Objective To construct a management program for upper limb lymphedema prevention in postopera-tive breast cancer patients and to evaluate its effectiveness.Methods The first draft of the upper limb lymphede-ma prevention and management protocol for postoperative breast cancer patients was constructed on the basis of ev-idence summaries and qualitative interviews,and 2 rounds of correspondence were conducted in December 2022.Using the convenience sampling method,patients undergoing surgery for malignant tumours in the breast surgery de-partment of a tertiary-level hospital in Zhengzhou City were selected as the study subjects,and 58 patients admitted from January to March 2023 were included in the experimental group according to the time of their first visit.57 patients admitted from July to December 2022 were included in the control group and were given routine care.The rates of lymphedema occurrence,upper limb function score and patients'adherence to lymphedema prevention be-haviours after 1,3,and 6 months of intervention were compared between the 2 groups.Results The valid ques-tionnaire recovery rates of the 2 rounds of expert correspondence were 92.59％and 100％,and the authority coeffi-cients of the experts were 0.940 and 0.950,and the Kendall's harmony coefficients were 0.228 and 0.254,respec-tively(P＜0.00 1).The coefficients of variation of the 2nd round of correspondence were 0.07～0.24.The final draft of the programme included 5 first-level entries,12 second-level entries,and 32 third-level entries.During the appli-cation of the programme,a total of 5 cases were dislodged,and 55 cases were finally included in each of the ex-perimental and control groups.The results of repeated measures ANOVA showed that there was an interaction ef-feet between the upper limb function scores and lymphedema prevention behavior compliance scores before inter-vention and at 1,3,and 6 months after discharge between the 2 groups(P＜0.05).Simple effects analysis showed that at 1,3,and 6 months after discharge,the upper limb function score and lymphedema prevention behavior com-pliance score of the experimental group were better than those of the control group,and the differences were sta-tistically significant(P＜0.05).At 6 months post-intervention,the difference in the occurrence of lymphedema was statistically significant when comparing the 2 groups(P=0.032).Adverse events such as subcutaneous bruising and falls did not occur in either group.Conclusion The upper limb lymphoedema prevention and management pro-gramme for postoperative breast cancer patients constructed in this study is scientific,feasible and safe,and can ef-fectively reduce the incidence of lymphoedema in patients and improve their quality of life.

Objective:To retrieve the evidence on rehabilitation functional exercise for total knee arthroplasty (TKA) patients both domestically and internationally, and summarize the best evidence to provide a basis for constructing a management plan of rehabilitation functional exercise for TKA patients.Methods:Using population, intervention, professional, outcome, setting and type of evidence (PIPOST) to construct evidence-based nursing issues, all evidence on rehabilitation functional exercise for TKA patients was searched through computers in the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia, British Medical Journal (BMJ) Best Practice, Embase, UpToDate, Web of Science, Cochrane Library, PubMed, American College of Sports Medicine, National Institute for Health and Clinical Excellence, China National Knowledge Infrastructure, WanFang Data and China Biomedical Literature Database. The Chinese and English search terms were "knee replacement/knee arthroplasty" and "functional training/exercise/strength training/early mobilization/recovery/ rehabilitation". The types of literature included guidelines, systematic reviews, summary of evidence, expert consensus, clinical decision-making, and randomized controlled trials (RCTs) . The search period was from the establishment of the database to January 10, 2023. Two researchers trained in evidence-based nursing independently completed the literature quality evaluation, and combined with professional judgment, extracted and summarized evidence for literature that met quality standards.Results:A total of 11 articles were included, including 4 guidelines, 4 systematic reviews, 2 RCTs, and 1 clinical decision-making. A total of 26 best evidence pieces were summarized from 5 aspects, namely multidisciplinary organizational management, pre-rehabilitation exercise, rehabilitation functional exercise plan, continuous function exercise, and exercise compliance.Conclusions:The best evidence summarized regarding rehabilitation functional exercise for TKA patients can provide a basis for medical and nursing staff to develop management plans. Medical and nursing staff need to consider clinical practice, patient's own condition, and willingness when applying evidence, and develop targeted rehabilitation functional exercise plans.

An ultimate goal of neuroscience is to decipher the principles underlying neuronal information processing at the molecular, cellular, circuit, and system levels. The advent of miniature fluorescence microscopy has furthered the quest by visualizing brain activities and structural dynamics in animals engaged in self-determined behaviors. In this brief review, we summarize recent advances in miniature fluorescence microscopy for neuroscience, focusing mostly on two mainstream solutions - miniature single-photon microscopy, and miniature two-photon microscopy. We discuss their technical advantages and limitations as well as unmet challenges for future improvement. Examples of preliminary applications are also presented to reflect on a new trend of brain imaging in experimental paradigms involving body movements, long and complex protocols, and even disease progression and aging.

