Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective:To understand the gene carrying rate of neonatal genetic deafness in Dalian area, and to analyze the pedigree of 6 newborns with positive deafness gene test, to provide a reference basis for preventing genetic deafness.Methods:A total of 1 536 newborns born in Dalian Women′s and Children′s Medical Center (Group) from January to October in 2022 were retrospectively enrolled to detect the 4 genes of hereditary deafness, including GJB2, GJB3, SLC26A4 (PDS) and MT-RNRI (12SrRNA). Among them, 6 newborns with hereditary deafness were tested for NGS Panel gene.Results:A total of 85 deafness gene mutations were detected in 1 536 newborns, with the total carrying rate of 5.53% (85/1 536). Thirty-two cases of GJB2 mutations with carrying rate of 2.08% (32/1 536); 4 cases of GJB3 mutation of 0.26% (4/1 536); 32 cases of SLC26A4 (PDS) gene mutations of 2.08% (32/1 536); 14 cases of MT-RNRI (12SrRNA) mutations with carrying rate of 0.91% (14/1 536); 2 cases had compound heterozygous mutations of GJB2/GJB3, with a carrier rate of 0.13% (2/1 536); 1 cases had compound heterozygous mutations of GJB2/SLC26A4 (PDS), with a carrier rate of 0.07% (1/1 536); 1 case of compound heterozygous mutation in three-gene and a heterozygous mutation in KCNQ4 were detected in NGS Panel testing for hereditary deafness.Conclusions:Homozygous mutation and compound heterozygous mutation are the main factors of autosomal recessive gene deafness, and the NGS Panel gene detection is of great significance for gene traceability and the detection of rare deafness gene.

Objective:To explore the related factors of chromosome abnormality in abortion tissue of patients after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) and to establish a predictive model of chromosome abnormality, so as to provide more clinical treatment basis. Methods:This was a retrospective case-control study. The abortion tissues of 113 cases of IVF/ICSI assisted pregnancy (106 cases of IVF and 7 cases of ICSI) were collected from the Reproduction and Genetics Laboratory of Dalian Women and Children Medical Center (Group) from June 2022 to August 2023. The samples were detected by copy number variation sequencing (CNV-seq). According to the maternal age, the samples were divided into young pregnant women (<35 years old, n=45) group and elderly pregnant women (≥35 years old, n=68) group. The correlations between different maternal age, male age, duration of infertility, times of previous abortion, number of embryos transferred, gestational age and chromosome abnormalities were analyzed. Results:1) A total of 72 cases [63.72% (72/113)] of abnormal chromosomes were detected in the abortion tissues of patients with IVF/ICSI-assisted pregnancy, of which 61 cases [84.72% (61/72)] were numerically abnormal, most of them were trisomy (53 cases), structural abnormalities were found in 8 cases [11.11% (8/72)], and other complex abnormalities were found in 3 cases [4.17% (3/72)]. 2) The chromosome abnormality rate of abortion tissue in the young pregnant women [51.11% (23/45)] was lower than that in the elderly pregnant women [72.06% (49/68)], and the difference was statistically significant ( P=0.023). 3) In the abortion tissue of elderly pregnant women, univariate analysis showed that the age of the man and times of previous abortion were related to the occurrence of chromosome abnormalities ( P=0.004, P=0.008). 4) Multivariate logistic regression analysis showed that the age of the man and times of previous abortion were the independent risk factors for chromosomal abnormalities in elderly pregnant women ( OR=1.248, 95% CI: 1.064-1.464, P=0.006; OR=0.493, 95% CI: 0.287-0.848, P=0.011), the regression equation was logit (P)=0.222×male age-0.707×times of previous abortion-6.042, area under curve was 0.789, 95% CI: 0.673-0.905, and the maximum value of Jordan index was 0.489. Conclusion:The age of pregnant women was correlated with the occurrence of chromosomal abnormalities in abortion tissues. At the same time, in pregnant women aged 35 years or above, under the condition of fixed abortion rates caused by female factors, an increase in male age and a decrease in previous abortions will lead to an increase in the incidence of chromosomal abnormalities. The model is of good value in predicting chromosome abnormalities.

