Objective:To evaluate the value of target blood pressure management based on cerebral oximetry index (COx) during cardiopulmonary bypass (CPB) in preventing postoperative delirium (POD) in patients with acute type A aortic dissection (ATAAD).Methods:One hundred and fifty-seven patients with ATAAD, aged 18-64 yr, regardless of gender, were divided into 2 groups by a random number table method: traditional experience group (group C, n=81) and COx management group (group M, n=76). The mean arterial pressure in group C was maintained in the traditional range of 60-80 mmHg during CPB. In group M, the mean arterial pressure range was obtained based on the COx and maintained within this range during CPB. The primary outcome assessed was the development of delirium within 7 days after surgery. Secondary outcomes included other postoperative complications, tracheal extubation time, and duration of cardiac intensive care unit stay. Results:Compared with group C, the incidence and severity scores of POD were significantly decreased, the duration of POD was shortened, the duration of POD was shortened, the extubation time and duration of cardiac intensive care unit stay were shortened, and the incidence of postoperative cerebral infarction and acute kidney injury was decreased in group M ( P<0.05). Conclusions:Target blood pressure management based on COx during CPB is helpful in reducing the occurrence of POD and improving the prognosis of patients undergoing surgery for ATAAD.

Objective To investigate the therapeutic effect of self-made Bitong Ointment combined with umbilical dressing of traditional Chinese medicine in the treatment of children with pediatric allergic rhinitis differentiated as type of latent heat in the lung meridian. Methods Eighty children with allergic rhinitis differentiated as type of latent heat in the lung meridian were randomly divided into observation group and control group, with 40 cases in each group. The control group was treated with loratadine, while the observation group was additionally treated with self-made Bitong Ointment and umbilical dressing of traditional Chinese medicine. After 4 weeks of treatment, the clinical effect, TCM syndrome score, airway stress response, inflammatory factors, and therapeutic safety were evaluated. Results The total effective rate in the observation group was 95.00% (38/40), which was higher than 77.50% (31/40) in the control group. After treatment, the scores of main TCM syndromes such as frequent sneezing, clear and thin nasal discharge, decreased sense of smell, shortness of breath, and reluctance to speak in the observation group were lower than those in the control group. After treatment, the levels of indicators of airway stress response such as exhaled nitric oxide (FeNO), lipid peroxide (LHP) and inducible nitric oxide synthase (iNOS) in the observation group were lower than those in the control group. After treatment, the levels of inflammatory factors such as monocyte chemoattractant protein-4 (MCP-4), cysteinyl leukotriene receptor 1 (CysLTR1), and interleukin-9 (IL-9) in the observation group were significantly lower than those in the control group (P < 0.05). The incidence rate of adverse reactions during treatment was 15.00% (6/40) in the observation groupand 10.00% (4/40) in the control group, with no significant difference between the two groups (P>0.05). Conclusion The combination of self-made Bitong Ointment combined with umbilical dressing of traditional Chinese medicine is effective in the treatment of children with pediatric allergic rhinitis differentiated as type of latent heat in the lung meridian, which can improve the TCM syndromes, inhibit the airway stress response, reduce the expression levels of inflammatory factors, and has good therapeutic safety.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

