With the reform of the national medical and health system entering a new stage of high-quality development of public hospitals,the large-scale implementation of day surgery in hospitals is imminent in the face of increasing patient demand.In this paper,the medical administration management and medical insurance policies related to day surgery in China and their im-pacts were sorted out,and the example of large-scale implementation of day surgery by a specialized ophthalmic medical institu-tion through pre-hospitalization mode was used to illustrate how to use management tools to break through the bottleneck in the promotion process of day surgery,and the positive effect of large-scale development of day surgery on both doctors and patients was expounded.

Optimizing the management of medical service appointment is an important measure to enhance the patient′s medical experience and promote the high-quality development of hospitals. In 2022, a tertiary comprehensive hospital in Jiangsu Province focused on the demand for digital appointments, and carried out coordinated management of intelligent appointment for medical examination both inside and outside the hospital, online and offline. By constructing an intelligent examination appointment system, enriching appointment categories, exchanging appointment information, improving supporting services, and establishing appointment supervision mechanisms, this practice provided intelligent, personalized, and precise examination appointment services for patients in multi-campus hospitals and member units of medical group. The average waiting time of patients for CT, MRI, and ultrasound examinations in this hospital decreased from 7.43 h, 8.75 h, and 4.63 h in 2021 to 4.63 h, 4.72 h, and 2.18 h in 2023, respectively, as well as the average satisfaction rate of patients with examination appointments increased from 90.7% to 96.5%. The intelligent examination appointment management had achieved good results, which could provide references for other hospitals to optimize appointment of medical services.

Uridine is one of the essential nutrients in organisms. To maintain normal cell growth and intracellular metabolism, the uridine must be maintained at certain concentration. Recent studies have shown that uridine can reduce inflammatory response in organisms, participate in glycolysis, and regulate intracellular protein modification, such as glycosylation and acetylation. Furthermore, it can protect cells from hypoxic injury by reducing intracellular oxidative stress, promoting high-energy compounds synthesis. Previous studies have shown that the protective effects of uridine are closely related to its effect on mitochondria. This review summarizes the effect of uridine on mitochondrial function.
Uridine/metabolism* ; Mitochondria/metabolism*

Objective:To evaluate the effect of hydrogen on the immunosuppressive status of septic rats.Methods:SPF healthy adult male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were studied.This study was performed in two parts.Part Ⅰ The rats were divided into 2 groups: sepsis group (Sep group, n=36) and sham operation group (Sham group, n=12). The model of sepsis was established by cecal ligation puncture in anesthetized rats.The histocompatibility DR antigen (HLA-DR)/CD14 + monocyte level in peripheral blood was detected by flow cytometry immediately after CLP and at 1, 2, 3 and 4 days after CLP.The establishment of sepsis-induced immunosuppression model was considered successful when the levels of HLA-DR/CD14 + monocyte in peripheral blood were <30%.Part Ⅱ Twelve rats with sepsis-induced immunosuppression were randomly selected and divided into 2 groups ( n=6 each) by a random number table method: sepsis immunosuppression group (Sep-IS group), sepsis immunosuppression plus hydrogen treatment group (Sep-IS+ H group). Another 12 rats were selected and divided into 2 groups ( n=6 each) by a random number table method: sham operation group (Sham group) and sham operation plus hydrogen group (Sham+ H group). In Sep-IS+ H group, 67% hydrogen was inhaled for 1 h starting from the time point immediately after successful establishment of sepsis-induced immunosuppression and from 6 h after establishment, and 67% hydrogen was inhaled for 1 h at the corresponding time points in Sham+ H group.The levels of helper T lymphocytes 17 (Th17 cells), regulatory T lymphocytes (Treg cells) and HLA-DR/CD14 + monocyte in peripheral blood were determined by flow cytometry immediately after the end of hydrogen inhalation mentioned above (T 0, T 1) and at 12 h after establishing the model (T 2). Results:Part Ⅰ Compared with Sham group, the levels of HLA-DR/CD14 + monocyte in peripheral blood were significantly decreased at 1-4 days after CLP in Sep group ( P<0.05). Part Ⅱ Compared with Sham group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly decreased, and the levels of Treg and Th17 cells were increased at each time point in Sep-IS and Sep-IS+ H groups ( P<0.05), and no significant change was found in the parameters mentioned above in Sham+ H group ( P>0.05). Compared with Sep-IS group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly increased at T 1, 2, the levels of Th17 cells were increased at T 2, and the levels of Treg cells were decreased at T 1, 2 in Sep-IS+ H group ( P<0.05). Conclusion:Hydrogen can improve the immunosuppressive state of septic rats.