Objective:To explore the related factors of chromosome abnormality in abortion tissue of patients after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) and to establish a predictive model of chromosome abnormality, so as to provide more clinical treatment basis. Methods:This was a retrospective case-control study. The abortion tissues of 113 cases of IVF/ICSI assisted pregnancy (106 cases of IVF and 7 cases of ICSI) were collected from the Reproduction and Genetics Laboratory of Dalian Women and Children Medical Center (Group) from June 2022 to August 2023. The samples were detected by copy number variation sequencing (CNV-seq). According to the maternal age, the samples were divided into young pregnant women (<35 years old, n=45) group and elderly pregnant women (≥35 years old, n=68) group. The correlations between different maternal age, male age, duration of infertility, times of previous abortion, number of embryos transferred, gestational age and chromosome abnormalities were analyzed. Results:1) A total of 72 cases [63.72% (72/113)] of abnormal chromosomes were detected in the abortion tissues of patients with IVF/ICSI-assisted pregnancy, of which 61 cases [84.72% (61/72)] were numerically abnormal, most of them were trisomy (53 cases), structural abnormalities were found in 8 cases [11.11% (8/72)], and other complex abnormalities were found in 3 cases [4.17% (3/72)]. 2) The chromosome abnormality rate of abortion tissue in the young pregnant women [51.11% (23/45)] was lower than that in the elderly pregnant women [72.06% (49/68)], and the difference was statistically significant ( P=0.023). 3) In the abortion tissue of elderly pregnant women, univariate analysis showed that the age of the man and times of previous abortion were related to the occurrence of chromosome abnormalities ( P=0.004, P=0.008). 4) Multivariate logistic regression analysis showed that the age of the man and times of previous abortion were the independent risk factors for chromosomal abnormalities in elderly pregnant women ( OR=1.248, 95% CI: 1.064-1.464, P=0.006; OR=0.493, 95% CI: 0.287-0.848, P=0.011), the regression equation was logit (P)=0.222×male age-0.707×times of previous abortion-6.042, area under curve was 0.789, 95% CI: 0.673-0.905, and the maximum value of Jordan index was 0.489. Conclusion:The age of pregnant women was correlated with the occurrence of chromosomal abnormalities in abortion tissues. At the same time, in pregnant women aged 35 years or above, under the condition of fixed abortion rates caused by female factors, an increase in male age and a decrease in previous abortions will lead to an increase in the incidence of chromosomal abnormalities. The model is of good value in predicting chromosome abnormalities.

【Objective:】 To understand the current status of narrative nursing knowledge, attitude, and practice (KAP) among nurses in grade A tertiary hospitals, and to provide a basis for the development of narrative nursing in relevant areas. 【Methods:】 Using convenience sampling methods, 931 nurses from three grade A tertiary hospitals in Xi’an were selected as subjects. A cross-sectional survey was conducted using the Clinical Nurses’ Narrative Nursing Knowledge and Trustworthiness Questionnaire and the General Self-Efficacy Scale. Multiple linear regression analysis was used to explore the influencing factors of nurses’ narrative nursing KAP. 【Results:】 The scores on the three dimensions of narrative nursing KAP were (23.70±2.99) points, (31.69±5.92) points, and (30.26±5.32) points, respectively. Nursing workload, general self-efficacy, professional title, and nursing satisfaction were the influencing factors of nurses’ narrative nursing knowledge dimension (P<0.05). There were statistically significant differences in nurses’ narrative nursing attitude dimension among nursing workload, general self-efficacy, professional title, monthly income, and nursing satisfaction (P<0.05). Nursing workload, general self-efficacy, nursing satisfaction, and accompanying experience were the influencing factors of nurses’ narrative nursing behavior dimension (P<0.05). 【Conclusion:】 Nurses in grade A tertiary hospitals have moderate narrative nursing knowledge, positive attitudes, and poor practice execution. The high nursing workload is the main barrier factor for the current development of narrative nursing. Nursing managers should actively build a diversified training system and guarantee system to boost the development of narrative nursing in clinical nursing work, and further promote the development of narrative nursing concepts.

Objective:To analyze the results of the joint screening of newborn hearing and deafness genes in Dalian to provide a reference for the prevention and control of hereditary deafness.Methods:Eight hundred and forty-two neonates born in Dalian Women and Children′s Medical Group from January 1, 2022 to May 30, 2022 were screened retrospectively, using AABR (automatic brainstem evoked potential). And 20 mutation sites of common genetic deafness 4 genes , including GJB2, GJB3, SLC26A4 (PDS) and mitochondrial genes associated with drug-induced deafness (MT-RNRI)(12SrRNA), were detected by high-throughput sequencing.Results:Among the 842 newborns, 840 passed hearing screening (99.8%); 36 cases (4.3%) passed the hearing screening but not the hearing loss gene screening; 804 cases passed through the both screening (95.5%); 2 cases (0.24%) failed in the both screening. 38 cases of deafness gene mutations were detected, with a total carrying rate of 4.51% (38/842). Among them, the carrying rates of heterozygous mutations in GJB2, GJB3, SLC26A4 (PDS), MT-RNRI (12SrRNA) were 1.90%, 0.24%, 1.30%, and 0.95%, respectively. The carrying rates of GJB2/GJB3 composite heterozygous mutations were 0.12%.Conclusions:The combined screening of neonatal hearing and deafness genes can reduce the missed rate of hearing screening. The carrier rate of neonatal deafness gene in Dalian is 4.51%, with the highest GJB 2 carrier rate, followed by SLC26A4 (PDS) carrier rate.

