With the deepening of population aging， the number of disabled and semi-disabled elderly individuals continues to increase， and the ethical care issues of mental health services for the disabled elderly are becoming increasingly prominent. When examining ethical issues， the concept of the “holistic view of traditional Chinese medicine” from ancient Chinese traditional culture was explored. While applying theories from the holistic view of traditional Chinese medicine， such as “the unity of form and spirit” and “the integration of form and spirit，” emphasis should be placed on the organic integration of psychology and physiology. The mental health status of the disabled elderly can be comprehensively improved by addressing both internal and external environmental factors. In response to the current situation of mental health services for the disabled elderly， ethical care should be provided for the mental health services of the disabled elderly， focusing on the value of subjectivity， difference， and continuity in ethical care， thereby improving the mental health status of the disabled elderly.

Objective:To analyze the pregnancy outcomes in patients with positive anti-centromere antibodies(ACA)receiving in vitro fertilization(IVF)-embryo transfer(ET)and natural conception.Methods:A case-control study was used to retrospectively analyze the clinical data of 3955 patients who received IVF-ET therapy and had the results of antinuclear antibody(ANA)spectrum at Zhejiang Provincial People's Hospital from June 2016 to June 2023.Patients with positive ACA and negative ACA were matched at a ratio of 1∶3 using propensity score matching.Embryo outcomes of IVF were compared between the two groups,and the impact of different fertilization methods and the use of immunosuppressants on pregnancy outcomes were analyzed using self-matching.The natural conception and disease progress were followed up for ACA-positive patients after IVF failure.Results:The ACA-positive patients accounted for 0.86%of all IVF patients(34/3955)and 2.51%of total ANA-positive IVF patients.Regardless of whether patients received conventional IVF(c-IVF)or intracytoplasmic sperm injection(ICSI),the ACA-positive group exhibited significant differences in oocyte maturity and fertilization compared to the ACA-negative group(both P＜0.01).Moreover,the ACA-positive group had a decreased number of D3 suboptimal embryos and D3 optimal embryos(both P＜0.05).In 5 cases of ACA-positive patients who underwent ICSI cycles,the two pronucleus(2PN)rate did not increase compared to c-IVF cycles(P＞0.05),and there was a decrease in the number of D3 high-quality embryos and D3 suboptimal embryos(both P＜0.05).After 1-2 months of immuno-suppressant treatment,12 ACA-positive patients underwent c-IVF/ICSI again,and there were no changes in egg retrieval and fertilization before and after medication(both P＞0.05),but there was an improvement in the 2PN embryo cleavage rate(P＜0.05).The number of embryos transferred was similar between the ACA-positive and negative groups,but the ACA-positive group had significantly lower embryo implantation rate and clinical pregnancy rate compared to the ACA-negative group(both P＜0.05),with no significant differences in the miscarriage rate between the two groups(P＞0.05).Twenty-seven ACA-positive patients attempted natural conception or artificial insemination after IVF failure,resulting in a total of 7 cases of clinical pregnancy.Conclusions:Serum ACA positivity may disrupt oocyte maturation and normal fertilization processes,with no improvement observed with ICSI and immunosuppressant use.However,ACA-positive patients may still achieve natural pregnancy.

Objective To investigate the value of Thromboelastogram(TEG)combined with conventional coagulation indexes and peripheral blood inflammation indexes in the diagnosis of threatened abortion.Methods A total of 33 patients with threatened abortion who were treated in the hospital from July 1,2022 to July 1,2023 were selected as the study group,and 40 healthy pregnant women in the first and second trimester of pregnan-cy were randomly selected as the control group.The blood routine,C-reactive protein(CRP),routine coagula-tion indexes and TEG were detected in the two groups,and the diagnostic value of TEG,routine coagulation indexes and peripheral blood inflammatory indexes in threatened abortion was analyzed.Results D-dimer(DD),white blood cell count(WBC),neutrophil count(NEU),neutrophil to lymphocyte ratio(NLR),CRP,coagulation Angle(α),maximum amplitude(MA),coagulation comprehensive index(CI)in the study group were higher than those in the control group(P＜0.05).The coagulation reaction time(R)and blood clot for-mation time(K)in the observation group were lower than those in the control group(P＜0.05).The correla-tion analysis between TEG and conventional coagulation indexes and inflammatory indexes showed that R was positively correlated with prothrombin time(PT)and activated partial thromboplastin time(APTT)(P＜0.05),K was negatively correlated with fibrinogen(FIB)(P＜0.05),and α was positively correlated with FIB(P＜0.05).MA and CI were positively correlated with PLT and FIB(P＜0.05).R and K were negatively cor-related with WBC,NEU and NLR(P＜0.05),α was positively correlated with CRP,WBC,NEU and NLR(P＜0.05),MA and CI were positively correlated with WBC,NEU and NLR(P＜0.05).Receiver operating characteristic curve analysis showed that the area under the curve of DD,CRP,α and the combination of the three were 0.775,0.748,0.922 and 0.959,respectively(P＜0.001).Conclusion TEG can be used to evaluate the coagulation function of patients with threatened abortion,and its combination with conventional coagula-tion indexes and peripheral blood inflammation indexes can provide an important basis for clinical diagnosis of threatened abortion,and has certain guiding significance for clinical diagnosis and treatment.

