Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Objective To investigate the brain voxel-mirrored homotopic connectivity(VMHC)alterations in patients with ves-tibular migraine(VM)by using resting-state functional magnetic resonance imaging(rs-fMRI).Methods The rs-fMRI data of 30 VM patients(VM group)and 30 healthy volunteers(control group)were prospectively collected.The brain VMHC values in all subjects were calculated and the differences between the two groups were compared.The correlations between VMHC values of significant brain regions and clinical scale scores were analyzed in the VM group.Results Compared with the control group,the VMHC values of the cerebellum region 6,orbital inferior frontal gyrus,insula,superior temporal gyrus and postcentral gyrus in the VM group were all decreased[cluster-level family wise error(FWE)corrected,Pvoxel-level<0.001,Pcluster-level<0.05].In the VM group,the VMHC values of the postcentral gyrus were negatively correlated with dizziness handicap inventory(DHI)score(r=-0.383,P=0.037).Additionally,the VMHC values of the insula were negatively correlated with headache impact test-6(HIT-6)score(r=-0.430,P=0.018).Conclusion VM patients have altered VMHC in certain brain regions,indicating related dysfunctions in vestibule,pain,hearing and emotion.

Objective To investigate the brain voxel-mirrored homotopic connectivity(VMHC)alterations in patients with ves-tibular migraine(VM)by using resting-state functional magnetic resonance imaging(rs-fMRI).Methods The rs-fMRI data of 30 VM patients(VM group)and 30 healthy volunteers(control group)were prospectively collected.The brain VMHC values in all subjects were calculated and the differences between the two groups were compared.The correlations between VMHC values of significant brain regions and clinical scale scores were analyzed in the VM group.Results Compared with the control group,the VMHC values of the cerebellum region 6,orbital inferior frontal gyrus,insula,superior temporal gyrus and postcentral gyrus in the VM group were all decreased[cluster-level family wise error(FWE)corrected,Pvoxel-level<0.001,Pcluster-level<0.05].In the VM group,the VMHC values of the postcentral gyrus were negatively correlated with dizziness handicap inventory(DHI)score(r=-0.383,P=0.037).Additionally,the VMHC values of the insula were negatively correlated with headache impact test-6(HIT-6)score(r=-0.430,P=0.018).Conclusion VM patients have altered VMHC in certain brain regions,indicating related dysfunctions in vestibule,pain,hearing and emotion.

Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Objective:To investigate the clinical characteristics and interventions associated with drug-induced anaphylaxis in the emergency infusion room.Methods:Bases on the adverse drug reaction database from the emergency medicine center of the First Affiliated Hospital of Nanjing Medical University, clinical data of patients who experienced drug-induced anaphylaxis in the emergency infusion room between November 2019 and November 2023 were collected, including gender, age, history of previous adverse drug reactions, allergy history, Charlson comorbidity index, medication details, information related to drug-induced anaphylaxis (onset time, clinical manifestations), interventions, outcomes, and follow-up. The clinical characteristics and interventions in these patients were analyzed.Results:During the study period, a total of 398 772 patients in the emergency infusion room in our hospital received intravenous infusion of drugs. Of them, 625 cases developed adverse drug reactions (ADRs) and 75 cases developed drug-induced anaphylaxis, accounting for 0.02% (75/398 772) of the total infusion patients and 12.0% (75/625) of all ADR cases. Of the 75 patients with anaphylaxis, 30 cases (40%) were classified as grade Ⅱ, and 45 cases (60%) as grade Ⅲ, with no grade Ⅳ cases. The most common drugs involved in 75 cases of anaphylaxis were anti-infective drugs (41 cases, 54.7%). Drug-induced anaphylaxis exhibited diverse clinical manifestations, with cardiovascular symptoms being the most common, primarily varying degrees of transient hypotension (67 cases, 89.3%), followed by systemic and neurological symptoms, including profuse sweating (31 cases, 41.3%) and dizziness (28 cases, 37.3%). All 75 patients with anaphylaxis were treated with measures such as discontinuation of medication, replacement of infusion sets, rapid assessment of circulation and respiration, and monitoring of vital signs, of which 65 (86.7%) received rapid intravenous infusion for volume expansion, 6 (8.0%) received intravenous injection of glucocorticoids, 3 (4.0%) received intramuscular injection of 0.5 mg epinephrine, and 2 (2.7%) received antihistamines. All 75 patients showed improvement in symptoms, and no sequelae or deaths were found.Conclusions:In the emergency infusion room, the severity of anaphylaxis is mainly grade Ⅱ and Ⅲ with a good prognosis after timely intervention. The treatment measures mainly focus on rapid intravenous infusion for volume expansion, and the use of epinephrine is relatively low.

