Objective To analyze the impact of patients ages on propofol dosage in painless gastroscopy.Methods A retrospective analysis was conducted on the clinical data of 158 painless gastroscopy patients from January 2017 to June 2020.They were divided into the young group(18～44 years old,n = 57),the middle-aged group(45～59 years old,n = 51),and the elderly group(≥60 years old,n = 50)based on their age.The anesthesia status and safety of each group were compared.Results The results showed that the dosage of propofol,average total dosage of propofol,MAP,HR,RR,SpO2 levels in the young group were higher than those in the middle-aged and elderly groups when consciousness disappeared,and the middle-aged group was higher than the elderly group;The onset time,anesthesia recovery time,orientation recovery time,and departure time in the young group of patients were shorter than those in the middle-aged and elderly groups,and the middle-aged group was shorter than the elderly group(P<0.05).The incidence of airway obstruction,hypoxemia,mandible support,mask ventilation,adverse cardiovascular events,sedation related adverse events,and incidence of obstructed endoscopy in the elderly group were higher than those in the young and middle-aged groups.The incidence of smooth endoscopy was lower than that in the young and middle-aged groups(P<0.05).Conclusion Aging may increase the dosage of propofol in patients underwent painless gastroscopy under anesthesia,prolong the onset time,anesthesia recovery time,orientation recovery time,and departure time,increase stress reactions and adverse reactions,and strengthen monitoring for elderly patients in clinical practice.

Objective To compare the performances of 3D MERGE sequence and 3D SPACE STIR sequence in detecting lumbar disc herniation(LDH).Methods The clinical data and MRI data of 135 LDH patients admitted between January 2020 and November 2022 were analyzed retrospectively.All patients were examined using conventional MRI,3D MERGE sequence and 3D SPACE STIR sequence.The consistency of 3D MERGE sequence and 3D SPACE STIR sequence in measuring the diameter of nerve root was analyzed,and the image quality parameters[signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)]and image definition score of the two sequences were evaluated.Results There were no statistically significant differences in L3-S1 nerve root diameters measured by 3D MERGE sequence and 3D SPACE STIR sequence(P＞0.05),and the diameters of L3,L4,L5 and S1 measured by the two sequences showed high correlations(r=0.957,0.986,0.975,0.972,P＜0.05).Compared with 3D SPACE STIR sequence,3D MERGE sequence had higher SNR and CNR,scored better on image definition,and displayed nerve root more clearly(P＜0.05).Conclusion 3D MERGE sequence and 3D SPACE STIR sequence have high consistency in the measurement of LDH nerve root diameter.3D MERGE sequence can display the anatomical morphology of nerve root more clearly as compared with 3D SPACE STIR sequence,and the former one has higher image quality.

Objective:To investigate the relationship between oral health and mild cognitive impairment(MCI)by using indicators that evaluate oral hypofunction.Methods:The study was conducted using a cross-sectional design.Participants were recruited from three communities(Shizi Ling, Wenyi Xincun, and Yaoling in Furong District)in Changsha in July 2021, using convenience sampling.Cognitive and oral functions were evaluated using the simple mental state examination, version 2(MMSE-2)and seven indicators of oral hypofunction, which included oral hygiene, oral dryness, occlusal force, tongue and lip movement, tongue pressure, mastication, and swallowing function.Results:A total of 144 subjects were included in this study, with 72 males.Except for education level, there were no statistically significant differences between the MCI group and the normal cognitive group in terms of demographic information and self-reported and measured oral functions(all P>0.05).There was a correlation between the subjects' self-reported oral function and the actual measured oral function.Multiple linear regression analysis revealed no significant correlation between the MMSE score and the seven indicators used to measure oral hypofunction(all P>0.05).The MMSE score of the female group showed a negative correlation with mastication( β=-0.003, P=0.043), while the MMSE score of subjects with elementary school education also showed a negative correlation with mastication( β=-0.022, P=0.016).Additionally, the MMSE score of subjects with middle school education showed a positive correlation with the number of residual teeth( β=0.090, P=0.030). Conclusions:The self-reported oral function can serve as an initial assessment of overall oral function.However, among elderly individuals who do not show significant decline in oral function, there was no significant correlation between oral function and MCI.To accurately identify individuals with MCI, a more detailed sub-analysis with a larger sample size is required.

