Objective:To evaluate the effect of ultrasound-guided adductor canal combined with knee joint posterior capsule space block on the recovery period delirium in elderly patients undergoing total knee arthroplasty (TKA).Methods:A total of 68 elderly patients who underwent unilateral TKA at the Nanjing First Hospital from December 2021 to December 2022 were selected. They were randomly divided into a control group ( n=34) and an observation group ( n=34) using a random number table method. Both groups received general anesthesia, and the observation group received ultrasound-guided myofascial tube combined with knee joint posterior capsule space block before the surgery began. The incidence of delirium within 24 hours after surgery was mainly observed in two groups of patients. The surgical time, recovery time, intraoperative blood loss, infusion volume, total use of propofol and remifentanil were recorded; The resting and motor Visual Analogue Scale (VAS) scores of the patient were recorded at 4, 8, and 24 hours postoperatively. The patient′s serum tumor necrosis factor-α (TNF-α) and melatonin levels were measured on the day before surgery, the evening after surgery, and the first day after surgery. The subjective sleep quality score was recorded on the first day after surgery; The total dosage of sufentanil for patient-controlled intravenous analgesia (PCIA) within 24 hours after surgery, the effective number of compressions (P1) and actual number of compressions (P2) of PCIA, and the number of cases of additional oxycodone analgesia were recorded; The occurrence of respiratory depression, excessive sedation, nausea, and vomiting within 24 hours after surgery was recorded; The occurrence of complications of nerve block in the observation group was recorded. Results:The incidence of delirium during the recovery period in the observation group was lower than that in the control group ( P<0.05). The dosage of propofol and remifentanil in the observation group was lower than that in the control group (all P<0.05), and the awakening time was shorter than that in the control group ( P<0.05). The VAS scores at rest and exercise at 4, 8, and 24 hours after surgery in the observation group were lower than those in the control group (all P<0.05). Compared with the day before surgery, the observation group showed an increase in melatonin levels on the night after surgery ( P<0.05) and an increase in TNF-α levels on the first day after surgery ( P<0.05); The control group had a decrease in melatonin levels on the first day after surgery ( P<0.05), and an increase in TNF-α levels on the night and day after surgery (all P<0.05). The serum melatonin levels in the observation group were higher than those in the control group on the evening and first day after surgery (all P<0.05), and TNF-α levels were lower than those in the control group (all P<0.05). The subjective sleep quality score of the observation group showed that the total dosage of PCIA sufentanil, P1, P2, and the number of cases of additional oxycodone analgesia within 24 hours after surgery were lower than those of the control group (all P<0.05). The incidence of nausea in the control group (13 cases, 38.2%) was higher than that in the observation group (3 cases, 8.8%) ( P<0.05). Conclusions:In elderly patients undergoing unilateral TKA under general anesthesia, preoperative use of ultrasound-guided adductor tube combined with knee joint posterior capsule space block can effectively reduce the occurrence of postoperative delirium.

