Objective To investigate the impact and significance of a precision nursing plan during the surgical manage-ment of femoral neck fractures in elderly patients.Methods From May 2022 to May 2023,70 patients with femoral neck frac-tures,including medium-sized neck and head-type,were randomly divided into a control group and an observation group equally.The two groups were managed with routine nursing interventions and specific nursing interventions,respectively.The two groups were compared in terms of the psychological status,complications,hip joint functions,and prognostic effects.Results After the intervention,the psychological status scores of both two groups significantly decreased.The observation group showed lower psy-chological status scores,indicating better psychological status compared to the control group(P＜0.05).The rate of postopera-tive complications in the observation group was significantly lower than that of the control group(P＜0.05).Additionally,the scores of hip joint function in the observation group were higher than those of the control group(P＜0.05).At the time of dis-charge,the scores of self-care ability in both two groups had increased,and the scores of femoral head necrosis were significantly decreased after 3 months of interventions(P＜0.05).Furthermore,the self-care ability scores in the observation group were higher,and the scores of femoral head necrosis were lower compared to those of the control group,indicating that the prognosis of the observation group was better than that of the control group(P＜0.05).Conclusion The precise nursing interventions could effectively enhance the prognosis of elderly patients with femoral neck fractures and improve their self-care ability.

Objective    To compare and investigate the efficacy and differences of modified B-T shunt, central shunt and right ventricle-pulmonary artery (RV-PA) connection in the treatment of pulmonary atresia with ventricular septal defect (PA/VSD). Methods    A total of 124 children with PA/VSD underwent initial palliative repair in Shanghai Children's Medical Center from September 2014 to August 2019, including 63 males and 61 females, aged 7 days to 15 years. They were divided into in a modified B-T shunt group (55 patients), a central shunt group (22 patients) and a RV-PA connection group (47 patients). The clinical data of these children were retrospectively analyzed. Results    There were 9 early deaths after palliation, with an early mortality rate of 7.3%. The mean follow-up time was 26.5±20.3 months, with 5 patients lost to follow-up, 5 deaths during the follow-up period, and 105 survivors. The 1-year and 5-year survival rates were both 89.7%. The monthly increased Nakata index was 5.2 (–0.2, 12.3) mm2/m2, 9.2 (0.1, 23.6) mm2/m2, 6.3 (1.8, 23.3) mm2/m2 in the modified B-T shunt group, the central shunt group, and the RV-PA connection group, respectively, with no statistical difference among the three groups. The 1-year survival rate was 85.3%, 78.4%, 95.2%, and the 5-year (4-year in the central shunt group) survival rate was 85.3%, 58.8%, 95.2% in the three groups, respectively, with a statistical difference among them (P<0.05). The complete repair rate was 36.5%, 19.0% and 67.4% in the three groups, respectively, with a statistical difference among the three groups (P<0.001). Conclusion    All these three palliative surgical approaches can effectively promote pulmonary vascular development. But compared with systemic-pulmonary shunt, RV-PA connection has a lower perioperative mortality rate and can achieve a higher complete repair rate at a later stage, which is beneficial for long-term prognosis.

Objective:To optimize the strategy of Nuss procedure with open approach via median sternotomy for pectus excavatum(PE) with congenital heart disease(CHD).Methods:25 PE patients with CHD treated in our center from January 2017 to November 2021 were reviewed and divided into two groups. The CHD surgery and open Nuss procedure with median sternotomy were performed concomitantly in 9 cases(group A), whose height of(121.7±28.0)cm, weight of(22.2±14.0)kg, age of(7.65±4.08) years old, and Haller index of 3.99±1.37. 16 cases underwent open Nuss procedure via median re-sternotomy after congenital heart surgery(group B), whose height of(130.9±27.2)cm, weight of(26.5±14.3)kg, age of(8.82±4.09) years old, and Haller index of 4.18 ± 0.97. The cardiac anatomy, cardiac function and the severity of PE of all patients were evaluated by echocardiography and computed tomography preoperatively. The preoperative gender, appearance of PE, types of associated CHD, retrosternal adhesion and the interval between open Nuss procedure and CHD surgery were collected. The details of operation, hospital stay, intraoperative adverse events, postoperative complications and follow-up were collected.Results:All the operations were accomplished successfully in 25 children. No intraoperative complications occurred. One had a postoperative wound infection in group A. The operation time of group A was significantly longer than that of group B[(3.78±1.54) h vs.(2.19±0.94) h, P<0.05]. There was no significant difference in the mechanical ventilation time between the two groups[(22.50±45.64) h vs.(4.18±1.41) h, P=0.263]. The ICU stay of group A was significantly longer than that of group B[(4.00±6.42) days vs.(1.13±0.34) days, P<0.05]. There was no significant difference in the length of hospital stay between the two groups[(16.00±15.18) days vs.(9.19±2.31) days, P=0.419]. The Nuss bar was removed in 14 cases of the two groups, with a interval of(27.9±11.25) months after open Nuss procedure, the postoperative Haller Index was 2.48±0.49. There was no difference of LVEF in postoperative and preoperative echocardiography(0.663±0.028 vs. 0.659±0.038, P=0.533). The FVC and FEV1 were significantly improved compared with before operation[(87.2±3.9)% vs.(84.1±8.2)%]. The outcome was good. Conclusion:For PE patients with CHD, one-stage or staged individualized Nuss procedure with open approach via median sternotomy can be performed after careful preoperative evaluation. A skillful median re-sternotomy and widely dissecting retrosternal adhesion between sternum and anterior wall of heart are necessary to avoid serious intraoperative complications such as massive heart bleeding and ensure good sternal elevation.

