Objective:To evaluate the effect of liposomal bupivacaine transversus abdominis plane block (TAPB) on the postoperative quality of recovery in patients undergoing laparoscopic colorectal surgery.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-75 yr, with a body mass index of 18.5-29.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic colorectal surgery, were allocated into 2 groups ( n=50 each) in a 1∶1 ratio using a random number table method: liposomal bupivacaine TAPB group (LB group) and hydrochloric bupivacaine TAPB group (HB group). Before anesthesia induction, ultrasound-guided bilateral TAPB was performed, liposomal bupivacaine (266 mg) 40 ml (20 ml per side) was injected in LB group, and bupivacaine hydrochloride (100 mg) 40 ml (20 ml per side) was injected in HB group. When pain scores at rest ≥4 within 72 h after the end of surgery, patient-controlled intravenous analgesia with morphine injectio 3 mg was used. The Quality of Recovery-15 scale score was recorded at 24, 48 and 72 h postoperatively. The time to first rescue analgesia and total consumption of morphine within 72 h after operation were recorded. The occurrence of adverse reactions, including nausea and vomiting, urinary retention, pruritus, local anesthetic toxicity and hematoma at the puncture site, was recorded within 72 h after surgery. Results:Compared to HB group, Quality of Recovery-15 scale scores were significantly increased at 24, 48 and 72 h postoperatively, the time to first rescue analgesia was prolonged, the consumption of morphine was reduced within 72 h postoperatively, and the incidence of postoperative nausea and vomiting was decreased( P<0.05), and no statistically significant changes in the incidence of urinary retention or pruritus were found within 72 h postoperatively in LB group ( P>0.05). No local anesthetic toxicity or hematoma at the puncture site occurred in either group. Conclusions:Liposomal bupivacaine TAPB can improve the postoperative quality of recovery in the patients undergoing laparoscopic radical resection for colorectal cancer.

Objective:To evaluate the effect of liposomal bupivacaine transversus abdominis plane block (TAPB) on the postoperative quality of recovery in patients undergoing laparoscopic colorectal surgery.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-75 yr, with a body mass index of 18.5-29.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic colorectal surgery, were allocated into 2 groups ( n=50 each) in a 1∶1 ratio using a random number table method: liposomal bupivacaine TAPB group (LB group) and hydrochloric bupivacaine TAPB group (HB group). Before anesthesia induction, ultrasound-guided bilateral TAPB was performed, liposomal bupivacaine (266 mg) 40 ml (20 ml per side) was injected in LB group, and bupivacaine hydrochloride (100 mg) 40 ml (20 ml per side) was injected in HB group. When pain scores at rest ≥4 within 72 h after the end of surgery, patient-controlled intravenous analgesia with morphine injectio 3 mg was used. The Quality of Recovery-15 scale score was recorded at 24, 48 and 72 h postoperatively. The time to first rescue analgesia and total consumption of morphine within 72 h after operation were recorded. The occurrence of adverse reactions, including nausea and vomiting, urinary retention, pruritus, local anesthetic toxicity and hematoma at the puncture site, was recorded within 72 h after surgery. Results:Compared to HB group, Quality of Recovery-15 scale scores were significantly increased at 24, 48 and 72 h postoperatively, the time to first rescue analgesia was prolonged, the consumption of morphine was reduced within 72 h postoperatively, and the incidence of postoperative nausea and vomiting was decreased( P<0.05), and no statistically significant changes in the incidence of urinary retention or pruritus were found within 72 h postoperatively in LB group ( P>0.05). No local anesthetic toxicity or hematoma at the puncture site occurred in either group. Conclusions:Liposomal bupivacaine TAPB can improve the postoperative quality of recovery in the patients undergoing laparoscopic radical resection for colorectal cancer.

Based on the investigative research of the construction, implementation, and assessment of ideological and political education in the Cardiology curriculum at Tongji University, three main problems were concluded: the teaching methods were not suitable for the current needs of ideological and political construction in the curriculum; the professional knowledge teaching and ideological and political education were disconnected; and the quality of teaching evaluation was not high. The teaching team conducted detailed research and exploration through reforming the teaching mode, building an ideological and political material library and innovating the integration of ideological and political education with the curriculum, and innovating the evaluation system for the professional learning and ideological and political education of the curriculum, and designed an innovative method to implement curriculum ideology and politics based on material library refining combined with investigation feedback. Teaching practice verified that the method could effectively solve the three problems. The effectiveness monitoring after class demonstrated that the new method achieved the expected results, and the ideological and political construction of the Cardiology curriculum had significant improvements, proving that the method is practical and worth being promoted.

