Objective:To analyze the application effects of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture on anesthesia for older adult patients with obesity.Methods:A case-control study was conducted on the clinical data of 85 older adult patients with difficult airways who underwent surgical treatment at Marine Police Corps Hospital of Chinese People's Armed Police Force from March 2021 to June 2023. Based on the different methods of anesthesia for tracheal intubation, the patients were divided into a control group ( n = 40) and an observation group ( n = 45). The control group received conventional superior laryngeal nerve block combined with cricothyroid membrane puncture, while the observation group received ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture. The success rate of tracheal intubation, time taken for tracheal intubation, hemodynamic indicators, stress indicators, and the incidence of adverse reactions related to anesthesia were compared between the two groups. Results:In the observation group, the first-attempt tracheal intubation success rate was 87% (39/45), and the overall success rate for tracheal intubation was 98% (44/45), both of which were significantly higher than those in the control group [68% (27/40), 95% (38/40); χ2 = 4.48, 4.58, both P<0.05]. The time taken for tracheal intubation in the observation group was significantly shorter than that in the control group [(36.41 ± 5.23) minutes vs. (39.50 ± 4.42) minutes; t = 2.98, P<0.05]. During tracheal intubation and at the start of surgery, the observation group exhibited lower heart rates and higher mean arterial pressures compared with the control group ( t = 4.58, 4.65, -1.90, -2.14, all P<0.05). The cortisol and norepinephrine concentrations in the observation group were (23.12 ± 1.63) ng/L and (1 436.13 ± 225.60) pmol/L, respectively, both of which were significantly lower than those in the control group [(28.33 ± 2.29) ng/L, (1 784.50 ± 217.79) pmol/L; t = 12.59, 7.39, both P<0.05]. The incidence of anesthesia-related adverse reactions in the observation group was significantly lower than that in the control group [7% (3/45) vs. 25% (10/40); χ2 = 4.17, P<0.05]. Conclusions:Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture can enhance the success rate of tracheal intubation prior to general anesthesia in older adult patients with obesity. This approach helps maintain hemodynamic stability, reduces stress responses, and demonstrates a high level of safety.

Objective:To investigate the effects of target-oriented liquid therapy on the treatment outcomes of skin grafting in patients with severe burns.Methods:A total of 60 patients with severe burns (total burn area over 20%, and deep second-degree burn area ≥ 10%) who were scheduled for skin graft surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from January 2019 to January 2022 were included in this cohort study. The patients were randomly divided into a control group (conventional fluid therapy) and an observation group (target-oriented fluid therapy) using a random number table method, with 30 patients in each group.The levels of lactate (Lac) and high-sensitivity cardiac troponin I (cTnI) were compared between the two groups. The usage of colloid and crystalloid fluids, urine output, length of hospital stay, and the incidence of complications were compared between the two groups.Results:At the end of the surgery, the levels of Lac and cTnI in the observation group were (1.13 ± 0.22) mmol/L and (0.95 ± 0.25) μg/L, respectively, both of which were significantly lower than those in the control group [(1.52 ± 0.34) mmol/L, (1.10 ± 0.31) μg/L; t = 5.24, 0.83, P < 0.001, P = 0.044]. The differences in Lac and cTnI levels in the observation group were (0.53 ± 0.36) and (0.13 ± 0.07), respectively, which were significantly greater than those in the control group [(0.23 ± 0.16), (0.02 ± 0.01), t = -4.17 and -3.45, P < 0.001, P = 0.001]. The volumes of colloid and crystalloid fluids and the length of hospital stay in the observation group were (960.25 ± 153.32) mL, (1 680.52 ± 253.08) mL, and (51.36 ± 17.25) days, respectively. These values were significantly lower or shorter than those in the control group [(1 459.73 ± 203.41) mL, (2 401.89 ± 301.23) mL, (81.05 ± 25.08) days, t = 10.74, 10.04, 5.34,all P < 0.001]. The incidences of postoperative infection, pneumonia, and arrhythmia in the observation group were 33.33% (10/30), 16.67% (5/30), and 16.67% (5/30), respectively, which were significantly lower than those in the control group [63.33% (19/30), 46.67% (14/30), 30.00% (15/30); χ2 = 5.41, 6.24, 7.50, P = 0.020, P = 0.013, P = 0.006]. However, there was no statistically significant difference in acute lung injury, heart failure, and myocardial injury between the two groups ( χ2 = 1.36, 1.92, 0.29; P = 0.243, 0.166, 0.592). Conclusions:Compared with traditional fluid replacement therapy, target-oriented fluid therapy has a more significant therapeutic effect on patients with severe burns. It not only reduces fluid usage and the length of hospital stay but also decreases the incidence of infection, pneumonia, and arrhythmia in these patients.

