Objective:To explore the association between the preoperative nocturnal blood pressure pattern and postoperative complications in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods:A prospective observational cohort study was conducted in 131 elderly patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia between September 2018 and September 2021.All subjects underwent 24 h ambulatory blood pressure monitoring 1 day before surgery and, based on the nocturnal blood pressure pattern, patients were divided into two groups.Those with the nocturnal blood pressure reduction rate ≥0% entered the nocturnal blood pressure reduction group(Group D, n=80), and those with the reduction rate <0% entered the nocturnal blood pressure increase group(Group R, n=51). Differences in postoperative complication rates between the two groups were compared, and multivariate Logistic regression was used to analyze the influencing factors of postoperative complications.Results:(1)Compared with Group D, the prevalence of diabetes and left ventricular mass index were significantly increased and the mean nighttime SBP and DBP were significantly increased in Group R( P<0.05); (2)Compared with Group D, the incidence of acute kidney injury and acute heart failure in Group R was significantly higher( P<0.05), with the relative risk( RR)values at 2.941(95% CI: 1.344-6.435)and 3.660(95% CI: 0.991-13.512), respectively; (3)Multivariate Logistic regression analysis showed that elevated blood pressure at night was an independent risk factor for acute kidney injury after surgery( OR=3.700, 95% CI: 1.286-10.648, P=0.015); (4)Kaplan-Meier curves for acute kidney injury and acute heart failure showed that the cumulative incidence of events in Group R was significantly higher than that in Group D(Log rank test: P<0.05). Conclusions:For elderly patients undergoing selective laparoscopic gastrointestinal surgery, preoperative nocturnal blood pressure patterns were associated with postoperative complications.Elevated preoperative nocturnal blood pressure increases the incidence of postoperative acute kidney injury and heart failure, and elevated nocturnal blood pressure is an independent risk factor for acute kidney injury.

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.

Objective To construct an intervention program for diabetic retinopathy(DR)patients undergoing surgery based on the theory of'Timing It Right'.Methods Guided by the theory of'Timing It Right',based on literature review and semi-structured interview,the first draft of the intervention program was formulated.From December 2022 to February 2023,15 medical and nursing experts in ophthalmology and endocrinology from 5 provinces(cities)in Zhejiang,Sichuan,Shanxi,Chongqing and Shanghai were interviewed by Delphi expert for 2 rounds to seek their advice and revision,and the final draft was formed.Results The effective recovery rate of 2 rounds of expert consultations was 93.75％and 100％.The authority coefficients were 0.87.The importance and feasibility of Kendall'W coordination coefficients were 0.325,0.138 and 0.193,0.141 in 2 rounds,respectively(P＜0.001).The finalized intervention program consisted of 6 months,which included 5 first-level items,18 second-level items and 43 third-level items.Conclusion The intervention program for DR patients undergoing surgery based on the theory of'Timing It Right'is reliable,scientific,feasible and practical,and it can meet the needs of such patients,providing a reference for improving their self-management ability,improving their negative emotions and delaying disease progression.

Objective:To investigate the efficacy of venetoclax-based combined regimen in treatment of adult patients with acute myeloid leukemia (AML).Methods:The data of 50 adult AML (non-acute promyelocytic leukemia) who received venetoclax-based combined regimen in the First Affiliated Hospital of Xiamen University, Dongguan People's Hospital, the First Hospital of Longyan City, Jieyang People's Hospital from December 2018 to May 2021 were retrospectively analyzed. Different doses venetoclax combined with demethylation drugs or low-dose chemotherapy regimen were used to analyze the therapeutic efficacy. The related factors influencing efficacy were analyzed by using logistic regression.Results:The composite complete remission (CR) rate of 50 AML patients was 62.0% (31/50), the overall response rate (ORR) was 76.0% (38/50); 28 patients achieved effectiveness [CR and partial remission (PR)] after the first cycle and could achieve effectiveness by 3 courses of treatment at the latest. Among 50 patients, 28 cases were newly diagnosed AML, the composite CR rate was 60.8% (17/28), ORR was 78.6% (22/28); 22 cases were recurrent and relapsed, the composite CR rate was 63.6% (14/22), ORR was 72.7% (16/22); and there was no statistically significant difference of ORR between the both groups ( χ2 = 0.23, P = 0.743). Logistic regression multivariate analysis showed age was the only independent influencing factor for the treatment effectiveness ( OR = 8.451, 95% CI 1.306-54.697, P = 0.025). The median duration time of patients receiving venetoclax treatment regimen was 4.5 months (1.1-15.0 months); 16 cases who had treatment effectiveness finally relapsed, the median time of maintaining effectiveness was 5 months (1.1-11.0 months). Additionally, the common treatment-related adverse reactions included bone marrow suppression after treatment, followed by some gastrointestinal reactions like nausea, vomiting and stomachache. In addition, no patient stopped medication for more than 1 week due to bone marrow suppression related complications. Conclusion:Venetoclax-based combined regimen shows a good short-term efficacy in treatment of AML. It is also effective and tolerable for elderly patients receiving reduced dose therapy.

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

Objective To evaluate the effects of tadalafil on chronic allograft vasculopathy. Method The abdominal aorta transplantation was performed on Male Lewis or Brown-Norwai rats as donors and male Male Lewis rats as recipients. The recipients were divided into 3 groups: Group A (Lewis-Lewis)with no treatment ;Group B (BN-Lewis) with no treatment; Group C (BN-Lewis) received tadalafil treatment (0.5 mg/kg per day). The rats were sacrificed at 8 weeks post treatment. The grafted aortas were used for histology and Western blot assay. Plasma cGMP level was detected by ELISA assay. Results The aortas intimal in group C was significantly thinner than that in group B. PKG-Ⅰprotein expression in group C was significantly higher than that in group B. Expression of RhoA in group C was lower than that in group B. Conclusion Tadalafil has positive effect on chronic allograft vasculopathy.

