Objective To analyze the clinical effect of small incision operation and traditional operation in treatment of pediatric hernia,and to provide a theoretical basis for the clinical treatment of pediatric hernia.Methods 68 children with pediatric hernia were treated as the research subjects,they were randomly divided into control group and observation group,34 children in each group.The control group adopted the traditional operation treatment,while the observation group was taken small incision.The clinical efficacy and complications of both two groups were compared. Results The operation time,bleeding volume,hospitalization time and incision length of the observation group were (10.45 ±1.35)min,(5.21 ±0.78)mL,(1.98 ±0.76)d,and (1.04 ±0.23)cm,which were better than those of the control group [(15.67 ±3.24)min,(8.56 ±1.87)mL,(3.78 ±1.12)d,and (2.54 ±0.65)cm,respectively],the differences were significant (t =5.760 0,5.747 7,4.171 7,7.986 8,all P <0.05).The incidence rate of complica-tions of the observation group was 2.94%,which was significantly lower than that of the control group (11.76%),the difference was significant (χ2 =5.7118,P <0.05).Conclusion The clinical curative effect of using small incision in the treatment of pediatric hernia is significant,this method has the advantages of small operation wound,less pain, faster postoperative recovery,less complications and other advantages,it is worthy of clinical application.

[Objective] Introduce 1 case of adult onset stil ’s disease cured by Chinese traditional medicine plus acupuncture therapy.[Methods] With TCM treatment we started from relieving shaoyang disorder, clearing heat and expel ing superficial evils, differentiated the case Shaoyang syndrome, then made a prescription of Xiao Chai-hu Tang and Qing-hao Bie-jia Tang to balance qi movement ,clear heat and expel dampness;with acupuncture treatment we discharged heat and expel ed wind at acute phase, supplemented the center and boosted the energy at stable phase. With the combined therapy that reached a total function of expel ing damp and regulating qi movement. [Results] The patient ’s symptoms relieved and discharged, fol owed the case 2 months without recurrence. [Conclusion] Chinese traditional medicine plus acupuncture therapy can cure adult onset stil ’s disease effectively, it is worth clinical application.

Objective To observe the results of free medialis pedis mini-flap pedicled on medial branch of deep branch of the medial plantar artery to repair a soft tissue defect of finger. Methods The mini-flap designed on the medial side of the foot pedicled on the medial branch of deep branch of medial plantar artery was used to repair the soft tissue defect of finger or the degloved injury of the finger combined with second toe flap, furthermore, the vascular pedicle of flap was anastomosed with the digital artery and dorsal vein respectively. 13 fingers of 11 cases, which included 10 fingers of 8 cases of male and 3 fingers of 3 cases of female with an average of 32 years ranging from 18 to 58 years, were performed 13 free medialis pedis mini-flaps transplantation. Eight free medialis pedis mini-flaps were used to repair the soft tissue defect of the finger, and 5 free medialis pedis mini-flaps combined with the second toe composite flap were used to reconstruct the degloved finger. Results All the patients were followed up on an average of 21 months ranging from 3 months to 5.5 years. The maximal area of flaps was 5 cm?4 cm, and the minimal was 2.5 cm?3 cm. 12 of the 13 free medialis pedis mini-flaps were survived completely, however, 1 healed but partly necrosis. The color, character and thickness of this flap after transplantation were similar to the skin of the finger; and the appearance of the reconstructed finger by mini-medialis pedis flap and second toe composite flap was perfect. The transplanted skin of donated areas survived well, and the appearance and functions of donated feet were not affected significantly. Conclusion The free medialis pedis flap pedicled on medial branch of the deep branch of the medial plantar artery was one of the optimal flaps to repair soft tissue defect of the finger especially on the palmer side.

Objective The stress reaction in double-balloon enteroscopy was investigated,the influencing factors and intervention countermeasures were studied.Methods Cardiovascular effects and physiological reactions of 60 double-balloon enteroscopy patients were surveyed.The patients were divided into 2 groups according to the cardiovascular effects to underwent single factor analysis of related factors.Results The incidence of physiological reactions was 68.3%,the incidence of cardiovascular reactions was 56.7%.Evident difference existed in blood pressure,heart rate and blood oxygen saturation rate before,during and after examination.The grouping analysis showed cardiovascular effects were influenced by many kinds of factors.Conclusions Different degrees of the stress reactions in double-balloon enteroscopy might appear.The influencing factors included the enteroscopy mode and time,gender,age,mood,and physician operation experience.The stress reactions might be reduced by taking the corresponding intervention measures according to the influencing factors.

