As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective:To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods:One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups ( n=75) using a random number table: esketamine group (group E) and control group (group C). Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration. After the delivery of the fetus, 0.15 mg/kg (1 mg/ml) esketamine was pumped intravenously for 30 min in the group E, while the same dosage of normal saline was administered in the group C. Furthermore, patients received an intravenous patient controlled intravenous analgesia (PCIA) pump after surgery (100 μg sufentanil + 1.25 mg/kg esketamine + 8 mg ondansetron for the group E, 100 μg sufentanil + 8 mg ondansetron for the group C). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in the initial time of esketamine administration, and 5, 15 min, and 30 min after administration. The pain Numerical Rating Scale (NRS) score at rest and during coughing were recorded at 2, 6, 12, 24 h and 48 h after surgery. The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h, 12-24 h, 24-48 h, 0-24 h and 0-48 h after surgery. Moreover, we recorded the incidence of chronic pain at 3 and 6 months after surgery. Results:There were no significant differences in HR, SBP and DBP between the two groups immediately after administration of esketamine and 5, 15 min and 30 min after administration (all P>0.05). At rest or during coughing, the pain NRS score were significantly lower at 2, 6 h, and 12 h postoperatively in group E compared to group C (all P<0.05). The time to first analgesia in group E was significantly longer than the group C [(176.8±18.3)min vs (148.5±16.9)min, P<0.05]. The cumulative sufentanil consumption was significantly lower in group E during 0-12 h, 12-24 h, 0-24 h and 0-48 h postoperatively than in group C (all P<0.05), but there was no statistical significance between the two groups at 24-48 h ( P>0.05). There were no significant difference between the two groups in the incidence of chronic pain at 3 months and 6 months after surgery ( all P>0.05). The incidence of chronic pain in group E was lower than that in group C at 3 months [13.4%(9/67) vs 18.8%(13/69), P=0.392] and 6 months [10.7%(6/56) vs 16.1%(10/62), P=0.391], but the difference was not statistically significant. Conclusions:Perioperative administration of esketamine provided superior short-term analgesia after cesarean section and did not increase the psychotomimetic adverse event rate. However, the development of chronic pain was not restrained.

Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.

Objective:To analyze the characteristics of adults (non-pregnant women) infected with Listeria monocytogenes and to provide evidence for diagnosis and treatment of this disease. Methods:Patients admitted in West China Hospital of Sichuan University between January 2008 and April 2020 with Listeriadisease were enrolled in this study. The clinical data of patients including age, symptoms, underlying diseases and prognosis, as well as the laboratory results of WBC, neutrophil ratio (N%), procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), were obtained for analyzing the clinical infection and prognosis characteristics of the patients. Results:A total of 57 patients were included, patients were 18-83 (52.8±15.9) years old, percent of over 60 years old patients accounted for 35.09% (20/57). The incidence rate in summer season was the highest (45.61%, 26/57). There were 48 cases with comorbidities, sepsis occurred in 31 cases and meningitis in 18 cases. The time of diagnosis of Listeriosis was (6.1±2.9) days. After diagnosis, the target therapy was applied: such as carbapenem (26.32%, 15/57) and penicillins (22.81%, 13/57). The levels of WBC (6.77 [2.99, 9.54]×10 9/L vs 10.23 [6.71, 16.55]×10 9/L), NLR (3.07 [1.66, 8.16] vs 11.26 [5.66, 20.08]) and CRP (40.7 [16.9, 91.9] g/L vs 92.8 [59.9, 142.7] g/L) were significantly lower after treatment than those before treatment in 47 hospitalized patients (all P<0.05). Thirty-eight patients were treated according to the guidelines, 33 cases improved, 2 cases had poor prognosis and 2 cases died. Conclusion:The main risk factors of Listeria monocytogenes infection in adults (non-pregnant women) are underlying diseases, especially autoimmune diseases and pulmonary infections. Penicillins can be used as the first choice for empirical therapy. Carbapenems and erythromycin serve as the combination medications during the full course of treatment.

