Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective To investigate the influencing factors of adverse pregnancy outcomes in patients with preeclampsia and the predictive value of serum trace elements in the second trimester.Methods A total of 98 patients with preeclampsia admitted to Qujing First People's Hospital from January 2019 to June 2022 were enrolled in the study.Patients were divided into poor outcome group and good outcome group according to whether they had adverse pregnancy outcomes.The clinical data of all patients enrolled in the study were col-lected and the serum levels of trace elements calcium,copper,zinc and iron were detected in the second trimes-ter.Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of ad-verse pregnancy outcomes in patients with preeclampsia.The levels of serum trace elements in the second tri-mester of pregnancy were compared between the poor outcome group and the good outcome group.The re-ceiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum trace elements calcium,copper,zinc and iron for adverse pregnancy outcomes in patients with preeclampsia.Results Univari-ate analysis showed that compared with the good outcome group,the poor outcome group had significantly higher systolic blood pressure,24 h urinary protein quantitation,and D-dimer level(P＜0.05)and significantly less gestational age and platelet count at admission(P＜0.05).Multivariate Logistic regression analysis showed that 24 h urinary protein quantification,D-dimer and platelet count were the influencing factors of ad-verse pregnancy outcomes in patients with preeclampsia(P＜0.05).The levels of serum trace elements calci-um,copper,and zinc in the poor outcome group were significantly lower than those in the good outcome group(P＜0.05),and the level of iron was significantly higher than that in the good outcome group(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum calcium,copper,zinc,and iron in the second trimester of pregnancy for predicting adverse pregnancy outcomes in preeclampsia patients were 0.830(95％CI:0.780-0.880),0.855(95％CI:0.805-0.905),0.847(0.797-0.897)and 0.861(95％CI:0.811-0.911),respectively.Conclusion Adverse pregnancy outcomes in patients with preeclampsia are re-lated to 24 h urine protein,D-dimer and platelet count.The levels of serum trace elements calcium,copper,zinc and iron in the second trimester of pregnancy change significantly in patients with adverse pregnancy out-comes,which may become predictive markers of adverse pregnancy outcomes.

Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.

Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F

Objective:Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures.Methods:According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized.Results:Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness.Conclusion:Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Objective:Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures.Methods:According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized.Results:Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness.Conclusion:Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Objective:To describe and analyze the self-care contributions of caregivers of chronic patients and provide guidance for future research on caregivers' contributions.Methods:Using the scoping review method, the computer search was conducted on PubMed, Web of Science, CINAHL, Embase, Cochrane Library, Medline, China National Knowledge Infrastructure, China Biology Medicine disc, VIP and Wanfang database. The search period was from the establishment of the databases to June 10, 2023, and the included literature was summarized and analyzed.Results:A total of 40 articles were included, of which 6 observational studies reported the significance of caregivers' self-care contributions to patients with chronic diseases. 17 articles reported measuring tools for caregivers' self-care contributions, 11 studies involved the influencing factors of caregivers' self-care contribution and 6 articles reported the intervention methods related to caregiver self-care contribution.Conclusions:Caregivers are of great significance to the health promotion behavior of patients with chronic diseases. Medical staff should accurately evaluate the self-care contributions of caregivers for chronic disease patients, implement personalized intervention measures to improve their quality of life and clinical outcomes.

