Objective To compare the clinical efficacy of neuroendoscopic intracranial hematoma evacuation and stereotactic minimally invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 111 patients with hypertensive intracerebral hemorrhage admitted from January 2019 to November 2023 were divided into the puncture group(58 cases)and the endoscopy group(53 cases)according to the surgical method.The puncture group was treated with stereotactic minimally invasive puncture,and the endoscopy group was treated with neuroendoscopic surgery.The perioperative indicators,activity of daily living(ADL),prognosis quality,and complications were compared between the two groups.Results The operation time of the endoscopy group and the puncture group was(90.19±20.18)minutes and(55.43±16.39)minutes,the intraoperative blood loss was(102.55±29.58)ml and(14.76±8.27)ml,and the hematoma evacuation rate was(95.98±5.50)％and(72.16±6.97)％,respectively.The differences were statistically significant(P＜0.05).There was no significant difference in ADL score between the two groups before surgery(P＞0.05).After surgery,the ADL scores of both groups increased,and the endoscopy group was higher than the puncture group[(81.59±9.34)points vs.(72.63±8.47)points],with a statistically significant difference(P＜0.05).The overall prognosis quality of the endoscopy group was higher than that of the puncture group,and the difference was statistically significant(P＜0.05).The total complication rate of the endoscopy group(5.66％)was lower than that of the puncture group(12.07％),but there was no significant difference between the two groups(P＞0.05).Conclusion Compared with stereotactic minimally invasive puncture,neuroendoscopic intracranial hematoma evacuation has better efficacy in the treatment of hypertensive intracerebral hemorrhage,with higher hematoma evacuation rate and better prognosis.

Objective To explore the therapeutic effect of picroside Ⅱ(P Ⅱ)on diabetes nephropathy(DN)rats by regulating fatty acid synthase(Fas)/fatty acid synthase ligand(FasL)signaling pathway.Methods A DN rat model was constructed by combining high sugar and high-fat diet with streptozotocin(STZ)injection.DN rats were grouped into model group(DN group),low,medium and high dose picroside Ⅱ groups(P-L group,P-M group,P-H group),and high dose picroside Ⅱ+Fas recombinant protein group(P-H+rh-Fas group),with healthy rats as control group,and 18 rats in each group.Fasting blood glucose(FBG),body mass,24-hour urinary protein(24h UTP),and renal function(SCr,BUN)were measured in rats.Hematoxylin-eosin(HE)staining and Masson staining were applied to observe the pathological changes in renal tissue of rats;immunohistochemistry and Western blot were applied to detect the expression of RAGE,COL-Ⅳ and pathway proteins,respectively.Results Compared with the control group,rats in DN group showed thickening of the glomerular basement membrane,mesangial proliferation,tubular degeneration,dilation,atrophy,fatty degeneration,obvious collagen deposition,higher levels of FBG,24h UTP,SCr,BUN,TNF-α,IL-6 and IL-1β,body mass loss,and higher expression of RAGE,COL-Ⅳ,Fas and FasL(P＜0.05).Compared with the DN group,the glomerular and tubular lesions were reduced and collagen deposition was decreased in the P-L,P-M and P-H groups,furthermore,the FBG,24h UTP,SCr,BUN,TNF-α,IL-6,IL-1β levels were lower,body mass was higher,and the RAGE,COL-Ⅳ,Fas,FasL expression was lower(P＜0.05).Compared with the P-H group,the renal tissue lesions in the P-H+rh-Fas group worsened,the FBG,24 h UTP,SCr,BUN,TNF-α,IL-6,IL-1β levels were higher,body mass was lower,and the RAGE,COL-Ⅳ,Fas,FasL expression was higher(P＜0.05).Conclusion Picroside Ⅱ exerts therapeutic effects on DN rats by inhibiting the Fas/FasL signaling pathway.

