Objective To assess effect of ultrasound-guided erector spinae plane block(ESPB)combined with patient controlled intravenous analgesia(PCIA)on postoperative analgesia after cesarean section.Methods A total of 120 full-term singleton pregnant women who underwent cesarean section under spinal anesthesia at Jiaxing Maternal and Child Health Care Hospital from May 2022 to August 2023 were selected.Participants were randomly divided into three groups using a random number table:Group E(ESPB combined with PCIA),group T[transversus abdominis plane(TAP)block combined with PCIA],and control group(PCIA alone),with 40 women in each group.Visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)scores during rest and coughing were recorded at 4h,8h,12h,24h,and 48h postoperatively.Number of effective PCIA presses,total sufentanil dosage,proportion of rescue analgesia and maternal satisfaction were also documented within 48h.Additionally,adverse reactions and neonatal outcomes were observed within the same 48h period.Results Postoperatively,VAS scores for rest and coughing in group E at 8h,12h,24h were significantly lower than those in group T,those in two groups were lower than those in control group(P＜0.05).Postoperatively at 8h,12h,and 24h,BCS scores in group E were significantly higher than those in group T,with both higher than those in control group(P＜0.05).Within 48h after surgery,the number of effective PCIA presses,proportion of rescue analgesia and total sufentanil dosage in group E were lower than those in group T,both lower than those in control(P＜0.05).Moreover,maternal satisfaction score in group E was significantly higher than that in group T,that in two groups was significantly higher than that in control group(P＜0.05).Within 48h after surgery,there were no significant differences in adverse reactions or neonatal outcomes among the three groups(P＞0.05).Conclusion Ultrasound-guided ESPB combined with PCIA outperforms TAP block combined with PCIA,with reducing analgesic dose and enhancing maternal satisfaction and comfort.

The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.

OBJECTIVE: To evaluate the performance of recombinase-aided amplification (RAA) assay in detection of Clonorchis sinensis metacercariae in freshwater fish samples, so as to provide insights into standardization and field application of this assay. METHODS: Wild freshwater fish samples were collected in the rivers of administrative villages where C. sinensis-infected residents lived in Jiangyan District, Xinghua County and Taixing County of Taizhou City, Jiangsu Province from June to September 2022. Genomic DNA was extracted from six freshwater fish specimens (5 g each) containing 0, 1, 2, 4, 8 and 16 C. sinensis metacercariae for fluorescent RAA assay, and the diagnostic sensitivity was evaluated. Fluorescent RAA assay was performed with genomic DNA from C. sinensis, Metorchis orientalis, Haplorchis pumilio and Centrocestus formosanus metacercariae as templates to evaluate its cross-reactions. In addition, the detection of fluorescent RAA assay and direct compression method for C. sinensis metacercariae was compared in field-collected freshwater fish samples. RESULTS: Positive amplification was found in fresh-water fish specimens containing different numbers of C. sinensis metacercariae, and fluorescent RAA assay was effective to detect one C. sinensis metacercaria in 5 g freshwater fish specimens within 20 min. Fluorescent RAA assay tested negative for DNA from M. orientalis, H. pumilio and C. formosanus metacercariae. Fluorescent RAA assay and direct compression method showed 5.36% (93/1 735) and 2.88% (50/1 735) detection rates for C. sinensis metacercariae in 1 735 field-collected freshwater fish samples, with a statistically significant difference seen (χ² = 478.150, P < 0.001). There was a significant difference in the detection of C. sinensis metacercariae in different species of freshwater fish by both the direct compression method (χ² = 11.20, P < 0.05) and fluorescent RAA assay (χ² = 20.26, P < 0.001), and the detection of C. sinensis metacercariae was higher in Pseudorasbora parva than in other fish species by both the direct compression method and fluorescent RAA assay (both P values < 0.05). CONCLUSIONS Fluorescent RAA assay has a high sensitivity for detection of C. sinensis metacercariae in freshwater fish samples, and has no cross-reactions with M. orientalis, H. pumilio or C. formosanus metacercariae. Fluorescent RAA assay shows a higher accuracy for detection of C. sinensis infections in field-collected freshwater fish than the direct compression method.
Animals ; Clonorchis sinensis/genetics* ; Metacercariae/genetics* ; Recombinases ; Fresh Water ; Fishes ; DNA ; Fish Diseases/diagnosis*

