Objective To compare the effect of glycopyrrolate or atropine in combination with neostigmine on adverse cardiovascular events(ACEs)after operation in elderly patients undergoing laparo-scopic surgery.Methods A total of 142 patients scheduled for elective laparoscopic surgery were enrolled,69 males and 73 females,aged 65-80 years,BMI 18-28 kg/m2,ASA physical status Ⅰ or Ⅱ.The pa-tients were randomly divided into two groups:the glycopyrrolate group(group G)and the atropine group(group A),71 patients in each group.After the last administration of muscle relaxants for more than 30 mi-nutes,antagonizing residual neuromuscular blockade was performed.Glycopyrrolate 4 μg/kg and neostigmine 20 μg/kg were given intravenously in group G,atropine 10 μg/kg and neostigmine 20 μg/kg were given intravenously in group A.The incidence of ACEs and severe ACEs during operation and 72 hours after operation were recorded.Recovery situation in PACU such as NRS scores at rest and coughing,Rich-mond agitation-sedation scale(RASS)score,and modified Aldrete score 15 and 30 minutes after extubation were recorded.Emergence agitation,dry mouth,nausea,vomiting,and delirium 24 hours after operation were recorded.Results Compared with group A,the total incidence of ACEs,tachycardia,and myocardial ischemia after operation were significantly decreased in group G(P＜0.05),the incidence of dry mouth 24 hours postoperatively was significantly increased in group G(P＜0.05).There was no severe ACEs oc-curred in the two groups 72 hours after operation.Conclusion Compared with atropine,glycopyrrolate combined with neostigmine in elderly patients undergoing laparoscopic surgery can reduce the incidence of cardiac tachycardia,myocardial ischemia,and total ACEs after operation,and there was no severe ACEs occurred.However,it can increase the incidence of dry mouth 24 hours after operation.

Abstract: Objective　To study the biological function of the possible efflux pump gene BPSL1972 in Burkholderia pseudomallei (Bp), so as to improve the drug resistance mechanism of Bp. Methods BPSL1972 gene knockout strain and its complement strain were constructed by homologous recombination and electric shock transformation, respectively. BPSL1972 protein expression vector was constructed by enzyme digestion and enzyme-linked method. The BPSL1972-encoded protein was expressed using a His-tag protein expression kit and the expressed proteins were verified by Western Blot. The changes in drug sensitivity, growth, biofilm formation, and cytotoxicity were compared by microbroth dilution assay, Kirby-Bauer assay, turbidimetric assay, tube assay, crystal violet staining, and CCK-8 kit. The physicochemical properties of BPSL1972 were predicted by Protscale and Protparam online websites, the signal peptide of BPSL1972 was predicted by SignalP 5.0 online website, and the transmembrane domain and gene function of BPSL1972 were predicted by Smart online website. The 3D structure of BPSL1972-encoded protein and its homology were analyzed through Phyre 2 online website. Results The predictions suggested that the BPSL1972-encoded protein is a class of neutral-stable hydrophobic protein with a lipoprotein signal peptide and a transmembrane region, classified under the RND efflux pump system with two lipoprotein outer membrane efflux proteins, potentially mediating macrolide resistance. Its 3D modeling results show high homology to VceC and fusaric acid efflux protein, possibly mediating the efflux of ion activators. Sequencing results confirmed the successful construction of both the deletion mutant strain and complement strain. However, there were no significant differences in biological characteristics between the deletion mutant strain and the wild-type strain, and there was also no significant difference in resistance to antibiotics such as cephalosporins, quinolones, carbapenems, aminoglycosides, tetracyclines, and surfactants such as sodium deoxycholate. Conclusion BPSL1972 may be an auxiliary gene of LysR family, and this auxiliary gene is secondary, thus resulting in no functional changes after its deletion. Further research is needed to investigate whether it has resistance to other antibiotics such as fusaric acid and its specific replacement or auxiliary function.

