OBJECTIVE To explore the efficacy and safety of different doses of bupivacaine liposome （referred to as “LB”） in posterior quadratus lumborum block （QLB） for postoperative analgesia in patients undergoing cesarean section （CS）. METHODS In prospective research method， a total of 168 patients undergoing CS admitted to Chongzhou Maternal and Child Health Hospital from June to December 2024 were randomly divided into LB1 group， LB2 group， and LB3 group （LB of 199， 133 and 67 mg， respectively） according to the random number sorting method， with 56 cases in each group. All patients underwent CS after combined spinal-epidural anesthesia， and received patient-controlled intravenous analgesia and bilateral posterior QLB with different doses of LB after the operation. Visual analogue scale score， Ramsay sedation score， the presence of postoperative block planes and muscle strength classification were observed in the three groups of patients at 6， 12， 24， 48 and 72 hours after the operation. The time of the first compression of the analgesic pump， the dosage of sufentanil and butorphanol within 72 hours after surgery， the number of compressions of the analgesic pump， the analgesic rescue rate， the time of initiating lactation， the score of neonatal behavioral neurological assessment （NBNA）， the time of postoperative exhaust， the indwelling time of urinary catheter， the length of hospital stay， and the total satisfaction at 72 hours after surgery were compared. The occurrence of adverse reactions within 72 hours after the operation was recorded. RESULTS The resting and motor pain scores， the dosage of sufentanil and butorphanol within 72 hours after surgery， the number of compressions of the analgesic pump， the analgesic rescue rate， and the time of initiating lactation at 6， 12， 24， 48 and 72 hours after surgery in the LB1 group and the LB2 group were significantly lower or shorter than those in the LB3 group（P＜0.05）. The proportion of postoperative block planes at 24， 48 and 72 hours after surgery， the time of the first compression of the analgesic pump and the total satisfaction in the LB1 group and the LB2 group were significantly higher or longer than those in the LB3 group（P＜0.05）. The proportion of patients with muscle strength≤grade 3 at 6 hours after surgery in the LB1 group was significantly higher than that in the LB2 and the LB3 groups （P＜0.05）. There were no statistically significant differences in the Ramsay sedation scores at each time point after surgery， NBNA scores， postoperative exhaust time， urinary catheter indwelling time， the length of hospital stay， as well as the occurrence of adverse reactions among the 3 groups （P＞0.05）. CONCLUSIONS Compared with 67 mg of LB， 199 mg and 133 mg of LB can improve the postoperative analgesic effect and total satisfaction of CS patients undergoing posterior QLB， reduce the use of postoperative analgesic drugs， and shorten the time to start lactation. Compared with 199 mg and 133 mg of LB， 67 mg of LB has a smaller impact on the motor function of CS patients. All three doses of LB had no significant effect on the neurobehavioral abilities of newborns, and demonstrated comparable sedative efficacy and safety.

Background Previous studies found that high temperature and heatwave increase the risk of traffic injuries. The complex road conditions in Yunnan Province result in frequent traffic accidents. However, there is limited evidence on the correlation between heatwave and traffic injuries in Yunnan Province. Objective To assess the association between heatwave events and traffic injuries, to estimate its disease burden, and to identify relevant sensitive groups. Methods We collected data on traffic injury cases and concurrent meteorological information from four surveillance sites in Yunnan Province, China: Dali, Lufeng, Zhaoyang, and Qilin from May to September each year from 2015 to 2023. Traffic injury cases refer to patients who visited the outpatient or emergency departments of local surveillance hospitals for the first time due to traffic injuries. Meteorological data were derived from the fifth generation atmosphericreanalysis dataset of the global climate provided by the European Centre for Medium-Range Weather Forecasts. A time-stratified case-crossover design combined with distributed lag non-linear model was used to analyze the association between short-term exposure to heatwave and traffic injuries. We also conducted subgroup analyses by sex, age, occupation, injury cause, activity at the time of injury occurrence, and severity of injury. Results A total of 34764 traffic injury surveillance cases were included in the analysis. The risk of traffic injuries occurred during heatwave was 1.13 times (95%CI: 1.07, 1.20) greater than those occurred during non-heatwave, and 2.64% (95%CI: 1.49%, 3.73%) of traffic injuries were attributed to heatwave exposure throughout the study period. The results of stratified analysis showed greater impacts of heatwave on the risk of traffic injuries in female [odds ratio (OR)=1.17, attributable fraction (AF)=3.23%], people aged 15-64 years (OR=1.13, AF=2.68%), farmers/workers (OR=1.22, AF=4.07%), people with non-motor vehicle traffic injuries (OR=1.17, AF=3.24%), people who were driving or riding when injuries occurred (OR=1.12, AF=2.43%), and people with minor injuries (OR=1.18, AF=3.49%) ( P<0.05). Longer duration [excess risk (ER)=0.99%] and greater intensity (ER=4.12%) of heatwave had greater impacts on the risk of traffic injuries (P<0.05). Conclusion Heatwave events are associated with an increased risk of traffic injuries. Female, people aged 15-64, farmers/workers, people with non-motor vehicle traffic injuries, those injured while driving/riding a vehicle, and people with minor injuries are particularly vulnerable. The findings suggest that targeted mitigation and adaptation measures should be taken to address the risk of traffic injuries associated with extreme climate events.

Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.

