Objective:To observe the efficacy of arthroscopic LUtarjet procedure in the treatment of recurrent anterior shoulder dislocation combined with a glenoid bone defect.Methods:A retrospective study was conducted to analyze the data of 15 patients with recurrent anterior shoulder dislocation combined with a glenoid bone defect who had been treated by the arthroscopic LUtarjet procedure at Department of Orthopedics, The 928th Hospital of PLA Joint Logistics Support Force from September 2022 to November 2023. All patients were male, aged (25.0±1.9) years, involving 10 left and 5 right sides. The anterior fear test for the affected shoulder was positive in all cases before surgery, and the dislocations averaged (13.8±5.4) times. By comparing the three-dimensional CT scans of both shoulders before surgery, the severity of the glenoid bone defect was calculated as over 20% wider than the width of the healthy glenoid. The shoulder function was evaluated at 6 and 18 months after operation using the American Shoulder and Elbow Surgeons score (ASES), Rowe score, Walch-Duplay score and shoulder active range of motion. Comparisons were made between preoperation and postoperation. CT plain scan and three-dimensional reconstruction were used to evaluate the location and resorption of the transferred bone block of the coracoid process.Results:All patients were followed up for (19.8±1.1) months. The operation time for the 15 patients was (117.6±13.8) min. Re-dislocation occurred in none of the patients during postoperative follow-up. There was no significant difference in the flexion elevation, lateral external rotation, internal rotation or abduction 90° external rotation between preoperation, 6 months or 18 months after operation ( P>0.05). Respectively, the ASES, Rowe and Walch-Duplay scores were (93.3±2.3) points, (90.8±2.6) points, and (95.9±1.0) points at 18 months after operation, and (89.6±3.8) points, (84.5±2.7) points, and (87.2±3.9) points at 6 months after operation, showing significant improvements compared with the preoperative values [(70.9±6.1) points, (42.9±6.0) points, and (66.2±11.0) points] ( P<0.05). In the 3 patients whose immediately postoperative CT scan showed that their bone blocks were slightly lower in position, the bone blocks grew and shaped well at the last follow-up. The last follow-up observed partial bone resorption in one patient. Conclusion:In the treatment of recurrent anterior shoulder dislocation combined with a glenoid bone defect, the arthroscopic LUtarjet procedure can restore satisfactory stability of the shoulder joint, leading to good short- and mid-term efficacy.

OBJECTIVE: To develop a digital intelligent multimodal shift handover system for the intensive care unit (ICU) and evaluate its application effect in ICU shift handovers. METHODS: A research and development team was established, consisting of 1 department director, 1 head nurse, 3 information technology engineers, 3 nurses, and 2 doctors. Team members were assigned responsibilities including overall coordination and planning, platform design and maintenance, pre-application training, collection and organization of clinical feedback, and research investigation respectively. A digital intelligent multimodal shift handover system was developed for ICU based on the Shannon-Weaver linear transmission model. This innovative system integrated automated data collection, intelligent dynamic monitoring, multidimensional condition analysis and visual reporting functions. A cloud platform was used to gather data from multi-parameter vital signs monitors, infusion pumps, ventilators and other devices. Artificial intelligence algorithms were employed to standardize and analyze the data, providing personalized recommendations for healthcare professionals. A self-controlled before-after method was adopted. Before the application of the ICU digital intelligent multimodal shift handover system (from December 2023 to March 2024), the traditional verbal bedside handover was used; from June 2024 to March 2025, the ICU digital intelligent multimodal shift handover system was applied for shift handovers. Questionnaires before the application of the shift handover system were collected in April 2024, and those after the application were collected in April 2025. The shift handover time, handover quality (scored by the nursing handover evaluation scale), satisfaction with doctor-nurse communication (scored by the ICU doctor-nurse scale) before and after the application of the handover system were compared, and nurses' satisfaction with the shift handover system (scored by the clinical nursing information system effectiveness evaluation scale) was investigated. RESULTS: After the application of the ICU digital intelligent multimodal shift handover system, the shift handover time was significantly shorter than that before the application [minutes: 20 (15, 25) vs. 30 (22, 40)], the handover quality was significantly higher than that before the application [score: 84.0 (78.0, 88.5) vs. 71.0 (55.0, 79.0)], and the satisfaction with doctor-nurse communication was also significantly higher than that before the application (score: 84.58±6.79 vs. 74.50±11.30). All differences were statistically significant (all P < 0.05). In addition, the nurses' system effectiveness evaluation scale score was 102.30±10.56, which indicated that nurses had a very high level of satisfaction with the ICU digital intelligent multimodal shift handover system. CONCLUSIONS The application of the ICU digital intelligent multimodal shift handover system can shorten the shift handover time, improve the handover quality, and enhance the satisfaction with doctor-nurse communication. Nurses have a high level of satisfaction with this system.
