Objective To compare the effects of subcostal nerve injury between two incision methods in retroperitoneoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of 91 patients who underwent retroperitoneal laparoscopic surgery in the Department of Urology of this hospital from July 2022 to June 2024.The patients were divided into group A(47 cases)and group B(44 cases)based on the different first opening methods for establishing the retroperitoneal space.In group A,the costovertebra angle was the first incision,while in group B,the midaxillary line above the iliac spine was the first incision.The patients were followed up for 6 to 24 months after the operation to observe the injury of the subcostal nerve on the surgical side,including the incidence of chronic pain,sensory numbness and abdominal wall bulge.Results The overall incidence of subcostal nerve injury in group A was 55.3%(26/47),significantly higher than 15.9%(7/44)in group B,and the difference was statistically significant(P<0.01).Among them,the incidence of chronic pain in group A was 31.9%(15/47),which was significantly higher than 9.1%(4/44)in group B,and the difference was statistically significant(P<0.01).There was no statistically significant difference in the side of nerve injury between the two groups of patients(P>0.05).Conclusion When retroperitoneal laparoscopic surgery uses the costovertebra angle as the first incision,there is relatively high risk of subcostal nerve injury.

Objective To develop an exercise rehabilitation program for the patients with upper limb lymphedema in order to provide standardised guidance for specialised management and nursing practice,and to promote the recovery of patients.Methods With the evidence-based methods,domestic and international literaturs were retrieved and the quality of the papers was evaluated.A research team was established to discuss and draft an initial version of the rehabilitation program for the patients with upper limb lymphedema.Delphi method was used to conduct two rounds of consultation with 15 experts in lymphedema between June and September 2023.According to the expert opinions,the exercise rehabilitation program for patients with upper limb lymphedema was finalised after screening and modification of the indicators.Results The final version of the exercise rehabilitation program for patients with upper limb lymphedema includes four tier-1 indicators(routine upper limb rehabilitation exercises,aerobic exercise,anti-resistance exercise and respiratory training),15 tier-2 indicators,and 33 tier-3 indicators.The positive response rate in both rounds of expert consultation was 100.00%,with the authority coefficient at 0.95.In the second round of expert consultation,it was founds that the importance of tier-3 indicators was from 3.93 to 5.00,with the rationality from 4.13 to 5.00 and the feasibility from 3.53 to 4.93.The coefficient of variation in tier-1 and tier-2 indicators was 0.00-0.17 and 0.07-0.23,respectively.The coefficients of variation of per tier-3 indicator in importance,rationality and feasibility were from 0.00 to 0.22,0.00 to 0.22 and 0.05 to 0.22,respectively.The Kendall's coefficient of concordance(W)for tier-1 and tier-2 indicators was 0.490 and 0.387,respectively.The Kendall's W of per tier-3 indicator in importance,rationality and feasibility was 0.427,0.311 and 0.530,respectively,with statistically significant differences(P<0.001).Conclusion The exercise rehabilitation program developed in this study is scientific,comprehensive and highly targeted.It provides a theoretical basis and practical guidance for exercise rehabilitation and nursing care of the patients with upper limb lymphedema.

Objective To develop an exercise rehabilitation program for the patients with upper limb lymphedema in order to provide standardised guidance for specialised management and nursing practice,and to promote the recovery of patients.Methods With the evidence-based methods,domestic and international literaturs were retrieved and the quality of the papers was evaluated.A research team was established to discuss and draft an initial version of the rehabilitation program for the patients with upper limb lymphedema.Delphi method was used to conduct two rounds of consultation with 15 experts in lymphedema between June and September 2023.According to the expert opinions,the exercise rehabilitation program for patients with upper limb lymphedema was finalised after screening and modification of the indicators.Results The final version of the exercise rehabilitation program for patients with upper limb lymphedema includes four tier-1 indicators(routine upper limb rehabilitation exercises,aerobic exercise,anti-resistance exercise and respiratory training),15 tier-2 indicators,and 33 tier-3 indicators.The positive response rate in both rounds of expert consultation was 100.00%,with the authority coefficient at 0.95.In the second round of expert consultation,it was founds that the importance of tier-3 indicators was from 3.93 to 5.00,with the rationality from 4.13 to 5.00 and the feasibility from 3.53 to 4.93.The coefficient of variation in tier-1 and tier-2 indicators was 0.00-0.17 and 0.07-0.23,respectively.The coefficients of variation of per tier-3 indicator in importance,rationality and feasibility were from 0.00 to 0.22,0.00 to 0.22 and 0.05 to 0.22,respectively.The Kendall's coefficient of concordance(W)for tier-1 and tier-2 indicators was 0.490 and 0.387,respectively.The Kendall's W of per tier-3 indicator in importance,rationality and feasibility was 0.427,0.311 and 0.530,respectively,with statistically significant differences(P<0.001).Conclusion The exercise rehabilitation program developed in this study is scientific,comprehensive and highly targeted.It provides a theoretical basis and practical guidance for exercise rehabilitation and nursing care of the patients with upper limb lymphedema.

