Objectives:To analyze the range of motion(ROM)and intradiscal pressure(IDP)of lower cervical spine in occipitocervical fixation with different posterior occipitocervical angles(POCA),and explore the selec-tion strategy of POCA in occipitocervical fusion(OCF)surgery.Methods:8 fresh frozen human occipitocervical cadaveric specimens(C0-T1,cephalic end included the bony structure of the skull base below the occipital tuberosity)were selected,including 4 males and 4 females,aged 25-45 years,and bone abnormalities and destruction were excluded with X-ray fluoroscopy.The speciemens were removed of muscles and fat tissues and preserved with ligaments,joint capsules and intervertebral discs as the normal group.Specimens were loaded with 2N·m in a servo-hydraulic materials testing system for measuring the ROM and IDP of C3/4,C4/5,C5/6 and C6/7 in the directions of flexion,extension,left torsion and left lateral bending with the help of optoelectronic motion analysis system and miniature pressure transducers.Then,the specimens were subject-ed to occipitocervical fixation with different POCAs as 5 experimental groups,which were:neutral position group(POCA=111°),neutral position-standard deviation(SD)group(POCA=101°),neutral position+SD group(POCA=121°),neutral position-2SD group(POCA=91°),and neutral position+2SD group(POCA=131°).The fixed segments were C0,C2 and C3.All experimental groups used the displacement control protocol to perform experiment,and the ROM and IDP of C3/4,C4/5,C5/6 and C6/7 in four directions were measured.Results:After occipitocervical fixation,ROM in the four directions of C0-C3 was significantly reduced compared with the normal group(P＜0.001).Of the four directions,the change of POCA had regular impacts on ROM and IDP of the 4 segments in flexion and extension:in flexion,with the increase of POCA,ROM and IDP of each segment showed a decreasing trend;In extension,with the increase of POCA,ROM of each segment showed an increasing trend,while IDP showed a decreasing trend.When POCA was in the neutral position,ROM in flexion or extension of each segment was significantly greater than that of normal group,yet there was no extremely increased ROM in flexion as POCA was too little or in extension as POCA was too large,and there was no significant difference of IDP compared with that of the normal group(P＞0.05).The change of POCA had no regular effect on ROM and IDP of 4 segments in left torsion and left lateral bending,although ROM increased significantly compared with that of the normal group.Conclusions:In OCF surgery,fixing POCA in a neutral position,the ROM and IDP of subaxial cervical spine are approximately normal.

Objective To investigate the effect and possible mechanism of Maslinic acid(MA)on apoptosis of cervical cancer HeLa cells.Methods HeLa cells were treated with different concentrations of MA,and cell survival rate was detected by MTT;Cell apoptosis was detected by Annexin V-FITC/PI flow cytometry;The changes of mitochondrial membrane potential were detected by JC-1 staining;The expression levels of OMA1,optic dystrophy protein 1(OPA1),Bax,Bcl-2,cleaved caspase-3,and cytoplasmic cytochrome C(Cyt C)were detected by Western blot.Whether MA induces HeLa cell apoptosis by regulating OMA1-mediated mitochondrial apoptosis has been verified through silencing OMA1 gene expression.Results MA inhibited the proliferation of HeLa cells in a dose-dependent manner.Different concentrations of MA could increase the apoptosis rate of HeLa cells and decrease the mitochondrial membrane potential,meanwhile,the protein expression levels of OMA1,Bax,cleaved caspase-3 and Cyt C in cytoplasm were up-regulated,and the protein expression levels of OPA1 and Bcl-2 were down-regulated.Silencing OMA1 gene expression inhibited the apoptosis of HeLa cells induced by MA.Conclusion MA can inhibit the proliferation of HeLa cells and induce cell apoptosis,and the mechanism may be related to the regulation of mitochondrial apoptosis pathway mediated by OMA1.

Objective:To investigate the significance of CT imaging features in the diagnosis of first-episode paranoid schizophrenia.Methods:Forty-five patients with first-episode paranoid schizophrenia admitted to Shaoxing 7 th People's Hospital from January 2018 to January 2019 were included in the study group. An additional 40 healthy controls who received health examination were included in the control group. All participants underwent head CT scans and CT values of cerebral lobes were measured. CT imaging features of first-episode paranoid schizophrenia were analyzed. The recurrence rate of paranoid schizophrenia was calculated. The diagnostic effect of CT imaging on paranoid schizophrenia was evaluated. Results:The CT value of the frontal lobe in the study group was significantly lower than that in the control group [(33.1 ± 1.4) HU vs. (36.9 ± 2.1) HU, t = 9.914, P < 0.001]. The proportions of patients having ventricular enlargement, sulcus widening, arachnoid cyst and cisterna magna in the study group were 51.1%, 24.4%, 31.1% and 20.0% respectively, which were significantly higher than 5.5%, 2.5%, 2.5% and 2.5% respectively in the control group ( χ2 = 21.688, 8.411, 11.928, 4.675, all P < 0.05). The recurrence rate of paranoid schizophrenia in the study group was 22.2% (10/45). The CT value of the left and right frontal lobe in patients with recurrent paranoid schizophrenia was (32.1 ± 1.7) HU and (32.5 ± 1.6) HU respectively, which was significantly lower than (35.0 ± 1.9) HU and (34.9 ± 1.7) HU in patients without recurrent paranoid schizophrenia ( t = 4.348 and 3.985, both P < 0.001). Conclusion:Patients with first-episode paranoid schizophrenia have brain structural abnormalities, as manifested by ventricular enlargement, sulcus widening, arachnoid cyst, and cisterna magna. CT imaging features are of great value in the diagnosis of first-episode paranoid schizophrenia. It deserves wide popularization and has a great innovation value.

