Objective To explore the basis of PERMA on the overall well-being and social support of elderly patients with maintenance hemodialysis(MHD).Methods A total of 60 elderly patients with MHD were selected from the blood purification center of a tertiary A hospital in Zhejiang Province from January to December 2022 as the study subjects.According to the different disease areas of the patients,they were randomly divided into an experimental group or a control group.Finally,30 patients were included in each group.The control group received routine care,and the experimental group received another 4-week bidirectional social support intervention based on the PERMA model.General well-being scale,social support rating scale,sleep duration,activity duration were used to evaluate the effect before intervention,4 weeks after intervention and 1 month after intervention.Results The results of repeated measurement ANOVA showed that there were statistically significant differences in general happiness score,social support score,sleep duration and activity duration in terms of time effect(P＜0.05),while there were statistically significant differences in general happiness score,social support score and sleep duration in terms of inter-group effect(P＜0.05).Social support score and sleep duration had statistically significant interac-tion effects(P＜0.05).Conclusion The bidirectional social support intervention based on well-being PERMA model can enhance the general well-being and social support level of elderly patients with MHD,and improve the sleep and activity status of elderly patients with MHD.

Objective To investigate the safety of totally thoracoscopic mitral valve reoperation with hypothermia-induced ventricular fibrillation arrest in elderly patients.Methods Clinical data of 108 elderly patients undergoing redo mitral valve surgery in our department from January 2008 to October 2024 were retrospectively collected,and according to surgical approach,they were di-vided into a totally thoracoscopic group(totally thoracoscopy with hypothermia-induced ventricu-lar fibrillation arrest,46 cases)and a median sternotomy group(cardiac arrest after median ster-notomy,62 cases).Their perioperative data were compared between the two groups.Results There were no statistical differences in baseline data between the two groups(P＞0.05).When compared with the median sternotomy group,the totally endoscopic group had significantly longer cardiopulmonary bypass time and higher mitral valvuloplasty rate and postoperative LVEF value,but obviously reduced lowest intraoperative temperature,lower blood transfusion rate,less vol-ume of suspended red blood cells transfused,decreased troponin T level 1 d postoperatively,shor-ter duration of mechanical ventilation and lengths of ICU stay and postoperative hospital stay,and less postoperative drainage volume(P＜0.05,P＜0.01).But there were no statistical differences between the two groups in terms of postoperative stroke(6.52％vs 3.23％,P=0.420)or in-hospital death(6.52％vs 6.45％,P=0.988).Conclusions Totally thoracoscopy with hypothermi-a-induced ventricular fibrillation arrest is safe and reliable for the elderly patients who need to receive mitral valve reoperation.

The central amygdala (CeA) is a crucial modulator of emotional, behavioral, and autonomic functions, including cardiovascular responses. Despite its importance, the specific circuit by which the CeA modulates blood pressure remains insufficiently explored. Our investigations demonstrate that photostimulation of GABAergic neurons in the centromedial amygdala (CeM^GABA), as opposed to those in the centrolateral amygdala (CeL), produces a depressor response in both anesthetized and freely-moving mice. In addition, activation of CeM^GABA axonal terminals projecting to the nucleus tractus solitarius (NTS) significantly reduces blood pressure. These CeM^GABA neurons form synaptic connections with NTS neurons, allowing for the modulation of cardiovascular responses by influencing the caudal or rostral ventrolateral medulla. Furthermore, CeM^GABA neurons targeting the NTS receive dense inputs from the CeL. Consequently, stimulation of CeM^GABA neurons elicits hypotension through the CeM-NTS circuit, offering deeper insights into the cardiovascular responses associated with emotions and behaviors.
Animals ; GABAergic Neurons/physiology* ; Male ; Central Amygdaloid Nucleus/physiopathology* ; Hypotension/physiopathology* ; Mice ; Blood Pressure/physiology* ; Mice, Inbred C57BL ; Solitary Nucleus/physiology* ; Photic Stimulation ; Neural Pathways/physiology*

