Objective:To explore the effects of online mindfulness-based stress reduction(MBSR)on the anxiety and depression status,and quality of life in the caregivers of patients with severe mental disorders.Methods:Ninety-three caregivers for patients with schizophrenia or bipolar disorder,who were hospitalized in Yunnan Provincial Mental Hospital in March 2021,were enrolled and randomly divided into control group(n=47)and MBSR intervention group(n=46).Both groups received basic health education and rehabilitation skill training,while the intervention group received additional online MBSR for 8 weeks.The anxiety and depression status,and the quality of life of the caregivers were evaluated by Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and the 36-item Short Form Health Survey(SF-36)before and 8 weeks after intervention,respectively.Results:Thirteen caregivers dropped out of the study,and 80 subjects(40 in each group)were included in the final analysis.At the baseline,there were no significant differences in SAS,SDS and SF-36 scores between two groups(all P>0.05).Compared with the baseline,SAS and SDS scores in the intervention group significantly decreased after 8 weeks of intervention(both P<0.01)and were significantly lower than those in the control group(both P<0.01).There were no significant changes in the control group(all P>0.05).Except the physiological function dimension,the total score and the scores of each dimension of SF-36 in the intervention group were significantly increased after 8-week intervention(all P<0.05),and were significantly higher than those in the control group(all P<0.01).There were no significant changes in the control group before and after intervention(all P>0.05).Conclusion:Online MBSR can reduce the anxiety and depression levels,improve the quality of life in the caregivers of patients with severe mental disorders.

Objective The aim of this study was to compare the effect of injection of indocyanine green(ICG)through peripheral vein and gallbladder in laparoscopic cholecystectomy(LC)of difficult gallbladder.Methods Patients with difficult gallbladder who underwent LC by the same surgical team from May to October 2023 in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui University of Science and Technology were divided into three groups according to A random number table.Group A was injected ICG through peripheral vein before operation,group B was injected ICG through gallbladder during operation,and group C was the control group.The differences of operation time,intraoperative blood loss,hospitalization time,hospitalization cost and postoperative complications among the three groups were compared,and the effects of fluorescence mode cholangio-gram in group A and group B were compared.One-way analysis of variance was used to compare the normal distri-bution of the measurement data among groups,and LSD-t test was used to compare the two groups.The counting data was compared by chi-square test.The Boferroni test was appied to compare the two groups.Results There were no differences in length of stay,hospitalization cost and postoperative complications among the three groups(P＞0.05).The operative time and intraoperative blood loss of group A and group B were lower than those of group C(P＜0.05),but there was no difference between group A and group B(P＞0.05).The total imaging rate of the first three tubes of free gallbladder triangle(early stage)in group A was 41.67%,which was significantly lower than that in group B(63.89%)(P＜0.05).Conclusion ICG is beneficial for the identification of extrahepatic bile duct structures during LC of difficult gallbladder,and ICG injection through the gallbladder is helpful for the early identification of extrahepatic bile duct.

Objective To investigate the values of systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII),neutrophil count/lymphocyte count(NLR),platelet count/lymphocyte count(PLR)and lymphocyte count/monocyte count(LMR)in prediction of the severity of acute pancreatitis(AP)at early stage.Methods The clinical data on 666 AP patients admitted to the department of hepatobiliary surgery,the First Affiliated Hospital of Anhui University of Science and Technology,from January 2020 to November 2023 were retrospectively analyzed.The patients were divided into a mild group(MAP group,mild acute pancreatitis)and a non-mild group(non-MAP group,including moderate to severe acute pancreatitis).Blood routine and biochemical indicators were collected at admission and 24 hours after admission.The differences in SIRI,SII,NLR,PLR and LMR between the two groups were compared,so were the values of these five indexes in prediction of non-MAP.Results Of the 666 AP patients,507 were in the MAP group and 159 in the non-MAP group.In the non-MAP group,C-reactive protein(CRP),SIRI,SII,and NLR were higher than those in the MAP group 24 hours after admission,while LMR was lower than that in the MAP group,and the differences were statistically significant(P<0.05).CRP(HR=1.008,95%CI:1.004～1.012,P<0.05)and SIRI(HR=1.216,95%CI:1.029～1.436,P<0.05)were identified as the risk factors for the severity of AP.The ROC curve showed that the AUC and sensitivity of SIRI for predicting non-MAP 24 hours after admission were 0.718 and 75.00%,respectively,higher than those of SII,CRP,NLR,and LMR.Both SIRI and CRP had AUC values greater than 0.7,and the combined AUC was 0.788(0.738～0.837),the sensitivity was 86.00%and the specificity was 81.44%.Conclusions SIRI can be used as a predictor of disease severity in early AP patients,and combined with CRP can improve the predictive value.