Objective To explore the causal relationship between breast cancer and free fatty acid receptor 4(FFAR4)by using two-sample Mendelian randomization.Methods By using Genome-wide Association Studies and expression quantitative trait locus(eQTL)data,single nucleotide polymorphism sites closely related to breast cancer and FFAR4 were extracted.Causal effect values were calculated by using five methods:inverse variance weighting(IVW),MR-Egger,weighted median,simple mode and weighted mode.Cochran Q tests were used to detect heterogeneity,MR-Egger intercept tests and MR-PRESSO tests were used to assess level multiplicity,and the hold-out method was employed for sensitivity analysis to ensure robustness of the results.Additionally,Bayesian co-location analysis was used to evaluate whether FFAR4 expression shares the same causal genetic variant with breast cancer in given genomic region.Results A total of 12 eQTLs closely related to FFAR4 expression levels were included in this study.The results of IVW analysis showed that increased FFAR4 expression levels increased the risk of overall breast cancer,Luminal A,Luminal B/HER2-negative,and HER2-enhanced subtypes of breast cancer.The co-location analysis showed that the posterior probability of FFAR4 expression level and total breast cancer shared causal variation was 0.889.Conclusion There may be a causal relationship between FFAR4 expression and breast cancer.

OBJECTIVE To establish the precise management model for the centralized preparation of cytotoxic drugs in pharmacy intravenous admixture services(PIVAS),and evaluate the effects of its application.METHODS Pharmacists in PIVAS established the precise management model by soliciting clinical opinions and consulting literature on the centralized preparation of cytotoxic drugs and continuously refining every step of the preparation of cytotoxic drugs,based on data feedback from the information closed-loop management system and the limit of stability time of finished solutions.The indicators such as the preparation time,delivery time,the storage time of finished infusion solutions after preparation,and the completion rate of infusion within the stability time limit were analyzed before the implementation(January to December 2023)and after the implementation(January to December 2024)of this model,to evaluate its application effectiveness.RESULTS The overall framework for the precise management model included upgrading the functions of the prescription review system,improving the prescription review database,providing specialized training for PIVAS pharmacists,managing dynamic batch decision for drug preparation,managing special drugs,managing finished infusion distribution,and establishing a continuous improvement mechanism.Compared with before implementation,the average preparation time of the second and third batches of cytotoxic drugs with more concentrated morning preparation tasks in this model was significantly shorter than before implementation(P＜0.05);the delivery time of finished infusion after implementation[(11.49±2.92)min]was significantly shorter than the delivery time before implementation[(22.11±5.03)min](P＜0.001);the storage time of some drugs with shorter stable time limit and carboplatin in combination regimens(paclitaxel or docetaxel+carboplatin)was significantly shortened compared to before implementation(P＜0.05),and the completion rate of infusion within the stability time limit was significantly improved compared to before implementation(P＜0.05).CONCLUSIONS Our hospital has successfully established a precise management model for the centralized preparation of cytotoxic drugs in PIVAS.This mode can significantly shorten the preparation time of each batch of PIVAS in the morning,make batch decisions more reasonable and improve the infusion completion rate within the stable time limit of the finished product.

Objective To explore the causal relationship between breast cancer and free fatty acid receptor 4(FFAR4)by using two-sample Mendelian randomization.Methods By using Genome-wide Association Studies and expression quantitative trait locus(eQTL)data,single nucleotide polymorphism sites closely related to breast cancer and FFAR4 were extracted.Causal effect values were calculated by using five methods:inverse variance weighting(IVW),MR-Egger,weighted median,simple mode and weighted mode.Cochran Q tests were used to detect heterogeneity,MR-Egger intercept tests and MR-PRESSO tests were used to assess level multiplicity,and the hold-out method was employed for sensitivity analysis to ensure robustness of the results.Additionally,Bayesian co-location analysis was used to evaluate whether FFAR4 expression shares the same causal genetic variant with breast cancer in given genomic region.Results A total of 12 eQTLs closely related to FFAR4 expression levels were included in this study.The results of IVW analysis showed that increased FFAR4 expression levels increased the risk of overall breast cancer,Luminal A,Luminal B/HER2-negative,and HER2-enhanced subtypes of breast cancer.The co-location analysis showed that the posterior probability of FFAR4 expression level and total breast cancer shared causal variation was 0.889.Conclusion There may be a causal relationship between FFAR4 expression and breast cancer.

