Objective To investigate the effect of auxiliary heterotopic partial liver transplantation in treating acute ischemic liver failure. Methods Auxiliary heterotopic partial liver transplantation was performed on pigs.The pigs were divided into two groups.Group I: The host′ liver was preserved in situ, liver artery was ligated, portal vein was constricted,and donor patial right liver was transplanted under the right lobe of the liver of the host.Portal venous blood supply was constructed only, and arterial blood supply was not constructed .Group B:Except both arterial blood supply and portal venous blood supply of the donor liver were constructed, and the other operative procedures were as the same as in Group A. The living condition, liver function, blood supply, pathology and bile secretion of the donor liver were observed. Results The survival rates in Group B before and after operation were higher than that in Group A .Serum bilirubin(SB) after the operation was higher than that before the operation in Group A, but showed no change in Group B.After the operation, SB in Group A was higher than that in Group B. In Group A, the donor liver didn't secret bile,and hepatocytes were necrosis.In Group B, the bile secretion and blood supply of donor liver were good,and hepatocyte of the donor liver were alive and proliferating actively.The hosts' liver was necrosis obviously in both groups. Conclusions Hosts' liver artery ligation and portal vein constriction can result in acute ischemic liver failure.Auxiliary heterotopic partial liver transplantation is effective in correcting liver failure.The good arterial blood supply must be constructed in the donor liver to get good donor liver quality.

Objective To analyze the effect of high quality nursing in gastroscopy examination. Method 1 300 pa﹣tients underwent gastroscopy from March 2014 to June 2014 were randomly divided to control group (n= 650) and intervention group (n= 650). Patients in control group received routine nursing, and patients in intervention group received high quality nursing intervention besides the routine nursing. Patients anxiety level, open state of esophageal meatus, one-time intubation success rate, and time-consumed in gastroscopy of the two groups were compared. Result Anxiety score between the two groups at the time of reservation was not statistically significant (P> 0.05), anxiety scores of the intervention group (31.40 ± 4.20) was lower than that of control group before gas﹣troscopy, and the difference was statistically significant (P<0.01). Open rate of esophageal meatus, one-time intuba﹣tion success rate, and time-consumed in gastroscopy of the intervention group (97.1%, 95.1%and 4.52 ± 1.23 min) were significantly better than those of the control group (79.4%, 82.3%and 5.42 ± 1.53 min). Conclusion The high quality nursing in gastroscopy can alleviate the anxiety level of patients, improve the success rate of gastroscopy, re﹣duce the pain of patients, and it is worthy of clinical promoting.

Objective To copy the mouse aging model with D-galactose,and to investigate the role of Schisandra total lignin (SCL)in the mouse brain tissue aging and its mechanism.Methods 50 mice were radomly divided into control group,model group (100 mg·kg-1 ·d-1),low dose (35 mg·kg-1 ·d-1)of SCL group (SCL-L), middle dose (70 mg· kg-1 · d-1 )of SCL group (SCL-M)and high dose (140 mg· kg-1 · d-1 )of SCL group (SCL-H)(n=10).D-galactose (100 mg·kg-1 ·d-1 )was injected into the mice hypodermically for 10 weeks to induce aging models in all the groups except control group,and 35,70,and 140 mg· kg-1 · d-1 SCL were administered for 10 weeks in SCL groups.The learning and memory abilities were measured by the Water Maze test.The expression levels of Bax,Bcl-2,ubiquitin (Ub),microtubule-associated protein light chain 3 (LC3)in the brain tissue of the mice in various groups were observed by Western blotting method. The LC3 protein expressions in mouse brain cortex and hippocampus were observed by immunohistochemistry.Results In learning and memory test,compared with control group,the swimming time of the mice in model group was increased (P<0.05),and the number of errors was increased (P<0.05);compared with model group,the swimming time in SCL-L,SCL-M and SCL-H groups was decreased (P<0.05)and the number of errors was also decreased (P<0.05). Compared with control group,the expression level of Bax was increased (P<0.05),the expression level of Bcl-2 was decreased (P<0.05),the expression levels of Ub and LC3-Ⅱ/LC3-Ⅰ proteins were increased (P<0.05)in model group;compared with model group,the expression level of Bax was decreased (P<0.05),the expression level of Bcl-2 was incerased (P<0.05),and the expression levels of Ub and LC3-Ⅱ/LC3-Ⅰ proteins were decreased (P<0.05)in SCL-L,SCL-M and SCL-H groups.In control group,the neuronal morphology was normal,and none of brown granules were visible in the cytoplasm of mouse brain cortex and hippocampus and the expression of LC3 protein was negative.In model group,the neurons were degeneration,and the number of LC3 protein positive cells in the cerebral cortex and hippocamptal tissue was increased (P<0.05).In SCL-L,SCL-M and SCL-H groups,the number of degenerative neurons was decreased,and the number of LC3 protein positive cells was decreased (P<0.05).Conclusion SCL can inhibit the D-galactose-induced brain tissue aging in the mice, and the mechanism is related to regulating autophagy and inhibiting apoptosis.

