Objective:To analyze the effect of laparoscopic primary suture in patients with choledocholithiasis of different common duct diameters.Methods:The clinical data of 99 patients with choledocholithiasis who received laparoscopic cholecystectomy (LC)+ laparoscopic common bile duct exploration (LCBDE) primary suture in the Zhangjiakou First Hospital from April 2020 to January 2022 were retrospectively analyzed, and according to different choledocholithiasis diameters they were divided into group A ( n=40, common bile duct diameter >8 mm), group B ( n=34, common bile duct diameter >6-8 mm), group C ( n=25, common bile duct diameter >4-6 mm). All patients were treated with intravenous anesthesia combined with LC+ LCBDE suture. General data, surgical indexes, liver function, stress response, immune function and postoperative complications were compared among the three groups. Results:There were no significant differences in gender, number of cases with acute mild cholangitis, age, body mass index and number of common bile duct stones among 3 groups (all P>0.05).There were no significant differences in operation success rate, operation time, conversion rate and intraoperative blood loss among the 3 groups (all P>0.05). 24 hours after surgery, serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST) [(58.46±7.12)U/L, (32.87±4.32)μmol/L, (67.59±8.60)U/L] in the group A were higher than those in the group B [(49.02±6.58)U/L, (26.54±3.40)μmol/L, (48.01±6.52)U/L], in the group C [(37.85±4.60)U/L, (21.06±2.17)μmol/L, (36.38±4.56)U/L] (all P<0.05). The levels of ALT, TBIL and AST in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) in the group A [(19.24±4.76)ng/ml, (148.04±14.30)ng/ml] were higher than those in the group B [(16.91±3.72)ng/ml, (131.24±11.65)ng/ml] and in the group C [(14.60± 2.83)ng/ml, (119.87±8.06)ng/ml] (all P<0.05). Serum ACTH and Cor levels in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, Serum immunoglobulin M (IgM) and immunoglobulin A (IgA) [(0.65±0.10)ng/ml, (1.07±0.25)ng/ml] in the group A were lower than those in the group B [(0.85±0.19)ng/ml, (1.35±0.29)ng/ml] and in the group C [(0.92±0.24)ng/ml, (1.60±0.34)ng/ml] (all P<0.05). Serum IgM and IgA levels in the group B were lower than those in the group C (all P<0.05). There were no significant differences in biliary leakage rate, incision infection rate, choledocholithiasis recurrence rate, peritoneal infection rate, pulmonary infection rate and postoperative bile duct stenosis rate among 3 groups (all P>0.05). Conclusions:Patients with choledocholithiasis with different common duct diameters can be treated with LC+ LCBDE one-stage suture with significant effect, which will not affect postoperative complications. However, the larger the diameter, the more the recovery of liver function will be affected, the stress reaction will be aggravated, and the immune function will be reduced.

Objective:To analyze the effect of laparoscopic primary suture in patients with choledocholithiasis of different common duct diameters.Methods:The clinical data of 99 patients with choledocholithiasis who received laparoscopic cholecystectomy (LC)+ laparoscopic common bile duct exploration (LCBDE) primary suture in the Zhangjiakou First Hospital from April 2020 to January 2022 were retrospectively analyzed, and according to different choledocholithiasis diameters they were divided into group A ( n=40, common bile duct diameter >8 mm), group B ( n=34, common bile duct diameter >6-8 mm), group C ( n=25, common bile duct diameter >4-6 mm). All patients were treated with intravenous anesthesia combined with LC+ LCBDE suture. General data, surgical indexes, liver function, stress response, immune function and postoperative complications were compared among the three groups. Results:There were no significant differences in gender, number of cases with acute mild cholangitis, age, body mass index and number of common bile duct stones among 3 groups (all P>0.05).There were no significant differences in operation success rate, operation time, conversion rate and intraoperative blood loss among the 3 groups (all P>0.05). 24 hours after surgery, serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST) [(58.46±7.12)U/L, (32.87±4.32)μmol/L, (67.59±8.60)U/L] in the group A were higher than those in the group B [(49.02±6.58)U/L, (26.54±3.40)μmol/L, (48.01±6.52)U/L], in the group C [(37.85±4.60)U/L, (21.06±2.17)μmol/L, (36.38±4.56)U/L] (all P<0.05). The levels of ALT, TBIL and AST in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) in the group A [(19.24±4.76)ng/ml, (148.04±14.30)ng/ml] were higher than those in the group B [(16.91±3.72)ng/ml, (131.24±11.65)ng/ml] and in the group C [(14.60± 2.83)ng/ml, (119.87±8.06)ng/ml] (all P<0.05). Serum ACTH and Cor levels in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, Serum immunoglobulin M (IgM) and immunoglobulin A (IgA) [(0.65±0.10)ng/ml, (1.07±0.25)ng/ml] in the group A were lower than those in the group B [(0.85±0.19)ng/ml, (1.35±0.29)ng/ml] and in the group C [(0.92±0.24)ng/ml, (1.60±0.34)ng/ml] (all P<0.05). Serum IgM and IgA levels in the group B were lower than those in the group C (all P<0.05). There were no significant differences in biliary leakage rate, incision infection rate, choledocholithiasis recurrence rate, peritoneal infection rate, pulmonary infection rate and postoperative bile duct stenosis rate among 3 groups (all P>0.05). Conclusions:Patients with choledocholithiasis with different common duct diameters can be treated with LC+ LCBDE one-stage suture with significant effect, which will not affect postoperative complications. However, the larger the diameter, the more the recovery of liver function will be affected, the stress reaction will be aggravated, and the immune function will be reduced.