Esketamine is a spin isomer of ketamine,which has the triple effect of sedation,analge-sia and amnesia,and is superior to ablative ketamine in terms of efficacy,controllability.It has been widely used in anesthesia,emergency and critical care in Europe and America,and is mostly used for sedation,analgesia and antidepressant in China.Esketamine is used in cardiac surgery to maintain stable hemodynam-ics,reduce the secretion of inflammatory factors and relieve postoperative pain.Its sympathomimetic effect allows it to be used for the induction of anesthesia in patients with hemodynamic instability and acute heart attack.This paper reviews the recent advance in the clinical value and limitations of esketamine in the perio-perative period of cardiovascular surgery and provides a reference for clinicians to use esketamine in the perioperative period of cardiovascular surgery.

Objective:To evaluate the effect of s-ketamine on perioperative myocardial injury in patients undergoing liver transplantation.Methods:This was a prospective randomized controlled study. Sixty American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ patients, aged 18-64 yr, with New York Heart Association classⅠ-Ⅲ, undergoing elective liver transplantation with general anesthesia in our hospital from May to October 2023, were divided into 2 groups ( n=30 each) using a random number table method: s-ketamine group (group S) and control group (group C). In group S, s-ketamine was intravenously injected at a dose of 0.5 mg/kg after induction of anesthesia, followed by an infusion of 0.5 mg·kg -1·h -1 until the end of surgery. The equal volume of normal saline was given instead in group C. Central venous blood samples were collected after induction of anesthesia (T 0), at 30 min of anhepatic phase (T 1), 30 min of neopepatic phase (T 2), abdominal closure (T 3), 24 h after operation (T 4) and 72 h after operation (T 5) for determination of the concentrations of serum high-sensitivity cardiac troponin I, creatine kinase-MB isoenzyme, N-terminal pro-B-type natriuretic peptide, tumor necrosis factor-α, interleukin-6 (IL-6), IL-10 and high-mobility group protein B1 by enzyme-linked immunosorbent assay. The occurrence of adverse cardiac events during surgery and within 24 h after surgery, postoperative mechanical ventilation time, time of intensive care unit stay, and postoperative length of hospital stay were recorded. Results:Compared with group C, the concentrations of serum high-sensitivity cardiac troponin I, creatine kinase-MB isoenzyme, N-terminal pro-B-type natriuretic peptide, tumor necrosis factor-α and IL-6 at T 2-5 and high-mobility group protein B1 at T 2-4 were significantly decreased, the concentrations of serum IL-10 were increased at T 2-5, the incidence of myocardial ischemia was decreased, the mechanical ventilation time was shortened ( P<0.05), and no significant change was found in the time of intensive care unit stay and postoperative length of hospital stay in S group ( P>0.05). Conclusions:Intraoperative usage of s-ketamine can inhibit the inflammatory responses and reduce perioperative myocardial injury in the patients undergoing liver transplantation.