【Objective】 To analyze the relevant studies on blood donor cohort and explore the current research status, research hotspots and development trends of blood donor cohort studies abroad. 【Methods】 Based on the Web of Science Core Collection, the literature related to blood donor cohort was searched. After screening and data processing, bibliometric analysis was carried out from the volume of literature trends, disciplines, authors, institutional distribution and other aspects of the included literature. At the same time, CiteSpace 5.6R5 software was used to carry out visual analysis of countries/regions, literature co-citation, keyword co-occurrence, keyword clustering and keyword emergence. Results A total of 672 papers (654 research papers, 18 review papers) were included. The total number of papers published in the field of blood donor cohort study showed a steady upward trend since 1991, the fastest growth was between 2019 and 2020. The top three cited authors were Kaaks R (1 301 citations), Rinaldi S (1 186 citations) and Riboli E (1 130 citations); the top three institutions were RLUK library in the UK, the University of California and the University of Copenhagen; the top three countries/regions in the volume of literature were the United States (176 papers), Germany (64 papers) and France (54 papers), and they all co-operated closely with other countries. The top five keywords were "blood donor" , "prevalence" , "infection" , "risk" and "antibody" . A total of 19 clusters were obtained by keyword cluster analysis, it was reflected in the immune mechanism and prevalence of blood-borne diseases, the relationship between blood donation behavior and non-communicable disease and its influencing factors, and the classification of the characteristics of blood donors. "Non-hepatitis B" was the keyword with the greatest burst intensity. The keywords that have burst out in recent years and continue to this day include "donation" , "seroprev-alence" , "donor" and "management" . Conclusion At present, the cohort study of blood donors has been paid more and more attention in the world, and its research trends mainly focus on the study of transfusion-transmitted disease risk. However, more researches begin to pay attention to the health problems and influencing factors of blood donors or recipients, which provides the research ideas and directions for establishing cohort study among blood donors in China.

Dermatomyositis(DM)is an autoimmune disease often complicated with malignant tumors.More than 50%of DM patients have myositis specific autoantibodies in their bodies.DM specific autoantibodies[including anti-migration inhibitory factor(Mi)-2 antibody,anti-nuclear matrix protein(NXP)-2 antibody,anti-transcription intermediary factor(TIF)1-γ antibody,and anti-small ubiquitin like modifier activating enzyme(SAE)antibody]play important roles in the pathogenesis of malignancy associated DM.Revealing the role of DM specific autoantibodies in the development of malignant tumors in DM patients can provide important evidence for accurately assessing the risk of developing malignant tumors in DM patients,and also provide new ideas for clinical diagnosis of DM and precise treatment.

The clinical practice teaching reform of pediatrics based on TBL combined with medical simulation teaching model was carried out. TBL teaching plan writing under the model of medical simulation teaching was researched. The principles, requirements, contents and procedures of compiling teaching plans were formed. Emphasis should be placed on medical simulation teaching, team cooperation, humanistic quality education and humanistic skills training. The purposes of the reform were to achieve standardized operation skills, improve clinical ability, ensure medical safety, and improve the quality of medical purposes, but still the reform need further improvement in the teaching practice.

Objective To evaluate ultrasound assisted virtual MRI guided radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) adjacent to gastrointestinal tract with artificial ascites.Methods A total of 33 HCC lesions in 32 patients adjacent to gastrointestinal tract in our hospital were collected.After the establishment of artificial ascites,they were treated with radiofrequency ablation guided by ultrasound-guiding fusion and virtual MRI navigation.The curative effect and complication rate were compared with the control group (non-hollow GI tract abutting HCC lesions).Results All 33 lesions were completely ablated without residual.After 1 month and 3 months follow-up,the reexamination of contrast-enhanced ultrasound and MRI showed no activity and no new lesions.All cases had no serious complications such as gastrointestinal injury.There were no statistically significant differences in tumor complete inactivation rate,complication rate and recurrence rate between the two groups.Conclusion Ultrasound-guiding fusion and virtual MRI guided radiofrequency ablation with artificial ascites is safe and effective in the treatment of liver cancer adjacent to gastrointestinal tract.

Objective To evaluate the accuracy of respiratory variations of internal jugular vein (IJV) in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,scheduled for elective radical gastrectomy for gastric cancer,were enrolled in this study.Before induction of anesthesia,the hemodynamic parameters such as heart rate,central venous pressure,cardiac index,stroke volume index (SVI),stroke volume variation and respiratory variation of IJV were recorded after haemodynamics was stable and were recorded again at 10 min after endotracheal intubation,and a loading dose of 6％ 130/0.4 hydroxyethyl starch 7 ml/kg was infused over 15 min.The parameters mentioned above were recorded within 5 min after loading dose.Patients were divided into 2 groups according to the percentage of increase in SVI (△SVI) after volume expansion:△SVI≥ 15％ was considered to be a positive response (responder group) and △SVI＜15％ was considered to be a negative response after volume expansion (non-responder group).Results The area under the receiver operating characteristic curve of respiratory variations of IJV in monitoring fluid responsiveness and 95％ confidence interval were 0.852 (0.744-0.961).Respiratory variation of IJV 24.6％ was considered as the cut-off value and used to monitor fluid responsiveness,and the sensitivity and specificity were 67.6％ and 92.3％,respectively.Conclusion Respiratory variation of IJV can be considered as an effective index in monitoring fluid responsiveness in the patients undergoing radical gastrectomy for gastric cancer.