Objective:To analyze the application effects of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture on anesthesia for older adult patients with obesity.Methods:A case-control study was conducted on the clinical data of 85 older adult patients with difficult airways who underwent surgical treatment at Marine Police Corps Hospital of Chinese People's Armed Police Force from March 2021 to June 2023. Based on the different methods of anesthesia for tracheal intubation, the patients were divided into a control group ( n = 40) and an observation group ( n = 45). The control group received conventional superior laryngeal nerve block combined with cricothyroid membrane puncture, while the observation group received ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture. The success rate of tracheal intubation, time taken for tracheal intubation, hemodynamic indicators, stress indicators, and the incidence of adverse reactions related to anesthesia were compared between the two groups. Results:In the observation group, the first-attempt tracheal intubation success rate was 87% (39/45), and the overall success rate for tracheal intubation was 98% (44/45), both of which were significantly higher than those in the control group [68% (27/40), 95% (38/40); χ2 = 4.48, 4.58, both P<0.05]. The time taken for tracheal intubation in the observation group was significantly shorter than that in the control group [(36.41 ± 5.23) minutes vs. (39.50 ± 4.42) minutes; t = 2.98, P<0.05]. During tracheal intubation and at the start of surgery, the observation group exhibited lower heart rates and higher mean arterial pressures compared with the control group ( t = 4.58, 4.65, -1.90, -2.14, all P<0.05). The cortisol and norepinephrine concentrations in the observation group were (23.12 ± 1.63) ng/L and (1 436.13 ± 225.60) pmol/L, respectively, both of which were significantly lower than those in the control group [(28.33 ± 2.29) ng/L, (1 784.50 ± 217.79) pmol/L; t = 12.59, 7.39, both P<0.05]. The incidence of anesthesia-related adverse reactions in the observation group was significantly lower than that in the control group [7% (3/45) vs. 25% (10/40); χ2 = 4.17, P<0.05]. Conclusions:Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture can enhance the success rate of tracheal intubation prior to general anesthesia in older adult patients with obesity. This approach helps maintain hemodynamic stability, reduces stress responses, and demonstrates a high level of safety.

Objective:To investigate the effects of target-oriented liquid therapy on the treatment outcomes of skin grafting in patients with severe burns.Methods:A total of 60 patients with severe burns (total burn area over 20%, and deep second-degree burn area ≥ 10%) who were scheduled for skin graft surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from January 2019 to January 2022 were included in this cohort study. The patients were randomly divided into a control group (conventional fluid therapy) and an observation group (target-oriented fluid therapy) using a random number table method, with 30 patients in each group.The levels of lactate (Lac) and high-sensitivity cardiac troponin I (cTnI) were compared between the two groups. The usage of colloid and crystalloid fluids, urine output, length of hospital stay, and the incidence of complications were compared between the two groups.Results:At the end of the surgery, the levels of Lac and cTnI in the observation group were (1.13 ± 0.22) mmol/L and (0.95 ± 0.25) μg/L, respectively, both of which were significantly lower than those in the control group [(1.52 ± 0.34) mmol/L, (1.10 ± 0.31) μg/L; t = 5.24, 0.83, P < 0.001, P = 0.044]. The differences in Lac and cTnI levels in the observation group were (0.53 ± 0.36) and (0.13 ± 0.07), respectively, which were significantly greater than those in the control group [(0.23 ± 0.16), (0.02 ± 0.01), t = -4.17 and -3.45, P < 0.001, P = 0.001]. The volumes of colloid and crystalloid fluids and the length of hospital stay in the observation group were (960.25 ± 153.32) mL, (1 680.52 ± 253.08) mL, and (51.36 ± 17.25) days, respectively. These values were significantly lower or shorter than those in the control group [(1 459.73 ± 203.41) mL, (2 401.89 ± 301.23) mL, (81.05 ± 25.08) days, t = 10.74, 10.04, 5.34,all P < 0.001]. The incidences of postoperative infection, pneumonia, and arrhythmia in the observation group were 33.33% (10/30), 16.67% (5/30), and 16.67% (5/30), respectively, which were significantly lower than those in the control group [63.33% (19/30), 46.67% (14/30), 30.00% (15/30); χ2 = 5.41, 6.24, 7.50, P = 0.020, P = 0.013, P = 0.006]. However, there was no statistically significant difference in acute lung injury, heart failure, and myocardial injury between the two groups ( χ2 = 1.36, 1.92, 0.29; P = 0.243, 0.166, 0.592). Conclusions:Compared with traditional fluid replacement therapy, target-oriented fluid therapy has a more significant therapeutic effect on patients with severe burns. It not only reduces fluid usage and the length of hospital stay but also decreases the incidence of infection, pneumonia, and arrhythmia in these patients.

