ObjectiveTo investigate the effect of Yuejuwan on lipid metabolism in serum， prefrontal cortex and hippocampus of depressed mice based on lipidomics， and to explore the potential pathways for improving lipid metabolism to prevent depression. MethodsSeven-week-old C57BL/6 mice were randomly divided into blank group， model group， Yuejuwan group（3.6 g·kg^-1） and fluoxetine group（10 mg·kg^-1）， and chronic unpredictable mild stress（CUMS） was used to establish the depression model. After 3 weeks of modeling， each administration group was gavaged with the corresponding drug solution according to the dose， and mice in the blank and model groups were given an equal volume of deionised water by gavage， one time/d for 2 weeks. After administration， the antidepressant effect of Yuejuwan was evaluated by neurobehavioral indices such as sucrose preference test， open field test， tail suspension test and forced swimming test. An automatic biochemical analyzer was used to measure contents of total cholesterol（TC）， triglyceride（TG）， low-density lipoprotein cholesterol（LDL-C）， high-density lipoprotein cholesterol（HDL-C）， aspartate aminotransferase（AST） and alanine aminotransferase（ALT） in mouse serum. Lipidomic analysis of mouse serum， prefrontal cortex and hippocampus was performed based on ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap mass spectrometry（UPLC-LTQ-Orbitrap-MS）， and the expression of mammalian target of rapamycin（mTOR）， ribosomal protein S6 kinase（S6K）， phosphorylation（p）-mTOR， p-S6K in gastric tissues of mice was detected by Western blot. ResultsCompared with the blank group， mice in the model group exhibited significantly reduced sucrose preference rate and center movement time in the open field test（P<0.01）， the immobility times in the tail suspension test and forced swimming test were significantly increased（P<0.01）， and serum levels of TC， TG， LDL-C， HDL-C， AST and ALT were significantly elevated（P<0.05， P<0.01）. Compared with the model group， the Yuejuwan group showed a significant increase in the sucrose preference rate and center movement time in the open field test（P<0.01）， the immobility times in the tail suspension test and forced swimming test were significantly reduced（P<0.01）， and the serum levels of TC， TG， LDL-C， AST and ALT were significantly decreased（P<0.05， P<0.01）. Lipidomic analysis revealed that Yuejuwan had a significant effect on lipid metabolism in serum， prefrontal cortex and hippocampus of depressed mice， and The differential lipid metabolites were mainly enriched in the metabolic pathways of glycerophospholipid metabolism， sphingolipid signaling， and glycosylphosphatidylinositol-anchored protein biosynthesis， among which the glycerophospholipid metabolic pathway was the most significant. Western blot results showed that compared with the blank group， the relative expression levels of p-mTOR/mTOR and p-S6K/S6K in the gastric tissues of mice in the model group were significantly increased（P<0.01）. In comparison with the model group， the relative expression levels of p-mTOR/mTOR and p-S6K/S6K in the gastric tissues of mice in the Yuejuwan group were significantly decreased（P<0.01）. ConclusionThe intervention of Yuejuwan on lipid metabolism is one of the potential pathways for its antidepressant effect， which may be related to the regulation of mTOR/S6K signaling pathway upstream of lipid metabolism in the gastric tissues.

