This case study summarizes the nursing experience of a patient with right forearm damage who underwent total shape combined replantation reconstruction after heterotopic limb salvage.Key nursing points included:preoperative assessment of the patient's injury and emergency treatment,formulation of a personalized surgical plan in collaboration with multiple departments,and complete preoperative preparation.Postoperatively,implement phased individualized nursing care postoperatively,strengthen monitoring and prevention of vascular emergencies,control and treat wound infections,implement multidimensional pain management strategies,provide comprehensive psychological care,and conduct stepwise functional rehabilitation training.After 2 stages of surgery and 112 days of treatment and nursing care,the patient's right forearm showed good functional recovery,and the patient was discharged successfully.

Objective:To investigate the synergistic activity and mechanism of vinegar baked radix bupleurum polysaccharides(VBCP)in combination with oxaliplatin(OXA),and to provide new ideas for the clinical treatment of primary hepatocellular carci-noma.Methods:MTT assay was used to detect the cytotoxic effect of VBCP 3-4 and VBCP 3-3 in combination with OXA on Huh7 cells;ICP-MS was used to measure the uptake rate of OXA by Huh7 cells and evaluate the in vitro synergistic pathway of VBCP 3-4 in combination with OXA;Western blotting was used to measure the expression levels of related transporter proteins in Huh7 cells and explore the synergistic mechanism of VBCP 3-4 in combination and MRP1 in Huh7 cells,and the protein expression level of multidrug resistance-associated protein(MRP)2 was upregulated to 18.11%and 25.00%,respectively(P=0.008,P=0.001),while that of MRP1 was upregulated to 28.51%(P>0.05)and 39.70%(P=0.015),respectively.After the combination of VBCP 3-4 and OXA,the protein expression of MRP2,MRP1,and breast cancer resis-tance protein(BCRP)was inhibited;MRP2 was reduced by 47.38%in the high-dose combination group(P=0.000)and 15.18%in the low-dose combination group(P=0.049);MRP1 was reduced by 64.96%in the high-dose combination group(P=0.000)and 34.63%in the low-dose combination group(P=0.000);BCRP was reduced by 29.00%(P=0.020)in the high-dose combination group.Acting on Huh7 cells alone,VBCP 3-4 significantly reduced the protein expression levels of MRP2,MRP1,and BCRP,and in the high-dose VBCP 3-4 group,MRP2 and MRP1 were reduced by 24.91%and 20.79%,respectively(P=0.004,P=0.005).VBCP 3-4 downregu-lated the protein expression level of BCRP by 15.02%in the high-dose group(P=0.003)and 13.92%in the middle-dose group(P=0.030).Conclusion:VBCP 3-4 exerts a synergistic effect by inhibiting the expression of the efflux transporter proteins MRP1,MRP2,and BCRP,promoting the intake of OXA by Huh7 cells,and increasing the intracellular effective concentration.

