Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P＜0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P＜0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P＜0.05).The incidence of nausea in group S was significantly lower than that in group C(P＜0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

Literature related to children's adenoid hypertrophy was retrieved to form an expert questionnaire.According to the group standard writing rules of the China Association of Chinese Medicine,the peer consultation,quality evaluation and suitability eval-uation were completed through three rounds of Delphi expert questionnaire surveys and expert discussion meetings,and the Clinical Practice Guidelines for TCM in Children with Adenoidal Hypertrophy was finally formed.The guidelines have been formulated to clarify the scope of application of the guidelines,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,prevention and care,and to provide an important reference for the clinical practice and diagnosis and treatment norms of tra-ditional Chinese medicine for children with adenoid hypertrophy.

This paper discusses from two aspects of case writing and PBL implementation experience. PBL cases should be based on professional requirements and reflect professional characteristics. Health inspection and quarantine cases targeted at application-oriented talent cultivation can be integrated into relevant experimental skills items. At the same time, the forms of case writing are expanded according to the differences of theme forms, which are designed as parallel cases and serial cases, so as to be applicable to the curriculum integration in different areas. In the implementation of PBL teaching, students' learning status is the key to the efficiency of classroom discussion, which determines whether the implementation of PBL is completely autonomous learning or embedded instruction. Teachers should establish cooperative learning atmosphere to improve the efficiency of classroom discussion

Objective:To analyze the correlation between indocyanine green retention rate at 15 minutes (ICG-R15) and modified Scheuer score in liver tissues of patients with hepatitis B e antigen-positive/negative chronic hepatitis B (CHB), and further explore the indocyanine green clearance test (ICGCT) applied value in judging the progress of CHB-related liver disease.Methods:407 HBeAg (+) / HBeAg (-) CHB inpatients with normal or slightly elevated serum alanine aminotransferase (ALT) [< 2 times the upper limit of normal (ULN)] and modified Scheuer score were collected, and divided into mild liver disease group (M group, 131 cases, modified Scheuer score < G2S2) and progressive liver disease group (A group, 276 cases, modified Scheuer score≥G2 and / or S2). Furthermore, the groups were sub-divided into HBeAg (+) - M group, HBeAg (-) - M group, HBeAg (+) - A group and HBeAg (-) - A group. The correlation between ICG-R15 and modified Scheuer score was analyzed retrospectively. The data were analyzed by SPSS 24.0 software.Results:Basic clinical characteristics: Among the 407 CHB cases with normal or mildly elevated serum ALT, 171 were HBeAg(+) CHB and 236 were HBeAg(-) CHB. The baseline mean serum HBV DNA was higher in HBeAg(+) CHB patients [(6.06 ± 1.95) log10IU/ml] than HBeAg(-) CHB patients [(3.60±1.37)log10IU/ml ( P = 0.000)]. Included patients ICG-R15 detection characteristics: (1) The baseline mean value of ICG-R15 was not statistically significant between the two groups of HBeAg(+) CHB and HBeAg(-) CHB, and was basically within the normal range (< 10%); (2) Comparison of ICG-R15 baseline mean value among the subgroups showed that the patients in the HBeAg(+)-A group/HBeAg(-)-A group were higher than the HBeAg(+)-M group/HBeAg(-)-M group patients, and the difference was statistically significant ( P = 0.013/ P = 0.000). Included patients’ correlation analysis between ICG-R15 and modified Scheuer score: (1) ICG-R15 and modified Scheuer score had shown weak positive correlation with inflammatory activity grade (g) in HBeAg (+) / HBeAg (-) CHB ( r = 0.237, P = 0.002); r = 0.244, P = 0.000); (2) There was a weak positive correlation between ICG-R15 and fibrosis stage (s) in HBeAg (+) / HBeAg (-) CHB ( r = 0. 254, P = 0; r = 0.225, P = 0.001). Included patients ICG-R15 predictive value for the severity of liver histological progression: when the cut-off value of ICG-R15 was 5.1%, the area under the receiver operating characteristic curve from M group to A group was 0.601 ( P = 0.001) for predicting HBeAg (+) / HBeAg (-) CHB patients. Conclusion:ICG-R15 is positively correlated with the modified Scheuer score of liver tissue in HBeAg (+)/HBeAg (-) CHB patients with normal or slightly elevated ALT. In addition, when the cut-off value of ICG-R15 was 10%, it could not accurately reflect the effective hepatocyte reserve function of HBeAg (+) / HBeAg (-) CHB patients with normal or slightly elevated ALT. Importantly, when the cut-off value of ICG-R15 is 4.0% ~ 5.0%, it may have predictive value for liver disease progression to modified Scheuer score ≥ G2 and / or ≥S2 in HBeAg (+) / HBeAg (-) CHB patients with normal or slightly elevated ALT.