Neutralizing antibodies have been designed to specifically target and bind to the receptor binding domain (RBD) of spike (S) protein to block severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus from attaching to angiotensin converting enzyme 2 (ACE2). This study reports a distinctive nanobody, designated as VHH21, that directly catalyzes the S-trimer into an irreversible transition state through postfusion conformational changes. Derived from camels immunized with multiple antigens, a set of nanobodies with high affinity for the S1 protein displays abilities to neutralize pseudovirion infections with a broad resistance to variants of concern of SARS-CoV-2, including SARS-CoV and BatRaTG13. Importantly, a super-resolution screening and analysis platform based on visual fluorescence probes was designed and applied to monitor single proteins and protein subunits. A spontaneously occurring dimeric form of VHH21 was obtained to rapidly destroy the S-trimer. Structural analysis via cryogenic electron microscopy revealed that VHH21 targets specific conserved epitopes on the S protein, distinct from the ACE2 binding site on the RBD, which destabilizes the fusion process. This research highlights the potential of VHH21 as an abzyme-like nanobody (nanoabzyme) possessing broad-spectrum binding capabilities and highly effective anti-viral properties and offers a promising strategy for combating coronavirus outbreaks.
Single-Domain Antibodies/immunology* ; Spike Glycoprotein, Coronavirus/metabolism* ; SARS-CoV-2/immunology* ; Animals ; Humans ; Antibodies, Neutralizing/immunology* ; Camelus ; COVID-19/immunology* ; Antibodies, Viral/immunology* ; Angiotensin-Converting Enzyme 2

Objective To investigate the effects of different contrast injection schemes on the image quality of triple-rule-out com-puted tomography angiography(TRO-CTA).Methods A total of 691 patients with acute chest pain who underwent TRO-CTA exami-nation from multiple centers were prospectively selected and randomly divided into mixed group and unmixed group according to dif-ferent contrast injection methods.The image quality of aorta,pulmonary artery and coronary artery in the two groups was evaluated subjectively and objectively and the radiation dose was calculated.Results There were no significant differences in subjective image quality scores,aorta and coronary CT values,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between the two groups(P>0.05),while there were significant differences in pulmo-nary CT values,SNR,CNR and radiation dose between the two groups(P<0.05).Conclusion The utilization of a mixed contrast injection scheme in TRO-CTA can satisfy diagnostic require-ments while ensuring a low proportional dosage and reduced radiation dose,which has clinical application value.

AIM:To evaluate the value of ultra-sound-guided erector spinae plane block(ESPB)combined with opioid-sparing anaesthesia in extra-corporeal shock wave lithotripsy(ESWL)for pancre-atic stones.METHODS:A total of 96 patients(60 males and 36 females,aged 20-65 years,ASA Ⅰ-Ⅱ,BMI 16-30 kg/m2)undergoing elective extracorpo-real shock wave lithotripsy for pancreatic duct stones were selected in our hospital from March 2022 to April 2023.The patients were randomly di-vided into conventional intravenous anesthesia group(group C,48 cases)and ESPB+opioid-sparing group(group E,48 cases).Patients in group C un-derwent general anesthesia with target-controlled infusion of propofol and remifentanil with sponta-neous breathing.Patients in group E underwent ul-trasound-guided bilateral ESPB before intravenous general anesthesia.The changes of hemodynamic indexes(HR,MAP)in the two groups were ob-served and recorded.The anesthetic effect,dosage of remifentanil,quality of anesthesia recovery,postoperative analgesic effect and incidence of perioperative adverse reactions(respiratory depres-sion,nausea and vomiting,pruritus,etc.)were ob-served in the two groups.RESULTS:Compared with group C,the incidence of intraoperative respiratory depression was significantly decreased,the intraop-erative consumption of remifentanil was de-creased,and the postoperative recovery time was shortened in group E(P＜0.05).The VAS scores of rest and cough pain and the incidence of postoper-ative nausea and vomiting were significantly de-creased in group E(P＜0.05).There was no signifi-cant difference in HR and MAP between the two groups(P＞0.05).CONCLUSION:Ultrasound-guided ESPB in ESWL for pancreatic duct stones is satisfac-tory and can save opioids with few complications.

