Objective To compare the clinical and functional differences between transoral and submandibular approach in mandibu-lar segmental resection and reconstruction with free fibula flaps(FFFs).Methods Patients who underwent mandibular segmental re-section and FFFs reconstruction in the Department of Oral and Maxillofacial Surgery of the Affiliated Stomatological Hospital of Nanjing Medical University from January 2015 to March 2023 were retrospectively analyzed.All cases were divided into transoral approach and submandibular approach groups.Clinical characteristics of the patients were recorded including age,gender,follow-up time,pathologi-cal diagnosis,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,James Brown classification of mandibular defect and number of fibular segments.The perioperative indexes,such as average operation time,average bleeding vol-ume,average blood transfusion volume,average drainage volume,average hospitalization time and postoperative complications such as malocclusion,fistula,infection,flap failure,and restriction of mouth opening were compared between the two groups.The University of Washington Quality of Life Questionnaire was used to investigate the appearance,function of swallow and speech more than 6-month postoperatively.Results The average intraoperative bleeding and postoperative drainage were significantly lower in the transoral ap-proach group than in the submandibular approach group(P=0.013 9,P=0.001 9).The appearance score was significantly higher in the transoral approach group than in the submandibular approach group(83.52±12.37)vs.(67.19±13.64)(P＜0.000 1).The differ-ences between the two groups in other variables were not statistically significant.Conclusion Cases of transoral approach had signifi-cantly better aesthetic outcomes compared with those of submandibular approach.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

To promote the standardization and normalization of perioperative care for follicular unit extraction(FUE) hair transplantation, ensure treatment efficacy, and align with advancements in the specialty, the Nursing Branch of the Chinese Association of Plastic and Aesthetics organized a panel of domestic experts. By integrating evidence-based medicine with clinical practice experience, and following thorough discussions, these experts developed the Clinical Practice Expert Consensus on Perioperative Nursing Care for Follicular Unit Extraction (2025). This consensus provides a comprehensive overview of hair transplantation, covering preoperative preparation, surgical procedures, intraoperative coordination, postoperative management, and complication prevention and treatment. It serves as a key reference and guide for implementing standardized perioperative nursing care in FUE hair transplantation.

Objective:This study aimed to explore the mediating effect of resourcefulness between frailty and self-manage-ment efficacy in patients with chronic heart failure(CHF).Methods:A survey was conducted on CHF patients who ad-mitted in Department of Cardiology,Central Hospital Affiliated to Shandong First Medical University between May 2022 and March 2024 using the general formation questionnaire,Tilburg weakness assessment scale,Resourcefulness Scale(RS)and Self-Efficacy for Managing Chronic Disease 6-item scale(SEMCD6).Results:Age,employment,marriage,ACC/AHA cardiac function classification,exercise frequency,and comorbid chronic diseases affected the level of frailty in pa-tients;Employed or not affected the patient's resourcefulness level(P＜0.05 or＜0.01).Multivariate linear regression and Spearman correlation analysis showed that frailty was direct negative predictive effect(β=-1.029,P=0.019)and in-versely correlated(r=-0.155,P=0.016)with self-management efficacy;resourcefulness was direct positive predictive effect(β=0.150,P＜0.001)and positively correlated(r=0.336,P＜0.001)with it.Resourcefulness played a partial mediating effect between frailty and self-management efficacy(21.93％).Conclusion:Resourcefulness level plays a par-tial mediating role between frailty and self-management efficacy in patients with chronic heart failure.Medical staff should pay attention to early screening and intervention of resourcefulness level.

Objective To compare the clinical and functional differences between transoral and submandibular approach in mandibu-lar segmental resection and reconstruction with free fibula flaps(FFFs).Methods Patients who underwent mandibular segmental re-section and FFFs reconstruction in the Department of Oral and Maxillofacial Surgery of the Affiliated Stomatological Hospital of Nanjing Medical University from January 2015 to March 2023 were retrospectively analyzed.All cases were divided into transoral approach and submandibular approach groups.Clinical characteristics of the patients were recorded including age,gender,follow-up time,pathologi-cal diagnosis,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,James Brown classification of mandibular defect and number of fibular segments.The perioperative indexes,such as average operation time,average bleeding vol-ume,average blood transfusion volume,average drainage volume,average hospitalization time and postoperative complications such as malocclusion,fistula,infection,flap failure,and restriction of mouth opening were compared between the two groups.The University of Washington Quality of Life Questionnaire was used to investigate the appearance,function of swallow and speech more than 6-month postoperatively.Results The average intraoperative bleeding and postoperative drainage were significantly lower in the transoral ap-proach group than in the submandibular approach group(P=0.013 9,P=0.001 9).The appearance score was significantly higher in the transoral approach group than in the submandibular approach group(83.52±12.37)vs.(67.19±13.64)(P＜0.000 1).The differ-ences between the two groups in other variables were not statistically significant.Conclusion Cases of transoral approach had signifi-cantly better aesthetic outcomes compared with those of submandibular approach.

