Day surgery has the advantages of fast turnover of beds,high patient satisfaction,low medical cost and low nosocomial infection rate,which is a kind of surgical mode vigorously explored and developed at home and abroad.Safety is the bottom line of day surgery,comfort is the core pursuit of day surgery,both of which cannot be guaranteed without high-quality perioperative anesthesia management.Therefore,under the fast-turnover day surgery mode,this paper focus on how to implement standardized anesthesia management strategies from the aspects of the formulation of clinical anesthesia pathways,facilities and personnel allocation,pre-anesthesia evaluation and preoperative preparation,anesthesia type selection,perioperative pain management,postoperative nausea and vomiting management,post-anesthesia monitoring and treatment,and postoperative follow-up.

Postoperative cognitive dysfunction(POCD)is a common complication affecting elderly patients after anaesthesia.It is characterised by acute or persistent impairments of attention,learning and memory after surgery.This cognitive disorder can lead not only to an increase in postoperative complications and prolonged hospi-tal stays,but also to an increased societal burden and waste of medical resources.Stellate ganglion block(SGB)is a commonly used nerve block technique in clinical practice.It works to block neural signals from stellate ganglion to control pain or treat certain conditions primarily by injecting local anaesthetics.This article summarises the mechanisms by which SGB improves POCD,focusing on the regulation of cerebral vasculature,oxidative stress and inflammatory responses.It aims to provide elderly patients with an approach to safer and more effective postop-erative recovery and seek new therapies to alleviate the burden of POCD.

Objective To study the relationship between marital status and prognosis of prostate cancer patients.Methods A total of 16 815 prostate cancer patients'data were extracted from the US SEER database,and the relationship between marital status and the prognosis of prostate cancer patients was assessed by using Log-rank unifactorial and multifactorial Cox risk-proportional models.Results ①At different stages of cancer,marital status can serve as an independent factor for tumor prognosis;②When the prostate-specific antigen(PSA)＜10ng/ml,the strongest correlation between marital status and prostate cancer survival rate was observed.There was a significant difference in tumor survival rate between different marital statuses with PSA＜10ng/ml and PSA levels between 10-20ng/ml;③ The survival curve and 5-year survival rate of patients with Gleason=7 points and Gleason ≥ 8 points in married group were significantly higher than those in unmarried group and divorced/widowed group;④ Patients who undergo surgical treatment have a longer survival time,and regardless of whether surgery is performed or not,the survival rate of married patients is significantly higher than that of patients with other marital statuses;⑤ In this study,the mortality risk of married prostate cancer patients was lower than that of patients with other marital statuses under different grouping conditions.Conclusion Marital status can be used as an independent prognostic factor for prostate cancer patients to a certain extent,and the mortality risk coefficient of married prostate cancer patients is lower than that of patients with other marital status.

Objective:To observe the influence of NOD-like receptor thermal protein domain associated protein 6 (NLRP6) on hepatic ischemia-reperfusion injury (IRI), and elucidate the related mechanism.Methods:Thirty C57BL/6 mice with body weight of (18.80±1.99) g, were divided randomly into 5 groups, with 6 mice in each group: the mice that experienced only exploratory laparotomy were Sham group; that only underwent an operation to establish a hepatic IRI model were IRI group; that were treated with tail intravenous injection of clodronate (Clo) liposomes before the establishment of hepatic IRI model were Clo group; that received tail intravenous injection of clodronate liposomes and transfusion of bone marrow derived macrophages (BMDM) before the operation were Clo+ BMDM group; that received preoperative tail intravenous injection of clodronate liposomes and transfusion of BMDM with NLRP6 knockdown were Clo+ NLRP6-knockdown group. Real time quantitative polymerase chain reaction analysis (RT-PCR) and Western blot were performed to analyze the expressions of pyroptosis related proteins and factors. Simulate a hypoxia/reoxygenation (H/R) model in vitro, and set up experimental groups: lipopolysaccharide (LPS) + adenosine triphosphate (ATP), LPS+ ATP+ NLRP6-knockdown, H/R, and H/R+ NLRP6-knockdown. The changes of expressions of pyroptosis related proteins and factors were detected by RT-PCR and Western blot. Expression of NF-κB in vivo and in vitro was measured.Results:Compared with those in Sham group, protein expressions of NLRP6, NLRP3, Caspase-1, gasdermin D (GSDMD), IL-1β and IL-18 were remarkably increased in IRI group, but the levels of these proteins were dramatically decreased in Clo group with the exhaustion of macrophages in comparison with in IRI group, which were significantly different statistically (all P<0.05). The levels of these proteins were enhanced again in Clo+ BMDM group with the reconstruction of macrophages in contrast to those in Clo group, while the enhancements were more obvious in Clo+ NLRP6-knockdown group comparing to those in Clo+ BMDM group, with significant differences (all P<0.05). In vitro, pyroptosis rate for LPS+ ATP group was (16.39±1.06)%, which was lower than (27.34±2.79)% for LPS+ ATP+ NLRP6-knockdown group, with a statistical significance ( P<0.05). Meanwhile, pyroptosis rate for H/R group was (20.59±5.66)%, also much more reduced than (37.76±2.00)% for H/R+ NLRP6-knockdown group ( P<0.05). Expressions of NLRP3, Caspase-1, GSDMD, IL-1β, IL-18 and NF-κB p65 in LPS+ ATP+ NLRP6-knockdown group were more elevated than in LPS+ ATP group, and these indices were also more enhanced in H/R+ NLRP6-knockdown group than which in H/R group. Compared to the Sham group, expression of NF-κB p65 significantly increased in IRI group, which was reversed in Clo group, but enhanced again in Clo+ BMDM group and reached a peak in Clo+ NLRP6-knockdown group. Conclusions:Macrophage plays a critical role in immune response to hepatic IRI, wherein NLRP6 functions specifically. NLRP6 acts to suppress inflammation during hepatic IRI through regulating macrophage pyroptosis via inhibiting NF-κB.

