Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P＜0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P＜0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P＜0.05).The incidence of nausea in group S was significantly lower than that in group C(P＜0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

Literature related to children's adenoid hypertrophy was retrieved to form an expert questionnaire.According to the group standard writing rules of the China Association of Chinese Medicine,the peer consultation,quality evaluation and suitability eval-uation were completed through three rounds of Delphi expert questionnaire surveys and expert discussion meetings,and the Clinical Practice Guidelines for TCM in Children with Adenoidal Hypertrophy was finally formed.The guidelines have been formulated to clarify the scope of application of the guidelines,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,prevention and care,and to provide an important reference for the clinical practice and diagnosis and treatment norms of tra-ditional Chinese medicine for children with adenoid hypertrophy.

Objective To analyze the prognostic value of serum microRNA(miRNA)-21-5p and miRNA-5189-5p expression levels in elderly patients with prostate cancer after laparoscopic radical prostatectomy(LRP).Methods A total of 213 elderly prostate cancer patients treated with LRP from January 2014 to Sep-tember 2018 in the First Affiliated Hospital of Hainan Medical College were retrospectively selected as the study objects.According to the 5-year follow-up outcome,the patients were divided into good prognosis group(87 cases)and poor prognosis group(126 cases).The preoperative clinical baseline data and the expression levels of serum miRNA-21-5p and miRNA-5189-5p were collected.Logistic regression analysis was used to screen the factors affecting the prognosis of patients.The prognostic prediction model was constructed with independent risk factors,and the predictive value was analyzed by drawing receiver operating characteristic(ROC)curve.Results Multivariate Logistic regression analysis showed that serum prostate specific antigen(PSA)level,positive incisal margin,and expression levels of miRNA-21-5p and miRNA-5189-5p were inde-pendent risk factors for the prognosis of elderly prostate cancer patients receiving LRP(P＜0.05).The com-bined prediction model was established based on independent risk factors,and the area under the curve of each factor alone predicting prognosis of elderly prostate cancer patients receiving LRP was less than that of four combined prediction(P＜0.05).Conclusion The expression levels of serum miRNA-21-5p and miRNA-5189-5p are of high value in predicting the prognosis of elderly prostate cancer patients after LRP.

Objective:To analyze the risk factors for complications of the retromandibular approach in patients with parotid gland posterior and lower pole tumors.Methods:A retrospective analysis was conducted on the clinical data of 140 patients with parotid posterior lower pole tumors admitted to the Xingtai Third Hospital from October 2019 to October 2021. They were divided into two groups based on whether complications occurred: the occurrence group and the non occurrence group. General data of the two groups of patients were collected, including age, gender, course of disease, previous surgical history, number of tumors, tumor length, resection range, facial nerve dissociation, tumor site resection frequency, and fascia preservation; Single factor and logistic multivariate analysis were conducted to determine the risk factors for complications of the posterior retromandibular approach in patients with parotid gland posterior and lower pole tumors.Results:A total of 140 patients with parotid gland posterior lower pole tumors underwent retromandibular approach treatment, with complications occurring in 38 cases (27.14%), including 7 cases of temporary facial paralysis, 10 cases of facial depression, 11 cases of Frey syndrome, 2 cases of fistula, and 8 cases of sensory abnormalities of the greater auricular nerve. Through logistic multivariate analysis, it was found that the number of tumors ≥ 2 ( OR=2.856), the resection range (total resection) ( OR=2.477), the number of surgeries ≥3 ( OR=5.637), facial nerve dissociation ( OR=3.526), and lack of fascia preservation ( OR=2.551) were all risk factors for postoperative complications in patients with parotid posterior pole tumors (all P<0.05). Conclusions:In clinical practice, relevant prevention and treatment measures should be formulated for these high-risk factors to reduce the incidence of postoperative complications.

The paper objectively analyzes the opportunities and challenges of Internet + medical,and puts forward relevant strategies and recommendations for deeply integratingInternet +into the traditional medical industry in several aspects,including strengthening the construction of Internet infrastructure in the medical industry,regulating the market access and improving the industry standards,as well as establishing and improving relevant supporting laws,regulations and policies.

Patients with chronic thromboembolic pulmonary arterial hypertension,aged＞ 18 yr,scheduled for primary pulmonary thromboendarterectomy from May 2014 to October 2016 in our hospital,were selected.The site and degree of thrombus obstruction,pulmonary hypertension and degree of right heart insufficiency were assessed on 1 day before surgery.Anesthesia was induced with midazolam,etomidate,rocuronium or cisatracurium,and the Swan-Ganz catheter was placed.Anesthesia was maintained with Ⅳ propofol,dexmedetomidine,cisatracurium or rocuronium,and intermittent Ⅳ large boluses of sufentanil.Deep hypothermia circulatory arrest was used for cardiopulmonary bypass.The bispectral index value was maintained between 40 and 60 during surgery.The systemic blood pressure was maintained above 90/60 mmHg during the non-cardiopulmonary bypass period,and pulmonary arterial pressure was maintained not higher than the preoperative baseline level.The vasoactive drugs such as lyophilized recombinant human brain natriuretic peptide,norepinephrine and dopamine were intravenously injected after cardiopulmonary bypass.A total of 53 patients were included in the study and completed surgery successfully,vital signs were stable during surgery,and the patients returned to the recovery room safely.The mean pulmonary arterial pressure was reduced from the preoperative (38±13) mmHg to (26±12) mmHg at the end of the operation,the incidence of reperfusion pulmonary edema after surgery was 8％,incidence of pulmonary hypertensive crisis was 4％,and no patients died in the perioperative period.There were two improvements in the method of anesthetic management of pulmonary thromboendarterectomy in the perioperative period:(1) Lyophilized recombinant human brain natriuretic peptide in combination with norepinephrine was used;(2) The aortic pressure was guaranteed to ensure oxygen supply for the heart and body.This method can maintain the intraoperative circulation stable and reduce postoperative complications and is a suitable anesthetic management method for pulmonary thromboendarterectomy.

It is one of the important tasks to promote the development of traditional Chinese medicine culture crea-tive industry in constructing the culture-rich Shandong Province. The major factors that influence the development of traditional Chinese medicine culture creative industry in Shandong Province and the ranks of their importance were thus analyzed by questionnaire survey and hierarchy analysis, respectively. Certain suggestions were put for-ward for the development of traditional Chinese medicine culture creative industry in Shandong Province.

Hierarchical diagnosis and treatment system has become one of the strategies for overcoming the diffi-culties in medical reform in our country. The important role of health information and its application in hierarchical diagnosis and treatment were thus elaborated in this paper in order to provide reference for the health information construction in establishing hierarchical diagnosis and treatment system at different levels in our country.

The distribution of authors, institutions that published papers, and key words in CNKI-covered papers on library information service model was analyzed, which showed that there are a number of high production authors in China engaged in studies on library information service model but the number of cooperative studies is few, aca-demic libraries are active in performing related studies but public libraries seldom participate in such studies, the related studies are focused on the application of information technologies and the personal demands of users.

The key words, social network and author cooperation network in papers ( published in 2003-2014 ) on reform in domestic public hospitals were analyzed using Ucinet and CiteSpace visual softwares with CNKI as the data source.The current situation in reform in domestic public hospitals was revealed by mining its research hotspots, progress and author cooperation .Some suggestions were put forward for strengthening the reform in domestic public hospitals .