Objective? To explore the clinical effects of intermittent oral gastrogavage in aged patients with dysphagia. Methods? Totally 66 aged patients with dysphagia hospitalized in the Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital between May 2016 and February 2018 were selected using convenient sampling and divided into the treatment group and the control group according to the random number table. Patients in the control group received nasogastric tube feeding, while patients in the treatment group received intermittent oral gastrogavage. The degree of aspiration, the effects on deglutition function and nutrition were compared between the two groups. Finally, totally 60 patients in the treatment group (n=30) and the control group (n=30) completed the study. Results? After 3 months, patients in the treatment group showed Class Ⅰ-Ⅱ aspiration, while 3 patients in the control group were found with Class Ⅲ or Ⅳaspiration (Z=-3.227,P＜ 0.05). The rehabilitation efficiency of deglutition function of the treatment group was higher than that of the control group (Z=-3.158,P＜0.05). The serum albumin and the pro-protein of the treatment group was (47.17±3.28) g/L and (0.32±0.08) g/L respectively, both higher than those of the control group (t=-10.500, 3.677; P＜ 0.05). Conclusions? Intermittent oral gastrogavage can enhance the patients' deglutition function, reduce their aspiration levels and improve their nutritional status, which is worth promoting in clinical practice.

Objective To identify the role of phosphatidylinositol-3-kinase(PI3K) in mediating necroptosis induced by tumor necrosis factor alpha (TNFα) and the involved mechanism.Methods Knockdown of p110α,receptor-interacting protein 1(RIP1) or both p110αand RIP1 was mediated by the specific short hairpin RNA (shRNA) lentivirus and verified by RT-PCR or Western blotting .In addition , Western blotting was used to detect phosphorylation of mixed lineage kinase domain-like protein(MLKL) and protein kinase B(AKT) or tetramerization of MLKL.Cell death was measured by micros-copy and flow cytometry.Results AKT phosphorylation and TNFα-induced necroptosis of L929 cells were suppressed by the inhibitors of PI3K or AKT, as well as p110αknockdown.Moreover, RIP1 knockdown did not inhibit L929 cell death induced by TNFαplus Z-VAD, but the RIP1-independent necroptosis was inhibited by p 110αknockdown.In addition, p110αknockdown suppressed MLKL phosphorylation and tetramerization induced by TNFαwith Z-VAD in L929 cells. Conclusion PI3K mediates necroptosis of L929 cells induced by TNFαby activating AKT and MLKL, respectively.

