Objective To investigate the influence of oral midazolam on postoperative behavioral changes(NPOBCs)in preschool children undergoing laparoscopic inguinal hernia sac ligation.Methods A total of 197 preschool children,118 males and 79 females,aged 1-6 years,BMI 14.0-24.5 kg/m2,ASA physical status Ⅰ or Ⅱ,who undergoing laparoscopic inguinal hernia sac ligation from July 2022 to A-pril 2023 were selected.The children were divided into two groups by random number table method:the oral midazolam group(group M,n=100)and the oral saline group(group C,n=97).In the observation room,group M received an oral dose of 0.5 mg/kg midazolam while group C received an oral dose of 5％sa-line 0.25 ml/kg before being accompanied by a clown doctor to the operating room after 30 minutes.Modi-fied Yale preoperative anxiety scale(m-YPAS)scores before entering the observation room and before ente-ring the operating room,as well as induction compliance checklist(ICC)scores before anesthesia induction were recorded.Postoperatively,FLACC and PAED scores were recorded at immediately,6,and 24 hours after surgery along with occurrences of postoperative nausea and vomiting and hypoxemia.Family members of the children were followed up at 1 day,7,14,and 30 days after discharge using PHBQ to record NPOBCs occurrence in children.Results Compared with group C,m-YPAS score,ICC score before anesthesia in-duction,PAED score immediately after surgery,and the incidence of NPOBCs 1 day,7,14,and 30 days after surgery were significantly reduced in group M(P＜0.05).There were no significant differences in YPAS scores before entering the observation room,6 and 24 hours PAED scores,incidence of postoperative nausea and vomiting,hypoxemia between the two groups.Conclusion Preoperative oral administration of midazolam to children undergoing laparoscopic inguinal hernia sac ligation can effectively alleviate periopera-tive anxiety and reduce the incidence of NPOBCs.It does not increase the risk of delayed awakening or post-operative adverse reactions in children.

As known, the benefits of photothermal therapy (PTT) are greatly limited by the heat tolerance of cancer cells resulting from overexpressed heat shock proteins (HSPs). Then HSPs further trigger the formation of stress granules (SGs) that regulate protein expression and cell viability under various stress conditions. Inhibition of SG formation can sensitize tumor cells to PTT. Herein, we developed PEGylated pH (low) insertion peptide (PEG-pHLIP)-modified hollow copper sulfide nanoparticles (HCuS NPs) encapsulating the SG inhibitor ISRIB, with the phase-change material lauric acid (LA) as a gate-keeper, to construct a pH-driven and NIR photo-responsive controlled smart drug delivery system (IL@H-PP). The nanomedicine could specifically target slightly acidic tumor sites. Upon irradiation, IL@H-PP realized PTT, and the light-controlled release of ISRIB could effectively inhibit the formation of PTT-induced SG to sensitize tumor cells to PTT, thereby increasing the antitumor effect and inducing potent immunogenic cell death (ICD). Moreover, IL@H-PP could promote the production of reactive oxygen species (ROS) by tumor-associated macrophages (TAMs), repolarizing them towards the M1 phenotype and remodeling the immunosuppressive microenvironment. In vitro/vivo results revealed the potential of PTT combined with SG inhibitors, which provides a new paradigm for antitumor and anti-metastases.

Community health institutions have entered a new development stage of featured specialty construction. After 12 years of development, rehabilitation medicine now is the featured specialty of Fenglin Community Health Service Center. This article presents the train of thought and key points of specialty construction in primary care institutions based on the Fenglin′s experience. The positioning of featured specialty should be based on the community. The construction process should include 7 elements, namely, the standard operation procedure(SOP)of service system construction, the detailed publicity and implementation of the collaboration of specialists, prevention and control knowledge promotion for general practitioners, prevention and control knowledge education for community residents, service list, clinical efficacy evaluation, and clinical database. In the later iterations, the head of the department should always focus on the service system construction SOP and clinical database construction, and the rest parts can be assigned to the relevant team members.

The construction of featured specialties is the current development strategy of community health service institutions to improve the service scope and to meet the health needs of residents. The rehabilitation medicine has undergone 12 years of development and become a relatively mature featured specialty in Fenglin Community Health Service Center. Based on the Fenglin′s experience, this article discusses the development status and restriction bottlenecks of general practice, and the development status and trend of rehabilitation medicine in the community; and also explores the integrated development model of community-featured specialty with general practice.

