Objective To investigate the clinical efficacy of mitral valve repair technique in the treatment of rheumatic mitral valve lesions. Methods The clinical data of patients diagnosed with rheumatic mitral valve lesions and undergoing mitral valve repair under extracorporeal circulation in our department from 2021 to 2022 were retrospectively analyzed. Results A total of 100 patients were collected, including 78 females and 22 males with an average age of 52 years. There were no secondary open heart or death in the whole group. Extracorporeal circulation time was 136.3±33.1 min, aortic cross-clamping time was 107.6±27.5 min, ventilator use time was 12.9±5.9 h, ICU stay was 2.6±1.4 d, and vasoactive medication use was 823.4±584.4 mg. Before and after the surgery, there were statistical differences in the left ventricular end diastolic diameter, left atrial end systolic diameter, effective mitral valve orifice area, shortening rate of left ventricular short axis, mitral E-peak blood flow velocity, mean mitral transvalvular pressure difference, mitral pressure half-time, and cardiac function graded by New York Heart Association (P＜0.05). While there was no statistical difference in left ventricular ejection fraction or left ventricular end-diastolic volume (P>0.05). Conclusion Overall repair of rheumatic mitral valve lesions can significantly improve the cardiac function and hemodynamics of the patients, and is a good choice for patients with rheumatic mitral valve lesions.

OBJECTIVE To systematically evaluate the efficacy and safety of the sedative effect of remimazolam in endoscopy and to compare it with propofol and midazolam. METHODS Search PubMed, Embase, Cochrane Library, Wanfang database, CNKI and other databases to collect the literature of randomized controlled trials of remimazolam for sedation in endoscopy. The search period was from 2018 onwards when remimazolam was approved for clinical trials until April 2022. The search strategy included the following variable keywords: remimazolam, gastroscopy, bronchoscopy, and colonoscopy. The quality of the included literature was assessed and the collected data were subjected to meta-analysis by RevMan 5.4 software. RESULTS Ten relevant RCTs involving midazolam and propofol, involving a total of 2 076 patients were included in the analysis. The results showed that the sedative effect of remimazolam was significantly higher than that of midazolam [OR=0.03, 95%CI(0.02, 0.05), I2=0%, P<0.000 01]; but lower than that of propofol [OR=11.32, 95%CI(2.12, 60.56), I2=0%, P=0.005]. The onset time of remimazolam was longer than that of propofol, but shorter than that of midazolam; the recovery time was faster than that of propofol and midazolam. Compared with midazolam, there was no significant difference in the incidence of adverse reactions. Compared with propofol, remimazolam was associated with lower rates of hypotension, slowed heart rate, hypoxemia, and injection pain, but higher risk ratio of nausea, with no difference invomiting. CONCLUSION The sedative effect and onset of action of remimazolam are better than midazolam but less than propofol when used for endoscopy. Wake-up time is faster than that of propofol and midazolam. The incidence of respiratory and circulatory depression is lower with remimazolam than with propofol, and there are no significant differences in adverse effects compared with midazolam.

