Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

Objective:To investigate the effects of evidence-based precision nursing in patients with sarcopenia undergoing total knee arthroplasty (TKA) .Methods:By convenience sampling, totally 41 TKA patients with sarcopenia treated in the Department of Orthopedics at The First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were selected as the control group, and 41 TKA patients with sarcopenia treated from March 2022 to March 2023 as the observation group. Patients in the control group received conventional nursing care, while patients in the observation group received an evidence-based precision nursing plan. The differences in muscle mass, grip strength, physical activity ability, knee joint function, and quality of life between the two groups before and after the intervention were compared.Results:After the intervention, the total muscle mass, affected limb skeletal muscle mass, limb skeletal muscle mass, limb skeletal muscle mass index, and grip strength in the observation group were significantly higher than those in the control group ( P< 0.05). The scores on the Short Physical Performance Battery, Lysholm Score, and Sarcopenia Quality of Life Scale in the observation group were also significantly higher than those in the control group ( P<0.05) . Conclusions:Evidence-based precision nursing can improve postoperative muscle mass and strength, enhance physical activity ability and joint function, and improve the quality of life in TKA patients with sarcopenia.

Abstract OBJECTIVE To develop a vancomycin individualized dosing-assisted decision platform suitable for practical clinical application scenarios and provide individualized dosing recommendations for the rational use of vancomycin. METHODS Based on the vancomycin population pharmacokinetic model that had been constructed and verified to be feasible, the vancomycin individualized assisted decision-making platform was developed by using Idea2019, JDK1.8, ETL and other software tools. The platform development had gone through three main stages, included ①requirement analysis; ②design stage; ③software testing and optimization. RESULTS The vancomycin individualized assisted decision-making platform, which was successfully developed and applied, had the advantages of simple page, perfect function and convenient operation, and was divided into four main modules according to functions, namely retrieval module, information module, concentration prediction module and reporting module. The platform could connect to the hospital intranet platform to automatically obtain patient information, medication information and blood concentration test results, and calculate individual pharmacokinetic parameters for subsequent concentration prediction based on the embedded population pharmacokinetic model, combined with individual parameters. The concentration prediction module incorporated the Bayesian feedback method with patient medication information, drug concentration measurement results and relevant covariate parameter values, took the guideline-recommended trough concentration and AUC range as the target value, calculated the individualized drug administration scheme that met the target concentration range, and set up custom simulation functions considering the actual clinical application scenarios, which was of more popularization and application value. CONCLUSION Based on the vancomycin population pharmacokinetic model that has been successfully constructed in the previous stage, with the assistance of Idea2019, JDK1.8, ETL and other software tools, a vancomycin individualized dosing-assisted decision platform has successfully constructed, which can more efficiently and conveniently assist monitoring pharmacists to provide individualized dosing advice for clinical use of vancomycin.

Objective:To analyze the effect of SBAR (situation, background, assessment, and recommendation) sign-out template in the standardized residency training in a neonatal ward.Methods:Based on SBAR communication mode, we designed and optimized neonatal ward sign-out checklist, and a total of 67 residents were trained for 2 weeks from April 2019 to June 2019, with control group (before training) and observation group (after training). The assessment indicators of sign-out information included sign-out duration, the incidence of sign-out errors, quality assessment scores and shift satisfaction (including sign-out satisfaction and self-evaluation) as well as competencies. A total of 1 553 children's morning shift data were collected, and SPSS 22. 0 was used for t test and chi-square test. Results:In the control group, the sign-out duration was (23.4±4.7) min, the incidence of sign-out errors was (43.6±6.6)%, quality assessment scores were (6.3±0.7) points, the satisfaction degree was (76.5±4.6)%, and the self-evaluation scores were (5.2±2.1) points. While, in the observation group, the sign-out duration was (15.9±3.2) min, the incidence of sign-out errors was (21.1±2.3)%, quality assessment scores were (8.9±0.9) points, the satisfaction degree was (94.1±2.9)%, and the self-evaluation scores were (8.9±0.8) points, with statistically significant difference ( P<0.05). There were statistically significant differences between the two groups in clinical skills and medical service ability [(2.2±0.1) vs. (3.8±0.3)], interpersonal communication ability [(2.6±0.5) vs. (4.2±0.1) points], teamwork ability [(3.1±0.2) vs. (4.6±0.3)], information and management ability [(2.5±0.5) vs. (4.2±0.2)] ( P<0.05). Conclusion:The SBAR template can improve sign-out process and the clinical skills of standardized training residents.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

