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.

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.

Objective:To evaluate the effect of small-dose esketamine on the learning and memory ability of chronic sleep-deprived rats and the role of hippocampal amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs).Methods:Forty healthy male Sprague-Dawley rats, aged 4 months, weighing 200-280 g, were divided into 4 groups ( n=10 each) using a random number table method: normal control group (N group), chronic sleep deprivation group (SD group), chronic sleep deprivation+ esketamine group (SDK group) and chronic sleep deprivation + esketamine + AMPAR antagonist CNQX group (SDKI group). The sleep deprivation model was prepared by the modified multi-platform water environment method. For 3 consecutive days after developing the model, ketamine 10 mg/kg was intraperitoneally injected in SDK group, and SDKI group received intraperitoneal injection of CNQX 1 mg/kg followed by ketamine 10 mg/kg. Morris water maze test was used to detect spatial learning and memory ability after the end of sleep deprivation or after administration. After the water maze test, rats were sacrificed, and the hippocampal tissue was obtained to detect the expression of hippocampal Homer1a mRNA (by quantitative polymerase chain reaction), Homer1a, metabotropic glutamate receptor 5 (mGluR5) and AMPAR (by Western blot). The density of dendritic spines in hippocampal CA1 region was determined by Golgi staining. Results:Compared with N group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of Homer1a protein and mRNA and mGluR5 was up-regulated, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SD group ( P<0.05). Compared with SD group, the escape latency was significantly shortened, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were increased, the expression of AMPAR was up-regulated, and the density of dendritic spines in hippocampal CA1 region was increased in SDK group ( P<0.05). Compared with SDK group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SDKI group ( P<0.05). There was no significant difference in the expression of Homer1a protein and mRNA and mGluR5 among SD group, SDK group and SDKI group ( P>0.05). Conclusions:Small-dose esketamine can improve the learning and memory ability of chronic sleep-deprived rats, and the mechanism may be related to up-regulation of the expression of hippocampal AMPARs.

Remimazolam is a new,ultra-short-acting benzodiazepine sedative narcotic drug that acts on γ-aminobutyric acid type A receptor(GABAAR).Benzodiazepine receptors on the α subunit of GABAAR have sedative,hypnotic and anxiolytic effects with mild cardiopulmonary effects.The clinical roles of remimazolam in painless endoscopy and general anesthesia have been gradually discovered.Organ protection is the focus of perioperative process,which has a profound impact on postoperative recovery and prognosis.Remimazolam has a protective effect on the nervous system,heart,lung,liver,gastrointestinal tract and other important organs,and its mechanism may be related to anti-inflammation,anti-apoptosis,and stress reduction.This article reviews the organ and systemprotective effect and mechanism of remimazolam,so as to provide some reference for its clinical application.

Objective:To evaluate the effects of propofol, dexmedetomidine and ketamine on oncentrations of β-amyloid peptide (Aβ) and tau in cerebrospinal fluid (CSF) of sleep-deprived rats.Methods:Forty SPF healthy male Sprague-Dawley rats, aged 3-4 months, weighing 230-280 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), sleep deprivation group (SD), propofol group (group P), dexmedetomidine group (group D) and ketamine group (group K). The sleep deprivation was induced using the improved multi-platform sleep deprivation model.Propofol 100 mg/kg, dexmedetomidine 100 mg/kg and ketamine 80 mg/kg were intraperitoneally injected at 72 h of sleep deprivation to maintain anesthesia for 3 h in P, D and K groups, respectively.Group C entered the large platform for 72 h free activity.The CSF was collected at 3 h of anesthesia for measurement of concentrations of Aβ and tau protein by enzyme-linked immunosorbent assay. Results:The concentrations of Aβ and tau protein in CSF were significantly higher in SD, P, K and D groups than in group C ( P<0.05). Compared with group SD, the concentrations of Aβ and tau protein in CSF were significantly increased in P and K groups, and the concentrations of Aβ and tau protein in CSF were significantly decreased in group D ( P<0.05). Conclusion:Dexmedetomidine can decrease the the concentrations of Aβ and tau protein in CSF of sleep deprived rats, while propofol and ketamine lead to the opposite effect.