Objective:To explore the clinical characteristics of adverse reactions induced by levofloxacin in the emergency infusion unit.Methods:The study was designed as a single center prospective cohort study. Data of adverse drug reaction (ADR) in the Infusion Unit of Emergency Medicine Center of First Affiliated Hospital of Nanjing Medical University was managed, recorded and collected according to the pre-formulated "emergency infusion unit drug adverse reaction management process" and "strengthening the reporting of observational studies in epidemiology (STROBE)". The incidence, severity, clinical characteristics, intervention measures, outcomes, and follow-up of adverse reactions induced by levofloxacin from November 2019 to October 2022 was summarized and analyzed.Results:A total of 426 cases of ADR occurred within the set time period, of which 62 (14.55%) were related to levofloxacin, involving 27 males (43.55%) and 35 females (56.45%) with a median age of 39 years. Among the 62 levofloxacin-related ADRs, 96.77% (60/62) occurred within 2 hours of intravenous infusion of levofloxacin; the severity of 44 (70.97%), 10 (16.13%) and 8 (12.90%) cases of ADRs was classified as grade 1, 2, and 3, respectively, and no grade 4 ADRs occurred. The most common clinical symptoms were skin and mucosa reactions, including rash and itching, followed by cardiovascular system and nervous system manifestations, including hypotension, palpitation, and dizziness. The skin and mucosa manifestations were more common in patients with severity grade 1 ADRs, while the cardiovascular, digestive, respiratory nervous system and systemic manifestations were more common in those with severity grade 2 and 3 ADRs; the differences were statistically significant (all P<0.05). After the occurrence of ADRs, levofloxacin was withdrawn in all the 62 patients, the infusion set was replaced, and infusion of 0.9% sodium chloride injection were used to flush the tube. Additionally, 24 patients (38.71%) were given drug intervention, including epinephrine in 2 patients. After the above intervention, the symptoms of all patients were relieved, with a median response time of 49 minutes. Conclusions:Levofloxacin was one of the common drugs causing ADR in the emergency infusion unit. The clinical manifestations were mainly rashes and itching, most of which were mild in severity. Timely discontinuation of levofloxacin and drug interventions often help get a good prognosis. However, the treatment procedure of severe ADRs remain to be standardized.

Objective:To investigate the clinical characteristics and interventions associated with drug-induced anaphylaxis in the emergency infusion room.Methods:Bases on the adverse drug reaction database from the emergency medicine center of the First Affiliated Hospital of Nanjing Medical University, clinical data of patients who experienced drug-induced anaphylaxis in the emergency infusion room between November 2019 and November 2023 were collected, including gender, age, history of previous adverse drug reactions, allergy history, Charlson comorbidity index, medication details, information related to drug-induced anaphylaxis (onset time, clinical manifestations), interventions, outcomes, and follow-up. The clinical characteristics and interventions in these patients were analyzed.Results:During the study period, a total of 398 772 patients in the emergency infusion room in our hospital received intravenous infusion of drugs. Of them, 625 cases developed adverse drug reactions (ADRs) and 75 cases developed drug-induced anaphylaxis, accounting for 0.02% (75/398 772) of the total infusion patients and 12.0% (75/625) of all ADR cases. Of the 75 patients with anaphylaxis, 30 cases (40%) were classified as grade Ⅱ, and 45 cases (60%) as grade Ⅲ, with no grade Ⅳ cases. The most common drugs involved in 75 cases of anaphylaxis were anti-infective drugs (41 cases, 54.7%). Drug-induced anaphylaxis exhibited diverse clinical manifestations, with cardiovascular symptoms being the most common, primarily varying degrees of transient hypotension (67 cases, 89.3%), followed by systemic and neurological symptoms, including profuse sweating (31 cases, 41.3%) and dizziness (28 cases, 37.3%). All 75 patients with anaphylaxis were treated with measures such as discontinuation of medication, replacement of infusion sets, rapid assessment of circulation and respiration, and monitoring of vital signs, of which 65 (86.7%) received rapid intravenous infusion for volume expansion, 6 (8.0%) received intravenous injection of glucocorticoids, 3 (4.0%) received intramuscular injection of 0.5 mg epinephrine, and 2 (2.7%) received antihistamines. All 75 patients showed improvement in symptoms, and no sequelae or deaths were found.Conclusions:In the emergency infusion room, the severity of anaphylaxis is mainly grade Ⅱ and Ⅲ with a good prognosis after timely intervention. The treatment measures mainly focus on rapid intravenous infusion for volume expansion, and the use of epinephrine is relatively low.