Objective To explore the effects of corticosteroids on the recurrence of atrial fibrillation (AF) after radio fre-quency catheter ablation (RFCA ) .Methods A total of 50 patients with paroxysmal AF who underwent RFCA and then treated with corticosteroids from January 2011 to April 2014 were enrolled in this study .At the same period ,37 patients with paroxysmal AF who also underwent RFAC but without corticosteroids treatment were selected as control group .The follow-up was carried out by the fixed physician at 1st week ,1st month ,3rd months ,6th months ,12th months after RFCA through a telephone visit or a hos-pital visit ,including the 12-lead electrocardiogram (ECG) and the HOLTER examination ,symptom of heart-throb inquiry and the interpretation of ECG ,AF recurrence were analyzed and compared between hormone treatment group and control group .Results After 1 week treatment ,the maintenance rates of sinus rhythm in treatment group and control group were 80 .0% and 54 .1% ,re-spectively ,there was statistic difference(P < 0 .05) ,the recurrence of AF in treatment group was significantly decreased ;after 1 month treatment ,the maintenance rates of sinus rhythm in treatment group and control group were 80 .0% and 67 .6% ,respective-ly ,there was no statistic difference(P = 0 .187) ;after 12 months treatment ,the recurrence of AF in treatment group and control group ,was not found statistic significance(P= 0 .711) .Kaplan-Meier survival rate was drew to conduct Log-rank test ,the difference of AF recurrence between the two groups was no statistic significance(P= 0 .711) .Conclusion Transient use of small amounts of corticosteroids after AF ablation may be effective for preventing AF recurrences within 1 week after ablation but it is not effective for preventing AF recurrences at 1st month and 12th months after ablation .

Objective To explore the short-term mindfulness behavior training on movement function of stroke patients with hemiplegia. Methods A total of 60 stroke patients were divided into two groups randomly,observation group and control group. The patients of control group received conventional rehabilitation therapy, while the patients of observation group received mindfulness training besides this. Before treatment and after 60 days, all patients had accepted the assessment by the Fugl-Meyer motor function scale ( FMA ) , the Pittsburgh sleep quality index scale ( PSQI) and self-rating depression scale ( SDS) . Results After treatment, all patients′motor function and sleep quality were improved, and degree of depression lowered compared before;the improvement of observation group was better than control group′s (P<0. 05). Conclusions Mindfulness behavior training combined with behavioral rehabilitation for stroke patients with hemiplegia has strengthening effect on recover motor function, and provides a reference for exploring the comprehensive rehabilitation therapy.

Objective The application of International Classification of Functioning,Disability and Health (ICF)generic set in rehabilitation nursing of stroke patients with hemiplegia was evaluated,providing a theory basis for rehabilitation in stroke patients.Methods Fifty-three stroke in-patients with hemiplegia were treated in the department of rehabilitation medicine in Xuzhou Central Hospital from January to October in 2015. They were included in the investigation.After admitted to hospital the patients were evaluated with the generic set of ICF.According to the scores of seven categories in the evaluation of the patients,appropriate rehabilitation and nursing measures were made.After the intervention in hospitalization the patients were evaluated with the generic set of ICF again when they were discharged from hospital.The rehabilitation of the patients was compared based on the two scores evaluated before and after the intervention.Results In the seven categories of ICF generic set,no significant difference was found in the scores of b152,b280 and d850 before and after the intervention (P >0.05).Significant differences were found in the scores of b130,d230,d450,d455 and so on before and after the intervention (P <0.05).Conclusions The application of ICF generic set in the assessment of the status of hemiplegic patients and the corresponding reinforcement of rehabilitation nursing intervention can make body functions,movement and participation degrees of hemiplegic patients strong and promote their recovery.

Objective Percoll density gradient centrifugation and Ficoll-Hypaque density gradient cen-trifugation, which are frequently-used methods for separation of tumor-associated macrophages (TAMs) from solid carcinoma were compared, in order to find an effective way to separate TAMs from colorectal carcinoma (CRC). Furthermore, we studied the best adherence time of separating macrophage among mononuclear cells. Methods specimens were collected from CRC patients , after digesting into single cells , TAMs were separated from the same specimen by 100% Ficoll, 35% percoll and 25% combined with 65% percoll respectively. After these pre-liminary separation, the collected cells were purified a second time by adherence separation. The purity of TAMs were detected by immunofluorescence. Results TAMs purity from Ficoll-Hypaque density gradient centrifugation was 80.18%, statistically higher than that from Percoll density gradient centrifugations (54.33% and 10.93% re-spectively). Conclusion Compared to Percoll density gradient centrifugation, Ficoll-Hypaque density gradient centrifugation is a more effective and simple way to isolate TAMs from colorectal carcinoma , suggesting it can be wildly used in clinical and basic medical research. 2-4 hours is the best adherence time for isolating macrophage.