⅱ/Ⅲ type AEG showed significantly greater performance than MSCT.

Objective To explore the effects of low-dose X-ray irradiation effects on ischemic flap survival and its possible mechanism.Methods From June, 2014 to December, 2014, 80 SD rats were include in the study, the rats were randomly divided into 2 groups: the experimental group A and control group B.There were 40 rats in each group.The ischemic flaps with the size of 9 cm × 3 cm were designed on the back of the rats.The pedicle of the flaps was near to the tail.A sterile biological isolating membrane was placed under the flap to block the blood supply between muscular layer and flaps.The flaps were intermittently sutured into their original position.The group A was immediately received single and local irradiation of 0.2 Gy after surgery, The group B was not treated.On days 1 to 14 after operation,general observation,HE staining and the western blot of the flaps were performed to calculate the survival vate of the flaps, observe neovascularization and determin the content of VEGF and MMP-9, respectively.Results On the third, seventh and fourteenth days, survival rates of the flaps in the experimental group [(66.46 ± 4.37)％, (44.30 ± 3.86)％, (32.20 ± 4.22)％, respectively] were higher than the control group [(43.15 ± 5.03)％, (27.71 ± 3.20)％, (16.40 ± 5.34)％, respectively] after inspection, there were statistically significant differences between these indices (P ＜ 0.01), HE staining of the flaps in the experimental group were seen in the fibroblast infiltration and neovascularization were higher than that of control group, and experimental group within the lumen of blood vessels were arranged in order, the groups were visible tissue edema obviously control, neovascularization in small numbers, the lumen was irregular.On the third and seventh days, MVD rates of the flaps in the experimental group (85.54 ± 6.12, 44.32 ± 3.56, respectively) were higher than the control group (49.35 ± 4.75,18.75 ± 2.89,respectively) after inspection, there were statistically significant differences between these indices (P ＜ 0.01).VEGF and MMP-9 protein content in the flap for the seventh day in the experimental group were significantly higher than that of the control group.Conclusion Low-dose X-ray irradiation can promote the survival rate of ischemic flap, the mechanism may be related to the expression of VEGF and MMP-9 increased and promoted angiogenesis of the flaps after low-dose X-ray irradiation.

Objective To investigate the effects of changing the arteriovenous pressure difference on the survival area of reverse island flap in New Zealand white rabbits models.Methods The saphenous artery and saphenous vein of New Zealand rabbits were selected to design experimental models of reverse island flap.Experi mental rabbits were randomly divided into 4 groups:group A:control group (reserved pedicle integrity of superficial veins);group B:part anastomosis of saphenous artery group (the distal saphenous artery of the flap was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group C:part anastomosis of vein group (distal superficial veins was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group D:ligated superficial veins group (pedicle superficial veins was ligated).After surgery,the flaps were measured by general observation.Blood distribution at different times of the flaps was detected by radionuclide scans.Survival area of the flap was measured to compare the survival rate of flap.Distribution of blood vessels and the state of blood cells were observed by Histological examination.Results The flap survival rate was (82.27-± 11.71)％ in group B,showing significant differences when compared with that group A (47.70-± 11.18)％,group C (47.70 ± 11.18)％ and group D (47.70 ± 11.18)％ (P ＜ 0.05).Radionuclide scans showed that the radioactive material in group B could be seen clearly,the radioactive material in groups A,C and D were a transient existence.Ten days postoperatively,histological observation showed that group B had more capillary regeneration and blood cells remain compared with other groups.Conclusion Increase the blood supply can increase the survival area of the reverse island flap,and simply promote the venous drainage can not effectively improve the survival rate of the flap.