Objective:To study the factors influencing repeatedly hospitalization in patients with acute pancreatitis (AP), and to analyse the predictive value of triglyceride for repeated hospitalization.Methods:The clinical data of 1 958 patients with AP treated at the First Affiliated Hospital of Anhui University of Science and Technology from January 2012 to April 2022 were analyzed. Of 1 733 AP patients who were enrolled, there were 1 000 males and 733 females, with mean ± s. d age being (49.4±16.4) years. Patients were grouped based on their ID numbers to determine their number(s) of hospitalization. Those who were admitted only once were included in the initial hospitalization group ( n=1 030), and those who were admitted twice or more were included in the repeated hospitalization group ( n=703). The factors influencing repeated hospitalization were analyzed by univariate analysis and multivariate logistic regression analysis. The predictive value of triglyceride for repeated hospitalization was evaluated by receiver operating characteristic (ROC) curve. Results:Multivariate logistic regression analysis showed that hypertriglyceridemia ( OR=1.445, 95% CI: 1.144-1.825, P=0.002) and biliary causes ( OR=3.184, 95% CI: 1.978-5.125, P<0.001) were independent risk factors for repeated hospitalization. When triglyceride <10.9 mmol/L, the prediction of AP patients without repeated hospitalization was 90.6%. The area under the ROC curve was 0.589, and the Yoden index was 0.170. Conclusion:Hypertriglyceridemia was risk factor for repeat hospitalization in AP patients and the efficacy of triglyceride in predicting repeat hospitalization in AP patients was good.

Despite complications were significantly reduced due to the popularity of percutaneous coronary intervention (PCI) in clinical trials, reperfusion injury and chronic cardiac remodeling significantly contribute to poor prognosis and rehabilitation in AMI patients. We revealed the effects of HSP47 on myocardial ischemia-reperfusion injury (IRI) and shed light on the underlying molecular mechanism. We generated adult mice with lentivirus-mediated or miRNA (mi1/133TS)-aided cardiac fibroblast-selective HSP47 overexpression. Myocardial IRI was induced by 45-min occlusion of the left anterior descending (LAD) artery followed by 24 h reperfusion in mice, while ischemia-mediated cardiac remodeling was induced by four weeks of reperfusion. Also, the role of HSP47 in fibrogenesis was evaluated in cardiac fibroblasts following hypoxia-reoxygenation (HR). Extensive HSP47 was observed in murine infarcted hearts, human ischemic hearts, and cardiac fibroblasts and accelerated oxidative stress and apoptosis after myocardial IRI. Cardiac fibroblast-selective HSP47 overexpression exacerbated cardiac dysfunction caused by chronic myocardial IRI and presented deteriorative fibrosis and cell proliferation. HSP47 upregulation in cardiac fibroblasts promoted TGFβ1-Smad4 pathway activation and Smad4 deubiquitination by recruiting ubiquitin-specific peptidase 10 (USP10) in fibroblasts. However, cardiac fibroblast specific USP10 deficiency abolished HSP47-mediated fibrogenesis in hearts. Moreover, blockage of HSP47 with Col003 disturbed fibrogenesis in fibroblasts following HR. Altogether, cardiac fibroblast HSP47 aggravates fibrosis post-myocardial IRI by enhancing USP10-dependent Smad4 deubiquitination, which provided a potential strategy for myocardial IRI and cardiac remodeling.