Objective To study the effect of Tacrolimus on blood lipid after renal transplantation,and the relationship between C825T polymorphism in G protein beta 3 subunit (GNB3) gene and serum lipid levels.Method Eighty-one cases of recipients patients after renal transplantation were divided into two groups in terms of Tacrolimus concentration:normal blood concentration group (group A) and low blood concentration group (group B).The serum lipid levels at 1st,3rd,6th,and 12th month after renal transplantation were measured.Genotype was determined by the simple sequence-specific primer polymerase chain reaction (SSP-PCR).Result The percentage of patients with hypertriglyceride in group A was significantly higher than in group B during the one-year follow-up period.There was significant difference between the two groups in the serum triglyceride levels but no difference in the serum cholesterol levels.The 825C/T polymorphism in the GNB3 gene was not associated with hypertriglyceride in renal transplantations in Wenzhou.Conclusion The serum triglyceride levels in renal transplantations in Wenzhou was associated with the Tacrolimus concentration,and the incidence of hypertriglyceride is not associated with the 825C/T polymorphism in the GNB3 gene.

[ABSTRACT]AIM:ToinvestigatetheeffectofimmunosuppressantFK506onserumglucoseinratsandtoex-plore its mechanism .METHODS: Sprague-Dawley rats ( n =12 ) were randomly divided into drug group and normal group.The rats in drug group were intraperitoneally injected with FK 506 at dose of 1 mg· kg-1 · d-1 and the rats in nor-mal group received saline (1 mL· kg-1 · d-1 , ip) for 14 d.The fasting weight and fasting glucose were regularly meas-ured every 2 d.Visceral fat was isolated from the rats at the end of experiment .The mRNA expression of adiponectin , lep-tin, visfatin, resistin, retinol-binding protein 4 ( RBP4) and peroxisome proliferator-activated receptors γ( PPAR-γ) was determined by real-time fluorescence quantitative PCR .The protein expression of PPAR-γand adiponectin was measured by Western blotting .RESULTS:Compared with normal group , the concentration of fasting blood glucose in model group was significantly increased from the 10th day (P<0.05).At day 14, the fasting blood glucose of the model group increased from (5.10 ±0.62) mmol/L to (7.73 ±0.73) mmol/L.No significant change of blood glucose in normal group between the 10th day and the 14th day [from (4.66 ±0.32) mmol/L to (5.80 ±0.10) mmol/L] was observed.Compared with normal group , the mRNA expression of PPAR-γ, adiponectin and leptin in the adipose tissue of model group was signifi-cantly decreased ( P <0.01 ) , whereas the expression of visfatin , resistin and RBP4 was significantly increased ( P <0.05).Compared with normal group, the expression of PPAR-γand adiponectin in model group was decreased (P <0.01).CONCLUSION:FK506 may decrease the expression of PPAR-γto change the expression of adipocytokines and induce hyperglycemia in rats .

Objective To investigate the effect of the polymorphisms of multidrug resistance 1 (MDR1) C3435T and G2677T on Tacrolimus (Tac) individualized treatment and prognosis of grafts in the renal transplantation recipients (RTRs).Methods One hundred and twenty-seven RTRs who treated with Tac regimen and had a stable graft function were enrolled,and were divided into adjuvant treatment group and non-adjuvant treatment group according to whether given adjuvant drugs to raise Tac trough concentrations. MDR1 C3435T and G2677T SNPs were detected by using sequence specific primers PCR.Tac trough concentrations of whole blood were measured by using enzymelabeled immunosorbent assay.Tac concentration-to-dose ratio (C/D) standardized by body weight was compared according to the various genotypes and haplotypes of MDR1 C3435T and G2677TA SNPs.Results Adjuvant treatment group including 36 recipients had a higher frequency of C genotype of C3435T than un-adjuvant treatment group (68.05％ vs 48.35％,P ＜ 0.01 ). The frequency of G2677TA polymorphisms was of no significant difference between the two group recipients (P＞ 0.05).As to non-adjuvant treatment recipients,the mean Tac DD required and C/D were not significantly different among various polymorphisms of MDR1 G2677T/A and C3435T or various haplotypes (P＞0.05).During A follow-up period of 4 years,13 recipients suffered graft dysfunction in which 84.6％ (11/13) carried 3435C genotype (P＞0.05).Conclusion The frequency of MDR1 C3435T polymorphisms in RTRs is high in the recipients given adjuvant treatment to raise Tac concentrations.Recipients with 3435C genotype were prone to graft dysfunction.

ObjectiveTo optimize Chonglian oral solution extracting craft. MethodsWith the obtaining rate of extract and the total content of the Pariphyllin Ⅰ and Phillyrin presented in the extract as the indexes for the water extraction process,and with the total content of the Pariphyllin Ⅰ and Phillyrin presented in the extract as the indexes for the alcohol deposition process,orthogonal design was used to optimize the conditions for the extraction process respectively. ResultsThe optimal conditions for the water extraction of Chonglian oral solution was as following:to add water 10 times,decocting 3 times,1 hour each time.The optimal conditions for the alcohol deposition of Chonglian oral solution was as following:concentrated for the relative density to 1.10(80C hot test),cold,add ethanol to the solution for the ethanol content of the solution reached 80%,static settlement for 24 hours. ConclusionThe extracting method is reasonable,stable,and suitable to industrialized producting.