Objective:To investigate the effects of B ultrasound-guided lumbar plexus combined with sciatic nerve block on immune function, stress response, and postoperative analgesia in older adult patients undergoing hip surgery, providing theoretical evidence for clinical diagnosis and treatment.Methods:We included 300 older adult patients undergoing hip surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from August 2018 to August 2019 in this study. We randomly allocated them into the observation and control groups ( n = 150/group). The control group was subject to general anesthesia and the observation group was subject to B ultrasound-guided lumbar plexus combined with sciatic nerve block. Hemodynamic changes and plasma cortisol levels were recorded in each group immediately after endotracheal intubation (T1), at 2 hours of surgery (T2), at the end of surgery (T3), and 24 hours after surgery (T4). Each patient's immune function was assessed 3 months after surgery. The Visual Analog Scale score at each time point was compared between the two groups. Results:The systolic blood pressure, diastolic blood pressure, and heart rate in the observation group at T1-T4 were (122.14 ± 8.68) mmHg, (117.41 ± 8.72) mmHg, (109.62 ± 8.43) mmHg, (127.82 ± 7.83) mmHg, (83.47 ± 6.32) mmHg, (72.34 ± 7.02) mmHg, (67.13 ± 6.72) mmHg, (74.15 ± 7.12) mmHg, (71.94 ± 7.64) beats/minute, (71.84 ± 7.11) beats/minute, (63.52 ± 6.16) beats/minute, (73.43 ± 7.29) beats/minute , respectively, which were significantly lower than those in the control group [(131.22 ± 8.69) mmHg, (125.81 ± 8.76) mmHg, (115.11 ± 8.44) mmHg, (133.26 ± 7.85) mmHg, (89.28 ± 6.12) mmHg, (77.64 ± 7.13) mmHg, (75.51 ± 8.02) mmHg, (81.13 ± 7.14) mmHg, (79.24 ± 7.65) beats/minute, (75.27 ± 7.13) beats/minute, (70.54 ± 6.22) beats/minute, (80.11 ± 7.32) beats/minute, t = 9.05, 8.32, 5.63, 6.00, t = 8.08, 6.48, 9.80, 8.47, t = 8.26, 4.17, 9.82, 7.91, all P < 0.001]. Plasma cortisol levels in the observation group at T2-T4 were (332.28 ± 15.64) ng/L, (334.67 ± 15.77) ng/L, (331.40 ± 15.68) ng/L, respectively, which were significantly lower than those in the control group [(344.75 ± 15.63) ng/L, (346.02 ± 15.76) ng/L, (345.83 ± 15.66) ng/L, t = 6.90, 6.23, 7.97, all P < 0.001]. At 3 months after surgery, the proportion of CD 4+ helper T cells, the proportion of CD 8+ cytotoxic T cells, and the ratio of proportion of CD 4+ Helper T cells to the proportion of cytotoxic CD 8+ T cells in the observation group were (31.39 ± 6.72)%, (25.73 ± 6.24)%, 1.31 ± 0.38, respectively, which were significantly lower than those in the control group [(38.61 ± 6.73)%, (32.79 ± 6.25)%, 1.52 ± 0.39, t = 9.29, 9.79, 4.72, all P < 0.001]. At 12-48 hours after surgery, The Visual Analog Scale scores in the observation group were (1.59 ± 0.54) points, (1.47 ± 0.33) points, (1.55 ± 0.41) points, respectively, which were significantly lower than those in the control group [(2.72 ± 0.55) points, (2.29 ± 0.36) points, (2.39 ± 0.43) points, t = 17.95, 20.56, 17.31, all P < 0.001]. Conclusion:B ultrasound-guided lumbar plexus combined with sciatic nerve block can effectively stabilize the hemodynamics in older adult patients undergoing hip surgery, reduce the occurrence of the stress response, promote the recovery of immune function, and alleviate pain.