ACC oxidase (ACO) is one of the key enzymes that catalyze the synthesis of ethylene. Ethylene is involved in salt stress response in plants, and salt stress seriously affects the yield of peanut. In this study, AhACO genes were cloned and their functions were investigated with the aim to explore the biological function of AhACOs in salt stress response, and to provide genetic resources for the breeding of salt-tolerant varieties of peanut. AhACO1 and AhACO2 were amplified from the cDNA of salt-tolerant peanut mutant M29, respectively, and cloned into the plant expression vector pCAMBIA super1300. The recombinant plasmid was transformed into Huayu22 by pollen tube injection mediated by Agrobacterium tumefaciens. After harvest, the small slice cotyledon was separated from the kernel, and the positive seeds were screened by PCR. The expression of AhACO genes was analyzed by qRT-PCR, and the ethylene release was detected by capillary column gas chromatography. Transgenic seeds were sowed and then irrigated with NaCl solution, and the phenotypic changes of 21-day-seedings were recorded. The results showed that the growth of transgenic plants were better than that of the control group Huayu 22 upon salt stress, and the relative content of chlorophyll SPAD value and net photosynthetic rate (Pn) of transgenic peanuts were higher than those of the control group. In addition, the ethylene production of AhACO1 and AhACO2 transgenic plants were 2.79 and 1.87 times higher than that of control peanut, respectively. These results showed that AhACO1 and AhACO2 could significantly improve the salt stress tolerance of transgenic peanut.
Salt Tolerance/genetics* ; Arachis/genetics* ; Plant Breeding ; Ethylenes/metabolism* ; Plants, Genetically Modified/genetics* ; Gene Expression Regulation, Plant ; Plant Proteins/genetics*

Objective:To observe the effect of pre injection of three different doses of butorphanol tartrate on postoperative pain in gynecological laparoscopic surgery.Methods:A prospective study was conducted on 172 patients who underwent gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Dalian Medical University from April to December 2022. According to the random number table method, patients were divided into B1 group, B2 group, and B3 group. These three groups were given 10, 20, and 30 μ g/kg butorphanol tartrate 15 minutes before surgery, respectively. Ramsay sedation score at 10 minutes after patient administration, the pain Numerical Rating Scale (NRS) scores and Bruggrmann Comfort Scale (BCS) for resting and active states at 2, 6, 12, 24, and 48 hours after surgery, hemodynamic parameters at different time points during surgery, postoperative use of adjuvant analgesics and effective number of compressions for patient-controlled intravenous analgesia (PCIA) and the incidence of postoperative adverse reactions were recorded.Resultsl:There was no statistically significant difference in general characteristics among the three groups of patients (all P>0.05). At 10 minutes after administration, there was a statistically significant difference in Ramsay scores between groups B2 and B3 compared to group B1 (all P<0.05). At 12 and 24 hours after surgery, the resting NRS score of B3 group was lower than that of B2 group and B1 group, and B2 group was lower than B1 group (all P<0.05); At 6, 12, and 24 hours after surgery, the NRS scores of postoperative activity in the B2 and B3 groups were lower than those in the B1 group (all P<0.05); At 6 and 12 hours after surgery, the NRS score of the B3 group was lower than that of the B2 group (all P<0.05). At 6 and 24 hours after surgery, there was a statistically significant difference in BCS between groups B2 and B3 compared to group B1 (all P<0.05). There was no statistically significant difference in the hemodynamic parameters at each time point during surgery, the effective number of PCIA compressions within 48 hours after surgery, and the incidence of postoperative adverse reactions among the three groups of patients (all P>0.05). There was a statistically significant difference in the rate of postoperative addition of analgesics among the three groups ( P<0.05). Conclusions:Intravenous injection of 15 minutes before gynecological laparoscopic surgery 30 μg/kg butorphanol tartrate can achieve good analgesic effects with fewer adverse reactions, and can be used as a priority dose for preventive analgesia in gynecological laparoscopic surgery.

