The flexible laryngeal mask airway is a commonly used airway management tool in pedi-atric anesthesia.It has a flexible and crush-resistant long ventilatory tube,which is easy to secure and allows for full exposure of the surgical field without obstructing the surgical procedure.However,anatomical factors such as a large tongue and a high laryngeal prominence in pediatric patients can make it difficult to insert and position the flexible laryngeal mask airway.Additionally,the lower sealing pressure of the flexible laryn-geal mask airway increases the risk of intraoperative air leakage and aspiration.This article provides a review of the clinical application progress of flexible laryngeal mask in children,giving insights for optimizing perio-perative airway management,thereby improving surgical safety and reducing postoperative complications.

Objective:To investigate the effect of end-expiratory positive pressure of pulmonary protective ventilation strategy in overweight patients undergoing laparoscopic surgery.Methods:Forty overweight patients, 24 kg/m 2≤BMI<28 kg/m 2, aged 20-65yr, of American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic surgery to radical resection of rectal cancer under general anesthesia, were randomly divided into 2 groups ( n=20 each) using a random number table: positive end-expiratory pressure (PEEP) group (group P), control group (group C). The rest of the settings in mechanical ventilation were the same in both groups, tidal volume (Vt)=6 ml/kg, initial respiration frequency (RR)=15 bpm, oxygen inhalation 100%, inspiratory expiratory time ratio ( I∶E)=1∶2. The concentration of oxygen inhalation was 50% and respiration frequency was adjusted to maintain P ETCO 2 35-45 mmHg after endotracheal intubation. The heart rate (HR), mean arterial pressure (MAP), tidal volume (Vt), airway peak pressure (Ppeak), airway pressure platform (Pplat) were recor-ded, and the lung dynamic compliance (Cdyn) was calculated; arterial oxygen partial pressure (PaO 2) and partial pressure of carbon dioxide in arterial blood (PaCO 2) were measured by gas analyzer; oxygenation index (OI) was calculated at the time of before induction of anesthesia (T 0) , 5 min after endotracheal intubation (T 1), 5 min after laparoscopic pneumoperitoneum (T 2), 60 min after laparoscopic pneumoperitoneum (T 3), and suturing the skin (T 4). The postoperative pulmonary complications were observed 3 days after surgery. Results:There was no significant difference between the two groups in patients characteristics and operative indicators ( P>0.05). Compared with T 0, the mean arterial blood pressure of the two groups decreased at T 3 and T 4, and there was no significant difference in heart rate at each time ( P>0.05). There was no significant difference in hemodynamic parameters between the two groups ( P>0.05). Compared with T 1, VT increased at T 2 in group P and T 3 in group C, while there was no significant difference in VT between the two groups ( P>0.05); compared with T 1, Ppeak and Pplat increased at T 2 and T 3 in both groups, while there was no significant difference between the two groups ( P>0.05); compared with T 1, Cdyn of the two groups decreased at T 2 and T 3 ( P<0.05), and cdyn of the P group at each time were higher than that of the group C ( P<0.05). Compared with T 1, PaO 2 and OI decreased and PaCO 2 increased at T 2, T 3 and T 4 in the two groups ( P<0.05). PaO 2 and OI at T 3 and T 4 in the P group were higher than those in the C group ( P<0.05). There was no significant difference in PaCO 2 between the two groups ( P>0.05). There was no significant difference in the incidence of pulmonary complications between the two groups ( P>0.05). Conclusions:Positive end-expiratory pressure of protective ventilation strategy from the induction period of general anesthesia can effectively improve dynamic lung cdyniance, improve oxygenation and promote pulmonary function recovery in overweight patients undergoing laparoscopic surgery.

