A 42-year-old male patient developed mild allergic symptoms after the use of cisatracurium besylate in laparoscopic left renal tumor resection,which was relieved by symptomatic treatment.When the drug was added again intraoperatively,the patient's blood pressure decreased sharply from 120/71 mmHg to 50/30 mmHg,and the airway resistance increased from 16 cmH2O to 38 cmH2O,and the patient developed typical signs of anaphylactic shock.After immediate intravenous injection of epinephrine,calcium chloride and other drugs,the patient's blood pressure rose to 95/57 mmHg,airway resistance decreased to 20 cmH2O,and vital signs tended to be stable.The Naranjo's Assessment Scale was used to evaluate and analyze the correlation of suspected drugs.The score was 9 points,indicating that the association between anaphylactic shock and cisatracurium besylate in this patient was judged to be"definitely related".This article suggests that cisatracurium besylate carries an allergic risk and should be used with caution,and the monitoring of vital signs and allergic reactions should be strengthened for early identification and timely treatment to ensure the safety of patients during the perioperative period.

A 42-year-old male patient developed mild allergic symptoms after the use of cisatracurium besylate in laparoscopic left renal tumor resection,which was relieved by symptomatic treatment.When the drug was added again intraoperatively,the patient's blood pressure decreased sharply from 120/71 mmHg to 50/30 mmHg,and the airway resistance increased from 16 cmH2O to 38 cmH2O,and the patient developed typical signs of anaphylactic shock.After immediate intravenous injection of epinephrine,calcium chloride and other drugs,the patient's blood pressure rose to 95/57 mmHg,airway resistance decreased to 20 cmH2O,and vital signs tended to be stable.The Naranjo's Assessment Scale was used to evaluate and analyze the correlation of suspected drugs.The score was 9 points,indicating that the association between anaphylactic shock and cisatracurium besylate in this patient was judged to be"definitely related".This article suggests that cisatracurium besylate carries an allergic risk and should be used with caution,and the monitoring of vital signs and allergic reactions should be strengthened for early identification and timely treatment to ensure the safety of patients during the perioperative period.

Appropriate positive end-expiratory pressure(PEEP)level is an important component of protective lung ventilation strategy.PEEP can maintain the openness of alveoli and reduce lung collapse in-jury.Although individualized PEEP application has been increasingly recognized by clinical physicians,the optimal PEEP titration method is still controversial.Electrical impedance tomography(EIT)is a non-inva-sive and radiation-free imaging technique that can be used to dynamically assess lung function at the bedside.EIT presents changes in impedance during ventilation as dynamic images,which can reflect altera-tions in ventilation and gas distribution before and after PEEP adjustments.Therefore,EIT can be utilized to tailor individualized PEEP.This article provides a brief overview of the basic principles and monitoring pa-rameters of EIT.It elucidates the PEEP titration method under the guidance of EIT in clinical applications(PEEPEIT),aiming at enhancing the understanding of the advantages and limitations of EIT and providing reference for the setting of individualized PEEP.

Objective:To explore the mediating chain effect between attachment and coping style of disease perception and hope in patients with advanced lung cancer, and to provide theoretical basis for improving coping style in patients with advanced lung cancer.Methods:From October 2021 to June 2022, 354 patients with advanced lung cancer in the First and Second Affiliated Hospitals of Anhui Medical University were selected by convenience sampling. The general information questionnaire, the Experiences in Close Relationships Inventory, the Brief Illness Perception Questionnaire, the Herth Hope Index, and the Medical Coping Modes Questionnaire were used to conduct cross-sectional questionnaire survey. SPSS 25.0 software and Bootstrap method were used to construct and verify the chain mediation model.Results:Finally, 336 patients with advanced lung cancer were included, including 214 males and 122 females, aged 27-79(59.43 ± 8.61) years old. Attachment avoidance score was (3.31 ± 1.01) points, attachment anxiety score was (3.86 ± 1.17) points, illness perception score was (40.07 ± 12.01) points, hope score was (34.05 ± 5.87) points, and face coping score was (18.75 ± 5.34) points in patients with advanced lung cancer. The avoidance coping score was (15.47 ± 1.97) points, and the yielding coping score was (9.62 ± 3.85) points. In patients with advanced lung cancer, attachment avoidance and attachment anxiety were positively correlated with yield coping ( r=0.448, 0.747, both P<0.01), positively correlated with illness perception ( r=0.356, 0.627, both P<0.01), and negatively correlated with hope ( r=-0.406, -0.670, both P<0.01). Illness perception was positively correlated with yield coping ( r=0.744, P<0.01), and negatively correlated with hope ( r=-0.628, P<0.01). Hope was negatively correlated with yield response ( r=-0.769, P<0.01). The mediation model showed that the chain mediating effect of attachment avoidance, illness perception, hope and yield coping was significant in patients with advanced lung cancer, with an effect value of 0.009 and an effect size of 13.95%. The chain mediating effect of attachment anxiety, illness perception, hope and yield coping were significant, with an effect value of 0.010 and an effect size of 8.27%. Conclusions:Attachment can not only directly predict submission coping in advanced lung cancer patients, but also indirectly predict submission coping through the chain mediation of illness perception and hope.

