Objective To investigate clinicians'practice and opinions on sedation therapy in end-stage patients at Peking Union Medical College Hospital.Methods From August,2022 to April,2023,an online questionnaire survey was conducted among clinicians involved in end-stage patient management.Results A total of 205 questionnaires were distributed,with an effective response rate of 56.1% .Among the clinicians,55.7% of them had experience of applying sedation therapy in end-stage patients;85.2% of clinicians believed that se-dation could relieve the suffering of terminal patients from physical refractory symptoms;75.7% of clinicians considered that sedation therapy could be used to relieve agony from psycho-existential distress.Most clinicians had concerns about sedation therapy due to the lack of legal support(86.1% )and the lack of understanding of patients or families(59.1% ).The majority(90.4% )of clinicians were willing to receive training on palliative sedation.Conclusions A majority of clinicians agree that sedation therapy could relieve the physical distress and psycho-existential distress in end-stage patients.However,most clinicians have concerns about the application of sedation therapy due to the lack of legal support.It is necessary to enhance the training on palliative sedation.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

OBJECTIVE To compar e the volatile components of Cuscuta chinensis and its processed products ，and to conduct principal component analysis （PCA）. METHODS The volatile components of C. chinensis ，C. chinensis stir-frying with saltwater ， C. chinensis stir-frying with wine were identified by headspace solid phase microextraction combined with gas chromatography- mass spectrometry. The relative percentage of each component was calculated by area normalization method. The PCA was conducted by using SPSS 21.0 software. RESULTS A total of 117 compounds were identified from C. chinensis ，C. chinensis stir-frying with saltwater and C. chinensis stir-frying with wine ，of which 68 compounds were identified from C. chinensis （relative percentage of 92.41％），such as phytone ，2-methoxy-3-（2-propenl）phenol，n-pentadecane，β-caryophyllene. Sixty compounds （relative percentage of 89.41％） were identified from C. chinensis stir-frying with saltwater ，such as maltol ，2，3-dihydro- benzofuran，4-vinyl-2-methoxyphenol. Fifty-eight compounds （relative percentage of 87.02％）were identified from C. chinensis stir-frying with wine ，such as phenylethanol ，β-caryophyllene，macrocarehe D. There were 24 common components in the three ， and relative percentage of them were 38.56％，30.61％，33.07％，respectively. After processing ，there were 49 new components ， such as furfural ，n-hexanoic acid ，caryophyllene oxide. The results of PCA showed that the cumulative contribution rate of the former two principal components was 100％ ；comprehensive score of volatile components of C. chinensis was the highest ， followed by C. chinensis stir-frying with wine and C. chinensis stir-frying with saltwater. CONCLUSIONS The quality of volatile components in C. chinensis is good ；the volatile components in processed products are more than those in C. chinensis .

Objective:To explore the anatomical and clinical effects of lateral-perineal approach in treating the fracture of inferior ramus of pubis-ischium ramus.Methods:The lateral approach of the perineum was simulated on 10 side of 5 intact wet adult cadavers to determine the surface symbols of incision design and to expose the operative field of the approach and to observe the anatomical characteristics of the perineal branch of the posterior femoral cutaneous nerve and the incision of the surgical approach. Five points were selected at the incision of the approach. The distance (L 1-L 5) between each point and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve was measured. A total of 11 patients, including 5 males and 6 females with an average age of 41.55±14.32 years, ranging from 18 to 62 years, were treated by this approach in clinical practice. All patients had a reduction and fixation to the fracture of inferior ramus of pubis-ischium ramus. The operation duration, incision length, intraoperative blood loss and surgical complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The strength of the adductor was measured. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up. Results:Anatomical studies shown that the line between the two points. One point was 4 cm lateral to the level of the apex of the pubic arch. Another point was 4 cm from the ischial tubercle on the line from the ischial tuberosity to the point that 4 cm lateral to the level of the apex of the pubic arch was the axis of the approach lateral of the perineum. Anatomical studies showed that the lateral-perineal approach could expose the range from pubic symphysis to sciatic tuberculum. The distance between the points selected at the incision of the approach and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve: L 1 was 19.40±1.17 mm, ranging from 18 to 21 mm; L 2 was 16.60±2.76 mm, ranging from 10 to 20 mm; L 3 was 18.30±1.89 mm, ranging from 16 to 21 mm; L 4 was 19.20±1.93 mm, ranging from 16 to 22 mm; L 5 was 14.70±1.83 mm, ranging from 13 to 18 mm. All patients were followed up for 17.91±4.09 months, ranging from 13 to 26 months. The incision length was 8.18±0.98 cm, ranging from 7 to 10 cm. The operation duration was 59.64±12.17 min, ranging from 43 to 85 min. The intraoperative blood loss was 100 ml, ranging from 50 to 130 ml. All incisions were healed in all patients. The fractures were healed in 13.36±2.06 weeks, ranging from 10 to 16 weeks. According to Matta radiographic criteria, the quality of fracture reduction was excellent in 6 cases, good in 4 cases and fair in 1 case. At the last follow-up, the adductor muscle strength reached grade 4 in 4 patients and grade 5 in 7 patients. Furthermore, according to the Majeed Pelvic Score, the score of every patient was 86.55±9.59, ranging from 66 to 100, and 8 cases were excellent, 3 cases were good at the last follow-up. The heterotopic ossification occurred in 2 patients, the pain during intercourse occurred in 2 patients. No patient had sensory disturbance or pain in the perineal area. Conclusion:A certain safe distance is between the lateral to the perineum and the perineal branch of the posterior femoral cutaneous nerve with limited risk of injuring posterior femoral cutaneous nerve via the lateral approach of the perineum. The advantages in treating the fracture of inferior ramus of pubis-ischium ramus by this approach have concealed incision, short operation duration and less bleeding with satisfied short-term clinical effects.