Objective:To explore the latent profile and characteristics of social isolation in patients with hematologic malignancy, and to analyze its related influencing factors, and to provide reference for improving social phobia disorder in different patients and implementing targeted intervention.Methods:This study was a cross-sectional survey. A convenient sampling method was used to select hematologic malignancy patients who were treated in Qilu Hospital of Shandong University from January 2022 to January 2023. General information questionnaire, the General Alienation Scale (GAS), and the Social Support Rating Scale(SSRS) were used for investigation. Latent profile was analyzed using the categories of social isolation in patients with hematologic malignancy, and univariate and multinomial logistic regression analysis were used to analyze relevant influencing factors.Results:A total of 195 survey subjects were included, of which 108 males and 87 females, aged (49.78 ± 13.52) years. The scores of GAS and SSRS were (43.21 ± 6.09) and (42.52 ± 6.77) respectively. The social isolation in patients with hematologic malignancy could be divided into 3 latent profiles, namely low-risk isolation 15.4% (30/195), medium-risk isolation 68.2%(133/195), and high-risk isolation16.4% (32/195). Multinomial Logistic regression analysis showed that age ( OR=0.941, 95% CI 0.894-0.990), percapita monthly income of families ( OR=0.050, 95% CI 0.004-0.657), primary caregivers (parents) ( OR=0.025, 95% CI 0.003-0.227), place of residence (town)( OR=0.170, 95% CI 0.039-0.749), disease type (leukemia) ( OR=15.610, 95% CI 2.973-81.979), disease type(lymphoma) ( OR=10.986, 95% CI 2.032-59.413) were the influencing factors of medium-risk isolation (all P<0.05). Age ( OR=0.933, 95% CI 0.880-0.988), percapita monthly income of families ( OR=0.029, 95% CI 0.002-0.525), primary caregivers (parents) ( OR=0.076, 95% CI 0.006-0.900), disease type (leukemia)( OR=19.257, 95% CI 2.580-143.723), disease type (lymphoma)( OR=9.952, 95% CI 1.290-76.763), social support ( OR=0.877, 95% CI 0.786-0.980) were the influencing factors of high-risk isolation (all P<0.05). Conclusions:The social isolation among patients with hematologic malignancy had apparent classification characteristics. It could be divided into three potential profiles. It is suggested that medical staff should take targeted social and psychological support based on different types of patients, improve their psychological and social outcomes, and utilize existing resources to implement intervention measures to help them adapt and return to society.

A 49-year-old patient with breast atrophy and abdominal fat accumulation was admitted in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences on January 29, 2018. The patient turned her entire head quickly to the left and to the right each 90 degree without any obvious predisposing factor after general anesthesia. Each episode lasted 3 to 10 seconds and wasn’t associated with limbs and facial tissue twitch. She was consciousness clear after the onset without other obvious discomfort. Intravenous administration of sedative and analgesic drugs could not improve patient’s situation significantly, followed by psychological supporting treatment. The patient returned to normal about 3 hours after onset without giving any other special therapy. Except postoperative agitation, psychiatric disorders and the related histories of medication, the possible inducing factors include but not limited to epilepsy and hysteria. The etiology, pathogenesis, diagnosis and treatment of this case need further discussion. However, it is important that it gives clinical medical staff good suggestion which they should conduct a comprehensive analysis on the treatment of clinical problems, not only attach importance to organic lesion, but also pay attention to the psychological and mental factors of the patients. It will provide guidance for taking appropriate drugs and psychotherapy in order to achieve the best therapeutic effects.

A 49-year-old patient with breast atrophy and abdominal fat accumulation was admitted in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences on January 29, 2018. The patient turned her entire head quickly to the left and to the right each 90 degree without any obvious predisposing factor after general anesthesia. Each episode lasted 3 to 10 seconds and wasn’t associated with limbs and facial tissue twitch. She was consciousness clear after the onset without other obvious discomfort. Intravenous administration of sedative and analgesic drugs could not improve patient’s situation significantly, followed by psychological supporting treatment. The patient returned to normal about 3 hours after onset without giving any other special therapy. Except postoperative agitation, psychiatric disorders and the related histories of medication, the possible inducing factors include but not limited to epilepsy and hysteria. The etiology, pathogenesis, diagnosis and treatment of this case need further discussion. However, it is important that it gives clinical medical staff good suggestion which they should conduct a comprehensive analysis on the treatment of clinical problems, not only attach importance to organic lesion, but also pay attention to the psychological and mental factors of the patients. It will provide guidance for taking appropriate drugs and psychotherapy in order to achieve the best therapeutic effects.

Three cases of dermatomyositis presenting with inverse Gottron's papules were reported.Of the 3 patients,there were 2 males and 1 female aged 43,41 and 46 years respectively,whose disease durations were 1,6,7 months respectively.Inverse Gottron's papules manifested as papules overlying the palmar aspect of the metacarpal and interphalangeal joints,which were arranged in a linear pattern in 2 cases.Of the 3 cases,1 presented with interstitial pneumonia,3 with myositis,and 2 showed negative anti-nuclear antibody test.Histopathological examination of inverse Gottron's papules in 1 case revealed focal liquefaction degeneration of basal cells and perivascular infiltration with inflammatory cells,especially lymphocytes,in the superficial dermis.The 3 patients received oral glucocorticoids and immunosuppressive agents in the early period of treatment.After 3-month treatment,clinical symptoms including muscle weakness and muscle pain were improved evidently,but no obvious improvement in inverse Gottron's papules was observed.After 1-year treatment,these papules on the palmar aspect were markedly relieved in 1 case.