Objective To evaluate the application effect of ciprofol-alfentanil in short urological surgery.Methods A total of 80 patients who were to undergo urological general anesthesia surgery in this hospital were divided into two groups by random number method:ciprofol-alfentanil group(group C)and propofol-alfentanil group(group P).Group C was injected with ciprofol 0.4 mg/kg,group P was injected with propofol 1.5-2.0 mg/kg,and when the bispectral index(BIS)was<60,the intravenous injection of alfen-tanil(10 μg/kg)and rocuronium bromide(0.6 mg/kg)was continued.When the modified alertness/sedation score(MOAA/S score)was 0,the laryngeal mask was placed and mechanical ventilation was used.During the maintenance period,ciprofol 0.8-1.2 mg·kg-1·h-1 was infused intravenously in group C,and propofol 4-6 mg·kg-1·h-1 was infused intravenously in group P.The heart rate(HR),blood pressure(BP),oxygen saturation(SpO2),end-tidal carbon dioxide(PetCO2),BIS and MOAA/S score were recorded at the begin-ning of anesthesia induction(T0),laryngeal mask insertion(T1),ureteroscopy entry(T2),10 min after sur-gery(T3)and the end of surgery(T4).The consciousness disappearance time,operation time,anesthesia re-covery time,drug dosage,injection pain during induction,hypotension,bradycardia and other adverse reactions during the operation were recorded.Results There was no significant difference in HR,SpO2,PetCO2,BIS value,MOAA/S score,operation time,consciousness disappearance time,and anesthesia recovery time be-tween the two groups at each time point(P>0.05).The dosage of sedative drugs in group C was less than that in group P(P<0.05).Compared with group P,systolic blood pressure and diastolic blood pressure at T1-T3 and diastolic blood pressure at T4 increased in group C(P<0.05).Compared with T0,systolic blood pressure at T1-T4 in group C and group P decreased,diastolic blood pressure at T2-T4 in group C de-creased,and diastolic blood pressure at T1-T4 in group P decreased(P<0.05).Compared with group P,the injection pain and the incidence of intraoperative hypotension were reduced in group C(P<0.05).Conclusion Cipro-fol-alfentanil is superior to propofol-alfentanil in short urological surgery.

Objective:To investigate the clinical application effect of enhanced recovery after surgery(ERAS) in the perioperative period of primary repair for children with hypospadias.Methods:Non-randomized controlled study.Retrospective analysis was made on clinical data of 206 children with hypospadias admitted to the Department of Urology, Shanxi Children′s Hospital from March 2018 to March 2022.According to whether the concept of ERAS was adopted for perioperative management of children, they were divided into the ERAS group(109 cases) and the non-ERAS group(97 cases). t-test and Chi-square test were used to analyze the differences between the two groups of patients in hospitalization days, hospitalization costs, pain scores on the first day after surgery, average number of bowel movements within 5 days after surgery, first out-of-bed activity time, hospital satisfaction score, and complication rate. Results:Pediatric patients in the ERAS group showed better outcomes compared to the non-ERAS group: shorter hospital stays[(7.71±1.12) d vs.(21.00±1.07) d], lower hospitalization costs[(10 043.21±1 341.00) yuan vs.(12 993.44±1 081.00) yuan], lower postoperative pain scores on the first day[(5.21±1.32) points vs.(6.09±1.07) points], more frequent bowel movements within 5 days[(5.16±0.65) times vs.(2.91±0.48) times], earlier time to first out-of-bed activity[(5.03±0.61) d vs.(7.12±0.57) d], and higher hospital satisfaction scores[(4.71±0.21) points vs.(4.14±0.15) points], and the differences were statistically significant(all P<0.05).Additionally, the ERAS group had lower rates of fever(6.42%, 7/109) and constipation(3.67%, 4/109) before urinary catheter removal compared to the non-ERAS group[21.64%(21/97) and 28.87%(28/97), respectively](all P<0.05).There were no significant differences in the incidences of complications such as urethral prolapse, infection, delayed wound healing, and bleeding, as well as urethral stricture, urethral fistula, and urethral diverticulum after urinary catheter removal between the two groups(all P>0.05). Conclusions:ERAS protocol applied in the perioperative period of primary repair for children with hypospadias can shorten the hospitalization time, lower the hospitalization costs, and accelerate the rehabilitation of children.It is worth further promotion.

