Objective To explore the effect of a phased rehabilitation training programme to relieve shoulder dys-function in patients after neck dissection and to provide effective solutions for postoperative shoulder joint function recov-ery of patients.Methods This study has been reviewed and approved by the Ethics Committee,and informed consent has been obtained from patients.A phased rehabilitaiton training programme for the shoulder after neck dessection was developed through literature review and discussion,and 70 eligible patients from Hospital of Stomatology,Sun Yat-sen University from December 2020 to April 2021 were selected and randomly divided into the test group and control group(35 patients in each group).The control group underwent motor rehabilitation training from 6 weeks postoperative to 1 year after surgery,such as shoulder mobility and coordination training and small range of motion training of the neck,while the test group took part in a rehabilitation training program that included familiarization maneuver training,protective rehabilitation,exercise rehabilitation,and resistance training in the following four stages:preoperative,postop-erative general anesthesia and awake until the removal of stitches,the removal of stitches until 6 weeks after surgery,and 6 weeks after surgery until 1 year after surgery.The frequency of training in both groups was at least 3 days per week,and the length of each training session was 10-15 min.The intensity of exercise was 2-3 points on the Borg Conscious Ex-ercise Intensity Scale(i.e.,mild-to-moderate tachypnea or fatigue).The neck dissection injury index(NDII)was used to evaluate the quality of life related to shoulder joint function at four time points:preoperative,postoperative 3 months,postoperative 6 months,and postoperative 12 months.The higher the score,the better the quality of life.Results 28 cases in the test group and 32 cases in the control group completed a one-year follow-up.At 3 and 6 months postopera-tive,the NDII of the test group was significantly higher than that of the control group[3 months postoperative:test group(93.48±9.36)vs.control group(80.00±11.34)(P＜0.001),6 months postoperative:test group(98.21±4.76)vs.control group(90.70±9.12)(P＜0.001)];12 months after surgery,the NDII of the test group(97.23±4.88)was still higher than that of the control group(96.33±4.49),but the difference was not statistically significant(P=0.458).The difference in NDII scores among subjects at 3,6,and 12 months after surgery was statistically significant in each group(P＜0.001).Conclusion The application of the phased rehabilitation training method in neck dissection patients has a feasibility and could improve the quality of life of patients'shoulder joint function within 6 months after surgery.

Objective:To explore the effects of health education based on reinforcement theory combined with empowerment theory in patients with chronic obstructive pulmonary disease (COPD) .Methods:From January 2018 to January 2021, convenience sampling was used to select 80 COPD patients admitted to the Respiratory Department of Lishui Hospital of Traditional Chinese Medicine as the subject. Patients were randomly divided into a control group and an observation group with 40 cases each in a 1∶1 ratio using the random number table. The control group received routine health education and psychological intervention, while the observation group was treated with health education based on reinforcement theory combined with empowerment theory. The pulmonary rehabilitation compliance, Short Form of the Profile of Mood States (POMS-SF) and Health-Promoting Lifestyle Profile (HPLP) scores before and after intervention were compared between two groups.Results:After intervention, the total score and all dimension scores of pulmonary rehabilitation compliance in both groups were higher than those before intervention, and the observation group scored higher than the control group, with statistically significant differences ( P<0.05). After intervention, the energy-vitality scores of the two groups were higher than those before intervention, the observation group scored higher than the control group, and the scores of other dimensions were lower than those before intervention, the observation group scored lower than the control group, and the differences were statistically significant ( P<0.05). After intervention, the scores of HPLP in all dimensions in both groups were higher than those before intervention, and the observation group scored higher than the control group, with statistically significant differences ( P<0.05) . Conclusions:Health education based on reinforcement theory combined with empowerment theory for COPD patients can enhance their rehabilitation compliance, effectively improve their mental state, and promote the development of healthy behaviors.

Objective To investigate the clinical value of ultrasound on parathyroid nodules.Methods A total of 93 patients(102 nodules)with parathyroid lesions admitted to Fujian Cancer Hospital from September 2007 to April 2023 and confirmed by postoperative pathology were retrospectively studied.Results There were 102 nodules in the 93 patients,including 80 parathyroid adenomas(78.43%),15 parathyroid hyperplasias(14.71%),2 parathyroid cysts(1.96%)and 5 parathyroid carcinomas(4.90%).A total of 90 nodules(88.24%)were detected by ultrasound,and most nodules were located on the dorsal side of the lower part of the thyroid gland.Among them,parathyroid adenoma and parathyroid hyperplasia showed low echo,clear boundary,uneven internal echo and abundant blood flow signals.Parathyroid cyst showed no echo,clear boundary,uniform internal echo and no obvious blood flow signal.Parathyroid carcinoma is mostly hypoechoic,with unclear boundary,uneven internal echo and rich blood flow signal.Parathyroid hormone(PTH)detection was performed in all 93 patients after surgery,except for 2 patients with metastatic parathyroid carcinoma,and 91 patients with metastatic parathyroid carcinoma.Conclusion Ultrasound is valuable in clinical diagnosis of parathyroid disease.