ObjectiveTo analyze the feasibility， reliability and validity of the disability assessment for dementia scale for the elderly. MethodsA total of 290 dementia patients from 17 survey sites in 13 districts and counties of Chengdu were enrolled by convenient sampling method， and they were assessed using demographic data inventory， Mini-Mental State Examination （MMSE）， Neuropsychiatric Inventory （NPI）， Physical Self-Maintenance Scale （PSMS） and disability assessment for dementia scale for the elderly. Cronbach's α coefficient， Spearman-Brown coefficient， Guttman split-half coefficient and test-retest reliability were used to evaluate the internal consistency of above scales. Criterion-related validity of the scale was analyzed based on MMSE， NPI and PSMS. ResultsA total of 276 patients （95.17%） completed valid questionnaires. The intraclass correlation coefficient of the total score and each dimension were between 0.828~0.976， the Spearman-Brown coefficient were between 0.790~0.917， the Guttman split-half coefficient were between 0.812~0.857， and the Cronbach’s α coefficient were between 0.737~0.886. The cognitive function dimension score was positively correlated with the MMSE score （r=0.948， P<0.01）， the mental behavior symptom dimension score was positively correlated with the NPI score （r=0.893， P<0.01）， and the daily living ability dimension score was positively correlated with the PSMS score （r=0.997， P<0.01）. The dimensions scores were positively correlated with the total score of the scale （r=0.634~0.841， P<0.05）. ConclusionDisability of dementia assessment scale has good feasibility， reliability and validity， which is a reliable tool to assess senile dementia and disability.

Objective:To evaluate the value of ultrasonography in evaluating the influential factors of early insufficient flow after central venous catheter placement in dialysis patients.Methods:Three hundred and twenty seven hemodialysis patients who underwent central venous catheterization at the Affiliated Hospital of Chengde Medical College from May 2016 to June 2019 were selected. According to the catheter flow, the patients were divided into the low catheter flow group(43 cases) and the normal catheter flow group(284 cases). The distribution variance of clinical features(age, gender, blood pressure) were compared and whether some ultrasonic parameters(position of catheter tip, left ventricular ejection fraction, left atrial end-systolic diameter, left ventricular end-diastolic diameter, distance from the catheter tip to superior vena cava beyond right atrial opening) had influence on the insufficient catheter flow in the early stage between the two groups were analyzed.Results:The differences of left ventricular ejection fraction, left atrial end-systolic diameter and position of catheter tip between the two groups were statistically different( P<0.05). However, univariate and multivariate analyses showed that there were significant differences in catheter tip approaches and touches the wall of right atrium( OR=5.393, 95% CI=2.039-14.263, P=0.001), increased left atrial end-systolic diameter( OR=0.321, 95% CI=0.124-0.827, P=0.019), left ventricular ejection fraction in critical range( OR=2.953, 95% CI=1.113-7.835, P=0.030) and decreased left ventricular ejection fraction( OR=5.828, 95% CI=1.869-18.174, P=0.002) were the independent risk factors of early insufficient catheter flow. Conclusions:Insufficient catheter flow after central venous catheterization is related to catheter position, left atrial end-systolic diameter and left ventricular ejection fraction. Ultrasonography evaluation is a primary method to observe the position of the catheter tip in dialysis patients and diagnose the early insufficient catheter flow after central venous catheterization.