Objective To compare the effects of subcostal nerve injury between two incision methods in retroperitoneoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of 91 patients who underwent retroperitoneal laparoscopic surgery in the Department of Urology of this hospital from July 2022 to June 2024.The patients were divided into group A(47 cases)and group B(44 cases)based on the different first opening methods for establishing the retroperitoneal space.In group A,the costovertebra angle was the first incision,while in group B,the midaxillary line above the iliac spine was the first incision.The patients were followed up for 6 to 24 months after the operation to observe the injury of the subcostal nerve on the surgical side,including the incidence of chronic pain,sensory numbness and abdominal wall bulge.Results The overall incidence of subcostal nerve injury in group A was 55.3%(26/47),significantly higher than 15.9%(7/44)in group B,and the difference was statistically significant(P<0.01).Among them,the incidence of chronic pain in group A was 31.9%(15/47),which was significantly higher than 9.1%(4/44)in group B,and the difference was statistically significant(P<0.01).There was no statistically significant difference in the side of nerve injury between the two groups of patients(P>0.05).Conclusion When retroperitoneal laparoscopic surgery uses the costovertebra angle as the first incision,there is relatively high risk of subcostal nerve injury.

This paper summarises the nursing care for a patient with fat embolism syndrome after the surgery of an intertrochanteric fracture of femur. The key measures of nursing care include predictive nursing in fat embolism syndrome,close monitor the conditions of patient,early identify the fat embolism syndrome,timely nursing care of fat embolism syndrome,perform temperature care,comprehensively assess transit risks to ensure transit safety,apply the integrated monitoring mode of medical care and caregiver care,and timely detection of subtle changes in the nervous system,perform skin care to identify skin petechiae,and implement individualised nutrition support. After 13 days of treatment and nursing care,the conditions of patient were improved and the patient was discharged.

This paper summarises the nursing care for a patient with fat embolism syndrome after the surgery of an intertrochanteric fracture of femur. The key measures of nursing care include predictive nursing in fat embolism syndrome,close monitor the conditions of patient,early identify the fat embolism syndrome,timely nursing care of fat embolism syndrome,perform temperature care,comprehensively assess transit risks to ensure transit safety,apply the integrated monitoring mode of medical care and caregiver care,and timely detection of subtle changes in the nervous system,perform skin care to identify skin petechiae,and implement individualised nutrition support. After 13 days of treatment and nursing care,the conditions of patient were improved and the patient was discharged.

OBJECTIVE To investigate the efficacy and safety of aerosol inhalation of polycolistin B in the treatment of severe pneumonia combined with mechanical ventilation， and to provide a reference of real-world data for clinical drug therapy. METHODS A retrospective cohort study was conducted to analyze the clinical data of 87 patients with severe pneumonia combined with mechanical ventilation at the First Affiliated Hospital of Shandong First Medical University from January 2021 to February 2023. According to route of administration， all patients were divided into combined group （24 cases， receiving aerosol YXH2021ZX013） inhibition of polycolistin B combined with intravenous dripping） and routine group （63 cases， intravenous dripping of polycolistin B alone）. The differences in efficacy （mortality，clinical response rate and bacterial clearance rate）and safety （elevated serum creatinine， bronchospasm and skin pigmentation） were compared between two groups； the influential factors of primary outcome index as mortality were analyzed through univariate analysis and multivariate Logistic regression analysis. RESULTS In terms of efficacy， there were no statistical differences in mortality（37.50% vs. 41.27%， P＝0.749）， clinical response rate （54.17% vs. 55.56%， P＝0.907） and bacterial clearance rate （45.83% vs. 44.44%， P＝0.907） between the two groups. In terms of safety， the incidence of bronchospasm in the combined group was significantly higher than that of the routine group （12.50% vs. 0， P＝0.028）， but the differences in incidence of elevated serum creatinine and skin pigmentation between two groups were not statistically significant （P＞0.05）. Univariate analysis showed that the moralities were higher in the case of infected with Acinetobacter baumannii， Klebsiella pneumoniae and combined use of quinolones （P＜0.05）； multivariate Logistic regression analysis showed that infection with A. baumannii （OR＝3.36， P＝0.014） and combined use of quinolones （OR＝3.54， P＝0.013） were independently associated with mortality （P＜0.05）. CONCLUSIONS For severe pneumonia patients with mechanical ventilation， intravenous dripping of polycolistin B combined with aerosol inhalation does not show superior efficacy compared with intravenous dipping of polycolistin B alone， but significantly increases the incidence of bronchospasm. Infection with A. baumannii and combined use of quinolones are independent risk factors for the increase of mortality.