Objective To explore the safety and mid-term efficacy of autologous hamstring tendon implantation in the treatment of severe anterior vaginal wall prolapse.Methods We performed a prospective single arm clinical study.From May 2021,pelvic organ prolapse(POP)patients with severe anterior vaginal wall prolapse as the main cause who had symptoms and required surgical treatment were included.The patient was fully informed and voluntarily selected autologous hamstring tendon implantation and high sacral ligament suspension.Postoperative follow-ups were carried out on the Pelvic Organ Prolapse Quantification(POP-Q),Pelvic Floor Distress Inventory-Short Form 20(PFDI-20),postoperative satisfaction score,and Patient Global Impression of Improvement(PGI-I).Function of the lower limb on the tendon removal side,as well as postoperative complications and re-operations were recorded.Results The operation time of tendon removal was(19.7±8.3)min,the operation time of pelvic floor was(122.1±37.8)min,the median intraoperative bleeding volume was 70 ml(range,50-400 ml),and there was no intraoperative co-morbidity or postoperative fever.A total of 12 cases were followed up for(26.4±2.5)months.The measured values of Aa,Ba,and C were 3(-1-3),5(2-10),and 4(-1-10)before operation and-3(-3-3),-3(-3-3),and-6(-6-3)at 24 months after operation,respectively,with significant difference(P＜0.05).The PFDI-20 scores of the 12 patients before surgery and at 24 months after surgery were 88.0 points(range,16.7-204.2 points)and 8.3 points(range,0-32.3 points),respectively,with significant difference(Z=-2.803,P=0.005).The PGI-I questionnaire showed 11 patients with significant improvement in postoperative symptoms and 1 patient with improvement.The satisfaction scores at 6 and 24 months after surgery were(4.8±0.4)points and(4.6±0.7)points,respectively.One patient experienced vaginal prolapse at 12 months after surgery,with a Ⅲ degree prolapse of the anterior wall and vaginal vault,the recurrence rate being 8.3％(1/12).Two patients had pulmonary embolism at 9 d and 2 weeks after surgery,with Clavien-Dindo Ⅱ and Ⅲ grades,and recovered after outpatient and hospitalization treatment.One patient was found fascia exposure at the vagina,and had improvement with medication treatment.All the patients had good wound healing at the tendon removal site,with normal muscle strength and lower limb activity.No re-operation was required due to recurrence or complications of tendon surgery.Conclusions Autologous hamstring tendon implantation is safe in the treatment of severe anterior vaginal wall prolapse with satisfactory mid-term efficacy.Before surgery,it is necessary to educate patients on lower limb exercise to prevent complications of venous thrombosis.

Objective:To explore risk factors of early acute kidney injury (AKI) after pediatric living donor liver transplantation (LT) and examine the effects on the prognosis of recipients.Methods:From January 2018 to December 2019, the relevant clinical data were retrospectively reviewed for 201 pediatric recipients of elective living donor LT. Post-LT AKI recipients were diagnosed and categorized according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria (2012). Based upon the presence or absence of AKI within 7 days post-LT, they were assigned into two groups of AKI (64 cases) and non-AKI (137 cases). Baseline profiles, preoperative results of major laboratory tests and operation-related parameters were compared between two groups. Univariate variables with statistical differences were included into binary Logistic regression model for multivariate analysis to identify the independent risk factors of early AKI post-LT. Prognostic data of recipients such as postoperative mechanical ventilation time, intensive care unit (ICU) stay time, total hospitalization stay, in-hospital mortality and 3-year postoperative mortality were compared between two groups. Survival analysis was conducted for pediatric recipients with different AKI grades.Results:The incidence of AKI within 7 days post-LT was 31.8% (64/201). Univariate analysis revealed significant inter-group differences in age, preoperative PELD score, diagnosis of biliary atresia, total bilirubin, cystatin C, operative duration and volume of blood loss ( P<0.001, P<0.001, P=0.002, P<0.001, P<0.001, P<0.001& P<0.001). Multi-factorial analysis showed that total bilirubin ( OR=1.154, 95% CI: 1.068-1.248, P<0.001), cystatin C ( OR=2.532, 95 % CI: 1. 627-3.939, P<0.001), operative duration ( OR=1.174, 95% CI : 1.064-1.295, P=0.001) and volume of blood loss ( OR=1.210, 95% CI : 1. 095-1.337, P<0.001) were independent risk factors of AKI within 7 days post-LT. As compared with non-AKI group, postoperative mechanical ventilation time and ICU stay time became markedly extended (178 vs 389 min, P<0.001 ; 2 vs 3 day, P<0.001) and mortality during hospitalization rose sharply (0.7% vs 7.8%, P=0.002) in AKI group. The survival rates of recipients during hospitalization in group non-AKI/AKI were 99.3% (136/137) and 96.8% (30/31, grade 1), 92.9 % (13/14, grade 2), 78.9% (15/19, grade 3 ). The survival rates of recipients 3 years post-LT in group non-AKI/AKI were 94.2% (129/137) and 96.8% (30/31, grade 1), 78.6% (11/14, grade 2), 73.7% (14/19, grade 3). Results of survival analysis indicated that, in group non-AKI and AKI (geade 1, 2, 3), survival rate of recipients during hospitalization and 3 years post-LT declined gradually ( χ2=21.102, P<0.001 ; χ2=13.316, P=0.004) . Conclusion:As one common complication after pediatric living donor LT, AKI adversely affects the prognosis of recipients. Elevated preoperative levels of total bilirubin and cystatin C, prolonged operative duration and greater volume of intraoperative blood loss may boost the postoperative risk of early AKI in pediatric recipients.