Objective To investigate the effects of Quyu Jiedu Prescription on iron autophagy in eutopic endometrial tissue of rats with endometriosis(EMS);To explore its mechanism in treating EMS.Methods A total of 50 female SD rats were randomly divided into blank group,model group,Western medicine group,Quyu Jiedu Prescription high-and low-dosage groups,with 10 rats in each group.Except for the blank group,all other groups were modeled using autologous transplantation method,and corresponding solutions were given by gavage for 4 weeks.HE staining was used to observe the morphology of eutopic endometrial tissue,the reagent kit was used to detect the content of ferrous ions(Fe2+)in eutopic endometrial tissue,Western blot was used to detect the protein expressions of nuclear receptor coactivator factor 4(NCOA4),ferritin heavy chain 1(FTH1),LC3BⅡ/Ⅰ and p62 in eutopic endometrial tissue,the mRNA expressions of NCOA 4,FTH1,LC3B and p62 were detected by qPCR,immunofluorescence colocalization was used to detect the co-localization of NCOA4 and LC3B in eutopic endometrial tissue.Results Compared with the blank group,the content of Fe2+in eutopic endometrial tissue of the model group decreased(P<0.01),the expression of NCOA4 protein and LC3B Ⅱ/Ⅰ ratio decreased(P<0.01),the expressions of FTH1 and p62 protein increased(P<0.05,P<0.01),the expression of NCOA4 mRNA decreased(P<0.01),the expression of p62 mRNA increased(P<0.01),and the co-localization of NCOA4-LC3B decreased(P<0.01).Compared with the model group,the content of Fe2+in eutopic endometrial tissue of each administration group increased(P<0.05,P<0.01),the expressions of FTH1 and p62 protein in Western medicine group decreased(P<0.05,P<0.01),the ratio of LC3B Ⅱ/Ⅰ in Quyu Jiedu Prescription high-dosage group increased(P<0.01),the expression of FTH1 and p62 protein decreased(P<0.05,P<0.01),the expression of NCOA4 protein and LC3B Ⅱ/Ⅰ ratio increased in Quyu Jiedu Prescription low-dosage group(P<0.05),while the expression of p62 protein decreased(P<0.05),the expression of NCOA4 mRNA increased in each administration group(P<0.01),and the co-localization of NCOA4-LC3B increased(P<0.05,P<0.01).There was no significant change in the morphology of eutopic endometrial tissue in each group.Conclusion Quyu Jiedu Prescription may activate the iron autophagy pathway mediated by NCOA4 to restore the activity of ferritin protein,increase the iron content,correct the imbalance of iron homeostasis in eutopic intima of EMS rats,and thus inhibit the development of EMS.

Objective:To investigate the effects of Quyu Jiedu Decoction on the levels of free iron and NF-κB, IL-6 and TNF-α in ectopic tissues of rats with endometriosis.Methods:Totally 18 rats were divided into blank group, model group and Quyu Jiedu Decoction group according to the random number table method, with 6 rats in each group. Except for the blank group, the endometriosis model was prepared by autologous transplantation in the rest of the groups. Quyu Jiedu Decoction was given 13.23 g/kg of Quyu Jiedu Decoction, and the rats in the blank group and model group were gavaged with the same volume of normal saline for 4 consecutive weeks for consecutive 4 weeks. The pathological changes of endometriosis tissues of the three groups were observed by HE staining; the free iron content of the ectopic tissues of the rats was detected by ferrous ion colorimetric test box; ELISA was used to detect the levels of IL-6 and TNF-α; the expressions of NF-κB, IL-6 and TNF-α mRNA of rat ectopic tissues were detected by q-PCR.Results:The results of HE staining showed that there was more inflammatory cell infiltration in ectopic lesions in the model group, and the inflammatory cell infiltration of ectopic lesions in the Quyu Jiedu Decoction group was significantly improved. Compared with the model group, the content of free iron in ectopic tissues decreased ( P<0.05), the levels of IL-6 and TNF-α decreased ( P<0.05), and the mRNA expressions of NF-κB and TNF-α were down-regulated ( P<0.05). Conclusion:Quyu Jiedu Decoction can improve the expressions of free iron, IL-6, TNF-α and NF-κB in ectopic tissues of rats with endometriosis, and has a certain effect on alleviating the inflammatory state of ectopic tissues in rats with endometriosis.

Objective:To evaluate the effect of virtual reality arthroscopic simulation system combined with case-based learning (CBL) in orthopedic clinical teaching.Methods:From January 2021 to June 2022, a total of 36 residents who took the standardized residency training at Department of Articular Orthopedics in The Third Affiliated Hospital of Soochow University were enrolled in this study. They were randomized into an experimental group and a control group, with 18 trainees in each group. The experimental group adopted the virtual reality arthroscopic simulation system combined with CBL teaching mode, while the control group adopted simple endoscopic simulation training box with traditional teaching mode. Theoretical and practical tests and questionnaire survey were carried out to evaluate the teaching effects in two groups. SPSS 22.0 was performed to conduct t-test on the measurement data between the two groups. Results:The theoretical and practical test scores of the experimental group [(89.39±3.09) and (82.72±4.28)] were better than those of the control group [(86.22±4.43) and (76.61±5.65)], with statistically significant differences ( t= 2.49, P=0.018; t=3.66, P=0.001). The questionnaire survey showed that the experimental group was better than the control group in creating novel forms of courses [(4.94±0.24) vs. (4.11±0.58), t=5.62, P<0.001], simulating more real scenes [(4.83±0.38) vs. (3.78±0.43), t=7.80, P<0.001], inspiring learning interests [(4.78±0.43) vs. (4.00±0.59), t=4.51, P<0.001], improving practical skills [(4.83±0.38) vs. (3.83±0.51), t=6.61, P<0.001], and building career confidence [(4.50±0.62) vs. (3.06±0.54), t=7.47, P<0.001], with statistically significant differences (all P<0.001). Conclusions:The virtual reality arthroscopic simulation system combined with CBL teaching mode can better simulate the real clinical scenes, help inspire the interest of learning and quickly improve practical skills, thereby improving the effect of orthopedic clinical teaching.

