The purpose of this survey was to understand the occurrence of hypocalcemia in dairy cows in large-scale pasture and its relationship with production performance,disease and culling.Eighty-one large-scale pastures were selected in China to carry out a questionnaire survey on the lactation performance,reproductive performance,disease status and culling situations of dairy cows,and analyzed the production data of dairy farms by SPSS software.The survey results show that the incidence of hypocalcemia in dairy cows in pasture was different,the subclinical type was nearly twice as high as the clinical type,and the incidence rate of hypocalcemia was higher in about 30％of pasture.Hypocalcemia has no obvious effect on the lactation performance of dairy cows on dairy farms.However,a high incidence rate can reduce the conception rate,increase the incidence of subclinical mastitis,ketosis,and other common internal diseases,and raise the annual culling rate and culling rate of adult cows.Clinical,subclinical and total incidence of hypocalcemia have differ-ent effects on reproduction and diseases such as mastitis and ketosis,but clinical hypocalcemia is more harmful.Hypocalcemia is still an important metabolic disease that harms the health and pro-duction of dairy cows in large-scale pastures in China.For farms with a high incidence rate,it is recommended to conduct regular monitoring of blood calcium levels in dairy cows before and after calving,and to conduct in-depth investigations into the related pathogenic factors.This will provide a scientific basis for improving the prevention measures for hypocalcemia,reducing the incidence of the disease,increasing reproductive efficiency,and reducing culling rates.

The development of surgery brings about the transformation of surgeons′ con-cepts, and in turn, each renewal of surgical concepts propels progress of surgical techniques. These two aspects complement each other. The treatment of hepatocellular carcinoma is a comprehensive therapy centered on surgery. With the deepening understanding of liver anatomy, the surgical methods have evolved from initial local resection to anatomical liver resection, and then to resection of the tumor-bearing portal vein territory. In recent years, with the emergence of hepatic membrane anatomy, portal plate theory, and three-dimensional visualization, the theoretical and technical systems of laparoscopic anatomical liver resection has become more and more mature. Based on own experience and literature reports, the authors systematically elaborate on the construction of theoretical and technological systems of laparoscopic anatomic liver resection for hepatocellular carcinoma, for reference by colleagues.

The purpose of this survey was to understand the occurrence of hypocalcemia in dairy cows in large-scale pasture and its relationship with production performance,disease and culling.Eighty-one large-scale pastures were selected in China to carry out a questionnaire survey on the lactation performance,reproductive performance,disease status and culling situations of dairy cows,and analyzed the production data of dairy farms by SPSS software.The survey results show that the incidence of hypocalcemia in dairy cows in pasture was different,the subclinical type was nearly twice as high as the clinical type,and the incidence rate of hypocalcemia was higher in about 30％of pasture.Hypocalcemia has no obvious effect on the lactation performance of dairy cows on dairy farms.However,a high incidence rate can reduce the conception rate,increase the incidence of subclinical mastitis,ketosis,and other common internal diseases,and raise the annual culling rate and culling rate of adult cows.Clinical,subclinical and total incidence of hypocalcemia have differ-ent effects on reproduction and diseases such as mastitis and ketosis,but clinical hypocalcemia is more harmful.Hypocalcemia is still an important metabolic disease that harms the health and pro-duction of dairy cows in large-scale pastures in China.For farms with a high incidence rate,it is recommended to conduct regular monitoring of blood calcium levels in dairy cows before and after calving,and to conduct in-depth investigations into the related pathogenic factors.This will provide a scientific basis for improving the prevention measures for hypocalcemia,reducing the incidence of the disease,increasing reproductive efficiency,and reducing culling rates.

The development of surgery brings about the transformation of surgeons′ con-cepts, and in turn, each renewal of surgical concepts propels progress of surgical techniques. These two aspects complement each other. The treatment of hepatocellular carcinoma is a comprehensive therapy centered on surgery. With the deepening understanding of liver anatomy, the surgical methods have evolved from initial local resection to anatomical liver resection, and then to resection of the tumor-bearing portal vein territory. In recent years, with the emergence of hepatic membrane anatomy, portal plate theory, and three-dimensional visualization, the theoretical and technical systems of laparoscopic anatomical liver resection has become more and more mature. Based on own experience and literature reports, the authors systematically elaborate on the construction of theoretical and technological systems of laparoscopic anatomic liver resection for hepatocellular carcinoma, for reference by colleagues.