Objective To investigate the clinical value of deep learning reconstruction(DLR)for flow sensitive black blood(FSBB)sequence in MRI of lenticulostriate artery(LSA).Methods Thirty robust volunteers were prospectively selected,performed scans with conventional FSBB sequences,and divided into DLR-FSBB group and conventional FSBB group according to whether DLR method was used.The signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)and number of branches of the two groups of images for bilateral LSA were compared,and the overall image quality was evaluated subjectively using Likert score(5-point scale).A paired t-test was used to compare quantitative indicators,SNR and CNR of image quality between the two groups.The Kappa coefficient was applied to eval-uate the consistency of subjective scores between the two observers.Results The SNR and CNR of DLR-FSBB images of cranial bilateral LSA were considerably higher than those of conventional FSBB images(left SNR 34.45±8.21 vs 16.91±4.67,P＜0.001,and right SNR 31.24±6.35 vs 16.02±3.00,P＜0.001;corresponding CNR 19.38±6.37 vs 9.27±3.12,15.82±4.29 vs 8.01±2.27,P＜0.001).The number of branches of LSA was slightly higher in the DLR-FSBB images[4.00(4.00,5.00)vs 3.00(3.00,4.00)on the left side,P＜0.001;3.00(3.00,4.00)vs 3.00(2.00,3.00)on the right side,P=0.003].The subjective score of overall image quality was higher in DLR-FSBB than that in conventional FSBB[reader 1:4.00(4.00,4.00)points vs 3.00(3.00,3.00)points;reader 2:4.00(4.00,4.00)points vs 3.00(3.00,3.00)points,P＜0.001].Conclusion Compared with conventional FSBB sequences,DLR-FSBB sequences of LSA have lower image noise,and vessel branches are displayed more plainly and slightly more numerous.DLR can improve the overall image quality of LSA in conventional FSBB sequences.

Objective:To investigate the effect of internal fixation of medial support and lateral wall on initial weight-bearing stability of femoral intertrochanteric fracture after reconstruction of intertrochanteric fracture.Methods:Based on the digital model of Sawbones femur, intertrochanteric fracture models with different medial support and lateral wall states were constructed. Combined with various intramedullary and extramedullary fixation methods, the mechanical models after fixation were simplified, and seven mechanical simplified models were obtained. The individual body weight load (70 kg) was simulated by applying concentrated force (700 N) to the end nodes of the femoral head. Through the analysis and calculation of each model in StrucMaster software, the axial force, shear force, bending moment, displacement deformation, and support reaction force of each bar in each mechanical model were obtained, and the results were output through the supporting SMConsole.Results:The median bending moment of model 1 was 11.55(5.57, 18.00) N·m, and the median bending moment was 2.89(2.81, 2.94) rad. The median bending moment of model 2 was 13.72(9.30, 20.05) N·m, and the median bending moment was 2.93(2.77, 3.05) rad. The median bending moment of model 3 was 19.65(10.23, 26.11) N·m, and the median bending moment was 2.93 (2.77, 3.05) rad. The median bending moment of model 4 was 25.95(25.14, 36.70) N·m, and the median bending moment was 4.38(3.16, 5.15) rad. The median bending moment of model 5 was 13.66(7.99, 25.62) N·m, and the median bending moment was 3.50(3.32, 3.56) rad. The median bending moment of model 6 was 24.60(9.33, 29.37) N·m, and the median bending moment was 3.90(3.69, 4.10) rad. The median bending moment of model 7 was 41.14(0.16, 41.30) N·m, and the median bending moment was 5.50(5.50, 7.05) rad. The mechanical properties of model 1 were better than those of the other six models.Conclusion:The simplified mechanical model and its mechanical calculation analysis based on the lever reconstruction balance theory can be used to preliminarily reveal the mechanical characteristics of femoral intertrochanteric fractures after internal fixation. The internal fixation methods of the medial support and lateral wall of femoral intertrochanteric fracture reconstruction can improve the initial stability of the weight bearing after internal fixation of femoral intertrochanteric fractures and have guiding significance for the functional rehabilitation of early postoperative weight bearing.

Our hospital first used the housing and training information management platform in 2018 in order to improve the management efficiency and teaching quality of standardized resident training in the Department of Otolaryngology-Head and Neck Surgery. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, through continuous optimization and upgrading of system functions and the mobile APP terminal, the integrated development of teaching and management and the maximization of resource sharing have been realized, thus making up for the defects and deficiencies of the traditional resident training management mode. Our practice shows that the new resident training management mode based on informatization mobile platform can not only save time and effort for departments to grasp all aspects of resident training management, but also enable residents to complete the resident training plan step by step and reasonably with improvement in their knowledge, skills, and competence. Therefore, the new resident training management mode has broad application prospects.