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Objective:To investigate the safety and feasibility of the CHESS endoscpic ruler (CHESS ruler), and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods:From January 2021 to January 2022, a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital, Xixia Branch Hospital, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region (29 cases), and the First People′s Hospital of Yinchuan (25 cases), General Hospital of Ningxia Medical University (18 cases), Wuzhong People′s Hospital (10 cases), the Fifth People′s Hospital of Ningxia Hui Autonomous Region (10 cases), Shizuishan Second People′s Hospital (6 cases), Yinchuan Second People′s Hospital (5 cases), and Zhongwei People′s Hospital (2 cases) 8 hospitals. The clinical characteristics of all the patients, including gender, age, nationality, etiolog of liver cirrhosis, and Child-Pugh classification of liver function were recorded. A big gastroesophageal varices was defined as diameter of varices ≥5 mm. Endoscopist (associated chief physician) performed gastroscopy according to the routine gastroscopy procedures, and the diameter of the biggest esophageal varices was measured by experience and images were collected, and then objective measurement was with the CHESS ruler and images were collected. The diameter of esophageal varices of 10 randomly selected patients (random number table method) was determined by 6 endoscopists (attending physician or associated chief physician) with experience or measured by CHESS ruler. Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results:Among 105 liver cirrhosis patients with portal hypertension, male 65 cases and female 40 cases, aged (54.8±12.2) years old, Han nationality 82 cases, Hui nationality 21 cases and Mongolian nationality 2 cases. The etiology of liver cirrhosis included chronic hepatitis B (79 cases), alcoholic liver disease (7 cases), autoimmune hepatitis (7 cases), chronic hepatitis C (2 cases), and other etiology (10 cases). Liver function of 32 cases was Child-Pugh A, Child-Pugh B 57 cases, and Child-Pugh C 16 cases. All 105 liver cirrhosis patients with cirrhotic portal hypertension were successfully measured the diameter of gastroesophageal varices by CHESS ruler, and the success rate of application of CHESS ruler was 100.0% (105/105). The procedure time from the CHESS ruler into the body to the exit of the body after measurement was (3.50±2.55) min. No complications happened in all the patients during measurement. Among 105 liver cirrhosis patients with cirrhotic portal hypertension, 96 cases (91.4%) were recognized as big gastroesophageal varices by the endoscopists. Totally 93 cases (88.6%) were considered as big gastroesophageal varices by CHESS ruler. Eight cases were recognized as big gastroesophageal varices by the endoscopist, however not by the CHESS ruler; 5 cases were recognized as big gastroesophageal varices by the CHESS ruler, but not by the endoscopists; 4 cases were not recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler; 88 cases were recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler. The missed diagnostic rate of big gastroesophageal varices by the endoscopists experience was 5.4% (5/93), and the Kappa value of consistency coefficient between the measurement by the CHESS ruler and the interpretation by endoscopists experience was 0.31 (95% confidence interval 0.03 to 0.60). The overall Kappa value of consistency coefficient by 6 endoscopists measured by CHESS ruler in big gastroesophageal varices diagnosis was 0.77 (95% confidence interval 0.61 to 0.93).Conclusion:As an objective measurement tool, CHESS ruler can make up for the deficiency of subjective judgment by endoscopists, accurately measure the diameter of gastroesophageal varices, and is highly feasible and safe.

