Objective:To investigate the effects of low-dose ropivacaine combined with sufentanil on the onset time of anesthesia and postoperative rectal traction reflectance in patients undergoing mixed hemorrhoid surgery.Methods:A total of 96 patients who underwent mixed hemorrhoid surgery at the General Hospital of the Southern Theater Command of the Chinese People′s Liberation Army from January 2020 to June 2021 were selected. They were randomly divided into a control group and an observation group using a random number table method, with 48 cases in each group. The control group was anesthetized with low-dose ropivacaine; The observation group was anesthetized with low-dose ropivacaine combined with sufentanil. The anesthesia effect, hemodynamic changes, pain score, bleeding score, postoperative rectal traction reflectance, and incidence of adverse reactions were compared between two groups of patients.Results:Compared with the control group, the observation group had a shorter onset time of anesthesia ( P<0.05) and a longer duration of anesthesia maintenance ( P<0.05). Before surgery, there was no statistically significant difference in heart rate and mean arterial pressure between the two groups of mixed hemorrhoid patients (all P>0.05); After surgery, both groups of patients had an increase in heart rate, a decrease in mean arterial pressure, and a more significant change in the control group (all P<0.05). Before surgery, there was no statistically significant difference in Visual Analogue Scale (VAS) scores and bleeding scores between the two groups of mixed hemorrhoid surgery patients (all P>0.05); After 1 day of surgery, the VAS score and bleeding score of both groups of patients were significantly reduced (all P<0.05), and the observation group showed a more significant decrease (all P<0.05). The postoperative recovery rate of anal contraction in the observation group was higher than that in the control group ( P<0.05), and the rectal traction reflectance was lower than that in the control group ( P<0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group (χ 2=4.667, P<0.05). Conclusions:The combination of low-dose ropivacaine and sufentanil has a definite anesthetic effect on patients undergoing mixed hemorrhoid surgery. It can improve the onset time of anesthesia and postoperative rectal traction reflectivity, alleviate patient pain, and has high safety.

The role and function of nurses in the application of assisted reproductive technology were sorted out.Addressing potential ethical dilemmas,this paper analyzed the restrictive factors in dealing with difficulties in nursing practice and proposed the construction of a nursing ethics literacy system.It is suggested to improve ethical rules and education systems,strengthen case education,enhance risk prevention capabilities,and cultivate a healthy ethical culture,so as to effectively enhance nurses'ethical literacy.

OBJECTIVE To explore the independent risk factors of voriconazole （VCZ）-related liver injury in elderly patients with hypoproteinemia. METHODS Elderly patients with invasive fungal infection and hypoproteinemia who were hospitalized in the respiratory intensive care unit of our hospital and treated with VCZ from August 2020 to July 2023 were selected. They were divided into group A （liver injury group） and group B （non-liver injury group） based on whether the liver injury occurred after using VCZ. Pearson correlation analysis was used to analyze the correlation between minimum concentration （cmin） of VCZ and inflammatory factor[C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）]， as well as liver function [alanine transaminase （ALT）， aspartate transaminase （AST）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， total bilirubin （TBIL）]； univariate analysis was performed by using χ 2 test； Logistic regression analysis was used to analyze the independent risk factors affecting the occurrence of liver injury. RESULTS A total of 320 patients were included in the study， of whom 56 developed liver injury， with an incidence of 17.50%. The VCZ cmin in group A was significantly higher than group B （P＝ 0.021）. CRP， PCT， IL-6， and TBIL were correlated with VCZ cmin （P＜0.05）. CRP， PCT， IL-6， and TBIL had a significant impact on VCZ cmin （P＜0.05）. VCZ cmin， PCT， and TBIL were independent risk factors for liver injury （P＜0.05）. The patients with VCZ cmin≥3.76 mg/L had a significantly increased risk of liver injury. CONCLUSIONS VCZ cmin， PCT， and TBIL are independent risk factors for the occurrence of liver injury in elderly patients with hypoproteinemia. For patients with high PCT and TBIL， VCZ cmin and liver function should be closely monitored during VCZ treatment to reduce the risk of liver injury.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

Immunothrombosis refers to the innate immune response caused by thrombosis in blood vessels(especially microvessels).Immunothrombosis is related to immune cells and specific thrombosis related molecules,producing intravascular scaffolds that promote pathogen recognition,inhibition,and destruction,thereby protecting the integrity of the host.However,abnormal or uncontrolled activation of immunothrombosis may be harmful to the host and serve as the foundation for various infectious and inflammatory related thrombotic diseases.Therefore,understanding the potential mechanisms of immunothrombosis plays a decisive role in developing more effective therapies for thrombosis treatment and prevention.This review provides an overview of the mechanisms of immunothrombosis in order to understand new treatment strategies for reducing the risk of immunothrombosis.