Objective:To translate the Dysfunctional Beliefs and Attitudes about Sleep Scale for Cancer Patients (C-DBAS-14) into Chinese and test its reliability and validity.Methods:The Korean version of C-DBAS-14 was translated, back-translated, and culturally adapted into Chinese based on Brislin's translation model, forming the Chinese version of C-DBAS-14. From October 2022 to May 2023, 361 hospitalized cancer patients at the First Affiliated Hospital of Anhui Medical University were selected as research objects by convenient sampling method. They were surveyed using a general information questionnaire, the Chinese version of C-DBAS-14, the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS) to evaluate the reliability and validity of the scale. The scale's item analysis was based on correlation coefficients and critical ratio values; structural validity, content validity, and convergent validity were used to evaluate the scale's validity; Cronbach's α coefficient and intraclass correlation coefficient were used to assess its reliability.Results:A total of 361 questionnaires were distributed, 356 were effectively returned, with an effective response rate of 98.6% (356/361). The Chinese version of C-DBAS-14 contained 14 items across four dimensions. The scale-level content validity index was 0.976, and the item-level content validity index ranged from 0.833 to 1.000. Totally four common factors were extracted in exploratory factor analysis, explaining 78.8% of the total variance. Confirmatory factor analysis showed a Chi-square/degrees of freedom ratio of 1.286, comparative fit index of 0.991, goodness of fit index of 0.945, incremental fit index of 0.991, Tucker-Lewis index of 0.988, and root mean square error of approximation of 0.036. The total Cronbach's α coefficient of the scale was 0.874, and the intraclass correlation coefficient was 0.863. The C-DBAS-14 score was negatively correlated with the ISI and HADS scores ( r=-0.734, -0.639; P<0.01) . Conclusions:The Chinese version of C-DBAS-14 has good reliability and validity and can be used as an assessment tool for irrational sleep beliefs in Chinese cancer patients.

Few studies have focused on the cost of acupuncture treatments although acupuncture has become popular in the United States (U.S.). The purpose of the current study was to examine the out-of-pocket costs incurred from acupuncture services based on an online website, OkCopay.com. We examined descriptive statistics (range, median and 20% intervals) for the cost of acupuncture "first-time visits" and "follow-up visits" in 41 metropolitan regions in the U.S. The acupuncture prices of 723 clinics throughout 39 metropolitan regions were included, except for Birmingham, Alabama and Detroit, Michigan as there was no online data available at the time of the study for these two regions. The cost range for a first-time acupuncture visit was $15-400; the highest median was $150 in Charleston, South Carolina, while the lowest was $45 in St. Louis, Missouri. The top 10 cities for the highest median were: Baltimore, Washington, D.C., New York, San Francisco, San Jose, Boston, Atlanta, Seattle, Portland and Indianapolis, with the median $120, while the median for all 723 clinics was $112. For the follow-up visits, the cost range was $15-300; the highest median was $108 in Charleston, South Carolina, and the lowest $40 in Miami, Florida. The 10 cities with highest median follow-up acupuncture visit costs were: New York, Baltimore, New Orleans, Washington, D.C., Philadelphia, San Francisco, San Jose, Seattle, Boston and Atlanta, with the median $85, while for all 723 clinics the median price was $80. The estimation of the average gross annual income of each acupuncturist from the regions studied was $95,760, while the total annual cost of patients seeking acupuncture services in the U.S. was about $3.5 billion in 2018.

Chronic low-back pain (CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association (ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity; therefore, it should be effective for CLBP in older adults.

Objective To investigate the neurodevelopmental toxicity of ACR by studying the expression of DCX and GAP-43 in the hippocampal dentate gyrus of rats after maternal exposure to acrylamide. Methods Pregnant rats were randomly divided into low-dose ACR(4.5 mg/kg),medium-dose(9 mg/kg),high dose groups(18 mg/kg)and the control group(0 mg/kg),8 in each group,and were exposed to toxicant from gestation-al day 15 to postnatal day 13. All rats and their pups were killed on postnatal day 14. ABC immunohistochemistry was used to detect the expression of GFAP in the hippocampus of mother rats and offspring. Results Compared with the control group,the expression of DCX and GAP-43 in hippocampus dentate gyrus of the pregnant rats in middle and high dose groups was significantly decreased(P < 0.05). Conclusion ACR may interfere with the growth and development of neurons by reducing the expression of DCX and GAP-43.