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Objective:To investigate the effect of ultrasound-guided lower transverse abdominal muscle plane (TAP) block combined with esketamine intravenous controlled analgesia on postoperative patients with colorectal cancer (CRC) .Methods:A total of 120 CRC patients admitted to Linyi Central Hospital from Aug. 2022 to Aug. 2024 were selected and divided into control group and observation group according to random number table method, with 60 cases in each group. The control group received esketamine intravenous controlled analgesia, and the observation group was combined with TAP under ultrasound guidance on the basis of the control group. The postoperative recovery, pain numerical score (NRS), heart rate and mean arterial pressure of 1h, 8h and 48h were compared between the two groups. The levels of serum interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1 β (IL-1 β) and adverse reactions were compared before anesthesia (T0), 24h (T1) and 48h (T2) after surgery. Results:The feeding time and the first exhaust time in the observation group were shorter than those in the control group ( P<0.05). The NRS scores of the observation group were lower than those of the control group at 1h, 8h and 48h after operation ( P<0.05). The heart rate and mean arterial pressure of both groups increased at 8h and 48h after surgery, and the observation group was lower than the control group ( P<0.05). Serum IL-6, IL-10 and IL-1 β in both groups were higher than those in T0 at T1 and T2, and IL-6 and IL-1 β in observation group were lower than those in control group, and IL-10 was higher than those in control group ( P<0.05). The incidence of adverse reactions in observation group was lower than that in control group ( P<0.05) . Conclusion:Ultrasound-guided TAP combined with esketamine intravenous controlled analgesia can effectively accelerate the postoperative recovery of CRC patients, reduce the level of pain, and alleviate the inflammatory response of the body, with high safety.

Objective:To investigate the effect of ultrasound-guided lower transverse abdominal muscle plane (TAP) block combined with esketamine intravenous controlled analgesia on postoperative patients with colorectal cancer (CRC) .Methods:A total of 120 CRC patients admitted to Linyi Central Hospital from Aug. 2022 to Aug. 2024 were selected and divided into control group and observation group according to random number table method, with 60 cases in each group. The control group received esketamine intravenous controlled analgesia, and the observation group was combined with TAP under ultrasound guidance on the basis of the control group. The postoperative recovery, pain numerical score (NRS), heart rate and mean arterial pressure of 1h, 8h and 48h were compared between the two groups. The levels of serum interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1 β (IL-1 β) and adverse reactions were compared before anesthesia (T0), 24h (T1) and 48h (T2) after surgery. Results:The feeding time and the first exhaust time in the observation group were shorter than those in the control group ( P<0.05). The NRS scores of the observation group were lower than those of the control group at 1h, 8h and 48h after operation ( P<0.05). The heart rate and mean arterial pressure of both groups increased at 8h and 48h after surgery, and the observation group was lower than the control group ( P<0.05). Serum IL-6, IL-10 and IL-1 β in both groups were higher than those in T0 at T1 and T2, and IL-6 and IL-1 β in observation group were lower than those in control group, and IL-10 was higher than those in control group ( P<0.05). The incidence of adverse reactions in observation group was lower than that in control group ( P<0.05) . Conclusion:Ultrasound-guided TAP combined with esketamine intravenous controlled analgesia can effectively accelerate the postoperative recovery of CRC patients, reduce the level of pain, and alleviate the inflammatory response of the body, with high safety.