Objective To compare the clinical efficacy of intraoperative intravenous tirofiban versus preoperative loading dose dual antiplatelet therapy in the acute phase LVIS stent-assisted coil embolization treatment for ruptured wide-necked intracranial aneurysms.Methods Patients with acutely ruptured,wide-neck intracranial aneurysms underwent LVIS stent-assisted coil embolization in the Department of Neurosurgery at Heze Municipal Hospital were retrospectively and consecutively enrolled from January 2017 to June 2023.According to the Chinese expert consensus on antiplatelet therapy for intracranial aneurysms,patients were divided into two groups based on the types of antiplatelet therapy they received:the loading-dose dual antiplatelet therapy(DAPT)group and the tirofiban group.Baseline and clinical data were collected and compared between the two groups,including age,sex,hypertension,diabetes mellitus,coronary artery disease,history of cerebral hemorrhage,preoperative Hunt-Hess grade,maximum aneurysm diameter,aneurysm neck width,and aneurysm location.Perioperative ischemic and hemorrhagic complications were collected and compared between the two groups.Perioperative ischemic complications included:intraoperative stent thrombosis(defined as filling defects in the parent artery,and,occlusion of the parent artery or stented branch during the procedure),and symptomatic ischemic infarction within 24 h postoperatively(confirmed by imaging with corresponding neurological deficits).Perioperative hemorrhagic complications included:intraoperative rupture of the target aneurysm(contrast extravasation or acute hemorrhage during embolization)and intracranial hemorrhage within 24 h postoperatively(new or worsened subarachnoid hemorrhage or intraparenchymal hemorrhage on CT).Clinical outcomes at 90 days were collected via telephone or outpatient follow-up,and evaluated using favorable prognosis defined as modified Rankin scale(mRS).A mRS score of 0-2 were defined as favorable prognosis and 3-6 as poor prognosis.Six-month postoperative imaging follow-up were collected,angiographic outcomes were categorized into four groups based on comparison with immediate post-embolization results:complete occlusion,total absence of contrast filling in the aneurysm sac;improved,reduced contrast filling;stable,unchanged contrast filling;and,recurrence,increased contrast filling.Results Totals of 108 patients with intracranial aneurysms treated by LVIS stent-assisted coiling were enrolled,with 30 males and 78females,aged32-75years(median age63[50,66]years).Among the108cases,55cases were assigned into the DAPT group,and 53 cases were included in the tirofiban group.(1)No statistically significant differences were observed between the tirofiban group and the DAPT group in baseline and clinical characteristics(all P＞0.05).(2)All patients underwent successful LVIS stent-assisted coiling,with a technical success rate of 100%.The total perioperative ischemic complications were 12.0%(13/108),including 4.6%(5/108)intraoperative stent thrombosis and 7.4%(8/108)symptomatic ischemic infarction within 24h after surgery.The total perioperative hemorrhagic complications rate was 1.9%(2/108),including 1 case of intraoperative aneurysm rupture and 1 case of postoperative intracranial hemorrhage within24h.92.6%(100/108)of the patients exhibited favorable prognosis and 7.4%(8/108)showed poor prognosis at the 90-day follow-ups.78.7%(85/108)of the patients accomplished at 6-month imaging follow-ups,the complete occlusion ratio was 94.1%(80/85)and the recurrence ratio was 2.4%(2/85).(3)The overall perioperative ischemic complication rates were 13.2%(7/53)in the tirofiban group and 10.9%(6/55)in the DAPT group,with no statistically significant difference(P=0.720).Intraoperative stent thrombosis occurred more frequently in the DAPT group(9.1%[5/55]vs.0,P=0.025),while symptomatic ischemic infarction within 24 h post-procedure was lower in the DAPT group(1.8%[1/55]vs.13.2%[7/53],P=0.028).The hemorrhagic complications occurred only in the DAPT group,with a rate of 3.6%(2/55),while no events observed in the tirofiban group.At the 90-day follow-up,the proportion of patients with favorable outcomes was 94.3%(50/53)in the tirofiban group and 90.9%(50/55)in the DAPT group,with no statistically significant difference between the groups(P=0.754).Conclusions Both intraoperative intravenous tirofiban and preoperative loading-dose DAPT demonstrated comparable safety profile and favorable clinical efficacy in the acute-phase treatment of ruptured wide-necked intracranial aneurysms with LVIS stent-assisted coil embolization.The results require further validation through large-scale prospective studies.