Objective:To compare the efficacy of pecto-intercostal fascial plane (PIFP) block versus transversus thoracic muscle plane (TTP) block under ultrasound guidance in coronary artery bypass grafting with general anesthesia.Methods:Ninety American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ patients of either sex, aged 50-79 yr, scheduled for elective coronary artery bypass grafting, were divided into 3 groups ( n=30 each) using a random number table method: PIFP block combined with general anesthesia group (PG group), TTP block combined with general anesthesia group (TG group), and general anesthesia group (G group). After anesthesia induction, bilateral PIFP block was performed under ultrasound guidance in group PG, TTP block was performed under ultrasound guidance in group TG. Three groups used the same general anesthesia method and patient-controlled intravenous analgesia after surgery. Visual analog scale scores (cough, position change, etc) at rest and during activity were recorded at 6, 12, 18 and 24 h after operation. The total consumption of intraoperative sufentanil, extubation time, length of stay in intensive care units, rate of rescue analgesia, effective pressing times of patient-controlled analgesia, incidence of postoperative nausea and vomiting, skin pruritus and nerve block-related adverse events were recorded. The operation time of nerve block was recorded and ultrasound-guided needle visibility score was assessed in PG group and TG group. Results:Compared with group G, the total consumption of intraoperative sufentanil was significantly reduced, the extubation time and length of stay in intensive care units were shortened, visual analog scale scores at rest and during activity were decreased at 6, 12 and 18 h after operation, the rate of rescue analgesia was decreased, and the effective pressing times of patient-controlled analgesia were decreased in group PG and group TG ( P<0.05), and no significant change was found in the aforementioned parameters in PG and TG groups ( P> 0.05). Compared with group TG, the operational time of nerve block was significantly shortened, and the ultrasound-guided needle visibility score was increased in group PG ( P<0.05). No nerve block-related adverse events were found in PG and TG groups. There was no significant difference in the incidence of postoperative nausea and vomiting and skin pruritus among the three groups ( P>0.05). Conclusions:PIFP block can provide good perioperative analgesia and promote the rapid recovery in the patients undergoing coronary artery bypass grafting with general anesthesia. Although the analgesic effect of PIFP blockade is similar to that of TTP blockade, PIFP blockade is more clinically valuable due to its simpler operation and less relative risk.

Objective:To evaluate the correlation between ultrasound parameters of internal carotid artery blood flow and regional cerebral oxygen saturation (rScO 2) in elderly patients undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods:Sixty-four elderly patients undergoing elective CABG under CPB, aged 60-80 yr, regardless of gender, with body mass index of 18.1-28.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, with left ventricular ejection fraction≥50%, were selected. The rScO 2 and ultrasonic parameters of internal carotid artery including peak systolic velocity (PSV-ICA), end-diastolic velocity (EDV-ICA), diameter (D-ICA) and blood flow volume (Q-ICA) were recorded before anesthesia induction (T 0), at surgical skin incision (T 1), at 30 and 60 min of CPB (mean value was calculated, T 2), and at 30 and 60 min after termination of CPB (mean value was calculated, T 3). The ratio of unilateral internal carotid artery blood flow to cardiac output (Q/CO) was calculated. The receiver operating characteristic curve was used to analyze the accuracy of ultrasound parameters of internal carotid artery blood flow in predicting rScO 2 < 60%. Results:PSV-ICA was positively correlated with rScO 2 at T 0, T 1 and T 3 ( P<0.05), but no correlation was found between PSV-ICA and rScO 2 at T 2 ( P>0.05). There was no correlation between EDV-ICA and rScO 2 at each time point ( P>0.05). Q-ICA was positively correlated with rScO 2 at each time point ( P<0.05). Q/CO was not correlated with rScO 2 at T 1 ( P>0.05), but Q/CO was positively correlated with rScO 2 at T 2 and T 3 ( P<0.05). During the non-CPB period (T 0, T 1, T 3), the cutoff values of PSV-ICA and Q-ICA in predicting rScO 2< 60% were 51.35 cm/s and 283.5 ml/min respectively, the sensitivity was 0.900 and 0.900 respectively, and the specificity was 0.610 and 0.857 respectively (AUC=0.761, P=0.006; AUC=0.903, P< 0.001). During the CPB period, the cutoff values of Q-ICA and Q/CO in predicting rScO 2<60% were 296.5 ml/min and 5.84% respectively, the sensitivity was 0.900 and 0.800, and the specificity was 0.545 and 0.659 (AUC=0.764, P=0.001; AUC=0.748, P=0.002), respectively. Conclusions:PSV-ICA and Q-ICA are positively correlated with rScO 2 during the non-CPB period, and Q-ICA and Q/CO are positively correlated with rScO 2 during the CPB period in elderly patients undergoing CABG. PSV-ICA, Q-ICA and Q/CO can accurately predict rScO 2<60%.

