Objective:To construct a postoperative nursing plan for liver transplant recipients using the NANDA international, nursing outcomes classification, nursing intervention classification (NANDA-I-NOC-NIC) link (referred to as NNN-link) as the theoretical framework, so as to optimize the nursing process after liver transplantation and improve the quality of nursing.Methods:This study retrospectively collected nursing diagnoses with a postoperative usage rate of over 50% from 300 liver transplant recipients at Shulan (Hangzhou) Hospital from January 2019 to December 2021, and matched nursing outcomes and measures based on the NNN-link theory framework. After two rounds of Delphi expert consultation and group discussion, the entry content was rated, discussed, and modified to form the final version of the postoperative NNN-link for liver transplant recipients.Results:In two rounds of expert consultation, the recovery rates were 96.67% (29/30) and 100.00% (29/29) , respectively. The expert authority coefficients were 0.83 and 0.84, respectively. The Kendall harmony coefficients for the second round were 0.50, 0.38, 0.35. The final postoperative NNN-link for liver transplant recipients included 15 nursing diagnoses, 42 nursing outcomes, and 106 nursing measures.Conclusions:The process of constructing the postoperative NNN-link for liver transplant recipients is scientific and reasonable, and the entries are highly specialized, which can provide reference for clinical nursing after liver transplantation.

Objective:To summarize the electroclinical characteristics of patients with epilepsy with myoclonic absence（EMA）and analyze the relationship with prognosis.Methods:Clinical data of 25 patients with EMA monitored at the pediatric EEG monitoring centers of Peking University People's Hospital and Peking University First Hospital between January 2012 and December 2022 were retrospectively analyzed and divided into three groups according to development before and after the onset of the disease to analyze the electroclinical characteristics and the relationship with prognosis.Results:There were 14 males and 11 females in 25 cases，and the median age of epilepy onset was 48（26，74）months.Sixteen cases in the group with normal development before and after the onset of epilepsy（group A），5 cases in the group with normal development before the onset of epilepsy but retarded development after the onset of epilepsy（group B），and 4 cases in the group with retarded development before and after the onset of epilepsy（group C）.The median age at onset was 62（36，82）months，34（21，66）months，and 26（20，32）months in the three groups，with 3，3，and 4 cases of early onset in each group，respectively.The EEG background activity slowed down in 10 cases，with 6，1 and 3 cases in the three groups，respectively.Interictal EEG was normal in 1 and abnormal in 24 cases，which showed generalized discharges，of which 11 cases showed coexisting focal discharges and generalized discharges.Among the focal discharges，there were cases in all three groups，involving the anterior-posterior，temporal and Rolandic regions.Fifteen cases had myoclonic absence（MA）induced by hyperventilation，with 10 cases in group A，4 cases in group B and 1 case in group C.The most prevalent concomitant seizure was myoclonic seizure（MS），with 9，3 and 2 cases in each group respectively.Statistically significant differences were seen in early onset and refractory EMA among the three groups（both P<0.05）.In further two by two comparisons，the proportion of early onset and drug refractory cases was greater in children in group C than in group A，with statistically significant differences（both P<0.017），and the difference in concomitant MS among the three groups was not statistically significant（ P>0.05）. Conclusions:The MA seizures in children with EMA are sensitive to hyperventilation.The common accompanying seizure is MS.Some children with EMA present with early onset and refractory epilepsy，with a tendency towards developmental epileptic encephalopathy.

