Objective To explore the safety and feasibility of posterior quadratus lumborum block(PQLB)in patients undergoing laparoscopic myomectomy.Methods A retrospective analysis was conducted on clinical data of 62 gynecological patients who underwent laparoscopic myomectomy from July 2021 to July 2024.The patients were divided into two groups based on the preoperative blocking method:the PQLB group and the transversus abdominis plane block(TAP)group,with 31 patients in each group.In the PQLB group,bilateral PQLB was performed under ultrasound guidance with 20 ml of 0.35％ropivacaine on each side.In the TAP group,bilateral transversus abdominis plane blocks were performed under ultrasound guidance with 20 ml of 0.4％or 0.5％ropivacaine on each side.The mean arterial pressure and heart rate were recorded before anesthesia(T0),at the time of the block(T1),at skin incision(T2),and during the recovery period(T3).The local anesthetic toxicity,nerve injury,intraoperative opioid consumption,postoperative remedial analgesic usage and dosage,as well as the incidence of nausea and vomiting,were monitored.Results The operations were successfully completed in all the 62 patients.No significant differences were observed between the two groups in mean arterial pressure(F=0.323,P=0.572)and heart rate(F=0.195,P=0.660)at 4 different time points.There were no significant differences in the dosage of anesthetic analgesics during surgery(Z=-0.458,P=0.647)and length of hospital stay(Z=-1.652,P=0.099)between the two groups.The postoperative remedial analgesic usage rate in the PQLB group was significantly lower than that in the TAP group(32.3％vs.74.2％,x2=10.949,P=0.000).Within 48 h after operation,the use of non-steroidal anti-inflammatory drugs(NSAIDs)dosage in the PQLB group was significantly lower than that in the TAP group[0(0,0)mg vs.400(0,1600)mg,Z=-4.849,P=0.000],and no significant difference was observed between the two groups in the use of opioid(tramadol)dosage(Z=-0.045,P=0.964).There was no significant difference in the incidence of postoperative nausea and vomiting(P＞0.05).The scores of numeric rating scale for abdomial wall pain and visceral pain in the PQLB group at 12 and 24 h after surgery did not exceed 3 points.No local anesthetic toxicity or nerve injury was observed.Conclusion PQLB provides effective analgesia for patients undergoing laparoscopic myomectomy,offering better control of visceral pain,helping reduce intraoperative opioid consumption,and lowering the risk of postoperative adverse reactions.

Objective To explore the safety and feasibility of posterior quadratus lumborum block(PQLB)in patients undergoing laparoscopic myomectomy.Methods A retrospective analysis was conducted on clinical data of 62 gynecological patients who underwent laparoscopic myomectomy from July 2021 to July 2024.The patients were divided into two groups based on the preoperative blocking method:the PQLB group and the transversus abdominis plane block(TAP)group,with 31 patients in each group.In the PQLB group,bilateral PQLB was performed under ultrasound guidance with 20 ml of 0.35％ropivacaine on each side.In the TAP group,bilateral transversus abdominis plane blocks were performed under ultrasound guidance with 20 ml of 0.4％or 0.5％ropivacaine on each side.The mean arterial pressure and heart rate were recorded before anesthesia(T0),at the time of the block(T1),at skin incision(T2),and during the recovery period(T3).The local anesthetic toxicity,nerve injury,intraoperative opioid consumption,postoperative remedial analgesic usage and dosage,as well as the incidence of nausea and vomiting,were monitored.Results The operations were successfully completed in all the 62 patients.No significant differences were observed between the two groups in mean arterial pressure(F=0.323,P=0.572)and heart rate(F=0.195,P=0.660)at 4 different time points.There were no significant differences in the dosage of anesthetic analgesics during surgery(Z=-0.458,P=0.647)and length of hospital stay(Z=-1.652,P=0.099)between the two groups.The postoperative remedial analgesic usage rate in the PQLB group was significantly lower than that in the TAP group(32.3％vs.74.2％,x2=10.949,P=0.000).Within 48 h after operation,the use of non-steroidal anti-inflammatory drugs(NSAIDs)dosage in the PQLB group was significantly lower than that in the TAP group[0(0,0)mg vs.400(0,1600)mg,Z=-4.849,P=0.000],and no significant difference was observed between the two groups in the use of opioid(tramadol)dosage(Z=-0.045,P=0.964).There was no significant difference in the incidence of postoperative nausea and vomiting(P＞0.05).The scores of numeric rating scale for abdomial wall pain and visceral pain in the PQLB group at 12 and 24 h after surgery did not exceed 3 points.No local anesthetic toxicity or nerve injury was observed.Conclusion PQLB provides effective analgesia for patients undergoing laparoscopic myomectomy,offering better control of visceral pain,helping reduce intraoperative opioid consumption,and lowering the risk of postoperative adverse reactions.