Objective:To investigate the independent risk factors of community-acquired pneumonia (CAP) complicated with acute respiratory distress syndrome (ARDS), and the accuracy and prevention value of ARDS prediction based on artificial neural network model in CAP patients.Methods:A case-control study was conducted. Clinical data of 414 patients with CAP who met the inclusion criteria and were admitted to the comprehensive intensive care unit and respiratory department of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from February 2020 to February 2021 were analyzed. They were divided into two groups according to whether they had complicated with ARDS. The clinical data of the two groups were collected within 24 hours after admission, the influencing factors of ARDS were screened out by univariate analysis, and the artificial neural network model was constructed. Through the artificial neural network model, the importance of input layer independent variables (that was, the influence factors obtained from univariate analysis) on the output layer dependent variables (whether ARDS occurred) was drawn. The artificial neural network modeling data pairs were randomly divided into training group ( n = 290) and verification group ( n = 124) in a ratio of 7∶3. The overall prediction accuracy of the training group and the verification group was calculated respectively. At the same time, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. Results:All 414 patients were enrolled in the analysis, including 82 patients with ARDS and 332 patients without ARDS. Univariate analysis showed that gender, age, heart rate (HR), maximum systolic blood pressure (MSBP), maximum respiratory rate (MRR), source of admission, C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), neutrophil count (NEUT), eosinophil count (EOS), fibrinogen equivalent unit (FEU), activated partial thromboplastin time (APTT), total bilirubin (TBil), albumin (ALB), lactate dehydrogenase (LDH), serum creatinine (SCr), hemoglobin (Hb) and blood glucose (GLU) were significantly different between the two groups, which might be the risk factors of CAP patients complicated with ARDS. Taking the above 19 risk factors as the input layer and whether ARDS occurred as the output layer, the artificial neural network model was constructed. Among the input layer independent variables, the top five indicators with the largest influence weight on the neural network model were LDH (100.0%), PCT (74.4%), FEU (61.5%), MRR (56.9%), and APTT (51.6%), indicating that that these five indicators had a greater impact on the occurrence of ARDS in patients with CAP. The overall prediction accuracy of the artificial neural network model in the training group was 94.1% (273/290), and that of the verification group was 89.5% (111/124). The AUC predicted by the aforementioned artificial neural network model for ARDS in CAP patients was 0.977 (95% confidence interval was 0.956-1.000).Conclusion:The prediction model of ARDS in CAP patients based on artificial neural network model has good prediction ability, which can be used to calculate the accuracy of ARDS in CAP patients, and specific preventive measures can be given.

Objective:To investigate the pathogenesis, precaution and treatment of neonatal congenital complete heart block (CCHB) in twins.Methods:The clinical data of a case of premature twins with neonatal CCHB from the Department of Neonatology, the First Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed and related literature was reviewed.Results:(1)Case review: the 37-year-old gravida had no symptoms.Fetal ultrasound cardiogram(fUCG)at 23 weeks of gestation indicated bradycardia and CCHB.Then, the mother was diagnosed with undifferentiated connective tissue disease.After treatment with human immunoglobulin, dexamethasone and hydroxychloroquine, fUCG at 31 weeks of gestation still suggested CCHB.An emergency cesarean section was performed on the diagnosis of threatened preterm labor.With weakly positive neonatal antinuclear antibody (ANA), and positive Ro60 and Ro52 autoantibodies, twins were diagnosed with CCHB by 24 hour-Holter monitors.One of the twins was discharged with CCHB (ventricular rate of 80-90 times/min) after systemic therapy, but the weight increased to 2 200 g. The other one of the twins suffered from the sudden decrease of heart rate and blood pressure and finally died of sudden cardiac arrest.(2) Literature search: two cases in Chinese and 9 cases in English were reviewed.Among them, 9 cases were sjogren syndrome type A (SSA)/Ro and sjogren syndrome type B(SSB)/La related CCHB, and 2 cases were idiopathic CCHB.Conclusions:The placental transfer of anti-SSA or anti-SSB is an important mechanism of neonatal CCHB in twins, and other factors may also be involved.Current treatments are unsatisfactory.Most patients need pacemaker implantation.Early diagnosis and prenatal management can improve the prognosis.