OBJECTIVE To compare the antibacterial drugs between the 2021 edition of WHO Model List of Essential Medicines for Children （WHO EMLc） and the 2018 edition of National Essential Medicines List of China （NEML）， and provide reference for the drug selection of Chinese essential medicine list for children.　METHODS By means of descriptive analysis， the similarities and differences in classification methods， special markers， the varieties， dosage forms and specifications were compared between WHO EMLc and NEML.　RESULTS WHO EMLc had strict limits and classifications on the antibacterial drugs， marked the age and weight of children who were restricted to use， and focused on the drug resistances and safety in children. In terms of varieties， there were 51 kinds of antibacterial drugs in NEML and 62 in WHO EMLc； 36 kinds of antibacterial drugs were both included in NEML and WHO EMLc； some antibacterial drugs， such as cloxacillin， procaine penicillin and ceftazidime avibactam， were listed in WHO EMLc but not in NEML. In terms of dosage forms， the dosage forms of antibacterial drugs included in WHO EMLc were more abundant and flexible， such as oral liquids， powder for oral liquids and scored tablets which were not included in NEML， and could improve the compliance of children’s medication and the accuracy of dosage. In terms of specifications， the total numbers of the specifications of antibacterial drugs both included in the two lists were close， but the specifications of some drugs included in NEML were more abundant， and the minimum specifications included in NEML were smaller. Although some of the unique antibacterial drugs included in WHO EMLc were listed in China， they could not be used in children due to the lack of drug data on children in China， such as clofazimine， bedaquinoline and delamanid.　CONCLUSIONS The antibacterial drugs included in NEML can not fully meet the medication needs of children in China. WHO EMLc has certain advantage and rationality as a special list for children. The relevant departments in China can learn from the excellent experience of WHO EMLc， improve the information of pediatric medication of NEML and launch Chinese Essential Medicine List for Children as soon as possible.

OBJECTIVE To compare the dosage forms and specifications of over-the-counter drug （OTC）（chemical drugs ） for children at home and abroad ，and to provide reference for the addition of new dosage forms and specifications of OTC for children in China . METHODS Data analysis was used to comb the active ingredients of OTC single -ingredient preparation for children in China . The similarities and differences of the dosage forms and specifications of OTC for children with the same active ingredients among China and 8th edition of WHO Model List of Essential Medicines for Children （WHO EMLc ）and US/UK/EU （this article refers specifically to EU countries ）/Japan were analyzed by comparative analysis . RESULTS There were 72 active ingredients of OTC single -ingredient preparation for children in China ，corresponding to 34 dosage forms and 216 specifications； 39 same active ingredients of OTC for children were retrieved in WHO EMLc and US/UK/EU/Japan ，corresponding to 38 dosage forms and 258 specifications. Among OTC for children corresponding to 39 active ingredients ，there were 10 unique dosage forms in China ，and 16 unique dosage forms in WHO EMLc and US/UK/EU/Japan ，of which some dosage forms have advantages for children（such as chewing gums ，gels for external use ，spray for oral liquid ，etc.），were included in the latter while not included in China . There were 107 unique specifications in China ，and 214 unique specifications in WHO EMLc and US/UK/EU/Japan ，of which the division of applicable age groups for specifications was more detailed . In addition ，the dosage forms and specifications corresponding to a few active ingredients （such as ibuprofen ，cetirizine hydrochloride ）were not included in OTC for children in China， while included in UK/EU . CONCLUSIONS The dosage forms and specifications of OTC for children in WHO EMLc and US/UK/EU/Japan are generally more abundant and E-mail：zjfyouyou@163.com flexible than in China . Relevant departments in China should learn from the advanced experience of WHO and foreign countries and increase the research and development of dosage forms and specifications of OTC for children .

Objective:To explore the status quo of spiritual care needs of patients with gynecological malignant tumors, and analyze their influencing factors.Methods:Totally 100 patients with gynecological tumors hospitalized by the Fifth Affiliated Hospital of Xinjiang Medical University from March 2018 to March 2021 were selected by convenient sampling and investigated with the general information questionnaire, the Chinese version of the Death Attitude Profile-Revised (DAP-R) , and the Chinese version of the Nurse Spiritual Therapeutics Scale (NSTS) . Multiple linear regression was used to analyze the related factors affecting the spiritual care needs of patients with gynecological tumors. A total of 100 questionnaires were distributed in this study, and 100 valid questionnaires were returned.Results:The total score of spiritual care needs of 100 patients with gynecological malignant tumors was (65.14±11.37) , at a medium level. The results of multiple linear regression analysis showed that the duration of disease, religious belief, tumor stage, and fear of death were the influencing factors for the spiritual care needs of patients with gynecological malignant tumors ( P<0.05) . Conclusions:The spiritual care needs of patients with gynecological malignant tumors are at a moderate level, which is affected by the duration of disease, religious beliefs, tumor stage, and fear of death. Targeted nursing interventions should be given to patients with gynecological malignant tumors in clinical practice.