Objective:To analyze the influence of epidural labor analgesia on neonatal breast-seeking behavior and first breastfeeding.Methods:This study was an observational study. According to the cross-sectional study formula and inclusion and exclusion criteria, 150 cases of puerperas and their full-term infants who underwent vaginal delivery in the Affiliated Hospital of Southwest Medical University from March to September 2020 were included as the research objects, and the time of breast searching behavior in newborn crawling was observed and recorded. According to whether epidural analgesia was used or not, the patients were divided into analgesic group and non-analgesic group (the specific names of the two groups), and the outcome variables were analyzed.Results:There were 81 cases of successful breast crawl, 69 cases of failure, including 94 cases of epidural analgesia, 56 cases of non-epidural analgesia. Epidural analgesia had no effect on breast crawl and the time of breast searching behavior ( P>0.05). For puerperas with epidural analgesia, the total score of Breastfeeding Assessment Tool (IBFAT) and the scores of its four dimensions such as feeding time, foraging, sucking and nipple holding behavior were 9(7, 10), 3(2, 3), 2(2, 3), 2(1, 2), 2(1, 2), which lower than those non-epidural analgesia puerperas, which were 10(8, 10), 3(3, 3), 3(2, 3), 2(2, 2), 2(1, 2), the differences were statistically significant ( Z values were -6.36- -4.32, all P<0.05). Conclusions:When epidural analgesia is used clinically, medical staff need to seize the best time of drug use, pay attention to continuous monitoring of drug use duration and dosage, while exerting drug analgesia effect, it is also necessary to minimize adverse outcomes and reduce the impact of analgesics on breastfeeding.

Bone infection is an osteal disorder with bone damage resulting from infection of bone marrow，cortex，periosteum and surrounding tissues，characterized by a high incidence and severe symptoms. The treatment is often complicated and prolonged. Regardless of the method used，the goal is to reduce bone defect caused by infection，control infection，rebuild impaired tissues，and promote bone healing，so as to restore bone homeostasis. Starting from bone homeostasis，the authors review the research progress in the commonly used drugs and molecular mechanisms that affect bone formation-related pathways caused by bone infection，activate bone resorption-related mechanisms，and regulate bone homeostasis，in order to provide a theoretical basis for reducing bone defect caused by bone infection and promoting bone healing.

Objective:To understand and analyze the current situation of core competence of graduate midwives in standardized training in Sichuan Province, so as to provide a reference for the training of midwives in Sichuan Province.Methods:A total of 102 midwives who participated in standardized training and graduated from July 2016 to June 2018 in Sichuan Province were investigated by using general information questionnaire (including 14 items of general information, occupational literacy and hospital conditions) and Midwives Core Competence Scale (including 54 items and 6 dimensions). Among 109 questionnaires distributed, 102 valid questionnaires were collected. SPSS 21.0 was used to analyze the results by single factor analysis and multiple linear regression analysis.Results:The average total score of the core competency scale in this study was (203.470±32.398). The scores of postpartum health care and prenatal health care were relatively high, while the score of public health care was relatively low. Multivariate regression analysis showed that whether the maternal and infant health certificates were obtained during the training period, and whether there was a training system for midwives alone and arrangements of department rotation were the influencing factors of the core competence of the graduate midwives ( P<0.05). Conclusion:The core competence of midwives in standardized training in Sichuan province is at the middle level. The standardized training of midwives is at the initial stage and lack of systematic management. Hence, it is urgent to build a unified and standardized training system.