Objective To investigate the role and mechanism of miRNAs in alcoholic liver injury in rats.Methods Thirty male SD rats were randomly divided into model and control groups.The model group was gavaged with 56%liquor and the control group was gavaged with distilled water for 8 weeks.Liver tissue was collected,miRNAs were analyzed,and target genes of differentially expressed miRNAs were predicted by a rat miRNA chip.Gene ontology(GO)and KEGG pathway enrichment analysis were used to understand the function of differentially expressed miRNA target genes.A differentially expressed miRNA-mRNA-pathway regulatory network was constructed using Cytoscape to further screen important regulatory miRNAs versus important pathways.RT-qPCR was performed for selected miRNAs to validate the expression analysis.Results Twelve differentially expressed miRNAs(P<0.05,Fold change≥2)were screened out,including two upregulated and 10 downregulated miRNAs by comparative analysis of microarray data between model and control groups.GO classification annotation of differential miRNA target genes showed close associations between differentially expressed miRNAs and biological functions such as signal transduction,metabolic processes,antioxidant activity,cell killing,enzyme regulatory activity and biological regulation.Differentially expressed miRNA target genes in KEGG pathway analysis revealed that the AMPK signaling pathway,PI3K-Akt signaling pathway,Hippo signaling pathway,Wnt signaling pathway,cancer,autophagy,insulin resistance,Ras signaling pathway,and other signaling pathways might play major regulatory roles in alcoholic liver injury lesions.Hub miRNAs and pathways screened by constructing the differentially expressed miRNA-mRNA-pathway regulatory network were miR-145-5p,miR-107-3p,miR-297,Hippo signaling pathway,cancer,PI3K-Akt signaling pathway,and AMPK signaling pathway.qRT-PCR validated the gene expression trends,and gene chip result were consistent.Conclusions We established an miRNA profile of alcoholic liver injury in rats,which suggests that miR-145-5p,miR-107-3p,and miR-297 play major roles in the process of alcoholic liver pathology.

Objective: To explore relationship between screen time and myopia in children aged 11-14 years in China. Methods: The data were extracted from "National Nutrition and Health Systematic Survey and Application for 0-18 Years Old Children". A total of 12 397 children aged 11-14 years old from 14 provinces and 28 districts/counties in seven regions of China were surveyed by using multi stage stratified random sampling method. Daily screen time and visual acuity information were collected through a questionnaire. Results: The myopia rate of 11-14 years old children in China was 45.0%, among which the rate of girls was higher than that of boys, and the rate of urban was higher than that of rural, and it increased with age ( χ 2=178.82,79.25, 495.96 , P <0.01). The daily screen time median of 12 397 children was 40.0 minutes, with boys(40.0 min) longer than girls( 35.0 min ) and urban children(40 min) longer than rural children(33.0 min) ( χ 2=20.86，102.68， P <0.01). The myopia rate of boys ( 42.5 %) with daily screen time greater than or equal to 60 minutes was higher than that of boys (36.4%) with daily screen time less than 60 minutes, and the myopia rate of girls (55.6%) with daily screen time greater than or equal to 60 minutes was higher than that of girls (48.0%)( χ 2=23.62，34.15， P <0.01). After adjusting for age, gender, region, time of medium and high intensity physical activity, intake of sugary food and sugary beverages, daily sleep time, multivariable Logistic regression model showed that girls with daily screen time greater than or equal to 60 minutes ( OR=1.14, 95%CI =1.03-1.27) had a higher risk of myopia than those with less than 60 minutes. After adjusting for confounding factors, there was no correlation between daily screen time and the degree of myopia in boys or girls( P >0.05). Conclusion Daily screen time greater than or equal to 60 minutes may be a risk factor for myopia in girls aged 11 to 14 years old. Given the complexity of the factors that affect vision, researches are needed to examine the relationship between screen time and myopia.

