Objective:To explore the feasibility, practicality, and safety of the day surgery management model for the treatment of patent ductus arteriosus with Da Vinci robotic surgery in children.Methods:A non-randomized controlled study was conducted.The clinical data of children with patent ductus arteriosus who underwent Da Vinci robotic surgery at Children′s Hospital, Zhejiang University School of Medicine from August 2020 to December 2023 were collected and retrospectively analyzed.The patients were divided into day surgery group and non-day surgery group according to whether they had discharged within 24 hours. t-test and Chi-square tests were used to compare the differences in clinical features, perioperative complications and prognosis between the two groups of patients.In addition, the satisfaction of the treatment effect was surveyed. Results:A total of 276 children were included in this study, with an age ranging from 6 to 154 months with a median of 34 months.The weight ranged from 6.2 to 63.2 kilograms, with a median of 13.5 kilograms.The operation time ranged from 23 to 90 minutes, with a median of 45 minutes.One hundred and thirty-five patients underwent day surgery and 141 patients underwent non-day surgery.The average age and average weight of the patients in the day surgery and non-day surgery groups was (43.7±30.8) months vs.(42.4±30.2) months and (15.0±6.4) kg vs.(14.8±6.9) kg, respectively.There was no statistically significant difference in age and weight between the two groups (all P>0.05).There was no difference in perioperative data and incidence of perioperative complications between the two groups (all P>0.05).However, the length of hospital stay of the day surgery group was significantly shorter than that of the non-day surgery group[(1.0±0) days vs.(2.5±0.9) days, t=-20.993, P<0.001], and the hospitalization cost of the day surgery group was also significantly lower than that of the non-day surgery group[(50 800±1 100) yuan vs.(53 500±3 900) yuan, t=-10.040, P<0.001].Both families of the two groups were satisfied with the treatment results, and there was no difference in satisfaction between the two groups ( χ2=0.501, P=0.479). Conclusions:The day surgery management model of Da Vinci robotic surgery for the treatment of pediatric patent ductus arteriosus is safe and feasible.To a certain extent, it can reduce the length of hospital stay, treatment costs, and treatment burden.

Objective:To explore the feasibility, practicality, and safety of the day surgery management model for the treatment of patent ductus arteriosus with Da Vinci robotic surgery in children.Methods:A non-randomized controlled study was conducted.The clinical data of children with patent ductus arteriosus who underwent Da Vinci robotic surgery at Children′s Hospital, Zhejiang University School of Medicine from August 2020 to December 2023 were collected and retrospectively analyzed.The patients were divided into day surgery group and non-day surgery group according to whether they had discharged within 24 hours. t-test and Chi-square tests were used to compare the differences in clinical features, perioperative complications and prognosis between the two groups of patients.In addition, the satisfaction of the treatment effect was surveyed. Results:A total of 276 children were included in this study, with an age ranging from 6 to 154 months with a median of 34 months.The weight ranged from 6.2 to 63.2 kilograms, with a median of 13.5 kilograms.The operation time ranged from 23 to 90 minutes, with a median of 45 minutes.One hundred and thirty-five patients underwent day surgery and 141 patients underwent non-day surgery.The average age and average weight of the patients in the day surgery and non-day surgery groups was (43.7±30.8) months vs.(42.4±30.2) months and (15.0±6.4) kg vs.(14.8±6.9) kg, respectively.There was no statistically significant difference in age and weight between the two groups (all P>0.05).There was no difference in perioperative data and incidence of perioperative complications between the two groups (all P>0.05).However, the length of hospital stay of the day surgery group was significantly shorter than that of the non-day surgery group[(1.0±0) days vs.(2.5±0.9) days, t=-20.993, P<0.001], and the hospitalization cost of the day surgery group was also significantly lower than that of the non-day surgery group[(50 800±1 100) yuan vs.(53 500±3 900) yuan, t=-10.040, P<0.001].Both families of the two groups were satisfied with the treatment results, and there was no difference in satisfaction between the two groups ( χ2=0.501, P=0.479). Conclusions:The day surgery management model of Da Vinci robotic surgery for the treatment of pediatric patent ductus arteriosus is safe and feasible.To a certain extent, it can reduce the length of hospital stay, treatment costs, and treatment burden.