Abstract： Objective　To analyze the characteristics and corresponding drug resistance of pathogenic bacterial spectrum in eight major infection sites of hospitalized patients, and to provide epidemiological data for the rational selection of antibiotics in clinical practice. Methods　A total of 396 bacterial strains isolated from clinical specimens of hospitalized patients in member institutions of the Hainan Provincial Bacterial Resistance Monitoring Network from September 1, 2020, to September 30, 2022, were included in this study. Data were screened and filtered from the database of MH120 Microbial Identification and Drug Sensitivity Analysis System based on the technical scheme of the National Bacterial Drug Resistance Surveillance Network and Science and Technology Basic Resources Investigation Project research plan in 2020. The testing data were integrated, summarized, and analyzed using EXCEL and WHONET 5.6 software, and statistical analysis was conducted using SPSS 26.0 software. Results　Among of 396 strains of bacteria, 78 (19.7%) were isolated from respiratory tract specimens, 74 (18.7%) from urinary tract specimens, 72 (18.2%) from blood specimens, 54 (13.6%) from abdominal cavity specimens, 48 (12.1%) from skin and soft tissue specimens 48 strains (12.1%), 30 (7.6%) from reproductive tract specimens, 22 (5.6%) from central nervous system specimens, 18 (4.5%) from digestive tract specimens. Gram-negative bacteria accounted for 69.4% of the isolates, while gram-positive bacteria accounted for 30.6%. The top five gram-negative bacteria isolated were Klebsiella pneumoniae (14.9%), Escherichia coli (14.4%), Pseudomonas aeruginosa (10.4%), Acinetobacter baumannii (5.3%), and Salmonella species (4.5%). The top five gram-positive bacteria were Staphylococcus aureus (11.1%), Streptococcus agalactis (7.8%), Enterococcus faecalis (3.0%), Enterococcus faecium (2.8%), and Streptococcus suis (1.8%). Respiratory failure and bloodstream infection were independent influencing factors of treatment response (P<0.01). The resistance rate of Escherichia coli to ampicillin was 81.4%, and the resistance rate of Staphylococcus aureus to gentamicin and levofloxacin were both below 7%. Conclusions　The pathogen spectra vary with different infection sites of patients, and rational selection of antibiotics based on drug susceptibility testing is crucial to shorten the treatment time of patients and avoid the unnecessary emergence of drug-resistant strains caused by drug abuse.

Objective:To explore the incidence of thirst in patients undergoing pancreaticoduodenectomy and analyze its influencing factors.Methods:From March to October 2022, 155 patients with pancreaticoduodenectomy admitted to the First Medical Center of the Chinese People's Liberation Army General Hospital were selected as the study subject by convenience sampling. The patients were surveyed using the self-made general information questionnaire, Thirst Numerical Rate Scale, oral mucosal misture score, Self-Rating Anxiety Scale, and Self-Rating Depression Scale to understand the incidence of thirst and analyze influencing factors.Results:A total of 153 valid questionnaires were collected, with a valid response rate of 98.71%. Among them, 124 patients (81.05%) experienced postoperative thirst. Univariate analysis showed that there were statistical differences in the incidence of thirst among patients with different ages, fasting time, smoking history, drinking history, hypertension history, diabetes history, anxiety and depression ( P<0.05). Logistic regression analysis showed that age, hypertension history, diabetes history, anxiety and depression were the main influencing factors for thirst in patients undergoing pancreaticoduodenectomy ( P<0.05) . Conclusions:Thirst is common in patients after pancreaticoduodenectomy. Age, hypertension history, diabetes history, anxiety and depression are the influencing factors of thirst in patients after pancreaticoduodenectomy. Medical and nursing staff should provide targeted interventions for thirst prevention and treatment based on relevant factors.