OBJECTIVE To systematically evaluate the efficacy and safety of vonoprazan （VPZ） for Helicobacter pylori （Hp） eradication therapy. METHODS Retrieved from The Cochrane Library， Embase， PubMed， CNKI， VIP and Wanfang database， randomized controlled trials about VPZ for Hp eradication therapy （trial group） versus proton pump inhibitor （PPI） （control group） were collected during the inception to July 2022. After data extraction and quality evaluation with bias risk assessment tool recommended by Cochrane System Evaluation Manual 5.1.0， meta-analysis was performed by using RevMan5.3 software. RESULTS Nine studies with 2 134 patients were included. Compared with control group， the overall Hp eradication rate of trial group increased significantly in either the ITT analysis or PP analysis， being 87.5% vs. 76.2% [RR＝1.14， 95%CI （1.06，1.21）， P＜0.001] and 92.4% vs. 80.5% [RR＝1.11， 95%CI （1.03，1.21）， P＜0.01]， respectively. According to ITT and PP analysis of primary treatment subgroup， compared with control group， the overall Hp eradication rate of trial group increased significantly， being 88.4% vs. 76.5% [RR＝1.15， 95%CI （1.09，1.22）， P＜0.000 01] and 92.8% vs. 80.9% [RR＝1.12， 95%CI（1.03，1.23）， P＜ 0.05]； according to ITT and PP analysis of rescue therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. According to ITT and PP analysis of triple therapy subgroup， compared with control group， overall Hp eradication rate of trial group increased significantly， being 88.3% vs. 75.6% [RR＝1.16， 95%CI （1.08， 1.25）， P＜0.000 1] and 92.6% vs. 77.6% [RR=1.15， 95%CI （1.04， 1.28）， P＜0.01]； according to ITT and PP analysis of quadruple therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. Compared with control group， the incidence of adverse events in trial group decreased significantly， being 34.2% vs. 40.9% [RR＝0.84， 95%CI（0.70，0.99）， P＜ 0.05]. There was no statistical significance in the incidence of serious adverse events between 2 groups （P＞0.05）. CONCLUSIONS Compared with PPI therapy， the efficacy of VPZ-based triple therapy is better， particularly in primary treatment patients. However， VPZ has no significant advantage in rescue treatment and bismuth-containing quadruple regimen. And the safety and tolerance of VPZ for Hp eradication therapy are well， even better than PPI.

Guillain-Barré syndrome (GBS) defines a kind of Immune-mediated acute inflammatory peripheral neuropathy. Miller-Fisher Syndrome (MFS) is a special variant of GBS, with mostly one-way course and rare clinical recurrence. Only a few recurrent cases have been reported in China. Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness, acute onset, with symptoms of upper respiratory tract infection before onset, accompanied by pupil abnormalities and autonomic nervous dysfunction, who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy. The patient had a triad of “ataxia, areflexia and ophthalmoplegia”. Cerebrospinal fluid showed protein-cell separation. Serum anti-Sulfatides antibody IgM, anti-GT1a antibody IgG, anti-GQ1b antibody IgG and anti-GM3 IgM were positive. Recurrent MFS was diagnosed and the symptoms improved after immunotherapy. This case suggests that MFS is clinically heterogeneous, a few patients can present with relapse and generally have a better prognosis with immunotherapy. Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.

