BackgroundThe issue of school absenteeism due to school refusal in adolescents has become increasingly prominent. Acceptance and Commitment Therapy （ACT） has been applied successfully to improve depression， anxiety， and psychological flexibility in adolescents， while few studies have tested the effect of ACT intervention on above-mentioned psychological aspects and return-to-school rate in adolescents with school absenteeism. ObjectiveTo explore the effect of ACT on depression， anxiety， psychological flexibility and return-to-school rate in school absenteeism adolescents， and to provide a broader evidence base for clinical interventions. MethodsFrom May to June 2024， a sample of 50 adolescents with Shenzhen school registration who had been suspended from school for more than a consecutive month for school refusal were recruited based on Wechat official account platform. The adolescents were divided into study group and control group by random number table method. Both groups received psychological education with the theme of 'Causes and Coping Strategies of School Refusal'， and study group added a 6-week ACT intervention with weekly 1-hour sessions. At baseline and after treatment， Patients’ Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7） and Comprehensive assessment of Acceptance and Commitment Therapy processes （CompACT） were used for the clinical evaluation. ResultsA total of 45 （90.00%）adolescents completed the study， including 25 in study group and 20 in control group. Analysis revealed that study group scored higher on PHQ-9 and GAD-7， while lower on total CompACT score， openness dimension and awareness dimension compared with control group， with statistical significance （F=7.786， 10.334， 12.922， 14.374， 3.075， P<0.05 or 0.01）. After intervention， the rate of return-to-school was higher in study group than in control group （40.00% vs 10.00%， χ²=5.114， P<0.05）. ConclusionACT intervention for adolescents with school absenteeism may alleviate depression and anxiety， improve their psychological flexibility and increase return-to-school rate.［Funded by the "14^th Five Year Plan" for Social Sciences Project in Jiangxi Province （number， 24JY41D）； Science and Technology Planning Project of Shenzhen Municipality （number， 20210617155253001）］

Objective:To evaluate the effectiveness of ultrasound assessing the risk of gastric content aspiration in patients undergoing emergency abdominal surgery.Methods:This was a prospective self-control study. Seventy-three American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged >18 yr, who underwent emergency abdominal surgery in Beijing Daxing District People′s Hospital from June 2022 to December 2023, were selected. Time method assessment: The time and category of fasting and no-drinking were inquired, the patient′s gastric emptying status and risk of gastric content aspiration were assessed based on the time of fasting and no-drinking, and a preliminary anesthesia plan was formulated. Ultrasound method assessment: The properties of gastric contents were determined, the cross-sectional area of the gastric antrum was measured, the volume of gastric fluid was estimated, the Perlas grading of the gastric antrum was performed to assess the risk of gastric content aspiration, and a final anesthesia plan for implementation was formulated.Results:The number of patients with a high-risk of gastric content aspiration determined by the time method and ultrasound method was 2 cases (3%) and 11 cases (15%), respectively, with a statistically significant difference between the two methods ( P<0.05). The risk class of gastric content aspiration changed after ultrasound examination in 11 patients. One patient with a high risk determined by the time method was identified as having a low risk by the ultrasound method, and the other 10 patients with a low risk determined by the time method were identified as having a high risk by the ultrasound method. There was a statistically significant difference in the anesthesia induction plans formulated based on two methods ( P<0.05), while there was no statistically significant difference in the airway maintenance plans between the two methods ( P>0.05). Regurgitation of gastric contents occurred only in one case (1.4%), and no gastric content aspiration was found in any case. Conclusions:Preoperative gastric ultrasound examination can be used to assess the risk of gastric content aspiration and guide the formulation of anesthesia plans for the patients undergoing emergency abdominal surgery.

Endoscopy, Gastrointestinal ; Anesthesia ; Surveys and Questionnaires ; Anesthesiology ; Hospitals, Public ; China ; Endoscopy

Bone Cysts ; Cysts ; Endoscopy ; Humans ; Maxilla/surgery* ; Maxillary Sinus/surgery*