Objective To determine the current status of occupational internal exposure to ¹³¹I in the thyroid of nuclear medicine workers, to explore the influencing factors for internal exposure, and to provide a basis for the radiation safety management of nuclear medicine. Methods The cluster sampling method was used to select 162 workers practicing ¹³¹I treatment in 24 hospitals in Hubei Province, China. Thyroid ¹³¹I activity levels were measured in vitro using a portable γ-spectrometer, and the committed effective dose was estimated. Results The thyroid ¹³¹I activity detected in 13 (54.17%) hospitals was above the lower limit of detection of the instrument. Two hospitals had the highest detection rates, 62.50% and 61.90%; the difference was significant compared with the remaining 11 hospitals (P < 0.0001). Thyroid ¹³¹I was detected in 34 workers in total, with a detection rate of 20.99% and a mean activity of 179.09 ± 138.71 (6.02-589.74) Bq. The highest detection rates were found in cleaners and nurses, which were 35.71% and 33.33%, respectively, with no significant difference in detection rate between positions (least P > 0.08). The mean value of the committed effective dose was 0.68 ± 0.52 (0.02-2.22) mSv/a in the 34 workers. Conclusion The ¹³¹I consumption and workplace ventilation may be important factors affecting the level of internal exposure. It is important to strengthen the training of nuclear medicine workers on radioprotection and workflow management, as well as the regular monitoring of occupational internal exposure for ¹³¹I treatment-related workers.

Objective:To analyze long-term outcomes of inoperable non-metastatic pancreatic cancer patients treated with definitive radiotherapy-based comprehensive treatment.Methods:Clinical data of 168 patients with medically unfit, refusal to surgery or inoperable non-metastatic pancreatic cancer treated with radiotherapy-based comprehensive treatment in PLA General Hospital between January 2016 and December 2020 were retrospectively analyzed. Survival outcomes,prognostic factors and patterns of treatment failure were analyzed in the radiotherapy ( n=95) and combined chemoradiotherapy ( n=73) groups. The survival analysis was conducted by Kaplan-Meier method. The survival curve was compared by log-rank test. Independent prognostic factors were identified by Cox proportional harzard model. Results:With a median follow-up of 20.2 months in the entire group, the median overall survival (OS) and median progression-free survival (PFS) were 18.0 and 12.3 months. The corresponding median OS and median PFS after receiving radiotherapy were 14.3 and 7.7 months. The 1-, 2-and 3-year OS rates were 72.1%, 36.6% and 21.5%, and the 1- and 2-year local control rates were 82.6% and 64.3%, respectively. The median OS for stage Ⅰ, stage Ⅱ and stage III were 27.1, 18.0 and 17.0 months, respectively. There was no significant difference in the median OS of patients with localized disease (stage Ⅰ-Ⅱ) between the radiotherapy and combined chemoradiotherapy groups (21.1 vs. 20.4 months, P=0.470). In patients with locally advanced disease (stage Ⅲ), combined chemoradiotherapy group showed better median OS compared with radiotherapy group (19.2 vs. 13.8 months, P=0.004). Clinical stage, CA19-9 before radiotherapy, comprehensive treatment and biological effective dose (BED 10) were identified as the independent prognostic factors for OS ( P=0.032, 0.011, 0.003 and 0.014). The cumulative 1- and 2-year actuarial rates of treatment failure, local-regional recurrence and distant metastasis were 48% and 74.4%, 15.0% and 27.4%, 23.6% and 33.1%, respectively. Liver metastasis (16.1%, 27/168) and local recurrence (11.9%, 20/168) were the primary patterns of treatment failure. Conclusions:Definitive radiotherapy-based comprehensive treatment effectively prolongs long-term survival in patients with inoperable non-metastatic pancreatic cancer. Definitive radiotherapy can be an alternative treatment option with curative intent for patients with localized pancreatic cancer who are medically unfit or refuse to undergo surgery. The combination of radiotherapy and chemotherapy remains an effective treatment choice for locally advanced unresectable pancreatic cancer.

