Objective To study the application of total intravenous anesthesia(TIVA) in patients with larp-aroscopic cholecystectomy(LC). Methods 100 cases with LC were randomly and evenly assigned to two groups: the combined intravenous with inhalation anesthesia(CIIA) group(n = 50) and the TIVA group(n = 50). The maintain anesthesia. BP, HR and SpO2 at all stages and time for extubation,the consciousness were recorded. Results The pneumoperitoneum after 10 min HR(96.8±13.5)times/min,SBP(142.5±14.3) mmHg、DBP(93.0±14.3) mm-Hg in A group higher than before induction of anesthesia(82.3±12.5) times/min, (129.0±21.7) mmHg, (77.3±13.5) mmHg(P < 0.05～0.01) ; The pneumoperitoneum after 10 min HR (84.0±11.0) times/min, pneumoperito-neum comphte(76.3±9.0) times/rain in B group lower than the(96.8±13.5) times/min, (84.1±11.0) times/min in A group(P >0.05); B group patients completed the opening time(6.5±1.5) min、extubation time (11.5±1.4) min、pestoperative nausea and vomiting in 3 cases,after 8 h VAS value of (2.8±1.1) in group B were lower than the (10.5±2.8) min,(25.2±9.5)min,12 cases(5.4±2.1) in group A(t =2. 411, P <0.05). Conclusion The application of TIVA to LC anesthetic effect is satisfaction.

Objective To observe the analgesic effect after cesarean section with different paregoric meth-ods. Methods 100 cesarean patients were randomly divided into A and B group. A group adopted patient controlled epidura analgesia(PCEA) micro-injection pump;B group using patient controlled intravenous analgesia(PCIA) mi-cro-injection pump,patients were observed and recorded for their pain, vomit disgustingly, exsufflation and the time of first urination or accidentally tube pull-out. Results The time of average surgery for A, B group were (53.5±8.5) min, (54.7±8.2) min, between the two groups was not significant (t=1.524, P>0.05) ; A group of visual Analog score (1.49±0.43) points were significantly higher than B group (1.13±0.56) points(t=2.119,P<0.05) ;the incidence of headache, dizziness, nausea and vomiting, skin itching(30.0%, 16.0% ,6.0%) in A group were signifi-candy higher than B group(16.0%,8.0% ,2.0%) (t=2.223, t=2.313, t=2.283, all P>0.05) ; the time of A first exhaust,voiding time[(24.56±8.77) h, (6.51±1.57) h] in A group were significantly higher than B group [(19.29±8.16)h,(4.06±1.76)h](t=2.445,t=2.415,P<0.05). Conclusion PCIA method was safe,effec-tive and allowed patients to have early activities after treatment and to promote early rehabilitation. It should be promo-ted for cesarean section.

To cultivate high quality nursing personnel,it is necessary to put significant emphasis on humanistic education.The combination of physiology teaching and humanistic education for nursing students was discussed in this article.In teaching practice,professional knowledge and humanistic quality of nursing students could be improved through various ways,including enhancing humanistic quality of teachers,establishing people oriented teaching philosophy,introducing history of science,carring out research-based learning projects.

Objective To compare the effects of butorphanol and tramadol on shiver in patients with cesarean section.Methods 200 cases with maternal shiver (both for waist hard combined anesthesia,ASA Ⅰ ～ Ⅱ) were chosen in this study.According to the digital meter method,they were randomly divided into two groups,100 cases in each group.The observation group(group Ⅰ) was intraoperatively given butorphanol (0.015mg/kg),the control group(group Ⅱ) was intraoperatively given tramadol(1mg/kg).Shivers rating before and after drug use 5min,10min,adverse reactions,blood pressure (MAP),heart rate (HR),respiratory (RR),pulse oxygen saturation (SpO2)and incidence rate of adverse reaction were recorded.Results Perioperative and postoperative BP,HR,RR,SpO2,etc between two groups had no statistically significant differences (P ＞ 0.05).At 5 min,10 min,the total effective rate of shiver vanishing of the observation group was 100％ and 98％,respectively,which of the control group was 100％ and 88％,respectively,the differences between the two groups were not statistically significant (P ＞ 0.05).In the observation group,intraoperative blood pressure decline occurred in 5 cases,sleepiness 8 cases,nausea and vomiting 1 case,recurrence of shivers in 2 cases,those in control group were 4 cases,6 cases,26 cases,12 cases.Blood pressure drop and incidence rate of sleepiness between two groups had no statistically significant differences(P ＞ 0.05).Nausea and vomiting,the incidence rate of recurrent shiver between two groups had statistically significant differences (x2 =26.7609,7.6805,all P ＜ 0.05).Conclusion The effect of butorphanol is better than tramadol in treatment of cesarean section intraoperatie shivers.

