Objective To analyze the risk factors and re-intervention strategies for mid- and long-term residual after arterial switch operation (ASO). Methods The clinical data of children with complex congenital heart disease who underwent ASO surgery in Shanghai Children’s Medical Center from January 2006 to June 2022 were retrospectively collected, and the risk factors for mid- and long-term residual after ASO were analyzed. Results A total of 952 children undergoing ASO were enrolled in this study, including 654 males and 298 females with an average age of (102.9±90.1) d and weight of (4.6±1.6) kg. There were 421 patients with D-transposition of the great arteries with intact ventricular septum (D-TGA/IVS), 357 patients with D-transposition of the great arteries with ventricular septal defect (D-TGA/VSD), and 174 patients with right ventricle double outlet combined with subpulmonary ventricular septal defect (Taussig-Bing malformation). Eighty-nine patients died early after the surgery, the mortality rate was 9.3%. The 746 surviving children were regularly followed up after the surgery (follow-up rate 86.4%), with a median follow-up time of 79.4 (12.0-188.0) months. During the follow-up, 53 children underwent surgical re-intervention due to residual, including 33 males and 20 females, with a median age of 62.5 (17.0-214.0) months. The median surgical weight was 19.0 (8.2-86.0) kg, and the mean time of re-intervention was 28.0-170.0 (77.5±45.4) months after the ASO. Residual problems included common trunk and branch stenosis of the pulmonary artery in 23 patients, right ventricular outflow tract (RVOT) obstruction in 11 patients, left ventricular outflow tract obstruction in 6 patients, aortic arch restenosis in 5 patients, aortic insufficiency in 5 patients, residual shunt of ventricular septal defect in 2 patients, and tricuspid valve insufficiency in 1 patient. The early postoperative mortality rate was 3.8% (2/53), with the causes of death being acute myocardial infarction due to coronary artery injury and acute left heart failure, respectively. The mean follow-up time of the surviving children was (52.4±28.6) months, and no mid- and long-term death occurred. Two patients underwent the third operations due to pulmonary restenosis. The multivariate analysis result showed that combined aortic arch surgery and early postoperative RVOT velocity>3 m/s were independent risk factors for mid- and long-term residual after ASO. Conclusion ASO is an ideal procedure for the treatment of D-TGA/IVS, D-TGA/VSD and Taussig-Bing malformations. Combined aortic arch surgery and early postoperative RVOT velocity>3 m/s are independent risk factors for mid- and long-term residual after ASO.

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)versus subcostal transversus abdominis plane block(STAPB)on perioperative analgesia and postoperative inflammation in patients undergoing laparoscopic radical resection of colorectal cancer.Methods In this prospective randomized study,we recruited 102 patients undergoing laparoscopic colorectal cancer surgery between October 2022 and October 2024 under general anesthesia and randomly assigned them to two groups:QLB-LSAL(Group Q,n=51)and STAPB(Group S,n=51).Mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),before surgical incision(T1),start of surgery(T2),during pneumoperitoneum establishment(T3),during peritoneal lavage(T4),at the end of surgery(T5),and upon leaving the operating room(T6).Intraoperative remifentanil consumption,time to first patient-controlled analgesia demand,and frequency of effective compression and rescue analgesia were recorded.Visual Analog Scale(VAS)scores at rest and during coughing were assessed at 24,48,and 72 hours postoperatively.Interleukin-6(IL-6)and systemic immune-inflammatory index(SII)at 1 day preoperatively,1,and 3 days postoperatively were recorded.Postoperative recovery indicators and adverse events were also recorded.Results Group Q demonstrated significantly lower MAP and HR compared with Group S from T3 to T6(P<0.05).Group Q had significantly lower intraoperative remifentanil consumption,significantly longer time to first analgesic pump demand,fewer effective pump compres-sion,and lower frequency for rescue analgesia requests(all P<0.05).VAS scores at rest and during coughing in Group Q were significantly lower at 24 h and 48 h postoperatively(P<0.05).As compared with preoperative levels,both IL-6 and SII increased at 1 and 3 days postoperatively,but magnitude of increase in Group Q was smaller than in Group S(P<0.05).In comparison to Group S,Group Q demonstrated significantly earlier ambulation,shorter hospital stay,and fewer adverse events(P<0.05).Conclusion QLB-LSAL is superior to STAPB in enhancing perioperative analgesia,attenuating inflammatory response,and accelerating postoperative rehabilitation in patients undergoing laparoscopic colorectal cancer resection.