Coronavirus disease 2019（COVID-19） is a severe infectious disease. New advances in the nucleic acid detection of SARS-CoV-2 is an important means to diagnose the new coronavirus infection. Rapid and accurate nucleic acid detection of SARS-COV-2 is of great significance for early detection of infected people and control of the spread of the epidemic. In this paper, the research progress of SARS-CoV-2 nucleic acid detection technology since the epidemic outbreak was reviewed, the main problems in clinical application were analyzed, and the development of SARS-CoV-2 nucleic acid detection technology was prospected.

Objective:To investigate the effect of the artificial facial nerve on the restoration of orbicularis oculi muscle function for unilateral peripheral facial paralysis in rabbit.Methods:Artificial facial nerve was implanted into the rabbit with unilateral peripheral facial paralysis between January 2018 and May 2019. At different time points after operation, the affected orbicularis oculi muscles′ stimulation closure threshold and the synchronism about the motion of the two sides of orbicularis oculi muscles were monitored. T test was used with SPSS 13.0 software. Results:There was no significant difference in the closure threshold of the orbicularis oculi muscle on the 7th and 28th days after artificial facial nerve implantation ( P>0.05). The synchronism of the normal side eye closing movement triggered the affected orbicular oculi muscle movement with the artificial facial nerve was up 19/20 to 20/20 at different times. Conclusions:The artificial facial nerve system had the features of stable working condition and high synchronizing effect for stimulating movement. It could restore the closed eye function in animals with peripheral facial paralysis animals and had great clinical application prospects.

Objective: To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones. Methods: The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A " T" tube was used according to intraoperative conditions. Results: Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation. Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved.

? The incidence of anxiety and depression is high among epileptic children, and the morbidity has a growth trend seriously affecting children's many aspects, such as life quality, learning ability and mental growth which should be paid more attention to. At present, there are various kinds of instruments to assess anxiety and depression of epileptic children. The unified research on the instruments for assessing anxiety and depression of epileptic children is less at the present stage. This paper reviewed the status, correlative factors, assessment instrument and application status of anxiety and depression of epileptic children.

Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.

Objective To evaluate the effect of "health education mobile classroom " in the outpatient department of children's hospital, and to analyze the needs of the outpatient and family members on health education. Methods Through the retrospective analysis of the information of the outpatient and emergency patients in the children's specialist hospital to determine the content, the venue and the time period of the "health education mobile classroom". Selection and training the health educator to implement the health education. At the same time, push the training content through the mobile APP to the patient's family, to expand the education audience. To compare and analyze the patient satisfaction of the hospital and the satisfaction with the dimensions of the project. In the evaluation of the effect of health education and the influencing factors, the relationship between income, occupation and children is positively related, and age is negatively related to it. Results After the implement of this project, the satisfaction of the patient had increased for 3.65%(P=0.001). Overall assessment of the audience was very satisfied with (3.94 ± 0.25) points. In each dimension analysis, the satisfaction of the "training method"was the highest, at (3.94 ± 0.26) points. Satisfied with the attitude of the trainers and comprehensive ability were more than 3.80 points. Conclusions The "health education mobile classroom" can improve patient satisfaction in the outpatient department and emergency of children's specialist hospital. Audience has a certain degree of acceptance and satisfaction with this health education mode.

Objective To discuss the effects of SBAR (situation-background-assessmedicine-recommendation) communication in patient hand-over from pediatric emergency ward. Methods SBAR communication mode has been applied in hand-over in the Emergency Department of Children's Hospital of Shanghai from November 2016. The incidence of nursing adverse events, writing error or omission rate of nursing documents and medical staff's satisfaction were compared between before and after intervention, which were from September to October 2016 and from November to December 2016. Results After the implementation of SBAR, the incidence of nursing adverse events was 4.9%, the writing error or omission rate of nursing documents was 3.1%, which were all lower than those of the control group, and the differences were statistically significant (χ2=9.141,10.794;P<0.01). After the implementation, the satisfaction rates on the comprehesiveness, language rationality and the focus of the disease were 95.0%, 97.5% and 95.0%, which were all higher than those of the control group, and the differences were statistically significant (χ2=8.029, 12.131, 4.675; P< 0.05). Conclusions After the SBAR communication mode being applied in patient hand-off in Pediatric Emergency Department, adverse events due to poor communication decreased; nursing documents became more normative; and the satisfaction rate of medical staff involved in hand-over increased. It is therefore worthy of further improving and making wider use of this type of communication.