Postoperative cognitive dysfunction(POCD)is a common complication affecting elderly patients after anaesthesia.It is characterised by acute or persistent impairments of attention,learning and memory after surgery.This cognitive disorder can lead not only to an increase in postoperative complications and prolonged hospi-tal stays,but also to an increased societal burden and waste of medical resources.Stellate ganglion block(SGB)is a commonly used nerve block technique in clinical practice.It works to block neural signals from stellate ganglion to control pain or treat certain conditions primarily by injecting local anaesthetics.This article summarises the mechanisms by which SGB improves POCD,focusing on the regulation of cerebral vasculature,oxidative stress and inflammatory responses.It aims to provide elderly patients with an approach to safer and more effective postop-erative recovery and seek new therapies to alleviate the burden of POCD.

Objective:To explore the turnover intention of dental outpatient nurses, and analyze its influencing factors.Methods:From August to September 2021, multi-stage sampling was used to select nurses from 20 stomatology hospitals in 7 geographical regions of North China, East China, South China, Central China, Southwest, Northeast, and Northwest China. The survey was conducted using the General Information Questionnaire, Turnover Intention Scale, Nursing Work Environment Scale, Psychological Capital Scale for Nurses, and Work Engagement Scale.Results:A total of 1 513 questionnaires were collected, including 1 135 valid questionnaires, with a valid rate of 75.02% (1 135/1 513). The total score of turnover intention among 1 135 dental outpatient nurses was (2.22±0.56). Pearson correlation analysis showed a negative correlation between nursing work environment, psychological capital, work engagement, and turnover intention ( r=-0.421, -0.340, -0.446; P<0.01). The structural equation model showed that the nursing work environment had a direct negative effect on the turnover intention of dental outpatient nurses (β=-0.401, P<0.01) and had an indirect negative effect on turnover intention through work engagement (β=-0.106, P<0.01), with a mediating effect of 20.91%. Psychological capital had an indirect negative effect on the turnover intention of dental outpatient nurses through work engagement (β=-0.271, P<0.01), with a mediating effect of 52.83%. Conclusions:The turnover intention of dental outpatient nurses is at a high level. Managers can reduce the turnover intention of dental clinic nurses by improving the nursing work environment, developing psychological capital, and increasing work engagement.

Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.

Objective:To adapt the clinical nursing practice guidelines for myeloproliferative neoplasms (MPN) to form high-quality localized evidence, so as to provide a basis for clinical knowledge transformation, and enable clinical practitioners to care for patients based on standards and evidence.Methods:We carried out guideline adaptation registration on the Practice Guideline Registration for Transparency. Guided by the ADAPTE method, evidence was searched and screened from top to bottom based on the "6S evidence pyramid" model. We conducted quality evaluation and content analysis on the included guidelines to extract, organize, and adapt recommendations on MPN clinical nursing practices. The search period was from September 2011 to September 2022.Results:A total of six evidence-based guidelines, six expert consensus guidelines, and four clinical decisions were included. A total of 40 recommendations were extracted, which were adapted into six Level Ⅰthemes for admission assessment, symptom management, risk factor management, medication management, treatment goal management, and follow-up management, as well as 19 Level Ⅱ themes.Conclusions:The guidelines included are of high overall quality, with rich, specific, and highly consistent recommendations, which can provide resource preparation for later evidence conversion. Some content still needs to be supplemented and expanded. It is recommended that scholars in this field develop comprehensive and specific clinical nursing practice guidelines based on clinical needs.

