Objective To investigate the effect of remimazolam on core body temperature(CBT)and thermoregulatory vasoconstriction in patients undergoing gynecological laparoscopic surgery.Methods 90 gynaecology patients with ovarian or cervical cancer from Jan 2024 to Jun 2024 were randomly divided into experimental group(group R)and control group(group C).45 patients in each group were induced and maintained with remimazolam or propofol.After induction of anesthesia,the CBT and mean skin temperature(MST)were continuously monitored using a nasopharyngeal temperature probe and a skin temperature probe respectively.Record CBT and MST of two groups of patients before surgery(T0),30 min(T1),60 min(T2),90 min(T3),120 min(T4),150 min(T5),180 min(T6)after induction of anesthesia and at extubation(T7),as well as forearm-fingertip temperature gradient(TFOR-FIN).Record vasoconstriction threshold and time to onset of vasoconstriction by TFOR-TIN.Record the changes in mean arterial pressure(MAP),heart rate(HR),and cardiac index(CI)at each time point(T0,T1,T2,T3,T4,T5,T6 and T7 time point);Record the incidence of hypothermia,hypotension and bradycardia and the use of vasoactive drugs.Results Compared with T0 time point,the CBT and TFOR-TIN at T1 to T7 time point decreased significantly,but the MST increased(P<0.05);In group C,the CBT at T1 to T5 decreased significantly than in group R(P<0.05);Compared with group C,MST in group R increased significantly at time T1 to T7(P<0.05).The vasoconstriction threshold in group R was significantly higher than that in group C,and the time to reach the vasoconstriction threshold was significantly less than that in group C(P<0.05).Compared with T0 time point,MAP and CI at T1,T2,T3 time point decreased significantly in two groups,MAP and CI at T1,T2,T3 time point in group R were higher than those in group C(P<0.05);Compared with group R,the incidence of perioperative hypothermia(PH)and hypotension and the utilization rate of ephedirine in group C were increased(P<0.05).Conclusion Remimazolam and propofol for gynecological laparoscopic general anesthesia can cause intraoperative temperature drop in patients,compared with propofol,remimazolam general anesthesia has less influence on CBT,more stable hemodynamics,less influence on thermoregulatory vasoconstriction,less degree of diastolic blood vessels,has better body temperature protection.

Objective To investigate the effect of remimazolam on core body temperature(CBT)and thermoregulatory vasoconstriction in patients undergoing gynecological laparoscopic surgery.Methods 90 gynaecology patients with ovarian or cervical cancer from Jan 2024 to Jun 2024 were randomly divided into experimental group(group R)and control group(group C).45 patients in each group were induced and maintained with remimazolam or propofol.After induction of anesthesia,the CBT and mean skin temperature(MST)were continuously monitored using a nasopharyngeal temperature probe and a skin temperature probe respectively.Record CBT and MST of two groups of patients before surgery(T0),30 min(T1),60 min(T2),90 min(T3),120 min(T4),150 min(T5),180 min(T6)after induction of anesthesia and at extubation(T7),as well as forearm-fingertip temperature gradient(TFOR-FIN).Record vasoconstriction threshold and time to onset of vasoconstriction by TFOR-TIN.Record the changes in mean arterial pressure(MAP),heart rate(HR),and cardiac index(CI)at each time point(T0,T1,T2,T3,T4,T5,T6 and T7 time point);Record the incidence of hypothermia,hypotension and bradycardia and the use of vasoactive drugs.Results Compared with T0 time point,the CBT and TFOR-TIN at T1 to T7 time point decreased significantly,but the MST increased(P<0.05);In group C,the CBT at T1 to T5 decreased significantly than in group R(P<0.05);Compared with group C,MST in group R increased significantly at time T1 to T7(P<0.05).The vasoconstriction threshold in group R was significantly higher than that in group C,and the time to reach the vasoconstriction threshold was significantly less than that in group C(P<0.05).Compared with T0 time point,MAP and CI at T1,T2,T3 time point decreased significantly in two groups,MAP and CI at T1,T2,T3 time point in group R were higher than those in group C(P<0.05);Compared with group R,the incidence of perioperative hypothermia(PH)and hypotension and the utilization rate of ephedirine in group C were increased(P<0.05).Conclusion Remimazolam and propofol for gynecological laparoscopic general anesthesia can cause intraoperative temperature drop in patients,compared with propofol,remimazolam general anesthesia has less influence on CBT,more stable hemodynamics,less influence on thermoregulatory vasoconstriction,less degree of diastolic blood vessels,has better body temperature protection.

