Objective:To evaluate the efficacy of perioperative analgesia with esketamine in the patients undergoing thoracoscopic surgery.Methods:A total of 90 patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into 3 groups ( n=30 each) by a random number table method: control group (C group) and different doses of esketamine groups (S 1 group, S 2 group). Before induction of anesthesia, esketamine 0.1 and 0.2 mg/kg were intravenously injected in S 1 group and S 2 group, respectively, while esketamine was not given in group C. Anesthesia was routinely induced in all the three groups. During anesthesia maintenance, esketamine 0.1 and 0.2 mg·kg -1·h -1 were intravenously infused in group S 1 and group S 2, respectively, and the remaining drugs used for anesthesia maintenance were the same in the three groups. Patient-controlled intravenous analgesia (PCIA) was used after operation, and PCIA solution contained sufentanil 2 μg/kg in group C, and esketamine 1 mg/kg was mixed on the basis as previously described in S 1 and S 2 groups. Aminotriol ketorolac was given as rescue analgesia to maintain numeric rating scale score at rest ≤3. The total amount of propofol and remifentanil during operation, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, and requirement for rescue analgesia were recorded. The occurrence of adverse reactions such as respiratory depression, nausea and vomiting, dizziness and salivation, and emergence time were recorded after surgery. The serum interleukin-6 (IL-6) concentration was measured by enzyme-linked immunosorbent assay at 30 min before and after surgery, and the malondialdehyde (MDA) concentration in serum was measured by thiobarbituric acid colorimetric analysis. The postoperative recovery was assessed using the 50-item quality of recovery scale at 1 and 2 days after surgery. The development of chronic pain was followed up by telephone within 1-3 months after surgery. Results:Compared with group C, the intraoperative consumption of remifentanil, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, rate of rescue analgesia, and postoperative serum IL-6 concentration were significantly decreased, and the 50-item quality of recovery scale score was increased in S 1 and S 2 groups, and the postoperative serum MDA concentration was significantly decreased in group S 2 ( P<0.05). Compared with group S 1, the consumption of intraoperative remifentanil was significantly decreased ( P<0.05), and no significant change was found in postoperative serum IL-6 and MDA concentrations in group S 2 ( P>0.05). Compared with group S 2, the postoperative emergence time was significantly shortened in S 1 and C groups ( P<0.05). There was no statistically significant difference in the intraoperative consumption of propofol, incidence of adverse effects and incidence of chronic pain among the three groups ( P>0.05). Conclusions:Esketamine for perioperative analgesia (dose before anesthesia induction 0.1 mg/kg, dose for maintenance of anesthesia 0.1 mg·kg -1·h -1, dose for postoperative PCIA 1 mg/kg) can raise the quality of analgesia and improve the quality of early postoperative recovery in the patients undergoing thoracoscopic lobectomy.

Objective:To explore the effectiveness of stratified teaching in improving the efficiency and quality of clinical teaching in the standardized training of residents in the department of prosthodontics.Methods:We enrolled a total of 297 participants who accomplished the standardized residency training in the Department of Prosthodontics of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to May 2023. They were divided into stratified group (141 trainees from September 2021 to May 2023) and control group (156 trainees from January 2020 to August 2021). The stratified group received stratified teaching at three levels according to the trainees' major, training stage, and identity category, and the teaching theme and teaching method were set according to teaching objectives. The control group used a traditional teaching mode. The two groups were compared in terms of medical history taking, oral examination, case analysis, skill practice, and case report scores. SPSSAU was used to perform the t test and chi-squared test for data analysis. Results:The stratified group showed better performance in the final assessment: the case analysis score of the first-level trainees was significantly higher than that of the control group (85.72±4.14 vs. 83.00±6.38, P=0.003); the second-level trainees had a higher medical history taking score than the control group (88.20±7.14 vs. 85.38±5.63); the proportions of trainees rated as excellent in case report in the stratified group (the first level, 54.02%; the second level, 52.63%; the third level, 75.00%) were higher than those in the control group (the first level, 42.65%; the second level, 45.33%; the third level, 46.15%). Conclusions:In standardized residency training, the stratified teaching method can effectively improve trainees' case analysis, medical history taking, and case report abilities, and the effects in improving the skill practice level of trainees majoring in prosthodontics need to be further explored.