Background: Insulin regulates glucose homeostasis and has important effects on metabolism, cell growth, and differentiation. Depending on the cell type and physiological context, insulin signal has specific pathways and biological outcomes in different tissues and cells. For studying the signal pathway of insulin on glycolipid metabolism in porcine embryonic fibroblast (PEF), we used high-throughput sequencing to monitor gene expression patterns regulated by insulin. Objectives: The goal of our research was to see how insulin affected glucose and lipid metabolism in PEFs. Methods: We cultured the PEFs with the addition of insulin and sampled them at 0, 48, and 72 h for RNA-Seq analysis in triplicate for each time point. Results: At 48 and 72 h, 801 and 1,176 genes were differentially expressed, respectively. Of these, 272 up-regulated genes and 264 down-regulated genes were common to both time points. Gene Ontology analysis was used to annotate the functions of the differentially expressed genes (DEGs), the biological processes related to lipid metabolism and cell cycle were dominant. And the DEGs were significantly enriched in interleukin-17 signaling pathway, phosphatidylinositol-3-kinase-protein kinase B signaling pathway, pyruvate metabolism, and others pathways related to lipid metabolism by Kyoto Encyclopedia of Genes and Genomes enrichment analysis. Conclusions These results elucidate the transcriptomic response to insulin in PEF. The genes and pathways involved in the transcriptome mechanisms provide useful information for further research into the complicated molecular processes of insulin in PEF.

Objective:To investigate the application value of contrast-enhanced ultrasound (CEUS) before and after microwave ablation of thyroid nodules.Methods:Fifty-six patients (79 thyroid nodules) who received microwave ablation of thyroid nodules in Huaian Medical District, General Hospital of Eastern Theater Command from March 2016 to October 2019 were included in this study. CEUS was performed before microwave ablation to accurately assess the size, number and blood supply of thyroid nodules as well as the position of the feeding vessels. CEUS was performed immediately after microwave ablation to determine whether the lesion area was thoroughly ablated and to measure the volume of thyroid nodules. At 1, 3, 6 and 12 months after surgery, the level of thyroid hormone was measured and the absorption of thyroid nodules was evaluated.Results:Preoperative CEUS showed that among the 79 thyroid nodules, 42 were solid nodules that had different degrees of enhancement, including 33 annular homogeneously highly enhanced nodules and 9 heterogeneously highly enhanced nodules; 24 were cystic mixed solid nodules that had solid components, including 16 homogeneously highly enhanced nodules and 8 nodules with only local high enhancement in the solid component; 13 were cystic nodules, including 9 nodules with septa and 3 nodules with contrast medium on the diaphragm. Contrast medium was still visible around three nodules immediately after microwave ablation. Ablation continued in three nodules until there was no contrast medium. The incidence of complications during and after treatment was 0%. The average volume of the thyroid nodules before treatment was (7.52 ± 6.74) cm3. At 1, 3, 6 and 12 months after surgery, the average volume of the thyroid nodules was (6.06 ± 5.19) cm3, (3.06 ± 2.85) cm3, (1.32 ± 1.23) cm3 and (0.59 ± 0.52) cm 3, respectively. There was significant difference in volume of thyroid nodules between before and after microwave ablation ( F = 96.32, P < 0.001). Conclusion:Preoperative CEUS can determine the distribution of the blood supply of thyroid nodules and the course of the feeding vessels, identify the needle-entering position for microwave ablation and the primary ablation area, improve the accuracy of treatment, and reduce the occurrence of complications such as bleeding. Postoperative CEUS can determine whether lesion area is thoroughly ablated, reduce residual lesions and excessive ablation.

Objective:To investigate the effect of applying waterproof film combined with non-woven tape fixation of endotracheal tube in cleft lip and palate operation.Methods:From July 2018 to December 2018, 72 cases of cleft palate and cleft lip were selected from the operating room of the First Affiliated Hospital of Zhengzhou University The cases were randomly divided into the control group (suture and thread fixation method) and the experimental group (medical waterproof lamination combined with non-woven cloth), with 36 cases in each group. The duration of catheter fixation, intraoperative catheter fixation and postoperative catheter-related complications were compared between the two groups.Results:There were statistically significant differences between the experimental group and the control group in the duration of catheter fixation, surgeon satisfaction score and incidence of needle stab injury and needle stab bleeding: (1.15±0.63) min, (4.50±0.56), 0 case, 0 case in the experimental group, and those in the control group were (2.36±0.56) min, (3.83±1.13), 6 cases, 6 cases ( t values were 0.000, 14.435, χ2 values were 72.000, 6.545, P<0.01 or 0.05). Compared with the control group, there were no statistically significant differences in operation time, intraoperative oxygen saturation, catheter fixation direction, incidence of tube tearing, and incidence of postoperative scar ( P>0.05) in the experimental group. Conclusions:Medical waterproof film combined with non-woven tape fixed endotracheal intubation can obviously shorten the preoperative endotracheal intubation fixing time, improve the surgeon satisfaction. At the same time, it is effective in preventing postoperative complications caused by fixation with needle and silk thread.