Objective To explore the basis of PERMA on the overall well-being and social support of elderly patients with maintenance hemodialysis(MHD).Methods A total of 60 elderly patients with MHD were selected from the blood purification center of a tertiary A hospital in Zhejiang Province from January to December 2022 as the study subjects.According to the different disease areas of the patients,they were randomly divided into an experimental group or a control group.Finally,30 patients were included in each group.The control group received routine care,and the experimental group received another 4-week bidirectional social support intervention based on the PERMA model.General well-being scale,social support rating scale,sleep duration,activity duration were used to evaluate the effect before intervention,4 weeks after intervention and 1 month after intervention.Results The results of repeated measurement ANOVA showed that there were statistically significant differences in general happiness score,social support score,sleep duration and activity duration in terms of time effect(P＜0.05),while there were statistically significant differences in general happiness score,social support score and sleep duration in terms of inter-group effect(P＜0.05).Social support score and sleep duration had statistically significant interac-tion effects(P＜0.05).Conclusion The bidirectional social support intervention based on well-being PERMA model can enhance the general well-being and social support level of elderly patients with MHD,and improve the sleep and activity status of elderly patients with MHD.

Objective To investigate the effects of different contrast injection schemes on the image quality of triple-rule-out com-puted tomography angiography(TRO-CTA).Methods A total of 691 patients with acute chest pain who underwent TRO-CTA exami-nation from multiple centers were prospectively selected and randomly divided into mixed group and unmixed group according to dif-ferent contrast injection methods.The image quality of aorta,pulmonary artery and coronary artery in the two groups was evaluated subjectively and objectively and the radiation dose was calculated.Results There were no significant differences in subjective image quality scores,aorta and coronary CT values,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between the two groups(P>0.05),while there were significant differences in pulmo-nary CT values,SNR,CNR and radiation dose between the two groups(P<0.05).Conclusion The utilization of a mixed contrast injection scheme in TRO-CTA can satisfy diagnostic require-ments while ensuring a low proportional dosage and reduced radiation dose,which has clinical application value.

AIM:To evaluate the value of ultra-sound-guided erector spinae plane block(ESPB)combined with opioid-sparing anaesthesia in extra-corporeal shock wave lithotripsy(ESWL)for pancre-atic stones.METHODS:A total of 96 patients(60 males and 36 females,aged 20-65 years,ASA Ⅰ-Ⅱ,BMI 16-30 kg/m2)undergoing elective extracorpo-real shock wave lithotripsy for pancreatic duct stones were selected in our hospital from March 2022 to April 2023.The patients were randomly di-vided into conventional intravenous anesthesia group(group C,48 cases)and ESPB+opioid-sparing group(group E,48 cases).Patients in group C un-derwent general anesthesia with target-controlled infusion of propofol and remifentanil with sponta-neous breathing.Patients in group E underwent ul-trasound-guided bilateral ESPB before intravenous general anesthesia.The changes of hemodynamic indexes(HR,MAP)in the two groups were ob-served and recorded.The anesthetic effect,dosage of remifentanil,quality of anesthesia recovery,postoperative analgesic effect and incidence of perioperative adverse reactions(respiratory depres-sion,nausea and vomiting,pruritus,etc.)were ob-served in the two groups.RESULTS:Compared with group C,the incidence of intraoperative respiratory depression was significantly decreased,the intraop-erative consumption of remifentanil was de-creased,and the postoperative recovery time was shortened in group E(P＜0.05).The VAS scores of rest and cough pain and the incidence of postoper-ative nausea and vomiting were significantly de-creased in group E(P＜0.05).There was no signifi-cant difference in HR and MAP between the two groups(P＞0.05).CONCLUSION:Ultrasound-guided ESPB in ESWL for pancreatic duct stones is satisfac-tory and can save opioids with few complications.