Based on the investigative research of the construction, implementation, and assessment of ideological and political education in the Cardiology curriculum at Tongji University, three main problems were concluded: the teaching methods were not suitable for the current needs of ideological and political construction in the curriculum; the professional knowledge teaching and ideological and political education were disconnected; and the quality of teaching evaluation was not high. The teaching team conducted detailed research and exploration through reforming the teaching mode, building an ideological and political material library and innovating the integration of ideological and political education with the curriculum, and innovating the evaluation system for the professional learning and ideological and political education of the curriculum, and designed an innovative method to implement curriculum ideology and politics based on material library refining combined with investigation feedback. Teaching practice verified that the method could effectively solve the three problems. The effectiveness monitoring after class demonstrated that the new method achieved the expected results, and the ideological and political construction of the Cardiology curriculum had significant improvements, proving that the method is practical and worth being promoted.

Objective:To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock.Methods:This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment.Results:A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value ( AUC=0.54, 95% CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion:EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

Objective: To investigate the implementation of sex education and its influencing factors among preschool teachers in Luzhou City, Sichuan Province, so as to provide insights into promoting the development of sex education, physical and mental health for preschool children. Methods: In January 2022, preschool teachers were sampled in 24 kindergartens in Longmatan District, Naxi District and Hejiang County of Luzhou City using the stratified random cluster sampling method. Demographic information, knowledge, attitudes, implementation of sex education, as well as difficulties, support, and needs in implementing sex education among preschool teachers were collected through questionnaire surveys. Factors affecting practice of sex education by preschool teachers were analyzed using a multivariable logistic regression model. Results: A total of 461 preschool teachers were included, including 456 females (98.92%), and had a median age of 28.00 (interquartile range, 9.50) years. The proportions of preschool teachers with good and pass of knowledge about sex education for preschool children were 10.20% and 57.48%, respectively. The proportions of preschool teachers with positive and general attitudes towards sex education were 28.20% and 36.44%, respectively. A total of 343 preschool teachers had implemented sex education (74.40%). A lack of a relaxed social environment was the main difficulty in carrying out sex education for preschool children (76.14%), while support from parents of preschool children was the primary need for conducting sex education activities (75.27%). Multivariable logistic regression analysis showed that age (>30 years, OR=2.218, 95%CI: 1.256-3.917), kindergarten type (public, OR=2.101, 95%CI: 1.253-3.524), attitude towards sex education (positive, OR=2.083, 95%CI: 1.036-4.187), participation in activities related to sex education (OR=6.355, 95%CI: 3.362-12.015), and communication with parents about sex education (OR=5.399, 95%CI: 3.152-9.248) were influencing factors for practice of sex education by preschool teachers. Conclusions The main difficulty in the practice of sex education for preschool children by preschool teachers in Luzhou City is a lack of a relaxed social environment, and there is a high demand for support from parents. Age, kindergarten type, attitude towards sex education, participation in activities related to sex education, and communication with parents about sex education are associated factors.

Objective: To understand the needs of parents of kindergarten children in urban areas for online training on sexuality education, so as to provide a basis for the development of parent training courses. Methods: In May 2023, a multistage cluster random sampling method was used to select 3 516 parents of young children from 12 kindergartens in urban areas of Changshou District, Chongqing. A self designed questionnaire on Knowledge, Attitude and Practice of Early Childhood Sexuality Education (Parents) was used for the survey, and χ 2 test and multi factor Logistic regression model were used for data analysis. Results: The online training demand rate of urban parents for early childhood sexuality education was 57.05%. The results of the multi factor Logistic regression analysis showed that age, education level, occupation, whether or not they were the main caregivers, total score level of the scale, awareness of their own responsibility, communication with family and friends about early childhood sexuality education and young children s participation in kindergarten sexuality education activities were the influencing factors of parents online training demand on sexuality education ( OR =1.18, 1.44, 1.42, 0.83, 1.19, 0.51, 0.75, 0.75, P <0.05). Conclusion Urban parents have a high demand for online training on early childhood sexuality education, and training courses should be developed according to the specific needs and characteristics of parents of young children.