Objective:To investigate the molecular mechanism of SUMO specific protease 1 (SENP1) regulating endoplasmic reticulum stress transcription regulator X-box binding protein 1 (XBP1) in the proliferation of liver cancer cells.Methods:The pathological samples of 180 patients with primary liver cancer in the Department of Hepatobiliary Surgery of Inner Mongolia People′s Hospital from January 2012 to January 2020 were collected. The expressions of SENP1 and XBP1 in liver cancer, adjacent tissues and different liver cancer cell lines were detected. The correlation between SENP1 positive expression and clinicopathological features of liver cancer patients was analyzed. Immunofluorescence and flow cytometry were used to detect the effect of SENP1 siRNA on XBP1 and apoptosis. SUMO1 expression on XBP1 surface was detected and the effect of SENP1 siRNA on SUMO formation of XBP1 was detected by immunoprecipitation.Results:The expression levels of SENP1 in liver cancer and adjacent tissues were 16.332±4.371 and 6.840±2.238, with a statistically significant difference ( t=-5.073, P=0.017). The expression levels of XBP1 in liver cancer and adjacent tissues were 6.641±2.482 and 16.051±4.452, with a statistically significant difference ( t=3.592, P=0.032). The expression of SENP1 was correlated with stage ( χ2=6.724, P=0.010) and metastasis ( χ2=6.265, P=0.012). Immunofluorescence staining showed that the expressions of XBP1 in L02 (0.509±0.219), MHCC97-L (0.092±0.022) and HCCLM3 (0.086±0.014) cells were significantly different ( F=6.378, P=0.004), while the expression of XBP1 in MHCC97-L and HCCLM3 cells was significantly lower than that in L02 cells ( P=0.023; P=0.021). The expression levels of SENP1 in L02, MHCC97-L and HCCLM3 cells were 0.109±0.079, 0.802±0.392 and 0.921±0.352, with a statistically significant difference ( F=7.783, P=0.004), while the expression level of SENP1 in MHCC97-L and HCCLM3 cells was significantly higher than that in L02 cells ( P=0.039; P=0.016). After transfection of SENP1 siRNA into MHCC97-L and HCCLM3 cells, the expressions of XBP1 increased (0.462±0.192, t=3.664, P=0.022; 0.524±0.203, t=3.383, P=0.028); the expressions of SENP1 decreased (0.153±0.093, t=2.790, P=0.049; 0.165±0.104, t=3.568, P=0.023). The results of flow cytometry showed that the apoptosis rates of L02, MHCC97-L, HCCLM3, MHCC97-L+ SENP1 siRNA and HCCLM3+ SENP1 siRNA cells were (20.80±3.11)%, (2.02±1.20)%, (0.12±0.01)%, (7.01±1.80)%, (6.20±2.01)%, with a statistically significant difference ( F=1.025, P=0.030). The apoptosis rate of MHCC97-L and HCCLM3 cells was significantly lower than that of L02 cells ( P=0.040; P=0.010), the apoptosis rate of MHCC97-L+ SENP1 siRNA and HCCLM3+ SENP1 siRNA cells was significantly higher than that of MHCC97-L and HCCLM3 cells (both P=0.009). Immunoprecipitation results showed that the expression levels of XBP1 in L02, MHCC97-L, HCCLM3, MHCC97-L+ SENP1 siRNA, HCCLM3+ SENP1 siRNA cells were 11.943±5.043, 7.467±1.903, 2.051±0.913, 9.532±3.012, 8.731±3.102, and SUMO1 expression levels were 10.158±4.005, 5.871±3.075, 1.941± 0.907, 8.658±4.878, 7.169±4.677, and the differences were statistically significant ( F=11.730, P=0.010; F=8.548, P=0.001). The expressions of XBP1 and SUMO1 in MHCC97-L ( P=0.028; P=0.038) and HCCLM3 ( P<0.001; P<0.001) cells were lower than those in L02 cells, XBP1 expression in HCCLM3+ SENP1 siRNA cells was higher than that in HCCLM3 cells ( P=0.001), and SUMO1 expression in MHCC97-L+ SENP1 siRNA cells and HCCLM3+ SENP1 siRNA cells respectively was higher than that in MHCC97-L ( P=0.045) and HCCLM3 ( P=0.039) cells. Conclusion:SENP1 siRNA can promote the apoptosis of liver cancer cells by up regulating SUMO modification of XBP1.