Objective:To understand the serotype distribution, drug resistance and molecular characterization of invasive non-typhoid Salmonella (iNTS) in Guangdong Province from 2018 to 2022 and provide scientific evidence for the prevention and treatment of blood flow infection caused by Salmonella. Methods:Serological identification, antimicrobial susceptibility testing, multilocus sequence typing (MLST), and whole genome sequencing were performed on Salmonella isolated from blood and stool samples in Guangdong from 2018 to 2022. Simultaneously, annotated the sequencing results for drug resistance genes and virulence factors by a microbial gene annotation system. Results:The 136 iNTS strains were divided into 25 serotypes, and Salmonella enteritidis accounted for 38.24% (52/136). The OR of other iNTS serotypes were calculated with Salmonella typhimurium as the control. The OR values of Oreninburg, Rysson, and Pomona serotypes were the highest, which were 423.50, 352.92, and 211.75, respectively. The drug resistance rate of iNTS was 0.74%-66.91%, which was lower than that of non-iNTS (3.90%-77.21%). The main iNTS of drug resistance were ampicillin and tetracycline, with resistance rates of 66.91% (91/136) and 50.00% (68/136), respectively, while the resistance rates to ciprofloxacin (5.88%,8/136), ceftazidime (5.88%,8/136), gentamicin (5.13%,7/136) and cefoxitin (0.74%, 1/136) were relatively low. iNTS carried a variety of drug-resistance genes and virulence factors, but no standard virulence factor distribution has been found. MLST cluster analysis showed that iNTS was divided into 26 sequence types, and ST11 accounted for 38.24% (52/136). Conclusions:The iNTS strains in Guangdong were dominated by Salmonella enteritidis, of which three serotypes, Oreninburg, Rison, and Pomona, may be associated with a higher risk of invasive infection during 2018 to 2022 . iNTS was sensitive to clinical first-line therapeutic drugs (cephalosporins and fluoroquinolones), with highly diverse sequences and clear phylogenetic branches. ST11 was the local dominant clone group.

Objective To identify easily confused Chinese herbal pieces by micro-macroscopical identification method,and study its application value in quality acceptance of Chinese herbal pieces in medical institutions.Methods Using the method of micro-macroscopical identification,with the help of related instruments,the microscopic characteristics of 10 groups of 31 kinds of Chinese herbal pieces,which were easy to be confused and could not be observed by naked eye and ordinary magnifying glass,were analyzed and summarized according to the classification of different medicinal parts,such as flowers,fruits,seeds,whole grass,roots and rhizomes,stems,and others,and pictures were taken to save them.Results The micro-characters of 10 groups of 31 easily confused Chinese herbal medicines,including Eriocauli flos,Eriocaulon sexangulare,Eriocaulon australe,Aurantii fructus,Citrus changshan-huyou,Chaenomelis fructus,Chaenomeles cathayensis,Perillae fructus,Perillae fructus(Physalis alba),Perillae fructus(Wild),Astragali complanati semen,Astragalus chinensis,Selaginellae herba,Selaginella pulvinata,Selaginella moellendorfii,Selaginella doederleinii,Selaginella uncinata,Lysimachiae herba,Lysimachia hemsleyana,Desmodium styracifolium,Dryopteris crassirhizoma,Woodwardia japonica,Brainea insignis,root of Valvate actinidia,Actinidia arguta,Tripterygium wilfordii,root of Romanet grape,Trogopterus dung,Bat dung,Hare dung and Silkworm sand were observed.The various traditional Chinese medicines possessed unique identification characteristics.Flower-based medicines could be studied for their color,tissue structure,and surface features such as texture and trichomes.Fruit-based medicines could be studied for their fruit peel structure,color,degree of development,and outer characteristics such as cuticle layer and wax.Seed-based medicines could be studied for their morphology,size,color,and texture.Whole plant-based medicines could be studied for leaf length-to-width ratio,widest point,surface characteristics,and splitting situation,as well as stem trichomes and stomata.Root-based medicines,rhizome-based medicines,and stem-based medicines could be studied for their bark,wood structure,and the morphology and arrangement of vascular bundles or ducts.Other kinds of medicines could be studied from their sources,and these unique micro-characteristic identification features could be easily discovered with the help of a microscope.Conclusion Compared with the traditional characteristic identification,micro-macroscopical identification is more capable of improving the accuracy of Chinese herbal pieces identification,which is economical,practical,simple and intuitive,and can be popularized as a commonly used identification method of herbal medicines in medical institutions,and it is a feasible solution to realize the rapid inspection of herbal medicines.