Optimizing pre-hospitalized services is a powerful measure for hospitals to improve patient experience. In June 2022, a certain maternal and child health hospital had carried out a value chain management for pre-hospitalized patient communication based on patient needs. The Kano model and value chain theory were used to analyze the patient demand attributes, clarify the value-added activities of pre-hospitalized patient communication value chain, and implement value-added activities, including carrying out the GLTC doctor-patient communication model, optimizing the information management system of the admission preparation center, establishing a hospital preparation group management platform, and introducing the " Zhejiang Nursing" platform, to achieve the added value of key value chains in patient communication, improve the quality of pre-hospitalized services, and improve patient experience. After one year of practice, the pre-hospitalized patient management indexes, including the unregistration rate after issuing the hospitalization certificate, the cancellation rate after registration, and the average length of stay had decreased from 9%, 3%, and 4.65 days before practice (June 2021 to May 2022) to 6%, 1%, and 4.13 days after practice (June 2022 to May 2023), respectively. As well as the timely completion rate of pre-hospital inspection and the average satisfaction rate of pre-hospitalized patients had increased from 93% and 94% to 98% and 97%, respectively. The practice had achieved good application effects, so as to provide references for improving the level of pre-hospitalized services and improving the patient experiences in medical institutions in our country.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

No abstract available.
Dermatitis, Contact ; Hyperthermia, Induced

Objective To observe the effect of costimulatory molecule B7-1 on cytoskeleton rearrangement in mouse podocytes induced by angiotensin Ⅱ (Ang Ⅱ),and to study the underlying molecular mechanism of B7-1 in the pathological changes of podocytes.Methods All cultivation of conditionally immortalized mouse podocytes (MPC) in vitro were divided into the following groups:normal control group,CTLA-4 group,Ang Ⅱ group (10-6 mmol/L 12 h,24 h;10-8 mmol/L 12 h,24 h) and CTLA-4 with Ang Ⅱ group.Transfect B7-1 RNA interference fragment (siRNA) to the mature podocytes,and then restimulated by Ang Ⅱ (10-6 mmol/L 12 h),the change of podocyte cytoskeleton after Ang Ⅱ stimulation were observed.The expression of B7-1 in each group was assayed by flow cytometry and Western blotting.The nephrin and p-nephrin protein levels in the four groups were also analyzed by Western blotting.At the same time,the podocyte cytoskeleton distribution as indicated by F-actin was observed by fluorescence microscopy.Results Flow cytometry and Western blotting showed that B7-1 was not expressed in the normal control group.Ang Ⅱ showed a concentration and time dependent induction of B7-1 expression in mouse podocytes (P ＜ 0.05).Western blotting indicated that Ang Ⅱ induced B7-1 protein expression (P ＜ 0.05).Expression of nephrin and p-nephrin was significantly down-regulated by Ang Ⅱ (P ＜ 0.05).Compared with the normal control group,the expression of podocyte protein nephrin and p-nephrin in Ang Ⅱ stimulation group was significantly reduced (P ＜ 0.05).Using FITC phalloidin fluorescence staining showed that CTLA-4+Ang Ⅱ stimulation group cytoskeleton rearrangement was improved significantly and F-actin recombinant score (mCFS) decreased compared with Ang Ⅱ group (P ＜ 0.05),suggesting that Ang Ⅱ led to the disorder of the podocytes cytoskeleton and the destruction of the cytoskeleton of podocytes by Ang Ⅱ could be improved after B7-1 blocking.Compared with the Ang Ⅱ stimulation,transfection of B7-1 siRNA + Ang Ⅱ stimulation group improved F-actin cytoskeletal rearrangement,and mCFS also decreased significantly (P ＜ 0.05),suggesting that transfection of B7-1 siRNA might improve the damage of Ang Ⅱ on podocytes cytoskeleton.Conclusions B7-1 participates in the process of cytoskeleton reconstruction and plays an important role in the pathological changes of podocytes.