Objective:To explore the values of Z-scores of fetal heart circumference (HC) and heart area (HA) in prediction of homozygous α-thalassemia.Methods:From February 2014 to March 2019, 233 fetuses of 15 to 23 gestation weeks with risk of homozygous α-thalassemia were examined by prenatal ultrasound in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. HC, HA and cardiothoracic ratio (CTR) were measured. HC and HA were converted into Z-scores, respectively. The ROC curves were established and analyzed based on HC Z-score, HA Z-score or CTR respectively to compare their predicting efficacies for fetal homozygous α-thalassemia. Finally, the sensitivity, specificity, positive predictive value and negative predictive value were obtained by the best cutoff values.Results:①Sixty-five fetuses were diagnosed as homozygous α-thalassemia and classified as α-thalassemia group. One hundred and sixty-eight fetuses were mild and normal and were classified as control group. ②HC Z-score, HA Z-score and CTR in the α-thalassemia group were significantly higher than those in the control group, and the differences between the two groups were statistically significant ( P<0.001). ③The area under ROC curve of HA Z-score was the largest compared with HC Z-score and CTR, and the prediction efficacy was the highest ( Z test=2.144 and 2.517 respectively, P<0.05). ④The best cutoff values were HC Z-score>1.67, HA Z-score>2.06 and CTR>0.53. Sensitivities of predicting homozygous α-thalassemia in 15 to 23 gestation weeks were 92.31%, 100% and 89.23%, respectively. Specificities were 94.05%, 95.83% and 93.45%, respectively. Positive predictive values were 84.43%, 89.00% and 84.05%, respectively. Negative predictive values were 96.91%, 100% and 95.57%, respectively. Conclusions:Fetal heart HC Z-score and HA Z-score are safe and effective novel ultrasonic indexes for predicting homozygous α-thalassemia. Especially compared with traditional CTR, HA Z-score has a significantly higher predicting efficacy, which can improve the detection rate of homozygous α-thalassemia and reduce the need for invasive examination.

Objective:To investigate the current situation of surrogate in China,analyze the reasons,and then provide effective suggestions and countermeasures.Methods:A questionnaire survey was conducted among medical staff and patients in an institution with assisted reproductive technology (ART),combining literature review and sociological research methods such as data maps,to explore and analyze the surrogacy.Results:The number of institutions with ART increased rapidly and its regulation became difficult.More surrogate network was observed in first-tier cities as well as the eastern and southeastern coastal provinces.That respondents agreeing with surrogacy was quite serious in some provinces.The reasons of surrogate were patients' needs,social concepts,weak government supervision,and so on.Conclusions:It should improve the laws of ART,explore long-term supervision mechanism,strengthen the management of internet,shield the information about surrogate,enhance medical ethics education for ART staff,and guide the infertility patients to establish the correct ethical concepts.

Objective To analyze the risk factors of deep venous thrombosis in elderly people after hip joint replacement and nursing countermeasures.Methods A total of 56 elderly patients with DVT after artificial joint replacement in our hospital were selected.And 60 patients without DVT were selected at the same time.Single factor analysis was used to analyze the independent influencing factors of deep vein thrombosis after TRK.At the same time, nursing experience of elderly patients was explored.Results Age, body mass index, blood coagulation function, blood coagulation function, blood loss, smoking history, history of diabetes, and anticoagulation care or not between the DVT group and no DVT group showed significant difference(P<0.05).Conclusion Age, body mass index, blood coagulation function, total hip replacement, blood loss, smoking history, diabetes history, and the prevention and nursing of the patients with DVT were the high risk factors of the patients.The patients need to strengthen preoperative, intraoperative and postoperative monitoring and actively carry out preventive anticoagulation in order to effectively prevent the emergence of DVT after TRK in elderly patients.