Objective:To explore the application effect and evaluation of virtual reality technology in oral implant therapy training.Methods:In November 2018, one adult patient (female, 36 years old) with missing right mandibular first molar was treated in the Department of Implantology, School and Hospital of Stomatology, Fujian Medical University. The three-dimensional virtual models of mandible and implant surgery tools were established, and the virtual reality software (Unity 3D 5.5.1) was imported. Combined with the virtual reality head mounted display, a virtual reality training system simulating the dental implant treatment process was independently developed. Ten refresher doctors and 20 graduate students in Department of Implantology, School and Hospital of Stomatology, Fujian Medical University from September 2018 to December 2019 were recruited as the experimental objects (no clinical experience was found). According to the level and seniority of doctors, they were randomly divided into virtual training group and conventional training control group, which made the two groups comparable, with 15 in each group. Subjective scores (including anatomical structure, surgical field of vision, cavity preparation, implant placement and process mastery) were given after the corresponding training in the two groups, and the virtual reality training system was used to test. The mesial and distal direction, buccolingual direction, depth and angle deviation of implants before and after the training were analyzed, and the differences between the two groups were compared.Results:The subjective scores of five dimensions in the virtual training group were significantly higher than those in the conventional training control group ( P<0.05). In the virtual training group, the mesial and distal, buccolingual, depth and angle deviation of implants were (0.73±0.33), (0.78±0.41), (0.61±0.32) mm and 6.66°±3.87°. All of them were significantly lower than those in the control group [(0.85±0.32), (1.12±0.38), (0.89±0.24) mm and 9.68°±3.74°] ( P<0.05). Conclusions:The self-developed virtual reality system of oral implant has good application effect, good operability and predictability. It can be effectively carried out in implant education and training, and it can strengthen skills of doctors, and is conducive to the practical operation.

ObjectiveTo investigate the optimal ratio of goat horn replacing antelope horn in Fufang Lingjiao Jiangya pills and the blood pressure-lowering mechanism of this medicine. MethodsThe blood pressure-lowering efficacy of Fufang Lingjiao Jiangya pills with varying proportions of goat horn replacing antelope horn was evaluated on spontaneous hypertensive rats （SHR）. In this experiment， 50 SHR rats were randomly grouped as follows： model （n=8）， captopril （0.01 g·kg^-1） （n=6）， low-dose blank Fufang Lingjiao Jiangya pills （0.342 g·kg^-1） （n=6）， high-dose blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1） （n=6）， low-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， high-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）， low-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， and high-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）. Additionally， 8 WKY rats were used as the normal group. Drugs were administered by gavage for 4 weeks while an equal volume of distilled water was administered for the normal and model groups. Blood pressure was measured before administration， 3 h post administration， and biweekly thereafter. In the experiment for Fufang Lingjiao Jiangya pills with goat horn replacing antelope horn in different proportions， 48 SHR rats were randomly grouped as follows： model， blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1）， antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1）， 2× goat horn-containing Fufang Lingjiao Jiangya pills （0.824 g·kg^-1）， 4× goat horn Fufang Lingjiao Jiangya pills （0.969 g·kg^-1）， and 6× goat horn Fufang Lingjiao Jiangya pills （1.112 g·kg^-1）. The normal group included 8 WKY rats， and the normal group and model group received an equal volume of distilled water. The treatment lasted for 2 weeks， and blood pressure was recorded at various time points （pre-administration， 3 h post administration， and on days 4， 7， 10， and 14 of administration）. Serum levels of angiotensin-converting enzyme （ACE）， angiotensin Ⅱ（Ang Ⅱ）， renin， and interleukin-6 （IL-6） were measured by enzyme-linked immunosorbent assay. Histopathological changes in the heart， kidney， and thoracic aorta were observed by hematoxylin-eosin staining. The protein levels of ACE2， angiotensin Ⅱ type 1 receptor （AT1R）， and angiotensinogen （AGT） in the kidney tissue were determined by Western blot， while the expression of nuclear factor （NF）-κB p65 and Toll-like receptor 4 （TLR4） in the thoracic aorta tissue was assessed by immunohistochemistry. ResultsCompared with the model group， all treatment groups showed lowered blood pressure （P<0.05， P<0.01）， and the 6× goat horn-containing Fufang Lingjiao Jiangya pills group showed consistent blood pressure-lowering effect with the antelope horn-containing Fufang Lingjiao Jiangya pills group. Compared with the normal group， the model group showed elevated serum levels of ACE， Ang Ⅱ， renin， and IL-6， while the elevations were declined in the Fufang Lingjiao Jiangya pills groups （P<0.05， P<0.01）. Pathological changes in the heart， kidney， and thoracic aorta were alleviated in all the treatment groups， with the 6× goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups exhibited the best effect. Western blot and immunohistochemistry results showed that all the treatment groups exhibited down-regulated protein levels of AT1R， AGT， NF-κB p65， and TLR4 and up-regulated protein levels of ACE2 （P<0.05， P<0.01） compared with model group， with the 6×goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups showcasing the best effect. ConclusionReplacing antelope horn with 6×goat horn in Fufang Lingjiao Jiangya pills can achieve consistent blood pressure-lowering effect with the original prescription. The prescription may exert the effect by inhibiting the renin-angiotensin-aldosterone system （RAAS） and TLR4/NF-κB signaling pathways.