Objective To investigate the analgesic effect and safety of transincisional quadratus lumborum block(TQLB)technique for laparoscopic nephrectomy.Methods Sixty patients scheduled for laparoscopic nephrectomy at the Affiliated Lihuili Hospital of Ningbo University from December 2023 to March 2024,the patients were randomly divided into TQLB group(T group)and control group(C group)using a random number table method,with 30 cases in each group.C group received general anesthesia with tracheal intubation,while T group received general anesthesia with tracheal intubation combined with TQLB.Two groups of patients were routinely given sufentanil controlled intravenous analgesia pump after surgery.Record the wound healing status of two groups of patients,postoperative 24h sufentanil consumption,resting and exercise time numerical rating scale(NRS)scores at 6h,12h,and 24h postoperatively,range of sensory blockade at 2h postoperatively,number of salvage analgesia cases at 24h postoperatively,analgesic satisfaction score,and incidence of postoperative complications.Results Compared with group C,patients in group T had a reduced consumption of sufentanil 24h after surgery(P＜0.001);The resting and exercise NRS scores decreased at 6h,12h,and 24h after surgery(P＜0.05);The number of postoperative 24h rescue analgesia cases and the satisfaction score of analgesia were both lower than C group(P＜0.05);The incidence of postoperative nausea and vomiting in group T was lower(P＜0.05);Both groups of patients did not experience serious complications.Conclusion TQLB appears to offer effective postoperative analgesia during the early stages of laparoscopic nephrectomy,while also reducing the occurrence of complications.This suggests that it could serve as a safe and efficient alternative for analgesic management in such surgical procedures.

Objective:To investigate the effect of mindfulness-based cognitive therapy (MBCT) on mindfulness attention awareness, experiential avoidance, and cognitive fusion in individuals with general anxiety disorder(GAD).Methods:A total of 53 patients aged 18-60 years who met the GAD diagnostic criteria of DSM-5 were selected from the Seventh People's Hospital of Hangzhou from May 2021 to September 2022.After receiving routine treatment, patients were randomly assigned to two groups: MBCT group( n=26) for an 8-week mindfulness cognitive therapy and health education group( n=27) for an 8-week health education program. Participants were evaluated using the generalized anxiety disorder scale(GAD-7), acceptance and action questionnaire-2nd edition(AAQ-Ⅱ), cognitive fusion questionnaire(CFQ), and mindful attention awareness scale (MAAS) before and after the intervention.Data were analyzed using SPSS 26.0 software, with the chi-square test, independent sample t-test, and paired sample t-test. Results:(1)There was no significant difference in MAAS score between the two groups before the intervention (42.63±10.18, 47.67±9.52, t=-1.55, P=0.13). However, after the intervention, the MAAS score in MBCT group was significantly higher than that in the health education group(54.42±9.87, 47.83±7.59, t=-2.27, P=0.03). (2) No significant difference was observed in CFQ score between the two groups before the intervention (57.11±15.97, 53.50±12.01, t=-0.77, P=0.45). However, after the intervention, the CFQ score in the MBCT group was significantly lower than that in the health education group(38.32±10.31, 47.11±10.66, t=-2.51, P<0.01). (3) There was no significant difference in AAQ-Ⅱ scores between the two groups before the intervention(33.79±7.90, 30.00±7.23, t=1.52, P=0.14). After the intervention, the AAQ-Ⅱ score in the MBCT group was significantly lower than that in the health education group(21.89±8.69, 30.22±8.68, t=-3.51, P<0.01) . Conclusion:MBCT has a positive effect on enhancing mindfulness attention awareness, reducing cognitive fusion, and mitigating experiential avoidance in GAD patients.