Objective To investigate the relationship between the levels of serum neuron-specific enolase(NSE)and tumor necrosis factor alpha(TNF-α)and the attack stage and prognosis of children with epilepsy secondary to viral encephalitis(VE).Methods A total of 96 children with VE admitted to the People's Hospital Affiliated to Inner Mongolia Medical University from January 2015 to January 2020 were selected as the research subjects,and they were divided into the control group(children with VE,n=30)and the observation group(children with epilepsy secondary to VE,n=66).In addition,30 healthy children who underwent physical examination in the hospital during the same period were selected as the health group.The levels of serum NSE and TNF-α in the health group,control group and observation group were compared.Children in the observation group were further divided into the 24h relapse group(n=48)and 24h non-relapse group(n=18)according to the attack of disease within 24h after admission.The levels of serum NSE and TNF-α were compared between the two groups.Pearson correlation was used to analyze the relationship between the levels of NSE,TNF-α and the attack stage of epilepsy secondary to VE.Children in the observation group were divided into the good prognosis group(n=45)and the poor prognosis group(n=21)according to the Glasgow Outcome Scale score at discharge.The serum levels of NSE,TNF-α and other possible prognostic factors were compared between the two groups.Multivariate logistic regression analysis was used to explore the prognostic factors of children with epilepsy secondary to VE,and the predictive value of serum NSE and TNF-αlevels on the prognosis of children with epilepsy secondary to VE was analyzed by drawing the receiver operating characteristic curve.Results The level of serum NSE in the control group was significantly higher than that in the health group(P＜0.05),and there was no significant difference in the level of serum TNF-α between the control group and the health group(P＞0.05).The serum levels of NSE and TNF-α in the observation group were significantly higher than those in the control group(P＜0.05).The serum levels of NSE and TNF-α in the observation group were significantly higher than those in the control group(P＜0.05).The levels of serum NSE and TNF-α in the 24 h relapse group were significantly higher than those in the 24 h non-relapse group(P＜0.05).The proportion of severe abnormal EEG,severe abnormal brain images and complicated respiratory failure,and serum levels of c-reactive protein,NSE and TNF-α in the good prognosis group were lower than those in the poor prognosis group(P＜0.05);there were no significant differences in sex,age,body mass,brain injury site,fever,hypokalemia,hyponatremia,previous convulsions,stress hyperglycemia,complicated organ dysfunction,viral infection,first episode of epilepsy,Glasgow Coma Scale score at admission,duration of convulsion,length of hospital stay,white blood cell count,aspartate transaminase,creatine kinase and cardiac troponin levels between the two groups(P＞0.05).The results of multivariate logistic regression analysis showed that complicated respiratory failure,serum NSE and TNF-α levels were correlated with the prognosis of children with epilepsy secondary to VE(P＜0.05).The area under the curve(AUC)of serum NSE and TNF-α levels in predicting the prognosis of children with epilepsy secondary to VE was 0.724(95％confidence interval:0.672-0.776)and 0.689(95％confidence interval:0.637-0.734),respectively,with a sensitivity of 82.22％and 75.56％and a specificity of 76.19％and 71.43％;the AUC of the combination of the two in predicting the prognosis of children with epilepsy secondary to VE was 0.826(95％confidence interval:0.774-0.873),with a sensitivity of 73.33％and a specificity of 80.95％.Conclusion The serum levels of NSE and TNF-α are abnormally high in children with epilepsy secondary to VE.Both of them are factors affecting the prognosis of children with epilepsy secondary to VE,showing a good predictive value for the prognosis of epilepsy secondary to VE.