Intensive Care Units ; Humans ; Patient Handoff ; Artificial Intelligence ; Algorithms

Objective:To observe the efficacy of arthroscopic LUtarjet procedure in the treatment of recurrent anterior shoulder dislocation combined with a glenoid bone defect.Methods:A retrospective study was conducted to analyze the data of 15 patients with recurrent anterior shoulder dislocation combined with a glenoid bone defect who had been treated by the arthroscopic LUtarjet procedure at Department of Orthopedics, The 928th Hospital of PLA Joint Logistics Support Force from September 2022 to November 2023. All patients were male, aged (25.0±1.9) years, involving 10 left and 5 right sides. The anterior fear test for the affected shoulder was positive in all cases before surgery, and the dislocations averaged (13.8±5.4) times. By comparing the three-dimensional CT scans of both shoulders before surgery, the severity of the glenoid bone defect was calculated as over 20% wider than the width of the healthy glenoid. The shoulder function was evaluated at 6 and 18 months after operation using the American Shoulder and Elbow Surgeons score (ASES), Rowe score, Walch-Duplay score and shoulder active range of motion. Comparisons were made between preoperation and postoperation. CT plain scan and three-dimensional reconstruction were used to evaluate the location and resorption of the transferred bone block of the coracoid process.Results:All patients were followed up for (19.8±1.1) months. The operation time for the 15 patients was (117.6±13.8) min. Re-dislocation occurred in none of the patients during postoperative follow-up. There was no significant difference in the flexion elevation, lateral external rotation, internal rotation or abduction 90° external rotation between preoperation, 6 months or 18 months after operation ( P>0.05). Respectively, the ASES, Rowe and Walch-Duplay scores were (93.3±2.3) points, (90.8±2.6) points, and (95.9±1.0) points at 18 months after operation, and (89.6±3.8) points, (84.5±2.7) points, and (87.2±3.9) points at 6 months after operation, showing significant improvements compared with the preoperative values [(70.9±6.1) points, (42.9±6.0) points, and (66.2±11.0) points] ( P<0.05). In the 3 patients whose immediately postoperative CT scan showed that their bone blocks were slightly lower in position, the bone blocks grew and shaped well at the last follow-up. The last follow-up observed partial bone resorption in one patient. Conclusion:In the treatment of recurrent anterior shoulder dislocation combined with a glenoid bone defect, the arthroscopic LUtarjet procedure can restore satisfactory stability of the shoulder joint, leading to good short- and mid-term efficacy.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

To effectively play the guiding role of pathogenic diagnosis in the rational use of antibiotics, hospitals at all levels urgently need to establish an effective control system for clinical microbial specimen submission. In response to the common problems in medical institutions in China, such as the low rate of microbiological specimen submission before antibiotic treatment, unreasonable structure of microbiological specimens, and the majority of morning sputum and urine specimens collected for pathogen testing, the Second Affiliated Hospital of Zhejiang University School of Medicine has constructed a management system for clinical microbiological specimen submission using artificial intelligence technology. It used a built-in intelligent rule engine to implement full process control over the sampling and submission of microbiological specimens by doctors when prescribing antibiotics, urge doctors to implement the requirement of collecting samples before using antibiotics for treatment, and recommend priority the collection of sterile specimens. In addition, the hospital transformed the laboratory and testing process with the goal of receiving microbial samples 24 hours without interruption and inoculating in real-time. The informatization management system began to be applied throughout the hospital in December 2015. The average rate of microbial sample submission before the first therapeutic use of antibiotics from June 2016 to 2023 was 79.2%, an increase of 90.2 percentage points from 41.7% in June 2014 ( χ2=467.781, P<0.01). The structure of microbial specimens continued to be optimized, and the proportion of sterile specimens in all submitted specimens increased from 47.2% in 2014 to 49.9% in 2023 ( χ2=139.119, P<0.01). The proportion of morning sputum and morning urine specimens decreased from 65.2% and 60.6% in 2014 to 11.1% and 16.9% in 2023, respectively ( χ2 values were 19 787.434 and 4 346.664, respectively, P<0.01), providing a more reliable basis for pathogenic diagnosis in clinical practice and providing reference for improving the management of pathogenic specimen submission in medical institutions.