Objectives:To study the molecular characteristics, virulence gene and resistance profiles of Staphylococcus aureus ( S. aureus, SA) isolates from bloodstream infections (BSI), so as to further understand the molecular characteristics of S. aureus in pediatric patients. Methods:A total of 53 S. aureus strains in bloodstream infections from Shanghai Children′s Hospital between 2016 and 2021 were collected. Antimicrobial susceptibility test were adopted by instrumental and disk diffusion method. Thirty-two kinds of virulence genes were detected by PCR and underwent multi-locus sequence typing (MLST), Staphylococcus protein A (spa) typing and staphylococcal chromosome cassette (staphylococcal cassette chromosome mec, SCCmec) typing characterizing methicillin-resistant Staphylococcus aureus (MRSA). Statistical analysis was performed using χ 2 test or Fisher exact test. Results:MRSA isolates accounted for 50.94% of the total(27/53), with ST398-t034-SCCmecV (6/53, 11.32%) and ST59-t437-SCCmecIV (4/53, 7.55%) as the most common MRSA clones. Methicillin-sensitive Staphylococcus aureus (MSSA) isolates occupied 49.06% (26/53), among which typing ST22-t309 (3/53, 5.66%) and ST7-t091/t1685 (2/53, 3.77% each) were prevalent. Of the 53 strains, all carried ≥6 virulence genes, 33 strains (62.26%) carried ≥10 virulence genes, including 18 strains of MSSA (69.23%) and 15 strains of MRSA (55.56%). The carriage rate of pvl gene in MSSA was higher than that of MRSA isolates (12/26, 33.33% vs. 6/27, 22.22%), and sasX was only detected in MRSA isolates (4/53, 7.55%). The resistant rates of BSI-SA isolates to penicillin, erythromycin and clindamycin were 98.11%, 49.06% and 41.51%, respectively. MRSA were more resistant to clinical antimicrobial agents than MSSA. Conclusions:MRSA strains cover a high proportion in S. aureus bloodstream infection of children, with ST398-t034 and ST59-t437 being the most common clones. The virulence gene carrying rate for BSI-SA was high with a greater pvl gene carrying rate in MSSA isolates while sasX was only detected in MRSA isolates. More clinical attention should be paid to the high resistance status and virulence genes characteristics of BSI-SA.

Background The chronic injury of the hematopoietic system caused by ionizing radiation (IR) is often ignored. The essential cause of this injury is the damage of hematopoietic stem and progenitor cells (HSPCs). Objective To explore the long-term effects of IR at different radiation doses and at different radiation fractions of the same radiation dose on HSPCs in the bone marrow of mice, and to provide a scientific basis for reducing the chronic damage to the hematopoietic system caused by IR. Methods A total of 16 male C57BL/6 mice aged 8-10 weeks were randomly divided into four groups that received different doses or fractions of total body X-ray irradiation, including 1.5 Gy×4 irradiation group (n=5), 3 Gy irradiation group (n=4), 6 Gy irradiation group (n=4), and non-irradiation group (n=3). Two months after irradiation, bone marrow cells from each mouse were collected and counted. The clone forming ability of bone marrow cells was analyzed by cobblestone area-forming cell (CAFC) assay. The proportion of HSPCs was measured by flow cytometry. The cell cycle of HSPCs was assessed by antigen identified by monoclonal antibody Ki 67 (Ki-67) and 7-amino-actinomycin D (7-AAD) double staining. The reactive oxygen species (ROS) levels of HSPCs were estimated with a 2,7-dichlorodihydrofluorescein diacetate (DCFDA) probe. The cellular senescence of HSPCs was evaluated with a 5-dodecanoylaminofluorescein di-β-D-galactopyranoside (C12FDG) probe. The expression of senescence related genes such as P16, P19, P21, and P27 was measured by real-time fluorescence quantitative PCR. Results There was no significant change in the numbers of bone marrow cells 2 months after different doses and fractions of radiation (P>0.05). The clone forming ability of bone marrow cells was significantly decreased after 3 Gy and 6 Gy irradiation when compared to non-irradiated mice (P<0.01). HSPCs responded inconsistently to different doses and fractions of irradiation. Overall, there was no significant change in long-term hematopoietic stem cells (LT-HSCs) proportion after irradiation (P>0.05), the proportions of hematopoietic progenitor cells (HPCs), hematopoietic stem cells (HSCs), short-term hematopoietic stem cells (ST-HSCs), and multipotent progenitors 2 (MPP2) increased after irradiation (P<0.05), and the proportions of LSK, MPP1, MPP3, and MPP4 cells decreased after irradiation (P<0.05); except for HPCs and MPP2, the proportion of HSPCs in G0 phase was decreased (P<0.05). The ROS production in HSPCs was increased significantly after 6 Gy irradiation (P<0.05), while the ROS levels after 3 Gy and 1.5 Gy×4 irradiation were similar to that of the non-radiation group (P>0.05). The cellular senescent proportion of HPCs, LSK, and HSCs increased after irradiation (P<0.05). The expression levels of senescence related genes P16, P19, and P21 in HSCs were significantly increased (P<0.05). Conclusion The responses of HSPCs in bone marrow to IR vary depending on doses and fractions of irradiation. Increased ROS production and cellular senescence may be involved in the damage process of HSPCs under radiation settings.