Objective To explore the effect of Enhanced Recovery After Surgery(ERAS)on postoperative rehabilitation of patients with acute Achilles tendon rupture caused by military training.Methods Forty patients with acute closed Achilles tendon rupture caused by military training who received rehabilitation training after surgery at Qingdao Special Service Sanatorium Center of PLA Navy from February 2021 to November 2021 were enrolled in this study.They were randomly divided into two groups using a random number table method,with 20 patients in each group.Traditional rehabilitation and ERAS were given for the control group and observation group,respectively.Therapeutic effect and complications at 3 months after surgery,Achilles tendon complete rupture score(ATRS)and Achilles tendon repair(Leppilahti)score at 6 and 12 months after surgery,and the recovery of muscle strength at the last follow-up were compared between the two groups.Results The observation group had higher effective rate of postoperative rehabilitation and lower incidence of complications than the control group at 3 months after surgery(P<0.05).The ATRS and Leppilahti score in the observation group were higher than those in the control group at 6 and 12 months after surgery,and the ATRS and Leppilahti score in the two groups at 12 months after surgery were significantly higher than those at 6 months after surgery(P<0.05).The excellent and good rate of muscle strength recovery in the observation group was higher than that in the control group(95.0%vs.65.0%,P<0.05).Conclusion ERAS has a significant effect on postoperative rehabilitation of patients with acute Achilles tendon rupture caused by military training.It can effectively improve therapeutic effect,promote postoperative muscle strength recovery,and reduce the incidence of ankle complications.

[摘 要] 目的：重新评价卡瑞利珠单抗联合阿帕替尼治疗原发性肝癌（PHC）的有效性和安全性。方法：回顾性收集2019年1月至2021年5月在安徽医科大学附属第一医院确诊的PHC患者的临床资料。所有患者均接受卡瑞利珠单抗200 mg q3w联合阿帕替尼250 mg qd×21 d治疗。应用卡方检验进行基线特征比较，采用Kaplan-Meier法进行生存分析，从中估计中位总生存期（OS），然后采用Log-Rank检验进行比较；采用单因素Cox回归分析预测影响OS的因素。结果：本研究共纳入43例PHC患者，一线治疗患者的客观缓解率（ORR）为23.3%（7/30），二线及以上治疗患者的ORR为15.4%（2/13）。两组患者的疾病控制率（DCR）分别为83.3%（25/30）和61.5%（8/13），中位无进展生存期（PFS）分别为5.0个月（95% CI 3.2，6.8）和4.0个月（95% CI 1.7，6.3）（P=0.514），中位OS分别为13.0个月（95% CI 11.2，14.8）和9.0个月（95% CI 2.8，15.2）（P=0.179）。在43例患者中，33例（76.7%）存在3级或以上的治疗相关不良反应（AE）；最常见的AE为血小板计数下降（14.0%）、高血压（9.3%）和蛋白尿（9.3%）。Cox单因素回归分析显示，Child-Pugh分级是影响PHC患者预后的独立危险因素[HR=0.324，95% CI （0.146，0.716），P<0.05]。结论：卡瑞利珠单抗联合阿帕替尼可显著改善PHC患者的OS、ORR和DCR，AE可控。

Objective To explore the systematic nursing intervention for patients with artificial anal bowel habit of effect.Methods Our hospital from May 2020 to select-treated 100 cases of artificial anal in May,2022 patients as the research object,the patients were randomly divided into control group and research group of consent of all the 50 cases,control group adopted routine nursing care,the team take systematic nursing intervention,compare the effect of two groups of patients with bowel movements.Results The team bowel habit each index compared with control group,difference has statistical significance(P<0.05).Conclusion Systematic nursing intervention to actively promote the use of clinical nursing work in the future.

In the original publication the PDB numbers were not cited.

Objective To investigate the clinical value of CT spectral imaging parameters in evaluating the liver function in patients with different types of Budd-Chiari syndrome (BCS),by comparing the normalized iodine concentration (NIC) and the slope of spectral curve in liver segment Ⅰ-Ⅷ,portal vein (PV),hepatic vein (HV),inferior vena cava (IVC) and spleen.Methods Eighty-one patients with BCS underwent spectral CT angiography.NIC,spectral decay curve and the slope of spectral curve of liver segment Ⅰ-Ⅷ in portal venous phase,PV,HV,IVC and spleen were measured and calculated.Clinical indicators of liver function including prothrombin time (PT),albumin (ALB),total bilirubin (TBIL),aspartate transaminase (AST),alanine transaminase (ALT) were recorded.Quantitative data were analyzed using One-way ANOVA.Pearson correlation analysis was used to evaluate the correlation of liver NIC and clinical liver function indexes.Results PT and TBIL were negatively correlated with liver NIC and there was a positive correlation between ALB and liver NIC (P＜0.05).The differences of NIC among the three types of BCS in liver segment Ⅱ-Ⅵ,HV,IVC and spleen were statistically significant (P＜0.05) and the difference of slopes of the spectral curves among three types of BCS in liver segment Ⅱ-V and spleen was statistically significant (P＜0.05).Conclusion Combined use of spectral CT multi-site and multi-parameter imaging may be useful in the evaluation of liver function in patients with BCS.

