Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.

ObjectiveTo investigate the difference in protein expression between hepatocellular carcinoma (HCC) patients with recurrence and those with good prognosis, the differential expression and regulatory mechanism of miR-152-3p target proteins, and the role of miR-152-3p in the recurrence of HCC. MethodsTMT-labeled proteomic sequencing and RT-PCR were used to measure the expression of proteins and the expression of miR-152-3p in the HCC tissue of six patients with recurrence at 2 years after HCC resection and six patients with good prognosis at 5 years. Six databases were used to analyze the target genes of miR-152-3p, and Gene Ontology, DAVID, and REACTOME databases were used to perform target gene screening, enrichment annotation, and signal transduction pathway enrichment analysis. Gene mutation frequency and survival curve analysis were performed for the target genes of miR-152-3p to verify the role of miR-152-3p target genes in patients with HCC recurrence. The independent samples t-test was used for comparison of continuous data between two groups, and a Kaplan-Meier analysis was performed to investigate the survival rates of liver-related genes. ResultsCompared with the patients with HCC recurrence, the patients with good prognosis after HCC resection had a significantly higher transcriptional expression level of miR-152-3p in HCC tissue (P＜0.05). The results of protein sequencing showed that there were 365 differentially expressed proteins in HCC tissue between the patients with good prognosis and the patients with recurrence, and the analysis of HCC recurrence databases showed that 17 proteins were regulated by miR-152-3p. Further analysis of the signaling pathways showed that the function of the 17 target genes regulated by miR-152-3p was enriched in the translation and regulation of mitochondria and ribosome, and multiple enrichment revealed that six target genes were closely associated with mitochondrial respiratory chain complex, i.e., AKAP1, FOXRED1, MRPL28, MRPL50, SHC1, and STAU1. Gene mutation frequency and survival curve analysis showed that the loss or weakening of the function of mitochondrial respiratory chain-related target proteins seriously affected the prognosis and survival rate of patients. ConclusionThere is a significant difference in the expression of miR-152-3p in HCC tissue between patients with good prognosis and those with recurrence after HCC resection, and miR-152-3p may lead to the recurrence of HCC by regulating the target genes AKAP1, FOXRED1, MRPL28, MRPL50, SHC1, and STAU1, acting on the mitochondrial respiratory chain, and affecting the oxidative respiratory function of cells.

Objective To investigate the effect of rehabilitation on memory deficits after acquired brain injury, to compare different training models of memory rehabilitation and to analyze the possible factors affecting memory rehabilitation. Methods 144 patients with acquired brain injury following memory deficits were randomly assigned to computer-assisted training group, face-to-face training group and control group. Both training groups were given memory-based cognitive training program once a day which sustained 30 minutes for 6 or 12 weeks. The instantaneous memory, short-term memory and long-term memory were evaluated and compared before and after training. The effect of gender, age, education, course, site of injury and coma time on training efficacy were analyszed as well. Results 6 weeks and 12 weeks at training, both computer-assisted and face-to-face training groups showed a significant improvement in memory abilities when compared to controls (P<0.01), with the former making more progress (P<0.01). Negative correlation was found between age and memory performance. Conclusion Effectiveness of memory rehabilitation is proven. 12 weeks training can significantly improve memory. Cognitive training using professional equipment is significantly more effective than the face-to-face training and should be recommended.

Objective:To explore the risk factors of microvascular invasion (MVI) in hepatocellular carcinoma (HCC), and to predict MVI preoperatively, non-invasively and accurately.Methods:A total of 150 HCC patients (183 HCC lesions) were retrospectively collected in the First Affiliated Hospital of Xi′an Jiaotong University from January 2016 to June 2022.The clinical data and hematological data, gray-scale ultrasonography (US), contrast-enhanced ultrasonography (CEUS), enhanced magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI) and pathological data of these patients were recorded. According to the pathological diagnosis of MVI, the lesions were divided into MVI (+ ) group and MVI (-) group. The indicators between the two groups were compared. All 183 lesions were put into the training set, and the prediction model with nomogram was constructed according to the risk factors of MVI selected by multivariate Logistic regression. The internal verification was carried out by ten-fold cross-validation method.Results:There were significant statistical differences in the following parameters between MVI (+ ) group ( n=109) and MVI (-) group ( n=74) (all P<0.05). These were cirrhosis, serological parameters (alpha-fetoprotein, albumin, total bilirubin), qualitative indexes of US (size, boundary, internal echo), qualitative indexes of CEUS (hyper/iso/hypovascularity of lesions in arterial phase, portal phase, and delayed phase compared with hepatic parenchyma), and quantitative indexes of EOB-MRI [post enhancement rate (post ratio) and gadolinium disodium rate (EOB ratio)] calculated mainly in terms of lesions and surrounding liver parenchyma in hepatobiliary phase and unenhanced T1 images). Finally, cirrhosis of patients, the size, boundary, internal echo of lesions in US; arterial phase (AP), portal phase (PP), post-vascular phase (PVP) features in CEUS; the EOB rate and post rate of EOB-MRI entered the prediction model of MVI. The training set exhibited good calibration and net gain rate. The areas under the ROC curve for the training set and the validation set were 0.981 and 0.961, respectively, while the diagnostic accuracy were 92.9% and 85.8%, respectively. Conclusions:The model constructed mainly by multimodality imaging methods can achieve favorable predictive performance for MVI, which provides valuable ideas for noninvasively predicting the incidence of MVI and optimizing the MVI-related treatment of MVI in HCC patients.