Objective To investigate the clinical utility of indocyanine green (ICG) fluorescence imaging in difficult laparoscopic cholecystectomy (LC). Methods The clinical data of LC patients from October 2021 to December 2021 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Based on whether ICG fluorescence imaging was used and whether gallbladder difficulties were detected, the patients were divided into four groups: ICG common gallbladder (Group A), ICG difficult gallbladder (Group B), common gallbladder (Group C), and difficult gallbladder (Group D). The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and postoperative complications were compared. Comparison of normally distributed continuous data between groups was performed by t test. Comparison of categorical data between groups was performed using the chi-square test or Fisher's exact probability method. Results The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and intraoperative complications in group A were comparable to those in Group C (all P > 0.05). The operative time and intraoperative bleeding were (75.41±12.96) min and (18.27±6.97) mL in group B, vs (106.78±19.21) min and (23.99±8.43) mL in group D, respectively, and the differences were statistically significant (all P < 0.05), while the length of hospitalization, hospitalization cost and postoperative complications in group B were comparable to those in group D (all P > 0.05). Conclusion The benefits of ICG fluorescence imaging during LC in patients with the common gallbladder are not obvious. However, in difficult gallbladder cases, ICG fluorescence imaging can improve biliary tract exposure and reduce operation time and intraoperative bleeding.

Objective:To explore the influence of the timing of the drainage tube removal on the clinical pathway after radical resection of papillary thyroid carcinoma.Methods:The clinical data of 64 patients with radical resection of papillary thyroid carcinoma discharged to the department of general surgery, First Affiliated Hospital of Anhui University of Science and Technology from December 2019 to May 2020 were retrospectively analyzed. There were 14 males and 50 females, aged (45.8 ± 11.7) years and ranging from 23 to 73 years. According to the amount of postoperative drainage fluid, decide whether to extubate and divide the patient into a study group and a control group, there were 37 cases in the study group and 27 cases in the control group. The extubation indication in the study group was 24 hours of drainage fluid volume <20 mL, the control group was 24 hours of drainage fluid volume <10 mL. The differences in operation time, intraoperative blood loss, tumor diameter, number of lymph node dissection, extubation time, postoperative complications, hospitalization cost, postoperative hospitalization time, total hospitalization time, and clinical path completion rate were compared between the two groups. The measurement data of normal distribution were expressed as mean±standard deviation ( Mean± SD), and the t test was used for comparison between groups, the measurement data of non-normal distribution were measured by M ( P25, P75), and the Mann-Whitney U test were used for comparison between groups.Counting data were expressed as percentages(%), and chi-square test was used in comparison between groups. Results:There were no significant difference between the two groups in the operation time, total intraoperative blood loss, tumor diameter, number of lymph node dissections, postoperative complications and hospitalization costs( P>0.05). The extubation time, postoperative hospitalization time, hospitalization time and clinical path completion rate of the study group were 2.9(2.5, 3.5) d、3.0(3.0, 3.5) d、7.0(7.0, 8.5) d and 70.3% (26/37), vespectively. In the control group, they were 4.5(3.8, 5.5) d、5.0(4.0, 6.0) d、11.0(10.0, 13.0) d and 11.1% (3/27), respectively. The difference between the two groups were statistically significant ( P<0.05). Conclusion:After radical resection of papillary thyroid cancer, taking the 24 h drainage volume <20 mL as the timing of extubation does not increase the incidence of postoperative complications, which can significantly shorten the extubation time, postoperative hospitalization time and total hospitalization time and improve clinical path completion rate.

Objective:To explore the safety of clinical application of liver cysts under the mode of ambulatory surgery.Methods:Retrospective analysis of the data of 84 patients with liver cysts admitted to the Huainan First People′s Hospital, the Fourth Affiliated Hospital of Bengbu Medical College from January 2017 to December 2019, they were divided into study group ( n=42) and control group according to the random number table method ( n=42). The control group adopted the traditional perioperative management method, and the research group adopted the day surgery treatment mode. The two groups of patients were evaluated for their hospitalization days, total cost, satisfaction, activity of daily living (ADL) score of 7 days after surgery, temporary cancellation rate, unplanned readmission rate, total postoperative complications and other indicators. Normally distributed measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t test was used for comparison between groups. Enumeration data was expressed as a percentage (%), and comparison between groups was performed by chi-square test. Results:The length of stay in the study group and the total cost of hospitalization were (1.76±0.82) d and (0.55±0.10) ten thousand yuan, respectively. The control group were (5.33±1.69) d and (0.90±0.22) ten thousand yuan, respectively. The study group was lesser than In the control group, the differences between the two groups were statistically significant ( P<0.001). The patient satisfaction score of the study group was (4.20±0.64) points, and the control group was (3.20±0.92) points. The study group was higher than the control group. The difference between the two groups was statistically significant ( P<0.001). The postoperative ADL score, temporary cancellation rate, unplanned readmission rate, and total postoperative complication rate in the study group were (46.45±9.75) points, 4.76%, 7.14% and 9.52%, respectively. The control group were (45.57±7.02) points, 2.38%, 4.76% and 7.14%, there was no significant difference between the two groups ( P>0.05). Conclusions:Ambulatory laparoscopic fenestration of liver cysts is safe and effective for the treatment of patients with liver cysts. Compared with traditional in-patient surgery, it can reduce the length of stay and the cost of hospitalization and increase the satisfaction of patients.