Objective To analyze the platelet activating factor acetylhydrolase ( PAF-AH) activity of a gene product encoded by LA2144 gene of Leptospira interrogans ( L. interrogans) , to investigate the ex-pression and secretion of LA2144 protein in various cell cultures and to further understand its function in in-ducing internal hemorrhage in an animal model. Methods The DNA sample containing LA2144 gene was extracted from L. interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai and used as the template for gene cloning by PCR. The LA2144 gene without the signal sequence coding region was amplified by PCR and inserted into a prokaryotic expression construct for the protein expression. The expressed recombinant protein, rLep-PAF-AH, was purified by Ni-NTA affinity chromatography. Spectrophotometry was used to measure the hydrolytic activity, hydrolytic efficiency, Km and Kcat values of the rLep-PAF-AH protein in hydrolyzing PAF substrate. Real-time fluorescent quantitative RT-PCR ( qRT-PCR) and Western blot assay were performed to measure the expression of LA2144 gene at mRNA and protein levels in human umbilical vein endothelial cells (HUVEC), human monocytes (THP-1) and murine macrophages (J774A. 1) with L. interrogans strain Lai infection, respectively. Each syrian hamster was intravenously injected with 100 μg of LPS-free rLep-PAF-AH for two times. Hemorrhage in the lungs, livers and kidneys were observed in three days after the injection. Results The constructed prokaryotic expression system for LA2144 gene of L. inter-rogans strain Lai could highly express the rLep-PAF-AH upon the induction of IPTG. The purified rLep-PAF-AH showed high purity with a single protein band in gel as indicated by SDS-PAGE. The efficiency of 5 μg of rLep-PAF-AH in hydrolyzing PAF substrate was 26. 6 U/L with a Km value of 82. 79 μmol/L and a Kcat value of 0. 24 S-1 . The expression of Lep-PAF-AH at mRNA level in HUVEC, THP-1 and J774A. 1 cells were significantly elevated after co-culture with L. interrogans strain Lai for 1 or 2 hours (P<0. 05). A large amount of Lep-PAF-AH were detected in the supernatants from co-cultures of L. interrogans strain Lai with the three cell lines, but not from the culture of the spirochete in EMJH medium. The signs of hemor-rhage were observed in the lung of hamsters injected with rLep-PAF-AH, but not in tissue samples from liver and kidney. Conclusion The LA2144 gene product was characterized by a stronger PAF-AH activity. The expression of LA2144 gene at mRNA and protein levels in various cell lines were enhanced during L. interro-gans infection. Moreover, the rLep-PAF-AH could induce the pulmonary hemorrhage in hamsters. This stud-y indicated that the protein encoded by LA2144 gene was an important virulence factor causing hemorrhage in hosts during L. interrogans infection.

Objective: Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a “morbid condition” which also needs medical attention. Methods: The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire. Results: For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC. Conclusion Our present findings supported the suggestion of subthreshold ADHD as “morbid condition,” which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.

OBJECTIVE To systematically evaluate the real-world effectiveness and safety of belimumab in the treatment of lupus nephritis （LN） in Chinese adult patients. METHODS Retrieved from PubMed， Embase， Web of Science， Cochrane Library， Wanfang data， CNKI， VIP and CBM， real-world studies on belimumab in the treatment of LN in Chinese adult patients were collected from the inception to July 7th， 2023. Two reviewers independently screened the literature， extracted data， and assessed the quality of the included studies. Meta-analysis was then performed using RevMan 5.3 software. RESULTS A total of 10 real- world studies were included， involving 253 Chinese adult patients with LN. The results of the meta-analysis demonstrated that the complete renal response rate， partial renal response rate， and the incidence of adverse reaction rate in Chinese adult patients with LN treated with belimumab were 61% （95%CI was 46%-76%， P＜0.000 01）， 23%（95%CI was 2%-44%， P＝0.03）， and 30% （95%CI was 16%-43%， P＜0.000 01）， respectively. Belimumab could reduce the 24-hour urinary protein （MD＝－1.71， 95%CI was －3.02-－0.40， P＝0.01）， urine protein-creatinine ratio （MD＝－1.76，95%CI was －2.06-－1.46，P＜0.000 01）， the systemic lupus erythematosus disease activity index （MD＝－8.63， 95%CI was －12.12-－5.13， P＜0.000 01）， and glucocorticoids dosage （MD＝－18.65， 95%CI was －31.82-－5.48， P＝0.006）. In addition， it could elevate the levels of complement C3 （MD＝0.19， 95%CI was 0.08-0.30， P＝0.000 6） and complement C4 （MD＝0.06， 95%CI was 0.02-0.09， P＝0.001）. However， belimumab could not improve the levels of serum creatinine and estimated glomerular filtration rate （P＞0.05）. CONCLUSIONS Belimumab has good efficacy and safety in Chinese adult patients with LN.