Objective    To compare the short-term effect of no-touch technique and routine method for harvesting great saphenous vein in coronary artery bypass grafting. Methods    The clinical data of patients receiving the great saphenous vein by no-touch technique (a NT group) or routine method (a routine group) for coronary artery bypass grafting from April 2016 to July 2017 in our hospital were retrospectively analyzed. There were 26 males and 13 females with an average age of 60.1±8.0 years ranging from 40 to 75 years in the routine group, as well as 21 males and 17 females with an average age of 61.3±6.9 years ranging from 38 to 75 years in the NT group. The operation time, postoperative ventilation duration, postoperative myocardial injury index, postoperative complications, postoperative ejection fraction, postoperative hospital stays and other indicators were compared. Results    There was no statistical difference between the two groups in operation time, postoperative ventilation time, postoperative ejection fraction or postoperative hospital stays. Incisions of postoperative lower extremity in two groups successfully healed. There was no recurrence of acute myocardial infarction or death. All patients recovered and discharged. One patient was treated with thoracotomy in the routine group. One patient in the NT group had bad healing of chest incision, and one patient with acute kidney injury recovered after treatment. Conclusion    The great saphenous vein by no touch technique has a good early effect in coronary artery bypass grafting without increasing the risk of surgery.

OBJECTIVE:To establish a method for the determination of dissolution of Xiaocaihu pill,and compare the differ-ence of preparation from different manufacturers. METHODS:Using 0.1 mol/L HCl as dissolution medium,rotating basket method was used to determine the dissolution of preparations. HPLC was adopted to determine the content of baicalin:column was TSKgel ODS C18 with mobile phase of methanol-water-phosphoric acid (65∶35∶0.7,V/V/V) at a flow rate of 1 ml/min,detection wave-length was 280 nm,column temperature was 30 ℃,and injection volume was 5 μl. RESULTS:The linear range of baicalin was 0.488-124.8 mg/L (r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2.0%;recovery was 100.14%-104.78%(RSD=1.58%,n=9). The average t50(50% dissolution time)of baicalin was 85.81 min. CONCLUSIONS:The method is simple with good precision,stability and reproducibility,and can be used for the dissolution determination of Xiaocaihu pill. Xiaocaihu pill from different manufacturers shows great differences,both preparation formulation and clinical use should attach importance to the dissolution of solid preparations.

Objective To study the set-up accuracy in radiotherapy of thoracic neoplasms by improving the body immobilization method.Methods Fifty patients with thoracic neoplasms were randomly divided into conventional group (without electrode paste) and improved group (with electrode paste).Using simulator for position calibration and center field digital image reconstruction from treatment planning system.Then compare the set-up accuracy of two groups with different body methods by grouped t-test.Results Set-up error in the left-right,superior-inferior,anterior-posterior direction were 2.5 ± 1.5 and 2.4 ± 1.4(P =0.010),4.4 ± 2.0 and 2.2 ± 1.2 (P =0.000),2.2 ± 1.3 and 2.1 ± 1.0 (P =0.100) in conventional group and improved group,respectively.Conclusions The improved body immobilization method improves setup accuracy in radiotherapy for thoracic neoplasms which also will be effective for clinical treatment.

Objective To investigate the setup errors of super chest segment of esophageal cancer patients before radiotherapy delivery by KV cone beam CT,and evaluate the margin from CTV to PTV.Methods From 2010 to 2012,13 patients with super chest segment of esophageal cancer whose IMRT planning CT images were included in this study.Delineate target on the CT images of treatment planning and enlarge the margin of CTV to form ITV,then enlarge the margin of ITV gradually 10 times by 1 mm each time to form varied PTV,and create the plan according to the size of the PTV,simulate setup errors in the new plan to obtain the simulation of the actual exposure curve and find a suitable PTV to assure 95％ ITV volume as ever to approach the prescription dose,obtained the outside enlarge distance of CTV → PTV.Results The maximum setup errors in the direction of the anterior and posterior positioning was (3.42 ±2.19) mm.The margin of ITV→PTV is 5 mm which was figured out by PTN enlarging method.Compared to the original plan that under the condition of draw up the radiotherapy plan that based on the method of PTV enlarging obtained the CTV→PTV and simulate the actual dose distribution according to the setup errors:total lung V5,spinal cord D1cm3,increased by about 0.87％,4.95 Gy,heart V40,PTV D95,PTV V100,ITV D95,ITV V100 were reduced about 0.62％,4.95 Gy,8.38％,1.84 Gy,1.87％,all of them have statistically difference.Conclusions Range of external expansion of the left to right,superior to inferior and anterior to posterior is 7 mm,8 mm and 7 mm respectively,according to the method of PTV enlarging obtained the margin of CTV→PTV of super chest segment of esophageal cancer patients.