Objective:To analyze the clinical characteristics of patients infected with 2019-nCoV Omicron variants BA.1 and BA.2 in Zhuhai city.Methods:A retrospective study was conducted to compare clinical characteristics of patients infected with 2019-nCoV Omicron variants BA.1 and BA.2, who were admitted in the Fifth Affiliated Hospital of Sun Yat-sen University during January 13 to March 8 2022. The Mann-Whitney U-test or Kruskal-Wallis H test was used for quantitative data, and the χ2 test or Fisher’s exact test was used for qualitative data. Results:Among 122 patients infected with the Omicron variant, there was 79 adults (BA.1 23 cases, BA.2 56 cases) and 43 children (BA.1 19 cases, BA.2 24 cases). In adults, patients infected with BA.2 sub-variant had a higher baseline viral loads at admission than BA.1 infected patients [7.64(6.92, 8.55) lg copies/mL vs. 6.64(6.04, 7.34) lg copies/mL; Z=-3.022, P=0.003]; compared to BA.1 patients, BA.2 patients had a higher proportion of mild and asymptomatic cases and a lower proportion of common infection cases ( χ2=8.052, P=0.012); the proportion of patients with pneumonia imaging changes in BA.1 patients was higher than that in BA.2 infected patients [(6/23, 26.1%) vs. (2/56, 3.6%); χ2=6.776, P=0.009). In children, the rate of fever in BA.2 group was higher than that in BA.1 group [(16/24, 66.7%) vs. ( 5/19, 26.3%); χ2=6.910, P=0.009); the proportion of patients with reduced lymphocyte counts in BA.2 group was higher than that in BA.1 group [(17/24, 70.8%) vs.(1/19, 5.3%); χ2=18.734, P<0.001). Compared with adult cases, children with BA.2 sub-variant infection had higher fever rate [(16/24, 66.7%) vs. (19/56, 33.9%); χ2=7.317, P=0.007). The viral loads of daily nasal swabs in BA.2 infected patients increased first and then decreased in both adults and children, with a greater decrease than BA.1 during the first two weeks. Conclusions:Compare with 2019-nCoV Omicron variant BA.1, BA.2 has a higher baseline viral loads in adults, which means much more contagious in the early stages. But the viral load drops faster in BA.2 infected patients. In children, BA.2 patients are more likely to have fever and reduced lymphocyte counts, which indicates that the prevention and control of 2019-nCoV Omicron sub-variant BA.2 is more difficult.

Objective:To assess the cost-effectiveness of influenza vaccination among people aged 60 years and older in Shenzhen.Methods:A Markov state transition model was constructed to evaluate the cost-effectiveness of annual influenza vaccination for preventing influenza infection compared with no vaccination among the elderly from the social perspective. Allowing seasonal variation of influenza activity, the model followed a five-year cohort using weekly cycles. We employed once the Chinese gross domestic product (GDP) per capita in 2019 (70 892 yuan) as the willingness-to-pay (WTP) threshold and calculated the net monetary benefit (NMB) with costs and quality-adjusted life-years (QALYs) discounted at 5% annually. The impact of parameter uncertainty on the results was examined using one-way and probabilistic sensitivity analyses (PSA).Results:The base case amounted to approximately 35 yuan of cost-saving and a net gain of 0.007 QALYs. Correspondingly, the NMB was 529 yuan per vaccinated person. One-way sensitivity analyses showed that the NMB was relatively sensitive to changes in the attack rate of influenza and vaccine effectiveness. Based on the results of PSA with 1 000 Monte Carlo simulations, influenza vaccination had a probability of being cost-effective in 100% of the repetitions.Conclusions:The present study provides evidence that influenza vaccination is a cost-saving disease prevention strategy for people aged 60 years and older in Shenzhen.