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Objective:To study the effect of melatonin (MEL) on the pyroptosis of hippocampus in neonatal rats with hypoxic-ischemic brain damage (HIBD), and the related mechanism.Methods:The animal model of HIBD was established by the modified Rice method.According to the random number table, a total of 105 Sprague-Dawley (SD) rats aged 7 days were divided into 7 groups (15 rats in each group): sham operation (Sham) group, model (HIBD) group, MEL treatment group (5, 10 and 20 mg/kg), phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway inhibitor (LY294002) treatment group and MEL+ LY294002 group.The hippocampus neuronal morphology and the changes of nissl bodies were observed through HE staining and nissl staining.The mRNA expression levels of Nod-like receptor family 3 (NLRP3), apoptosis-associated speck-like protein containing a card (ASC), Caspase-1, gasdermin D (GSDMD), interleukin-1β (IL-1β) and interleukin-18 (IL-18) in the left hippocampus of rats were detected by real-time fluorescence quantitative PCR.The protein expression level of the above indexes and the level of phosphorylated Akt (p-Akt) were measured by Western blot.Results:Compared with the Sham group, the number of cell layers in hippocampal CA1 region in the HIBD group decreased, the cell arrangement was irregular, and there were less nissl bodies.Besides, the mRNA expression levels of NLRP3 (1.98±0.08 vs.0.86±0.13), ASC (1.40±0.12 vs.0.81±0.07), Caspase-1 (1.46±0.10 vs.0.75±0.09), GSDMD (1.35±0.10 vs.0.81±0.10), IL-18 (1.23±0.08 vs.0.23±0.04), IL-1β (1.83±0.09 vs.0.57±0.08) and p-Akt (1.12±0.12 vs.0.54±0.07) in the HIBD group were significant higher than those in the Sham group (all P<0.05). Compared with the HIBD group, there were more cell layers in hippocampal CA1 region of the MEL group (10 mg/kg), the arrangement of cells was more regular, and the number of nissl bodies increased.The mRNA expression levels of NLRP3 (1.04±0.10), ASC (0.91±0.06), Caspase-1 (0.63±0.06), GSDMD (1.01±0.09), IL-18 (0.65±0.05) and IL-1β (0.63±0.10) in the MEL group were statistically significantly lower than those in the HIBD group (all P<0.05). Compared with the MEL group (10 mg/kg), the arrangement of cells in hippocampal CA1 region of the MEL+ LY294002 group was relatively disordered, the nissl bodies declined, the p-Akt protein level (0.87±0.09 vs.1.99±0.27) decreased significantly, and the Caspase-1(p20) protein level (0.85±0.09 vs.0.58±0.09) increased significantly (all P<0.05). Conclusions:MEL may inhibit the hippocampal pyroptosis in neonatal rats with HIBD by activating the Akt signaling pathway, thereby protecting the brain.

Objective:To explore the effects and mechanism of PR-957 on hypoxic-ischemic brain damage(HIBD) of newborn rats.Methods:A total of 54 rats aged seven days were recruited and randomly divided into sham operation group, HIBD group and PR-957 intraperitoneal group.HIBD model was established according to modified Rice method.PR-957 group was given intraperitoneal injection PR-957(20 mg/kg) after hypoxic-ischemic.Model group was intraperitoneally injected with equal volume of DMSO.Ligation or hypoxic treatment were not given in sham operation group.HE staining was applied to observe inflammation in cortex.Immunohistochemical analysis was adopted to observe the expression of interleukin(IL)-17 and IL-10 in brain tissue.Western blot was carried out to test the protein level of low molecular poly peptide 7 (LMP7), forkhead box P3(FOXP3), and retinoic acid-recepter-related orphan receptor gamma t(RORγt). The proportion of T helper cells 17(Th17)/Treg was detected by flow cytometry.Results:HE staining displayed that sham operation group brain structure was basically normal, HIBD group revealed significant inflammation in the left cerebral cortex, while some pathological improvement was observed in PR-957 group.Immunohistochemistry: IL-10 positive cells in left cortex of HIBD group [(12.11±3.73)%] were lower than sham operation group[(29.12±3.95)%] and PR-957 group[(22.61±6.59)%], and the differences were statistically significant (all P<0.05). IL-17 positive cells in the left cortex of HIBD group [(35.55±4.85)%] were higher than sham operation group [(8.48±2.58)%] and PR-957 group [(19.16±4.31)%], and the differences were statistically significant (all P<0.05). Western blot: the expression of LMP7 and RORγt in HIBD group (1.01±0.12, 0.71±0.10) were higher than those in sham operation group (0.50±0.10, 0.34±0.07) and PR-957 group (0.65±0.13, 0.54±0.07), and the differences were statistically significant ( P<0.05). The expression of FOXP3 in HIBD group (0.44±0.10) was lower than sham operation group (0.93±0.07) and PR-957 group (0.68±0.09), and the differences were statistically significant (all P<0.05). The flow cytometry of peripheral blood: the Th17/Treg ratio of HIBD group (0.66±0.24) was higher than sham operation group (0.20±0.09) and PR-957 group (0.45±0.18), and the differences were statistically significant (all P<0.05). Conclusion:PR-957 can regulate the immune balance of Th17/Treg cells and reduce the inflammatory in the brain tissues of HIBD newborn rats.