Objective To observe the clinical effect of multimodal analgesia for painless artificial abortion . Methods 150 cases of ASA Ⅰ-Ⅱ pregnancy received painless artificial abortion operation ,no contraindication for all patients,were randomly divided into the five groups ,30 cases in each group,the blank control group (group S):do not use any analgesia measure ,intravenous injection of 0.9% sodium chloride 2mL preoperation;the fentanyl group ( F group ) :intravenous injection of fentanyl 1μg/kg preoperation ;the parecoxib group ( group P ) :intravenous injection of parecoxib sodium 40mg preoperation.The patients were given painless artificial abortion after injection the above drugs.Nerve block group ( N group):the implementation of painless induced abortion operation after sleep in patients with the cervical nerve block ,injection of 1%lidocaine 2 mL.Multimodal analgesia group (group M):intra-venous injection of parecoxib sodium 40mg,fentanyl 1μg/kg,then the implementation method the same as N group . The operation time,anesthesia onset time,recovery time,time of accurate orientation and additional dosage of propo-fol;incidence rate of artificial abortion syndrome ,the incidence rate of uterine contraction pain ,10min,30min,1h,6h pain scores after operation; adverse reaction;satisfaction score of analgesic effect postoperative 24h were observed. Results The additional dosage of propofol in the group S ,group F,group P,group N and group M were (78.45 ± 20.36)mg,(15.55 ±12.33)mg,(16.75 ±13.13)mg,(14.55 ±10.25)mg,(9.35 ±8.27)mg.The incidence rates of uterine contraction pain in the group S ,group F,group P,group N and group M were 30%,10%,10%,10%,0. Compared with group M ,the additional dosage of propofol and incidence rate of uterine contraction pain in the other four groups were significantly increased (t=3.05,1.82,1.84,1.78,χ2 =72.1,68.2,68.2,68.2,all P<0.05). Pain scores after operation 10min,30min,1h,6h in the group S were (6.6 ±1.5)points,(5.6 ±1.4)points,(4.6 ± 1.1)points,(3.6 ±1.4)points.Those in group F were (5.1 ±1.5)points,(4.3 ±1.1)points,(3.1 ±0.9)points, (2.8 ±0.8).Pain scores after operation 10min,30min,1h,6h in the group P were (4.6 ±1.5) points,(4.2 ± 0.9)points,(2.9 ±0.8) points,(2.7 ±0.6) points.Those in the group N were (4.5 ±1.5) points,(4.1 ± 0.8)points,(2.9 ±0.8)points,(2.6 ±0.5).Pain scores after operation 10min,30min,1h,6h in the group M were (2.2 ±0.8)points,(1.9 ±0.7)points,(1.5 ±0.5)points,(1.2 ±0.3)points.Compared with the group M,pain scores after operation 10min,30min,1h,6h in the other four groups were significantly elevated ( t=2.03,1.96,1.86, 1.84,1.98,1.82,1.80,1.76,2.05,1.99,1.95,1.86,2.06,1.88,1.82,1.76,all P<0.05).Compared with S group,postoperative 24h satisfaction score of analgesia in the group M was improved significantly ( t =1.98,P<0.05).Compared with group M,the incidence rate of nausea in the other four groups was increased significantly (χ2 =72.2,68.9,68.1,68.1,all P<0.05).Conclusion Multimodal analgesia method can greatly reduce artificial abor-tion postoperative pain ,reduce the adverse reactions ,improve patients'satisfaction score ,ensure the safety of operation .

