Obj ective To explore yhe causes and yhe nursing measures of unexpecyed exyu-bayion of indwelling cayheyer in hepayobiliary surgery.Methods The clinical daye of 10 payienys wiyh unexpecyedly exyubayion among 402 payienys wiyh hepayobiliary surgery and indwelling cayheyers was analyzed.Results In 10 unexpecyedly exyubayion payienys,yhere were 3 payienys pulling ouy yhe syomach yube by yhemselves,2 payienys pulled ouy abdominal drainage yube in yhe nighy when yurning over.2 payienys′abdominal drainage were auyomayically pulled ouy.1 payieny′s cayheyer and 1 payieny’s deep venous inyubayion were pulled ouy by overly power in yheir yranspory. Jejunum nuyriyion yube wiyhouy suyure fixayion of 1 payieny was pulled ouy.Conclusion According yo yhe causes of unexpecyed exyubayion,improvemeny of nursing measures,syandardized and insyiyu-yionalized nursing can reduce yhe incidence raye of unexpecyed exyubayion.

Obj ective To explore yhe causes and yhe nursing measures of unexpecyed exyu-bayion of indwelling cayheyer in hepayobiliary surgery.Methods The clinical daye of 10 payienys wiyh unexpecyedly exyubayion among 402 payienys wiyh hepayobiliary surgery and indwelling cayheyers was analyzed.Results In 10 unexpecyedly exyubayion payienys,yhere were 3 payienys pulling ouy yhe syomach yube by yhemselves,2 payienys pulled ouy abdominal drainage yube in yhe nighy when yurning over.2 payienys′abdominal drainage were auyomayically pulled ouy.1 payieny′s cayheyer and 1 payieny’s deep venous inyubayion were pulled ouy by overly power in yheir yranspory. Jejunum nuyriyion yube wiyhouy suyure fixayion of 1 payieny was pulled ouy.Conclusion According yo yhe causes of unexpecyed exyubayion,improvemeny of nursing measures,syandardized and insyiyu-yionalized nursing can reduce yhe incidence raye of unexpecyed exyubayion.

Objective To explore the effect of methylene blue combined with ropivacaine for sa-phenous nerve block on the postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty patients were selected for elective TKA,24 males and 36 females,aged 60-75 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅱ or Ⅲ.The patients were divided into two groups using randomized nu-merical table method:methylene blue combined with ropivacaine group(group MR)and ropivacaine group(group R),30 patients in each group.Ultrasound-guided saphenous nerve block was performed with 0.10％methylene blue+0.25％ropivacaine composite 20 ml in group MR,and ultrasound-guided saphenous nerve block was performed with 0.25％ropivacaine 20 ml in group R before the combined spinal-epidural anesthe-sia.The VAS pain scores at rest and during activity at 6,12,24,48,and 72 hours postoperatively,the maximum range of motion mobility(ROM)of the knee joint of the affected limb,the quadriceps unarmed manual muscle test(MMT)scores at 24,48,and 72 hours postoperatively,the effective number of analge-sic pump presses,and the time of the first additional time of the remedial analgesic were recorded.The com-plications related to nerve block,such as bleeding,infection,local anesthetic poisoning,nerve injury,and peripheral tissue injury were recorded.Results Compared with group R,the VAS pain score at rest was significantly lower in group MR at 12,24,48,and 72 hours postoperatively(P＜0.05).Compared with group R,the VAS pain scores during activity were significantly lower in the group MR at 48 and 72 hours postoperatively(P＜0.05).Compared with group R,ROM of the knee joint of the affected limb was signif-icantly greater in group MR at 24,48,and 72 hours postoperatively(P＜0.05).The effective number of analgesic pump presses and the rate of remedial analgesia were significantly lower in the group MR compared with group R(P＜0.05).There were no complications related to nerve block during hospital stay in both groups.Conclusion Ultrasound-guided methylene blue combined with ropivacaine for saphenous nerve block can enhance the postoperative analgesic effect,prolong the duration of analgesia,reduce the use of postoperative analgesics,and facilitate the functional exercise of the knee joint in the early postoperative pe-riod.

