Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Non-alcoholic fatty liver disease(NAFLD)has become the most important cause of chronic liver disease,and its pathogenic mechanism is very complex.microRNA(miRNA)are widely distributed non-cod-ing RNA.miRNA play an important regulatory role in the pathogenesis and progression of various chronic liv-er diseases,including NAFLD,and may even be used as diagnostic indicators or even therapeutic targets for liver diseases.As a non-invasive biological indicator,a large number of research data show that miRNA has important clinical value in the diagnosis and prognosis of NAFLD.This article provides a review of the re-search progress related to the pathogenic mechanism and clinical diagnostic value of miRNA in NAFLD.

Objective This study aimed to explore the differences and influencing factors of static teeth exposure in different postures of orthognathic surgery patients.Methods A total of 148 patients were collected before or after or-thognathic surgery.Photographs were taken in the upright and supine positions,and the static teeth exposure values were measured to compare whether the difference among different positions was statistically significant.The patients were classified in accordance with gender,presence or absence of orthodontic brackets,measurement time(preoperative or postoperative),and maxillary movement direction(forward or backward),and the difference of static teeth exposure was compared.The correlation between the difference of static teeth exposure and age was analyzed.Results The diffe-rence of static teeth exposure between the two positions was 0.99 mm±0.95 mm,which was statistically significant(P=0.000).A statistical difference in the difference of static exposure was observed between female and male(P<0.05).No statistical difference in the difference of static expo-sure was observed among orthodontic brackets,preopera-tive or postoperative time points,and maxillary move-ment direction.In addition,no significant correlation was found between the difference of static teeth exposure and age(r=-0.087,P=0.291).Conclusion Compared with the upright position,the static exposure of teeth increased by ap-proximately 0.99 mm in the supine position.The difference of static exposure under different postures was greater in males than in females.Furthermore,orthodontic bracket,maxillary surgery,maxillary movement direction,and age had no effect on the difference of static teeth exposure in different postures.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To assess the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis of children with biliary atresia.Methods:A prospective survey of infants with hepatitis syndrome and hyperbi-lirubinemia in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 was performed.The children with hepatitis syndrome were divided into the biliary atresia group( n=45) and non- biliary atresia group( n=30). Thirty children with hyperbilirubinemia were selected as the control group.Shear wave speed (SWS) of all infants was collected by ARFI ultrasound and compared among 3 groups.Receiver ope-rating characteristic curve(ROC curve) was used to analyze the optimal threshold value for SWS in the diagnosis of biliary atresia. Results:The mean SWS values in the biliary atresia group, non-biliary atresia group and the control group were (1.79±0.29) m/s, (1.26±0.12) m/s and (1.08±0.06) m/s, respectively.Compared with the control group, the mean SWS values in the biliary atresia group and non-biliary atresia group were significantly higher ( t=165.43, 15.75, all P<0.05). The mean SWS value in the non-biliary atresia group was significantly lower than that in the biliary atresia group ( t=90.27, P<0.05). With the non-biliary atresia group as reference, the area under the ROC curve of SWS for diagnosis of biliary atresia was 0.98(95% CI: 0.95-1.00), the optimal threshold was 1.45 m/s, and the sensitivity and specificity were 88.9% and 96.7%, respectively. Conclusions:Rapid non-invasive ARFI elastography is effective in the diagnosis of biliary atresia, and thus has important value for early diagnosis and treatment in clinical practice.