Objective To analyze the quality of 22 batches of Fritillariae thunbergii bulbus Formula Granules from 12 different manufacturers by using water-extraction reference substance of Fritillariae thunbergii bulbus(ZBM ERS ST)and water-extraction reference substance of Fritillariae hupehensis bulbus(HBBM ERS ST)as references.Methods Ethyl acetate-methanol-triethylamine-water(17∶1∶1∶0.5)was used as the developing solvent for high-performance thin-layer chromatography(HPTLC)fingerprint analysis.The high-performance liquid chromatography(HPLC)fingerprint analysis was performed on a Agilent Eclipse XDB-C18 column(4.6 mm×250 mm,5 μm)with the gradient mobile phase consisted of acetonitrile-0.03%diethylamine solution.The column temperature was set at 25℃and evaporative light-scattering detector was used.The determination was conducted according to standard test method for measurement of Fritillariae thunbergii bulbus Formula Granules(Guangdong PFKL00117).Results The results of HPTLC and HPLC analysis showed that there are significant differences among the 22 batches of Fritillariae thunbergii bulbus Formula Granules.There were 4 batches of Fritillariae thunbergii bulbus Formula Granules from 3 manufacturers among them showed fingerprint characteristics of Fritillariae hupehensis bulbus.The total amount of peimine and peiminine in the remaining 18 batches of Fritillariae thunbergii bulbus Formula Granules was 0.291-3.179 mg·g-1,which were quite different.Conclusion Currently,the quality of Fritillariae thunbergii bulbus Formula Granules on the market varies greatly.Standardized water-extract reference substance has better applicability for the analysis of the quality of Fritillariae thunbergii bulbus Formula Granules than the control medicinal materials.

Objective To explore and organize the standards of rehabilitation big data. Methods The connotation and extension of rehabilitation big data were discussed based on International Classification of Functioning,Disability and Health(ICF)framework.Referring to the documents of Guidance on the analysis and use of routine health information systems rehabilitation module,Rehabilitation in health systems:guide for action,Rehabilitation indicator menu:a tool accompanying the Framework for Rehabilitation Monitoring and Evaluation(FRAME),and Data quality assurance.Module 1.Framework and metrics,the sources,patterns,clas-sification systems and coding standards were discussed under the ICF theory,and the metadata standards were ex-plored.The application and management of rehabilitation big data standards were discussed according to Nation-al Health Medical Big Data Standards,Security and Service Management Measures(Trial). Results The rehabilitation big data included rehabilitation service data and personal health data,coming from population-based and institution-based data,covering macro,meso and micro levels.The pattern of rehabilitation data flow corresponded to the interaction and source of the entire process of rehabilitation service,to organize and manage rehabilitation big data.The classification system included object classes,object feature classes,participant role classes,relationship classes,and activity and event classes,each of which was further subdivided into subcatego-ries to cover the entities,features,roles,relationships and activities involved in the rehabilitation process.The metadata standards included three levels:core,general and specialized metadata,ensuring standardized manage-ment,sharing and interoperability of rehabilitation data. Conclusion This study delves into the standardization of rehabilitation big data based on the ICF framework,encompass-ing multiple dimensions such as the connotation and extension of rehabilitation big data,data sources,data mod-els,classification systems,coding standards,and metadata standards.The construction of a rehabilitation big data standard system involves standardization efforts in various aspects,including data content,data structure,data coding,and metadata.These standards not only adhere to the norms of data flow,but also take into account the complexity of data composition.This system aligns with health big data standards,ensuring data consistency,ac-curacy,and interoperability,thus providing a foundation for effective exchange and comparison between different data sources.The establishment of a rehabilitation big data standard system not only ensures the standardized pro-cessing of rehabilitation big data,but also lays a solid foundation for effective exchange between rehabilitation big data and other health data,as well as for the widespread application of rehabilitation big data.This provides crucial support for improving the quality and efficiency of rehabilitation services,ensuring that patients receive appropriate care,rehabilitation and support.It holds significant theoretical and practical implications for promot-ing the development of the rehabilitation field.