Objective To determine the optimum cuff pressure of the flexible laryngeal mask airway (LMA) for airway management in pediatric patients.Methods One hundred and twenty pediatric patients undergoing strabismus surgery with general anesthesia,of American Society of Anesthesiologists physical status Ⅰ or Ⅰ,aged 3-10 yr,were randomly divided into 3 groups (n=40 each) according to the cuff pressure of the flexible LMA:20 cmH2O pressure group (group A),40 cmH2O pressure group (group B) and 60 cmH2O pressure group (group C).The cuff was inflated to the predetermined pressure using the inflatable cuff manometer in each group.Oropharyngeal leak pressure was measured after LMA placement.Peak airway pressure and the difference between inhaled and exhaled tidal volume were recorded at 5 min of positive pressure ventilation.The LMA insertion condition,LMA removal time,and development of sore throat,hoarseness,dysphagia and abdominal distention within 24 h after operation were recorded.Results There were no significant differences in the success rate of LMA placement at first attempt,peak airway pressure,or incidence of sore throat among the three groups (P＞0.05),and no hoarseness or dysphagia was found in the three groups.Compared with group A,oropharyngeal leak pressure was significantly increased,and the difference between inhaled and exhaled tidal volume and incidence of abdominal distention were decreased in B and C groups (P＜0.05).There was no significant difference in the parameters mentioned above between group B and group C (P＞0.05).Conclusion The optimum cuff pressure of the flexible LMA is 40 cmH2O when used for airway management in the pediatric patients.

Progressing vasopressor-refractory hypotension is a major contributor to the high mortality of septic shock.The effect of corticosteroids on peripheral vascular circulation recovery and immune modulation is crucial to the survival of patients with septic shock .However, despite more than fifty years of animal experiments and human trials, the role of corticosteroid therapy in septic shock , its proper applications including dosage, duration and withdrawal remain uncertain and controversial .This paper reviews the development of research , the mechanism, application, and the future direction of low-dose glucocorticoids in the treatment of septic shock .

Objective To investigate whether transcatheter renal sympathetic denervation (RSD) by radiofrequency ablation interfere with the development of left ventricular (LV) mechanical dyssynchrony during the progression of heart failure (HF).Methods Nineteen beagles were randomly divided into sham-operated group (six dogs),control group (seven dogs),and RSD group (six dogs).Sham-operated group were implanted with pacemakers without pacing;Control group were implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing;and RSD group underwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers.LV dyssynchrony was analyzed via 2D speckle-tracking strain echocardiography to evaluate LV function.Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain on apical 4-and 2-chamber views.Radial and circumferential dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in mid-and base-LV short-axis views.LV systolic pressure (LVSP) and LV end-diastolic pressure (LVEDP) were measured.The LV interstitial fibrosis was determined by histological analysis.Results After 3 weeks,all of the dogs in both the control and RSD groups showed greater LV end-diastolic volume compared with the sham-operated group;however,the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the control group (P ＜0.001).The LV systolic strains were higher in the RSD group than in the control group (P ＜0.001 for longitudinal,circumferential and radial strain,respectively).The levels of LV dyssynchrony were lower in the RSD group than in the control group (P ＜ 0.001 for longitudinal,circumferential and radial dyssynchrony,respectively).Compared with control group,RSD group had lower LV end-diastolic pressures and less fibrous tissue.Conclusions RSD inhibites the development of left ventricular mechanical dyssynchrony during the progression of heart failure in dogs.

