Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective To review and analyze the clinical and pathological data of children with autoimmune hepatitis (AIH).Methods Medical records of 46 patients hospitalized in Pediatric Liver Diseases Treatment and Research Center,Fifth Medical Center,General Hospital of People's Liberation Army(PLA) from April 2012 to April 2018 were extracted.Medical data included type of AIH,clinical manifestations,biochemical parameters,liver biopsy results,and outcomes of treatment were analyzed retrospectively.Among 46 children,19 were males and 27 were females.The age of onset was 10.1 (1.4-18.0) years old.Chi-Square test,Rank sum test or t test were used for inter-group comparison.Results There were 32 (70％)AIH-Ⅰ cases and 14 (30％)AIH-Ⅱ cases (x2=12.565,P=0.000).Among the 46 patients,there were 5 modes of onest:17 cases (37％) had acute viral hepatitis-like presentation,2 cases (4％)had fulminant hepatic failure,9 cases (20％) had insidious onset,5 cases (11％) showed cirrhosis and portal hypertension,and 13 cases (28％) were incidentally found to be due to elevated hepatic aminotransferases.Comorbidities including primary sclerotic cholangitis (n=3),primary biliary cholangitis (n=1),systemic lupus erythematosus (n=1) and inflammatory bowel disease (n=2),were all seen in AIH-Ⅰ cases.The elevated biochemical parameters of these patients were as follows:alanine aminotransferase (n=46),aspartate transminase (n=46),total bilirubin (n=35) γ-glutamyl transpeptadase (n=39),γ-globulin (n=32) and IgG (n=33).The γ-globulin and IgG levels were significantly higher in AIH-Ⅰ patients than those with AIH-Ⅱ ((32±9)％ vs.(23±8)％,t=3.217,P=0.002,(27± 10) vs.(18±8)g/L,t=3.193,P=0.003,respectively).Thirty-nine patients received liver biopsy,among whom 22 (56％) with inflammation grade (G)≥3,26(67％) with fibrosis stage (S) ≥3,and 7 with hepatic cirrhosis (S4) according to pathological analysis.Typical histopathological changes of AIH included:36 cases of interfacial hepatitis (92％),23 cases of lymphocyte/plasma cell infiltration (59％),3 cases of rosette (8％).Forty patients received prednisolone monotherapy or combined with azathioprine after diagnosis.Complete remission was seen in 29 (72％) patients,partial remission in 10 (25％) patients and no response in 1 (3％) patient.Among complete remission patients,15 (52％) had relapse in the process of prednisolone reduction.Repeated liver biopsy performed in 8 patients after treatment showed that hepatic inflammation and fibrosis were both improved in 6 patients,only inflammation was alleviated without fibrosis improvement in 1 patient,and neither inflammation nor fibrosis was improved in 1 case.The length of follow-up was 3.3 (0.3-10.5) years,and none of the 39 prednisolone-responded cases discontinued treatment successfully.Adverse effect of long-term prednisolone therapy included bilateral cataract (n=6),spinal fracture accompanied with delayed bone age development (n=1).Conclusions AIH-Ⅰ is more common than AIH-Ⅱ in children,with diverse clinical characteristics.Most cases have progressive liver inflammation and fibrosis when diagnosed.Prednisolone monotherapy or combined with azathioprine could achieve both biochemical and pathological improvement,but relapse is inevitable during drug tapering,hence long-term treatment is essential.

Objective To investigate the effect of 9-cis retinoid acid(c-RA),a retinoid X receptor(RXR)agonist,on hydrogen peroxide(H2O2)induced apoptosis in cultured rat neonatal cardiomyoeytes,and to explore the mechanism.Method Cultured cardiomyocpes were randomly divided into three groups:normal group treated with vehicle(N group),H2O2 group treated with 100 μmol/L H2O2(H group),and c-RA group pretreated with 100nmol/L c-RA(H+R group).Cell viability was detected by MTT.Morphological changes of apoptotic cardiomyocytes were observed by Hoechst 33258 staining under fluorescence microscope.The apoptotic rate was determined by flow cytometry.Mitochondrial membrane potential(△(ψ)m)was measured by JC-1 dye.Cellular reactive oxygen species(ROS)production was detected by CM-H2DCFDA fluorescent probe.All measurement data wIe expressed as(x±s),and statistically analyzed using one-way ANOVA analysis and Dunnett test.Differences were considered significant when P was＜0.05.Results Treatment with c-RA significantly enhanced cell viability,reduced apoptosis ratio,stabled mitoehondrial membrane potential and reduced level of cellular reactive oxygen species.Conclusions RXR agonist c-RA inhibits H2O2-induced myocyte apoptosis in cultured rat neonatal cardiomyocytes,which may be related to alleviate oxidative stress injury.