Objective:To evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) for refractory glaucoma.Methods:A prospective multicenter observational case series study was conducted.A total of 63 refractory glaucoma patients (67 eyes) who underwent MP-TSCPC treatment were enrolled at Zhongshan Ophthalmic Center, Sun Yat-sen University, Chengdu First People's Hospital (Chengdu Integrated TCM& Western Medicine Hospital), and Changsha Aier Eye Hospital from August 2022 to April 2023.Among these cases, there were 40 eyes (59.7%) with unreduced intraocular pressure (IOP) after glaucoma surgery, 4 eyes (6.0%) with secondary glaucoma after vitrectomy, 2 eyes (3.0%) with secondary glaucoma after keratoplasty, 8 eyes (11.9%) with neovascular glaucoma, 3 eyes (4.5%) with secondary glaucoma due to iridocorneal endothelial syndrome, 6 eyes (9.0%) with primary open-angle glaucoma and 4 eyes (6.0%) with primary angle-closure glaucoma.Best corrected visual acuity (BCVA) was measured using the ETDRS chart and the IOP was measured using the Goldmann applanation tonometry before and 6 months after the surgery.The usage of anti-glaucoma medications before and after surgery and postoperative complications were recorded.Surgical success rate was calculated and surgical success was defined as an IOP reduction of more than 20% from baseline or a reduction in the number of ocular hypotensive medications with no change in IOP.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2022KYPJ225).Written informed consent was obtained from each subject.Results:There was a statistically significant overall difference in IOP at different time points before and after surgery ( F=60.10, P<0.001), and the IOP at different time points after surgery was significantly lower than that before surgery, with statistically significant differences (all at P<0.001).IOP reduction at 6 months after surgery was (43.7±20.7)%.The number of anti-glaucoma medications used postoperatively was 2(0, 3) types, which was significantly less than the 3(2, 3) types used preoperatively ( Z=-2.70, P=0.007).The 6-month postoperative BCVA (LogMAR) was 1.40(0.52, 2.70), which showed no significant change compared to the preoperative 1.40(0.70, 2.70) ( Z=-0.10, P=0.952).The surgical success rate was 83.6%(56/67) at 6 months postoperatively.Postoperative complications included mydriasis (11/67), conjunctival hemorrhage (11/67), mild anterior chamber inflammation (1/67), mild ciliary body detachment (3/67), local choroidal detachment (1/67), and cystoid macular edema (1/67), all of which were reversible after treatment. Conclusions:MP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.

Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective:To explore the effect of evidence-based nursing best practice in postoperative pain management of neurosurgery patients.Methods:From January to June 2019, a cluster sampling method was used to select 146 neurosurgery patients from Huashan Hospital, Fudan University as the control group. We examined the patient's postoperative pain management status, and applied evidence-based nursing methods to obtain best practice evidence. From July to December 2019, the clinical evidence practice application model of the Australia Joanna Briggs Institute (JBI) Evidence-Based Health Care Center was used to apply evidence to postoperative pain management in neurosurgery patients. From January to June 2020, a cluster sampling method was used to select 146 neurosurgery patients as the observation group for re-examination after the application of evidence. The Modified American Pain Society Patient Outcome Questionnaire (APS-POQ-Modified) was used to investigate the postoperative pain perception beliefs and postoperative pain degree of the two groups of patients. The qualification rate of 146 pain nursing records before and after the application of the evidence was checked and the differences were compared.Results:The scores of 7 items regarding pain perception beliefs in control group were (3.45±1.42) , (3.21±1.21) , (3.58±1.53) , (3.37±1.26) , (3.63±1.34) , (3.55±1.06) , (3.45±1.35) , and those of observation group were (2.44±1.31) , (2.35±1.21) , (2.34±1.35) , (3.06±1.17) , (2.57±1.25) , (3.05±1.02) , (3.12±1.42) , the differences between the two groups were statistically significant ( t=6.346, 6.057, 7.350, 2.166, 6.994, 4.108, 2.027; P<0.05) . In control group, the current pain degree score was (2.34±0.89) , the most severe pain degree score within 24 hours after operation was (4.44±1.17) , and the average pain degree score within 24 hours after operation was (3.21±0.75) , and the scores in observation group were (1.98±0.96) , (3.54±1.10) , (2.46±0.70) , and the differences were statistically significant ( t=3.355, 6.731, 8.808; P<0.01) . The qualification rate of pain nursing record sheet before and after the application of the evidence was 67.12% (98/146) and 82.88% (121/146) respectively, the difference was statistically significant (χ 2=9.662, P=0.002) . Conclusions:The evidence-based nursing best practice can improve neurosurgery patients' pain perception beliefs, reduce the degree of postoperative pain of patients, and increase the qualification rate of nurses' pain nursing records.

Objective To explore the best position of oxygen inhalation for premature infants so as to reduce the time of oxygen inhalation .Methods Fifty premature infants who needed oxygen inhalation in the warm box were divided into the prone position group (singular) and the supine position group (dual) according to the order of sequence .The transcutaneous oxygen/carbon dioxide pressure ( TcPaO2/TcPaCO2 ) and HR were monitored by transcutaneous oxygen/carbon dioxide partial pressure monitoring equipment and electrocardiogram monitor before and one hour after oxygen inhalation , and the transcutaneous oxygen saturation ( TcSpO2 ) were monitored before the oxygen inhalation , and the time of TcSpO 2 stabilized at 88%-93% were monitored one hour after oxygen inhalation.The changes of TcPaO2, TcPaCO2, the index of oxygenation index (PaO2/FiO2), HR and the time of TcSpO 2 stabilized at 88%-93%were compared in two groups .Results No difference was found in the TcSpO2, TcPaO2, TcPaCO2, HR in two groups before the oxygen inhalation (P>0.05).The time of TcSpO2 stabilized at 88%-93%, TcPaO2, TcPaCO2, HR and PaO2/FiO2 were (92.3 ±3.2)min, (65.2 ± 11.6)mmHg, (36.7 ±4.2)mmHg, (120 ±9)beats/min, (179.3 ±10.4) one hour after oxygen inhalation in the prone position group, and were respectively (97.3 ±5.5) min, (55.5 ±9.7) mmHg, (33.1 ±3.5) mmHg, (132 ±10) beats/min, ( 170.5 ±9.5 ) in the supine position group , and the differences were statistically significant (t=3.77, 3.01, 3.88, 4.40, 3.18, respectively;P<0.01).Conclusions Prone position of oxygen inhalation can significantly improve the oxygenation state of premature infants so as to stop oxygen inhalation as soon as early .

Objective To study the characters of using the high pressure injector in the contrast CT scanning for children. Methods Summarized the nursing measures of 407 children who had accepted the contrast CT scanning. Results There were 369 children have obtained perfect effects of CT scanning, 35 children have obtained general effects and there were 2 children failure. Conclusion The method of using high pressure injector in the contrast CT scanning for children is convenient, safety and effective.