Objective:To explore the effect of esketamine on inflammatory cytokines and myocardial injury markers in children undergoing living-donor liver transplantation (LT).Methods:Considering the inclusion criteria, 50 children with biliary atresia were selected for living donor LT. They were equally randomized into two groups of control (C) and esketamine (E) (25 cases each). Esketamine 0.5 mg/kg was administered to group E during induction and continued at a dose of 0.5 mg·kg –1·h -1 after an induction of anesthesia. Group C provided the same dose of 0.9% sodium chloride injection during induction and then continued to pumping until the end of the procedure. Basic profiles of two groups were recorded. Hemodynamic parameters, such as heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP), were monitored at 5 min of anesthesia induction (T 0), 30 min of anhepatic phase (T 1), immediately after repercussion (T 2), 30 min of neohepatic phase (T 3) and end of surgery (T 4) in both groups. Central venous blood samples were collected at T 0, T 1, T 3 and T 4. Serum levels of cardiac troponin I (cTnI), creatine kinase isoenzyme-MB (CK-MB) ,tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were measured. The incidence of adverse cardiac events, postoperative mechanical ventilation time, ICU stay and hospitalization length were compared. Results:As compared with T 0, mean arterial pressure (MAP) at T 2 declined markedly in group E [(48.6±12.7) mmHg (1 mmHg=0.133 kPa) vs (55.6±10.7) mmHg, P<0.001] and C [(39.3±8.0) mmHg vs (53.2±9.4) mmHg, P<0.001 ] ;As compared with T 0, the TNF-α and IL-6 spiked at T 3 in group C [169.0 (207.1) ng/L vs 43.8 (26.4) ng/L, (132.63±51.75) ng/L vs (51.79±17.83) ng/L, P<0.001] and E [78.5 (138.8) ng/L vs 43.8 (26.4) ng/L, (87.44±32.17) ng/L vs (51.79±17.83) ng/L, P<0.001 ] ; In group C, the concentration of myocardial injury markers CK-MB and cTnI rose at T 3/T 4 compared with T 0[T 3 vs T 0: 5.7 (5.4) μg/L vs 4.0 (3.5) μg/L, 0.09 (0.08) μg/L vs 0.02 (0.02) μg/L; T 4 vs T 0: 5.3 (5.0) μg/L vs 4.0 (3.5) μg/L, 0.07 (0.08) μg/L vs 0.02 (0.02) μg/L, P<0.001 ]. In group E, the levels of CK-MB and cTnI were higher at T 3/T 4 than those at T 0[T 3 vs T 0: 7.0 (5.0) μg/L vs 4.6 (2.1) μg/L, 0.06 (0.09) μg/L vs 0.03 (0.04) μg/L; T 4 vs T 0: 5.4 (4.9) μg/L vs 4.6 (2.1) μg/L, 0.03 (0.06) μg/L vs 0.03 (0.04) μg/L; P<0.001]. Compared with group C, the MAP of E rose at T 1/T 2/T 3 [(58.8±10.3) mmHg vs (53.3±8.6) mmHg, P=0.048; (48.6±12.7) mmHg vs (39.3± 8.0) mmHg, P=0.003; (55.8±7.4) mmHg vs (51.5±7.3) mmHg, P=0.044]. Compared with group C, TNF-α and IL-6 decreased in E at T 3/T 4[T 3: 78.5 (138.8) ng/L vs 169.0 (207.1) ng/L, P=0.010; (87.44±32.17) ng/L vs (132.63±51.75) ng/L, P=0.017. T 4: 62.3 (118.3) ng/L vs 141.3 (129.2) ng/L, P=0.001; (74.34±26.38) ng/L vs (100.59±30.40) ng/L, P=0.002]. Compared with group C, cTnI decreased in E at T 3/T 4[0.06 (0.09) μg/L vs 0.09 (0.08) μg/L, P=0.014; 0.03 (0.06) μg/L vs 0.07 (0.08) μg/L, P=0.003]. Compared with group C, the mechanical ventilation time in group E decreased [195 (120) min vs 315 (239) min, P<0.001]. Compared with group C, the incidence of severe hypotension [16%(4/25) vs 48% (12/25), P=0.015 ], bradycardia [12% (3/25) vs 36 % (9/25), P=0.047 ], myocardial ischemia [4 % (1 /25) vs 24 % (6/25), P=0.042 ] and premature ventricular contractions [0 vs 4 %(1/25), P=0.312 ] decreased in group E. Conclusion:Intraoperative dosing of esketamine may suppress inflammatory reactions and alleviate perioperative myocardial injury in children undergoing living-donor LT.