Objective:To systematically analyze the incidence and influencing factors of frailty in elderly patients with hematologic malignancies.Methods:Research on frailty in elderly patients with hematologic malignancies was retrieved from Chinese and English databases such as China National Knowledge Infrastructure, Wanfang Data, PubMed, and Web of Science. The search period was from database establishment to August 23, 2024. Two researchers screened the included studies, conducted quality assessment, and extracted data. Meta-analysis was conducted using Stata 18 and RevMan 5.4.Results:A total of seven studies were included, encompassing 19 076 elderly hematologic malignancy patients, with a frailty incidence of 59% [95% CI (0.48, 0.69) ]. Meta-analysis revealed that age [ MD=4.31, 95% CI (3.67, 4.96) ], gender [ OR=0.88, 95% CI (0.83, 0.93) ], alcohol consumption [ OR=1.67, 95% CI (1.15, 2.44) ], self-care ability [ MD=-1.79, 95% CI (-3.17, -0.41) ], anemia [ OR=6.67, 95% CI (2.94, 15.14) ], infection [ OR=1.81, 95% CI (1.16, 2.84) ], and neuropathy [ OR=2.52, 95% CI (1.38, 4.61) ] were the influencing factors of frailty in elderly patients with hematologic malignancies. Conclusions:The incidence of frailty is high in elderly patients with hematologic malignancies. Elderly patients with hematologic malignancies who are older, female, consume alcohol, have low self-care ability, anemia, infections, and neuropathy are prone to frailty. Healthcare providers can conduct early screening and intervention for high-risk populations of frailty based on risk factors to improve the quality of life for elderly hematologic malignancy patients.

Objective To explore the mediating effects of self-disclosure and rumination on stigma and self-image in patients with head and neck cancer after surgery,so as to provide a reference for targeted intervention.Methods A total of 390 postoperative patients with head and neck cancer who were hospitalized in a Class Ⅲ Grade A general hospital in Shandong Province were selected by quota sampling method according to disease type.The general information questionnaire,shame and stigma scale in head and neck cancer distress disclosure index,ruminative responses scale and body image scale were used to investigate.Results A total of 360 patients with head and neck cancer after surgery completed the survey.The scores of stigma,self-image,rumination and self-disclosure were(37.9±11.0),(13.9±5.6),(56.5±12.4)and(28.9±7.3),respectively.There was a negative correlation between stigma and self-disclosure in patients with head and neck cancer after surgery(r=-0.386,P<0.001),and a positive correlation with self-image and rumination(r=0.455,0.565,all P<0.001).Self-disclosure and rumination had parallel mediating effects on stigma and self-image in patients with head and neck cancer after surgery,and the mediating effect accounted for 38.82％of the total effect.Conclusion The degree of self-image of postoperative patients with head and neck cancer not only directly affects the level of stigma,but also indirectly affects stigma through the mediating effect of self-disclosure and rumination.In clinical work,measures can be taken to improve the level of self-image and self-disclosure ability of patients,reduce the level of rumination and reduce the stigma of patients.

Objective:To systematically analyze the incidence and influencing factors of frailty in elderly patients with hematologic malignancies.Methods:Research on frailty in elderly patients with hematologic malignancies was retrieved from Chinese and English databases such as China National Knowledge Infrastructure, Wanfang Data, PubMed, and Web of Science. The search period was from database establishment to August 23, 2024. Two researchers screened the included studies, conducted quality assessment, and extracted data. Meta-analysis was conducted using Stata 18 and RevMan 5.4.Results:A total of seven studies were included, encompassing 19 076 elderly hematologic malignancy patients, with a frailty incidence of 59% [95% CI (0.48, 0.69) ]. Meta-analysis revealed that age [ MD=4.31, 95% CI (3.67, 4.96) ], gender [ OR=0.88, 95% CI (0.83, 0.93) ], alcohol consumption [ OR=1.67, 95% CI (1.15, 2.44) ], self-care ability [ MD=-1.79, 95% CI (-3.17, -0.41) ], anemia [ OR=6.67, 95% CI (2.94, 15.14) ], infection [ OR=1.81, 95% CI (1.16, 2.84) ], and neuropathy [ OR=2.52, 95% CI (1.38, 4.61) ] were the influencing factors of frailty in elderly patients with hematologic malignancies. Conclusions:The incidence of frailty is high in elderly patients with hematologic malignancies. Elderly patients with hematologic malignancies who are older, female, consume alcohol, have low self-care ability, anemia, infections, and neuropathy are prone to frailty. Healthcare providers can conduct early screening and intervention for high-risk populations of frailty based on risk factors to improve the quality of life for elderly hematologic malignancy patients.