In the COVID-19 epidemic prevention and control work, not only the safety management of in-hospital organ transplantation is facing severe challenges, but also a large number of patients at home after transplantation are in immunosuppressive state, and professional protection management is urgently needed. Since the outbreak of the epidemic, Shulan(Hangzhou)hospital fully identified the risks of transplant patients, established a special team, and formulated and implemented the control management plan for organ transplant patients based on the crisis leadership model. The control management plan has achieved staged results.From January 15 to March 2, 2020, 29 liver transplants and 31 kidney transplants were performed in our hospital. The remote health education of 1 002 patients after liver and kidney transplantation was completed. The goal of " zero infection" was achieved, and the protection management quality indicators were ideal.

Objective: To analyze the activation of brain regions associated with olfactory in patients with mild cognitive impairment (MCI) by olfactory functional magnetic resonance imaging (fMRI). Methods: Twenty six patients with MCI were compared with twenty six controls in the dementia center of Tianjin HuanHu hospital in terms of olfactory function T&T testing, the differences between the activation of the whole brain and region of interest associated with olfactory (bilateral primary olfactory cortex(POC), bilateral hippocampus, bilateral orbital frontal gyrus) by olfactory stimulator using event correlation design for olfactory fMRI scanning. To analyze the correlation between the number of activator in POC and the threshold of olfactory discriminate as well as the severity of cognitive impairment.SPSS 19.0 software was used for the statistical analysis. Results: T&T olfactory testing revealed that MCI patients had higher scores than controls (3.57±1.29 (±s) vs 1.02±0.35, t=4.372, P<0.05). The activation range of whole brain in MCI patients was less than controls (pleasant odor (po) 147.36±21.45 vs 323.11±39.76, unpleasant odor (upo) 201.86±24.93 vs 447.73±57.22, t_po=4.241, t_upo=5.365, both P<0.05). The activation range of whole brain in inhaling unpleasant odor was more than pleasant odor in controls (447.73±57.22 vs 323.11±39.76, t=3.936, P<0.05). The number of activator in ROI_awo in MCI patients was less than controls (pleasant odor (po) 51.0[8.0, 109.0](M[P₂₅, P₇₅]) vs 135.0[21.0, 321.5], unpleasant odor (upo) 65.0[6.0, 158.0]vs 205.0[36.5, 491.0], Z_po=-2.199, Z_upo=-2.216, both P<0.05). The number of activator in POC in MCI patients was less than controls (pleasant odor (po) 19.0[4.0, 35.5]vs 46.0[9.0, 118.5], unpleasant odor (upo) 26.0[2.0, 51.0]vs 79.0[17.5, 189.0], Z_po=-1.898, Z_upo=-2.167, both P<0.05). The number of activator in POC was negatively correlated with olfactory discriminate threshold in MCI patients (r_po=-0.415, r_upo=-0.409, both P<0.05). The number of activator in POC was positively correlated with MoCA in MCI patients (r_po=0.289, r_upo=0.296, both P<0.05). Conclusion Olfactory fMRI can objectively assess the olfactory function in MCI, it is a imaging indicator with neuropsychological tests for detection in MCI, the number of activator in POC can reflect the severity of MCI.

Traditional Chinese medicine thinking is the core method of diagnosis and treatment of traditional Chinese medicine. Thus, cultivating the clinical thinking of traditional Chinese medicine in the orthopeadics department has become the importance. TCM tendon and muscle injuries were well characterised by the TCM, becoming an important part of TCM orthopedics., The tendon and muscle injuries were used to explore the application and cultivation of traditional Chinese medicine thinking. This will help to improve the clinical curative effect, complement the modern Chinese medicine.

OBJECTIVETo compare the effects of acupuncture on sphenopalatine ganglion and acupuncture on the common acupoints for life quality of patients with allergic rhinitis(AR).