ObjectiveTo investigate the pollution level of deoxynivalenol （DON） in wheat flour and its products sold in Shanghai， and to assess the health risks of DON exposure for residents in Shanghai who ingested DON from wheat flour and its products. MethodsRisk monitoring data of DON in wheat flour and its products sold in Shanghai from 2017 to 2021 were combined with the consumption data of wheat flour and its products by Shanghai residents. A probabilistic assessment method was used to assess dietary exposure of DON in wheat flour and its products. ResultsThe overall detection rate of DON in wheat flour and its products was 77.3% （1 041/1 347）， with a mean concentration of 226.3 μg·kg^-1， P₅₀ of 130.0 μg·kg^-1 and a maximum value of 3 080.0 μg·kg^-1. The mean daily exposure and 95th percentile daily exposure （by body weight） of DON from wheat flour and its products in Shanghai residents were 0.279 μg·kg^-1 and 1.146 μg·kg， accounting for 27.9% and 114.6% of the daily tolerable intake of DON TDI， 1 μg·kg， respectively. The probability assessment results indicated that 6.1% of the whole population in Shanghai had DON exposure exceeding the TDI value. Among them， 12.8% of the population aged 6 years old and below， 16.4% of the population aged between 7 and 17 years old， 3.9% of the population aged between 18 and 59 years old and 3.2% of the population aged 60 years old and above exceeded the TDI value for daily DON exposure through wheat flour and its products. ConclusionCertain populations in Shanghai may face certain health risks from daily DON intake wheat flour and its products. Special attention should be paid to the health risk of daily DON exposure through wheat flour and its products for individuals age below 18 years old .

ObjectiveTo assess the health risk of dietary exposure to nonylphenol in infants aged 0-36 months through infant formula in Shanghai. MethodsA monitoring of nonylphenol pollution in infant formula was conducted in 2022. A total of 90 samples were obtained from maternal and infant stores， supermarkets， and online stores in Shanghai. Based on the daily consumption data of infant formula， a point assessment method was used to assess the dietary exposure to nonylphenol in infant formula. ResultsThe prevalence of nonylphenol in infant formula retailed in Shanghai was 95.6% （86/90）. The amount of nonylphenol varied from non-detected to 22.70 μg·kg^-1， with the mean value of 8.47 μg·kg^-1 and the P₅₀ value of 7.77 μg·kg^-1. The mean daily nonylphenol exposure （estimated by body weight） from infant formula in infants aged 0-6 months， 7-12 months and 13-36 months in Shanghai was 0.091， 0.068 and 0.054 μg·kg^-1， respectively； furthermore， the P₉₅ value of daily exposure （by body weight） was 0.228， 0.152 and 0.119 μg·kg^-1， respectively. These amounts were much lower than the tolerable daily intake （TDI） of nonylphenol （by body weight 5 μg·kg^-1）. ConclusionThe health risk of daliy nonylphenol intake from infant formula remains low among infants aged 0-36 months in Shanghai.