Objective:To explore the role and mechanism of nuclear receptor subfamily 4 group A member 1 ( NR4A1) in suppressing cisplatin nephrotoxicity. Methods:The expression of NR4A1 gene in renal cell subpopulations was analyzed using the "Tabula-muris" single cell transcriptome sequencing database. NR4A1 gene was over-expressed by lentivirus infection in HK-2 cell line and primary renal proximal tubular epithelial cells. Cell counting kit-8 was used to detect the cytotoxicity of cisplatin. The cell death ratio was analyzed using propidium iodide (PI) staining by flow cytometry. The expression of NR4A1 and nuclear factor erythroid 2-related factor 2 ( NRF2) was detected by real-time fluorescent quantitative PCR and Western blotting. Ferroptosis was analyzed by detecting the contents of malondialdehyde (MDA), oxidized glutathione (GSSG) and lipid reactive oxygen species (ROS). Results:The single cell transcriptome sequencing database showed that NR4A1 gene was the lowest expression in renal proximal tubular epithelial cell subsets. Cisplatin (50 μmol/L or 100 μmol/L) could significantly induce MDA, GSSG and lipid ROS production in renal proximal tubular epithelial cells (all P<0.01), and higher cisplatin concentration accompanied with a more increase of MDA, GSSG and lipid ROS. Compared with the control HK-2 cells, the lipid ROS content and iron ion content of HK-2 cells over-expressing NR4A1 were significantly lower (all P<0.01), and the over-expression of NR4A1 inhibited cisplatin-induced cytotoxicity and ferroptosis in renal proximal tubular epithelial cells. Mechanistically, NR4A1 up-regulated the expression of anti-ferroptosis gene NRF2 in proximal renal tubular epithelial cells ( P<0.01). Furthermore, single cell data analysis showed that, similar to the expression of NR4A1 in renal tissue subsets, NRF2 was also the lowest in renal proximal tubular epithelial cells. Conclusions:Cisplatin can induce ferroptosis of renal proximal tubular epithelial cells in a dose-dependent manner. NR4A1 can inhibit cisplatin-induced ferroptosis by up-regulating NRF2 in renal proximal tubular epithelial cells, thereby alleviating the cytotoxicity of cisplatin.

To provide a scientific basis for determining the health surveillance period of dust-exposed workers, data of a retrospective cohort study was re-analyzed with emphasis on natural course of silicosis. 33640 workers exposed to silica dust who were employed for at least 1 year from 1972 to 1974 in twenty Chinese mines or pottery factories were included as subjects, and were followed up till December 31, 1994. The cohort included subjects from 8 tungsten mines, 4 tin mines and 8 pottery factories. Our results showed that the mean latency of silicosis, for all the cases of the cohorts, was 22.9±9.8 y. 52.2 % of silicosis was diagnosed approximately 9. 1±5.7 y after the dust exposure had ceased. The progression rates of silicosis from stage Ⅰ to Ⅱ and from stage Ⅱ to Ⅲ were 48.2% and 18.5 %, and the duration was 4.1±0.2 and 6.8±0.2 y,respectively.The survival times of silicosis stage Ⅰ , Ⅱ and Ⅲ , from the year of diagnosis to death, were 21.5,15.8 and 6.8 years, respectively. There was 25 % of the silicosis patients whose survival time was beyond 33 y. The mean death age of all silicosis cases was 56.0 y. The death age increased to 65.6y in the middle of 1990s. Among dust-exposed workers,subjects who became suspected case (0+)accounted for 15.0%. 48.7% of the suspected silicosis cases developed to silicosis, and the aver age year from the time of being suspected of the disease to the first stage of silicosis was 5.1 y. The natural characteristics, as mentioned above, varied with different mines and factories. We are led to conclude that silicosis is chronic in nature, but progress quickly. As a serious occupational disease it significantly reduces the life span of exposed workers. The study of its natural history is of importance for the development of health surveillance criteria for dust-exposed workers.

To provide a scientific basis for determining the health surveillance period of dust-exposed workers, data of a retrospective cohort study was re-analyzed with emphasis on natural course of silicosis. 33640 workers exposed to silica dust who were employed for at least 1 year from 1972 to 1974 in twenty Chinese mines or pottery factories were included as subjects, and were followed up till December 31, 1994. The cohort included subjects from 8 tungsten mines, 4 tin mines and 8 pottery factories. Our results showed that the mean latency of silicosis, for all the cases of the cohorts, was 22.9 +/- 9.8 y. 52.2 % of silicosis was diagnosed approximately 9.1 +/- 5.7 y after the dust exposure had ceased. The progression rates of silicosis from stage I to II and from stage II to III were 48.2 % and 18.5 %, and the duration was 4.1 +/- 0.2 and 6.8 +/- 0.2 y, respectively. The survival times of silicosis stage I , II and III, from the year of diagnosis to death, were 21.5, 15.8 and 6.8 years, respectively. There was 25 % of the silicosis patients whose survival time was beyond 33 y. The mean death age of all silicosis cases was 56.0 y. The death age increased to 65.6 y in the middle of 1990s. Among dust-exposed workers, subjects who became suspected case (0+ ) accounted for 15.0 %. 48.7 % of the suspected silicosis cases developed to silicosis, and the average year from the time of being suspected of the disease to the first stage of silicosis was 5.1 y. The natural characteristics, as mentioned above, varied with different mines and factories. We are led to conclude that silicosis is chronic in nature, but progress quickly. As a serious occupational disease it significantly reduces the life span of exposed workers. The study of its natural history is of importance for the development of health surveillance criteria for dust-exposed workers.