Objective To investigate the effects of preconditioning with different doses of levothyroxine sodium on myocardial ischemia-reperfusion (I/R) injury in immature rats. Methods Forty-eight female immature Wistar rats, aged 35 days, weighing 120-140 g, were randomly allocated into 6 groups ( n = 8 each): control group (group C), I/R group, and preconditioning with levothyroxine sodium 10, 20, 40 and 80 μg/100 g groups (groups LS1-4 ) . The rats received levothyroxine sodium 10, 20, 40 and 80 μg/100 g through a gastric tube every day for 7 days in groups LS1-4 , respectively. Venous blood samples were taken on 8th day for determination of serum thyroid hormone levels. The hearts were removed from the animals and perfused in a Langendorff apparatus with K-H solution saturated with 95% O2-5% CO2 at 37 ℃. The hearts were continuously perfused for 80 min in group C. After 30 min of equilibration, the isolated hearts were subjected to 20 min of ischemia followed by 30 min of reperfusion in I/R and LS1-4 groups. HR, SP and ± dp/dtmax were recorded at 20 min of perfusion and 30 min of reperfusion. The recovery rates of HR, SP and ± dp/dtmax were calculated at 30 min of reperfusion. The coronary effluent was collected at 10 min of perfusion and 15 min of reperfusion for determination of creatine kinase (CKMB) activity. The samples of ventricular myocardial tissues were taken at 30 min of reperfusion to detect the expression of heat shock protein 70 (HSP70), thyroid hormone receptor (TR) mRNA (TRa, , TRoj and TRft ) and myosin heavy chain (MHC) mRNA. Results Compared with group C, the recovery rates of HR, SP and. ± dp/dtmax were significantly decreased, the CK-MB activity was significantly increased, and MHCα mRNA expression was down-regulated in group I/R, the recovery rates of SP and ± dp/dtmax were significantly decreased, the CK-MB activity was significantly increased, and the expression of HSP70 and MHCα mRNA was up-regulated in groups LS1-4, and the serum thyroid hormone level was significantly increased and the expression of TRa, mRNA was up-regulated in groups LS2-4 ( P ＜ 0.05) . Compared with group I/R, the recovery rates of HR and ± dp/dtmax were significantly increased, the pression of HSP70 and MHCa mRNA was up-regulated, and the MHCJ3 mRNA expression was down-regulated in groups LS1-4 the CK-MB activity was significantly decreased in groups LS1-3, and the serum thyroid hormone level was significantly increased and the expression of TRα1, mRNA was up-regulated in groups LS2-4 ( P ＜ 0.05) . The serum thyroid hormone level increased gradually with the increase in the dose of levothyroxine sodium in groups LS1-4 ( P ＜ 0.05) . The CK-MB activity was significantly higher, while the HSP70 expression lower in groups LS3-4 than in groups LS1-2 (P ＜ 0.05). Conclusion Preconditioning with levothyroxine sodium 10 μg/100 g can alleviate the myocardial I/R injury in immature rats and does not lead to the increase in the level of thyroid hormone, and the up-regulation of HSP70 and MHCa mRNA expression may be involved in the mechanism.

Objective To evaluate the influence of head anteflexion on airway sealing pressure during intermittent positive pressure ventilation(IPPV) with ProSeal laryngeal mask airway (PLMA) with an esophageal vent.Methods Fifty ASA Ⅰ or Ⅱ patients (20 males and 30 females), aged 18-51 ye are, weighing 50-70 kg and scheduled for elective plastic surgery under general anesthesia, were enrolled in this study. Anesthesia was induced with fentanyl 2 μg/kg, propofol 2 μg/kg and vecuromium 0.1 mg/kg. PLMA with an esophageal vent was inserted at 2 min after intravenous vecuronium injection.The airway sealing pressure, the anatomic position of the cuff and the efficacy of positive pressure ventilation were checked in the neutral and anteflexed head positions with the cuff deflated and inflated to an intracuff pressure of 60 cm H2 O, respectively.Results The lungs were better ventilated in the head anteflexion position than in the head neutral position whether the cuff was deflated or inflated. There was no significant difference in the volume of air required to achieve an intracuff pressure of 60 cm H2O between the two head positions ( P＞ 0.05). The airway seating pressure increased from (27 ± 6) cm H2O in the head neutral position to (33 ± 6) cm H2O in the head anteflexion position, with no significant difference between them ( P＞ 0.05). The expired tidal volume and the peak inspiratory pressure during IPPV were (496 ± 81 ) ml and (14.3 ± 1.9) cm H2O respectively in the head neutral position and (496 ± 81 ) ml and ( 14.5 ± 2.1 )cm H2O respectively in the head anteflexion position.Conclusion Head anteflexion can significantly improve airway sealing but does not affect the anatomic position of the cuff.Appropriate head anteflexion is a simple and effective way to improve IPPV when the airway sealing pressure is inadequate in the head neutral position.