Objective:To explore the effect of goal-directed fluid therapy (GDFT) on the gastrointestinal function of patients after laparoscopic radical resection of cervical cancer.Methods:A total of 60 patients who were scheduled for laparoscopic radical resection of cervical cancer in Shanxi Provincial People's Hospital from October 2016 to September 2018 were selected. They were randomly divided into observation group and control group by random number table method, with 30 cases in each group. Patients in the observation group received GDFT, they were connected to the Flotrac/Vigile monitoring system, and the fluid supplementation was guided according to the changes in mean arterial pressure (MAP), stroke volume variability (SVV) and cardiac index, the goal was to maintain MAP≥60 mmHg (1 mmHg = 0.133 kPa), SVV≤13%, and cardiac index 2.5-4.0 L·min -1·m -2. The conventional fluid therapy was applied in the control group, and the liquid's input speed was adjusted according to the changes of MAP and central venous pressure (CVP) which were respectively maintained at 60-110 mmHg and 8-12 cmH 2O (1 cmH 2O = 0.098 kPa). The crystal/colloid input, bleeding volume and urine output were recorded. The first bowel sounds recovery time, exhaust time, postoperative hospitalization time, and the incidence of nausea and vomiting after surgery were recorded. Arterial blood and central venous blood were drawn before anesthesia induction and 12, 24 and 36 hours after operation to determine the concentrations of arterial blood lactate and central venous oxygen saturation (ScvO 2) as well as intestinal type fatty acid binding protein (IFABP). Results:Compared with the control group, the urine output was increased ( t = -7.738, P < 0.01), the crystal input was reduced ( t = -13.439, P < 0.01), the colloid input was increased ( t = -8.360, P < 0.01), the recovery time of first bowel sounds after surgery was shortened ( t = 6.694, P < 0.01), the exhaust time was shortened ( t = -10.326, P < 0.01), and the time of postoperative hospitalization was shortened ( t = -7.377, P < 0.01). The incidence of nausea and vomiting in the observation group were 10.0% (3/30) and 6.7% (2/30), which were lower than 33.3% (10/30) and 26.7% (8/30) in the control group ( χ2 = 4.812, P = 0.028; χ2 = 4.320, P = 0.038). Compared with the control group, the concentration of IFABP in the observation group was reduced at 12 h ( t = 2.983, P = 0.004), 24 h ( t = 6.452, P < 0.01), and 36 h ( t = -3.880, P < 0.01) after surgery; the concentration of lactate in the observation group was reduced at 12 h ( t = -7.377, P < 0.01), 24 h ( t = -6.036, P < 0.01), and 36 h ( t = -8.933, P < 0.01) after surgery; the value of ScvO 2 in the observation group was increased at 12 h ( t = 2.710, P = 0.009) and 24 h ( t = 2.387, P = 0.020) after surgery. Conclusion:GDFT can maintain the balance between oxygen delivery and oxygen consumption in the gastrointestinal mucosa cells, which can promote the recovery of gastrointestinal function of patients undergoing laparoscopic radical resection of cervical cancer.

Objective To discuss the relationship between discipline ranking and personnel rationality,and explore the problems of personnel development among all the disciplines and put forward further countermeasures.Methods A 3A general hospital in Beijing was targeted,and departments in it were divided into,in descending order of hospital regulations,key disciplines,developing-key disciplines,characteristic disciplines and general disciplines.To analyze the rationality of personnel,four dimensions as educational background structure,professional title structure,age structure and academic proficiency of department leader were adopted.Results The hospital had 52 departments in total,which were divided into key disciplines (7),developing-key disciplines (10),characteristic disciplines (6) and general disciplines (29).With the decline of the discipline level,the problem of the talent team was gradually increasing.The major problem of personnel among all the disciplines was that the proportion of senior staff was too high,so did the key disciplines and developing key disciplines.Age structure irrationalized was another major problem for developing-key disciplines.As for characteristic disciplines,the problems in personnel were even diversified,which included not only the irrational age structure and senior professional proportion,but also the fact that director of one third of these departments showed low academic proficiency.In general disciplines,all above four types of problems exited.Conclusions The rationality of the talent team is closely related to the level of the discipline.Problems in personnel varied among different disciplines,and countermeasures should be provided targeted at existing problems.