Objective To study the cellular changes of colonic smooth muscle cells in rats with spleen-deficiency functional diarrhea treated with Pixu Sihao Fang (PXSHF, No.4 Formula for Spleen Deficiency) dosed serum.Methods Colonic smooth muscle cells from functional diarrhea spleen-deficiency rats were extracted for primary culture and then divided into the following six groups: normal control group, model group, PXSHF low-dose, medium-dose, and high-dose groups, and montmorillonite powder (Mnt) group.All the dosed serum groups were treated with 5% drug serum for 48 h.CCK-8 test for detecting the cell proliferation activity and QRT-PCR test for checking the expression of brain-gut petide mRNA were performed.Results OD value of the model group was significantly lower than that of the control group (P<0.01) in CCK-8 test while the OD value of the drug serum groups were significantly higher than that of the model group (P<0.01).QRT-PCR test showed that the CCK/VIP/SS mRNA expression of the model group was significant lower than that of the control group (P<0.05).Compared with the model group, the CCK/VIP/SS mRNA expression in each drug serum group presented with an increase tendency.CCK mRNA expression of the group treated with low-dose PXSHF dosed serum was higher than of the model group (P<0.05).VIP mRNA expression of the groups treated with PXSHF dosed serum were significantly higher than that of the model group (P<0.01).Conclusion PXSHF dosed serum can effectively promote the proliferation activity of the colonic smooth muscle cells.Changes in the expression of CCK, VIP and SS mRNA might be indicative of the role of brain-gut peptide in the development of functional diarrhea with spleen deficiency pattern.

Objective:To explore the walking speed and cognitive function status of elderly inpatients and analyze the relationship between them.Methods:A total of 1 800 elderly inpatients in Beijing Hospital from January to July 2022 were selected as the research objects by the convenient sampling method. General Data Questionnaire and Mini-Mental State Examination (MMSE) were used to investigate the walking speed, and 3 m pace measurement was used to evaluate the pace. Binomial Logistic regression analysis was used to explore the influencing factors of cognitive dysfunction in elderly inpatients.Results:A total of 1 800 questionnaires were collected and 1 771 were valid, with the effective recovery rate of 98.39%. 9.82% (174/1 771) of the elderly inpatients had cognitive dysfunction. Binomial Logistic regression analysis showed that walking speed decline was a risk factor for cognitive dysfunction in elderly inpatients ( OR=1.860, 95% CI: 1.217-2.843) . In addition, age, visual impairment, education level and regular physical exercise were factors affecting cognitive impairment in elderly hospitalized patients ( P<0.05) . Conclusions:Elderly inpatients with decreased walking speed have a higher risk of cognitive dysfunction. Medical staff should pay attention to assessing the walking speed of elderly inpatients, early identification of pace changes and intervention to help elderly inpatients maintain a higher quality of life and better cognitive function.

Objective:To explore effects of different lower limb placement angles on venous drainage among patients undergoing thoracolumbar surgery in prone position.Methods:From January 2017 to January 2018, we selected patients underwent elective thoracolumbar surgery in prone position of Operating Room in Beijing Hospital as research objects. According to the need of surgery, it was divided into 51 cases in low-angle group and 54 cases in traditional-angle group. We compared effects of different lower limb placement angles on patients by taking the changes of lower limb venous blood flow under ultrasound before and after surgery as main observation indicators and taking changes of lower limb skin temperature and leg circumference as the secondary observation indicator.Results:There were statistical differences in the changes of blood flow on the left and right popliteal veins, the left and right posterior tibial veins of patients under ultrasound between two groups before and after surgery ( P<0.05) . There were no statistical differences in the changes of the leg circumference of 10 cm above the left and right ankles and the changes of the leg circumference of 15 cm above the left and right patellae of patients between two groups ( P>0.05) ; there was also no statistical difference in the change of bilateral skin temperature ( P>0.05) . Conclusions:The lower limb placement angles among patients undergoing thoracolumbar surgery in prone position may affect the venous drainage which nurses of Operating Room should pay attention to when placing positions.