Objective    To investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation. Methods    A total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed. Results    Patients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. Conclusion    AVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.

Objective:To develop an UPLC-MS/MS method for the determination of paeoniflorin, tetramethylpyrazine, nobiletin, paeonol, amygdalin and ligustilide in Gexia-Zhuyu Decoction. Methods:Isocratic elution was carried out with mobile phase consisting of methanol- 4 mM ammonium formate. The separation was performed on Waters XTerra MS C18 (2.1 mm × 50 mm, 3.5 μm), and the mass spectrometer was operated in the positive and negative ionization electrospray (ESI) mode using multiple monitoring (MRM) for analysis of six components. Quantitative analysis by external standard method. The precursor to product ion transitions monitored for paeoniflorin, tetramethylpyrazine, nobiletin, paeonol, amygdalin and ligustilide were m/z 525.0→449.1, 137.1→55.1, 403.0→373.0, 167.2→149.4, 456.5→323.3 and 191.1→91.1, respectively. Results:Paeoniflorin, tetramethylpyrazine, nobiletin, paeonol, amygdalin and ligustilide were all analyzed exactly, the linear ranges were 0.000 2-0.012 8, 0.000 8-0.051 2, 0.000 1-0.006 4, 0.000 2-0.012 8, 0.000 6-0.038 4, 0.000 1- 0.006 4 ng, respectively. The r were 0.999 3, 0.997 5, 0.999 6, 0.992 6, 0.995 5 and 0.999 1, respectively. The recoveries of six analytes ranged from 98.00% to 105.3% and the relative standard deviations ( RSD) were all below 2.47%. Conclusions:This method was sensitive, which could be applied for the determination of paeoniflorin, tetramethylpyrazine, nobiletin, paeonol, amygdalin and ligustilide in Gexia-Zhuyu Decoction.

To analyze the outcomes of early Fontan failure after Fontan takedown. Methods A retrospective study of early Fontan Failure(EFF) children undergoing Fontan takedown from November 2013 to December 2017 was performed. Fontan takedown was defined as takedown back to an intermediate circulation, superior cavopulmonary connection. Fontan takedown was performed in 14 patients. There were 9 boys and 5 girls. Children were on average aged(4. 3 ± 1. 4) years when they had Fontan procedure. The mean weight was(14. 3 ±2. 7)kg. Operative procedure was extra-cardiac Fontan in 5 children, 9 had intra-cardiac Fontan. Fenestration was used in 11/14 patients. The outcomes were summarized with statistics, and risk factors for mortality after Fontan takedown were identified. Results The mortality after Fontan takedown was 4/ 14(28. 6％). In two patients(14. 3％), ECMO was followed after takedown, one of them died after two days. The time of ICU stay and hospital stay was relatively long(17. 0 ±11. 2)days and(33. 8 ±19. 4)days. The interval time between the Fontan procedure and the takedown operation is the risk fact after Fontan takedown. Conclusion Fontan takedown can be used as an effective management for the early Fontan failure, still with a high risk of mortality. Early diagnosis and takedown is recommended for EFF.

Objective To summarize 566 consecutive cases of Fontan operation in the treatments of complex congenital heart diseases and to analyze the risk factors of early surgical outcome.Methods We reviewed all 566 consecutive patients who underwent a Fontan procedure in Shanghai Children's Medical Center from January 2006 to May 2014.Preoperative records of staged surgeries,perioperative data and imaging results were obtained from medical records.Results A total of 566 patients(M/F =345/221) underwent a Fontan operation,with 166 cases of single stage Fontan operation and 400 cases of multi-staged operation.The median age at the time of the Fontan procedure was 5 years,and the median weight was 15.4 kg.In our series,there were 278 extracardiac conduits,110 intracardiac conduits,114 lateral tunnels,36 intracardiac/extracardiac conduits,and 27 direct cavopulmonary conduits.There were 36 cases of early Fontan failure,with overall early postoperative survival rate being 93.6％.The median ventilation duration was 8 h,with the median postoperative intensive care unit stay being four days,the average oxygen saturation being 0.90 at the end of ICU stay,the median chest drainage time being 10 days,and the median postoperative hospital stay being 19 days.Besides the CICU oxygen saturation,the rest postoperative results had no obvious differences in five surgical groups.Heterotaxy syndrome,earlier age at the time of the Fontan procedure,bilateral Glenn shunt,moderate AV valve regurgitation and severe and right ventricular-type morphology were risk factors of early Fontan failure,P ＜ 0.05.Conclusion In order to improve the early outcome of Fontan operation,closely follow-up should be taken directly after Glenn operation in high-risk patients.Doctors should also have an in-depth understanding of the of postFontan physiological and pathological features,and select the operation time and Fontan type most suited to the of the individualized characteristics.