Uterine arteriovenous fistula (UAVF), a relatively rare vascular anomaly, may lead to life-threatening hemorrhage and poses diagnostic and management challenges for primary hospitals during initial encounters. This article reports four cases of UAVF treated with Drospirenone and ethinyl estradiol tablets at Department of Gynaecology, Zhuji Maternal and Child Health Hospital between 2023 and 2024. Combined with literature review, we systematically analyzed the etiological mechanisms, clinical characteristics, and diagnostic-therapeutic strategies of this condition, with particular focus on evaluating the efficacy and safety of conservative pharmacological management. By summarizing case features and individualized treatment protocols, this study aims to provide clinical references for early identification, accurate diagnosis, and rational intervention of UAVF, thereby reducing risks of massive hemorrhage and long-term complications while improving patient prognosis.

Objective:To examine the influence of physical function status on supportive care needs (SCNS) in patients with primary liver cancer (PLC) and to explore the mediating roles of perceived social support and anxiety-depression, with the aim of providing evidence for nursing interventions to improve patients' care experience.Methods:A convenience sampling method was used to select PLC inpatients admitted to The First Affiliated Hospital of Jinan University between December 2022 and February 2024. Data were collected using a general information questionnaire, the 34-item Supportive Care Needs Survey-Short Form, the Hospital Anxiety and Depression Scale, the Perceived Social Support Scale, and the Karnofsky Performance Status Scale to conduct a cross-sectional survey. Pearson correlation analysis was performed to examine associations among SCNS, perceived social support, anxiety-depression, and physical function status. Structural equation modeling was used to assess the mediating effects of perceived social support and anxiety-depression on the relationship between physical function status and SCNS.Results:A total of 304 patients were enrolled, including 260 males and 44 females, 31 cases aged 18-40 years old, 160 cases aged 41 to 60 years old, and 113 cases over 60 years old. The mean total SCNS score was (98.32 ± 21.75) points, the mean anxiety-depression score was (23.31 ± 9.64) points, the mean perceived social support score was (56.62 ± 13.05) points, and the mean physical function status score was (66.28 ± 12.31) points. Pearson correlation analysis showed that physical function status was negatively correlated with SCNS and anxiety-depression ( r =-0.509, -0.447; both P<0.05) and positively correlated with perceived social support ( r =0.439, P<0.05). Physical function status had a direct effect of 60.74% on SCNS, with specific mediating effects of perceived social support and anxiety-depression accounting for 23.15% and 11.85%, respectively, and a chain mediating effect of 4.26%. Conclusions:Patients with PLC exhibited a moderately high level of supportive care needs. Physical function status not only exerted a direct negative effect on SCNS but also indirectly influenced SCNS through the chain mediation of perceived social support and anxiety-depression. Clinical medical staff should focus on enhancing patients' perception of social support and effectively alleviating anxiety and depressive symptoms, thereby reducing supportive care needs to some extent.

Objective:To explore the effectiveness of a modified puncture method in hemodialysis patients with difficult internal fistula.Methods:From January 2022 to October 2023, patients with difficult internal fistula undergoing dialysis at the Blood Purification Center of Qingdao Municipal Hospital were selected for the study using the convenience sampling method. According to the hemodialysis time, patients dialyzed on Mondays, Wednesdays, and Fridays were included in the conventional group, and patients dialyzed on Tuesdays, Thursdays, and Saturdays were included in the experimental group, with 56 cases in each group. Internal fistula puncture was performed in the conventional group using the traditional puncture method and in the experimental group using the modified puncture method. The success rate of one-time puncture of internal fistula and the injury rate of internal fistula were compared between the two groups of patients.Results:The success rate of one-time puncture of internal fistula in the experimental group was higher than that in the conventional group, with a statistical difference ( P<0.05). The injury rate of the internal fistula vessel of the experimental group was lower than that of the conventional group, and the difference was statistically significant ( P<0.05) . Conclusions:Modified puncture methods have a positive effect on increasing the success rate of a one-time puncture of the internal fistula and decreasing the rate of internal fistula injuries in patients with difficult internal fistula.