Objective:To investigate the distribution characteristics of atherosclerosis in patients with obstructive sleep apnea syndromes (OSAS) by ultrasonography and explore the differences of intracranial and extracranial atherosclerosis lesions.Methods:From July 2016 to July 2019, 139 patients with OSAS confirmed by the department of neurology and/or respiratory of Xuanwu Hospital, Capital Medical University were enrolled retrospectively. According to the results of polysomnography (PSG), patients were divided into 3 groups: mild degree (53 cases), moderate degree (35 cases) and severe degree (51 cases). Demographic parameters, distribution and the severity of atherosclerosis both in intracranial and extracranial arteries, and the incidence of ischemic stroke were compared among the three groups.Results:①Among 139 OSAS patients, there were more males (64.7%) than females (35.3%). Of all the risk factors for cerebrovascular diseases, the prevalence of hypertensin was the highest (50.4%), followed by hyperlipidemia (48.9%). The prevalences of hypertension and ischemic stroke, the body mass index (BMI) in severe OSAS group were higher than those in mild group (all P<0.017). ②The total detection rate of extracranial atherosclerosis (83.5%) was significantly higher than that of intracranial atherosclerosis (23.0%)( P<0.01). ③The extracranial atherosclerotic lesion with highest detection rate of was simple plaque formation (51.1%, 71/139 cases), and there was no significant difference in extracranial lesions among the three groups ( P=0.106). However, with the aggravation of OSAS degree, the stenosis degree of extracranial artery increased ( P=0.006), and there was a weak correlation between the severity of OSAS and the degree of extracranial artery stenosis ( r s=0.263, P=0.002). ④The incidence of middle cerebral artery stenosis accounted for 15.8%(22/139 cases) of intracranial arteries involved and there were no significant differences in the rate, degree and distribution of intracranial artery lesions among the three groups (all P>0.05). Conclusions:The detection rate of extracranial arterial lesions in OSAS patients is higher. With the aggravation of OSAS, the degree of atherosclerosis stenosis in extracranial arteries and the incidence of ischemic stroke trend to increase.

Two male patients aged 33 and 38 years with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)admitted in our hospital in 2016 and 2017 were reported.The main symptoms included abdominal pain and distension,numbness and weakness of the limbs.MRI showed mild ventriculomegaly with deepened sulcus and widened cerebral fissure,deepened bilateral cerebellar sulcus and the widened cleavage,atrophy of cerebellum and brainstem,and manifestations of acute cerebral infarction.Gene analysis showed mutation of mitochondrial DNA(mtDNA) A3243G.After definite diagnosis was made,patients reveived coenzyme Q10,ATP and vitamin supplements for improving circulation,and neurotrophic drugs for symptomatic treatment.The symptoms were slightly improved after treatment and two cases were followed-up as outpatients.

Objective The aim of this study was to explore the correlation between postoperative aromatase inhibitor(AIs) -based bone metabolism and ERα gene rs9340799,rs2234693 single nucleotide polymorphisms(SNPs)in breast cancer.Methods One hundred and sixty-six breast cancer patients who underwent AIs treatment(≤2 years)were enrolled and hospitalized in our hospital from October 2015 to April 2017.The ERα gene rs9340799 and rs2234693 sites were sequenced and compared subtype of lumbar spine and femur,bone mineral density BMD value and the relationship between BMD value and T value.Results The BMD of lumbar spine in patients with ERα gene rs9340799 was significantly different when compared to those of A/A,A/G and G/G(P<0.01).The BMD of lumbar spine in patients with A/A and A/G genotypes were significantly higher than those in G/G genotypes(P<0.05).The BMD of lumbar spine in patients with ERα gene rs2234693 was significantly different when compared to those of T/T,T/C and C/C(P<0.01). The BMD of lumbar spine in patients with T/T and C/T genotypes were significantly higher than those in C/C genotypes(P<0.05). However,there was no difference in femoral BMD,lumbar spine,and femur T between the 2 subtypes of patients with genotypes(P>0.05).Conclusion Aromatase inhibitor-related bone loss(AIBL)may be related to ERα gene phenotype.In ERα gene rs9340799 and rs2234693 loci,C and G alleles may be susceptible genes for aromatase inhibitor-related bone loss(AIBL).