Objective:To investigate the analgesic efficacy of dexmedetomidine combined with dizosine after lumbar internal fixation and its effects on hyperalgesia.Methods:Seventy-two patients who underwent lumbar internal fixation in General Hospital of Armed Police and Marine Police between April 2018 and June 2019 were included in this study. They were randomly assigned to undergo either flurbiprofen axetil and dizosine administration (control group) or dexmedetomidine and dizosine (observation group) for postoperative analgesia. Mechanical pain, degree of postoperative pain, and incidence of complications were recorded in each group.Results:At 6, 24 and 48 hours after surgery, peri-wound pain threshold in the observation group was (119.52 ± 20.42) points, (120.19 ± 17.44) points, (120.94 ± 20.73) points, respectively, which were significantly higher than (108.42 ± 15.24) points, (107.63 ± 16.83) points, (108.47 ± 17.82) points in the control group ( t = 0.01, 0.00, 0.01, all P < 0.05). At 24 and 48 hours after surgery, forearm pain threshold in the observation group was (109.93 ± 15.87) points and (110.79 ± 22.85) points, respectively, which were significantly higher than (97.07 ± 16.49) points and (95.63 ± 24.06) points ( t = 3.37, 2.74, both P < 0.05). There was no significant difference in Ramsay Sedation Scale score between the two groups ( P > 0.05). There was no significant difference in the dose of dizosine used within 48 hours after surgery between the two groups ( P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [8.33% (3/36) vs. 27.78% (10/36), χ2 = 4.60, P < 0.05]. Conclusion:Dexmedetomidine combined with dizosine exhibits obvious analgesic efficacy after lumbar internal fixation. The combined therapy can effectively prevent hyperalgesia with a low incidence of comphications.

Objective:By comparing standard gonadotropin-releasing hormone antagonist regimen and gonadotropin-releasing hormone agonist-antagonist protocol (AAP regimen) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group 3 and group 4 patients with low prognosis, to study if AAP regimen could improve the clinical outcomes in low prognosis patients.Methods:A case-control study was performed, the clinical data of 646 cycles of prospective poor ovarian response (POR) patients (POSEIDON group 3 and 4) who received in vitro fertilization and embryo transfer (IVF-ET) in Peking University Third Hospital Department of Obstetrics and Gynecology, Reproductive Medical Center from January 2016 to May 2018 were retrospectively analyzed. The total number of AAP cycle was 323, and control group was selected from the database with 1∶1 matching of contemporaneous prospective POR patients (POSEIDON group 3 and group 4) with similar age and approaching date of oocyte retrieval. Patients' general information, ovarian stimulation indexes and clinical outcomes were compared. Results:AAP group had fewer antral follicle count (AFC) [3.00(2.00,4.00) vs. 4.00(2.00,5.00), P<0.001] and similar anti-Müllerian hormone (AMH) level [0.51(0.25,0.83) μg/L vs. 0.53(0.31,0.81) μg/L, P>0.05] compared with control group. AAP group had shorter duration of gonadotropin (Gn) used [10.00(8.00,11.00) d vs. 10.00(9.00,11.00) d, P=0.020] and lower dosage of Gn used [2 675.00(2 100.00,3 300.00) U vs. 3 075.00(2 550.00,3 750.00) U, P<0.001] than control group. AAP group had similar number of oocytes obtained [3.00(2.00,5.00) vs. 4.00(2.00,6.00), P>0.05] compared with control group. Under the same proportion of fertilization schemes (routine or intracytoplasmic sperm injection methods), AAP group had higher fertilization rate [74.15% (955/1288) vs. 69.13% (918/1328), P=0.004] and good-quality embryo rate [62.57% (585/935) vs. 56.94% (509/894), P=0.014], and ultimately had higher embryo implantation rate [22.31% (87/390) vs. 15.84% (64/404), P=0.020], cumulative clinical pregnancy rate [32.50% (78/240) vs. 22.86% (56/245), P=0.018] and cumulative live birth rate [25.83% (62/240) vs. 17.96% (44/245), P=0.036]. Conclusion:For POSEIDON patients with low prognosis and POR, controlled ovarian hyperstimulation with AAP regimen had better clinical outcomes compared with conventional antagonist regimen.