Objective:To investigate the curative effect of transfer of free anteriolateral thigh flap (ALTF) with partial iliotibial tract on reconstruction of composite tissue defects in dorsal wrist/hand.Methods:Ten patients who were admitted in the Department of Hand Surgery of Yongkang Orthopaedic Hospital from March 2018 to August 2022 were entered in the study due to extensive composite tissue defects in dorsal wrists and hands. The patients were 24-48 (37 in average) years old. All patients had tendon defects in 3 or more digits with 35 digits in total. The length of the tendon defects were 5.0-11.0 cm in various digits. The soft tissue defects ranged from 6.0 cm×8.0 cm to 11.0 cm×21.0 cm in size. Six patients had defects accompanied with metacarpal and phalangeal bone fracture and joint capsule. In emergency surgery, all patients received thorough debridement and VSD coverage after internal fixation for combined fractures. At 3-5 days after the primary surgery, free ALTF transfer with partial iliotibial tract was employed to reconstruct the defects on dorsal wrists and hands and the digit extension function. The size of flap was 6.0 cm×9.0 cm-9.0 cm×17.0 cm, and the rest of defect wound was covered by skin graft. All the donor sites were sutured directly, except 1 that received abdominal skin graft. Patients had the follow-ups in outpatient clinics, or via telephone or Wechat, to observe the sensation and appearance of the flap, and the healing of the donor site. The recovery of the extension function of the hand was evaluated according to the totle active motion (TAM) system.Results:All flaps survived except one that had vascular compromise after the surgery and it survived after two explorations and a vascular transfer. Postoperative follow-ups lasted for 6 to 24 months, with 13 months in average. At the last follow-up, a all the flaps were found soft in texture and slightly swollen in appearance. There was no obvious pigmentation or rupture of skin and extensor tendon. Sensory recovery achieved to S 2 in 7 patients and S 3 in 3 patients. The hand function was evaluated according to TAM system and rated as excellent for 3 digits, good for 18 digits, fair for 9 digits and poor for 5 digits. There were linear scars in the donor sites. Conclusion:Free ALTF transfer with partial iliotibial tract in the reconstruction of composite tissue defect of dorsal wrists and hands can not only reconstruct the wound surface, but also the extension of digits, which cuts short the course of treatment.

The concept of enhanced recovery after surgery (ERAS) has attracted more and more attention so far, but there are different opinions on it. ERAS philosophy covers many fields, in which anesthesiology plays an irreplaceable role by virtue of its professional advantages. Based on ERAS philosophy, anesthesiologists will provide guidance on preoperative assessment, preoperative prehabilitation, intraoperative fluid management, analgesia, temperature management, and postoperative rehabilitation to improve patient comfort and satisfaction.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Objective:To explore the clinical effect of repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap.Methods:The clinical data included 15 patients with distal thumb degloving injury received in Yongkang Orthopedic Hospital from March 2015 to June 2018. These patients included 10 males and 5 females, aged between 24 and 61 years. For the injury, 7 cases were beyond the interphalangeal joint, 8 cases were beyond the nail root. The length of the distal segment of degloving finger was 1.8 to 2.3 cm, and the skin and soft tissue defect ranged from 1.8 cm × 4.6 cm to 2.3 cm × 5.6 cm. The distal thumb degloving injury was repaired with B-shaped first palmar dorsal neurocutaneous vascular flap. The radial dorsal metacarpal nerve of the first metacarpal was anastomosed with the ulnar proper digital nerve stump. And full-thickness skin graft transplantation was performed in donor area. After the operation, the shape and function of the thumb were followed up. The sensory function of the skin was determined by British Medical Research Association Sensory Function Evaluation Standard, and the function of the thumb was evaluated with reference to the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:The flap area was 2.0 cm × 5.0 cm-2.5 cm × 6.0 cm, and all the flaps were survived. Follow-up period was 5-18 months after the operation, with an average of 10 months. The flap at the thumb repair site was soft, wear-resistant, non-bloated, no obvious pigmentation. Its protective sensation was restored. The two-point discrimination of the flap reached 8-11 mm, with an average of 9.3 mm, basically restoring the original shape and function of the thumb. There were 13 cases reaching the S3 + flap sensory function, 2 cases reaching S3. The thumb function was evaluated as excellent for 9 cases, and good for 6 cases. There were no complications such as scar contracture and hypersensitivity in the donor area. Conclusions:The repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap can complete skin coverage and sensory reconstruction, with satisfactory postoperative effect.