Objective:To study the effect of eye-open/closed state on 40 Hz auditory steady state response (ASSR) in first-degree relatives of schizophrenia.Methods:Thirty-eight first-degree relatives of schizophrenic patients treated in Shanghai Mental Health Center from March 2010 to October 2011 were selected, and 31 healthy controls were recruited in the same period. All subjects were assessed with schizotypal personality questionnaire (SPQ). The 40 Hz EEG ASSR signals lasting for 3 min under open and closed eyes of all subjects were sequentially collected.Event-related spectrum perturbation (ERSP) and intertribal phase coherence (ITC) were used to evaluate ASSR. SPSS 22.0 software was used for statistical analysis. Two-way analysis of variance was used to compare ITC and ERSP between the two groups under open and closed eyes. Spearman correlation analysis was used to analyze the correlation between each measurement.Results:ITC in group main effect and group×the eye open/closed interaction effect were not significant (both P>0.05), but the main effect of eye-open and eye-closed was significant ( F(1, 67)=10.61, P=0.002). In the healthy control group, the ITC in eye-open state was significantly higher than that in eye-closed state ( P=0.014), and in the first-degree relatives group, the ITC in eye-open state was higher than that in eyes closed state ( P=0.039). ERSP in the main effect of eye-open and eye-closed ( F(1, 67)=0.195, P=0.660), group main effect ( F(1, 67) =0.627, P=0.431), group × the eye-open/closed interaction effect ( F(1, 67)= 1.034, P=0.313) was not significant. Spearman correlation analysis showed that there was no correlation between ERSP (eye open: r=-0.260, P=0.210; eye closed: r=-0.318, P=0.122), ITC (eye open: r=-0.248, P=0.232; eye closed: r=-0.260, P=0.209) and SPQ score in the healthy control group. There was also no correlation between ERSP (eye open: r=-0.387, P=0.226; eye closed: r=-0.363, P=0.238) or ITC (eye open: r=0.126, P=0.485; eye closed: r=0.096, P=0.595) and SPQ score in the first-degree relatives group of schizophrenia. Conclusion:The regulation pattern of 40 Hz ASSR in schizophrenic first-degree relatives is not significantly impaired in the eye-open/closed state, suggesting that the open/closed regulation pattern of 40 Hz ASSR may not be a potential marker for predicting the genetic high-risk prognosis of schizophrenia.

With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.

Most patients with schizophrenia have experienced a period called clinical high risk (CHR) preceding the first episode of psychosis.Early identification of CHR and timely medication or psychological intervention may reduce conversion to psychosis.By exploring biomarkers that predict the onset of psychosis and improving the accuracy of predicting the prognosis of CHR state, it is possible to take a more active intervention measure.As a fast and economical neurophysiological test, event-related potential (ERP) may reflect the perception process, pre-attention process, and attention distribution of the cognitive processes.And it holds promise for becoming objective indices in predicting the clinical outcomes of the CHR patients.This paper reviews the current studies on different ERP components in the CHR population and their performance as predictors of clinical outcomes.The results show that among ERP abnormalities, P300 and MMN amplitude reductions appear to be more reliable than others, which may indicate that distinct components reflect different stages of the disease.However, as a physiological index in the CHR group, aberrant ERP lacks certain specificity.The algorithm analysis combining different ERP components or combining components with symptoms may make the test more specific in the future.

Objective:To discuss the value of ultrasound in the diagnosis of pelvic lipomatosis and analyze the causes of misdiagnosis.Methods:A retrospective analysis of 68 cases of pelvic lipomatosis confirmed by operation or imaging in Peking Union Medical College Hospital from January 2000 to December 2018 was made to summarize the characteristics of ultrasonic manifestations.Results:Ultrasonographic findings were as follows: 6 cases (8.8%) had increased fat-like hyperecho in pelvic cavity; 60 cases (88.2%) had abnormal bladder; 42 cases (61.7%) had pyelectasis and 24 cases (35.3%) had ureterectasis. Of the 68 cases, 6 cases (8.8%) were correctly diagnosed; 54 cases (79.4%) were missed; 8 cases (11.8%) were misdiagnosed, including 7 cases (10.3%) of bladder tumor and 1 case (1.5%) of retroperitoneal giant mass.Conclusions:Pelvic lipomatosis has characteristic sonographic features.When urinary tract obstruction and bladder wall thickening are observed, pelvic lipomatosis should be considered. Bladder shape and existence of increasing fat-like hyperecho in the pelvis should be further scanned to reduce the misdiagnosis rate of pelvic lipomatosis.

Objective:To explore the effect of intervention of E-cadherin (E-cad) and B-lymphoma Moloney murine leukemia virus insertion region-1 (Bmi-1) mediated by transcription activator-like effector nuclease (TALEN) on the biological behaviors ofnasopharyngeal carcinoma cells.Methods:Multi-locus gene targeting vectors pUC-DS1-CMV-E-cad-2A-Neo-DS2 and pUC-DS1-Bmi-1 shRNA-Zeo-DS2 were constructed,and the E-cad and Bmi-1 targeting vectors were transferred with TALEN plasmids to CNE-2 cells individually or simultaneously.The integration of target genes were detected by PCR,the expressions of E-cad and Bmi-1 were detected by Western blot.The changes of cell proliferation were detected by cell counting kit-8 (CCK-8) assay.T-he cell cycle and apoptosis were detected by flow cytometry.The cell migration and invasion were detected by Transwell assay.Results:The E-cad and Bmi-1 shRNA expression elements were successfully integrated into the genome of CNE-2 cells,the protein expression level of E-cad was up-regulated,and the protein expression level of Bmi-1 was down-regulated.The intervention of E-cad and Bmi-1 didn't affect the proliferation,cell cycle and apoptosis of CNE-2 cells,but it significantly inhibited the migration and invasion ability of CNE-2 cells.Furthermore,the intervention of E-cad and Bmi-1 together significantly inhibited the migration ability of nasopharyngeal carcinoma cells compared with the intervention of E-cad or Bmi-1 alone (all P＜0.01).Conclusion:The joint intervention of E-cad and Bmi-1 mediated by TALEN can effectively inhibit the migration and invasion of nasopharyngeal carcinoma cells in vitro,which may lay the preliminary experimental basis for gene therapy of human cancer.