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus oxiracetam in treating mild vascular dementia (VD) and seek its underlying mechanism. Methods: Ninety-six patients with mild VD were randomized into an observation group and a control group, with 47 cases in the observation group and 49 cases in the control group. The control group received oral oxiracetam capsules for treatment, and the observation group was given additional Tuina treatment. Before and after treatment, the mini-mental state examination (MMSE) was adopted to assess the patient's cognitive function; the activities of daily living (ADL) scale was used to evaluate their ability to conduct daily activities; changes in the serum inflammatory factors and oxidative stress indicators were also detected. Results: After treatment, the serum content of malondialdehyde (MDA) decreased in both groups (P<0.05) and was lower in the observation group than in the control group (P<0.05); the serum contents of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased in both groups (P<0.05) and were higher in the observation group than in the control group (P<0.05); the serum contents of interleukin (IL)-1, tumor necrosis factor (TNF)-α, IL-6, and IL-8 declined in both groups (P<0.05) and were lower in the observation group than in the control group (P<0.05). After the intervention, the levels of systolic velocity (Vs) and mean velocity (Vm) of the middle cerebral artery elevated, and the pulsatility index (PI) dropped in patients in the two groups, showing significant intra-group differences (P<0.05); the levels of Vs and Vm in the observation group were higher than those in the control group, and the PI was lower in the observation group than in the control group, showing significant between-group differences (P<0.05). The MMSE and ADL scores increased in both groups after the intervention (P<0.05) and were higher in the observation group than in the control group (P<0.05). Conclusion: In the treatment of mild VD, Tuina plus oxiracetam can improve the cerebral blood supply, ADL, and cognitive function; the mechanism may be associated with the reduction of oxidative stress damages and inflammatory reactions.

The concept of enhanced recovery after surgery (ERAS) has attracted more and more attention so far, but there are different opinions on it. ERAS philosophy covers many fields, in which anesthesiology plays an irreplaceable role by virtue of its professional advantages. Based on ERAS philosophy, anesthesiologists will provide guidance on preoperative assessment, preoperative prehabilitation, intraoperative fluid management, analgesia, temperature management, and postoperative rehabilitation to improve patient comfort and satisfaction.

Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.

Objective: To observe the impact of Tiao Shen Tong Du (regulating the mind and unblocking the Governor Vessel) Tuina (Chinese therapeutic massage) on neuropsychological development of premature infants, discover effective early-stage intervention techniques, and improve the prognosis of premature infants.Methods: A total of 115 eligible premature infants were recruited and divided into a control group of 59 cases and an observation group of 56 cases based on different interventions. The control group received three-month physical therapy (PT) and conventional early-stage intervention, and the observation group received additional Tiao Shen Tong Du Tuina treatment. Before and after treatment and at the one-year follow-up, the Gesell developmental schedule was adopted to evaluate neuropsychological development. Results: After treatment, the gross motor development quotient (DQ) was higher in the observation group than in the control group, and the difference was statistically significant (P<0.05); there were no significant differences in the other four domains between the two groups (P>0.05). At the one-year follow-up, the observation group showed more notable improvements in all five domains' DQs than the control group, and the between-group differences were statistically significant (P<0.05 or P<0.01).Conclusion: Based on conventional intervention, Tiao Shen Tong Du Tuina can significantly improve the gross motor function of premature infants in the short term, alongside valid long-term efficacy for gross motor function, fine motor function, adaptive behaviors, language, and personal-social behaviors.

