Donors with a serum sodium concentration of >155 mmol/L are extended criteria donors for liver transplantation (LT). Elevated serum sodium of donors leads to an increased incidence of hepatic dysfunction in the early postoperative period of LT; however, the exact mechanism has not been reported. We constructed a Lewis rat model of 70% hepatic parenchymal area subjected to ischemia-reperfusion (I/R) with hypernatremia and a BRL-3A cell model of hypoxia-reoxygenation (H/R) with high-sodium (HS) culture medium precondition. To determine the degree of injury, biochemical analysis, histological analysis, and oxidative stress and apoptosis detection were performed. We applied specific inhibitors of the epithelial sodium channel (ENaC) and Na⁺/Ca²⁺ exchanger (NCX) in vivo and in vitro to verify their roles in injury. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels and the area of hepatic necrosis were significantly elevated in the HS+I/R group. Increased reactive oxygen species (ROS) production, myeloperoxidase (MPO)‍-positive cells, and aggravated cellular apoptosis were detected in the HS+I/R group. The HS+H/R group of BRL-3A cells showed significantly increased cellular apoptosis and ROS production compared to the H/R group. The application of amiloride (Amil), a specific inhibitor of ENaC, reduced ischemia-reperfusion injury (IRI) aggravated by HS both in vivo and in vitro, as evidenced by decreased serum transaminases, inflammatory cytokines, apoptosis, and oxidative stress. SN-6, a specific inhibitor of NCX, had a similar effect to Amil. In summary, hypernatremia aggravates hepatic IRI, which can be attenuated by pharmacological inhibition of ENaC or NCX.
Animals ; Reperfusion Injury/drug therapy* ; Hypernatremia/complications* ; Rats ; Liver/metabolism* ; Rats, Inbred Lew ; Male ; Apoptosis ; Sodium-Calcium Exchanger/antagonists & inhibitors* ; Reactive Oxygen Species/metabolism* ; Oxidative Stress ; Epithelial Sodium Channel Blockers/pharmacology* ; Epithelial Sodium Channels ; Cell Line ; Liver Transplantation

Objective:To compare the safety and efficacy of 3D-printed porous bioceramic artificial bone and artificial bone substitutes in the treatment of limb bone defects.Methods:A total of 220 patients with post-traumatic limb bone defects admitted to Xijing Hospital Affiliated to Air Force Medical University of the Chinese People's Liberation Army (34 cases), the Third Hospital of Hebei Medical University (60 cases), Xi'an Honghui Hospital (28 cases), the Third Hospital of Southern Medical University (18 cases), Changsha Third Hospital (28 cases), Foshan Traditional Chinese Medicine Hospital (16 cases), Foshan Fuxing Chancheng Hospital (12 cases), and Henan Provincial Orthopaedic Hospital (24 cases) from May 2022 to October 2023 were included as research subjects. According to the manufacturing method of the bone graft material, the subjects were randomly divided into the 3D printed porous bioceramic artificial bone group (3D printing group) and the artificial bone substitute group (non-3D printing group) at a ratio of 1:1 by the envelope method. Adverse events that might be related to the surgery were selected through correlation evaluation and classified as abnormal laboratory indicators, systemic or other site symptoms and abnormalities, and local symptoms and abnormalities of the affected limb. The safety of the two groups was compared. The bone graft fusion rate, bone defect repair and healing rate, and short form 12 (SF-12) score of the two groups were calculated to evaluate the postoperative recovery.Results:Thirty-two cases were excluded (4 cases refused to use their data after reconsideration, 7 cases were not used after preoperative assessment, and 21 cases exceeded the standard for body mass index and laboratory indicators upon re-examination). A total of 188 cases were randomly divided into the 3D printing group and the non-3D printing group according to the random method, with 94 cases in each group. Among them, 11 cases in the 3D printing group and 9 cases in the non-3D printing group dropped out due to loss to follow-up. Finally, 168 cases completed the follow-up, including 83 cases in the 3D printing group and 85 cases in the non-3D printing group. In the 3D printing group, there were 53 males and 30 females, with an average age of 47.9±12.7 years; in the non-3D printing group, there were 53 males and 32 females, with an average age of 48.6±12.9 years. A total of 51 cases in the two groups experienced adverse events related to the surgery, including 13 cases of abnormal laboratory indicators (5 cases in the 3D printing group and 8 cases in the non-3D printing group), 15 cases of systemic or other site symptoms and abnormalities (9 cases in the 3D printing group and 6 cases in the non-3D printing group), and 23 cases of local symptoms and abnormalities of the affected limb (13 cases in the 3D printing group and 10 cases in the non-3D printing group). There was no statistically significant difference in the incidence of adverse events between the two groups ( P>0.05). The bone graft fusion rates of the 3D printing group and the non-3D printing group at 6 months after surgery were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 89%(74/83) and 89%(76/85), respectively. At the time of 12 months after surgery, the bone graft fusion rates were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 94%(78/83) and 92%(78/85), respectively. There was no statistically significant difference in the bone graft fusion rate and bone defect repair and healing rate between the two groups ( P>0.05). The SF-12 scores during the screening period were 27.82±2.96 points and 27.22±4.23 points in the 3D printing group and the non-3D printing group, respectively, and at 3 months after surgery were 28.08±3.13 points and 27.64±3.16 points, at 6 months after surgery were 29.42±3.10 points and 28.55±3.45 points, and at 12 months after surgery were 29.78±2.80 points and 29.58±2.94 points, respectively. There was no statistically significant difference between the groups ( P>0.05). Both groups of surgeries were successfully completed without any serious surgical or bone graft-related complications. Conclusion:The safety and efficacy of 3D-printed porous bioceramic artificial bone in the treatment of limb bone defects are not significantly different from those of currently clinically applied artificial bone substitutes.