Objective:To investigate the anatomy and therapeutic effecton skin soft tissue defect at the great toe of perforator flap from distal deep branch of medial plantar artery.Methods:The arteries of one adult foot specimens were filled with red latex and vascular anatomy was performed. Branch distribution and anastomosis of medial plantar artery and dorsal foot artery were observed. The clinical data of 12 patients with skin soft tissue defect at the great toe repaired by retrograde perforator flap from distal deepbranch of medial plantar artery from September 2016 to September 2019 in Affiliated Hospital of Zunyi Medical University was selected, and the donor sites were repaired with skin grafts. The flap survival and complications were observed.Results:Anatomy result demonstrated that deep branch of the medial plantar artery was direct continuation of the medial plantar artery. It traveled along between short toe flexor muscle and abductor hallucis muscle, and gave out several perforators. The proximal perforators passed through the abductor hallucis muscle, and anastomosed with superficial branch of medial plantar artery, anterior medial malleolus artery, and medial tarsal artery. Three perforators were issued at the proximal end of the first metatarsophalangeal joint, namely articular perforator, cutaneous perforator, and communication branch. The cutaneous perforator was main blood supply source for perforator flap from distal deep branch of medial plantar artery.A total of 12 skin flaps were harvested from 12 patients, with an area from 4.5 cm×3.0 cm to 9.0 cm×6.0 cm. Postsurgery dark purple and a few blisters occurred in three flaps, and the sutures at the pedicle were immediately removed, and the flap was coated with antibiotic ointment to keep it moist, then the flap color gradually improved after postsurgery 5 days.12 skin flaps eventually survived completely. All patients were followed up by telephone for 2-12 months. The flap color, texture and appearance were excellent. The traumatic feet walked normally.Conclusions:The perforator flap from distal deep branch of medial plantar artery has reliable blood supply for retrograde repairing small and medium skin defect at the great toe of distal the first metatarsophalangeal joint, with simple operation, less trauma, and positive postoperative effect.

Objective:To investigate the anatomy and therapeutic effecton skin soft tissue defect at the great toe of perforator flap from distal deep branch of medial plantar artery.Methods:The arteries of one adult foot specimens were filled with red latex and vascular anatomy was performed. Branch distribution and anastomosis of medial plantar artery and dorsal foot artery were observed. The clinical data of 12 patients with skin soft tissue defect at the great toe repaired by retrograde perforator flap from distal deepbranch of medial plantar artery from September 2016 to September 2019 in Affiliated Hospital of Zunyi Medical University was selected, and the donor sites were repaired with skin grafts. The flap survival and complications were observed.Results:Anatomy result demonstrated that deep branch of the medial plantar artery was direct continuation of the medial plantar artery. It traveled along between short toe flexor muscle and abductor hallucis muscle, and gave out several perforators. The proximal perforators passed through the abductor hallucis muscle, and anastomosed with superficial branch of medial plantar artery, anterior medial malleolus artery, and medial tarsal artery. Three perforators were issued at the proximal end of the first metatarsophalangeal joint, namely articular perforator, cutaneous perforator, and communication branch. The cutaneous perforator was main blood supply source for perforator flap from distal deep branch of medial plantar artery.A total of 12 skin flaps were harvested from 12 patients, with an area from 4.5 cm×3.0 cm to 9.0 cm×6.0 cm. Postsurgery dark purple and a few blisters occurred in three flaps, and the sutures at the pedicle were immediately removed, and the flap was coated with antibiotic ointment to keep it moist, then the flap color gradually improved after postsurgery 5 days.12 skin flaps eventually survived completely. All patients were followed up by telephone for 2-12 months. The flap color, texture and appearance were excellent. The traumatic feet walked normally.Conclusions:The perforator flap from distal deep branch of medial plantar artery has reliable blood supply for retrograde repairing small and medium skin defect at the great toe of distal the first metatarsophalangeal joint, with simple operation, less trauma, and positive postoperative effect.

Objective To explore the application effect of key indicators of oncology nursing quality evaluation in the continuous improvement of specialist nursing quality. Methods The Delphi method was used to cons-truct 14 key indicators of oncology nursing quality evaluation, and the key indicators were used to control the quality of specialist nursing in the tumor area. Data were collected and a database was established. Based on the data, the quality of the nursing care and continuous quality improvement were carried out. Results The results of the data from the first year (before the intervention in 2016) and the second year (after the intervention in 2017) were compared with the data of the key indicators of the quality evaluation of the specialist nursing. The results showed that the indicators had different degrees of decline. The data before and after intervention were: chemotherapy drug extravasation rate 0.20% (33/16 861) and 0.10% (20/19 957), and the incidence of severe pain was 1.65% (1 747/106 114) and 1.43% (1 521/106 462). The incidence of anxiety was 2.17% (2 305/106 114) and 1.53% (1 633/106 462), and the incidence of depression was 2.27% (2 408/106 114) and 1.28% (1 359/106 462). The difference was statistically significant (χ2=5.80-300.90, P<0.05); The other 9 indicators of process have improved to varying degrees. Conclusions 14 key indicators of oncology nursing quality evaluation are applied to the oncology ward for specialized nursing quality management and quality improvement, which can monitor the quality of key specialist nursing in real time and dynamically. It can accurately select clinical nursing priority improvement projects and improve specialist nursing. Quality;energy evaluation to improve the quality of specialist nursing quality; help improve the quality management of specialist nursing and ensure patient safety.