Objective:Using high-throughput transcriptome sequencing technology to study the differentially expressed genes (DEGs) and related regulatory signaling pathways involved in H1N1 influenza virus infection in primary human retinal pigment epithelial (RPE) cells.Methods:Primary human RPE cells were infected with H1N1 influenza virus for 2 h or 12 h, respectively. Taking H1N1 uninfected cells as a control group, total RNA was extracted, a library was constructed, and transcriptome sequencing was performed. DEGs were screened by DESeq2 software, and DEGs were analyzed by gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway.Results:Compared with the control group, a total of 1830 DEGs were identified in the 2 h H1N1 influenza virus infection group, and 2847 DEGs were identified in the 12 h infection group; 1213 DEGs were identified in the H1N1 influenza virus infection kinetics process (2 h: 12 h). The GO functional annotation analysis of DEGs in the H1N1 influenza virus infection group for 12 h showed that DEGs widely exist in a variety of cellular components and participate in various biological processes such as cellular processes, biological regulation, and metabolic processes. KEGG pathway enrichment analysis showed that DEGs were mainly enriched in the PI3K-Akt signaling pathway, MAPK signaling pathway, cancer MicroRNAs, and cytokine-cytokine receptor interactions in the 2 h H1N1 influenza virus infection group; in the 12 h H1N1 influenza virus infection group, DEGs were mainly enriched in PI3K-Akt signaling pathway, cancer MicroRNAs, AGE-RAGE signaling pathway and immune-inflammatory pathways; during the kinetics of H1N1 influenza virus infection (2 h: 12 h), DEGs were mainly enriched in cytokine-cytokine receptor interaction, TGF-β signaling pathway.Conclusions:Infection with H1N1 influenza virus leads to significant changes in the transcriptome of RPE cells. These data provide scientific reference for elucidating the molecular mechanism of eye infection by respiratory viruses such as influenza virus.

Objective: To investigate the association between the family relationship of college students in Shanghai and the psychological stress response under the COVID-19 epidemic. Methods: Totally 904 college students from universities in Shanghai were investigated with questionnaire of FACESII-CV and IES-R. Results: The score of family relationship intimacy was(61.32±6.29), the score of family relationship adaptability was(43.30±5.83), the score of psychological stress was(30.77±7.33), the score of internal dimension，avoidance, high alertness were(11.63±2.53)(11.69±2.64)(7.45±2.33). About 77.5%(701) and 17.3%(156) of college students showed mild and moderate stress reactions. Three dimensional scores of psychological stress response and two dimensional scores of family relationship differed significantly by age, grade, family income and parental education(P<0.01). Moreover, family relationship intimacy and adaptability scores showed negative associations with intrusive symptoms, avoidance symptoms, and high alert symptom dimension scores(P<0.05). Conclusion College students showed mild psychological stress under the COVID 19 epidemic with intrusion and avoidance symptoms as the most common. The intimacy and adaptability of family relationships are negatively associated with psychological stress response of college students under the epidemic. High-quality family relationships can reduce the psychological impact and adverse effects of the new crown epidemic on college students.