As an important setting for the administration of vaccinations, the reasonable setting up and standardized management of vaccination clinics will enhance immunization service quality, public satisfaction, and improve the vaccination rate to protect people′s health. In recent years, various provinces in China are continuously promoting the standardized construction and management of vaccination clinics. However, the level of standardization management remains unbalanced, and the capacity of vaccination services needs to be further improved. This paper reviews the standardized management process of vaccination clinics, summarizes the practice and achievements in various regions, and analyzes the challenges and issues during these processes, to provide reference for improving the standardized management level of vaccination clinics in the future.

As an important setting for the administration of vaccinations, the reasonable setting up and standardized management of vaccination clinics will enhance immunization service quality, public satisfaction, and improve the vaccination rate to protect people′s health. In recent years, various provinces in China are continuously promoting the standardized construction and management of vaccination clinics. However, the level of standardization management remains unbalanced, and the capacity of vaccination services needs to be further improved. This paper reviews the standardized management process of vaccination clinics, summarizes the practice and achievements in various regions, and analyzes the challenges and issues during these processes, to provide reference for improving the standardized management level of vaccination clinics in the future.

Objective:To evaluate the therapeutic role of balanced matching concept in the surgical release of moderate and severe elbow stiffness after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 20 patients who had been treated by surgical release from June 2022 to January 2024 for elbow stiffness after moderate and severe trauma at Department of Orthopedic Trauma, The First Hospital Affiliated to Air Force Medical University of PLA using the balanced matching concept (combination of elbow soft tissue balance and bone matching). There were 15 males and 5 females, with an age of (33.0±8.9) years. Six left sides and 14 right sides were affected. The elbow stiffness was severe in 13 cases and moderate in 7 cases. Six patients had mainly bony stiffness, 4 patients mainly soft stiffness, and 10 patients mixed stiffness. The elbow flexion and extension, Mayo elbow performance score (MEPS) and disabilities of the arm, shoulder, and hand (DASH) score were recorded and compared before release and at the last follow-up. The recurrence of ectopic ossification, infection, iatrogenic fracture and other complications of the elbow joint of the affected limb were recorded.Results:All the 20 patients were followed up for (16.6±3.5) months. At the last follow-up, the elbow flexion and extension (121.8°±8.9° and 14.8°±8.2°) were significantly greater than those before operation (73.5°±25.7° and 47.3°±19.2°), and the MEPS and DASH scores [ (90.0±5.6) points, (5.6±3.0) points] were significantly better than those before operation [(53.0±12.8) points, (62.1±14.0) points] ( P<0.05). Iatrogenic fracture of the ulna occurred in 1 patient, and pinky numbness occurred in 1 patient after surgery. None of the patients had recurrence of ectopic ossification or wound infection. Conclusion:In the surgical release of moderate and severe elbow stiffness after trauma, the concept of balanced matching plays a positive role by facilitating the functional restoration of the elbow and reducing the incidence of complications.