Objective To observe the therapeutic effect of Qiwei Tangmaishu capsules on type 2 diabetes mice,and explore the mechanisms of its treatment of type 2 diabetes based on network pharmacology.Methods TCMSP,ETCM databases were used to query all components and of Qiwei Tangmaishu capsules and their targets.OMIM and DrugBank databases were used to search for targets of type 2 diabetes.The targets of type 2 diabetes and Qiwei Tangmaishu capsules were intersected by Venny 2.1.0.to perform GO and KEGG pathway enrichment analysis on those intersecting targets using the Metascape website.Then,a mouse model of type 2 diabetes was established,and Qiwei Tangmaishu capsules were given to low,medium,and high dose groups(234,468,and 936 mg/kg,respectively),and metformin(MET)group(200 mg/kg)for 2 weeks.The weight of each mouse was measured before and after treatment,and fasting blood glucose was also measured.After the 2 weeks,fasting insulin was measured;ELISA was used to detect levels of inflammatory factors IL-1β,TNF-α,IL-6,TLR4,and NF-κB in serum;Hematoxylin eosin staining was used to observe the morphology of pancreatic islets;and Caspase 3 and INS immunofluorescence were used to detect apoptosis of pancreatic islet cells and the number of pancreatic beta cells.Western Blot assay was used to detect the expression levels of pancreatic tissue proteins such as p-Akt,Akt,p-PI3K,PI3K,Bax,Bcl2.Results 1260 active ingredient targets were identified in Qiwei Tangmaishu capsules;1205 targets of type 2 diabetes were found.Of these,312 targets were intersected by Venny,with core targets involving Akt1,TNF,IL-6,TLR4,among others.Enrichment analysis identified 240 KEGG pathways,among which"insulin resistance""PI3K/Akt signaling pathway"were the key pathways enriched.The animal experiment result showed that compared with the model group,the intervention of Qiwei Tangmaishu capsules and metformin significantly improved blood glucose and insulin resistance;the content of inflammatory factors in serum decreased,and the apoptosis rate of pancreatic islet cells significantly decreased;the number of pancreatic beta cells significantly increased;the expression of pro-apoptotic protein Bax decreased,the expression of anti-apoptotic protein Bcl2 significantly increased,and the expression of p-PI3K and p-Akt was upregulated.Conclusions Qiwei Tangmaishu capsules can significantly reduce blood glucose levels,restore insulin sensitivity,and reduce islet cell apoptosis in type 2 diabetic mice.The mechanism may be related to the activation of the PI3K/Akt signaling pathway.

Objective To observe the therapeutic effect of Qiwei Tangmaishu capsules on type 2 diabetes mice,and explore the mechanisms of its treatment of type 2 diabetes based on network pharmacology.Methods TCMSP,ETCM databases were used to query all components and of Qiwei Tangmaishu capsules and their targets.OMIM and DrugBank databases were used to search for targets of type 2 diabetes.The targets of type 2 diabetes and Qiwei Tangmaishu capsules were intersected by Venny 2.1.0.to perform GO and KEGG pathway enrichment analysis on those intersecting targets using the Metascape website.Then,a mouse model of type 2 diabetes was established,and Qiwei Tangmaishu capsules were given to low,medium,and high dose groups(234,468,and 936 mg/kg,respectively),and metformin(MET)group(200 mg/kg)for 2 weeks.The weight of each mouse was measured before and after treatment,and fasting blood glucose was also measured.After the 2 weeks,fasting insulin was measured;ELISA was used to detect levels of inflammatory factors IL-1β,TNF-α,IL-6,TLR4,and NF-κB in serum;Hematoxylin eosin staining was used to observe the morphology of pancreatic islets;and Caspase 3 and INS immunofluorescence were used to detect apoptosis of pancreatic islet cells and the number of pancreatic beta cells.Western Blot assay was used to detect the expression levels of pancreatic tissue proteins such as p-Akt,Akt,p-PI3K,PI3K,Bax,Bcl2.Results 1260 active ingredient targets were identified in Qiwei Tangmaishu capsules;1205 targets of type 2 diabetes were found.Of these,312 targets were intersected by Venny,with core targets involving Akt1,TNF,IL-6,TLR4,among others.Enrichment analysis identified 240 KEGG pathways,among which"insulin resistance""PI3K/Akt signaling pathway"were the key pathways enriched.The animal experiment result showed that compared with the model group,the intervention of Qiwei Tangmaishu capsules and metformin significantly improved blood glucose and insulin resistance;the content of inflammatory factors in serum decreased,and the apoptosis rate of pancreatic islet cells significantly decreased;the number of pancreatic beta cells significantly increased;the expression of pro-apoptotic protein Bax decreased,the expression of anti-apoptotic protein Bcl2 significantly increased,and the expression of p-PI3K and p-Akt was upregulated.Conclusions Qiwei Tangmaishu capsules can significantly reduce blood glucose levels,restore insulin sensitivity,and reduce islet cell apoptosis in type 2 diabetic mice.The mechanism may be related to the activation of the PI3K/Akt signaling pathway.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.