Objective:To compare the efficacies of negative pressure wound therapy (NPWT) and functional dressings in primary repair of spinal cord injury complicated with lacunar soft tissue defects.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with spinal cord injury complicated with lacunar soft tissue defects. The patients were admitted to West China Hospital, Sichuan University from January 2020 to December 2022, including 20 males and 10 females; aged 23-54 years [(42.1±7.8)years]. Wound site was located at the sacrococcygeal region in 16 patients, the buttock in 11, and the femoral trochanter in 3. Wound area was 28-36 cm 2 [(32.1±2.1)cm 2]. Time of wound formation was at range of 1-4 months [(2.0±0.8)months]. Among them, 15 patients received functional dressing treatment after mechanical/ultrasonic debridement (dressing treatment group), and 15 patients received NPWT treatment on the basis of mechanical/ultrasonic debridement (negative pressure treatment group). The following items were compared between the two groups: the time of primary wound repair, results of bacterial culture of wound secretions before and at the end of primary wound repair, and levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP) as well as Bates-Jensen wound assessment tool (BWAT) score before, at 5 days after the primary repair and at the end of the primary repair. Results:All the patients were followed up for 3-6 months [(4.1±0.9)months]. The time of primary wound repair in the negative pressure treatment group was (13.4±2.3)days, which was markedly shorter than that in the dressing treatment group [(22.8±2.5)days] ( P<0.01). Before the primary repair, 11 patients in the negative pressure treatment group showed positive bacterial culture of wound secretions [73.3% (11/15)], and 9 patients in the dressing treatment group were positive [60.0% (9/15)] ( P>0.05). At the end of primary repair, there was 1 patient with positive bacterial culture of wound secretions in the negative pressure treatment group [6.7% (1/15)], which was less than 7 patients in the dressing treatment group [46.7% (7/15)] ( P<0.05). The numbers of positive patients at the end of the primary repair were lower than those before the primary repair in both groups, and the difference in the negative pressure treatment group was statistically significant ( P<0.01), with no significant difference found in the dressing treatment group ( P>0.05). Before the primary repair, the IL-6, CRP and BWAT score were 20.5(8.4, 32.3)pg/ml, 24.2(14.7, 33.0)mg/L, and (37.1±4.8)points in the negative pressure treatment group, comparable with 13.8(11.8, 35.4)pg/ml, 23.6(13.1, 52.3)mg/L, and (35.2±4.7)points in the dressing treatment group (all P>0.05). At 5 days after primary repair, the IL-6, CRP and BWAT score in the negative pressure treatment group were 20.2(7.9, 28.6)pg/ml, 20.0(11.6, 30.5)mg/L, and (34.9±4.3)points, comparable with 11.6(8.9, 20.6)pg/ml, 25.3(10.0, 50.3)mg/L, and (35.2±4.5)points in the dressing treatment group (all P>0.05). At the end of primary repair, the IL-6, CRP and BWAT score were 2.3(1.5, 4.5)pg/ml, 4.8(3.7, 6.9)mg/L, and (23.6±1.8)points in the negative pressure treatment group, statistically different from 4.4(3.3, 6.9)pg/ml, 8.4(5.5, 31.4)mg/L, and (31.4±3.3)points in the dressing treatment group (all P<0.01). The IL-6, CRP and BWAT score at the end of the primary repair were significantly different compared with those before and at 5 days after the primary repair in the two groups ( P<0.05 or 0.01). However, no significant difference was found between the two groups before and at 5 days after the primary repair (all P>0.05). Conclusion:Compared with functional dressings, NPWT can shorten the time required for primary repair of spinal cord injury complicated with lacunar soft tissue defects, control the inflammatory state of the wound, improve the trend of wound healing, and create a good condition for secondary repair treatment of the wound.

Objective:To explore the development trends, frontiers, and hotspots of research on early rehabilitation for patients with severe neurological diseases at home and abroad in the past 10 years, with a view to providing reference for the development of early rehabilitation for patients with severe neurological diseases in China.Methods:The article on early rehabilitation for patients with severe neurological diseases was systematically searched in the Web of Science and China National Knowledge Infrastructure (CNKI) . The search period was from January 1, 2012 to June 1, 2022. CiteSpace software was used to construct a visual graph of early rehabilitation for patients with severe neurological diseases in authoritative databases in both Chinese and English, for agency cooperation, author cooperation, keyword co-occurrence, and keyword clustering analysis.Results:A total of 349 articles were included, including 237 Chinese articles and 112 English articles. According to the search results of CNKI, there were 161 institutions publishing article related to early rehabilitation for patients with severe neurological diseases in China, among which the Nursing Department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School had the highest number of publications (4 articles) . The search results of the Web of Science showed that there were 160 institutions publishing article in this field, among which the Florey Institute of Neuroscience and Mental Health in Australia in Australia had the highest number of publications (16 articles) . Foreign researchers mainly focused on the safety assessment and timing of early rehabilitation for patients with severe neurological diseases, while domestic research mainly focused on the evaluation of the effectiveness of different rehabilitation methods on early rehabilitation for patients with severe neurological diseases.Conclusions:The research on early rehabilitation of patients with severe neurological diseases in foreign countries is more in-depth and comprehensive than in China, and there are more multi-center clinical studies, providing a high-level evidence for clinical decision-making. On the basis of existing research results, domestic scholars should focus on strengthening interdisciplinary and inter institutional cooperation, improving the quality and effectiveness of rehabilitation, and fully leveraging the leading role of nurses while collaborating across multiple disciplines.

Objective:To retrieve, evaluate, and integrate the best evidence of low-fiber diet bowel preparation before colonoscopy in children, providing a basis for clinical nursing practice.Methods:Guidelines, systematic reviews, evidence summaries, expert consensus, randomized controlled trials and so on related to bowel preparation for low-fiber diet before colonoscopy in children were searched through computers in domestic and foreign databases, guideline websites and professional association websites. The search period was from database establishment to October 31, 2021. The evidence included was graded using the Joanna Briggs Institute (JBI) evidence pre-grading and evidence recommendation grading system (2014 version) in Australia.Results:A total of 8 articles were included, including four guidelines, one evidence summary, one systematic review, one expert consensus, and one randomized controlled trial. A total of 25 pieces of evidence were summarized from 7 aspects, including assessment before eating, duration of dietary restriction, dietary content, evaluation indicators, eating effectiveness, bowel preparation methods, and health education.Conclusions:This study strictly follows evidence-based methods and summarizes the best evidence of low-fiber diet bowel preparation before colonoscopy in children. This can provide reference for the standardization of low-fiber diet bowel preparation before colonoscopy in children in China, and improve the quality of bowel preparation before colonoscopy in children.