Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.

【Objective】 To determine the rare ABO blood subgroups rapidly and ensure the blood transfusion safety of five patients by a series of serological tests and family investigation, as their preliminary serological results of ABO blood grouping was inconsistent. 【Methods】 ABO blood grouping, antibody screening and Coombs′ tests were performed by the routine serological methods, including manual tube and automatic blood group analyzer, which had matched micro-column gel cards from Diagnostic Grifols. Polymerase chain reaction (PCR) was used to amplify the 6 and 7 exons as well as their adjacent intron region of ABO gene. The patients and their relatives′ ABO blood group and subgroup were analyzed and identified through the comparison with serological phenotype database of ABO blood group. The products of PCR were sequenced directly, and the gene mutation was identified through the comparison with the Blood Group Antigen Gene Mutation Database. 【Results】 Whether micro-column gel cards or manual tube test, the forward and reverse tests of serological grouping were not supported by each other on the five patients′ ABO blood grouping. The forward tests of patients No.1~3 showed AwB phenotype and the reverse tests showed B group. No.4 patient was the forward ABw phenotype and the reverse A group, and No.5 patient was the forward normal AB phenotype and the reverse B group, respectively. All of 5 patients′ Rh C/D/E blood grouping showed clearly; the IDT test and antibody screening result of patient No.1 was positive, while the antibody screening result of patient No.4 was negative. 【Conclusion】 The blood group serological characterization of patient No.1~3 met B(A) blood group, and patient No.4~5 met CisAB blood group. These tests can make a preliminary diagnosis of blood group phenotype, which are verified correctly via blood group genotype.

【Objective】 To construct an in-vitro model of erythrocyte antibody-mediated complement activation, and establish quantitative detection methods based on flow cytometry and spectrophotometry, so as to explore the correlation of anti-body titers and complement activation speed, and provide a methodological basis for studying the adverse transfusion reactions of anti-body mediated complement hemolysis. 【Methods】 Mouse monoclonal antibody that recognized human C3b and fluorescent secondary antibody were used to label C3b fragments on erythrocytes, and the deposition of C3b fragments after complement activation was detected by flow cytometry. The absorbance at 540 nm of the supernatant in the complement activation reaction system was measured by spectrophotometry as the amount of hemoglobin released was related to the absorbance. 【Results】 The complement activation system was constructed according to the ratio of 3% red blood cell suspension (mixed for 6 people) 1∶anti-Tj^a 1∶complement 2. The repeatability was good (P value>0.05) as different red blood cell mixtures had been used to repeat the detection reaction system. When using 32×, 64× and 128× dilutions of anti-Tj^a mediated complement activation, the deposition of C3b fragments has been detected by flow cytometry at 30 s, 1 min and 2 min, respectively, and MFI peaked at 5 min, 10 min and 30 min, respectively. No obvious hemolysis has been observed within 1.5 h. 【Conclusion】 In vitro model of anti-Tj^a-mediated complement activation demonstrates the speed of complement activation is related to the concentration of antibody. At a certain antibody concentration, the speed of complement activation has been slowed down, and no obvious hemolysis observed.

Sepsis is a critical illness with high morbidity and mortality. Anaerobic glycolysis plays an important role in the pathogenesis of sepsis. Pyruvate dehydrogenase complex (PDHC) serves as a key regulator during sepsis. With PDHC dephosphorylation and deacetylation, PDHC activity is upregulated, allowing pyruvate translocate to mitochondria in aerobic condition, preceding the production of acetyl-CoA to accelerate aerobic oxidation. Activation of PDHC improves the prognosis of sepsis through regulating the balance of lactate, release of inflammatory factors and energy metabolism. A variety of remedies can improve the prognosis of patients with sepsis by up-regulating the activity of PDHC, including dichloroacetate (DCA), vitamin B1, milrinone, tumor necrosis factor binding protein, and ciprofloxacin.This article reviews the role and the regulatory mechanism of PDHC and signal pathway in the sepsis metabolism, in order to innovate treatment for sepsis and multiple organ dysfunction.