Objective:To compare the safety and efficacy of 3D-printed porous bioceramic artificial bone and artificial bone substitutes in the treatment of limb bone defects.Methods:A total of 220 patients with post-traumatic limb bone defects admitted to Xijing Hospital Affiliated to Air Force Medical University of the Chinese People's Liberation Army (34 cases), the Third Hospital of Hebei Medical University (60 cases), Xi'an Honghui Hospital (28 cases), the Third Hospital of Southern Medical University (18 cases), Changsha Third Hospital (28 cases), Foshan Traditional Chinese Medicine Hospital (16 cases), Foshan Fuxing Chancheng Hospital (12 cases), and Henan Provincial Orthopaedic Hospital (24 cases) from May 2022 to October 2023 were included as research subjects. According to the manufacturing method of the bone graft material, the subjects were randomly divided into the 3D printed porous bioceramic artificial bone group (3D printing group) and the artificial bone substitute group (non-3D printing group) at a ratio of 1:1 by the envelope method. Adverse events that might be related to the surgery were selected through correlation evaluation and classified as abnormal laboratory indicators, systemic or other site symptoms and abnormalities, and local symptoms and abnormalities of the affected limb. The safety of the two groups was compared. The bone graft fusion rate, bone defect repair and healing rate, and short form 12 (SF-12) score of the two groups were calculated to evaluate the postoperative recovery.Results:Thirty-two cases were excluded (4 cases refused to use their data after reconsideration, 7 cases were not used after preoperative assessment, and 21 cases exceeded the standard for body mass index and laboratory indicators upon re-examination). A total of 188 cases were randomly divided into the 3D printing group and the non-3D printing group according to the random method, with 94 cases in each group. Among them, 11 cases in the 3D printing group and 9 cases in the non-3D printing group dropped out due to loss to follow-up. Finally, 168 cases completed the follow-up, including 83 cases in the 3D printing group and 85 cases in the non-3D printing group. In the 3D printing group, there were 53 males and 30 females, with an average age of 47.9±12.7 years; in the non-3D printing group, there were 53 males and 32 females, with an average age of 48.6±12.9 years. A total of 51 cases in the two groups experienced adverse events related to the surgery, including 13 cases of abnormal laboratory indicators (5 cases in the 3D printing group and 8 cases in the non-3D printing group), 15 cases of systemic or other site symptoms and abnormalities (9 cases in the 3D printing group and 6 cases in the non-3D printing group), and 23 cases of local symptoms and abnormalities of the affected limb (13 cases in the 3D printing group and 10 cases in the non-3D printing group). There was no statistically significant difference in the incidence of adverse events between the two groups ( P>0.05). The bone graft fusion rates of the 3D printing group and the non-3D printing group at 6 months after surgery were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 89%(74/83) and 89%(76/85), respectively. At the time of 12 months after surgery, the bone graft fusion rates were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 94%(78/83) and 92%(78/85), respectively. There was no statistically significant difference in the bone graft fusion rate and bone defect repair and healing rate between the two groups ( P>0.05). The SF-12 scores during the screening period were 27.82±2.96 points and 27.22±4.23 points in the 3D printing group and the non-3D printing group, respectively, and at 3 months after surgery were 28.08±3.13 points and 27.64±3.16 points, at 6 months after surgery were 29.42±3.10 points and 28.55±3.45 points, and at 12 months after surgery were 29.78±2.80 points and 29.58±2.94 points, respectively. There was no statistically significant difference between the groups ( P>0.05). Both groups of surgeries were successfully completed without any serious surgical or bone graft-related complications. Conclusion:The safety and efficacy of 3D-printed porous bioceramic artificial bone in the treatment of limb bone defects are not significantly different from those of currently clinically applied artificial bone substitutes.