Objective To explore the correlation between hyponatremia at admission and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Methods The 331 cases of elderly patients with intestinal obstruction(aged ≥ 60 years)who visited the General Surgery Department of Nanjing Meishan Hospital from January 2017 to December 2020 were selected as the research objects for retrospective cohort study analysis.According to the patient's blood sodium level at admission,they are divided into two groups:the hyponatremia group(Na＜135 mmol/L)and the non hyponatremia group(Na≥135 mmol/L).Divided into death group and survival group based on whether death occurred within one year after discharge.SPSS 25.0 software was used for statistical analysis.Independent sample t test,x2 test,Kaplan Meier method,and multivariate Cox regression analysis were used to observe the correlation between admission hyponatremia and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Results A total of 331 patients were enrolled.The incidence of hyponatremia was 32.3％,and 56 deaths occurred within one year,accounting for 16.92％.The one-year mortality rate in the hyponatremia group was 23.4％(25/107),which was higher than 13.8％(31/224)in the non hyponatremia group.The difference was statistically significant(P＜0.05).The survival analysis(Kaplan Meier)results showed that the survival rate of the hyponatremia group was lower than that of the non hyponatremia group(Log Rank P＜0.05).After adjusting for other confounding factors in multivariate Cox regression analysis,hyponatremia(HR=1.88,95％CI:1.07-3.29)was an independent risk factor for one-year all-cause mortality in elderly patients with intestinal obstruction(P＜0.05).Conclusion Hyponatremia at admission is an independent risk factor for all cause mortality in elderly patients with intestinal obstruction within one year after discharge.

Apelin is an adipokine family which includes Apelin-13,Apelin-36 and other isoforms and regulates phys-iological functions by immunomodulation,oxidative stress,glycolipid metabolism,and apoptosis and so on.Apelin is closely related to polycystic ovary syndrome,ovarian cancer and other diseases of the female reproductive system so it is expected to be new target molecules and may orient the development of research and clinical treatment.

Objective To assess the impact of intravenous esketamine administered prior to car-diopulmonary bypass(CPB)initiation on ventricular function and internal carotid artery blood flow in pa-tients undergoing heart valve replacement surgery.Methods Sixty patients underwent elective CPB heart valve replacement,38 males and 22 females,aged 18-75 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅱ or Ⅲ,NYHA cardiac function classification Ⅰ-Ⅲ,and a left ventricular ejection fraction(LVEF)of≥45％,were selected.The patients were randomly divided into two groups:esketamine group(group E)and normal saline group(group C),30 patients in each group.Total intravenous anesthesia was used during the operation.Following the initiation of CPB,group E received an intravenous infusion of es-ketamine at a rate of 0.5 mg·kg-1·h-1 until the conclusion of the procedure,while group C received an equivalent volume of normal saline concurrently at the same rate.HR,MAP,CVP,and cardiac output index(CI)were recorded before anesthesia induction,during skin resection,and within 60 minutes after stopping CPB.LVEF,left ventricular global longitudinal strain(GLS),global longitudinal time-to-peak strain standard deviation(GLTSD),global circumferential strain(GCS),global circumferential time-to-peak strain standard deviation(GCTSD),right ventricular ejection fraction(RVEF),right ventricular GLS,and GLTSD were obtained during skin resection,within 40 minutes of CPB,and 60 minutes after stopping CPB.rScO2,BIS,concentrations of Hb and lactic acid(Lac),peak systolic flow velocity(SPV),quantity of flow-internal carotid artery(Q-ICA),and blood flow resistance index(RI)were recorded before anesthesia induction,during skin resection,within 40 minutes of CPB,and within 60 minutes after stopping CPB.Concentrations of cardiac troponin Ⅰ(cTnⅠ),alanine aminotransferase(ALT),creatinine(Cr),and neuron-specific enolase(NSE)were recorded before anesthesia induction and 6 hours after operation.Spon-taneous resuscitation after CPB,postoperative extubation time,duration of ICU stay,total hospital stay,in-cidence of adverse cardiac events,and 30-day postoperative mortality were recorded.Results Compared with group C,group E exhibited a significant increase in CI within 60 minutes after stopping CPB(P＜0.05).The LVEF,RVEF,and right ventricular GLS demonstrated significant increases within 60 minutes after stopping CPB in group E compared with group C(P＜0.05).The left ventricular GLS and left ven-tricular GCTSD displayed significant increases 30 minutes after stopping CPB in group E compared with group C.The RI exhibited a significant increase within 40 minutes of CPB in group E compared with group C(P＜0.05).There were no significant differences in cTnⅠ,ALT,Cr,NSE,spontaneous resuscitation affter CPB,postoperative extubation time,duration of ICU stay,total hospital stay,incidence of cardiac adverse events,and 30-day postoperative mortality between the two groups.Conclusion Administration of esket-amine following the onset of CPB in patients undergoing cardiac surgery demonstrates a significant elevation in CI post-CPB cessation.Furthermore,it may augment ventricular longitudinal strain,thereby enhancing myocardial contraction,leading to increased postoperative ventricular ejection fraction,and sustaining hemo-dynamic stability.