Objective:To evaluate the efficacy and safety of endoscopic stricturotomy (EST) under balloon-assisted enteroscopy (BAE) in treatment of benign jejuno-ileal stenosis.Methods:From December 2015 to August 2021, at the Air Force Medical Center, 41 patients who were diagnosed with benign jejuno-ileal stenosis underwent BAE deep small bowel EST and/or surgery due to ineffective or ineffective drug treatment were retrospectively analyzed. Twenty-one patients were treated with EST (EST group) and 20 patients were treated with surgery (surgery group). The etiology and follow-up time were analyzed, the general conditions (male proportion and age), the immediate technical success rate (the percentage of the stenosis that the enteroscope could pass through after EST in the total number of treated stenoses), the incidence of complications (including perforation, bleeding, etc.), the symptom remission rates at 3-month, 6-month, and 1-year after treatment (the percentage of patients with complete or partial remission in the total number of patients), cumulative symptom-free survival rate (no obstruction-related symptoms after EST or surgery till the last follow-up) and cumulative surgery-free survival rate of two groups were compared. Chi-square test, independent t-test, Fisher′s exact probability method and Kaplan-Meier analysis were used for statistical analysis. Results:The main etiology of stricture of EST group and surgery group was Crohn′s disease (71.4%, 15/21 and 60.0%, 12/20, respectively), and the median follow-up time was 12 months (6 to 46 months) and 45 months (14 to 73 months), respectively. There were no significant differences in male proportion, age, immediate technical success rate and incidence of complication between EST group and surgery group (57.1%, 12/21 vs. 65.0%, 13/20; (45.2±17.4) years old vs. (43.1±20.3) years old; 95.3%, 41/43 vs. 100.0%, 30/30; 26.9%, 7/26 vs. 10.0%, 2/20, all P>0.05). In the EST group, 9.5% (2/21) of the patients received surgery because of perforation during EST, 76.2% (16/21) of the patients did not need surgery after EST, and the median symptom-free survival time of patients without symptoms in EST group was 13.3 months. There was no significant difference in the symptom remission rate at 3-month after treatment between EST group and the surgery group (17/19 vs. 100.0%, 20/20, P>0.05). The symptom remission rate at 6-month and 1-year of EST group were lower than those of the surgery group (15/19 vs. 100.0%, 20/20; 8/11 vs. 100.0%, 20/20), and the differences were statistically significant (both were Fisher′s exact probability method, P=0.047 and 0.037). The cumulative symptom-free survival rates at 3-month, 6-month and 1-year of EST group and surgery group were 66.0% vs. 90.0%, 61.0% vs. 85.0% and 54.0% vs. 80.0%, respectively.The results of Kaplan-Meier analysis indicated that there was no significant difference in the symptom-free survival curve between two groups ( P>0.05). The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in EST group were 90.0%, 81.0% and 73.0%, respectively. The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in surgery group were all 100.0%. Conclusion:EST under BAE is technically feasible, and safe in the treatment of benign jejuno-ileal stenosis, and can effectively relieve clinical obstruction symptoms and avoid or delay surgery in the short term.

Objective: To investigate the incidence rate of transjugular intrahepatic portosystemic shunt (TIPS) complications in the treatment of cirrhotic portal hypertension, and analyze the cause of complication to management methods. Methods: Data of 116 patients obtained from Zhongnan Hospital of Wuhan University were retrospectively analyzed. Portal venous pressure, routine blood test, coagulation test, liver and kidney function test, ammonia blood test, imaging and endoscopy reports were collected before and after procedure. The incidence rate of hepatic encephalopathy, gastrointestinal bleeding, ascites and shunt dysfunctions were observed. Data were expressed as mean ± Standard deviation and analyzed by t-test. A chi-squared test was used for comparison between categorical variables. Results: The success rate of TIPS operation was 97.41% (113/116). Two patients underwent prompt TIPS procedure due to active bleeding. Bleeding was successfully stopped. Portal venous pressure of 113 patients decreased from (42.73 ± 7.64) cmH₂O to (24.92 ± 7.60) cmH₂O, and the difference was statistically significant (P < 0.01). Twenty cases were of hepatic encephalopathy. Preoperative level of Child-pugh class C patients was more susceptible to hepatic encephalopathy within 3 months after procedure than class A and B. After TIPS procedure, there were 22 cases of gastrointestinal bleeding, 18 cases of shunt dysfunctions and 26 cases of disease related death. Conclusion Rational patient selection strategies can effectively reduce portal venous pressure, incidence of hepatic encephalopathy, improve mid-and long-term therapeutic effects, and provide opportunities for liver transplantation.