This paper summarized the current status of infection and quality control of medical flexible endoscope (abbreviation:endoscope),which can identify that defect of the quality control of endoscopic forceps channels was a major cause of nosocomial infections of endoscopy. Based on this,a multifunctional quality control workstation with forceps channel of detecting flexible endoscope,and precision components included top ends for medical endoscopes has been developed,which can clearly display residual contaminants and damages in the forceps channels and precision components after the endoscope was reprocessed. It is contribute to enhance the quality control of reprocessing endoscope,and reduce cross-infection of endoscope.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.

This paper summarized the current status of infection and quality control of medical flexible endoscope (abbreviation:endoscope),which can identify that defect of the quality control of endoscopic forceps channels was a major cause of nosocomial infections of endoscopy. Based on this,a multifunctional quality control workstation with forceps channel of detecting flexible endoscope,and precision components included top ends for medical endoscopes has been developed,which can clearly display residual contaminants and damages in the forceps channels and precision components after the endoscope was reprocessed. It is contribute to enhance the quality control of reprocessing endoscope,and reduce cross-infection of endoscope.

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)versus subcostal transversus abdominis plane block(STAPB)on perioperative analgesia and postoperative inflammation in patients undergoing laparoscopic radical resection of colorectal cancer.Methods In this prospective randomized study,we recruited 102 patients undergoing laparoscopic colorectal cancer surgery between October 2022 and October 2024 under general anesthesia and randomly assigned them to two groups:QLB-LSAL(Group Q,n=51)and STAPB(Group S,n=51).Mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),before surgical incision(T1),start of surgery(T2),during pneumoperitoneum establishment(T3),during peritoneal lavage(T4),at the end of surgery(T5),and upon leaving the operating room(T6).Intraoperative remifentanil consumption,time to first patient-controlled analgesia demand,and frequency of effective compression and rescue analgesia were recorded.Visual Analog Scale(VAS)scores at rest and during coughing were assessed at 24,48,and 72 hours postoperatively.Interleukin-6(IL-6)and systemic immune-inflammatory index(SII)at 1 day preoperatively,1,and 3 days postoperatively were recorded.Postoperative recovery indicators and adverse events were also recorded.Results Group Q demonstrated significantly lower MAP and HR compared with Group S from T3 to T6(P<0.05).Group Q had significantly lower intraoperative remifentanil consumption,significantly longer time to first analgesic pump demand,fewer effective pump compres-sion,and lower frequency for rescue analgesia requests(all P<0.05).VAS scores at rest and during coughing in Group Q were significantly lower at 24 h and 48 h postoperatively(P<0.05).As compared with preoperative levels,both IL-6 and SII increased at 1 and 3 days postoperatively,but magnitude of increase in Group Q was smaller than in Group S(P<0.05).In comparison to Group S,Group Q demonstrated significantly earlier ambulation,shorter hospital stay,and fewer adverse events(P<0.05).Conclusion QLB-LSAL is superior to STAPB in enhancing perioperative analgesia,attenuating inflammatory response,and accelerating postoperative rehabilitation in patients undergoing laparoscopic colorectal cancer resection.

Objective:To explore the feasibility and effectiveness of hierarchical teaching based on team-based learning (TBL) combined with Bandura's role model theory in improving the training effectiveness of newly hired gastroenterology nurses.Methods:The 98 nurses recruited in the Department of Gastroenterology from July 2019 to July 2023 were divided into a control group (47) and an observation group (51) according to their order of enrollment. The control group received routine teaching, while the observation group received hierarchical teaching based on TBL plus Bandura's role model theory. The two groups were compared for theoretical and skill assessment scores, clinical communication skills, teamwork ability, training effectiveness, and satisfaction with teaching.Results:After the training, the theoretical and practical assessment scores of the observation group were (81.69±4.26) and (80.29±5.21) points, respectively, which were significantly higher than the (77.57±4.16) and (75.28±5.43) points in the control group ( P<0.05). After the training, both groups showed significant improvements in building harmonious relationships, listening skills, team participation, problem confirmation, information transmission, and validation of feelings, with the observation group scoring higher than the control group. After the training, the trust and support, team orientation, team leadership, and team mental model dimensions scores of both groups were significantly improved, and the observation group showed higher scores than the control group. After the training, the leadership ability, critical patient monitoring, teaching and cooperation, planning evaluation, communication, and professional development scores of both groups were significantly improved, and the observation group demonstrated higher scores than the control group. The observation group scored higher on various dimensions of teaching satisfaction than the control group ( P<0.05). Conclusions:Hierarchical teaching based on TBL plus Bandura's role model theory can improve the quality of training newly hired nurses in the gastroenterology department, enhance their clinical communication skills, teamwork abilities, and clinical nursing quality, and facilitate the cultivation of high-quality gastroenterology clinical nurses.