Lycophytes and seed plants constitute the typical vascular plants. Lycophytes have been thought to have no paleo-polyploidization although the event is known to be critical for the fast expansion of seed plants. Here, genomic analyses including the homologous gene dot plot analysis detected multiple paleo-polyploidization events, with one occurring approximately 13-15 million years ago (MYA) and another about 125-142 MYA, during the evolution of the genome of Selaginella moellendorffii, a model lycophyte. In addition, comparative analysis of reconstructed ancestral genomes of lycophytes and angiosperms suggested that lycophytes were affected by more paleo-polyploidization events than seed plants. Results from the present genomic analyses indicate that paleo-polyploidization has contributed to the successful establishment of both lineages-lycophytes and seed plants-of vascular plants.
Evolution, Molecular ; Genome, Plant ; Genomics ; Phylogeny ; Polyploidy ; Selaginellaceae/genetics*

Objective:To explore the relationship between anxiety, depression and various dimensions of cognitive function in patients with mild cognitive impairment (MCI) .Methods:The convenient sampling method was adopted to conduct memory screening for 727 elderly people who visited the multidisciplinary joint memory clinic of a Class Ⅲ Grade A hospital in Beijing from January to December 2019. With their consent, 247 MCI patients were investigated using Montreal Cognitive Assessment (MoCA) , Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) .Results:A total of 247 questionnaires were distributed and 233 valid questionnaires were returned. There were 67 cases (28.8%) of MCI patients with anxiety and depression, 11 cases (4.7%) with anxiety, 53 cases (22.7%) with depression and 102 cases (43.8%) without anxiety and depression. In MCI patients, anxiety was positively correlated with delayed recall ( P<0.05) , while depression was negatively correlated with language function ( P<0.05) . MCI patients with different emotional states had statistically significant differences in language function ( P<0.05) . Conclusions:MCI patients have a higher incidence of anxiety and depression, and anxiety and depression will affect different dimensions of cognitive function in MCI patients. Medical staff need to provide targeted interventions for MCI patients with different emotional characteristics.

Objective? To construct the certification evaluation index system for specialized nurse in operating room in accord with nursing practice in China, so as to provide a reference for administrative department to formulate the standards. Methods? From November 2017 to February 2018, we established the certification evaluation index and standard for specialized nurse in operating room by literature review, expert interview and Delphi method, and we tested the reliability of expert enquiry by the concentration degree of expert opinion, coordination coefficient, active coefficient and authority coefficient. The analytic hierarchy process was used to determine the indexes and weight of evaluation standards. Results? A total of 22 experts participated in the study. Among two rounds of enquiries, the active coefficients were 86.67% and 84.62% respectively, and authority coefficients were 0.89 and 0.93 respectively. In the second enquiry, the coordination coefficient was 0.215. The certification evaluation index system for specialized nurse in operating room consisted of 8 primary indexes, 28 secondary indexes and 76 evaluation criteria. The weight of primary indexes, secondary indexes and valuation criteria ranged from 0.031 4 to 0.275 8,from 0.002 0 to 0.206 9 and from 0.000 7 to 0.137 9 respectively. CI values of comparison matrix were from 0 to 0.0480 and CR values were from 0 to 0.053 3. Conclusions? The certification evaluation index system for specialized nurse in operating room is reliable, which can be a reference standard for certification evaluation for specialized nurse in operating room.