Objective:To explore the clinical characteristics of adverse reactions induced by levofloxacin in the emergency infusion unit.Methods:The study was designed as a single center prospective cohort study. Data of adverse drug reaction (ADR) in the Infusion Unit of Emergency Medicine Center of First Affiliated Hospital of Nanjing Medical University was managed, recorded and collected according to the pre-formulated "emergency infusion unit drug adverse reaction management process" and "strengthening the reporting of observational studies in epidemiology (STROBE)". The incidence, severity, clinical characteristics, intervention measures, outcomes, and follow-up of adverse reactions induced by levofloxacin from November 2019 to October 2022 was summarized and analyzed.Results:A total of 426 cases of ADR occurred within the set time period, of which 62 (14.55%) were related to levofloxacin, involving 27 males (43.55%) and 35 females (56.45%) with a median age of 39 years. Among the 62 levofloxacin-related ADRs, 96.77% (60/62) occurred within 2 hours of intravenous infusion of levofloxacin; the severity of 44 (70.97%), 10 (16.13%) and 8 (12.90%) cases of ADRs was classified as grade 1, 2, and 3, respectively, and no grade 4 ADRs occurred. The most common clinical symptoms were skin and mucosa reactions, including rash and itching, followed by cardiovascular system and nervous system manifestations, including hypotension, palpitation, and dizziness. The skin and mucosa manifestations were more common in patients with severity grade 1 ADRs, while the cardiovascular, digestive, respiratory nervous system and systemic manifestations were more common in those with severity grade 2 and 3 ADRs; the differences were statistically significant (all P<0.05). After the occurrence of ADRs, levofloxacin was withdrawn in all the 62 patients, the infusion set was replaced, and infusion of 0.9% sodium chloride injection were used to flush the tube. Additionally, 24 patients (38.71%) were given drug intervention, including epinephrine in 2 patients. After the above intervention, the symptoms of all patients were relieved, with a median response time of 49 minutes. Conclusions:Levofloxacin was one of the common drugs causing ADR in the emergency infusion unit. The clinical manifestations were mainly rashes and itching, most of which were mild in severity. Timely discontinuation of levofloxacin and drug interventions often help get a good prognosis. However, the treatment procedure of severe ADRs remain to be standardized.

Objective: This study uses structural magnetic resonance imaging to explore changes in the cerebellar lobules in patients with autism spectrum disorder (ASD) and further analyze the correlation between cerebellar structural changes and clinical symptoms of ASD. Methods: A total of 75 patients with ASD and 97 typically developing (TD) subjects from Autism Brain Imaging Data Exchange dataset were recruited. We adopted an advanced automatic cerebellar lobule segmentation technique called CEREbellum Segmentation to segment each cerebellar hemisphere into 12 lobules. Normalized cortical thickness of each lobule was recorded, and group differences in the cortical measures were evaluated. Correlation analysis was also performed between the normalized cortical thickness and the score of Autism Diagnostic Interview-Revised. Results: Results from analysis of variance showed that the normalized cortical thickness of the ASD group differed significantly from that of the TD group; specifically, the ASD group had lower normalized cortical thickness than the TD group. Post-hoc analysis revealed that the differences were more predominant in the left lobule VI, left lobule Crus I and left lobule X, and in the right lobule VI and right lobule Crus I. Lowered normalized cortical thickness in the left lobule Crus I in the ASD patients correlated positively with the abnormality of development evident at or before 36 months subscore. Conclusion These results suggest abnormal development of cerebellar lobule structures in ASD patients, and such abnormality might significantly influence the pathogenesis of ASD. These findings provide new insights into the neural mechanisms of ASD, which may be clinically relevant to ASD diagnosis.

Objective To investigate the study of magnetic resonance (MR) diffusion tensor imaging in children with acute kidney injury,and further improve the clinical research level of early diagnosis of acute kidney injury (AKI).Methods Twenty-two children who met the clinical AKI diagnostic criteria were collected from the Children's Hospital of Hunan Province.Twenty-three children volunteers were collected as the control group.The anisotropy fraction (FA) and mean diffusion coefficient (ADC) values of the renal cortex and medulla of all the tested children were detected,and the serum creatinine value and disease test results of children with AKI were collected.Spearman correlation analysis was used to analyze the correlation between the renal and medullary ADC values and FA values and serum creatinine values in the children with AKI.Results There were no significant differences in the FA,ADC values of left and right renal cortex and medulla of case group (P ＞ 0.05).There were no significant differences in the FA,ADC values of left and right renal cortex and medulla of control group (P ＞ 0.05).The medullary FA value,cortical FA and ADC value of the children with AKI were significantly lower than those of normal children (P ＜ 0.05).There was no significant difference in medullary ADC values between children with AKI and normal children (P ＞ 0.05).The medullary FA value and cortical ADC value of AKI patients were negatively correlated with serum creatinine value (r =-0.868,-0.436,P ＜ 0.05),and there was no correlation between cortical FA,medullary ADC and serum creatinine in the rest of the children.Conclusions As a non-invasive imaging method,diffusion tensor imaging (DTI) can reflect the early renal damage of AKI and has potential application value for clinical diagnosis of AKI.