Objective:To investigate the current status of clinical leadership among Interventional Operating Room nurses in Shandong Province and to analyze its influencing factors.Methods:In December 2024, 220 Interventional Operating Room nurses from 46 ClassⅢ Grade A general hospitals in Shandong Province were selected for a cross-sectional survey using convenience sampling. General Information Questionnaire, Clinical Leadership Survey, Chinese version of Wong and Law Emotional Intelligence Scale (WLEIS-C) , and Jefferson Scale of Empathy-Health Professionals (JSE-HP) were used as survey instruments. Multiple linear regression was used to analyze the factors influencing clinical leadership among Interventional Operating Room nurses. Pearson correlation analysis was used to explore the relationship between emotional intelligence, empathy, and clinical leadership.Results:A total of 220 questionnaires were distributed and 204 valid questionnaires were recovered, with a valid recovery rate of 92.73% (204/220) . The clinical leadership scores of the 204 Interventional Operating Room nurses were (66.35±8.74) , and the dimensions scored, in descending order, as encouraging the heart, enabling others to act, modeling the way, inspiring a shared vision, and challenging the process. The mean scores of WLEIS-C and JSE-HP items were (5.88±0.90) and (4.61±0.63) , respectively. Multiple linear regression analysis showed that the nature of employment and whether or not they participated in leadership training were influencing factors for clinical leadership among Interventional Operating Room nurses (partial regression coefficients of -2.831 and -2.999, respectively; P<0.05) . Emotional intelligence and empathy ability among Interventional Operating Room nurses were positively correlated with clinical leadership ( P<0.05) . Conclusions:Clinical leadership of nurses in the Interventional Operating Room of ClassⅢ Grade A general hospitals in Shandong Province is at a moderate to high level. Nurses who participate in leadership training, have staffing, have greater empathy, and have higher emotional intelligence have greater clinical leadership. It is recommended that nursing administrators add leadership-related courses to the training of nurses in the Interventional Operating Room, and take steps to improve nurses' emotional intelligence and empathy ability, thereby promoting clinical leadership among Interventional Operating Room nurses.

Objective:To investigate the current status of clinical leadership among Interventional Operating Room nurses in Shandong Province and to analyze its influencing factors.Methods:In December 2024, 220 Interventional Operating Room nurses from 46 ClassⅢ Grade A general hospitals in Shandong Province were selected for a cross-sectional survey using convenience sampling. General Information Questionnaire, Clinical Leadership Survey, Chinese version of Wong and Law Emotional Intelligence Scale (WLEIS-C) , and Jefferson Scale of Empathy-Health Professionals (JSE-HP) were used as survey instruments. Multiple linear regression was used to analyze the factors influencing clinical leadership among Interventional Operating Room nurses. Pearson correlation analysis was used to explore the relationship between emotional intelligence, empathy, and clinical leadership.Results:A total of 220 questionnaires were distributed and 204 valid questionnaires were recovered, with a valid recovery rate of 92.73% (204/220) . The clinical leadership scores of the 204 Interventional Operating Room nurses were (66.35±8.74) , and the dimensions scored, in descending order, as encouraging the heart, enabling others to act, modeling the way, inspiring a shared vision, and challenging the process. The mean scores of WLEIS-C and JSE-HP items were (5.88±0.90) and (4.61±0.63) , respectively. Multiple linear regression analysis showed that the nature of employment and whether or not they participated in leadership training were influencing factors for clinical leadership among Interventional Operating Room nurses (partial regression coefficients of -2.831 and -2.999, respectively; P<0.05) . Emotional intelligence and empathy ability among Interventional Operating Room nurses were positively correlated with clinical leadership ( P<0.05) . Conclusions:Clinical leadership of nurses in the Interventional Operating Room of ClassⅢ Grade A general hospitals in Shandong Province is at a moderate to high level. Nurses who participate in leadership training, have staffing, have greater empathy, and have higher emotional intelligence have greater clinical leadership. It is recommended that nursing administrators add leadership-related courses to the training of nurses in the Interventional Operating Room, and take steps to improve nurses' emotional intelligence and empathy ability, thereby promoting clinical leadership among Interventional Operating Room nurses.