Objective:To observe the development of elevated body temperature during surgical correction under different general anesthesias in the pediatric patients with congenital ptosis.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅰ pediatric patients with blepharoptosis of both sexes, aged 2-10 yr, undergoing elective surgery for blepharoptosis correction, were divided into total intravenous anesthesia group(TIVA group) and combined intravenous-inhalational anesthesia group(CIIA group) using a random number table method, with 30 cases in each group. Anesthesia was induced with intravenous propofol 1-2 mg/kg, cisatracurium 0.15-0.25 mg/kg and fentanyl 2-3 μg/kg in both groups, and then the patients were endotracheally intubated. Anesthesia was maintained with intravenous infusion of propofol 50-200 μg·kg -1·min -1 and remifentanil 0.2-0.05 μg·kg -1·min -1 in TIVA group and with intravenous infusion of propofol 25-75 μg·kg -1·min -1 and remifentanil 0.2-0.5 μg·kg -1·min -1 and inhalation of 1%-1.5% sevoflurane in CIIA group. After completion of anesthesia induction, the nasopharyngeal temperature was continuously monitored until the end of surgery, and the occurrence of elevation in intraoperative body temperature (≥37.5 ℃) was recorded. Results:The incidence of elevated body temperature was 20% and 40% in TIVA group and CIIA group, respectively. Body temperature ≥39.0 ℃ did not occur in two groups. There was no significant difference in the incidence of elevated body temperature and constituent ratio of degree of elevation in body temperature between the two groups ( P>0.05). Conclusions:When total intravenous anesthesia and combined intravenous-inhalational anesthesia are used in the surgery for blepharoptosis correction in the pediatric patients with congenital ptosis, concurrent mild hypothermia is a non-small probability event, but it is safe to evaluate it in terms of the occurrence of malignant hyperthermia.

Normal human blood pressure has a unique "dipper type" rhythm, but various pathological factors will lead to abnormal nighttime blood pressure decline, seriously damage the target organs such as the heart, brain and kidneys, and significantly increase the incidence of cardiovascular events. Therefore, it is necessary to pay sufficient attention to rhythm disorder of blood pressure and intervene early. Modern Traditional Chinese Medicine (TCM) mostly understands the changes of rhythm of blood pressure from the view of the unity of nature and man, yin-yang theory and the theory of meridian flow, and study the syndrome distribution and TCM constitution law of rhythm disorder of blood pressure by combining TCM syndrome differentiation method and TCM constitution theory. TCM treatment can restore blood pressure rhythm and improve clinical symptoms and sleep quality of patients.