Objective To explore the mechanism and clinical significance of left atrioventricular interval abnormality in the patients with coronary artery disease.Methods A total of 48 patients with coronary artery disease were selected and divided into the left interval atrioventricular shortening group(AV≤100 ms) and the left atrioventricular interval normal group(AR＞100 ms) according to the left atrioventricular interval measured by the esophageal electrocardiogram.The clinical features,cardiac echocardiography and coronary vessel lesions were compared between the two groups.Results The age in the AR≤ 100 ms group was higher than that in the AR＞10 ms group(P=0.018);the proportion of right coronary arterial lesion in the AR ≤ 100 ms group was higher in that in the AR＞10ms group(P=0.038);the left atrial diameter in the AR ≤100ms group was enlarged compared with that in the AR＞ 100 ms group(P=0.041).Conclusion The cardiac electric transduction abnormality exists in the patients with coronary heart disease,the majority of the patients with left atrioventricular interval shortening have the right coronary artery lesion.

OBJECTIVETo observe the clinical effect differences between infraoccipital needle-knife and massage for cervical vertigo.

METHODSA total of 366 patients with cervical vertigo were randomly assigned into a needle-knife group (186 cases) and a massage group (180 cases). With cases dropping excluded, 183 cases in the needle-knife group and 176 cases in the massage group were included. Needle-knife was used at Fengchi (GB 20), infraoccipitalpoint, etc. in the needle-knife group. The treatment was given for one course, once three days, 5 times as one course. The traditional massage was applied in the massage group for one course, including systematic stroking, kneading, and the application of pressure and plucking, etc., once every two days and 7 times as one course. The dizziness handicap inventory (DHI) score was observed before and after treatment, as well as 3, 6, and 12 months after treatment. The effects were also evaluated.

RESULTSThe total effective rate was 92.3% (169/183) in the needle-knife group, which was better than 85.2% (150/176) in the massage group (<0.05). Compared with those before treatment, the DHI scores at all the observation time points after treatment were improved in the two groups (all<0.05), with better improvements after treatment as well as 3 and 6 months after treatment in the needle-knife group (all<0.05). There was no significant difference in the improvement of DHI scores between the two groups 12 months after treatment (>0.05). The recurrence rate was 10.3% (12/117) in the needle-knife group, and it was 10.7% (11/103) in the massage group 12 months after treatment (>0.05).

CONCLUSIONSInfraoccipital needle-knife achieves apparent effect for cervical vertigo, which is superior to massage in short period.

OBJECTIVETo assess the association of single nucleotide polymorphisms (SNPs) of endotheline receptor gene with the severity of coronary heart disease (CHD).

METHODSA total of 553 CHD patients, including 324 patients with mult-vessel disease based on result of selected coronary angiography, and 553 age- and sex-frequency matched controls were selected. Clinical data were collected. Genotypes of rs501120, rs899997, rs1878406 and rs7173743 were determined with TaqMan-MGB probes.

RESULTSThe distribution of genotypes of the 4 SNPs showed no significant difference between the two groups. However, the frequency of A allele of rs501120 and T allele of rs1878406 were significantly higher in the CHD group compared with the control group (P< 0.05). For rs7173743 and rs899997, no significant difference was detected between the two groups. After adjusting for conventional risk factors by logistic regression analysis, the results suggested that the distribution of rs1878406 TT+TC genotype in severe multi-vessel disease group is significantly higher than that in the control group (OR=1.43, 95% CI: 1.05-2.07, P=0.033).

CONCLUSIONThe above results suggested that the rs1878406 polymorphism of endotheline receptor gene may serve as a genetic marker for severe multi-vessel disease in CHD among ethnic Han Chinese.

Case-Control Studies ; Coronary Disease ; genetics ; Endothelins ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Multiple Chronic Conditions ; Polymorphism, Single Nucleotide ; genetics

Objective To explore the use of marginal kidneys from DBD (donation after brain death) donors and the indication for adult dual kidney transplantation.Methods Two pairs of graft kidneys were procured from two marginal adult donors.Dual kidney transplants were performed in two recipients.In each recipient,two kidneys were implanted in unilateral site of right lower quadrant and placed extraperitoneally,two separate extravesical ureterneocysto-anastomoses were performed.Results Delayed graft function (DGF) combined with acute rejection occurred in two cases,and all two cases recovered after treatments.Lymphocele and hematoma occurred in one case.No graft embolism and no urinary leak happened.Conclusions Adult dual kidney transplant offers an important use of kidneys from marginal donors to increase the number of organs available for transplantation.