Objective To compare the efficacy of different sedation depths of monitored anesthesia care (MAC) in vitrectomy.Methods Ninety-six patients of both sexes,aged 40-64 yr,with body mass index ≤ 35 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective vitrectomy,were randomly divided into 2 groups (n =48 each) using a random number table:mild sedation group (group Ⅰ) and profound sedation group (group Ⅱ).Anesthesia was induced with iv midazolam 0.02 mg/kg and sufentanil 0.15 μg/kg.Anesthesia was maintained with iv infusion of propofol 0.5-2.0 mg · kg-1 · h-1 maintaining bispectral index (BIS) value＞80 in group Ⅰ,or with iv infusion of propofol 2-6 mg · kg-1 · h-1 maintaining BIS value at 65-80 in group Ⅱ.The occurrence of unexpected head movement,SPO2＜90％,snoring,and oculocardiac reflex during the procedure,postoperative nausea and vomiting,and the time when the patients in supine position were turned to prone position were recorded after surgery.Results Compared with group Ⅰ,the incidence of unexpected head movement,SpO2 ＜90％,and snoring was significantly increased,and the time when the patients in supine position were turned to prone position was prolonged (P＜0.05),and no significant difference was found in the incidence of postoperative nausea and vomiting and oculocardiac reflex during the procedure in group Ⅱ (P＞0.05).Conclusion Mild sedation of MAC (BIS value ≥ 80) provides better efficacy than profound sedation (BIS value 65-80) when used for vitrectomy.

Objective To investigate the effects of different infusion rates of remifentanil infusion on spontaneous ventilation in children received sevoflurane anesthesia. Methods A total of 120 children underwent strabismus surgery were randomly assigned to four groups: C group (administration of saline), L group (remifentanil 0.03 μg · kg-1 · min-1), M group (remifentanil 0.06μg · kg-1 · min-1) and H group (remifentanil 0.09μg · kg-1 · min-1). The mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), tidal volume (VT), minute ventilation (MV), endtidal CO2 [p(CO2)] and endtidal SEV were recorded after laryngeal mask insertion (T1), an initial bolus dose of remifentanil (T2),10 mins after remifentanil infu-sion (T3),15 mins after remifentanil infusion (T4) and laryngeal mask remove (T5) respectively. The adverse events and time of induction, maintenance and emergence were also recoded. Results There were no significant differences in patient age, body mass index, anesthesia time, operation time, HR and MBP at different time points between four groups. No body movement and hypoxemia were observed. The values of RR and MV at T3, T4 and T5 were significantly lower in H group than those of other three groups (P <0.05). Values of p(CO2)at T3 and T4 were significantly higher in H group than those of other three groups (P<0.05). The values of RR at T3, T4 and T5 were significantly lower in L group and M group than those of C group. The values of MV at T3 and T4 were significantly lower in L group and M group than those of C group. p(CO2)at T4 was significantly higher in L group and M group than that of C group(P<0.05), but no significant difference was found be-tween L group and M group. There was no significant difference in value of VT between four groups. Conclusion Remifent-anil infusion at a rate of 0.03~0.09μg·kg-1·min-1 could depress spontaneous ventilation in children received sevoflurane an-esthesia. The respiratory depression effect is mainly manifested by reduction of RR. It is a good option to choose 0.03~0.06μg · kg-1 · min-1 infusion to keep spontaneous ventilation and avoid severe respiratory depression according to the demand of operations in children.