Objective To evaluate the additional efficacy of local anesthetic injection (LAI) as a part of multimodal anal?gesia in patients undergoing total knee arthroplasty (TKA) with respect to pain, narcotic use, knee function and complications. Methods A multicenter randomized, controlled, double blind study was performed. A total of 101 patients undergoing unilateral TKA in two centers were randomly divided into injection group and control group. Injection group (50 cases) received local anes?thetic injection of ropivacaine (200 mg), fentanyl (1μg) and epinephrine (1∶1 000, 0.25 mg) in operation and control group (51 cas?es) did not. All patients received standardized general anesthesia and postoperative intravenous patient controlled analgesia (PCA). Preoperative baseline data, surgery?related conditions, postoperative pain (on a 0 to 10 scale), knee function, time of open?ing PCA, narcotic dosage in PCA and complications were compared respectively. Results The time of opening PCA in injection group (4-10 h, M=8 h) was longer than that in control group (2-5 h, M=4 h) (P<0.05). The 12 h, 24 h and total narcotic use of PCA in injection group (8.62±3.601 ml, 21.22±9.220 ml, 38.52±7.764 ml) was less than that in control group (18.43±9.671 ml, 35.30± 11.414 ml, 55.52±12.405 ml) (P<0.05). At post anesthesia care unit the mean VAS in injection group (2.40±1.927) was lower than that in control group (3.06 ± 2.073) (P<0.05). There was no difference in mean VAS at other time points, knee function, length of stay between two groups (P>0.05). Conclusion LIA in TKA can relieve pain early after TKA, prolong the time of opening PCA and reduce narcotic use compared with patients without it. It is simple and safe to use.

ObjectiveTo investigate the efficacy of along-meridian distal point selection in treating post-cerebral infarction shoulder-hand syndrome.MethodSixty patients with post-cerebral infarction shoulder-hand syndrome were randomly allocated to treatment and control groups, 30 cases each. The control group was treated by routine neurological medical treatment, conventional acupuncture for stroke-attack on meridians and rehabilitation training and the treatment group, by along-meridian distal point selection in addition. The therapeutic effects were evaluated in both groups after four courses of treatment. The VAS scores, affected-side hand swelling scores and upper limb FMA scores were compared between the two groups before and after treatment. ResultThe VAS score, affected-side hand swelling score and upper limb FMA score were significantly better in both groups after treatment than before (P<0.01). Post-treatment VAS score, affected-side hand swelling score and upper limb FMA score were significantly better in the treatment group than in the control group; there were statistically significant differences (P<0.01,P<0.05). ConclusionAlong-meridian distal point selection has clinically a better improving effect on the pain, affected-side hand swelling and upper limb function in patients with post-cerebral infarction shoulder-hand syndrome.

Objective To further elaborate the clinical characteristics,diagnosis,treatment and prognosis of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma.Methods The clinical characteristics,diagnosis and treatment of a patient with primary cutaneous invasive epidermotropic CD8 positive cytotoxicity T-cell lymphoma were summarized,and diagnosis and treatment of the disease from published literature were reviewed.Results After one year long,recurrence of exudative maculopapule on his body and limbs,a middle-aged male patient visited our hospital.Then,the patient was diagnosed as T2N0M0 Ⅰ phase of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma based on results of skin biopsy,immunohistochemistry,T-cell gene rearrangement and PET-CT.Through integrative medicine treatment (combination of bruceolic oil emulsion and chemotherapy with GDP regimen),the patient achieved complete remission (CR).The treatment and follow-up continues till now and his condition was stable.Conclusions Clinical occurrence of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma is rare and early diagnosis is difficult.It could be diagnosed with histopathology combined with T-cell gene rearrangement.In order to avoid misdiagnosis,great caution should be taken during disease history inquiry and physical examination,should be early lesion for delayed healing of recurrent lesions,biopsy should be conducted as soon as possible and immunohistochemistry should be performed simultaneously,which will provide a good basis for further treatment.