Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective To investigate the expressions of H3.3G34W,p63 and SATB2 in giant cell tumor of bone(GCTB)and the effect and value of their combined application in the diagnosis of GCTB.Methods We collected the samples and medical records of 54 cases of GCTB and 83 cases of non-giant cell tumor of bone(14 cases of aneurysmal bone cyst,16 cases of chondroblastoma and 53 cases of non-ossifying fibroma)diagnosed between 2020 and 2022 in the Department of Pathology of Honghui Hospital Affiliated to Xi'an Jiaotong University.The expressions of H3.3G34W,p63 and SATB2 were detected by EliVision immunohistochemical method.X2 test was used to determine whether there are significant differences in the positive rates of H3.3G34W,p63 and SATB2 among all the groups.The combined diagnostic model including H3.3G34W,p63 and SATB2 was established by Logistic regression analysis,and the diagnostic value of the model was evaluated by ROC curve analysis.Results The positive rates of H3.3G34W,p63 and SATB2 in GCTB group were 81.5％,90.7％and 92.6％,respectively;the positive rates in NGCTB group were 2.4％,28.9％and 62.7％.Compared with NGCTB group,the age of GCTB group was significantly older[(41.222±14.849)vs.(16.566±9.439),P＜0.001],and the prevalence was higher in women than in men(51.9％vs.48.1％,P＜0.001).In addition,compared with the NGCTB group,the positive rates of H3.3G34W(81.5％vs.2.4％,P＜0.001),p63(90.7％vs.28.9％,P＜0.001)and SATB2(92.6％vs.62.7％,P＜0.001)were significantly higher in the GCTB group.Univariate regression analysis built a univariate prediction modeland ROC curve analysis showed that age(AUC=92.9％,P＜0.001),sex(AUC=64.5％,P=0.004),H3.3G34W positive rate(AUC=89.5％,P＜0.001),p63 positive rate(AUC=80.9％,P＜0.001)and SATB2 positive rate(AUC=65.0％,P=0.003)were independent predictors of diagnosis of giant cell tumor of bone.Multivariate regression analysis(Logistic)constructed a hybrid prediction model.ROC curve analysis suggested that the hybrid model showed better prediction value than the single factor model(AUC=98.4％,P＜0.001).Conclusion H3.3G34W,p63 and SATB2 are effective molecular markers for the diagnosis of GCTB,and their combined application can improve the prediction efficiency of the diagnosis of GCTB.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

Objective:To gain a deeper understanding of the experience of medical staff in the oncology department in understanding and managing chemotherapy-induced taste alterations (CITAs).Methods:Using phenomenological research methods, in-depth interviews were conducted with 15 medical staff in the oncology department of Fudan University Shanghai Cancer Center, and the interview materials were transcribed, encoded, categorized, and described by Colaizzi 7-step analysis method.Results:Totally 15 respondents aged 26-43, 3 males and 12 females. Three themes were extracted, including the perception of benefits of CITAs symptom management ("hard outcome" benefit perception - improving symptom management level; "soft outcome" benefit perception-enhancing effective communication among multiple parties); the obstacles between the lack of awareness of knowledge about CITAs and symptom management (differences in medical staff′s understanding of CITAs; low accessibility of acquisition channels about CITAs knowledge); the management and intervention measures of CITAs lack specialization and high efliciency (CITAs′ management measures mostly stem from work experience; CITAs′ management may be based on information construction in the future).Conclusions:Hospital managers should fully utilize the opportunity of symptom management in CITAs, develop professional and efficient intervention and management strategies, strengthen the learning of relevant knowledge of the symptom among medical staff in oncology department, reduce symptom distress and patient self-perception burden, and improve the level of symptom management among medical staff in the oncology department.

Supracondylar humerus fractures represent the most prevalent type of upper limb fractures in pediatric patients. As a result of the interplay of external forces, muscular contractions, and periosteal reactions, these fractures are prone not only to axial displacement but also to rotational displacement in a certain degree. Rapid and accurate assessment of the rotational displacement holds a paramount importance for intraoperative realignment, choice of fixation modalities, and anticipation of postoperative function. Currently, methods to evaluate the rotational displacement involve X-ray, CT, and ultrasound, but the various assessment techniques and criteria often pose challenges in differentiation. This paper reviews the current diverse imaging modalities for assessment of the rotational displacement, aiming to translate the intricate three-dimensional spatial rotation into single-plane rotations within the coronal, sagittal, and horizontal planes, thereby aspiring to furnish those concerned with clinical guidance.

Objective The development of the expert consensus on self-management of skin adverse reactions in patients undergoing targeted cancer therapy(hereinafter referred to as"the consensus")aims to enhance the effectiveness of self-management for skin-related adverse reactions in cancer patients receiving targeted therapy.It seeks to reduce the incidence of these reactions and alleviate their severity.Methods Utilizing evidence-based approaches,a systematic search was conducted across both domestic and international databases and relevant websites.This process included the evaluation and summarization of pertinent evidence to create a preliminary draft of the consensus.Through 2 rounds of Delphi expert inquiries and a round of expert panel discussion,the content was refined,leading to the final draft of the consensus.Results The consensus comprises 11 sections:gathering information before medication,identifying risk factors prior to medication,self-assessment and proactive reporting,skin cleansing,skin moisturizing,sun protection,makeup application,appropriate clothing,engaging in household activities,prophylactic medication,and common management techniques.Conclusion This consensus provides a valuable reference for clinical nurses to guide cancer patients in the self-management of skin adverse reactions associated with targeted drug therapy.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.