Objective:To investigate the effectivensess of intraoperative S-ketamine infusion in alleviating postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures.Methods:A prospective randomized controlled study was conducted to analyze the clinical data of 84 patients with traumatic long bone fracture admitted to General Hospital of Southern Theatre Command of PLA from October 2022 to April 2023. The patients undergone selective open reduction and internal fixation were divided into S-ketamine group and saline group according to the random number table. Pittsburgh sleep quality index (PSQI) scores and hospital anxiety and depression scale (HADS) scores were compared between the two groups before surgery, at 24, 48, and 72 hours after surgery. Visual analogue scale (VAS) scores were compared between the two groups before, at 3, 6, 12, 24, 48, and 72 hours after surgery. The number of times the patients pressed the pump of patient-controlled intravenous analgesia postoperatively and adverse reactions such as nausea, vomiting, hallucinations or nightmares were recorded.Results:A total of 60 male and 24 female patients with traumatic long bone fracture were included, aged 18-65 years [36.5(25.5, 54.8)years]. The S-ketamine group ( n=42) received intravenous infusion of S-ketamine at a rate of 0.5 mg·kg -1·h -1 until the end of surgery, while the saline group ( n=42) received intravenous infusion of saline of the same volume until the end of surgery. All the patients were followed up for 4-9 days [6.0(5.0, 7.0)days]. No significant differences in PSQI scores were found between the two groups before surgery ( P>0.05), while PSQI scores at 24, 48, and 72 hours after surgery were 7.5(7.0, 9.0)points, 4.0(3.0, 5.3)points, and 1.0(1.0, 2.0)points respectively in the S-ketamine group, significantly lower than those in the saline group [10.0(8.0, 12.0)points, 7.0(5.0, 8.0)points, and 2.0 (1.0, 3.0)points] ( P<0.05 or 0.01). There were no significant differences in HADS scores between the two groups before surgery and at 48 and 72 hours after surgery ( P>0.05), while HADS score at 24 hours after surgery in the S-ketamine group was 2.0(0.0, 3.0)points, significantly lower than that in the saline group [3.0(2.0, 5.0)points] ( P<0.01). There were no significant differences in VAS scores between the two groups before, at 6, 12, and 72 hours after surgery ( P>0.05), while the VAS scores at 3, 24, and 48 hours after surgery in the S-ketamine group were 3.0(2.0, 4.0)points, 2.3(2.0, 3.0)points, and 2.0(1.0, 3.0)points respectively, significantly lower than those in the saline group [4.0(2.8, 5.0)points, 3.0(2.5, 4.0)points, and 3.0(2.0, 3.7)points] ( P<0.05). There were no significant differences in the number of times the patients pressed the pump of patient-controlled intravenous analgesia postoperatively and the incidence of nausea and vomiting between the two groups ( P>0.05). In the S-ketamine group, transient hallucination upon awakening was found in 2 patients and intraoperative nightmare in 1, who showed no abnormalities after returning to the ward. Conclusion:Intraoperative S-ketamine infusion can significantly alleviate postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures, with simultaneous alleviation of anxiety, depression as well as pain.

Objective To develop plantar force model of patellofemoral pain (PFP), so as to provide theoretical references for the assessment of PFP rehabilitation. Methods The case-control study was conducted, and a total of 126 patients with PFP and 126 healthy controls matched by gender and age were enrolled in the study. The participants were tested for plantar force and pressure during level walking, and twelve plantar regions were divided and recorded. Whether the participants suffered PFP was analyzed as dependent variable, meanwhile the peak force and peak pressure in 12 plantar regions of participants at selected speed during level walking were analyzed as independent variables. Conditional logistic regression (CLR) equations of peak force and peak pressure with PFP were established, respectively. The receiver-operating characteristic (ROC) curve of the corresponding equations was derived, and the area under ROC curve was calculated to analyzed the validity of different equations on PFP assessment. Results The CLC equation of peak force in 12 plantar regions of the participants with FFP was constructed, and only peak force of lateral heel was in the equation. The CLC equation of peak pressure in each plantar region included medial heel, midfoot, 1st and 2nd metatarsals. Meanwhile, the area under ROC curve of the pressure equation was larger than that of the force equation. Conclusions Peak force and pressure at different plantar regions can be used to assess PFP during level walking, and peak pressure is more effective for assessment.