Objective To explore the correlation between the occurrence of pulmonary infection after thoracotomy and preoperative pulmonary function indexes in patients with esophageal cancer,and to provide clinical theoretical basis for reducing the incidence of pulmonary infection after thoracotomy.Methods The clinical data of 80 patients with esophageal cancer who underwent thoracotomy from May 2017 to May 2018 in Qinhuangdao Military Industrial Hospital of Hebei Province were retrospectively analyzed.The patients were divided into infected group and uninfected group according to whether pulmonary infection occurred after operation.The preoperative maximal voluntary ventilation (MVV),MVV as a percentage of predicted value (MVV％pred),forced vital capacity (FVC),FVC as a percentage of predicted value (FVC％ pred),forced expiratory volume in one second (FEV1),FEV1 as a percentage of predicted value (FEV1％ pred),peak expiratory flow (PEF),PEF as a percentage of predicted value (PEF％ pred) of the two groups were compared and analyzed.Logistic regression was used to analyze the correlation between pulmonary function indexes and postoperative pulmonary infection.Results Postoperative pulmonary infection occurred in 24 out of 80 patients (30.00％).There was no correlation between gender (t =1.755,P =0.086),nationality (t =2.125,P =0.073) and the severity of pulmonary infection after operation.Age (t =4.084,P =0.024),smoking history (t =5.881,P =0.001),operation duration (t =3.583,P =0.041),intraoperative bleeding volume (t =5.115,P =0.003) and combined basic diseases (t =4.574,P =0.018) were significantly correlated with the severity of pulmonary infection after operation.MVV (x2 =4.242,P =0.039),MVV％ pred (x2 =4.405,P =0.036),FVC (x2 =17.500,P ＜0.001),FVC％pred (x2 =12.382,P ＜0.001),FEV1 (x2 =12.070,P =0.001) were associated with pulmonary infection.FVC (OR =9.102,95％ CI:2.691-28.213,P =0.027),FEV1 (OR =21.621,95％ CI:8.956-81.145,P =0.002) and MVV％ pred (OR =5.648,95％ CI:2.979-15.248,P =0.001) were high risk factors for pulmonary infection.Conclusion Partial pulmonary function indexes are significantly associated with postoperative pulmonary infection.It is necessary to strengthen the detection and improvement of preoperative pulmonary function in order to reduce the incidence of pulmonary infection.

Objective To investigate the pressure of male nurses in women and children′s Hospital and analyze it, so as to provide decision support for nursing administrators. Methods Used general information questionnaire, Perceptual Stress Scale, China Nurses'Pressure Source Scale (CPSS) in Sichuan,Chongqing,Yunnan,Guizhou,Tibet and other places of the maternal and child hospital male nurses, and analyzed the results. Results According to the CPSS scoring standard,63 in 101 subjects(62.4%)male nurses were in the state of stress, and the average score of stress was 26.0 ± 7.4. Binary Logistic regression showed that the main factors of male nurses′pressure were the lack of support from parents and family,low income, less promotion opportunities and non-nursing work. Conclusion The pressure situation of male nurses in maternity and child care hospitalis affected by family, work, society and so on. Managers should timely relieve the stress for male nurses and maintain the stability of male nurses′team.

BACKGROUND: Total hip arthroplasty is an effective measure to treat hip involvement in ankylosing spondylitis.Ankylosing spondylitis patients have different degrees of anemia after total hip arthroplasty. The hidden blood loss accounts for a large proportion of perioperative blood loss in total hip arthroplasty, and can affect the recovery of joint function.OBJECTIVE: To investigate risk factors of hidden blood loss after total hip arthroplasty in patients with hip involvement in ankylosing spondylitis.METHODS: We studied a consecutive series of 70 hips in 60 patients with ankylosing spondylitis hip involvement who were converted to cementless total hip arthroplasty. The average age of surgery was 35.12 years. The hidden blood loss was calculated according to Cross formula linear equation. The effects of operation time, erythrocyte sedimentation rate,C-reactive protein, body mass index, Bath ankylosing spondylitis radiology index, allogenic blood transfusion, and osteoporosis on hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (< 480 mL) according to the high blood loss. Risk factors of high hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed by single factor analysis and multivariate Logistic regression analysis (SPSS 17.0).RESULTS AND CONCLUSION: (1) The hidden blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis was (737.76±419.18) mL, and the total blood loss was (1312.83±487.41) mL, and the percentage of hidden blood loss was 51.48%. The high blood loss group included 41 hips, and the low blood loss group included 29 hips; and the ratio was 41:29. (2) Single factor analysis showed that the operation time, Bath ankylosing spondylitis radiology index and osteoporosis, allogenic blood transfusion, decrease of hemoglobin were significantly associated with high hidden blood loss. (3) Multivariate Logistic regression analysis showed that Bath ankylosing spondylitis radiology index,allogeneic blood transfusion, and decrease of hemoglobin were significantly associated with high hidden blood loss. (4)Hidden blood loss is an important portion of total blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis. Bath ankylosing spondylitis radiology index, allogeneic blood transfusion and decrease of hemoglobin are risk factors for high hidden blood loss.

BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003)were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

Objective To study correlation between biochemical markers of bone metabolism and postmenopausal osteoporot-ic vertebral fractures.Methods The clinical data of 100 cases with postmenopausal osteoporotic were study retrospectively.Fifty patients were postmenopausal osteoporotic,the rests were postmenopausal osteoporotic vertebral fractures.Lumbar spine,hip BMD,serum P1NP,β-CTX,N-MID,25-(OH)VitD and Ca2 + were recorded.Results There was a significant difference among ser-um P1NP,β-CTX and 25-(OH)VitD(P <0.05 ).There was positive correlation between postmenopausal osteoporotic vertebral fracture with serum P1NP (P <0.05),and negative correlation with serum 25-(OH)VitD (P <0.05),but had no correlation with serumβ-CTX (P >0.05).Conclusion Serum P1NP and 25-(OH)VitD could predict risk of postmenopausal osteoporotic vertebral fractures.Biochemical markers of bone metabolism combined with BMD could reduce postmenopausal osteoporosis fractures.