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Shift handover is a process of transferring power and responsibility between medical staff,and it is also a basic part of medical activities.Intensive care unit(ICU)is the core area for the treatment of critically ill patients,with complex patient conditions and fine and diverse treatment.If clinical information cannot be shared accurately and in time,it will lead to the delay of the patient's condition,diagnosis and treatment plan.At the same time,the omission of handover information and communication problems can easily lead to safety risks,prolonged hospital stay and increased number of readmissions.Therefore,as one of the important links in ICU diagnosis and treatment and nursing work,accurate,complete and effective handover can ensure the rapid and accurate transmission of patient information and promote the smooth development of diagnosis and treatment and nursing work.This paper reviews the application scope of ICU shift handover model,analyzes the main characteristics,application status and application effects of ICU shift model,and discusses the problems and shortcomings of the existing ICU shift model,in order to provide a reference for further optimizing the quality of ICU shift.PRISMA extension for scoping reviews(PRISMA-ScR)as methodological guidance,we conducted a systematic search across major databases including PubMed,Web of Science,Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL),and Chinese databases(Wanfang,CNKI,Chinese Medical Association,CBM)using both subject headings and free-text terms).The search time limit was from the establishment of the database to July 18,2024.The preliminary retrieved literature bibliographer was imported into Endnote 20.0 software,and the obtained literature was selected and screened by two researchers.A total of 14 articles were included,of which 10 were from China and 4 were from the United States,and all were published between 2012 and 2022.The analysis showed that the ICU shift mode mainly included improved shift mode,group system shift mode,anti-shift mode,checklist type shift sheet mode and electronic information ICU shift.The shift mode showed diversified characteristics,optimized staffing to a certain extent,standardized the specific content and process of shift,and improved the quality of shift.Significant advances have been made in information delivery and quality of care.However,domestic research is mostly focused on the improvement of the shift mode,which faces the shortcomings of increasing workload,coordination and communication challenges,and the scientification and standardization of tools.Electronic information technology makes up for the shortcomings of information omission in the traditional shift process through the advantages of automatic data collection and information collection,and shows positive results in the process of shift.Future research needs to further explore the basis of not increasing the load of ICU clinical medical staff,ensuring the efficiency of shift and normal work flow.Pay attention to the intelligent,standardized and personalized construction of ICU shift,improve the quality of diagnosis and treatment and nursing,and ensure the safety of patients.

Shift handover is a process of transferring power and responsibility between medical staff,and it is also a basic part of medical activities.Intensive care unit(ICU)is the core area for the treatment of critically ill patients,with complex patient conditions and fine and diverse treatment.If clinical information cannot be shared accurately and in time,it will lead to the delay of the patient's condition,diagnosis and treatment plan.At the same time,the omission of handover information and communication problems can easily lead to safety risks,prolonged hospital stay and increased number of readmissions.Therefore,as one of the important links in ICU diagnosis and treatment and nursing work,accurate,complete and effective handover can ensure the rapid and accurate transmission of patient information and promote the smooth development of diagnosis and treatment and nursing work.This paper reviews the application scope of ICU shift handover model,analyzes the main characteristics,application status and application effects of ICU shift model,and discusses the problems and shortcomings of the existing ICU shift model,in order to provide a reference for further optimizing the quality of ICU shift.PRISMA extension for scoping reviews(PRISMA-ScR)as methodological guidance,we conducted a systematic search across major databases including PubMed,Web of Science,Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL),and Chinese databases(Wanfang,CNKI,Chinese Medical Association,CBM)using both subject headings and free-text terms).The search time limit was from the establishment of the database to July 18,2024.The preliminary retrieved literature bibliographer was imported into Endnote 20.0 software,and the obtained literature was selected and screened by two researchers.A total of 14 articles were included,of which 10 were from China and 4 were from the United States,and all were published between 2012 and 2022.The analysis showed that the ICU shift mode mainly included improved shift mode,group system shift mode,anti-shift mode,checklist type shift sheet mode and electronic information ICU shift.The shift mode showed diversified characteristics,optimized staffing to a certain extent,standardized the specific content and process of shift,and improved the quality of shift.Significant advances have been made in information delivery and quality of care.However,domestic research is mostly focused on the improvement of the shift mode,which faces the shortcomings of increasing workload,coordination and communication challenges,and the scientification and standardization of tools.Electronic information technology makes up for the shortcomings of information omission in the traditional shift process through the advantages of automatic data collection and information collection,and shows positive results in the process of shift.Future research needs to further explore the basis of not increasing the load of ICU clinical medical staff,ensuring the efficiency of shift and normal work flow.Pay attention to the intelligent,standardized and personalized construction of ICU shift,improve the quality of diagnosis and treatment and nursing,and ensure the safety of patients.