Objective:This study aimed to explore the mediating effect of resourcefulness between frailty and self-manage-ment efficacy in patients with chronic heart failure(CHF).Methods:A survey was conducted on CHF patients who ad-mitted in Department of Cardiology,Central Hospital Affiliated to Shandong First Medical University between May 2022 and March 2024 using the general formation questionnaire,Tilburg weakness assessment scale,Resourcefulness Scale(RS)and Self-Efficacy for Managing Chronic Disease 6-item scale(SEMCD6).Results:Age,employment,marriage,ACC/AHA cardiac function classification,exercise frequency,and comorbid chronic diseases affected the level of frailty in pa-tients;Employed or not affected the patient's resourcefulness level(P＜0.05 or＜0.01).Multivariate linear regression and Spearman correlation analysis showed that frailty was direct negative predictive effect(β=-1.029,P=0.019)and in-versely correlated(r=-0.155,P=0.016)with self-management efficacy;resourcefulness was direct positive predictive effect(β=0.150,P＜0.001)and positively correlated(r=0.336,P＜0.001)with it.Resourcefulness played a partial mediating effect between frailty and self-management efficacy(21.93％).Conclusion:Resourcefulness level plays a par-tial mediating role between frailty and self-management efficacy in patients with chronic heart failure.Medical staff should pay attention to early screening and intervention of resourcefulness level.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Aim To investigate the molecular mecha-nisms of the Wenyang Huazhuo Tongluo formula in in-hibiting endothelial-to-mesenchymal transition(En-doMT)of pulmonary microvascular endothelial cells and improving pulmonary microvascular injury in sys-temic sclerosis(SSc).Methods Pulmonary micro-vascular endothelial cells were cultured with serum from SSc patients to establish SSc pulmonary microvas-cular endothelial cells.A hypoxia model was estab-lished in SSc pulmonary microvascular endothelial cells using liquid paraffin sealing,and the cells were treated with the Wenyang Huazhuo Tongluo formula or HIF-1a inhibitor KC7F2.Western blot was used to detect the protein expression levels of VE-cadherin,CD31,vimen-tin,HIF-1α,Foxm1,smad3,Tie-1,and vWF.ELISA was used to measure the concentrations of E-selectin and ICAM-1 in cell culture medium.The luciferase re-porter gene system was used to detect the promoter ac-tivity of the Foxm1 gene.Results Compared to the control group,the levels of VE-cadherin,CD31,HIF-1α,Foxm1,smad3,Tie-1,and vWF significantly de-creased under hypoxic condition,while the levels of vi-mentin,E-selectin,and ICAM-1 significantly in-creased.In addition,the cell morphology exhibited a distinct"spindle-like"myoblast morphology.Treat-ment with the Wenyang Huazhuo Tongluo formula or KC7F2 reversed these changes in protein expression levels and cell morphology induced by hypoxia.Con-clusion The Wenyang Huazhuo Tongluo formula im-proves pulmonary microvascular injury in SSc by inhib-iting the HIF-1a/Foxm1/smad3 pathway-mediated En-doMT of pulmonary microvascular endothelial cells.

Aim To investigate the effect of paeonol(PAE)on cardiac hypertrophy induced by Angio-tensinogen Ⅱ(Ang Ⅱ)in rats and its mechanism.Methods Forty Sprague-Dawley rats were divided in-to five groups:control group,Ang Ⅱ model group,low concentration paeonol group,middle concentration pae-onol group,high concentration paeonol group.PAE was administered intragastrically(25,50 and 100 mg·kg-1·d-1)for 28 days.The hypertrophic model was established by adding 1 μmol·L-1 Ang Ⅱ to H9c2 cells for 48 hours.Results In Ang Ⅱ-induced rats,PAE improved echocardiography parameters,the cardi-ac hypertrophy index,the mRNA and protein expres-sion levels of ANP and BNP were decreased,and the cardiac fibrosis was alleviated.In vitro,PAE reduced cardiomyocyte hypertrophy and decreased the mRNA and protein expression levels of ANP and BNP in H9c2 cells induced by Ang Ⅱ,at the same time,the expres-sion of endoplasmic reticulum stress marker proteins p-PERK,GRP78,ATF4 and CHOP were decreased and reversed after treatment with the endoplasmic reticulum stress agonist tunicamycin(TN).Conclusion This study suggests that PAE can improve cardiac hypertro-phy by inhibiting endoplasmic reticulum stress,which may be a new drug to delay the development of cardiac hypertrophy.