Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective:To detect the level of N6-methyladenosine(m6A)methylation modifier regulator in peripheral blood mononuclear cell(PBMC)of patients with rheumatoid arthritis(RA),and to investigate its expression level and clinical significance in RA.Methods:PBMC from 50 RA patients and 36 healthy controls(HC)were examined by RT-qPCR to compare the mRNA expres-sion levels of m6A methylation modifier regulators(METTL3,METTL14,WTAP,ALKBH5,FTO,YTHDF2)on PBMC from RA and HC groups and their correlation with laboratory test data was analyzed.Results:①The expression levels of m6A methylation modifica-tion regulators on PBMC in peripheral blood were significantly lower in the RA group than in the HC group,and the differences were statistically significant;②The expression levels of METTL3,METTL14,WTAP and YTHDF2 on PBMC of RA patients were negatively correlated with rheumatoid factor;③The expression levels of YTDHF2 on PBMC of RA patients were negatively correlated with inflam-matory indexes CRP,ESR,N,N%,NLR and dNLR,and positively correlated with L%and LMR;the expression levels of WTAP on PBMC of RA patients were negatively correlated with N,N%,NLR and dNLR,and positively correlated with L%and LMR;④The expression level of YTDHF2 on PBMC of RA patients increased significantly after treatment,and the difference was statistically signifi-cant;⑤The expression levels of m6A methylation modifier regulators on PBMC of RA patients were positively correlated with each other;⑥Logistic regression analysis showed that the decreased expression levels of FTO and YTHDF2 in PBMC of RA patients were risk factors for the development of RA.Conclusion:The expression levels of m6A methylation-modified regulators on PBMC are gener-ally reduced in the RA group.m6A methylation-modified regulators are clearly correlated with inflammation levels,autoantibody pro-duction and disease severity,and can be used as an indicator to assess the severity and activity of the disease.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective:To detect the level of N6-methyladenosine(m6A)methylation modifier regulator in peripheral blood mononuclear cell(PBMC)of patients with rheumatoid arthritis(RA),and to investigate its expression level and clinical significance in RA.Methods:PBMC from 50 RA patients and 36 healthy controls(HC)were examined by RT-qPCR to compare the mRNA expres-sion levels of m6A methylation modifier regulators(METTL3,METTL14,WTAP,ALKBH5,FTO,YTHDF2)on PBMC from RA and HC groups and their correlation with laboratory test data was analyzed.Results:①The expression levels of m6A methylation modifica-tion regulators on PBMC in peripheral blood were significantly lower in the RA group than in the HC group,and the differences were statistically significant;②The expression levels of METTL3,METTL14,WTAP and YTHDF2 on PBMC of RA patients were negatively correlated with rheumatoid factor;③The expression levels of YTDHF2 on PBMC of RA patients were negatively correlated with inflam-matory indexes CRP,ESR,N,N%,NLR and dNLR,and positively correlated with L%and LMR;the expression levels of WTAP on PBMC of RA patients were negatively correlated with N,N%,NLR and dNLR,and positively correlated with L%and LMR;④The expression level of YTDHF2 on PBMC of RA patients increased significantly after treatment,and the difference was statistically signifi-cant;⑤The expression levels of m6A methylation modifier regulators on PBMC of RA patients were positively correlated with each other;⑥Logistic regression analysis showed that the decreased expression levels of FTO and YTHDF2 in PBMC of RA patients were risk factors for the development of RA.Conclusion:The expression levels of m6A methylation-modified regulators on PBMC are gener-ally reduced in the RA group.m6A methylation-modified regulators are clearly correlated with inflammation levels,autoantibody pro-duction and disease severity,and can be used as an indicator to assess the severity and activity of the disease.

OBJECTIVE:To compare the anti-inflammation,analgesia effects of decoctions extracted from Aconiti lateralis with different leaf shapes(dahua leaf,xiaohua leaf)from different producing areas(Jiangyou,Butuo). METHODS:Animals were randomly divided into blank group(distilled water),positive group,groups of Aconiti lateralis with dahua,xiaohua leaf from Ji-angyou,groups of Aconiti lateralis with dahua,xiaohua leaf from Butuo(with dose of 5 g/kg,calculated by crude drug). The an-ti-inflammation effect of decoctions extracted from Aconiti lateralis with different variety sources and leaf shapes was investigated by xylene-induced ear swelling test (n=12) in mice and egg white-induced toe swelling test (n=10) in rats (positive drug was Dexamethasone acetate tablet,0.005 g/kg). And its analgesic effect was investigated by acetic acid-induced writhing body reaction test(n=12)and hot-plate-induced pain test(n=12)in mice(positive drug was Morphine hydrochloride tablet,0.0025 g/kg). RE-SULTS:The decoctions extracted from Aconiti lateralis with dahua,xiaohua leaf from Butuo and xiaohua leaf from Jiangyou can significantly reduce the ear swelling degree(P<0.01). The decoctions extracted from Aconiti lateralis with dahua leaf from Jiangy-ou and Butuo can significantly decrease the toe swelling degree after 6 h of medication(P<0.05). And decoctions extracted from Aconiti lateralis with xiaohua leaf from Butuo can significantly reduce the number of writhing body in mice with acetic acid-in-duced pain and prolong the pain threshold of mice with hot-plate-induced pain (P<0.05 or P<0.01). CONCLUSIONS:Aconiti lateralis with dahua and xiaohua leaf from Butuo and with xiaohua leaf from Jiangyou show better anti-inflammation effect,and Aconiti lateralis with xiaohua leaf from Butuo shows better analgesic effect.

ObjectiveTo dynamically observe the effects ofJieduan Niwan Formula on mitochondrial apoptotic pathway in acute-on-chronic liver failure (ACLF) rats; To further reveal the possible mechanism ofJieduan Niwan Formula.MethodsSPF Wistar rats were randomly divided into normal group, model group andJieduan Niwan group. 13-week porcine serum injection followed withD-galactosamine and lipopolysaccharide joint acute attack was used to established ACLF model in all rats except for normal group. Rats inJieduan Niwangroup were orally givenJieduan NiwanFormula for 3 days before acute attack. Rats were sacrificed respectively at 4, 8 and 12 h after models were established. The expressions of Bid, Cytochrome C (Cyt C) and hepatocyte ultrastructure were detected by Western blot method, immunohistochemical analysis and transmission electron microscope, respectively.Results Compared with normal group, the levels of Cyt C and Bid in model group increased at 4 h and peaked at 8 h but decreased at 12 h (P<0.05); however, the levels of Cyt C and Bid inJieduan Niwan group were lower than those in model group at 4 and 8 h but higher at 12 h (P<0.05). The ultrastructures were significantly damaged in model rats, which severity was escalated through time; inJieduan Niwan group, the degree of injury decreased at each timing.ConclusionJieduan NiwanFormula can efficiently alleviate the hepatocyte damage in ACLF rats, and the mechanism might be involved in the inhibition of the mitochondrial apoptotic pathway.

The article summarized relevant theories and successful practical experience about medical resource integration, analyzed the background of regional medical-trust in Shanghai, and discussed three different model of regional medical-trust building, and their own advantages and disadvantages. Furthermore it discussed the main framework of regional medical-trust pilot reform,including administrative and operational model, insurance-payment model and visiting-doctor model. Then, it introduced the reform strategies of regional medical-trust pilot and present progress.