Objective: This study uses structural magnetic resonance imaging to explore changes in the cerebellar lobules in patients with autism spectrum disorder (ASD) and further analyze the correlation between cerebellar structural changes and clinical symptoms of ASD. Methods: A total of 75 patients with ASD and 97 typically developing (TD) subjects from Autism Brain Imaging Data Exchange dataset were recruited. We adopted an advanced automatic cerebellar lobule segmentation technique called CEREbellum Segmentation to segment each cerebellar hemisphere into 12 lobules. Normalized cortical thickness of each lobule was recorded, and group differences in the cortical measures were evaluated. Correlation analysis was also performed between the normalized cortical thickness and the score of Autism Diagnostic Interview-Revised. Results: Results from analysis of variance showed that the normalized cortical thickness of the ASD group differed significantly from that of the TD group; specifically, the ASD group had lower normalized cortical thickness than the TD group. Post-hoc analysis revealed that the differences were more predominant in the left lobule VI, left lobule Crus I and left lobule X, and in the right lobule VI and right lobule Crus I. Lowered normalized cortical thickness in the left lobule Crus I in the ASD patients correlated positively with the abnormality of development evident at or before 36 months subscore. Conclusion These results suggest abnormal development of cerebellar lobule structures in ASD patients, and such abnormality might significantly influence the pathogenesis of ASD. These findings provide new insights into the neural mechanisms of ASD, which may be clinically relevant to ASD diagnosis.

Objective:To explore new head nurses' demands of training and construct the theoretical framework of training demands of new head nurses. In order to provide reference for management department about making training plans and improving the competence of new head nurses.Methods:From November 2018 to March 2019, semi-structured in-depth interviews were conducted with 15 new head nurses in a ClassⅢ Grade A hospital in Beijing by using the objective sampling method. The data were sorted out and analyzed by the grounded theory, the themes were separated out and then the training model is built.Results:34 concepts, 13 categories and 4 main categories were extracted. The core categories including external-driven, self-development, training needs and key elements of training. Eventually, the theoretical framework of training demands in new head nurses was developed.Conclusions:Under the role of external drive and self-development, the new head nurse has a strong desire for training. The management department should formulate training strategies according to the specific needs of the new head nurse to meet their training intentions, help them adapt to the working environment as soon as possible and promote the development of their own education.

Objective: To evaluate the outcome of combination of haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT) with an unrelated cord blood unit for severe aplastic anemia (SAA). Methods: The clinical data of 127 SAA patients [including 74 male and 53 female patients, 65 very severe aplastic anemia (vSAA), the median age as 23.5(3-54) years] received HID-HSCT from September 2011 to April 2017 were analyzed retrospectively. The median interval from SAA diagnosis to transplantation was 2 (0.5-180) months. The conditioning was modified Bu/Cy+ATG/ALG-based (Busulfan + cyclophosphamide + antithymocyte immunoglobulin/antilymphocyte immunoglobulin) regimen. Cord blood units were selected based on the results of HLA typing and cell doses evaluated before freezing. Units with at least 4/6 matched HLA loci became the candidates. Prophylaxis for graft-versus host disease (GVHD) was by cyclosporine (CsA), mycophenolate mofetil (MMF) plus short-term methotrexate (MTX). Results: The median values of absolute nucleated cell counts were 10.87 (3.61-24.00)×10⁸/kg in the haploidentical grafts and 2.22 (1.10-7.30)×10⁷/kg in the cord blood units, respectively. The median doses of CD34⁺ cells infused were 3.49(1.02-8.89) ×10⁶/kg in the haploidentical grafts and 0.56 (0.16-2.27) ×10⁵/kg in the cord blood units, respectively. Of the 127 patients, 5 patients occurred early death, one patient occurred primary graft failure. All 121 surviving patients attained complete haploidentical engraftment. The median durations of myeloid engraftment were 11 (9-28) days and 15 (9-330) days for platelets, with a cumulative platelet engraftment incidence of 96.1%. The incidence of infection was 58.27% (74/127). During a median follow-up of 20.5 (4-60) months, the incidence of grade Ⅱ-Ⅳ acute GVHD was 24.79% (30/121), moderate-severe chronic GVHD was 14.15% (15/106), 4-year estimated overall survival was (78.5±4.3) %, 4-year estimated failure-free survival was (77.4±4.3) %, respectively. Conclusion Combination of HID-HSCT and an unrelated umbilical cord blood unit was a feasible choice with favorable outcome for SAA patients without matched donors.