The ZNF804A variant rs1344706 has consistently been associated with schizophrenia and plays a role in hippocampal-prefrontal functional connectivity during working memory. Whether the effect exists in the resting state and in patients with schizophrenia remains unclear. In this study, we investigated the ZNF804A polymorphism at rs1344706 in 92 schizophrenic patients and 99 healthy controls of Han Chinese descent, and used resting-state functional magnetic resonance imaging to explore the functional connectivity in the participants. We found a significant main effect of genotype on the resting-state functional connectivity (RSFC) between the hippocampus and the dorsolateral prefrontal cortex (DLPFC) in both schizophrenic patients and healthy controls. The homozygous ZNF804A rs1344706 genotype (AA) conferred a high risk of schizophrenia, and also exhibited significantly decreased resting functional coupling between the left hippocampus and right DLPFC (F(2,165) = 13.43, P < 0.001). The RSFC strength was also correlated with cognitive performance and the severity of psychosis in schizophrenia. The current findings identified the neural impact of the ZNF804A rs1344706 on hippocampal-prefrontal RSFC associated with schizophrenia.
Adult ; Analysis of Variance ; Female ; Functional Laterality ; genetics ; Genotype ; Hippocampus ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Kruppel-Like Transcription Factors ; genetics ; Magnetic Resonance Imaging ; Male ; Neural Pathways ; diagnostic imaging ; Neuropsychological Tests ; Oxygen ; blood ; Polymorphism, Single Nucleotide ; genetics ; Prefrontal Cortex ; diagnostic imaging ; Psychiatric Status Rating Scales ; Schizophrenia ; diagnostic imaging ; genetics ; physiopathology ; Severity of Illness Index ; Young Adult

Objective To investigate if anesthetic sensitivity to propofol will be restored after biliary decompression.Methods Twenty-four adult male SD rats were randomly assigned into 3 groups:sham group (group S),irreversible obstructive jaundice group (group Ⅰ) and reversible obstructive jaundice group (group R).The serum total bilirubin (TBL) and total bile acid (TBA) concentratins were detected in the rat blood samples collected from the caudal vein before and after the operation,3,7,14,21 d respectively.Propofol was administered to measure the time of loss of righting reflex and recovery pre or 7th and 21th day post ligation.Results Serum TBL and TBA in group Ⅰ and serum TBA in group R were significantly higher than that in group S on 3rd,7th,14th,21th day post surgery(P＜0.05).Compared with group S,seum TBL in group R were significantly high on 3rd,7th,14th day post-surgery.Serm TBL and TBA in group R were significantly lower than group Ⅰ on 14th,21th day post-surgery (P＜0.05).Compared with group S,the time to loss of righting reflex in group I and group R were significantly shortened and the time to recovery were significantly increased on 7th day post-surgery (P＜0.05).Conclusion Obstructive jaundice could significantly potentiate the ability of propofol to induce a loss of righting reflex,and the increased anesthesia sensitivity will be restored after biliary decompression.

Objective To explore the effect of pitch in three-dimensional computed tomography (3DCT)on the gross tumor volume(GTV)and spatial position of solitary pulmonary lesion(SPL), and to evaluate the feasibility of high-pitch 3DCT simulation for SPL. Methods Twenty-two patients with peripheral lung cancer or metastatic SPL were divided into groups A and B according to the tumor location. All patients underwent spiral CT scans at different pitches(pitchCON=0.938, pitchS=0.438, and pitchB=1.188)during free breathing. All GTVSwere delineated by the same radiation oncologist using the same contouring protocol. GTVCONgenerated at pitchCON, GTVSgenerated at pitches, and GTVBgenerated at pitchB were compared in terms of volume and geometric position, and GTVSand GTVBwere registered to GTVCONgained at the conventional pitch. The Friedman M and Wilcoxon rank-rum test were used for comparison. Results The volumes of GTVCON, GTVS, and GTVBwere 11.58± 16.42 cm3, 11.63± 17.73 cm3, and 12.09± 17.46 cm3, respectively(P=0.11). There were no significant differences in the centroid position in x,y,and z directions between GTVCON,GTVS,and GTVB(Px=0.33,Py=0.81, Pz=0.39). The same result was found in group B (Px=0.92,Py=0.05, Pz=0.37). The matching index(MI)between GTVSand GTVCONwas related to the tumor location,so was the MI between GTVBand GTVCON. Conclusions The pitch in 3DCT simulation has no significant effect on the GTV and spatial position of SPL. Increasing CT pitch appropriately can improve the scanning speed and shorten the duration of 3DCT simulation,so high-pitch 3DCT simulation is feasible for SPL.