Objective To compare the clinical efficacy of neuroendoscopic intracranial hematoma evacuation and stereotactic minimally invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 111 patients with hypertensive intracerebral hemorrhage admitted from January 2019 to November 2023 were divided into the puncture group(58 cases)and the endoscopy group(53 cases)according to the surgical method.The puncture group was treated with stereotactic minimally invasive puncture,and the endoscopy group was treated with neuroendoscopic surgery.The perioperative indicators,activity of daily living(ADL),prognosis quality,and complications were compared between the two groups.Results The operation time of the endoscopy group and the puncture group was(90.19±20.18)minutes and(55.43±16.39)minutes,the intraoperative blood loss was(102.55±29.58)ml and(14.76±8.27)ml,and the hematoma evacuation rate was(95.98±5.50)％and(72.16±6.97)％,respectively.The differences were statistically significant(P＜0.05).There was no significant difference in ADL score between the two groups before surgery(P＞0.05).After surgery,the ADL scores of both groups increased,and the endoscopy group was higher than the puncture group[(81.59±9.34)points vs.(72.63±8.47)points],with a statistically significant difference(P＜0.05).The overall prognosis quality of the endoscopy group was higher than that of the puncture group,and the difference was statistically significant(P＜0.05).The total complication rate of the endoscopy group(5.66％)was lower than that of the puncture group(12.07％),but there was no significant difference between the two groups(P＞0.05).Conclusion Compared with stereotactic minimally invasive puncture,neuroendoscopic intracranial hematoma evacuation has better efficacy in the treatment of hypertensive intracerebral hemorrhage,with higher hematoma evacuation rate and better prognosis.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objective To explore the therapeutic effect of picroside Ⅱ(P Ⅱ)on diabetes nephropathy(DN)rats by regulating fatty acid synthase(Fas)/fatty acid synthase ligand(FasL)signaling pathway.Methods A DN rat model was constructed by combining high sugar and high-fat diet with streptozotocin(STZ)injection.DN rats were grouped into model group(DN group),low,medium and high dose picroside Ⅱ groups(P-L group,P-M group,P-H group),and high dose picroside Ⅱ+Fas recombinant protein group(P-H+rh-Fas group),with healthy rats as control group,and 18 rats in each group.Fasting blood glucose(FBG),body mass,24-hour urinary protein(24h UTP),and renal function(SCr,BUN)were measured in rats.Hematoxylin-eosin(HE)staining and Masson staining were applied to observe the pathological changes in renal tissue of rats;immunohistochemistry and Western blot were applied to detect the expression of RAGE,COL-Ⅳ and pathway proteins,respectively.Results Compared with the control group,rats in DN group showed thickening of the glomerular basement membrane,mesangial proliferation,tubular degeneration,dilation,atrophy,fatty degeneration,obvious collagen deposition,higher levels of FBG,24h UTP,SCr,BUN,TNF-α,IL-6 and IL-1β,body mass loss,and higher expression of RAGE,COL-Ⅳ,Fas and FasL(P＜0.05).Compared with the DN group,the glomerular and tubular lesions were reduced and collagen deposition was decreased in the P-L,P-M and P-H groups,furthermore,the FBG,24h UTP,SCr,BUN,TNF-α,IL-6,IL-1β levels were lower,body mass was higher,and the RAGE,COL-Ⅳ,Fas,FasL expression was lower(P＜0.05).Compared with the P-H group,the renal tissue lesions in the P-H+rh-Fas group worsened,the FBG,24 h UTP,SCr,BUN,TNF-α,IL-6,IL-1β levels were higher,body mass was lower,and the RAGE,COL-Ⅳ,Fas,FasL expression was higher(P＜0.05).Conclusion Picroside Ⅱ exerts therapeutic effects on DN rats by inhibiting the Fas/FasL signaling pathway.

Objective:To evaluate the efficacy of oral midazolam solution for preoperative sedation in the pediatric outpatients undergoing root canal treatment under general anesthesia.Methods:One hundred and forty-seven pediatric patients of either sex, aged 2-7 yr, weighing 10-30 kg, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, were divided into 3 groups ( n=49 each) using a random number table method: oral midazolam solution group (OM group), midazolam injection group (M group), and dexmedetomidine group (D group). In OM group, patients received oral midazolam solution at a dose of 0.5 mg/kg along with a placebo (an equivalent amount of normal saline based on body weight) administered via nasal drops. In M group, patients were given oral midazolam injection at a dose of 0.5 mg/kg along with a placebo via nasal drops. In D group, patients were administered a placebo orally along with dexmedetomidine at a dose of 2 μg/kg via nasal drops. The Induction Compliance Checklist (ICC) scores upon entering the operating room, sedation success rates (ICC score ≤ 3), drug acceptance scores, mask acceptance scores, and separation anxiety scores were recorded. The emergence time, time of stay in postanesthesia care unit (PACU), and occurrence of adverse events such as bradycardia, hypotension, hypoxemia, and laryngospasm during surgery and in PACU were recorded. Results:A total of 143 pediatric patients were finally included in the study, with 48 cases in OM group, 48 cases in M group and 47 cases in D group. Compared with M and D groups, the ICC scores upon entry to the operating room were significantly decreased, the sedation success rates were increased, drug acceptance scores were increased, separation anxiety scores were decreased, and mask acceptance scores were decreased in OM group ( P<0.05). Compared with D group, the ICC scores upon entry to the operating room were significantly decreased, the sedation success rates were increased, and mask acceptance scores were decreased in M group ( P<0.05). There were no statistically significant differences in the emergence time, time of stay in PACU, and incidence of adverse events during surgery and in PACU among the three groups ( P>0.05). Conclusions:Oral midazolam solution provides good effect with less adverse reactions when used for preoperative sedation in the pediatric outpatients undergoing root canal treatment under general anesthesia.