Objective:To evaluate the therapeutic role of balanced matching concept in the surgical release of moderate and severe elbow stiffness after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 20 patients who had been treated by surgical release from June 2022 to January 2024 for elbow stiffness after moderate and severe trauma at Department of Orthopedic Trauma, The First Hospital Affiliated to Air Force Medical University of PLA using the balanced matching concept (combination of elbow soft tissue balance and bone matching). There were 15 males and 5 females, with an age of (33.0±8.9) years. Six left sides and 14 right sides were affected. The elbow stiffness was severe in 13 cases and moderate in 7 cases. Six patients had mainly bony stiffness, 4 patients mainly soft stiffness, and 10 patients mixed stiffness. The elbow flexion and extension, Mayo elbow performance score (MEPS) and disabilities of the arm, shoulder, and hand (DASH) score were recorded and compared before release and at the last follow-up. The recurrence of ectopic ossification, infection, iatrogenic fracture and other complications of the elbow joint of the affected limb were recorded.Results:All the 20 patients were followed up for (16.6±3.5) months. At the last follow-up, the elbow flexion and extension (121.8°±8.9° and 14.8°±8.2°) were significantly greater than those before operation (73.5°±25.7° and 47.3°±19.2°), and the MEPS and DASH scores [ (90.0±5.6) points, (5.6±3.0) points] were significantly better than those before operation [(53.0±12.8) points, (62.1±14.0) points] ( P<0.05). Iatrogenic fracture of the ulna occurred in 1 patient, and pinky numbness occurred in 1 patient after surgery. None of the patients had recurrence of ectopic ossification or wound infection. Conclusion:In the surgical release of moderate and severe elbow stiffness after trauma, the concept of balanced matching plays a positive role by facilitating the functional restoration of the elbow and reducing the incidence of complications.

The medical records from 20 pregnant women with pregnancy preservation who underwent only cardiac surgery in our hospital from January 2012 to December 2022 were retrospectively analyzed. The patients were divided into 2 groups according to the fetal outcome: fetal survival group and fetal loss group. Eleven patients were included in fetal survival group and 9 patients in fetal loss group. The overall fetal mortality rate was 45%. In fetal loss group, 2 cases died during operation, and the other 7 cases died at 26 (29) days after operation. The valvular disease and infective endocarditis were the most common heart diseases diagnosed in fetal survival group, while type A aortic dissection in fetal loss group. There were 2 cases and 6 cases with pulmonary hypertension, 2 cases and 3 cases with a history of cardiac surgery, and 3 cases and 5 cases underwent emergency surgery in fetal survival group and in fetal loss group, respectively. Four pregnant women underwent deep hypothermic circulatory arrest in fetal loss group. One patient with type A aortic dissection died 15 days after cardiac surgery, with an overall maternal mortality rate of 5% in fetal loss group. The incidence of adverse events after maternal cardiac surgery was 25%, all of which occurred in fetal loss group. In conclusion, the adverse fetal outcomes may be related to type A aortic dissection, pulmonary hypertension, recardiac surgery, emergency surgery, deep hypothermic circulatory arrest, adverse events after cardiac surgery, and long-term related factors after surgery in pregnant women with pregnancy preservation undergoing cardiac surgery alone.