Objective To analyze the influence of validating the parental origin to the interpretation of clinical pathogenicity of total 54 copy number variations(CNV)with different clinical significance in 46 patients undergo chromosomal microarray analysis(CMA).Methods A retrospective study.This study enrolled 46 patients conducted in Department of Pediatric Endocrinology and Genetics of Shanghai Xinhua Hospital during the period of August 2014 to December 2015,involving 54 different CNVs detected by CMA.The parental origin of CNVs was examined by CMA or quantitative real-time polymerase chain reaction.Results Totally 54 different CNVs were found in 46 patients by CMA.Seventeen out of the 54 CNVs were pathogenic variations.After validating the parental origin,14 CNVs were proved de novo mutation,while 3 CNVs have maternal origin including 1q21.1 deletion syndrome,Xq27.3q28 and Xq22.1q22.3 duplications which inherited from maternal X chromosome.CNVs of 1q21.1 deletion syndrome often inherited from parents,and no phenotype appears on mother which may be due to the deactivation mechanism of duplications on mother′s X chromosome.Therefore,these 17 pathogenic variations were still considered to be clinical pathogenic significance after validating the parental origin.Ten out of 54 CNVs were variants of uncertain significance-likely pathogenic.After parental original validation,3 CNVs were proved de novo mutation considering likely pathogenic significance,while 7 CNVs have parental origin still judged to be unknown clinical pathogenicity.Twenty-seven out of 54 CNVs were variants of uncertain significance.After validating the parental origin,only 1 CNV was proved de novo mutation considering likely pathogenic significance,while all the others had parental origin considered to be variations likely benign.Conclusion CNVs reported as likely pathogenic should be validated the parental origin in order to further study their clinical pathogenicity,while variants of uncertain significance can preliminary clear its nature by validating parental origin.

OBJECTIVE:To promote rational drug use clinically. METHODS:Sampling rate of prescriptions in outpatient and emergency departments was no less than 1‰ of total prescriptions and no less than 100 prescriptions were reviewed every month;the sampling rate (according to the hospital records of discharge) of ward (district) doctor’s advice was no less than 1% and no less than 30 prescriptions were reviewed every month. According to drugs evaluation indicators of rational drug use,the prescrip-tions were analyzed statistically,immediate intervention and administrative intervention were adopted for irrational prescriptions and medical orders. RESULTS:The average qualified rate of outpatient prescriptions was 97.86%and 0.92%was non-standard prescrip-tions,1.20% was inappropriate prescriptions and 0.01% was extraordinary prescriptions. The non-standard prescriptions in the sec-ond half year were significantly lowered,with statistical significance(P<0.05). The inappropriate usage and dosage was not effec-tively controlled. The average qualified rate of medical orders was 96.30% and drug replacement withont any reference and incom-plete diagnosis in the second half year were significantly lowered,with statistical significance(P<0.05). The utilization rate of an-tibiotics in emergency department was 41.51%and the other indicators were basic standard. The qualified rate of Majing drugs’pre-scriptions was 81.60%and non-standard prescriptions accounted for 88.37%in the irrational prescriptions. CONCLUSIONS:Imme-diate intervention and administrative intervention have achieved some success. Immediate intervention has mainly reduced the non-standard prescriptions and administrative intervention has controlled some specific irrational prescriptions.

The ompA gene of Chlamyia psittaci in cows was amplified by PCR with primers designed based on those reported in GenBank.The amplified ompA gene was inserted into the bacterial plasmid vector pGEX-4T-1 and then transformed into E.coli BL21(DE3) with IPTG induction. The gene was derived from plasmid pMD18-T vector and then sequenced.It was demonstrated that this recombinant fusion protein of approximately 68kD in molecular mass was highly expressed in inclusion body and more pure proteins would be produced after purification.The fusion protein specifically reacted with positive sera of bovine Chlamydia as demonstrated by Western blotting. These results indicate that this recombinant fusion protein shows good reactivity and could be used to develop the diagnostic kit for bovine Chlamydia and genetic engineering vaccine.