Objective:To investigate the effects of theta burst stimulation(TBS)mode repeated transcranial magnetic stimulation (r-TMS) in the left prefrontal on negative symptoms and cognitive function in the elderly chronic schizophrenic patients.Methods:Totally 48 patients with stable chronic senile schizophrenia (24 cases in r-TMS treatment group and 24 cases in r-TMS pseudo stimulation control group) were selected. The treatment group was given the TBS mode r-TMS performed in the left dorsolateral prefrontal cortex. The control group was given pseudo stimulation at the same site. Before and after treatment, the brief psychiatric rating scale(BPRS), scale for assessment of negative symptoms(SANS), and positive and negative syndrome scale(PANSS)were used to assess mental symptoms, while Mattis-dementia rating scale(MDRS-2)and social adaptation functioning evaluation(SAFE)were used to assess cognitive function and social function. SPSS 20.0 was used for statistical analysis.Comparisons of the differences between inter groups and intra groups were conducted by independent sample t test and paired t-test. Results:(1)There were significant differences in the total score of PANSS scale((60.17±3.73), (56.67±3.12)), the negative symptom subscale score of PANSS((20.88±2.94), (17.96±2.33)) and the score of SANS((30.67±1.66), (30.25±1.45)) before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of BPRS ( t=3.513, P=0.001), PANSS ( t=6.048, P<0.01), negative symptom subscale ( t=6.610, P<0.01) and SANS ( t=8.239, P<0.01) were significantly different between the two groups. (2)There were significant differences in the scores of MDRS-2 and its sub scales before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of MDRS-2 ( t=6.216, P<0.01), attention ( t=4.596, P<0.01), start/maintain ( t=6.424, P<0.01), concept formation ( t=3.974, P<0.01), construction( t=2.194, P=0.033) and memory ( t=3.162, P=0.003) were significantly different between the two groups.(3)There was no significant difference in the SAFE score between the treatment group and the control group before and after treatment ( t=0.138, 0.142, both P>0.05). Conclusion:TBS can improve the negative symptoms and cognitive function in patients with the elderly chronic schizophrenic, but the effect of social function is not clear.

Oleic acid(OA),a monounsaturated fatty acid(MUFA),has previously been shown to reverse saturated fatty acid palmitic acid(PA)-induced hepatic insulin resistance(IR).However,its underlying molecular mechanism is unclear.In addition,previous studies have shown that eicos-apentaenoic acid(EPA),a ω-3 polyunsaturated fatty acid(PUFA),reverses PA-induced muscle IR,but whether EPA plays the same role in hepatic IR and its possible mechanism involved need to be further clarified.Here,we confirmed that EPA reversed PA-induced IR in HepG2 cells and compared the proteomic changes in HepG2 cells after treatment with different free fatty acids(FFAs).A total of 234 proteins were determined to be differentially expressed after PA+OA treat-ment.Their functions were mainly related to responses to stress and endogenous stimuli,lipid meta-bolic process,and protein binding.For PA+EPA treatment,the PA-induced expression changes of 1326 proteins could be reversed by EPA,415 of which were mitochondrial proteins,with most of the functional proteins involved in oxidative phosphorylation(OXPHOS)and tricarboxylic acid(TCA)cycle.Mechanistic studies revealed that the protein encoded by JUN and reactive oxygen species(ROS)play a role in OA-and EPA-reversed PA-induced IR,respectively.EPA and OA alle-viated PA-induced abnormal adenosine triphosphate(ATP)production,ROS generation,and calcium(Ca2+)content.Importantly,H2O2-activated production of ROS increased the protein expression of JUN,further resulting in IR in HepG2 cells.Taken together,we demonstrate that ROS/JUN is a common response pathway employed by HepG2 cells toward FFA-regulated IR.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.