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones.Methods From June 2017 to December 2017,94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively.All patients were included in clinical pathway management.According to whether the perioperative period was combined with ERAS,there were 45 cases in the study group and 49 cases in the control group.The study group was combined with ERAS during perioperative period,while the control group received traditional perioperative management.The preoperative hospitalization days,operative time,intraoperative bleeding volume,total hospitalization days,postoperative complications,hospitalization costs,postoperative hospitalization days,clinical pathway completion rate and positive and negative variation rates were compared between the two groups.The measurement data were expressed by (Mean ± SD),and the comparisons between groups were performed by t test;Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Results Preoperative hospitalization days,operation time,intraoperative bleeding volume,total hospitalization days and postoperative complications in the study group were (3.3 ± 1.2) d,(63.1 ± 24.3) min,(9.4 ± 3.9) ml,(7.1 ± 1.5) d and 1 case respectively,while those in the control group were (3.2 ± 1.5) d,(68.4 ± 25.4) min,(9.5 ± 2.9) ml,(8.4 ± 1.8) d and 2 cases respectively,and the differences between the two groups ware not statistically significant (P ＞ 0.05).Postoperative hospitalization days,hospitalization expenses and shortened hospitalization days in the study group were (2.9 ± 0.8) d,(9 407.2 ± 500.9) yuan and 64.4％ (29/45) respectively,while those in the control group were (4.5 ± 1.1) d,(10 594.9 ±792.3) yuan and 36.7％ (18/49) respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay,reduce hospitalization costs,increase the positive variation rate of clinical pathway without increasing postoperative complications.

Objective To explore the application effect of the concept of accelerated rehabilitation surgery in elderly patients with choledocholithiasis.Methods A total of 28 patients with choledocholithiasis were treated in Department of General Surgery,Huainan First People's Hospital of Anhui Province in recent years.According to different interventions during perioperative period,they were divided into group ERAS (n =15) and control group (n =13).In group ERAS,systematic and orderly intervention was guided by the concept of rapid rehabilitation during perioperative period,while the control group adopted traditional perioperative management plan.Postoperative anal ventilation time,first out of bed time,postoperative hospital stay,postoperative complications,postoperative leukocyte and albumin differences between the two groups were compared.Measurement data were expressed by (-x ± s).T test was used for comparison between groups.Comparison of counting data were analyzed using Fisher exct probability between groups.Results The anus ventilation time after operation in group ERAS was (37.5 ± 3.7) h,the first time to get out of bed was (14.2 ± 4.1) h,and the number of days after operation was (8.7 ± 4.6) d,while the time of anus ventilation in the control group was (46.1 ± 3.2) h,and the first time to get out of bed was (21.4 ±4.2) h,and the number of days after operation was (13.8 ±7.2) d,and the difference of two groups was statistically significant (P ＜ 0.05).In group ERAS,albumin was (34.3 ± 1.7) g/L for the first time after operation,while (29.5 ± 2.0) g/L in control group.The difference between the two groups was statistically significant (P ＜ 0.05).However,the complications and first reexamination of leukocyte in the two groups were no difference.Conclusion The application of ERAS in the operation of choledocholithiasis in elderly patients with choledocholithiasis can accelerate the anal ventilation,shorten the days of hospitalization,reduce postoperative complications,and improve the postoperative recovery.