Objective:To investigate clinical outcome and the risk factors for death in acute pancreatitis (AP) patients complicated with acute kidney injury (AKI).Methods:The clinical data of 232 AP patients complicated with AKI admitted to the Center of Severe Pancreatitis of Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into survival group ( n=162) and death group ( n=70) based on the survival status. The two groups' clinical characteristics, biochemical indexes, and renal function indexes were compared. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors for death in AP patients complicated with AKI. Results:Sixteen patients(6.9%) among the 232 had AKI Ⅰ, 15(6.5%) had AKI Ⅱ, and 201(86.6%) had AKI Ⅲ. Forty-one patients (17.7%) became AKI with a disease course <7 days, 184 patients (79.3%) gradually progressed to acute kidney disease with a disease course of 7-90 days, and 7 patients (3.0%) eventually progressed to chronic kidney disease with a disease course >90 days. Renal replacement treatment (RRT) was administered in 179 patients (77.2%), lasting an average of 14 (7-25) days. 138 patients (59.5%) had their renal function recovered while they were hospitalized, including 9 patients (6.5%) who did so within 7 days, 69 patients (50.0%) within 30 days, and 127 patients (92.0%) within 90 days. The average recovery time was 16 (7-28) days. Seventy patients (30.2%) died during hospitalization, including 8(3.5%) within 7 days, 42(18.1%) within 30 days, and 68(29.3%) within 90 days. Univariate analysis revealed that the proportions of biliary etiology, neutrophil to lymphocyte ratio (NLR), serum cystatin C, sequential organ failure assessment(SOFA) score, AKI Ⅲ proportion, number of patients undergoing RRT, and duration of AKI were significantly higher in the death group compared to the survival group. The number of patients complicated by infected pancreatic necrosis (IPN) and having surgical intervention was also significantly greater than that in the survival group, while the proportion of patients whose renal function recovered was much lower than that in the survival group. The differences were all statistically significant (all P value <0.05). Multivariate logistic analysis showed that SOFA( OR=1.182, 95% CI 1.000-1.396, P=0.049), and IPN( OR=8.403, 95% CI 3.748-18.838, P<0.001) were independent risk factors for death. Conclusions:SOFA score and IPN at admission were independent risk factors for death in AP patients with AKI. Vigilance should be given as soon as possible to improve the outcome of patients through clinical intervention.

Objective:To sum up nursing experience of a multi-drug resistant patient with upper gastrointestinal hemorrhage who underwent Lateral skull base.Methods:One patient with multi-drug resistant was admitted to our hospital in October, 2019. To observe and prevent the postoperative complications of lateral skull base and to prevent the rupture bleeding of carotid artery. The early detection and treatment the symptoms of upper gastrointestinal bleeding is effective and necessary. Intervention for patient receiving nutrition therapy is promoted.Results:By giving psychological care to improve patient compliance. The patient had no postoperative complications of lateral skull base, and the bleeding symptoms of upper gastrointestinal hemorrhage was controlled in time.Conclusion:The patient was discharged from the hospital with a tracheal tube in a stable condition.

The traditional proportional hazard model is commonly used to investigate the association between main outcome and predictor variables. However, the endpoints in medical studies are often not unique. The analyses of labeling other competing outcomes other than the main outcome as censored data will theoretically lead to a biased estimate of the risk of main outcome. Although the traditional competitive risk model can adjust the influence of other outcomes on the risk of the main outcome, it can not directly compare the differences on the risks of different outcomes. The multi-state competing risk model provides a relatively suitable solution for this problem. In this study, based on a previously published follow-up data set for prostate cancer patients, we developed traditional proportional hazard model, traditional competitive risk model, and multi-state competing risk model, respectively. By comparing the advantages and disadvantages of the three models with the same survival data, we clarified the clinical application value of the multi-state competitive risk model in survival data with multiple outcomes.