Teaching anesthesia-physiology is a subject worth to be discussed.Arranging the high quality teachers to teach,making a careful study and preparation of the teaching materials,teaching plan and enhancing the teachers’teaching art should be first emphasized.And then the advantages of using multimedia should be given full play in combination with various kinds of methods to let the students become active class participants so as to improve the teaching effect in anesthesia-physiology.

AIM:To investigate the effect of growth differentiation factor 11 ( GDF11 ) on the expansion of CD8 +memory stem T cells ( Tscm) and to further improve the effect of adoptive immunotherapy.METHODS:Healthy human peripheral blood mononuclear cells ( PBMCs) were isolated by density gradient centrifugation at first.Among the i-solated PBMCs, CD8 +T cells were further purified with MACS microbeads.The CD8 +T cells were then randomly divided into experimental groups and control group.The same volume of different concentrations of GDF11 were added into the ex-perimental groups, and the same volume of PBS solution was added into the control group.Finally, the expansion of Tscm in experimental groups and control group was measured by flow cytometry at several time points.RESULTS:GDF11 sig-nificantly increased the number of Tscm in CD8 +T cells in vitro expansion and also dramatically increased the ratio of Tscm in CD8 +T cells.Furthermore, 400 μg/L GDF11 treatment for 3 weeks was the optimal condition to induce CD8 +Tscm. CONCLUSION:GDF11 effectively increases the number and ratio of Tscm in the CD8 +T cells in cell culture growth, thereby creating a new strategy to further improve the efficiency of adoptive immunotherapy.

Objective:To evaluate the changes of right ventricular function in patients with pneumoconiosis in different stages using three-dimensional speckle-tracking imaging (3D-STI) .Methods:In June 2020, 114 pneumoconiosis patients were selected as subjects, including 45 patients in stage Ⅰ pneumoconiosis group, 36 patients in stage Ⅱ pneumoconiosis group and 33 patients in stage Ⅲ pneumoconiosis group. Fifty healthy subjects were enrolled and served as control group. The longitudinal strain (LS) , radial strain (RS) and circumferential strain (CS) of free wall middle and basal segment of right ventricular were collected and compared. The right ventricular global longitudinal strain (GLS) , right ventricular global circumferential strain (GCS) , right ventricular ejection fraction (RVEF) , right ventricular global radial strain (GRS) , the rate of fractional area change (FAC) , the tricuspid valve systolic peak velocity (TVSPV) and the pulmonary artery systolic pressure (PASP) of each subject in the groups were collected and compared by 3D-STI.Results:The LS and RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The LS, CS, RS of the right ventricular basal segment and RS of right ventricular middle segment of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The LS, CS and RS of the right ventricular basal segment of patients in stage Ⅰ pneumoconiosis group were significantly higher than those of stage Ⅲ pneumoconiosis group ( P<0.0125) , and the RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . The levels of RVEF and GLS of patients in stage Ⅱ and stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) , while the levels of PASP were significantly higher than that of control group ( P<0.0125) . The levels of FAC and TVSPV of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The levels of RVEF, GLS and FAC of patients in stage Ⅰ pneumoconiosis group were significantly higher those that of stage Ⅲ pneumoconiosis group ( P<0.0125) , and the PASP level was significantly lower than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . The FAC level of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . Conclusion:Patients with pneumoconiosis could experience a decline in right ventricular function at an early stage. The 3D-STI can accurately detect the GLS, GRS, GCS and hemodynamic changes of the right ventricular and evaluate the right ventricular function comprehensively and objectively. 3D-STI is of great significance for the early detection of right ventricular dysfunction in patients with pneumoconiosis.

Objective:To evaluate the changes of right ventricular function in patients with pneumoconiosis in different stages using three-dimensional speckle-tracking imaging (3D-STI) .Methods:In June 2020, 114 pneumoconiosis patients were selected as subjects, including 45 patients in stage Ⅰ pneumoconiosis group, 36 patients in stage Ⅱ pneumoconiosis group and 33 patients in stage Ⅲ pneumoconiosis group. Fifty healthy subjects were enrolled and served as control group. The longitudinal strain (LS) , radial strain (RS) and circumferential strain (CS) of free wall middle and basal segment of right ventricular were collected and compared. The right ventricular global longitudinal strain (GLS) , right ventricular global circumferential strain (GCS) , right ventricular ejection fraction (RVEF) , right ventricular global radial strain (GRS) , the rate of fractional area change (FAC) , the tricuspid valve systolic peak velocity (TVSPV) and the pulmonary artery systolic pressure (PASP) of each subject in the groups were collected and compared by 3D-STI.Results:The LS and RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The LS, CS, RS of the right ventricular basal segment and RS of right ventricular middle segment of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The LS, CS and RS of the right ventricular basal segment of patients in stage Ⅰ pneumoconiosis group were significantly higher than those of stage Ⅲ pneumoconiosis group ( P<0.0125) , and the RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . The levels of RVEF and GLS of patients in stage Ⅱ and stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) , while the levels of PASP were significantly higher than that of control group ( P<0.0125) . The levels of FAC and TVSPV of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group ( P<0.0125) . The levels of RVEF, GLS and FAC of patients in stage Ⅰ pneumoconiosis group were significantly higher those that of stage Ⅲ pneumoconiosis group ( P<0.0125) , and the PASP level was significantly lower than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . The FAC level of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group ( P<0.0125) . Conclusion:Patients with pneumoconiosis could experience a decline in right ventricular function at an early stage. The 3D-STI can accurately detect the GLS, GRS, GCS and hemodynamic changes of the right ventricular and evaluate the right ventricular function comprehensively and objectively. 3D-STI is of great significance for the early detection of right ventricular dysfunction in patients with pneumoconiosis.

