Objective:To investigate the effect of 3D-printed customized flanged cup in hip revision with severe acetabular bone defects.Methods:Since February 2017, 10 cases of 3D-printed customized flanged cups were used in hip revision with severe acetabular bone defects, including 2 cases of Paprosky type IIIA and 8 cases of Paprosky type IIIB. There were 5 males and 5 females, mean age 73.6±8.1 yrs (range, 62-87 yrs), 5 left and 5 right cases. The preoperative thin-layer CT scan was preformed to reverse reconstruct digital pelvis. Five cases of one-piece flanged cups and 5 cases of decomposed flanged cups, including 3 cases of composite one-piece cups were designed by computer. The surgery was performed strictly according to the plan.Postoperative follow-up was performed to evaluate the Harris score. Operation time,intraoperative bleeding and other complications such as vascular and nerve injury, postoperative infection, and dislocation were counted. Pelvic X-ray was used to assess the height and horizontal position of the center of rotation and the stability of the prosthesis.Results:The surgical procedure was successful, with an average operative time of 147.9±48.3 min (range, 96-212 min) and an average intraoperative bleeding of 730.4±262.6 ml (range, 500-1 300 ml). The mean time of final follow-up was 40.8±18.7 months (range, 16-70 months) after surgery. At the last follow-up, the average Harris score was 83.80±6.73, with 4 cases excellent, 5 cases good, and 1 case fair. The excellent and good rate was 90%. The last Harris score was significantly higher than that before operation 28.60±8.40 ( t=16.84, P<0.001). The height of affected hip joint rotation center decreased from 46.24±7.74 mm before operation to 15.54±2.54 mm after operation with significant difference ( t=14.61, P<0.001). It was slightly higher than the opposite side (13.81±1.48 mm), which had no significant difference ( t=1.83, P=0.100). The horizontal distance of affected hip joint rotation center increased from 33.79±5.27 mm before operation to 40.53±4.50 mm after operation with significant difference ( t=3.62, P=0.006). It had no significant difference ( t=1.28, P=0.232) compared with the opposite side (38.54±3.46 mm). All incisions were healed in one stage without infection, vascular or nerve injury. During the following-up, all prostheses were in satisfied position without loosening, dislocation or screw breaks. Conclusion:Digitally assisted 3D-printed flanged cups can be used in hip revision with severe acetabular bone defect. It can not only improve hip joint function, but also restore the acetabular rotation center and the prosthesis stability, which can achieve good early and mid-term effect.

Objective:To study the effect of early nursing intervention to prevent lymphedema of upper limb after breast cancer surgery and its effect on postoperative quality of life.Methods:Between July 2018 and March 2020, one hundred and seventeen cases of breast cancer, all female, admitted to department of thyroid and breast surgery, the affiliated Zhongshan hospital of Dalian University, were underwent modified radical mastectomy with axillary lymph node dissection. Fifty-eight cases were included in the control group whereas fifty-nine cases were in the intervention group. The control group received conventional nursing, the intervention group added early care intervention measures on the basis of conventional nursing. Follow-ups were carried out monthly in a period of 9 months post-surgery. The incidence and grade of lymphedema were compared between the two groups.Results:The incidences of lymphedema at 1,3,9 months after surgery were 8.5% (5/59), 8.5% (5/59), 10.2% (6/59) in the intervention group, which were lower than 31.0% (18/58), 36.2% (21/58), 43.1% (25/58) in the control group. Statistics showed significant difference between the two groups ( χ2 value was 9.425, 13.041, 16.289, P<0.05). The incidence of mild, moderate, and severe lymphedema were statistically different between the two groups ( χ2 value was 10.350, 12.078, 17.422, P<0.05). Follow-up for the quality of life was assessed using a 5-dimension evaluation method, including physical status, social/family status, emotional status, functional status and additional attention. One month follow-up showed 20.36±1.80, 20.03±1.68, 34.63±3.52, 15.86±1.96, 19.81±1.04 in the intervention group, all higher than the control group 17.03±1.36, 17.10±1.46, 19.38±1.51, 10.91±1.22, 18.36±1.21. Three-month follow-up showed 23.56±2.72, 23.73±2.20, 39.93±4.17, 20.31±3.04, 26.37±2.23 in the intervention group, higher than those of the control group 20.90±2.14, 19.12±2.63, 25.79±3.59, 13.97±2.67, 21.02±2.50. Nine month follow-up showed 27.44±2.01, 25.80±1.85, 40.88±3.72, 21.02±2.78, 27.02±2.45 in the intervention group, which were high than the control group 19.93±1.66, 20.67±1.46, 19.38±2.29, 16.33±2.65, 22.29±2.52. The difference between the two groups were statistically significant ( t value was 8.691-34.383, P<0.05). Conclusions:Early nursing intervention could prevent lymphedema of upper limb after breast cancer surgery, delay the progress of lymphedema, reduce the incidence and grade of lymphedema, and promote the rehabilitation of patients' affected limbs, improve quality of Life of patients, which is worthy of clinical application.