The traditional proportional hazard model is commonly used to investigate the association between main outcome and predictor variables. However, the endpoints in medical studies are often not unique. The analyses of labeling other competing outcomes other than the main outcome as censored data will theoretically lead to a biased estimate of the risk of main outcome. Although the traditional competitive risk model can adjust the influence of other outcomes on the risk of the main outcome, it can not directly compare the differences on the risks of different outcomes. The multi-state competing risk model provides a relatively suitable solution for this problem. In this study, based on a previously published follow-up data set for prostate cancer patients, we developed traditional proportional hazard model, traditional competitive risk model, and multi-state competing risk model, respectively. By comparing the advantages and disadvantages of the three models with the same survival data, we clarified the clinical application value of the multi-state competitive risk model in survival data with multiple outcomes.

Objective:To design and evaluate a new type of clothes for patients with reconstruction after oral cancer resection.Methods:According to the characteristics of patients after oral tumor resection and reconstruction, a new type of patient clothing was designed. From January 2018 to June 2018, 79 patients with oral malignant tumor radical resection combined with reconstruction were selected as the control group, using traditional patient clothing. 64 patients with the same operation were selected as the experimental group from July 2018 to December 2018, and the new patient clothing was used. The time of changing clothing, wearing comfort and privacy protection, the convenience for medical staff to observe and change wound dressing were to evaluate.Results:The clothing change time of the patients was (124.00±23.35) s in the experimental group, and (156.09±25.66) s in the control group,the difference was statistically significant( t value was 14.97, P<0.01). The scores of clothing comfort and privacy protection were 8.23±0.91, 7.17±0.94 in the experimental group, and 4.78±0.94, 5.50±0.89 in the control group, the difference were statistically significant( t values were -15.21, -9.95, P<0.01). The scores of medical staff observing wounds and changing wound dressings were 7.88±0.89, 7.87±0.83 in the experimental group, and 4.15±0.78, 4.15±0.78 in the control group, the difference was statistically significant( t values were -18.98, -17.75, P<0.01). Conclusions:The new clothes is effective for patients with reconstruction after oral cancer resection. It can be popularized in patients with oral cancer resection and reconstruction.

Objective: To explore the characteristics of perioperative venous therapy in patients undergoing simultaneous repair and reconstruction of oral cancer after radical resection, and prevention of femoral vein catheterization complications, to provide clinical evidence for venous therapy. Methods: A retrospective analysis was perfomed to assess the choice of venous access and its effects in 95 patients undergoing simultaneous reconstruction due to oral cancer during the perioperative period. Results : In total, 95 patients underwent successful indwelling femoral vein catheterization with double lumens, and a midline catheter and peripheral intravenous indwelling needles were used to complete the intravenous therapy after surgery. Among the femoral vein complications, 1 case was complicated with lower extremity venous thrombosis (incidence was 1.1%), and 17 cases were complicated with puncture point bleeding (incidence was17.9%). Two cases of puncture site bleeding were noted among 28 cases using a midline catheter. Local phlebitis and infiltration were the most common complications of peripheral venous catheters. The difference in catheter-related complications among different types of catheters was statistically significant (P < 0.05). The complication rate of the midline catheter was lower than that noted with femoral vein catheterization and peripheral intravenous indwelling needles. Conclusion Based on the treatment characteristics of patients, proper venous catheters should be established during the perioperative period. The application of a femoral vein catheter during the operation combined with the use of a midline catheter and peripheral venous indwelling needles after the operation can satisfy intravenous therapy needs in patients undergoing simultaneous repair and reconstruction for oral cancer, and the midline catheter can effectively reduce venous catheter-related complications.

Objective To investigate the clinical value of ultrasound-guided catheterization in intraperitoneal perfusion chemotherapy for postoperative abdominal malignant tumor without ascites. Methods A retrospective analysis were performed in 146 postoperative patients with abdominal malignancies who were admitted to Fujian Cancer Hospital from April 2013 to September 2018, and there were no ascites founded in these patients before abdominal catheterization. Two hundred and seventy-nine times ultrasound-guided catheterization in intraperitoneal perfusion chemotherapy were performed under clinical guidance. Results Two hundred and seventy-seven times abdominal catheterization was completed, with a success rate of 99.3％(277/279), and the one-time success rate was 83.2％(232/279), 2 times (0.7％, 2/279) had to be abandoned for peritoneal adhesions. Fifty-three patients (36.3％, 53/146) underwent catheterization ≥ 2 times. The intraperitoneal perfusion chemotherapy was successfully completed after catheterization, no intestinal injury and bleeding occurred. Conclusions In the absence of ascites, ultrasound guided catheterization in perfusion chemotherapy is safe, reliable, simple, accurate and has a high success rate. This new approach is good for clinical application when the conventional catheterization with ascites is blocked.