Objective:To study the effects of compound schisandra extracts (CSE) (schisandra,astragalus,acanthopanax,and rhodiola)on the exhaustive swimming time and the levels of blood urea nitrogen(BUN),serum lactic acid(LD),liver glycogen and muscle glycogene,superoxide dismutase(SOD)activity,and malonaldehyde(MDA) level in the mice and to charify its anti-fatigue effect and the mechanism.Methods:Eighty male ICR mice were randomly divided into blank control group,50 mg·kg-1 CSE group,100 mg·kg-1 CSE group,and 200 mg·kg-1CSE group;there were 20 mice in each group.The mice were administered orally for 30 d.Then 10 mice were randomly selected for exhaustive swimming test in each group and the exhaustive swimming time of the mice was recorded.The remaining 10 mice in each group were used for 90 min swimming,then all the mice were sacrificed and the blood and tissue samples were taken for the measurement of the levels of BUN,LD,liver glycogen and muscle glycogen,the SOD activity and MDA level;the total inhibitory rate of oxidation of CSE in vitro was determined by linoleic acid-ferric thiocyanate method.Results:Compared with blank control group,the exhaustive swimming time of the mice in 50,100,and 200 mg·kg-1 CSE groups were significantly increased (P<0.01);the levels of BUN and LD of the mice in 100 and 200 mg·kg-1 CSE groups were significantly decreased (P<0.05 or P<0.01);the levels of liver glycogen and muscle glycogen of the mice in 100 and 200 mg·kg-1 groups were significantly increased(P<0.05 or P<0.01);whereas the SOD activities were significantly increased and the levels of MDA were decreased(P<0.05 or P<0.01).Compared with 100 mg·kg-1 CSE group,the levels of serum BUN and LD of the mice in 200 mg·kg-1 CSE group were decreased (P<0.01),and the levels of liver glycogen and muscle glycogen were increased(P<0.05).The total inhibitory rate of oxidation of 5 g·L-1CSE was 76.94%.Conclusion:CSE has an anti-fatigue effect and the mechanism may be related to anti-oxidation effect.

Objective:To explore the application effect and feedback of online pediatrics teaching for the clerkship and internship stage of medical students of clinical medicine eight-year program.Methods:In this study, 38 clerkship medical students and 12 internship medical students of clinical medicine eight-year program in pediatrics department of Peking University First Hospital from February to March, 2020 were selected as research objects. They had two weeks of online teaching, including online flipped classroom, case-based learning (CBL), and problem-based learning (PBL). The effect of online teaching, and the feedback from these students were all investigated through the questionnaire survey.Results:All students were satisfied with the overall arrangement of the online teaching and believed that the results exceed [42% (21/50)] or meet [58% (29/50)] their expectations. According to the feedback, network congestion [82% (41/50)] was the biggest problem in online teaching, followed by the inability of effective interaction [20% (10/50)]. Students all believed that the online teaching arrangement was most helpful for the cultivation of theoretical knowledge (Total scores 4.58±0.50), autonomous learning ability (Total scores 4.42±0.58) and clinical reasoning (Total scores 4.42±0.58), but had minimal impact on the skills operation (Total scores 2.68±0.87) and scientific research ability (Total 2.98±0.98). For the ability of communication between doctors and patients, the scores of clerkship students (3.79±0.99) were significantly higher than those of internship students (3.08±0.67), ( P<0.05). Clerkship students considered that online flipped classroom was the most helpful teaching mode, while internship students believed online CBL teaching was the most helpful one. Majority of the students (94%) think it's necessary to keep online teaching in the future. Conclusion:Online teaching of pediatrics is approved by the medical students of clinical medicine eight-year program in the stage of clerkship and internship, and plays an important role in the cultivation of the ability of medical students, but it can't completely replace offline clinical practice.

Objective:To explore the effect of perioperative aspirin administration on intraoperative and postoperative bleeding in patients undergoing video-assisted thoracoscopic (VATS) pulmonary wedge resection.Methods:Sixty-three patients scheduled for VATS pulmonary wedge resection in Shougang Hospital of Peking University from November 2020 to April 2022 were randomly assigned in 2 groups. All patients had a history of aspirin taking, patients in study group ( n=32) continued aspirin taking perioperatively, and patients in the control group ( n=31) stopped taking aspirin for 7 days before surgery and resumed taking 3 days after surgery. The volume of intraoperative blood lost, operation time, postoperative drainage volume, thoracic drainage tube placement time, postoperative hospital stay, postoperative thrombosis of lower extremity, perioperative cardiovascular and cerebrovascular events, and postoperative wound healing were documented and compared between the two groups. Results:There were no significant differences in age, gender, oral aspirin time, lesion location, lesion nature, localization, lesion size and underlying disease between the two groups (all P>0.05). All patients successfully completed the operation, and no patients switched to thoracotomy. The intraoperative blood loss in study group and control group was (27.72±12.86) ml and (31.35±13.81) ml ( t=1.08, P=0.283); the operation time was (61.16±10.24) minutes and (61.39±13.79) minutes, respectively ( t=0.08, P=0.940). There were no significant differences in postoperative thoracic drainage, drainage tube placement time, length of hospital stay, incidence of lower extremity thrombosis, incidence of cardiovascular and cerebrovascular events, and rate of poor wound healing between the two groups (all P>0.05). Conclusion:Perioperative administration of aspirin may not increase intraoperative and postoperative bleeding, and the incidence of operation-related complications in patients undergoing VATS pulmonary wedge resection.