Objective:To investigate the influence of pre-pregnancy body mass index (BMI), gestational weight gain and early feeding behavior on delayed onset of lactogenesis stage Ⅱ(DOL Ⅱ).Methods:This was a prospective study involving puerperae from Women's Hospital of Nanjing Medical University from March 2020 to June 2020. Demographic data and delivery data were obtained using questionnaires and breastfeeding behavior and milk secretion were followed up every day after delivery. According to whether the lactation initiation was longer than 72 h or not, all subjects were divided into DOL Ⅱ group or non-DOL Ⅱ group. Differences in general condition and breastfeeding between the two groups were compared using independent sample t-test, Chi-square test, and Mann-Whitney U test. Multivariate logistic regression analysis was used to analyze the risk factors of DOL Ⅱ. Results:During the study period, a total of 390 cases were enrolled and 334 cases among them were analyzed due to lost of follow-up in 56 cases. The incidence of DOL Ⅱ was 19.2% (64/334). Univariate analysis showed that body mass index [lean:18.8% (12/64) vs 13.3% (36/270); fit:56.2% (36/64) vs 74.8% (202/270); overweight: 25.0% (16/64) vs 11.9% (32/270); χ2=9.78], mode of delivery [vaginal delivery: 37.5% (24/64) vs 52.6% (142/270); cesarean section: 62.5% (40/64) vs 47.4% (128/270); χ2=4.71], nipple type score in LATCH score [2.0 (1.0-2.0) vs 2.0 (2.0-2.0), U=－2.08], frequency of breastfeeding in 24 h [(6.3±3.0) vs (8.3±3.6) times per day, t=－3.94], adding formula within 24 h [71.9% (46/64) vs 56.3% (152/270), χ2=5.20] and the proportion of attending breastfeeding clinic during pregnancy [73.4% (47/64) vs 85.6% (231/270), χ2=5.44] were significantly different between the DOL Ⅱ and non-DOL Ⅱ groups (all P<0.05). Multivariate logistic regression analysis showed that pre-pregnancy overweight was an independent risk factor for DOL Ⅱ ( OR=2.240, 95% CI:1.020-4.918, P=0.044), either was pre-pregnancy overweight with appropriate gestational weight gain ( OR=5.595, 95% CI:1.492-20.985, P=0.011), while breastfeeding frequency within 24 h ( OR=0.867, 95% CI: 0.780-0.963, P=0.008) and attending breastfeeding clinic during pregnancy ( OR=0.377, 95% CI: 0.173-0.820, P=0.014) were independent protective factors for DOL Ⅱ. Conclusions:Women who were overweight before pregnancy are more likely to suffer from DOL Ⅱ. Extra guidance should be given to this population during early breastfeeding. Attending prenatal breastfeeding consultation and increasing the frequency of breastfeeding in the early postpartum period may prevent DOL.

Objective:To explore the effect of transcatheter chemoembolization (TACE) on recurrence and survival time of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) following curative resection.Methods:Of 724 HBV-related HCC patients who underwent curative resection in the Third Affiliated Hospital of Naval Military Medical University from October 2009 to August 2010 were retrospectively analyzed. Patients who underwent resection only and no recurrence within 3 months after surgery were classified into control group, while those received adjuvant TACE were classified into intervention group. The patients were further divided into 4 sub-groups according to tumor size, tumor number and tumor thrombus which were defined as risk factors for recurrence. Tumor diameter ≤5 cm with low or high risk factors (tumor number ≥2 or presence tumor thrombus) were in group 1 and group 2 respectively, tumor diameter >5 cm with low or high risk factors for recurrence were in group 3 and group 4 respectively.Results:A total of 354 patients were classified in the control group and 370 patients were classified in the TACE group. Adjuvant TACE showed an overall survival benefit in patients with tumor diameter >5 cm and presenting high risk factors, the 1-, 3-, and 5-year cumulative survival rates were 90.1%, 67.6%, and 46.5%, respectively, for the lip-TACE group 83.3%, 52.4%, and 33.3%, respectively, for the control group ( P<0.05). Patients with the tumor diameter ≤5 cm, there was no significant difference in cumulative survival between the TACE group and the control group regardless of the risk level ( P>0.05). There was no significant difference in recurrence curve between TACE group and control group in each stratum. Conclusions:Adjuvant TACE had no preventive effect on recurrence, but TACE can prolong the survival time of HCC patients with high risk factors for recurrence.

Objective:To understand the current situation of nursing practice environment and clinical innovation ability of pediatric nurses and to explore the effect of nursing practice environment on clinical innovation ability of clinical pediatric nurses.Methods:A cross-sectional survey method was adopted to select 478 pediatric nurses from the Children's Hospital of Nanjing Medical University as the research objects from May to June 2019 by the convenient sampling method. The general data questionnaire, profession practice environment-nursing work index (PES-NWI) and innovation ability of clinical pediatric nurse scale were used to analyze the effect of nursing practice environment on clinical innovation ability of clinical pediatric nurses.Results:The total score of PES-NWI of pediatric nurses was (90.73±13.02) , and the total score of innovation ability of clinical pediatric nurse scale was (120.79±10.84) . There was a positive correlation between the nursing practice environment and the innovation ability score of pediatric nurses ( P<0.05) . The results of stratified regression analysis showed that nurses' participation in hospital affairs and provision of high-quality nursing services in the nursing practice environment of pediatric nurses had a predictive effect on the innovation ability of pediatric nurses ( P<0.05) . Conclusions:The innovation ability of pediatric nurses is at a medium level, and the nursing practice environment has a predictive effect on innovation ability. Nursing managers should pay attention to the improvement of nursing practice environment and take effective measures to improve their innovative ability.