Objective:To investigate the value of number of negative lymph nodes (NLNs) in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 924 patients with esophageal cancer after neoadjuvant therapy uploaded to the Surveillance, Epidemiology, and End Results Database of the National Cancer Institute from 2004 to 2015 were collected. There were 1 624 males and 300 females, aged 63 (range, 23?85)years. All 1 924 patients were randomly divided into the training dataset of 1 348 cases and the validation dataset of 576 cases with a ratio of 7:3 based on random number method in the R software (3.6.2 version). The training dataset was used to constructed the nomogram predic-tion model, and the validation dataset was used to validate the performance of the nomogrram prediction model. The optimal cutoff values of number of NLNs and number of examined lymph nodes (ELNs) were 8, 14 and 10, 14, respectively, determined by the X-tile software (3.6.1 version), and then data of NLNs and ELNs were converted into classification variables. Observation indicators: (1) clinicopathological characteristics of patients in the training dataset and the validation dataset; (2) survival of patients in the training dataset and the validation dataset; (3) prognostic factors analysis of patients in the training dataset; (4) survival of patients in subgroup of the training dataset; (5) prognostic factors analysis in subgroup of the training dataset; (6) construction of nomogram prediction model and calibration curve. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Based on the results of multivariate analysis, the nomogram prediction model was constructed. The prediction efficacy of nomogram prediction model was evaluated using the area under curve (AUC) of the receiver operating characteristic curve and the Harrell′s c index. Errors of the nomogram prediction model in predicting survival of patients for the training dataset and the validation dataset were evaluated using the calibration curve. Results:(1) Clinicopathological characteristics of patients in the training dataset and the validation dataset. There was no significant difference in clinicopatholo-gical characteristics between the 1 348 patients of the training dataset and the 576 patients of the validation dataset ( P>0.05). (2) Survival of patients in the training dataset and the validation dataset. All 1 924 patients were followed up for 50(range, 3?140)months, with 3-year and 5-year cumulative survival rate as 59.4% and 49.5%, respectively. The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the training dataset was 46.7%, 62.0% and 66.0%, respectively, and the 5-year cumulative survival rate was 38.1%, 52.1% and 59.7%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=33.70, P<0.05). The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the validation dataset was 51.1%, 54.9% and 71.2%, respectively, and the 5-year cumulative survival rate was 39.3%, 42.5% and 55.7%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=14.49, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the training dataset was 53.9%, 60.0% and 62.7%, respectively, and the 5-year cumulative survival rate was 44.7%, 49.1% and 56.9%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=9.88, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the validation dataset was 56.2%, 47.9% and 69.3%, respectively, and the 5-year cumula-tive survival rate was 44.9%, 38.4% and 51.9%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=9.30, P<0.05). (3) Prognostic factors analysis of patients in the training dataset. Results of multivariate analysis showed that gender, neoadjuvant pathological (yp) T staging, ypN staging (stage N1, stage N2, stage N3) and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=0.65, 1.44, 1.96, 2.41, 4.12, 0.69, 0.56, 95% confidence interval as 0.49?0.87, 1.17?1.78, 1.59?2.42, 1.84?3.14, 2.89?5.88, 0.56?0.86, 0.45?0.70, P<0.05). (4) Survival of patients in subgroup of the training dataset. Of the patients with NLNs in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 61.1%, 71.6% and 76.8%, respectively, and the 5-year cumulative survival rate was 50.7%, 59.9% and 70.1%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=12.66, P<0.05). Of the patients with positive lymph nodes in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 26.1%, 42.9% and 44.7%, respectively, and the 5-year cumulative survival rate was 20.0%, 36.5% and 39.3%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=20.39, P<0.05). (5) Prognostic factors analysis in subgroup of the training dataset. Results of multivariate analysis in patients with NLNs in the training dataset showed that gender, ypT staging and number of NLNs (>14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadju-vant therapy ( hazard ratio=0.67, 1.44, 0.56, 95% confidence interval as 0.47?0.96, 1.09?1.90, 0.41?0.77, P<0.05). Results of multi-variate analysis in patients with positive lymph nodes in the training dataset showed that race as others, histological grade as G2, ypN staging as stage N3 and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=2.73, 0.70, 2.08, 0.63, 0.59, 95% confidence interval as 1.43?5.21, 0.54?0.91, 1.44?3.02, 0.46?0.87, 0.44?0.78, P<0.05). (6) Construction of nomogram prediction model and calibration curve. Based on the multivariate analysis of prognosis in patients of the training dataset ,the nomogram prediction model for the prognosis of patients with esophageal cancer after neoadju-vant treatment was constructed based on the indicators of gender, ypT staging, ypN staging and number of NLNs. The AUC of nomogram prediction model in predicting the 3-, 5-year cumulative survival rate of patients in the training dataset and the validation dataset was 0.70, 0. 70 and 0.71, 0.71, respectively. The Harrell′s c index of nomogram prediction model of patients in the training dataset and the validation dataset was 0.66 and 0.63, respectively. Results of calibration curve showed that the predicted value of the nomogram prediction model of patients in the training dataset and the validation dataset was in good agreement with the actual observed value. Conclusion:The number of NLNs is an independent influencing factor for the prognosis of esophageal cancer patients after neoadjuvant therapy, and the nomogram prediction model based on number of NLNs can predict the prognosis of esophageal cancer patients after neoadjuvant therapy.

Humans ; Atrial Fibrillation/surgery* ; Left Atrial Appendage Closure ; Heart Atria/surgery* ; Catheter Ablation/methods* ; Atrial Appendage/surgery* ; Treatment Outcome