Objective:To explore mechanism of Chaihu Longgu Muli Decoction and Ganmai Dazao Decoction in treatment of post-stroke depression(PSD)based on network pharmacology,molecular docking and animal experiment.Methods:TCMSP and other databases were used to predict active components and targets of Chaihu Longgu Muli Decoction and Ganmai Dazao Decoction.Targets of PSD were retrieved from PharmGKB and other databases,and"component-intersection target-disease"network was constructed by Cytoscape(v3.9.1)software.PPI network was constructed by String(v11.5)database,and GO enrichment and KEGG pathway analy-sis of intersection targets were performed by DAVID6.8 database.AutoDock vina(v1.1.2)software was used for molecular docking.Pymol(v 2.5)and other softwares were used to visualize optimal docking results.Animal experiments were setup in control group,model group,fluoxetine group,TCM group and TCM+fluoxetine group,neurobehavioral scores and expressions of neurotransmitters and inflammatory factors in brain tissues were detected.mRNA and protein expressions of key genes PPARG,MAPK3,AKT1,PIK3CA were detected by RT-qPCR and Western blot.Results:A total of 225 kinds of active ingredients of Chaihu Longgu Muli Decoction and Ganmai Dazao Decoction were obtained,which acted on 119 targets of PSD,among which key targets included MAPK3,AKT1,PIK3CA and PPARG,key pathways including MAPK signaling pathway,PI3K-Akt signaling pathway and etc.Compared with model group,MAPK3 mRNA and protein expressions were decreased,AKT1,PIK3CA,PPARG mRNA and protein expressions were increased in TCM group and TCM+fluoxetine group(P<0.05).Conclusion:Mechanism of Chaihu Longgu Muli Decoction and Ganmai Dazao Decoction in treatment of PSD may be related to inhibition of MAPK3 expression,promotion of AKT1,PIK3CA,PPARG expressions,alleviation of inflammatory response and oxidative stress in brain tissues.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the application effect of medical sterile gloves-assisted cutting cloth samples in the repair of finger degloving injury.Methods:The clinical data of patients with finger skin and soft tissue degloving defects treated in Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine from April 2015 to December 2021 were analyzed retrospectively. Medical sterile gloves were used to make cloth samples of finger defects, and then the dorsal foot flap or toenail flap was cut according to the cloth samples to repair finger defects. The survival of flaps and the appearance of the fingers’ body were observed after surgery, and the patients’ satisfaction was investigated. The finger function was evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Society of Chinese Medical Association.Results:A total of 12 patients with 13 fingers were enrolled. There were 9 males (10 fingers) and 3 females (3 fingers), aged 17-54, average of 37-year-old. There were 5 cases (5 fingers) in the left hand and 7 cases (8 fingers) in the right hand, all with unilateral finger injury. The size of the dorsal flaps and great toenail flaps harvested were appropriate, ranging from 5.5 cm×4.5 cm to 10.5 cm×5.8 cm. After surgery, all patients were regularly followed up for 3-15 months, an average of 7 months. All the dorsal flap and great toenail flap of the foot after surgery survived, and the appearance of the finger body was not bloated. All patients were very satisfied with the appearance and function of the hand, and the finger function was evaluated as excellent in 7 cases and good in 5 cases.Conclusion:The application of sterile gloves-assisted cutting cloth samples for the treatment of finger degloving injury can simplify the procedure, reduce donor damage, make up for the lack as much as needed, and the repaired fingers can obtain better shape and function.

Objective:To systematically evaluate the real experience and needs of caregivers of children with type 1 diabetes mellitus.Methods:Qualitative researches on the real experience and needs of caregivers of children with type 1 diabetes mellitus were searched through Wanfang Databese, China National Knowledge Infrastructure, VIP, CBM, PubMed, Cochrane Library, Web of Science and Embase. The retrieval time limit was from the establishment of database to March 6, 2022. Literature screening and data extraction were conducted independently by 2 researchers. The quality of the literatures was evaluated using the Australian Joanna Briggs Institute (JBI) evidence-based health care center qualitative research quality evaluation standard (2016). The results were synthesized by the integrating method.Results:A total of 15 literatures were included, 62 research results were extracted, 8 categories were classified, and 3 integrated results were synthesized: the caregivers of children with type 1 diabetes mellitus suffer from multiple pressure and burden at the early stage of diagnosis; caregivers during the home care period are eager to obtain various support due to lack of knowledge, experience and support; caregivers gradually adapt to the role change brought by the disease, actively respond and regain confidence.Conclusions:Families, medical institutions and society should pay attention to the psychological emotion of caregivers of children with type 1 diabetes mellitus, and provide information, psychological, economic and social support, help them better perform their role as caregivers, so as to improve the quality of life of children and caregivers.