ObjectiveTo explore the effect of different drying conditions on the appearance and intrinsic quality indicators of Pinelliae Rhizoma for screening suitable drying conditions， so as to provide reference for its standardized production and quality evaluation. MethodsDifferent dried samples of Pinelliae Rhizoma were prepared by lime-assisted sweating method and intermittent drying method. Visual analysis was employed to measure the color brightness values（L^*） of the surface， cross-section and powder of the samples， texture analyzer was used to determine the hardness of the samples under different drying conditions. The total starch content was calculated by measuring the contents of amylose and amylopectin in the samples with ultraviolet-visible spectroscopy. High performance liquid chromatography（HPLC） was used to determine the contents of seven nucleoside components（uracil， hypoxanthine， uridine， inosine， guanosine， β-thymidine and adenosine） in the samples. Pearson correlation analysis was conducted to explore the correlation between the external characteristics and intrinsic indicators of the different dried samples. Principal component analysis（PCA） was used to comprehensively rank the data of various indicators， and partial least squares-discriminant analysis（PLS-DA） was used to screen differential components with variable importance in the projection（VIP） value>1. Furthermore， the difference between the optimal drying condition for Pinelliae Rhizoma and the traditional sun-drying method was explored by independent samples t-test. ResultsWith the increase of temperature， the color of the intermittently dried samples gradually deepened， while their hardness gradually decreased. Concurrently， the contents of extract， total starch， uridine and adenosine exhibited an upward trend， whereas the contents of uracil， hypoxanthine and inosine displayed a downward trajectory. Compared with the intermittent drying group， the content of extract in the samples subjected to lime-assisted sweating increased. With the increase of lime dose， the hardness and the total content of nucleoside components in the samples showed a downward trend， while the total starch content showed an upward trend. Correlation analysis showed that the comprehensive score of L^* was negatively correlated with the contents of uracil， hypoxanthine and inosine， and positively correlated with the contents of uridine， guanosine and adenosine. Hardness was negatively correlated with adenosine content， and positively correlated with the contents of inosine， uracil and hypoxanthine. Through comprehensive consideration and comprehensive score of principal components， the method of 5% lime-mixed sweating for 6 days emerged as the top-ranking approach. Except for the extract， the results of independent samples t-test showed that there was no significant difference between the 5% lime-mixed sweating for 6 days and the traditional sun-drying in terms of other content indicators. ConclusionThe whiteness and firmness of Pinelliae Rhizoma exhibit significant correlations with its chemical composition， while uridine， uracil， guanosine， adenosine and inosine are the key constituents responsible for the quality difference of Pinelliae Rhizoma under different drying conditions. The lime-assisted sweating method optimized in this study can be proposed as a viable alternative to the traditional sun-drying method. This method not only ensures the quality of the medicinal material but also effectively reduces the drying time and prevents mold contamination， which provides a valuable reference for the standardization of drying conditions and the establishment of quality evaluation criteria for Pinelliae Rhizoma.

ObjectiveTo investigate the mechanisms by which the combination of berberine （BBR） and baicalin （BAI） ameliorates type 2 diabetes mellitus （T2DM） due to internal accumulation of dampness-heat from the perspectives of gut microbiota and metabolomics. MethodsAntibiotics were used to induce pseudo-sterile mice. Thirty pseudo-sterile mice were randomized into a normal fecal microbiota transplantation group （n=10） and a T2DM （syndrome of internal accumulation of dampness-heat） fecal microbiota transplantation group （n=20）. The mice were then administrated with suspensions of fecal microbiota from healthy volunteers and a patient with T2DM due to internal accumulation of dampness-heat by gavage， respectively. Each mouse received 200 µL suspension every other day for a total of 15 times to reshape the gut microbiota. The T2DM model mice were then assigned into a model group （n=8） and a BBR-BAI group （n=11）. BBR was administrated at a dose of 200 mg·kg^-1， and BAI was administrated in a ratio of BBR-BAI 10∶1 based on preliminary research findings. The administration lasted for 8 consecutive weeks. Fasting blood glucose （FBG）， glycated hemoglobin （HbA1c）， insulin （INS）， triglycerides （TG）， total cholesterol （CHOL）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT） levels were measured to evaluate the effects of the BBR-BAI combination on glucose and lipid metabolism and liver function in T2DM mice. Hematoxylin-eosin staining was employed to observe pathological changes in the colon tissue. The expression of claudin-1， zonula occludens-1 （ZO-1）， and occludin in the colon tissue was determined by Western blot. Real-time quantitative polymerase chain reaction（Real-time PCR） was employed to assess the levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） in the colon tissue. The fecal microbiota composition and differential metabolites were analyzed by 16S rRNA sequencing and ultra-high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry （UPLC-Q-TOF-MS）， respectively. ResultsThe BBR-BAI combination lowered the FBG， HbA1c， and INS levels （P<0.05， P<0.01） and alleviated insulin resistance （P<0.01） in T2DM mice. Additionally， BBR-BAI elevated the levels of ZO-1， occludin， and claudin-1 （P<0.05， P<0.01） and down-regulated the expression levels of TNF-α， IL-1β， and IL-6 in the colon （P<0.05， P<0.01）. The results of 16S rRNA sequencing showed that BBR-BAI increased the relative abundance of Ligilactobacillus， Phascolarctobacterium， and Akkermansia （P<0.05）， while significantly decreasing the relative abundance of Alistipes， Odoribacter， and Colidextribacter （P<0.05）. UPLC-Q-TOF-MS identified 28 differential metabolites， which were primarily involved in arachidonic acid metabolism and α-linolenic acid metabolism. ConclusionBBR-BAI can ameliorate T2DM due to internal accumulation of dampness-heat by modulating the relative abundance of various bacterial genera in the gut microbiota and the expression of fecal metabolites.