Objective:To investigate the clinical value of ventricular intracranial pressure monitoring (V-ICPM) in gradient decompression for patients with traumatic cerebral hernia.Methods:The clinical data of 103 patients with traumatic cerebral hernia admitted to our hospital from October 2016 to October 2020 were retrospectively analyzed. These patients were divided into observation group ( n=49) and control group ( n=54) according to whether V-ICPM was applied. Patients in the observation group accepted V-ICPM before gradient decompression, and patients in the control group accepted gradient decompression directly. Incidence of malignant encephalocele, clinical short-term and long-term efficacies, and complications were compared between the two groups. According to intracranial pressure (ICP), the patients were divided into normal or slightly increased ICP (≤22 mmHg), moderate increased ICP (23-40 mmHg) and severe increased ICP (>40 mmHg); the relationship between ICP and prognoses was analyzed in the observation group. Results:(1) The incidences of intraoperative malignant encephalocele in the observation group (16.33%) were slightly lower than that in the control group (29.63%), without significant difference ( P>0.05). Twenty four h after gradient decompression, pupils recovered in 35 patients (71.43%) from the observation group and 28 patients (51.85%) from the control group, significant difference in the pupils recovery rate was noted between the two groups ( χ2=4.145, P=0.042); the Glasgow Coma Scale (GCS) scores between the observation group (8.43±2.56) and control group (7.39±2.47) showed statistical differences ( t=-2.095, P=0.039). Three months after gradient decompression, there were 7 patients with Glasgow Outcome Scale (GOS) scores of 5, 18 patients with scores of 4, 10 patients with scores of 3, 8 patients with scores of 2, and 6 patients with score of 1 in the observation group; there were 12 patients with GOS scores of 5, 17 patients with scores of 4, 12 patients with scores of 3, 7 patients with scores of 2, and 6 patients with score of 1 in the control group; the difference was not statistically significant ( Z=-0.681, P=0.496). (2) The higher the ICP in the observation group (initially and when the dura mater is cut), the worse the prognosis. Conclusion:The application of V-ICPM before gradient decompression cannot further improve the long-term prognosis of the patients, but it can provide intraoperative reference and prognosis prediction for the operators.

Objective:To detect the contents of brain water, Na + , and K + and the permeability of blood brain barrier (BBB) of the rats with brain edema in traumatic brain injury (TBI) complicated by seawater drowning(SWD) at different time points, so as to analyze the time course changes of brain edema after the combined injury. Methods:A total of 216 SD rats were randomly divided into control group ( n=6), sham operation group ( n=14), TBI group ( n=98), and TBI+ SWD group ( n=98). The TBI + SWD rat models were created on the basis of Marmarou′s weight-drop TBI modeling and instilling seawater into the trachea by syringe pump. Dry-wet mass method was used to detect the content of brain water. Flame spectrophotometry method was used to detect the contents of Na + and K + . Evans blue (EB) staining method was used to detect BBB permeability. Results:In the TBI group, the contents of brain water and Na + began to rise obviously 12 h after injury, reached the peak 2-3 d after injury, and returned to the normal levels 14 d after injury. The content of K + showed a fall 12 h after injury, reached the lowest point in 2-3 d after injury, and was still at a lower level than normal in 7 d. The EB content showed double peaks in 3 h and 2 d after injury respectively, and the latter peak was higher. Compared with those in the TBI group, the contents of brain water, Na + , and EB in the TBI + SWD group were significantly increased, but the content of K + was obviously decreased. In the TBI + SWD group, the contents of brain water and Na + began to rise 3 h after injury, reached the peak at 12 h till 7 d after injury, and were still higher than the normal levels 14 d after injury. The content of brain K + showed an obvious fall 3 h after injury, reached the lowest point at 12 h till 3 d, and was still lower than the normal level 7 d after injury. The EB content increased obviously 3 h after injury, reached the peak at 12 h till 3 d after injury, and was still higher than the normal level 14 d after injury. Conclusion:SWD aggravates brain edema in TBI rats. TBI + SWD rats may develop severe cerebral edema in the early period after injury, which last for a longer time.