Objective:To study the impact of perioperative intestinal microecological intervention on abdominal infection after liver transplantation.Method:Fifty patients who underwent liver transplantation at the Department of Hepatobiliary Surgery, Ningbo Medical Center Lihuili Hospital from June 2017 to June 2019 were retrospectively studied. There were 34 males and 16 females. The average age was 47 years. These patients were divided into two groups using the method of non-randomized concurrent control. One group formed the perioperative intestinal microbiological intervention group, while the other group served as the conventional treatment control group. There were 25 patients in each group. The preoperative and postoperative intestinal flora and the occurrence of postoperative abdominal infection of the two groups were compared.Results:After operation in both groups, enterococci increased, enterobacteriaceae decreased, while non-fermenting bacteria and candida showed no significant changes. In the intervention group, the counts of enterobacter, enterococcus and candida were significantly lower than the control group on day 15 after operation ( P<0.05). The contents of bifidobacteria and lactobacillus in the intervention group were significantly higher than that in the control group on days 7 and 15 after operation. On the other hand, the contents of enterobacter on day 7 and enterococcus on day 15 after operation in the intervention group were significantly lower than the control group ( P<0.05). The intestinal flora of the two groups were imbalanced before liver transplantation. The ratio of bifidobacterium / enterobacteriaceae in the intervention group was significantly higher than the control group on day 7 and 15 after operation ( P<0.05). The incidence of intestinal bacterial translocation in the control group was 32.0% (8/25), with 6 patients diagnosed to have abdominal infection caused by intestinal bacterial translocation. The incidence of intestinal bacterial translocation was 8% (2/25) in the intervention group, with 1 patient diagnosed to have abdominal infection caused by intestinal bacterial translocation. The incidence of bacterial translocation in the intervention group was significantly lower than the control group ( P<0.05). There were no significant differences in the incidences in the intestinal bacterial translocation and abdominal infection between the two groups ( P>0.05). Conclusions:Probiotics intervention in the perioperative period of liver transplantation improved the imbalance of intestinal flora, reduced the incidence of intestinal bacterial translocation, and played a positive role in reducing abdominal infection after liver transplantation.

Objective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.Methods Seventy five patients, aged 40-65 years, BMI 18-24 kg/m2, ASA physical statusⅠ orⅡ, scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups (n = 25 each) using a random number table:morphine group (group M), oxycodone with background infusion group (group O1) and oxycodone without background infusion group (group O2).The anesthesia was induced by intravenous fentanyl 4μg/kg, propofol 2-2.5 mg/kg and cisatracurium 0.2 mg/kg.Group M was given morphine 50 mg+ondanstron 8 mg in100 ml normal saline, groups O1 and O2 were given oxycodone 50 mg+ ondanstron 8 mg in 100 ml normal saline.The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 2 ml/h.Group O2 was set up with a 4 ml bolus dose, a 5 min lockout interval and without background infusion.The NRS scores of three groups at 4, 8, 12, 24 and 48 hafter operation were recorded.The total morphine or oxycodone consumption, and the number of rescue analgesia within 48 hafter surgery were recorded.The adverse events within 48 hafter surgery were also observed.Results Compared with group M, the NRS scores at rest were significantly decreased at 4, 8, and 12 hafter operation (P<0.05), and the NRS scores at movement were significantly decreased at 4 and 8 hafter operation (P<0.05), and the number of rescue analgesia within 48 hafter surgery was significantly decreased in groups O1 and O2 (P<0.05).The total analgesic consumption and the incidence of adverse event within 48 hafter surgery in group O2 were significantly lower than those in groups M and O1 (P<0.05).Conclusion Compared with morphine, oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery.Meanwhile, the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased.

Objective To establish a quality control method for bomeol and artificial musk in Xinfufang-Zhenzhusan and Xinfufang-Zhenzhugao.Methods We used petroleum ether-toluene-ethyl acetate (9:3:2)as developer for TLC to identify isoborneol and borneol and petroleum ether-dichloromethane (2:3) as developer for TLC to identificate musk ketone.Agilent 7890 B gas chromatograph,FDI detector;Column:Thermo-TG-WaxMS GC (0.25 mm × 30 m,0.25 mm) was employed;the carrier gas was high purity nitrogen and flow rate for 1 mg/ml,the injection port temperature is 200 C and detector temperature is 250 ℃;the split ratio is 10:1 and injection volume was 1 μl,using temperature programmed.Results The isoborneol,borneol and musk ketone in the range of 0.001-10 mg/ml showed good linearity.The recovery of the method is in the range of 95 ％ to 105 ％.The TLC for isobomeol,bomeol,musk ketone can be identified easily.Conclusions The method was simple and reasonable,which can be used for the quality control of borneol and artificial musk in the Xinfufang-Zhenzhusan and Xinfufang-Zhenzhugao.

Objective To evaluate the nucleated red blood cell (NRBC)count of Sysmex XN-9000 automatic hematology anal-ysis lines comparing with manual method,and verify the accuracy of the analyzer results.Methods 60 blood samples with more than 1% of NRBCs detected by XN-9000 were counted NRBCs by traditional manual microscopy in blood smears,and verified the analyzer results.Results According to the reliability analysis,the results of total 60 samples were all within the range of the reliability;correlation analysis showed that correlation coefficient (r)of group NRBC (%)1~10 and>10 were 0.972 1 and 0.996 2,respectively.There were no significant differences between them (P>0.05).Conclusion Compared with manual method,the results of NRBC count of XN-9000 were within the range of reliability,and showed good correla-tion.The analyzer test results of NRBC were accurate and reliable and could be applied to the detection of clinical samples.