Objective To identify the key factors affecting the risk of medical surges and their coupling relation5 ships,providing strategic support for medical institutions to optimize risk management and emergency governance.Methods 17 influencing factors were determined based on WSR theory,and an expert scoring method was employed to assess the impact strength among the factors.The DEMATEL method was applied to calculate the centrality,cau5 sality,influence,and being influenced degrees of the influencing factors.The ISM method was used to construct a hierarchical structure of the influencing factors related to medical surge risks,thereby revealing the connections and interaction mechanisms among these factors.Results Seven critical influencing factors were identified,including the crisis decision-making capacity and leadership effectiveness of emergency managers,the completeness of the emer5 gency system and dynamic execution capabilities,and the cross-departmental coordination mechanism and com5 mand collaboration efficiency.Deep driving factors and coupling pathways were also revealed.Conclusion The risk of medical surges exhibits multi-factorial coupling cascade effects;attention should be directed towards the construc5 tion of mid-to-deep level mechanisms such as information systems,institutional frameworks,and organizational management,to enhance targeted capabilities and systemic resilience in risk governance.

Objective To define the conceptual connotation of network dynamic collaboration capacity in medical surge response and construct its theoretical model.Methods A mixed concept analysis method was employed,integrating multidisciplinary literature and collecting empirical evidence through semi-structured expert interviews to extract the concept of network dynamic collaboration capacity in medical surge response.By integrating complex systems,network science,synergetics,and dynamic capability theory,and combining the interview results,the study used the analogy of flood control in hydraulic engineering to develop a"network-dynamic-collaboration"triangular capacity theoretical model.Results It reveals one antecedents(sudden external shocks have led to an abnormal and continuous surge in medical demand),six core attributes(information interconnection accessibility,dynamic resource adaptability,risk perception responsiveness,multi-party collaborative interactivity,service process adaptability elasticity,and learning iterative evolution),and four consequences(mitigation of crowding risk,protection of service continuity,minimization of crisis spillover,and enhancement of system resilience)for the network dynamic collaboration capacity in medical surge response.The theoretical model elucidates the coupling mechanisms among network structural resilience,dynamic regulation processes,and collaborative co-evolution in resisting medical surge.Conclusion The new concept and theoretical model proposed in this study deepen the understanding of medical surge response system mechanisms and offer a theoretical framework and practical guidance for strengthening the full-chain resilience of health emergency systems.

Objective To empirically analyze multiple pathways for enhancing medical surge response capacity and provide useful references for improving the resilience of health systems.Methods A comprehensive theoretical analysis framework for improving medical surge response capacity was constructed based on the 4S theory and collaborative governance theory.68 interview texts on medical surge response capacity conducted in July 2024 were selected as analysis samples.Using fuzzy-set Qualitative Comparative Analysis(fsQCA),7 conditional variables were selected from four dimensions:management system,information system,materials,and personnel to analyze their impact on medical surge response capacity.Results(1)A single conditional variable does not constitute a necessary condition for improving medical surge response capacity;(2)After the combination of conditions,8 specific configuration paths for capacity improvement were identified.Through systematic and comprehensive refinement,they were summarized into three modes of comprehensive configuration capacity improvement paths,namely:rapid response and collaborative operation mode,information empowerment and precise response mode,and resource conditions and resilience construction mode.Conclusion It is necessary to explore and construct systematic,combined,modularized and path-oriented capacity building strategies,refine the operational implementation paths for improving China's medical surge response capacity,target the linkage and configuration modes of different conditional variables,promote the formulation and implementation of modular construction schemes oriented by key capacity,and make efforts from multiple aspects to enhance the resilience of the health system.