Objective To explore the effect of supplemental parenteral nutrition (SPN) combined with early enteral nutrition (EN) for enhanced recovery in postoperative liver cancer patients.Methods From June 2015 to June 2018,liver cancer patients admitted to our hospital were randomly divided into two groups with 47 patients receiving SPN combined with early EN in the study group and 45 patients receiving early EN in the control group.Results There were no significant difference in bilirubin recovery,liver enzyme recovery,postoperative exhaust and defecation time and complication rate between the two groups (P ＞ 0.05).In study group prealbumin (PAB) synthesis recovered faster (F =7.89,P =0.006),albumin use was significantly lower (t =-2.29,P =0.0024),and postoperative hospital stay was shorter (t =2.46,P =0.016).Conclusion In ERAS patients with liver cancer,the combination of SPN and early EN provide reasonable energy support to improve nutritional status and accelerate patient recovery.

OBJECTIVE： To observe the effects of dihydroquercetin （DHQ） on hemorheology and other relevant related indexes in local cerebral ischemic injury model rats. METHODS： SD rats were randomly divided into sham operation group， model group， nimodipine group （positive control， 20 mg/kg） and DHQ low-dose， medium-dose and high-dose groups （15， 30， 60 mg/kg）， with 10 rats in each group. Administration groups were given relevant medicine intragastrically， sham operation group and model group were given constant volume of 0.4％ Sodium carboxymethyl cellulose solution， once a day， for consecutive 14 d. After last administration， local cerebral ischemic injury model was induced by bilateral common carotid artery ligation in other groups except for sham operation group. After 24 h of cerebral ischemia， histopathological changes of brain tissue in rats of each group were observed； the levels of hemorheology indexes [whole blood viscosity （low， medium and high shear）， whole blood reduced viscosity （low， medium and high shear）， plasma viscosity]， erythrocyte parameters （hematocrit， EAI， DI， IR）， coagulation function indexes （APTT， PT， TT， FIB） were detected. RESULTS： Compared with sham operation group， the cells in the brain tissue of model group were loose， the gap was obvious， and the neurons around the ischemic area were damaged obviously； the levels of whole blood viscosity， whole blood reduced viscosity， plasma viscosity， hematocrit， EAI， IR and FIB were increased significantly， while the levels of DI， APTT， PT and TT were decreased or shortened significantly （P＜0.05 or P＜0.01）. Compared with model group， above symptoms of administration groups were improved to different extents， whole blood viscosity， plasma viscosity， EAI and IR of nimodipine group， whole blood viscosity and hematocrit of DHQ high-dose group， plasma viscosity and EAI of DHQ groups， and IR of DHQ medium-dose and high-dose groups were decreased significantly； DI， APTT， PT and TT of nimodipine group， DI， APTT and TT of DHQ groups and PT of DHQ high-dose group were increased or prolonged significantly （P＜0.05 or P＜0.01）. There was no statistical significance in other indexes among those groups （P＞0.05）. CONCLUSIONS： DHQ can protect against local cerebral ischemic injury model rats， the mechanism of which may be associated with improving hemorheology indexes and coagulation function disorder.

Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.

Objective To explore the effect of workshop on postoperative function of affected limb in patients with breast cancer. Meth-ods From August, 2015 to June, 2016, 70 patients with breast cancer after modified radical mastectomy were randomly divided into control group (n=35) and observation group (n=35). The control group was instructed by the primary nurse bedside based on the traditional method, while the observation group was guided with workshop mode. Results Ten days and one month after surgery, the range of motion of the shoulder joint in the observation group was superior to the control group (t>2.030, P<0.01);the incidence of lymphedema of the affected limb in the observation group was lower than that in the control group (u=2.195, P<0.05). Conclusion Functional exercise guided with work-shop mode could improve postoperative function of affected limb in patients with breast cancer.

Objective To evaluate the postoperative imaging features of lung ultrasound on patients undergoing lung transplantation ,and to provide the evidence for diagnosis and therapy . Methods Between October 2016 and March 2017 ,51 patients undergoing lung transplantation ( unilateral:37 ,bilateral:14 ) admitted to the ICU in Wuxi People′s Hospital were examined by bedside lung ultrasound ,and imaging features were analyzed . Results The main features on ultrasound of 51 patients undergoing lung transplantation were:①Pneumothorax :The A-line arising at the pleural line was shown in all of 51 patients , mainly on anterolateral parts of the chest wall initially ,then fade away towards anterosuperior parts over time . ② Hydrothorax :An anechoic fluid collection was detected ( up to 50 mm in width ) ,and became narrow over time in most patients . A mass of floccules or progressive growth of pleural effusion indicated the need for emergency surgery ,and were confirmed bleeding after surgery . ③Subcutaneous emphysema:The E-line was detected mainly in anterior and lateral parts around the surgical incision of postoperative patients ,and gradually fade away over time . ④Pulmonary edema:On the first postoperative day ,multiple B-lines were shown in 49 cases ,lung consolidation in 36 cases ( mainly in the inferior and inferoposterior parts) ,lung consolidation sonographic air bronchogram in 12 cases . Then the area of consolidation and B-lines reduced ,the air bronchogram sign became more prevalent ,and the shred sign appeared on the border of consolidation over time . Conclusions The imaging features of lung ultrasound provides clinic diagnostic and therapeutic value for postoperative patients undergoing lung transplantation .