OBJECTIVETo explore the trend change of the morbidity and mortality of colorectal cancer in China in order to provide reference to the prevention and control of colorectal cancer.

METHODSAccording to the 1-3 volumes of "Pathogenesis and death of malignancies in pilot program city and county of China", "Pathogenesis and death of cancer in China"(2003-2007) and "Registration annual report of tumor in China" published in 2011 and 2012, data of pathogenesis and death of colorectal cancer from 10 tumor registration spots, including Beijing urban, Shanghai urban, Wuhan urban, Harbin urban (defined as city urban), and Hebei Ci County, Jiangsu Qidong District, Zhejiang Jiashan District, Guangxi Fusui County, Fujian Changle District, Henan Lin County (defined as rural district), between 1988 and 2009 were collected. The morbidity and mortality were elucidated with world population standardized rate. Ratio of pathogenesis to death was calculated with crude rate of morbidity and mortality. Data of 22 years were enrolled into the linear regression analysis to calculate the annual change rate of morbidity and mortality statistically.

RESULTS(1) Colon cancer: morbidity presented increasing trend; male morbidity in city urban increased faster; mortality presented increasing trend as well; no significant difference of increasing velocity was observed between city urban and rural district; morbidity and mortality in city urban were higher compared to rural district; morbidity and mortality of males were higher compared to females; except stable Fujian Changle District, ratio of pathogenesis to death presented decreased trend in Shanghai urban and Hebei Ci County, and increased trend in other 7 spots (all P<0.05). (2) Rectal cancer: morbidity presented increasing trend, and its increasing velocity of city urban was faster compared to rural district; mortality presented decreased trend, especially in females, and this trend in rural district was worse compared to city urban; morbidity and mortality of males were higher compared to females, while no significant difference was observed between city urban and rural district; morbidity and mortality of males and females in Zhejiang Jiashan District were all decreased (all P<0.05); except stable Harbin city, ratio of pathogenesis to death presented increased trend in other 9 spots (all P<0.05). (3) Ratio analysis of morbidity and mortality showed that percentage of colon cancer increased gradually in all 10 spots between 1988-2009.

CONCLUSIONSIn the past 2 decades, the overall morbidity and mortality of colorectal cancer are higher in city urban and in male as compared with rural district and female. Colon cancer has higher morbidity than rectal cancer and its morbidity and mortality present increased trend, while morbidity of rectal cancer presents increased trend but its mortality presents decreased trend.