Objective:This study aims at exploring the groin area, the ulnar side of the wrist, and the medial plantar side as a more optimal donor area for repairing children’s hand volar skin defects.Methods:From December 2017 to December 2018, clinical data of children with palmar skin defects of hands who underwent full-thickness skin grafting in the Department of Burn and Plastic Surgery, Children’s Hospital Affiliated to Chongqing Medical University, were retrospectively analyzed. All skin grafts survived utterly. According to the donor site of full-thickness skin graft, the children were divided into three groups: the groin, ulnar wrist, and medial plantar skin donor group. The PANTONE skin tone guide measured the color difference between the full-thickness skin graft and the surrounding skin. The postoperative scars of the recipient and donor areas were scored by the Patient and Observer Scar Assessment Scale. Meanwhile, the postoperative effect and parents’ satisfaction with recipient and donor areas were evaluated. Kruskal Wallis rank-sum test and Mann Whitney U test were used for measurement data. Fisher’s exact test was used for counting data. A P-value <0.05 was considered significant. Results:A total of 68 children were enrolled, including 44 males and 24 females. The mean age was (3.19 ± 2.74) years (ranging from 6 months to 14 years). Among them, 37 children’s palmar skin defects were reconstructed by full-thickness skin grafts from the inguinal region, 19 from the ulnar side of the wrist, and 12 from the medial side of the plantar. The final follow-up time was from 7 months to 18 months, with an average of (14.07±2.94) months. There were significant differences among the three groups in the pigmentation of skin grafts and parents’ satisfaction ( P<0.01). The color difference of medial plantar skin donor group and ulnar wrist skin donor group was small, and the groin skin donor group had the most obvious color difference of skin graft. The satisfaction of parents in the medial plantar skin donor group was the best, followed by the ulnar wrist skin donor group, and the groin skin donor group had the worst satisfaction of parents. There was no significant difference in scar evaluation in recipient and donor areas among the three groups( P>0.05). Among the parents’ satisfaction ratings in the receiving area of the three groups, the medial plantar group had the highest proportion of excellent, followed by the ulnar wrist group and the groin group. There were significant differences among the three groups( P<0.01). Conclusions:The full-thickness skin graft harvested from the medial plantar and ulnar side of the wrist are better choices for small or medium-sized palmar skin defects in children than the inguinal area with superior aesthetics. The medial plantar area is recommended as a donor site for the palmer skin defects in hands, choosing the ulnar aspect of the wrist is more appropriate for the defects in the lateral fingers.

Objective:This study aims at exploring the groin area, the ulnar side of the wrist, and the medial plantar side as a more optimal donor area for repairing children’s hand volar skin defects.Methods:From December 2017 to December 2018, clinical data of children with palmar skin defects of hands who underwent full-thickness skin grafting in the Department of Burn and Plastic Surgery, Children’s Hospital Affiliated to Chongqing Medical University, were retrospectively analyzed. All skin grafts survived utterly. According to the donor site of full-thickness skin graft, the children were divided into three groups: the groin, ulnar wrist, and medial plantar skin donor group. The PANTONE skin tone guide measured the color difference between the full-thickness skin graft and the surrounding skin. The postoperative scars of the recipient and donor areas were scored by the Patient and Observer Scar Assessment Scale. Meanwhile, the postoperative effect and parents’ satisfaction with recipient and donor areas were evaluated. Kruskal Wallis rank-sum test and Mann Whitney U test were used for measurement data. Fisher’s exact test was used for counting data. A P-value <0.05 was considered significant. Results:A total of 68 children were enrolled, including 44 males and 24 females. The mean age was (3.19 ± 2.74) years (ranging from 6 months to 14 years). Among them, 37 children’s palmar skin defects were reconstructed by full-thickness skin grafts from the inguinal region, 19 from the ulnar side of the wrist, and 12 from the medial side of the plantar. The final follow-up time was from 7 months to 18 months, with an average of (14.07±2.94) months. There were significant differences among the three groups in the pigmentation of skin grafts and parents’ satisfaction ( P<0.01). The color difference of medial plantar skin donor group and ulnar wrist skin donor group was small, and the groin skin donor group had the most obvious color difference of skin graft. The satisfaction of parents in the medial plantar skin donor group was the best, followed by the ulnar wrist skin donor group, and the groin skin donor group had the worst satisfaction of parents. There was no significant difference in scar evaluation in recipient and donor areas among the three groups( P>0.05). Among the parents’ satisfaction ratings in the receiving area of the three groups, the medial plantar group had the highest proportion of excellent, followed by the ulnar wrist group and the groin group. There were significant differences among the three groups( P<0.01). Conclusions:The full-thickness skin graft harvested from the medial plantar and ulnar side of the wrist are better choices for small or medium-sized palmar skin defects in children than the inguinal area with superior aesthetics. The medial plantar area is recommended as a donor site for the palmer skin defects in hands, choosing the ulnar aspect of the wrist is more appropriate for the defects in the lateral fingers.