In recent decades,the advent of coronaviruses has engendered multiple large-scale infectious outbreaks,leading to profound human casualties and posing a significant menace to global public health.At the crux of the coronavirus lifecycle,the assembly and release phases emerge as pivotal processes,necessitating meticulous investigation into the underlying mechanisms.This paper systematically expounds upon the intricate assembly and packaging mechanisms intrinsic to coronaviruses,scrutinizes the diverse release pathways employed by these viruses,and delves into the discourse surrounding targeted antiviral drugs.The comprehensive insights encapsulated in this exposition serve as valuable reference points for formulating effective strategies in the prevention and treatment of coronavirus infections.

Objective:To evaluate the effect of gender factor on efficacy of remimazolam combined with alfentanil in the patients undergoing gastrointestinal endoscopy.Methods:Two hundred patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ, scheduled for elective gastrointestinal endoscopy, were divided into 2 groups ( n=100 each) according to gender: male group (group M) and female group (group F). Remimazolam 0.2-0.3 mg/kg and alfentanil 5-7 μg/kg were intravenously injected, remimazolam 0.5-0.7 mg·kg -1·h -1 was continuously infused during operation to maintain the modified observer′s assessment of alert/sedation score<3 points, and alfentanil 2 μg/kg was administered when necessary. The consumption of remimazolam and alfentanil, examination time, recovery time and time of post-anesthesia care unit stay were recorded. The satisfaction scores of examination physicians and patients were recorded. The occurrence of adverse reactions such as injection pain, intraoperative body movement, respiratory depression, hypotension, bradycardia and hiccups and postoperative dizziness, nausea, vomiting, fatigue, abdominal pain and abdominal distension were recorded. Results:There was no significant difference in the consumption of remimazolam and alfentanil, examination time, recovery time, satisfaction scores of examination physicians and patients between the two groups ( P>0.05). There was no significant difference in the incidence of respiratory depression, hypotension, bradycardia, injection pain, body movement, hiccups, abdominal pain, abdominal distension, and fatigue between the two groups ( P>0.05). Compared with group M, the time of post-anesthesia care unit stay was significantly prolonged, and the incidence of postoperative dizziness, nausea and vomiting was increased in group F ( P<0.05). Conclusions:Remimazolam combined with alfentanil provides better efficacy in male patients than in female patients undergoing gastrointestinal endoscopy.

Objective:To explore the preventive effects of pancreatic duct stent combined with rectal administration of indomethacin suppository for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after difficult bile duct intubation during endoscopic retrograde cholangiopancreatography (ERCP).Methods:From January 2019 to December 2021, patients with biliary and pancreatic diseases undergoing ERCP in Hangzhou Hospital Affiliated to Nanjing Medical University were given 100 mg indomethacin suppository to anal canal 30 minutes before the operation. And those with difficult bile duct intubation during the operation ( n=204) were included in this study. According to the random number table, they were divided into the combination group (implanted with pancreatic duct stent during the operation, n=104) and the indomethacin group (not implanted with stent, n=100). The incidences of hyperamylasemia and PEP were compared between the two groups. Results:The incidences of postoperative hyperamylasemia [21.2% (22/104) VS 34.0% (34/100), χ2=4.22, P=0.040] and PEP [14.4% (15/104) VS 32.0% (32/100), χ2=8.88, P=0.003] in the combination group were significantly lower than those in the indomethacin group. There was no significant difference in the incidence of severe PEP between the two groups [1.0% (1/104) VS 1.0% (1/100), χ2=0.001, P=0.978]. Conclusion:Compared with rectal administration of indomethacin suppository alone, the incidences of hyperamylasemia and PEP after difficult bile duct intubation during ERCP can be further reduced when it is combined with pancreatic duct stent placement.