Objective To investigate the nursing clinical practice of ICU ventilator-associated pneumonia(VAP)prevention and control of tertiary hospitals in China,and analyze relevant countermeasures.Methods A self-designed questionnaire consisted of 3 parts and 26 items.A questionnaire survey was conducted among nurses in 380 ICUs in 194 tertiary hospitals in 26 provinces from September 1 to 15,2021,using the convenient sampling method.Results A total of 380 valid questionnaires were collected,with an effective rate of 100%.In the system process,369(97.11%)ICUs had files to prevent VAP;291(76.58%)ICUs had a checklist of measures to prevent VAP clustering;274(72.11%)ICUs had continuous improvement projects about VAP in the last 3 years.In the aspect of body position management,semi-decubitus position was the first choice for the patients with invasive mechanical ventilation of 338(88.95%)ICUs.For nursing operation,224(58.95%)ICUs used Subglottic suction,and 128(33.68%)among them used air shock to remove the retention on the balloon;normal saline is still routinely injected before sputum aspiration in 72(18.95%)ICUs.In terms of balloon pressure monitoring,253(66.58%)ICUs did the oral care 3-4 times a day.In the balloon pressure monitoring,313(82.37%)ICUs use airbag pressure gauges to intermittently monitor airbag pressure;293(77.11%)ICUs replaced the ventilator pipeline once a week.There are significant differences in the current practice status of different types of ICUs in terms of compliance strategies for bed head lifting,subglottic secretion drainage,airbag pressure monitoring,and oral care(P<0.05).Conclusion At present,the relevant systems and procedures to prevent VAP have been improved,but the specific prevention and control measures need to be further unified.Therefore,it is suggested to analyze the weak links of VAP nursing prevention and control practice in various medical structures,carry out relevant training and quality control for the weak links,and further improve the working mechanism of continuous quality improvement,thus effectively reduce the incidence of VAP.

Objective:To explore the effects of different blood glucose management modes on self-management ability and glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM) based on the WeChat platform.Methods:240 patients with T2DM were selected in Taiyuan Central Hospital from January to June 2020 for the study. They were randomly divided into general management groups, medical care management groups, peer management groups, and medical care and peer co-management groups using random number table, with 60 cases in each group. The general management group received routine outpatient follow-up. The medical care management group, peer management group, and medical care and peer management group established WeChat groups for management, respectively. Each group′s self-management ability and glucose and lipid metabolism indexes were compared before and after six months of intervention. t-test or nonparametric tests were used to compare. Results:After the intervention, self-management abilities such as diet, exercise, blood glucose monitoring, medication compliance, foot care, smoking and fasting blood glucose (FBG), and glycosylated hemoglobin (HbA 1c) were improved in the four groups (all P<0.05). The medical care management, peer management, and medical care and peer co-management groups were further improved than the general group (all P<0.05). Except for smoking, the above medical care and peer co-management group indicators were statistically different from those of the separate medical care management and peer management group (all P<0.05). Triacylglycerol (TG) of the four groups were improved compared with the previous [1.9(1.2, 2.7) compared with 2.3(1.6, 3.5)mmol/L, 1.4(1.2, 2.1) compared with 2.2(1.6, 3.2)mmol/L, 1.6(1.1, 2.0) compared with 2.2(1.4, 3.2)mmol/L, 1.5(1.0, 2.1) compared with 2.4(1.3, 3.1)mmol/L] (all P<0.05), and after the intervention, the total cholesterol (TC) of the four groups was also improved compared with that before the intervention [(4.7±0.9) compared with (5.1±1.2)mmol/L, (4.2±1.1) compared with (5.2±1.2)mmol/L, (4.3±1.1) compared with (5.4±1.3)mmol/L, (4.2±1.1) compared with (5.0±1.4)mmol/L] (all P<0.05), and TG and TC of the medical care management, peer management, and medical care and peer co-management groups were lower than those of the general group (all P<0.05). Conclusion:Based on the WeChat platform, the management mode of medical care and peer co-management is conducive to T2DM patients′ better self-management and blood glucose control.

Objective:To analyze and compare the effects of conventional treatment and the dynamic 3C therapy, continuous glucose monitoring system, and on outcomes, length of hospital stay and medical costs in patients with type 2 diabetes mellitus.Methods:A total of 122 type 2 diabetes mellitus patients who visited the Department of Endocrinology of Shanxi Baiqiu'en Hospital between June 2022 and December 2022 were selected and randomized at 1:1 into the control group and the experimental group using the randomized numerical table method. The t-test and non-parametric test were used as appropriate to compare the glycemic control, length of hospital stay and medical costs of the two groups.Results:Before treatment, there was no significant difference in the indicators for blood glucose levels and fluctuations between the two groups ( P>0.05). After treatment, the glycosylated hemoglobin, fasting plasma glucose, and 2-hour postprandial blood glucose decreased in both groups. Moreover, the glycosylated hemoglobin, fasting plasma glucose, and 2-hour postprandial blood glucose showed more significant decreases in the experimental group compared with the control group after treatment. The glycemic variability indicators, including the time out of range, standard deviation of blood glucose, and the largest amplitude of glycemic excursion, decreased after treatment in both groups. The time in range increased after treatment. After treatment, the standard deviation of blood glucose and the largest amplitude of glycemic excursion in the experimental group were lower than those in the control group, and the length of hospital stay in the experimental group was shortened (all P<0.05). Conclusion:3C therapy contributes to better glycemic control and shorter hospital stay in patients with type 2 diabetes mellitus.