OBJECTIVETo detect potential mutation in a family affected with congenital dyserythropoietic anemia type II (CDA II).

METHODSTargeted sequence capture and next-generation sequencing (NGS) were used to analyze the exons and exon-intron boundaries of the SEC23B gene in a clinically suspected CDA II patient. Genotypes of the relatives were validated by Sanger sequencing. Potential impact of amino acid substitution on the structure and function of SEC23B protein was predicted with MutationTaster and PolyPhen-2. The protein structure was predicted with SWISS-MODEL software.

RESULTSThe proband was found to harbor double heterozygous mutations of the SEC23B gene, c.1727T>C (p.F576S) and c.1831C>T (p.R611W), which resulted in amino acid substitutions p.F576S and p.R611W. Both mutations were confirmed by Sanger sequencing. The sister of the proband was found to have carried c.1727T>C (p.F576S), while her father and son have carried c.1831C>T (p.R611W) mutation. In addition, the proband was detected to have carried c.211C>T (p.R71X) of the HFE gene, which resulted in substitution of arginine by a stop codon. The impact of above mutations on the structure or function of protein was predicted to be harmful. Splenectomy and iron chelation therapy have achieved effective improvement of anemia and iron overload. Computer simulation suggested that the mutations have altered the 3D structure of the SEC23B protein.

CONCLUSIONThe novel compound mutations of c.1727T>C and c.1831C>T of the SEC23B gene probably underlie the CDA II in the family, and there is a strong correlation between the genotype and phenotype.

Adult ; Anemia, Dyserythropoietic, Congenital ; genetics ; Computer Simulation ; Family ; Female ; Genotype ; High-Throughput Nucleotide Sequencing ; Humans ; Mutation ; Phenotype ; Vesicular Transport Proteins ; genetics

Objective To study the mechanical properties and degradation behavior of biodegradable silicon-covered magnesium alloy stent in vitro,to investigate the technical feasibility of its implantation into rabbit esophagus and to observe the tissue reaction in vivo.Methods The mechanical compression recovery properties and the degradation behavior of biodegradable silicon-covered magnesium alloy stent were tested in vitro.A total of 30 healthy Holland rabbits were randomly divided into silicon-covered magnesium alloy stent group (n=15) and control group (n=15).For rabbits in the silicon-covered magnesium alloy stent group fluoroscopy-guided insertion of the stent into the lower third segment of esophagus was conducted,while for rabbits in the control group no intervention was adopted.One,2 and 4 weeks after the implantation of the stent,esophagography was performed for all rabbits of both groups,and each time every 5 rabbits from both groups were sacrificed,the specimens were collected and sent for histological examinations.Results In vitro test indicated that biodegradable silicon-covered magnesium alloy stent had good flexibility and elasticity,and in phosphate-buffered saline with pH 4.0 or pH 7.4 it degraded more slowly than bare magnesium alloy stent.In vivo test showed that the stent implantation could be well tolerated by all experimental rabbits.Before stent insertion the esophageal diameter was(9.2±0.8) mm,and at one,2 and 4 weeks after stent insertion the esophageal diameters were (9.7±0.7) mm,(9.6±0.8) mm and (9.6±0.5) mm respectively (P＞0.05).In the silicon-covered magnesium alloy stent group,stent displacement occurred in 6 rabbits in one week (n=l),2weeks (n=1) and 4 weeks (n=4).After stent implantation,the tissue reactions such as esophageal wall injury,collagen deposition,etc.were not obviously different from those in the control group (P＞0.05).Conclusion It is technically feasible to insert silicon-covered magnesium alloy stent into the rabbit's esophagus,the stent can provide sufficient support for at least 2 weeks,the stent displacement rate is low and acceptable,and no severe esophageal wall injury and collagen deposition are observed.