METHODSEighty patients with AR,who were in accord with the inclusive criteria,were randomly divided into an observation group and a control group,40 cases in each one. Acupuncture on sphenopalatine ganglion was used in the observation group. The needle was inserted into the gap between zygoma and mandibular coronoid process about 55 mm. Acupuncture was adopted on the main acupoints,Yingxiang(LI 20),Yintang(GV 29) or Fengchi(GB 20) in the control group. The course was four weeks. Follow-up was applied one month after treatment. Rhinoconjunctivitis quality of life questionnaire (RQLQ),rhinitis symptoms scale and visual analogue scale(VAS) were evaluated at different time points before and after treatment,and follow-up was implemented to know the recurrence situation,satisfactory degree and adverse reaction.

RESULTS(1) RQLQ scores:along with treatment,the RQLQ scores were gradually apparently decreased in the two groups(<0.01),and the reducing trend from the first week to the second week of the observation group was more obvious than that of the control group. The differences of the RQLQ scores at all timepoints after treatment between the two groups were not statistically significant(all>0.05). The interaction of the time factor and the group factor had statistical significance(<0.01). (2) Rhinitis symptoms scores:along with treatment,the scores presented decreasing trend in the two groups(<0.01). The scores of the two groups after treatment and the interaction of the time factor and the group factor were not statistically different(both>0.05). (3)VAS scores:the VAS scores after treatment were lower than those before treatment(both<0.01). The differences before and after treatment were statistically significant(<0.01),with more change in the observation group(<0.05). (4)There was no statistical significance about the number of recurrence days between the two groups(>0.05). (5) Above 80 percent patients were content with the therapeutic method in each group,with no statistical difference(>0.05). (6)The method of the observation group spent less time. (7) Two patients with light adverse reaction came up in the observation group,but no special treatment was needed.

CONCLUSIONSAcupuncture on sphenopalatine ganglion acquires more obvious short-term effect than conventional acupuncture. It spends less time to relieve symptoms and improves life quality.

OBJECTIVETo identify the feasibility and safety of fossa infratemporalis approach for blind-needle at sphenopalatine ganglion so as to provide anatomical evidence for the operation and the prevention of non-immediate adverse reaction.

METHODSThe variations of pterygopalatine fossae in sixty dry skulls were observed by selecting measuring points for facial skull width. The brains of six wet skulls were taken out,then acupuncture of fossa infratemporalis approach was applied. Sphenopalatine ganglion was separated accurately with the pterygopalatine segment of maxillary arteria retained in the pterygopalatine fossa after its paries posterior was opened. We detected whether the needle was inserted into pterygopalatine fossa. Measurements showed needle inserted depth, facial skull width,the distance between the needle and sphenopalatine ganglion,the distance between the needle and the pterygopalatine segment of maxillary arteria,the distance between the pterygopalatine segment of maxillary arteria and the crotaphitic nerve in pterygopalatine fossa.

RESULTSThe distance between the slight hollow under bilateral arcus superciliaris was selected as skull width, and 3 dry skulls showed the variation of pterygopalatine fossa. Needles were inserted into the pterygopalatine fossae of the wet skulls (12 times). The proportion of the inserting depth to the distance between the slight hollow under bilateral arcus superciliaris was 44%-54%. Only twice did the needle contact sphenopalatine ganglion. The average distances between the sphenopalatine ganglion and the needle were (5.88±3.70) mm in the left side and (6.43±5.54) mm in the right side. The average distances between the needle and the pterygopalatine segment of maxillary arteria were (2.77±3.99) mm left and (2.53±3.10) mm right. The average distances between the pterygopalatine segment of maxillary arteria and the crotaphitic nerve in pterygopalatine fossa were (2.83±4.05) mm left and (2.67±4.95) mm right. The mean data between the two sides had no statistic significance about all the above indices (all>0.05).

CONCLUSIONSFossa infratemporalis approach is feasible for blind-needle at sphenopalatine ganglion with less possibility to contact it. The effect of treating nasitis may achieved by little distance to nerve. Pricking at the pterygopalatine segment of maxillary arteria may induce non-immediate adverse reaction. The safety and efficacy should be comprehensively considered. There is a proportional relationship between the width of the skull and the insertion depth of the needle. The inserting depth of 44 percent may appropriate accounted for skull width.