Objective To analyze the influencing factors of poor anal function after laparoscopic intersphincteric resection(Lap-ISR)for extremely low rectal cancer,and to construct and verify a prediction model based on this model,in order to provide guidance for improving the anal function of patients with extremely low rectal cancer after Lap-ISR.Method A total of 127 patients with extremely low rectal cancer who underwent Lap-ISR in Taizhou People's Hospital from June 2020 to June 2022 were retrospectively selected.Patients were followed up for 12 months after surgery,and postoperative anal function was evaluated by the anal incontinence score(Wexner).According to Wexner score,the patients were divided into good anal function group(106 cases)and poor anal function group(21 cases).The clinical data of patients were collected and the risk factors affecting postoperative poor anal dysfunction were analyzed,and a Nomogram model was constructed to predict the risk of postoperative anal dysfunction in patients after Lap-ISR,and the receiver operating characteristic curve(ROC)was drawn.The area under the curve(AUC)was used to analyze the predictive efficacy of the prediction model for poor anal dysfunction after Lap-ISR.Result The incidence of anal dysfunction after Lap-ISR in patients with extremely low rectal cancer was 16.54％(21/127).Univariate analysis showed that there was no significant difference in gender,age,body mass index,clinical stage,combined underlying diseases,operation time,intraoperative blood loss,anastomosis method,and the distance from the lower edge of the tumor to the dentate line between the two groups(P＞0.05).The proportion of tumor diameter≥5 cm,the proportion of neoadjuvant chemotherapy,the distance between anastomosis and anal verge＜2 cm,and the proportion of anastomotic leakage in the anal dysfunction group were higher than those in the good anal function group(P＜0.05).Cox multivariate regression analysis showed that tumor diameter≥5 cm(OR=5.124),neoadjuvant chemotherapy(OR=5.761)and anastomotic leakage(OR=6.881)were risk factors for postoperative anal function(P＜0.05).Wexner score of patients with tumor diameter ≥5 cm was higher than that of patients with tumor diameter＜5 cm,Wexner score of patients with neoadjuvant chemotherapy was higher than that of patients without neoadjuvant chemotherapy,and Wexner score of patients with anastomotic leakage was higher than that of patients without anastomotic leakage(P＜0.05).Internal validation of Bootstrap method showed that the C-index was 0.785(95％CI:0.692-0.851).The results of ROC curve showed that the sensitivity and specificity of the nomogram model in predicting postoperative poor anal function of patients were 85.70％and 88.70％,respectively,and the AUC was 0.895(95％CI:0.795-0.984).Conclusion Tumor diameter,neoadjuvant chemotherapy and anastomotic leakage are risk factors for poor anal function after Lap-ISR in patients with extremely low rectal cancer.The nomogram risk prediction model based on the above risk factors has a good risk efficiency in evaluating the risk of postoperative anal dysfunction in patients.

Objective:To explore the teaching effect of high-fidelity simulation teaching in emergency and critical care nursing course.Methods:From March to June 2019, 56 four-year nursing undergraduates from Xiamen Medical College in 2016 were selected as research subjects by convenient sampling. The high-fidelity simulation teaching was carried out in the emergency and critical care nursing course. The Jeffries Simulation Design Scale (SDS) and open-group interviews were used to evaluate the learning effect.Results:Among 56 students, scores of simulation teaching confidence and satisfaction were (3.80±0.80) and (4.00±0.62) respectively. Group interviews showed that students directly applied the theoretical knowledge they had learned to work situations, and students enhanced their self-learning ability and reflected on operational errors in simulation so as to provoke thinking and enhance learning confidence and personal learning ability.Conclusions:The application of high-fidelity simulation teaching in emergency and critical care nursing course can improve the self-confidence, teamwork ability and comprehensive quality of nursing undergraduates, and increase teaching satisfaction, which is feasible.