Objective To investigate the effects of ω-3 polyunsaturated fatty acids(ω-3PUFAs)and ω-6 polyunsaturated fatty acids(ω-6PUFAs)on Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway,and the expressions of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β and IL-6 in neonatal rats with brain injury induced by lipopolysaccharide (LPS). Methods Ninety-six neonatal rats were divided into control group,ω-3PUFAs group,ω-6PUFAs group,and LPS group by using random number table method. Intraperitoneal injection of LPS was performed in LPS group,ω-6PUFAs group and ω-3PUFAs group to establish models of rat brain injury. The rats in control group received 9 g/L saline. Twelve newborn rats were killed at 1 d or 5 d after intraperito-neal injection in each group for hippocampus selection. Real -time PCR and Western blot were used to detect the mRNA and protein expression levels of TLR4,NF-κB,TNF-α,IL-1β and IL-6. Results One day after mode-ling,TLR4,NF-κB,TNF-α,IL-1β and IL-6 mRNA expressions in ω-3PUFAs group (10. 63 ± 0. 07,5. 86 ± 1. 05,7. 65 ± 2. 29,5. 23 ± 1. 31,3. 36 ± 0. 72)were lower than those in ω-6PUFAs group (18. 83 ± 2. 10,8. 79 ± 2. 08,11. 95 ± 3. 23,10. 97 ± 2. 24,6. 37 ± 1. 17)and LPS group (15. 76 ± 1. 59,7. 13 ± 1. 10,9. 71 ± 2. 14,7. 83 ± 0. 85,4. 78 ± 0. 51),and the differences were all statistically significant(all P＜0. 05);which in ω-6PUFAs group were higher than those in LPS group,and the differences were all significant (all P＜0. 05). TLR4,NF-κB,TNF-α, IL-1β and IL-6 protein levels in ω-3PUFAs group (1. 57 ± 0. 11,1. 58 ± 0. 09,1. 55 ± 0. 09,1. 63 ± 0. 31,1. 36 ± 0. 12)were lower than those in ω-6PUFAs group (1. 96 ± 0. 17,2. 21 ± 0. 12,1. 95 ± 0. 23,1. 97 ± 0. 24,1. 77 ± 0. 17)and LPS group (1. 73 ± 0. 15,1. 87 ± 0. 10,1. 79 ± 0. 14,1. 83 ± 0. 15,1. 58 ± 0. 11)in 1 d,and the diffe-rences were all significant (all P＜0. 05),and those in ω-6PUFAs group were higher than those in LPS group (all P＜0. 05). Similarly,TLR,NF-κB,TNF-α,IL-1β and IL-6 mRNA and protein expression levels in ω-3PUFAs group (3. 78 ± 0. 88,3. 86 ± 0. 62,6. 26 ± 1. 94,3. 65 ± 1. 44,2. 11 ± 0. 87;1. 15 ± 0. 08,1. 32 ± 0. 10,1. 46 ± 0. 04, 1. 38 ± 0. 14,1. 21 ± 0. 09)were lower than those in ω-6PUFAs group (7. 76 ± 1. 65,5. 51 ± 0. 88,7. 96 ± 2. 13,5. 35 ± 1. 75,4. 88 ± 1. 35;1. 42 ± 0. 15,1. 51 ± 0. 36,1. 65 ± 0. 13,1. 72 ± 0. 23,1. 48 ± 0. 10)and LPS group (6. 21 ± 1. 87, 4. 98 ± 0. 73,7. 11 ± 2. 10,4. 84 ± 1. 75,4. 25 ± 0. 64;1. 35 ± 0. 13,1. 44 ± 0. 22,1. 59 ± 0. 10,1. 61 ± 0. 18,1. 35 ± 0. 07) in 5 d (all P＜0. 05),and which in ω-6PUFAs group were higher than those in LPS group,and the differences were sig-nificant (all P＜0. 05). Conclusion ω-6PUFAs can up-regulate the activity of TLR4,NF-κB,and reduce the re-lease of TNF-α,IL-1β and IL-6;and ω-3PUFAs can down-regulate the activity of TLR4,NF-κB,and reduce the release of TNF-α,IL-1β and IL-6,so it has a neural protective effect in brain injury induced by LPS.