"When warm evil is received,it first attacks the lungs and then spread to the pericardium reversely"is the general rule of warm diseases.Doctors of different dynasties have different views on the phrase"reverse spread to the pericardium",especially the word"reverse".Professor Tong Xiaolin proposed that the heart governs the mind,the pericardium and the heart are connected in qi,and when the heart is affected by evil,the pericardium instead suffers from the evil.The"reverse spread to the pericardium"proposed by Ye Tianshi is actually the spread of warm evil to the brain.Taking meningococcal meningitis as the basic disease,it can be matched one by one with the typical stages of the transmission of Wei-Qi-Ying-Xue.Combined with the theory of Dingjiao,it is believed that the function of"the heart governing the mind"focuses more on the brain in the modern anatomical sense.Combining traditional Chinese medicine's ideas on diagnosis and treatment of warm diseases with modern medicine,revealing the essence of the disease,grasping the core of the pathogenesis,analyzing the word"reverse"from a new perspective,and exploring its true meaning,is of great significance for clarifying its connotation,exploring the development laws of warm diseases,and guiding the diagnosis and treatment of warm disea-ses.

"When warm evil is received,it first attacks the lungs and then spread to the pericardium reversely"is the general rule of warm diseases.Doctors of different dynasties have different views on the phrase"reverse spread to the pericardium",especially the word"reverse".Professor Tong Xiaolin proposed that the heart governs the mind,the pericardium and the heart are connected in qi,and when the heart is affected by evil,the pericardium instead suffers from the evil.The"reverse spread to the pericardium"proposed by Ye Tianshi is actually the spread of warm evil to the brain.Taking meningococcal meningitis as the basic disease,it can be matched one by one with the typical stages of the transmission of Wei-Qi-Ying-Xue.Combined with the theory of Dingjiao,it is believed that the function of"the heart governing the mind"focuses more on the brain in the modern anatomical sense.Combining traditional Chinese medicine's ideas on diagnosis and treatment of warm diseases with modern medicine,revealing the essence of the disease,grasping the core of the pathogenesis,analyzing the word"reverse"from a new perspective,and exploring its true meaning,is of great significance for clarifying its connotation,exploring the development laws of warm diseases,and guiding the diagnosis and treatment of warm disea-ses.