Objective To investigate the characteristics of auditory P300 amplitude and latency and cognition in patients with clinical high-risk of psychosis (CHR). Method Thirty six CHR (study group) and thirty five healthy con?trols (control group) were included. Oddball paradigm and MATRICS Consensus Cognitive Battery (MCCB) were used to record auditory P300 and to evaluate the cognition, respectively. The structured interview for psychosis-risk syndromes (SIPS) was used to evaluate the clinic symptoms of patients. Result The cognition of CHR was significantly lower than healthy controls in information processing, attention/vigilance, working memory, verbal learning, visual learning, reason?ing and problem solving and social cognition (P<0.01). The study group showed decreased amplitude in Fz, Cz and Pz and delayed latency in Pz (P<0.05). P300 latency of CHR in Fz positively correlated with positive score of SOPS (r=0.544, P=0.001), while P300 amplitude positively correlated with verbal fluency (r=0.339,P=0.043). Conclusion Cogni?tion and P300 is abnormal in CHR. The correlation between P300 and clinical symptoms, cognitive dysfunction reminds that we should put more attention on the role of P300 in CHR subjects.

Objective To establish a fluorescent quantitative polymerase chain reaction method for quantifying the ICP4 gene expression of herpes simplex virus type 2(HSV2).Methods According to the HSV2 ICP4 gene sequence,we designed and synthesized PCR primer.The purified PCR product was sequenced after connecting with pMD-18 T plasmid.According to the sequence assay results,the primer and probe of fluorescent quantitative PCR was designed and synthesized.Standard recombinant plasmid extracted from the positive bacteriumclone was used as standard substance.The plasmid as standard substance was diluted for 10 times,then PCR reaction proceeded.The sensitivity and dependability of the real-time fluorescent quantitative PCR were analyzed.Results The sequence result indicated that there was non-sense mutation of A-G and T-C.And the detection sensitivity was 101 copy.The Ct value were 14.275土0.137,17.988?0.162,22.081土0.259,25.957土0.345,29.565?0.203,33.269土0.287,37.737?0.698,respectively with 107~ 101 copies/?l.The coefficient of variability were 0.965%,0.902%,1.174%,1.329%,0.686%,0.862% and1.851%,respectively.There was a good linear function in statistics between the Ct value and the concentration gradient of standard plasmid DNA specimen.The coefficient of regression was 0.998.Conclusion The method of quantification of ICP4 gene of HSV2 with real-time fluorescent quantitative PCR is successfully established,and the method has good sensitivity and dependability,which can be used to quantitative detecting HSV2 ICP4.

Objective To explore the arterial origin and the artery distribution to the brachial plexus and its clinical significance. Methods 1)To observe the zonal pattern of arteries supplying brachial plexus in three fresh cadavers by means of modified lead-oxide and gelatin infusion and radiologic development. 2)To observe the arterial origin and distribution under microscope in 10 cadavers embalmed which were injected with red latex from the common carotid artery. Results The brachial plexus was supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other, according to their distribution feature, the supplied neural structures were divided into three zones. The first zone including the nerve roots from intervertebral foramina to the trunks and this region of the brachial plexus were supplied by the vertebral artery and the deep cervical artery. The second zone including the divisions and the main region of the cords of the brachial plexus were supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The dorsal scapular artery was usually thick and contributed to blood supply of a large region. There were 2.7 (1-5) direct branches of the subcalvian artery on the average which have relatively smaller diameter. The third zone including the distal portion of the cords and the terminal branches of the brachial plexus were supplied by direct branches of the axillary artery. The mean number of these branches was 3.4 (1-6). Conclusion The brachial plexus has plenty of vascular supply which can be divided into three zones. Every vasa nervorum tends to divide into a distal branch and a proximal branch shortly after they enter the brachial plexus. The branches from vasa nervorum communicates without changing their diameter which is called "real connection", and the blood supplied from the three zones can compensate each other, which provide a rich longitudinal blood supply to the brachial plexus. This study provides an anatomical basis for vascularized brachial plexus replacement.