Objective:To explore and analyze the online Q&A texts for hyperglycemia in pregnancy (HIP) users in online health communities, and to provide references for health information services for HIP patients.Methods:A total of 108 590 Q&A texts were collected from "Diabetes Forum" and "Mom Forum". Social network analysis was used to construct the co-occurrence network of feature words in text content and carry out visual analysis and display. On the basis of identifying content themes, the relationship between themes and the nodes within themes were further analyzed, and the attributes of content themes were differentiated with Wilson's information behavior model.Results:In this study, a question and answer text feature word network for pregnant hyperglycemia users with 321 nodes was constructed, among which the largest sub-net included 177 nodes. A total of 12 content themes were identified to seek motivation around two major categories of information, including blood sugar control and coping with disease stress. Among them, the themes with physiological, cognitive, and emotional attributes were 4, 7 and 6, respectively. The number of feature words contained in drug treatment, diet and nutrition was the most prominent, and there were feature words with high degree of centrality in each theme.Conclusions:The content that hyperglycemia in pregnancy (HIP) users pay attention to has multiple attributes and dimensions. Clinical and community healthcare workers and other health information providers can continuously improve the information service content for HIP patients to meet their health information needs.

Objective:To investigate the application effect of medical sterile gloves-assisted cutting cloth samples in the repair of finger degloving injury.Methods:The clinical data of patients with finger skin and soft tissue degloving defects treated in Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine from April 2015 to December 2021 were analyzed retrospectively. Medical sterile gloves were used to make cloth samples of finger defects, and then the dorsal foot flap or toenail flap was cut according to the cloth samples to repair finger defects. The survival of flaps and the appearance of the fingers’ body were observed after surgery, and the patients’ satisfaction was investigated. The finger function was evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Society of Chinese Medical Association.Results:A total of 12 patients with 13 fingers were enrolled. There were 9 males (10 fingers) and 3 females (3 fingers), aged 17-54, average of 37-year-old. There were 5 cases (5 fingers) in the left hand and 7 cases (8 fingers) in the right hand, all with unilateral finger injury. The size of the dorsal flaps and great toenail flaps harvested were appropriate, ranging from 5.5 cm×4.5 cm to 10.5 cm×5.8 cm. After surgery, all patients were regularly followed up for 3-15 months, an average of 7 months. All the dorsal flap and great toenail flap of the foot after surgery survived, and the appearance of the finger body was not bloated. All patients were very satisfied with the appearance and function of the hand, and the finger function was evaluated as excellent in 7 cases and good in 5 cases.Conclusion:The application of sterile gloves-assisted cutting cloth samples for the treatment of finger degloving injury can simplify the procedure, reduce donor damage, make up for the lack as much as needed, and the repaired fingers can obtain better shape and function.

Objective:To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods:From August 2013 to December 2020, 25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting. The area of the defects was 0.8 cm× 0.8 cm to 1.6 cm× 1.4 cm. The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm. In order to make the flap transfer to a further distance, the subcutaneous fibre connection of the flap was cut-off during the operation. At the same time, cut off 1 side of subcutaneous pedicle. Finally, the advanced distance of the flap reached 0.5-1.2 cm. After the flap harvested, the medium thickness skin was removed for graft to close the donor site from the wrist striations. After the surgery, follow-up visits were conducted regularly by outpatient clinic, or via telephone or WeChat review or by home visit. Throughout the follow-up, the flap appearance, sensation and recovery of the function of digital joint were observed, together with the patient satisfaction. Results:After the surgery, the postoperative follow-up lasted for 4 months to 8 years. All 25 flaps and skin grafts were survived in first stage wound healing. The flaps and skin grafting areas had excellent texture. The fingerprint had been reconstructed with good appearance. The TPD was 4-9 mm, the functions of digital joint recovered well, and there was no complain about a discomfort at the donor site. According to the evaluation standard of Michigan hand function questionnaire, all 25 patients were very satisfied with the overall appearance and function of the hand. According to Total Angle of Motion (TAM) evaluation standard, finger mobility was excellent in all 25 patients.Conclusion:Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip. The surgery characterises a simple flap cutting, less traumatic damage, long advancing distance of flap and good repair effect.