Objective To compare the clinical efficacy of intraoperative intravenous tirofiban versus preoperative loading dose dual antiplatelet therapy in the acute phase LVIS stent-assisted coil embolization treatment for ruptured wide-necked intracranial aneurysms.Methods Patients with acutely ruptured,wide-neck intracranial aneurysms underwent LVIS stent-assisted coil embolization in the Department of Neurosurgery at Heze Municipal Hospital were retrospectively and consecutively enrolled from January 2017 to June 2023.According to the Chinese expert consensus on antiplatelet therapy for intracranial aneurysms,patients were divided into two groups based on the types of antiplatelet therapy they received:the loading-dose dual antiplatelet therapy(DAPT)group and the tirofiban group.Baseline and clinical data were collected and compared between the two groups,including age,sex,hypertension,diabetes mellitus,coronary artery disease,history of cerebral hemorrhage,preoperative Hunt-Hess grade,maximum aneurysm diameter,aneurysm neck width,and aneurysm location.Perioperative ischemic and hemorrhagic complications were collected and compared between the two groups.Perioperative ischemic complications included:intraoperative stent thrombosis(defined as filling defects in the parent artery,and,occlusion of the parent artery or stented branch during the procedure),and symptomatic ischemic infarction within 24 h postoperatively(confirmed by imaging with corresponding neurological deficits).Perioperative hemorrhagic complications included:intraoperative rupture of the target aneurysm(contrast extravasation or acute hemorrhage during embolization)and intracranial hemorrhage within 24 h postoperatively(new or worsened subarachnoid hemorrhage or intraparenchymal hemorrhage on CT).Clinical outcomes at 90 days were collected via telephone or outpatient follow-up,and evaluated using favorable prognosis defined as modified Rankin scale(mRS).A mRS score of 0-2 were defined as favorable prognosis and 3-6 as poor prognosis.Six-month postoperative imaging follow-up were collected,angiographic outcomes were categorized into four groups based on comparison with immediate post-embolization results:complete occlusion,total absence of contrast filling in the aneurysm sac;improved,reduced contrast filling;stable,unchanged contrast filling;and,recurrence,increased contrast filling.Results Totals of 108 patients with intracranial aneurysms treated by LVIS stent-assisted coiling were enrolled,with 30 males and 78females,aged32-75years(median age63[50,66]years).Among the108cases,55cases were assigned into the DAPT group,and 53 cases were included in the tirofiban group.(1)No statistically significant differences were observed between the tirofiban group and the DAPT group in baseline and clinical characteristics(all P＞0.05).(2)All patients underwent successful LVIS stent-assisted coiling,with a technical success rate of 100%.The total perioperative ischemic complications were 12.0%(13/108),including 4.6%(5/108)intraoperative stent thrombosis and 7.4%(8/108)symptomatic ischemic infarction within 24h after surgery.The total perioperative hemorrhagic complications rate was 1.9%(2/108),including 1 case of intraoperative aneurysm rupture and 1 case of postoperative intracranial hemorrhage within24h.92.6%(100/108)of the patients exhibited favorable prognosis and 7.4%(8/108)showed poor prognosis at the 90-day follow-ups.78.7%(85/108)of the patients accomplished at 6-month imaging follow-ups,the complete occlusion ratio was 94.1%(80/85)and the recurrence ratio was 2.4%(2/85).(3)The overall perioperative ischemic complication rates were 13.2%(7/53)in the tirofiban group and 10.9%(6/55)in the DAPT group,with no statistically significant difference(P=0.720).Intraoperative stent thrombosis occurred more frequently in the DAPT group(9.1%[5/55]vs.0,P=0.025),while symptomatic ischemic infarction within 24 h post-procedure was lower in the DAPT group(1.8%[1/55]vs.13.2%[7/53],P=0.028).The hemorrhagic complications occurred only in the DAPT group,with a rate of 3.6%(2/55),while no events observed in the tirofiban group.At the 90-day follow-up,the proportion of patients with favorable outcomes was 94.3%(50/53)in the tirofiban group and 90.9%(50/55)in the DAPT group,with no statistically significant difference between the groups(P=0.754).Conclusions Both intraoperative intravenous tirofiban and preoperative loading-dose DAPT demonstrated comparable safety profile and favorable clinical efficacy in the acute-phase treatment of ruptured wide-necked intracranial aneurysms with LVIS stent-assisted coil embolization.The results require further validation through large-scale prospective studies.

Objective To explore the mediating effects of self-disclosure and rumination on stigma and self-image in patients with head and neck cancer after surgery,so as to provide a reference for targeted intervention.Methods A total of 390 postoperative patients with head and neck cancer who were hospitalized in a Class Ⅲ Grade A general hospital in Shandong Province were selected by quota sampling method according to disease type.The general information questionnaire,shame and stigma scale in head and neck cancer distress disclosure index,ruminative responses scale and body image scale were used to investigate.Results A total of 360 patients with head and neck cancer after surgery completed the survey.The scores of stigma,self-image,rumination and self-disclosure were(37.9±11.0),(13.9±5.6),(56.5±12.4)and(28.9±7.3),respectively.There was a negative correlation between stigma and self-disclosure in patients with head and neck cancer after surgery(r=-0.386,P<0.001),and a positive correlation with self-image and rumination(r=0.455,0.565,all P<0.001).Self-disclosure and rumination had parallel mediating effects on stigma and self-image in patients with head and neck cancer after surgery,and the mediating effect accounted for 38.82％of the total effect.Conclusion The degree of self-image of postoperative patients with head and neck cancer not only directly affects the level of stigma,but also indirectly affects stigma through the mediating effect of self-disclosure and rumination.In clinical work,measures can be taken to improve the level of self-image and self-disclosure ability of patients,reduce the level of rumination and reduce the stigma of patients.