Objective:To evaluate the effects of mouse nerve growth factor (mNGF) on the brain water content and the expressions of β-amyloid precursor protein (β-APP) and neurofilament light polypeptide (NF-L) in rats with traumatic brain injury (TBI) complicated by seawater drowning (SWD). Methods:A total of 60 male rats were randomly divided into three groups: Sham group ( n=12), TBI+ SWD group ( n=24), and mNGF group ( n=24). The rat models were created on the basis of Marmarou′s weight-drop TBI modeling and instilling seawater into the trachea by syringe pump. The mNGF group was administered mNGF intraperitoneally; while the Sham group and the TBI+ SWD group were injected with an equivalent amount of normal saline. The brain water content was measured by using the dry-wet weight method. The pathological changes of the hippocampal tissue and the expressions of β-APP and NF-L were observed through hematoxylin-eosin (HE) staining and immunohistochemical (IHC) staining. Results:Brain water content in the mNGF group was similar to that in the TBI+ SWD group ( P>0.05). Compared with the TBI+ SWD group, the expressions of β-APP and NF-L in the hippocampal tissue of the mNGF group were significantly reduced. Conclusion:mNGF can reduce the expressions of β-APP and NF-L, and protect the neurons of the rats after TBI+ SWD.

Objective:To detect the contents of brain water, Na + , and K + and the permeability of blood brain barrier (BBB) of the rats with brain edema in traumatic brain injury (TBI) complicated by seawater drowning(SWD) at different time points, so as to analyze the time course changes of brain edema after the combined injury. Methods:A total of 216 SD rats were randomly divided into control group ( n=6), sham operation group ( n=14), TBI group ( n=98), and TBI+ SWD group ( n=98). The TBI + SWD rat models were created on the basis of Marmarou′s weight-drop TBI modeling and instilling seawater into the trachea by syringe pump. Dry-wet mass method was used to detect the content of brain water. Flame spectrophotometry method was used to detect the contents of Na + and K + . Evans blue (EB) staining method was used to detect BBB permeability. Results:In the TBI group, the contents of brain water and Na + began to rise obviously 12 h after injury, reached the peak 2-3 d after injury, and returned to the normal levels 14 d after injury. The content of K + showed a fall 12 h after injury, reached the lowest point in 2-3 d after injury, and was still at a lower level than normal in 7 d. The EB content showed double peaks in 3 h and 2 d after injury respectively, and the latter peak was higher. Compared with those in the TBI group, the contents of brain water, Na + , and EB in the TBI + SWD group were significantly increased, but the content of K + was obviously decreased. In the TBI + SWD group, the contents of brain water and Na + began to rise 3 h after injury, reached the peak at 12 h till 7 d after injury, and were still higher than the normal levels 14 d after injury. The content of brain K + showed an obvious fall 3 h after injury, reached the lowest point at 12 h till 3 d, and was still lower than the normal level 7 d after injury. The EB content increased obviously 3 h after injury, reached the peak at 12 h till 3 d after injury, and was still higher than the normal level 14 d after injury. Conclusion:SWD aggravates brain edema in TBI rats. TBI + SWD rats may develop severe cerebral edema in the early period after injury, which last for a longer time.

Objective:To evaluate the effects of mouse nerve growth factor (mNGF) on the brain water content and the expressions of β-amyloid precursor protein (β-APP) and neurofilament light polypeptide (NF-L) in rats with traumatic brain injury (TBI) complicated by seawater drowning (SWD). Methods:A total of 60 male rats were randomly divided into three groups: Sham group ( n=12), TBI+ SWD group ( n=24), and mNGF group ( n=24). The rat models were created on the basis of Marmarou′s weight-drop TBI modeling and instilling seawater into the trachea by syringe pump. The mNGF group was administered mNGF intraperitoneally; while the Sham group and the TBI+ SWD group were injected with an equivalent amount of normal saline. The brain water content was measured by using the dry-wet weight method. The pathological changes of the hippocampal tissue and the expressions of β-APP and NF-L were observed through hematoxylin-eosin (HE) staining and immunohistochemical (IHC) staining. Results:Brain water content in the mNGF group was similar to that in the TBI+ SWD group ( P>0.05). Compared with the TBI+ SWD group, the expressions of β-APP and NF-L in the hippocampal tissue of the mNGF group were significantly reduced. Conclusion:mNGF can reduce the expressions of β-APP and NF-L, and protect the neurons of the rats after TBI+ SWD.

Surgery management is key to surgical quality control. The authors presented the IT system design for surgery anesthesia of the children′s hospital of Fudan University, featuring all-process information support by means of IT development and process reengineering. Such a process comprises perioperative patient handover, medication, surgical safety check, and intraoperative care. This surgery anesthesia system development has interconnected hospital information systems within and beyond operation rooms in terms of informationization. It proves that the system can effectively enhance safety and convenience of surgery related works and supervision, reducing error exposure of surgical operations and ensuring patient safety.