Objective:To evaluate the relationship between preoperative widespread pain and chronic post-surgical pain (CPSP) following total knee arthroplasty (TKA) in the patients with knee osteoarthritis.Methods:Two hundred American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients with knee osteoarthritis, aged 40-70 yr, undergoing elective the first unilateral primary TKA under general anesthesia, were enrolled.The widespread pain index, visual analogue scale score, Hospital Anxiety and Depression Scale and Central Sensitization Inventory scores were recorded at 1 day before surgery.The patients were divided into CPSP-positive group and CPSP-negative group according to visual analogue scale score at 6 months after surgery.Risk factors for CPSP were analyzed by logistic regression.Results:The results of logistic regression analysis showed that increased preoperative widespread pain index score, Central Sensitization Inventory score and Hospital Anxiety and Depression Scale score and female were risk factors for CPSP after TKA.Conclusions:Preoperative widespread pain is a risk factor for CPSP following TKA in the patients with knee osteoarthritis.

Objective:To evaluate the effect of parecoxib sodium on phenotypic transformation of alveolar macrophages in a mouse model of ventilator-associated lung injury (VALI).Methods:Forty-five SPF healthy adult male C57BL/6J mice, weighing 22-30 g, aged 8-12 weeks, were divided into 3 groups ( n=15 each) using a random number table method: sham operation group (S group), VALI group (V group) and parecoxib sodium group (P group). Lipopolysaccharide 20 ng was intraperitoneally injected, and 2 h later the animals were mechanically ventilated (tidal volume 30 ml/kg, respiratory rate 70 breaths/min, inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 21%, positive end-expiratory pressure 0) for 4 h to establish the model of VALI.Parecoxib sodium 30 mg/kg was intravenously injected at 1 h prior to mechanical ventilation in group P. The mice were sacrificed at 4 h of ventilation, the right lung was lavaged and the broncho-alveolar lavage fluid (BALF) was collected for determination of interleukin-6 (IL-6), IL-10 and tumor necrosis factor-alpha (TNF-α) concentrations (by enzyme-linked immunosorbent assay), expression of inducible nitric oxide synthase (iNOS) and arginase-1(Arg-1) in BALF and expression of phosphorylated Janus kinase 2 (p-JAK2) and phosphorylated signal transduction and transcription activator 3 (p-STAT-3) (by Western blot). The left lung was removed for determination of the wet/dry weight ratio (W/D ratio) and for examination of the pathological changes which were scored. Results:Compared with group S, the lung injury score, W/D ratio, concentrations of IL-6, IL-10 and TNF-α in BALF, and expression of iNOS, Arg-1, p-JAK2 and p-STAT-3 were significantly increased in V and P groups ( P<0.05). Compared with group V, the concentration of IL-10 in BALF and expression of Arg-1, p-JAK2 and p-STAT-3 were significantly increased, and the lung injury score, W/D ratio, concentrations of IL-6 and TNF-α in BALF and expression of iNOS were decreased in group P ( P<0.05). Conclusion:Parecoxib sodium promotes phenotypic transformation of alveolar macrophages from M1 subtype to M2 subtype and inhibits inflammatory responses, thus alleviating VALI, which may be related to activating JAK2/STAT-3 signaling pathway in mice.