Objective To evaluate the accuracy of respirophasic variation in carotid artery blood flow peak velocity(ΔVpeak-CA)in predicting fluid responsiveness in the patients undergoing surgery in the prone position. Methods Forty-three American Society of Anesthesiologists physical status Ⅰ-Ⅲ pa-tients of both sexes, aged 45-75 yr, with body mass index of 20-25 kg∕m2, scheduled for elective posteri-or approach lumbar surgery, were enrolled in the study.After induction of anesthesia, hydroxyethyl starch 130∕0.4 sodium chloride injection 7 ml∕kg was intravenously infused over 20 min when the patients were in the prone position.Subjects were classified as responders if stroke volume index increased≥15% after vol-ume expansion.The receiver operating characteristic curve for ΔVpeak-CA in determining positive fluid re-sponsiveness was drawn. Results The results of receiver operating characteristic curve analysis showed that: the cut-off value of ΔVpeak-CA in predicting positive fluid responsiveness was 7.94%, sensitivity 81.8%, specificity 70.0%, and the area under the curve(95% confidence interval)was 0.818 (0.378-0.757). Conclusion Respirophasic ΔVpeak-CA can accurately predict fluid responsiveness in the patients undergoing surgery in the prone position.

[Objective]To investigate the disturbance between Th17 and Treg cell balance in ovarian endometriosis patients.[Methods]Case-control study comparing 40 women with histo-pathologically confirmed ovarian endometriosis and with 40 control infertility women without visible endometriosis foci ,pelvic inflammations who were subjected to laparoscopic surgery during the same period. Peripheral blood,peritoneal fluid,ovarian ectopic endometrial tissue and eutopic endometrial tissue of ovarian endometriosis patients and controls were collected during surgery. T lymphocytes subpopulations in peripheral blood were analyzed by flow cytometry using specific monoclonal antibodies recognizing CD4+,CD25+and CD127-markers and CD3+,CD8-and IL-17A+markers. Then, IL-17,IL-22,IL-10and TGF-βconcentration in the serum and peritoneal fluid was determined using enzyme linked immunosorbent assay(ELISA). Also,Q-PCR was performed to verify Foxp3 mRNA and ROR-γt mRNA expression differences in eutopic and ectopic endometrial tissue.[Results]1.The percentage of CD4+CD25+CD127-Treg cells was significantly decreased in the peripheral blood ofwomen with ovarian endometriosis compared with control women. On the other hand ,the proportion of CD3+CD8-IL-17A+Th17 cells was significantly increased in the peripheral blood of women with endometriosis compared with control wom en. 2. Comparing with the controls ,the concentration of IL-17 and IL-22 was significantly higher in the serum of women with ovarian endometriosis ,and the levels of IL-10 and TGF-β were significantly lower in the serum of women with endometriosis. On the contrast ,in the peritoneal fluid of women with ovarian endometriosis ,the concentration of IL-17 and IL-22 were lower ,and the concentration of IL-10 and TGF-β were significantly higher than the controls. 3.Foxp3 mRNA expression level was significantly elevated in ectopic endometrial tissue of patients with ovarian endometriosis compared with eutopic endometrial tissue ,while the ROR-γt mRNA expression level of ectopic endometrial tissue was significantly decreased than eutopic endometrial tissue.[Conclusion]The present study verifies the imbalance of Th17/Treg in peripheral blood ,peritoneal fluid and endometrial tissue in ovarian endometriosis patients ,which implies the immune dysregulation and the disturbance of immunity homeostasis in the establishment and progression of endometriosis.