The occurrence of the clinical manifestations of myocardial ischemia shows clear circadian rhythmicity ,and they are unevenly distributed during the 24 h with higher morbidity during the initial hours of the daily activity span and in the late afternoon or early evening .Such temporal patterns result from circadian rhythms in pathophysiological mechanisms plus cyclic environmental stressors that trigger these clinical events .β‐receptor antagonist medications ,oral nitrate ,and calcium channel blocker have been shown to be influenced by the circadian time of their administration .Here we briefly review the char‐acteristics of circadian rhythmicity in MI ,the pathophysiological mechanisms as well as the current chronotherapy ,and then discuss the future treatment strategies .

Objective:To compare the clinical effects of Zero-profile (Zero-p) intervertebral fusion and titanium plate combined with cage fusion in treating symptomatic adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF).Methods:Retrospective analysis was performed on 26 patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019. There were 17 males and 9 females, aged 54.15±8.60 (range 41-68) years. The index level included C 2, 3 1 case, C 3, 4 3 cases, C 4,5 9 cases, C 5, 6 6 cases, C 6, 7 7 cases. Twelve cases underwent anterior cervical decompression with Zero-p intervertebral fusion and fixation (Zero-p group), while 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion and fixation (titanium plate group). The following parameters, including operative duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) score, visual analogue score (VAS), neck disability index (NDI), dysphagia Bazaz grade, bone graft fusion Eck grade, C 2-C 7 Cobb angle, and related complications, were compared between the two groups. Results:The operation was performed successfully in all the patients. The patients were followed up for averagely 33.38±21.26 (range 12-71) months. The operation duration was 95.83±5.47 (range 89-105) min in the Zero-p group, which was shorter than 121.28±8.24 (range 106-131) min in the titanium plate group. The Bazaz classification of dysphagia in the Zero-p group was superior to the titanium plate group at 1 month after operation ( W=126.00, P=0.022). Neither group had dysphagia 3 months after surgery. The JOA score increased from preoperative 9.50±1.31 to 14.33±0.78, and VAS decreased from 5.33±1.67 to 0.83±0.72 in the Zero-p group. The NDI decreased from 43.62%±9.31% to 14.99%±3.26%, and C 2-C 7 Cobb changed from 8.26°±2.92° to 14.80°±4.18° in the Zero-p group. The JOA score increased from preoperative 9.14±1.79 to 14.71±0.73, and VAS decreased from 5.43±1.55 to 1.43±0.76 in the titanium plate group. The NDI decreased from 43.76%±8.47% to 14.22%±4.59%, and C 2-C 7 Cobb changed from 5.53°±9.04° to 14.68°±6.89° in the titanium plate group. No complication, such as screw loosening or breakage or esophageal injury, occurred during the follow-up. Conclusion:Both methods can achieve good clinical effects in treating symptomatic ASD and can restore the physiological curvature of the cervical spine to a certain extent. Furthermore, the advantages of Zero-p intervertebral fusion include shorter operation duration, reducing soft tissue injury and less postoperative dysphagia.

Objective:To analyze the effects of SARS-CoV-2 infection and vaccination on virus mutation.Methods:The whole genome sequencing sequences of 2 659 local SARS-CoV-2 specimens from Jiangsu Province in 2023 were selected for analysis, and relevant information such as demographic and clinical characteristics were collected, and the effects of infection and vaccination on the genome-wide mutation rate and S gene′s selective pressure of the virus were analyzed by univariate and multivariate linear regression models.Results:The average age of these infected patients was 55.0 (31.0, 74.0) years, 1 150 cases (43.2%) in the age group of ≥60 years, 1 367 cases (51.4%) were males, 2 044 cases (76.9%) had a history of COVID-19 vaccination, and 1 629 cases (61.3%) had the first-time infection. The clinical symptoms of the infected patients were mainly mild, with a total of 2434 cases (91.5%), and 29 cases (1.1%) with severe symptoms or more. The average substitution rate of SARS-CoV-2 was 9.69 (9.38, 9.98)×10 -4 subs/site/year, and the dN/dS value of the S gene was 6.08 (5.56, 8.66), which was significantly greater than that of 1 ( P<0.001), indicating positive selection. The result of univariate and multivariate linear regression model analysis showed that the SARS-CoV-2 substitution rate was higher in those with vaccination history and reinfection, aged 20-30 years, ≥60 years, and the SARS-CoV-2 substitution rate was lower in males with moderate clinical symptoms and severe disease and above. Those with a history of vaccination and reinfection, aged 50-60 years old, ≥60 years old have smaller S gene dN/dS. Conclusions:Under the immune pressure exerted by vaccination and infection, the genome-wide mutation of SARS-COV-2 accelerated, but the non-synonymous mutation rate of the S gene decreased. The mechanism causing these phenomena needs further study.