Objective:To evaluate the role of long-chain non-coding RNA-lung cancer metastasis-related transcript 1/microRNA-145/Bcl-2 and adenovirus E1B19k Da interacting protein 3 (Lnc-MALAT1/miRNA-145/BNIP3) signaling pathway in sufentanil preconditioning-induced cardioprotection in rats.Methods:Rat H9C2 cells were inoculated in 6-well culture plates or flasks at a density of 1×10 6 cells/ml and divided into 5 groups ( n=30 each) using a random number table method: control group (group C), hypoxia-reoxygenation (H/R) group, sufentanil preconditioning group (S group), eukaryotic expression vector pcDNA3.0 group (pcDNA group) and pcDNA-MALAT1 group (MALAT1 group). Cells were incubated with 10 μmol/L sufentanil for 2 h, and then the H/R injury model was established in group S. In pcDNA group and MALAT1 group, cells were transfected with pcDNA3.0 and pcDNA-MALAT1, respectively, and then incubated with 10 μmol/L sufentanil for 2 h starting from 24 h after transfection, and then the H/R injury model was established.At 2 h after reoxygenation, the expression of Lnc-MALAT1, miRNA-145 and BNIP3 mRNA was detected by real-time polymerase chain reaction, the cell survival rate was detected by CCK-8, the apoptosis rate was detected by flow cytometry, the malondialdehyde (MDA) and superoxide dismutase (SOD) levels and amount of lactic dehydrogenase (LDH) released were detected, and the expression of Bcl-2, Bax and cleaved-caspase-3 was detected by Western blot. Results:Compared with group C, the survival rate was significantly decreased, apoptosis rate was increased, the MDA level and amount of LDH released were increased, SOD levels were decreased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was up-regulated, and miRNA-145 and Bcl-2 expression was down-regulated in the other four groups ( P<0.05). Compared with group H/R, the cell survival rate was significantly increased, apoptosis rate was decreased, the MDA level and amount of LDH released were decreased, SOD levels were increased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was down-regulated, and miRNA-145 and Bcl-2 expression was up-regulated in S and pcDNA groups ( P<0.05). Compared with group S, the survival rate was significantly decreased, apoptosis rate was increased, MDA level and amount of LDH released were increased, SOD levels were decreased, the expression of LncRNA-MALAT1, BNIP3 mRNA, Bax, and cleaved-caspase-3 was up-regulated, and miRNA-145 and Bcl-2 expression was down-regulated in group MALAT1 ( P<0.05). Conclusion:The mechanism of sufentanil preconditioning-induced cardioprotection is related to inhibiting Lnc-MALAT1/miRNA-145/BNIP3 signaling pathway in rats.

Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Objective:To explore the mechanism of the extraction of Carthami flos in the treatment of chronic alcoholic liver injury based on metabolomics. Methods:The rats were randomly divided into normal group, model group, positive control group and low, medium and high dose groups of the extraction of Carthami flos, with 10 rats in each group. In addition to the normal group, the other groups were gavaged with 8 ml/kg of 56° Niulanshan Baijiu to prepare the rat model with chronic alcoholic liver injury. After the successful modeling, the positive control group was gavaged with 0.36 mg/kg of Hugan tablet, and the low, medium and high dose groups were gavaged with 0.476 7, 1.430 1 and 4.290 3 g/kg of the extraction of Carthami flos respectively, once a day for 21 days. The contents of GPT, GOT, TG and ALP2 in serum were detected by automatic biochemical analyzer, and the effects of the extraction of Carthami flos on chronic alcoholic liver injury in rats were analyzed by Ultra High Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS), cluster analysis, Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). Results:The levels of GPT [(42.11±6.58)U/L, (42.38±6.58)U/L vs. (49.96±10.70)U/L] and GOT [(104.81±14.70)U/L, (102.91±23.65)U/L vs. (159.66±53.69)U/L] decreased ( P<0.05 or P<0.01), while the levels of TG [(0.85±0.29)U/L, (0.85±0.23)U/L vs.(0.62±0.21)U/L] and ALP2 [(104.53±13.53)U/L, (100.30±17.28)U/L vs.(77.13±12.54)U/L] increased ( P<0.05 or P<0.01); The results of cluster analysis, PCA and OPLS-DA showed that the model group and the high-dose group of the extraction of Carthami flos could be distinguished obviously. A total of 20 chemical markers were obtained in the serum of rats with chronic alcoholic liver injury treated with the extraction of Carthami flos. Among them, the extraction of Carthami flos can down regulate the level of serum linolenic acid triglyceride in rats with chronic alcoholic liver injury and up regulate triglyceride, palmitic acid, lysophosphatidylcholine, palmitoyl ethanolamide, epinephrine, sphingosine, lysophosphingomyelin α-Linolenic acid, docosahexaenoic acid and eicosapentaenoic acid are 10 endogenous metabolites. Conclusion:The treatment of chronic alcoholic liver injury with the extraction of Carthami flos may be related to the regulation of endogenous metabolites docosahexadilute acid, docosapentadilute acid α- Linolenic acid.

Objective:To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa.Methods:A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared.Results:(1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95% CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 ( P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 ( P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion ( P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions:In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.