Objective: To investigate the effect of recombinant human keratinocyte growth factor 2 (rhKGF-2) on lung tissue of rabbits with severe smoke inhalation injury. Methods: A total of 120 New Zealand rabbits were divided into 5 groups by random number table after being inflicted with severe smoke inhalation injury, with 24 rats in each group. Rabbits in the simple injury group inhaled air, while rabbits in the injury+phosphate buffer solution (PBS) group inhaled 5 mL PBS once daily for 7 d. Rabbits in injury+1 mg/kg rhKGF-2 group, injury+2 mg/kg rhKGF-2 group, and injury+5 mg/kg rhKGF-2 group received aerosol inhalation of 1 mg/kg, 2 mg/kg, and 5 mg/kg rhKGF-2 (all dissolved in 5 mL PBS) once daily for 7 d, respectively. On treatment day 1, 3, 5, and 7, blood samples were taken from the ear central artery of 6 rabbits in each group. After the blood was taken, the rabbits were sacrificed, and the tracheal carina tissue and lung were collected. Blood pH value, arterial oxygen partial pressure (PaO₂), arterial blood carbon dioxide pressure (PaCO₂), and bicarbonate ion were detected by handheld blood analyzer. The expressions of pulmonary surfactant-associated protein A (SP-A) and vascular endothelial growth factor (VEGF) in lung tissue were detected by Western blotting. Pathomorphology of lung tissue and trachea was observed by hematoxylin-eosin staining. Data were processed with analysis of variance of two-way factorial design and Tukey test. Results: (1) Compared with those in simple injury group, the blood pH values of rabbits in the latter groups on treatment day 1-7 had no obvious change (P>0.05). The PaO₂ of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 5 and 7 were (75.0±2.4) and (71.0±4.5) mmHg (1 mmHg=0.133 kPa), respectively, which were significantly higher than (62.0±6.8) and (63.0±3.0) mmHg in simple injury group (q=4.265, 8.202, P<0.05 or P<0.01). The PaO₂ of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 7 was (82.0±4.9) mmHg, which was significantly higher than that in simple injury group (q=6.234, P<0.01). Compared with that in simple injury group, the PaCO₂ of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 3 was significantly decreased (q=4.876, P<0.01) and significantly increased on treatment day 5 (q=5.562, P<0.01); the PaCO₂ of rabbits in injury+5 mg/kg rhKGF-2 group was significantly increased on treatment day 5 and 7 (q=5.013, 4.601, P<0.05 or P<0.01). Compared with that in simple injury group, the serum bicarbonate ion of rabbits in injury+1 mg/kg rhKGF-2 group on treatment day 7 was significantly increased (q=5.142, P<0.01); the serum bicarbonate ion of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 5 and 7 were significantly increased (q=4.830, 6.934, P<0.01); the serum bicarbonate ion of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 5 were significantly increased (q=3.973, P<0.05). (2) The expressions of SP-A in lung tissue of rabbits in simple injury group and injury+PBS group in each treatment time point were close (P>0.05). The expressions of SP-A in lung tissue of rabbits in injury+2 mg/kg rhKGF-2 group and injury+5 mg/kg rhKGF-2 group on treatment day 3 were 0.091±0.007 and 0.101±0.009, respectively, significantly higher than 0.069±0.009 in simple injury group (q=10.800, 13.580, P<0.01). The expressions of SP-A in lung tissue of rabbits in injury+1 mg/kg rhKGF-2 group, injury+2 mg/kg rhKGF-2 group, and injury+5 mg/kg rhKGF-2 group on treatment day 5 and 7 were 0.127±0.008, 0.132±0.006, 0.194±0.006, 0.152±0.017, 0.166±0.004, 0.240±0.008, significantly higher than 0.092±0.003 and 0.108±0.005 in simple injury group (q=6.789, 12.340, 17.900, 9.875, 31.480, 40.740, P<0.01). (3) On treatment day 1 and 5, there was no significant difference in the expression of VEGF in lung tissue of rabbits among the 5 groups (P>0.05). Compared with those in simple injury group, the expressions of VEGF in lung tissue of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 3 and 7 were significantly increased (q=4.243, 8.000, P<0.05 or P<0.01), and the expression of VEGF in lung tissue of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 7 was significantly increased (q=20.720, P<0.01). (4) On treatment day 1, the injury of rabbits in each group was similar, with a large number of neutrophils infiltrated and abscess formed in the alveolar and interstitial tissue, thickened alveolar septum, some collapsed alveolar and atelectasis; large area of tracheal mucosa was degenerated and necrotic, with a large amount of inflammatory exudates blocking in the cavity. On treatment day 3, the inflammation of lung tissue and trachea in each group were improved, but the inflammation in simple injury group and injury+PBS group was also serious. On treatment day 5, the inflammation in lung tissue and trachea of rabbits in injury+2 mg/kg rhKGF-2 group and injury+5 mg/kg rhKGF-2 group were improved much obviously than those in the other groups. On treatment day 7, the inflammation in lung tissue of rabbits in injury+5 mg/kg rhKGF-2 group alleviated obviously than those in the other groups, most alveoli had no obvious exudative fluid, the alveolar cavity was intact and clear, the local alveolar dilated like a cyst, and the alveolar septum thinning; the improvement of inflammation of trachea was more obvious than the other groups, the tracheal mucosa tended to be more complete, and few neutrophils were infiltrated in the endotracheal cavity. Conclusions Atomization inhalation of rhKGF-2 can improve the PaO₂ level of rabbits with severe smoke inhalation injury, reduce airway inflammation, increase the expression of SP-A and VEGF in lung tissue, thus promoting the repair of lung tissue.

Objective To evaluate the power of two risk assessment tools in predicting deep venous thrombosis (DVT) in critically ill patients. Methods The DVT risks of totally 221 critically ill patients admitted in the intensive care unit (ICU) of West China Hospital, Sichuan University, between January and August 2016 were evaluated with Autar DVT Scale and Caprini DVT Scale, respectively. The predictive power of the two tools was statistically compared. Results The areas under the receiver operating characteristics curve (AUC-ROC) of Autar DVT Scale and Caprini DVT Scale in predicting DVT in the patients were 0.525 and 0.697, respectively (P＜0.05). There was also statistic difference between the two scales in predicting DVT in the inpatients in ICU (P＜ 0.05). Conclusions Both tools are useful and reliable in predicting DVT in the inpatients in ICU, but Caprini DVT Scale has a stronger predictive power.