Objective:To study the effects of hypertensive disorders of pregnancy (HDP) on the birth weight (BW) differences in twins.Method:From January 2011 to January 2020, twins delivered in our hospital were retrospectively analyzed. The twins born to HDP mothers were the HDP group and those born to healthy mothers were the control group. The maternal and neonatal data of the two groups were collected and the effects of HDP on the BW differences were analyzed.Result:The age of the mothers, the proportion of mothers of older ages and more-than-once delivery in HDP group (418 cases) were significantly higher than the control group (499 cases) [(31.4±5.3) years vs. (30.4±3.8) years, 26.6% (111/418) vs. 12.6% (63/499), 20.6% (86/418) vs. (15.0% (75/499)] ( P<0.05). The gestational age (GA) of newborns in the HDP group (836 cases) was significantly lower than the control group (998 cases) [(35.1±2.2) weeks vs. (36.7±1.2)]( P<0.05). The proportion of twins with GA <34 weeks in the HDP groups was significantly higher than the control group [24.2% (101/418) vs. 3.8% (19/499)] ( P<0.05). Cesarean section was the main delivery mode in both groups. The BW differences of the twins in the HDP group were larger than the control group [22.4% (9.1%, 31.9%) vs. 13.1% (5.8%, 19.6%)]. Significantly more twins in the HDP group showed ≥30% BW difference than the control group [28.7% (120/418) vs. 3.8% (19/499)] ( P<0.05). The incidences of BW discordant in twins (BWDT) in the HDP group was significantly higher than the control group [BWDT≥15%:61.5% (257/418) vs. 38.3% (191/499), BWDT≥20%: 51.4% (215/418) vs. 25.3% (126/499)] ( P<0.05).Among twins with GA of 34~37 weeks, the BW of the bigger infants and the smaller infants in the HDP group were all lower than the control group and the percentage of BW difference was significantly higher than the control group ( P<0.05). Conclusion:HDP may influence the intrauterine growth of the twins, aggravate the BW differences and increase the incidences of BWDT. It is necessary to make better prenatal management of HDP and closely monitor the intrauterine growth of the fetuses.

Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.

Objective To analyze the dynamic changes and the influencing factors of T lymphocyte subsets in recipients with stable graft status within 1 year after lung transplantation. Methods Clinical data of 41 recipients with stable graft status after allogeneic lung transplantation were analyzed. The absolute value and ratio of T lymphocyte subsets in peripheral blood from recipients were measured by flow cytometry before operation, 2 weeks and each month (within 1 year) after operation, respectively. The effects of age, gender, body mass index (BMI), surgical method, incidence of primary graft dysfunction (PGD) after operation, and primary disease upon the absolute values of T lymphocytes were evaluated. Results Within 1 year after lung transplantation, the absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes and CD4⁺/CD8⁺ ratio were changed over time (all P < 0.001). Compared with preoperative values, there was no statistical significance in the absolute values of CD3⁺ and CD3⁺CD4⁺T lymphocytes at 12 months after operation (P=0.659, 0.109), whereas the absolute value of CD3⁺CD8⁺T lymphocytes was increased (P=0.02) and the CD4⁺/CD8⁺ ratio was decreased (P < 0.001). Age, gender, BMI, surgical method and incidence of PGD after operation exerted no significant effect on the dynamic changes of absolute values of CD3⁺CD4⁺ and CD3⁺CD8⁺T lymphocytes (all P > 0.05). Primary disease before lung transplantation exerted no effect on the changes of CD3⁺CD4⁺T lymphocytes, whereas the postoperative absolute value of CD3⁺CD8⁺T lymphocytes was higher in recipients with infectious lung diseases (P < 0.05). Conclusions The absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes in recipients with stable graft status after lung transplantation are relatively low in the early stage after lung transplantation, then gradually restore, and stabilize at 6 months after operation. Dynamic changes are not associated with age, gender, BMI, surgical method and incidence of PGD after operation of recipients.