Objective:To construct the intelligent medical cloud management platform of diabetes education clinic in ClassⅢ general hospital and observe the clinical effects.Methods:A total of 260 young and middle-aged patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Endocrinology in the First Affiliated Hospital of Henan University from June to December 2019 were selected by convenience sampling method. They were divided into the control group and the experimental group by the random number table method, with 130 cases in each group. Patients in the control group were given routine diabetes outpatient follow-up, while the experimental group was given group education, case management, behavioral intervention, condition supervision and online follow-up intervention based on the intelligent medical cloud management platform of the diabetes education clinic. The blood glucose control status and the self-management ability of the two groups before and after 3 months of intervention were compared.Results:After intervention for 3 months, fasting plasma glucose (FPG) , 2h plasma glucose of 75g oral glucose tolerance test (OGTT 2h PG) and hemoglobin A1c (HbA1c) of patients in two groups were reduced than those before intervention, and FPG, OGTT 2h PG and HbA1c levels in the experimental group were lower than those in the control group. The differences were statistically significant ( P<0.05) . The mean blood glucose (MBG) and mean amplitude of plasma glucose excursions (MAGE) in the experimental group were lower than those in the control group, and the difference was statistically significant ( P<0.05) . After 3 months of intervention, blood glucose was monitored 6 833 times in the control group and 7 279 times in the experimental group. The incidence of hypoglycemia in the experimental group was lower than that in the control group [0.77% (56/7 279) vs. 2.82% (193/6 833) , χ 2=85.885, P<0.05]. After 3 months of intervention, the scores of diet, exercise, blood glucose monitoring, prevention of complications and medical compliance in the two groups were all higher than those before intervention, and the scores of diet, exercise, blood glucose monitoring and medical compliance in the experimental group were higher than those in the control group. The differences were statistically significant ( P<0.01) . Conclusions:The construction and application of intelligent medical cloud management platform of diabetes education clinic can better improve blood glucose control and improve self-management ability of patients.

Objective To explore the feasibility of FloTrac/Vigileo System in hemodynamic monitoring during the surgery of single-lung ventilation patients.Methods Twenty-five patients with thoracoscopic lobectomy under general anesthesia,aged 35-65 years,ASA physical status Ⅰ or Ⅱ, preoperative showed no application taboo of FloTrac/Vigileo system or transesophageal echocardio-graphy (TEE).The radial artery puncture catheter was inserted after getting into the operating room, then connect the FloTrac/Vigileo system,after that the TEE was inserted following the induction of general anesthesia.Using the FloTrac/Vigileo system to record the stroke volume (SVF),cardiac output (COF),stroke volume variation (SVV),at the moment of after turning over (T0),opening chest and single-lung ventilation(T1),single-lung ventilation for 15 minutes (T2),single-lung venti-lation for 30 minutes (T3),single-lung ventilation for 45 minutes (T4)single-lung ventilation for 60 minutes (T5).Using TEE to monitor the index and record the the stroke volume (SVT)cardiac out-put(COT)and inferior vena cava collapse index(cIVC)of the same patient at same time as Group F. Results There was no statistically significant different between SVFand SVTat T0-T5in both groups,Overall correlation analysis,r=0.84,P<0.01.There is no statistically significant different between COFand COTat T0-T5in both groups,Overall correlation analysis,r=0.92,P<0.01. Correlation analysis of SVV of group F and cIVC of group T,the results were positively correlate,r=0.80,P<0.01.Conclusion FloTrac/Vigileo system can be used as a monitoring method for mo-nitoring hemodynamics in thoracic surgery.

Objective: To discuss the clinical results of three-stage functional ear reconstruction for microtia with congenital aural stenosis (CAS). Methods: From September 2007 to June 2017, 53 cases of microtia with CAS underwent all three-stage functional ear reconstruction, and 445 cases of microtia underwent two stage ear reconstruction without meatoplasty at the same periods. First-stage of three-stage functional ear reconstruction: it was similar to Nagata technique. The crus of helix could not be too long, since we needed the space for the next meatoplasty. Second-stage: it was a modified meatoplasty with endoaural-conchal incision, in which two local rotation flaps and a transposition split-thickness scalp flap were used to widen the stenotic external auditory canal (EAC) and reconstructed the tympanic membrane. Third-stage: it was a modified technique for firm elevation of the reconstructed auricle by using the retro-auricular fascial flap wrapping a porous polyethylene (Medpor) wedge or stored cartilage as the strut. If the patient showed EAC cholesteatoma or infection, we could do the meatoplasty at the first stage. If the patient had completed ear reconstruction, meatoplasty could be done at the third stage. Results: 53 cases underwent all three-stage functional ear reconstruction. There were 41 cases (77.4%) obtaining serviceable hearing. The complication rate of meatoplasty was 1.89% and the complication rate of ear reconstruction was 5.66%. Among the 445 cases of microtia treated with two stage ear reconstruction without meatoplasty, the complication rate of ear reconstruction was 9.43%. There was no significant difference between the two groups (P>0.05). Conclusions Our novel three-stage functional ear reconstruction is a feasible strategy for microtia with CAS. The patients can obtain satisfactory auricle and serviceable hearing. The results are stable and can improve the life quality in both aesthetics and hearing function.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

The application of transesophageal echocardiography (TEE) in perioperative monitoring was introduced,and its involvement in non-cardiac surgery was described.The advantages and disadvantages of TEE were analyzed when applied to cardiac and non-cardiac operations for congenital heart disease,coronary disease,vascular heart disease,aorta disease and etc.The abuse of vasoactive drug or fluid is avoided due to subjective evaluation on cardiac function and volume load.TEE facilitates the anesthetist in diagnosis and evaluation of the patient with heart diseases,and the surgeon in immediate assessment of the operation,which can be used for real-time monitoring of cardiac function and hemodynamics.