Objective To study the therapeutic effect of the thrombus suction and direct percutaneous coronary intervention (PCI) for elderly patients with acute ST segment elevation myocardial infarction (STE‐MI) .Methods A total of 124 elderly pa‐tients with acute STE‐MI in our hospital from September 2012 to September 2014 were collected and divided into two groups(under the agreement of patients and family members) ,the experimental group (56 cases) was treated with thrombus suction and direct PCI ,while the control group (68 cases) was only treated with PCI treatment ;the postoperative immediate TIMI flow of coronary artery ,postoperative corrected TIMI frame count (CTFC) ,levels of myoglobin ,cTnT and CK‐MB ,percentage of ST elevation back over 50% ,postoperative 6-month follow‐up situation were observed in the two groups .Results The percentage of postoperative ST segment elevation drop>50% at postoperative 1 h in the experimental group was significantly higher than that in the control group (P<0 .05);the levels of myoglobin ,cTnT and CK‐MB ,postoperative corrected CTFC frames and rate of no reflow in the ex‐perimental group were significantly lower than those in the control group (P<0 .05);during postoperative 6 -month follow up , there were no statistically significant differences in major adverse cardiac events (such as angina pectoris ,myocardial infarction ,re‐vascularization ,etc) between the two groups(P>0 .05);the percentage of LVEF>50% in the experimental group was significantly higher than that in the control group(P<0 .05) ,moreover the percentage of LVEF>50% in the two groups had statistical differ‐ence between before and after operation(P<0 .05) .Conclusion Clinical curative effect of thrombus suction and direct PCI for eld‐erly patients with acute STE‐MI is superior to simple direct PCI treatment .

Objective To discuss the clinical effect of thumb and fingers reconstruction with vascular anastomosis transplantation from toes.Methods From April 2009 to April 2013,166 cases of thumb and finger defect were treated,including 46 cases Ⅰ °-Ⅲ° thumb defect and 120 cases Ⅰ °-Ⅴ° finger defects.Sixty-two cases were emergency reconstructed by vascular anastomosis transplantation from toes,the other 104 cases were subemergency reconstructed.Early functional rehabilitation was carried out postoperative.Results All 208 thumb and fingers in 166 cases with these procedures were survived.Patients were followed up from 4 to 24 months,averaged of 1 l months.The reconstructed thumb and fingers were all with abundant blood supply,having similar shape to the normal thumb and fingers,good pain and temperature sensation,with two-point discrimination of 6-10 mm,with normal range of joint activity,flexible function of finger to finger and finger to palm.Most patients were satisfied with the thumb and finger shape,regained life and work ability as before.The donor sites had no obvious discomfort,and walking and weight-bearing function remained normal.Conclusion For patients with thumbs Ⅰ °-Ⅲ° and fingers Ⅰ °-Ⅴ ° degree of traumatic defect,emergency and subemergency reconstruction of fhumb and fingers by vascular anastomosis transplantation from toes have good clinical effect and less damage to the donor site.

ObjectiveTo elucidate the clinical application value of intravascular ultrasound(IVUS) in assessing intermediate lesions and the relationship between serum levels of fractalkine,CD36 and LP-PLA2and severity of coronary artery atherosclerosis.MethodsOne hundred and twenty patients with unstable angina underwent coronary angiography.Then the patients were divided into two groups:severe lesion group (lumen diameter stenosis greater than 70％,including 40 patients),and the intermediate lesion group lumen diameter stenosis(50％～70％,80 patients).IVUS were performed in all patients to analysis the coronary lesions.Concentrations of CD36,fractalkine and LP-PLA2 were measured by means of ELISA.Results IVUS found that 74％ intermediate lesion patients had soft lipid plaques,while 48％ severe lesion patients had lipid plaques ( P＜0.01 ).Patients with severe lesion had larger plaque burden and vascular remodeling index than those of patients with intermediate lesions(P＜0.05～0.01).There were 59 patients(74％) in the intermediate lesion group underwent PCI.IVUS also found the PCI patients had larger plaque burden and vascular remodeling index.Concentration of CD36 was significantly higher in severe lesion group than that of intermediate lesion group (P＜0.05).ConclusionsIVUS could further clarify the characteristics of the intermediate and severe lesions,and provide guidance for PCI treatment.Plasma CD36 level could be used to predict pathological severity of coronary atherosclerosis.

Objective To explore the treatment method for femoral neck fracture in the young adult patients and discuss the corresponding curative efficacy.Methods Closed reduction and internal fixation with hollow screws were carried out in treatment of 58 young adult patients with femoral neck fracture.There were 37 males and 21 females at age range of 19-56 years(average 37.5 years).According to Garden classification,there were seven patients with type Ⅰ fractures,19 with type Ⅱ,23 with type Ⅲ and nine with type Ⅳ.Results Follow-up lasted for 0.5-7.0 years(average 3.8 years),which showed the average one stage healing time of 5.8 months in 50 patients.Nonunion occurred in three patients and avascular necrosis of the femoral head(ANFH)in five patients,of which six patients were treated with two stage sartorius pedicled iliac graft,with fracture healing in three patients.According to Harris evaluation,the result was rated as excellent in 29 patients,good in 22,fair in two and poor in five,with excellence rate of 88％.Conclusions Closed reduction and internal fixation with hollow screw takes advantages of minor wound,few complications,high healing rate and satisfactory function recovery,and is effective in treatment of femoral neck fracture in the young adult patients.Open reduction and internal fixation with sartorius pedicled iliac graft can be used as remedial treatment for fracture nonunion and avascular necrosis.

Objective To discuss the curative effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of comminuted fracture of metaphyseal tibia. Methods The study involved 38 patients with comminuted fracture of metaphyseal tibia treated by indirect reduction and MIPPO. Results All patients were followed up for 10-30 months (average 18.6 months), which showed one stage union in all patients. The time for bony union was 4.2-7.8 months (mean 5.4 months). The operation lasted for 50-130 minutes (average 75 minutes). According to Johner-Wruhs system, the outcome was excellent in 26 patients, good in 10 and fair in two, with satisfactory rate of 95%. Conclusion MIPPO takes advantages of minor trauma, few complication, simple manipulation, high success rate and satisfactory recovery of joint function recovery and bony union, and hence is a safe and effective treatment for comminuted fracture of metaphyseal tibia.

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.