Objective To explore the effects of comprehensive nurisng intervention on prenventing incontinence-associated dermatitis in patients with consciousness disorder,and to provide effective prevention methods accordingly. Methods Patients with consciousness disorder and fecal incontinence who were admitted by a Grade Ⅱ general hospital between April 2015 and December 2016 were selected and randomly divided into an intervention group and a control group. Patients in the control group received stool drainage with anal tracheal catheter with aerocyst connected to drainage bags,while patients in the intervention group received comprehensive nurisng,including disposable drainage with stoma bags,skin protection with liquid dressing and stoma bag rinsing with 0.9% sodium chloride solution. Results The patients in the control group were nursed for(62.00±6.41)min a day,while the patients in the intervention group were nursed for(47.00±5.26) min a day. The patients in the intervention group needed shorter nursing time than the patients in the control group(t=4.24,P<0.01). The incidence of incontinence-associated dermatitis of the patients in the intervention group(26.92%)was lower than that of the patients in the control group(47.83%)(χ2=4.59,P < 0.05). Conclusions Comprehensive nurisng can reduce the incidence of incontinence-associated dermatitis in patients with mental disorder.

Objective To investigate cognition degree and learning demands of medical adhesive-related skin injury ( MARSI) of ICU nurses in a hospital, so as to provide reference basis for corresponding knowledge training and improve nursing quality of clinical wound care. Methods In November 2014, a self-designed questionnaire about cognition and learning demands of MARSI was given to 234 nurses in this hospital from intensive care units of Comprehensive Department, Department of Surgery, Thoracic and Cardiovascular Department, PediatricsDepartment, Department of Neurology, and Department of Pneumology. The data was analyzed by SPSS 17. 0. Results Total cognition score was(24. 50 ± 9. 35);there was no statistical significance from different genders and races. The scores from nurses with different ages, educational backgrounds, job titles, job posts, working years, working years in ICU and wound specialist nurses or not were statistically significant. Only 4. 7% of ICU nurses had "never encountered" this kind of skin injury; only 2. 1% of the nurses had "had confidence" in handling such injury; their knowledge mainly came from past experience and communication between colleagues;88. 5% of the nurses thought it was necessary to take learning courses of MARSI. Conclusions ICU nurses′cognition scores of MARSI are low, but their learning demands are high. So the nurse managers should provide knowledge training of MARSI.

Objective To understand the current situation of occupational exposure and occupational safety attitudes among nursing students in Kunming Medical University, and to find effective interventions to improve nurses' occupational safety,and to reduce occupational exposure.Methods 854 students in Kunming Medical University were investigated by a questionnaire survey, including Demographic characteristics, Occupational exposure conditions, Occupational safety attitude and Gathers, quit intention . The correlations between occupational safety attitudes and occupational exposure were analyzed with Simple Linear Correlation.Results There were 94.30%female respondents,and only 5.70%male respondents.The average age of respondents was 22.52±2.90 years. The Simple Linear Correlation analysis showed that correlation between Negative attitude and occupational exposure was positive correlated, the occupational exposure and Support from managers, and Optimistic were negative correlation ( <0.05) .Conclusions Occupational safety and attitude are related to occupational exposure. Nursing students should apply standardized operation to improve the professional quality and ability. Schools should strengthen the education of occupational protection for nursing students. Hospital management should regularly organize nurses to study occupational exposure protection knowledge,give full affirmation of the nurse's achievements in the work, and offer certain reward appropriately.

Objective To understand the undergraduate nursing students’ awareness of the basic situation of occupational exposure in Kunming Medical University, and to understand their knowing status of occupational exposure knowledge. Methods We used self- designed questionnaire to investigate 449 undergraduate nursing students in Kunming Medical University to obtain the status of occupational exposure and protection knowledge level of students.Results (1) 449 students were investigated, and 258 of them had been in clinical practice, and occupational exposure occurred in 48.8% of them. (2) Occupational exposure factors included grade, washing hands and wearing gloves;The results showed that:Grade was a risk factor and wearing glove and washing hands were protective factors. (3) There was relevance between accepting the occupational protection education and the occupational exposure. Conclusions A useful measure to reduce the occurrence of occupational exposure is Pre-service training for undergraduates nursing students. Operation should be in strict accordance with operating specifications. Schools and departments should implement occupational protection system, so as to strengthen the related knowledge vocational education,enhance self-protection awarenes,and reduce or minimize the occurrence of occupational exposure.

Third party custody system at the Second Affiliated Hospital ot Zhejiang University has reduced hospital costs,raised efficiency and optimized resources.The standardized management system featuring 5S+ 1 achieved such outcomes as +5 and -5,and 0 inventory.A three-year review of the economic performance at the hospital has saved three million yuan of costs,proving that the system can help build an effective material supply system for contemporary general hospitals.