Objective:To explore the application effectiveness of multidisciplinary team(MDT)in the diagnosis and treatment of chronic refractory wounds,and to provide new ideas for optimizing the clinical diagnosis and treatment of such diseases.Methods:A retrospective analysis was performed on the clini-cal data of patients with chronic refractory wounds who underwent surgery at Peking University Third Hos-pital from January 2015 to October 2023,and a total of 456 patients,including 290 males and 166 females,with an average age of(49.4±16.9)years.According to whether preoperative MDT discussion was conducted,the patients were divided into MDT discussion group and non-MDT discussion group.The overall implementation process of MDT included:Starting and recording with the medical office,collec-ting data and discussing the initial MDT,informing the patient of the treatment plan and strictly imple-menting it,and the change of the condition needs to be discussed again by MDT.The general clinical da-ta,anesthesia risk grade,complications(hypertension,diabetes,coronary heart disease),and the etiology and location of chronic refractory wounds between the two groups were compared.The main observational measurements and outcome indicators of treatment effectiveness included the number of sur-geries required to achieve wound healing after admission,the recurrence rate after wound healing,the incidence of perioperative complications(pulmonary infection,severe cardiovascular event,vein thrombus embo-lism,cerebral stroke and delirium,etc.),and patient satisfaction score.Results:There were 189 patients in the MDT discussion group and 267 patients in the non-MDT discussion group.There was no significant statistical difference in the clinical data,such as age,gender,body mass index,American Society of Anesthesiologists,comorbidities,etiology,and location of chronic refractory wounds between the two groups(P＞0.05).The average number of surgeries required for wound healing in MDT discussion group and non-MDT discussion group was 2.1±1.1 and 2.8±1.6,respectively,with a sta-tistically significant difference(P＜0.001).This difference was also significant in chronic refractory wounds caused by three etiologies:Diabetic ulcer,infection after trauma or surgery,and non-union after radiotherapy(P＜0.05).The recurrence rate of the patients in the non-MDT discussion group after wound healing was 18.0％,slightly higher than that in the MDT discussion group of 14.3％(P＞0.05).In terms of perioperative complications,the non-MDT discussion group also had a higher incidence(3.7％vs.2.6％),but the difference was not statistically significant(P＞0.05).In terms of patient satisfac-tion,the MDT discussion group scored significantly higher(96.5 vs.91.1,P=0.028).Conclusion:The MDT mode can significantly reduce the number of surgeries for patients with chronic refractory wounds,improve the effectiveness of therapy and increase patient satisfaction.It is a recommended model for optimizing the clinical diagnosis and treatment effectiveness of chronic refractory wounds.

Piezo1 is a mechanosensitive ion channel protein widely expressed in mammalian cells with the function of sensing mechanical stimuli and of mediating signaling,and is embedded in the membranes of erythrocytes,the major cellular component of blood.Piezo1 regulates the morphology and function of erythrocytes by mediating the in-flux of Ca2+into the cell in crosstalk with the Gardos channel(KCa3.1),constituting the"Piezo1-Ca2+-Gardos channel axis".However,when Piezo1 is abnormally expressed or over-activated by its specific agonist(Yoda1),it can also lead to abnormal erythrocyte morphology and dysfunction,and even cause the development of related he-reditary diseases.

Objective:To investigate the incidence and potential risk factors associated with postopera-tive spinal epidural hematoma(SEH)following anterior cervical spine surgery(ACSS).Methods:A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022.Patients who developed postoperative SEH were categorized as the SEH group,while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator,same gender,same surgery year,and similar age(±5 years)at a ratio of 4:1.The general condition,pre-operative comorbidities,anticoagulant or antiplatelet therapy,preoperative coagulation and platelet counts,American society of Anesthesiologists physical status classification,cervical spondylosis classifi-cation,preoperative modified Japanese Orthopaedic Society score and cervical disability index score,sur-gical modality,surgical segment levels,ossification of the posterior longitudinal ligament among the surgi-cal level,surgery duration,estimated blood loss,postoperative drainage volume,preoperative mean arte-rial pressure,mean arterial pressure during postoperative awakening periods,hospital stay and hospitali-zation cost were compared between the two groups.A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH.Receiver operating characteristic curve and area under the curve(AUC)were used to describe the dis-crimination ability of the indicators.Results:A total of 85 patients were enrolled in the study,including 17 patients in the SEH group and 68 patients in the non-SEH group.Seventeen patients with SEH under-went hematoma evacuation,and all of them were successfully treated and discharged from the hospital.Corpectomy(OR=7.247;95％CI:1.962-26.766;P=0.003)and the highest mean arterial pressure during awakening(OR=1.056;95％CI:1.002-1.113;P=0.043)were independent risk factors for SEH.The AUC values were 0.713(95％CI:0.578-0.848)and 0.665(95％CI:0.51-0.82)re-spectively.The patients with SEH had longer hospital stays(P＜0.001)and greater hospitalization costs(P=0.035).Conclusion:Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS.High-risk patients should be closely monitored during the perioperative period.

In total knee arthroplasty, perioperative analgesia is transforming into multimodal analgesia.As a significantly important part of fast track surgery ( FTS ) protocol, perioperative analgesia does affect the recovery of patients.We reviewed the advantages and disadvantages of perioperative ( pre-operative, intra-operative and post-operative ) analgesia in FTS protocols in total knee arthroplasty, including the latest progress of the field.

Objective To understand the current status of aloneness and analyze the influencing factors,and to provide reference to improve the aloneness among middle?aged and elderly. Methods A total of 994 middle?aged and elderly in Donggang sampled by stratified random sampling method were investigated by UCLA scale. The influencing factors were assessed by t?test and one?way ANOVA. The data were analyzed by SPSS 16.0. Results The average score of UCLA scale among middle?aged and elderly was 41.54 ± 8.91. The results indicated whether living with their children,alcohol drinking,quality of sleep,history of trauma,psychological counseling,monthly income,chronic disease and physical training were the influencing factors of aloneness among middle?aged and elderly,and the differences were statistically significant(P<0.05). Conclusion The aloneness was obvious among middle?aged and elderly in China. Health interventions and effective social support should be provided to improve the physiological,psychological and economic levels that will lead to important influence on the improvement of aloneness among middle?aged and elder?ly in China.