Objective: To assess the feasibility and efficacy of a staged invasive treatment strategy for the treatment of pulmonary atresia with intact ventricular septum, in the first stage using a catheter-based stent placement, second-stage surgery, and three-stage atrial septal occlusion. Methods: Totally 19 children with pulmonary atresia with intact ventricular septum were enrolled at Department of Cardiovascular Surgery, the Children′s Hospital of Zhejiang University School of Medicine from January 2009 to December 2017, including 11 male and 8 female patients. The age was (13.8±7.7) days (ranging from 3 to 35 days). The weight was (3.4±0.5) kg (ranging from 2.8 to 4.1 kg). Among them, there were 13 cases of type Ⅱ and 6 cases of type Ⅲ. Regular follow-up visits for patients with stage Ⅰ arterial duct stenting after 1, 3, and 6 months; and routine follow-ups for 1, 3, and 6 months after stage Ⅱ surgery.The t test was used to compare the oxygen saturation between pre-operation and post-operation. Results: All 19 patients underwent arterial catheterization. The preoperative peripheral oxygen saturation was (64.4±5.3)%, while increased to (86.0±3.0)% after operation (t=16.353, P=0.000). One patient died during follow-up and 2 patients lost follow-up. One patient received stent balloon dilatation due to oxygen saturation decrease.Twelve patients completed the second-stage surgery and 1 case died after surgery. The rest were alive, including 2 cases of double-ventricular correction and 9 cases of semi-ventricular treatment in one room; 2 cases had completed three-stage atrial septal occlusion. Conclusions Stage Ⅰ arterial duct stent, stage Ⅱ surgery, and stage Ⅲ atrial septal occlusion to treat pulmonary atresia with intact ventricular septum in children is feasible and effective. The method can be used as the important treatment direction for pulmonary atresia with intact ventricular septum.

Mechanosensitive (MS) channels are extensively studied membrane protein for maintaining intracellular homeostasis through translocating solutes and ions across the membrane, but its mechanisms of channel gating and ion selectivity are largely unknown. Here, we identified the YnaI channel as the Na/K cation-selective MS channel and solved its structure at 3.8 Å by cryo-EM single-particle method. YnaI exhibits low conductance among the family of MS channels in E. coli, and shares a similar overall heptamer structure fold with previously studied MscS channels. By combining structural based mutagenesis, quantum mechanical and electrophysiological characterizations, we revealed that ion selective filter formed by seven hydrophobic methionine (YnaI) in the transmembrane pore determined ion selectivity, and both ion selectivity and gating of YnaI channel were affected by accompanying anions in solution. Further quantum simulation and functional validation support that the distinct binding energies with various anions to YnaI facilitate Na/K pass through, which was defined as binding-block mechanism. Our structural and functional studies provided a new perspective for understanding the mechanism of how MS channels select ions driven by mechanical force.
Cryoelectron Microscopy ; Escherichia coli Proteins ; chemistry ; isolation & purification ; metabolism ; ultrastructure ; Ion Channels ; chemistry ; isolation & purification ; metabolism ; ultrastructure ; Mechanotransduction, Cellular ; Models, Molecular ; Quantum Theory

Objective To identify the changes in composition of gut microbiome in patients with different clinical phases of bipolar disorder(BD). Method A total of 28 healthy controls and 31 BD patients including 19 patients with manic episode(BDM group)and 12 patients with depressive episode (BDD group), were enrolled in this study. Baseline characteristics and diet were collected from all participants. Stool samples were collected to extract genomic DNA for PCR and bioinformatics analysis. 16S rRNA sequencing technology was used to obtain gut microbiome diversity among groups subsequently. QIIME was used to calculate observed species index,shannon index,simpson index,psylogenetic diversity index for each group.Linear discriminant analysis(LDA)using LEfSe software was screening for differences species among four groups. Results There was no significant difference between baseline characteristics and diet among four groups. Comparison of gut microbiome alpha diversity among groups, the gut microbiome diversity of BD group were all significantly higher than that in healthy control group,including observed species index(312.0±71.0 vs.229.3±38.6,t=5.475,P<0.01),shannon index(4.9±0.8 vs.3.7±0.9,t=5.747,P<0.01),simpson index(0.9±0.1 vs.0.8±0.1,t=4.446,P<0.01),psylogenetic diversity index(23.7±4.6 vs. 20.2±5.2,t=2.715,P<0.01),especially in BDM group.In composition of gut microbiome(LDA>4,P<0.05)the relative abundance of proteobacteria, ruminococcus, veillonella and lanchnospira in BD group were significantly higher than that in controls, but the relative abundance of bacteroides was significantly lower than that in controls. The relative abundance of enterobacteriaceae, ruminococcus, megamonas and bifidobacterium adolescentis in BDM groups were significantly higher than that in controls,while the relative abundance of bacteroides was significantly lower.The relative abundance of selenomonadales,lachnospira, eubacrerium and plebeius in BDD group were significantly higher than that in controls, while the relative abundance of plebeius was significantly lower. The relative abundance of eschericha coli and bifidobacterium adolescentis of BDM group were significantly higher than that in BDD group, while the relative abundance of stercoris in BDD group was significantly higher than that in BDM group. Conclusion The gut microbiome diversity of patients with BD may be increased and the abundance of several bacterial species changed.