Objective:To assess the impact of vaccination at school and influenza vaccination rates among school-age children on school absenteeism in Shenzhen.Methods:The study subjects were primary school students in Shenzhen. School absenteeism panel database from December 2017 to June 2020 of 286 primary schools in Shenzhen was merged with vaccination rates and organizational patterns ( i.e., vaccination at school vs. non-school) data of 9 districts in Shenzhen after influenza vaccination for children. The outcome was the number of school absenteeism. The treatment and control groups were distinguished by organizational patterns and district vaccination rates. Difference-in-Difference (DiD) Poisson regressions were used to analyze the effectiveness of vaccination at school and higher vaccination rates. Besides, a robustness test was performed on the regression results. Results:Poisson regression analysis and robustness test of regression results showed that vaccination at school and higher vaccination rates effectively reduced the risk of school absenteeism, with effectiveness against absenteeism of 32.6% (95% CI: 17.0%-45.3%, P<0.01) and 53.0% (95% CI: 42.1%-61.8%, P<0.01), respectively. Conclusion:A free influenza vaccination program for school-age children in Shenzhen and prioritizing school-based vaccination may be an effective measure to reduce the risk of school absenteeism.

Objective:To ananlyze the toxic effects and mechanisms of Cr (Ⅵ) subchronic exposure based on metabonomics techniques.Methods:Twenty-nine female Sprague-Dawley rats were randomly divided into control group, low dose group and high dose group, 10, 9, 10, respectively. The control group, low dose group and high dose group were treated with 0, 10, 50 mg/L Cr (Ⅵ) for 90 days respec tively. The serum samples of rats with different dose of Cr (Ⅵ) treatment were detected Using UPLC-Q-TOF-MS/MS technique and data was analyzed by PCA, PLS-DA and OPLS-DA to compare with metabolic profile in different Cr (Ⅵ) dose treatments. Pathway analysis was performed using MetaboAnalyst 4.0 software.Results:UPLC-Q- TOF-MS/MS has stable detection performance and reliable experimental data. The control group, low Cr (Ⅵ) and high Cr (Ⅵ ) metabolic profiles of rats serum differences was obviously, and there is significant difference of serum metabolic profile among rats treated with different dose of Cr (Ⅵ) . 18 differential metabolites were screened between Cr (Ⅵ) low dose group and control group, 23 differential metabolites between Cr (Ⅵ) high dose group and control group. Compared to control group, there were 13 differential metabolites in both Cr (Ⅵ) high dose group and Cr (Ⅵ ) low dose group, such as 3-Hydroxy-11Z-octadecenoylcarnitine, Anserine, Farnesyl pyrophosphate, Linoleoyl ethanolamid e, Linoleyl carnitine, Lithocholate 3-O-glucuronide, LysoPC [20∶2(11Z, 14Z) ], LysoPC[20∶3 (5Z, 8Z, 11Z) ], LysoPC[22∶2(13Z, 16Z) ], PG[16∶0/22∶5(7Z, 10Z, 13Z, 16Z, 19Z) ], PI[18∶1 (11Z) /20∶4(5Z, 8Z, 11Z, 14Z) ], PI[20∶3(5Z, 8Z, 11Z) /18∶0], Serotonin. These differential metabolites were related to Glycerophospholipid metabolism, Tryptophan metabolism, Pentose and glucuronate interconversions, Terpenoid backbone biosynthesis.Conclusion:Cr (Ⅵ) subchronic exposure could induce the significant difference of serum metabolic profile. The differential metabolites induced by Cr (Ⅵ) subchronic ex- posure were mainly related to amino acid and lipid metabolism.