Objective To observe the effects of prazosin on matrix metalloproteinase‐1(MMP‐1) and tissue inhibitor of met‐alloproteinase 1 (TIMP‐1) expression in atherosclerosis plaque of ApoE knock‐out(ApoE-/- ) mice model and to explore its anti‐atherosclerotic effect and mechanism .Methods Twenty‐four 8‐week‐old ApoE-/- mice were randomly divided into the normal diet group ,high‐fat diet group and prazosin group ,8 cases in each group .The normal diet group was fed by common fodder ,while the high fat group and prazosin group were fed by high fat diet ;on the basis of the high fat diet ,the prazosin group was started to con‐duct gavage of prazosin hydrochloride 1 mg/kg every day ,while the normal diet group and the high fat diet group were daily ga‐vaged by the same volume of normal saline .The abdominal aortic venous blood after 12 weeks in each group was collected for detec‐ting the blood lipid levels .The aorta arterial blood sample was collected for detecting MMP‐1 and TIMP‐1 expression levels by im‐munohistochemistry .Results Compared with the high fat diet group ,the levels of serum TG ,TC and LDL‐C in the prazosin group were significantly decreased ,and the HDL‐C level was increased ,the differences were statistically significant (P< 0 .01 or P<0 .05);the area of aorta arterial atherosclerotic plaque and intima thickness were significantly increased ,while prazosin could signif‐icantly inhibit the plaque formation and intima hyperplasia ;compared with the normal diet group ,the expression level of MMP‐1 protein in the high fat diet group and prazosin group was significantly increased ,while the TIMP‐1 protein expression level was de‐creased ,moreover the MMP‐1 protein expression level in the prazosin group was lower than that in the high fat diet group ,while the TIMP‐1 protein expression level was higher than that in the high fat diet group ,the differences were statistically significant (P<0 .05) .Conclusion Prazosin can decrease the level of TC and LDL‐C ,increase the HDL‐C level and has certain anti‐atherosclerotic effect ,its mechanism may be related with the decrease of the MMP‐1 level and the increase of the TIMP‐1 level in plaque .

Objective To investigate the inhibitory effect of testosterone on oxidized low-density lipoproteins ( ox-LDL)-stimulated phenotypic transition and proliferation of vascular smooth muscle cells ( VSMCs) in vitro, and to explore its possible mechanisms. Methods Rat VSMCs cultured in vitro were divided into control group, ox-LDL group(50μg/mlox-LDL),fetalbovineserum(FBS)group(10% FBS),andtestosteronegroups(5×10-8 or5×10-7 mol/L testosterone plus 50μg/ml ox-LDL) . The effect of testosterone on ox-LDL-induced proliferation of VSMCs was explored by WST-1 assay. The cell cycle distribution was determined using flow cytometry. Western blotting was used todetecttheexpressionsofmitofusin2(Mfn2),phosphorylatedextracellularsignal-regulatedkinases1/2(p-ERK1/2) , proliferating cell nuclear antigen ( PCNA) ,α-smooth muscle actin (α-SMA) ,and osteopontin ( OPN) . Results Compared with control group, the proliferation of VSMCs was promoted by ox-LDL, the number of VSMCs decreased in G0/G1 phase and increased in S phase significantly, the expression levels of Mfn2 and α-SMA were significantly reduced, and the expression levels of p-ERK1/2, PCNA, and OPN were significantly raised in ox-LDL group. Compared with ox-LDL group, the proliferation of VSMCs was inhibited, the number of VSMCs increased in G0/G1 phase and decreased in S phase in two testosterone groups, along with the increased expressions of Mfn2 andα-SMA, and the descended expressions of p-ERK1/2, PCNA, and OPN. Conclusions Testosterone inhibits phenotypic transition and proliferation of VSMCs induced by ox-LDL in vitro, which may be related to the up-regulated expression of Mfn 2 and the suppression of ERK1/2 pathway.