Objective:To investigate the effects of human umbilical cord mesenchymal stem cell-derived exosome (hucMSC-ex) on proliferation, migration, apoptosis and autophagy in ischemia-anoxia neurons, and to provide a theoretical study for clinical research on stroke.Methods:Primary glial cells were cultured and OGD model was established. Then, these cells were incubated with huMSC-exosome. The inhibition rate of proliferation was detected by MTT assay. Apoptosis was observed by flow cytometry. The expressions of apoptosis related proteins were confirmed by RT-PCR and Western blot. The expressions of autophagy related proteins and PI3K/Akt signal were observed by Western blot. The data were analyzed using SPSS 17.0 software, multiple-group comparisons were performed using one-way ANOVA, and SNK- q test was used for pairwise comparison between groups. Results:MTT assay showed that OGD could inhibit cell proliferation of primary glial cells. After incubation with hucMSC-ex for 2 h, the inhibition rate of cell proliferation was lower than that of the control. The flow cytometry technology showed that hucMSC-ex reduced cell apoptosis. The cell migration experiments showed that OGD reduced cell migration capacity, but cell migration increased after exosomal incubation. RT-PCT and Western blot showed that OGD induced autophagy and apoptosis, hucMSC-ex activated PI3K/Akt signaling pathway, inhibited the expression of Bax and Caspase-3 (both P<0.05), and promoted the expression of Bcl-2 ( P<0.05). hucMSC-ex inhibited the expression of Beclin-1, Atg3 and LC3-Ⅱ(al l P<0.01). Conclusions:huMSC-exosome promote the proliferation and migration in ischemia-anoxia-injured neurons and inhibit the apoptosis and autophagy. The mechanism that hucMSC-ex repaired the injured nerve cells might be associated with PI3K/Akt signaling pathway.

Objective:To study the clinical efficacy of nanocrystalline needles combined with 5% minoxidil tincture in the treatment of androgenetic alopecia of male.Methods:A total of 60 patients with androgenetic alopecia were randomly divided into treatment group and control group, with 30 patients in each group. The control group was treated with 5% minoxidil tincture 2 times a day. On the basis of the control group, the treatment group was treated with nanocrystalline needles combined with 5% minoxidil tincture for 10 minutes 2 times a week. The clinical effects of different treatments were compared after six months.Results:There was a significant difference in overall response rate between the treatment group and the control group (80.00% vs. 53.30%, P<0.05). The improvement of the each clinical features of image by dermoscopy in patients with hair loss disease included more than 20% of hair diameter diminish, vellus hair increased, partly acomia and yellow dot sign had a significant difference between the treatment group and the control group ( P<0.05). Conclusion:Nanocrystalline needles combined with 5% minoxidil tincture has a good clinical effect in the treatment of androgenetic alopecia.

Objective:To investigate the risk factors on androgenetic alopecia (AGA) of primary healthcare staffs.Methods:Primary healthcare staffs were investigated by a questionnaire.Results:A total of 934 healthcare staffs (550 males and 384 females) were surveyed, of which 238 cases were diagnosed as AGA. 68.8% of AGA patients had poor mental health self-assessment; 52.94% of AGA patients had a family history; the prevalence in the people who usually had the night shift was 26.03%, which was higher than that in the people who had no night shift.Conclusions:The prevalence of AGA in healthcare staffs is higher than the national average, which might be related to working pressure, mental status, night shifts, genetic and alcohol drinking.

Objective: To observe the species distribution, clinical features, efficacy and safety of anti-fungus therapy in advanced elderly patients with fungemia. Methods: Clinical data of patients aged 70 years and over with fungemia admitted into geriatric intensive care unit (GICU) of our hospital from Nov. 2012 to Nov. 2017 were retrospectively analyzed. The specie distribution, liver toxicity, differences in biochemical liver and renal functions before and after 28 days of treatment between the caspofungin group and the azole group (fluconazole plus voriconazole), and 28-d survival rate and its risk factors for death were analyzed. Results: A total of 72 patients were enrolled, with a median age of 85.5 years (83, 90), a median score of Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) of 25.5 (20.3, 31.5), a median score of Sequential Organ Failure Assessment (SOFA) 7 (4.0, 9.8). There were 33 patients (45.8%) with diabetes, 2 patients (2.8%) with hematological diseases, 44 patients (61.1%) with solid tumors and 18 patients (25.0%) with renal insufficiency. Thirty patients (41.7%) needed mechanical ventilation. The detection rate of Candida parapsilosis was 73.6% (53 cases), Candida famata 9.7% (7 cases), Candida tropicalis 5.6% (4 cases), Candida albicans 2.8% (2 cases), Candida glabrata 2.8% (2 cases) and others 5.6% (4 cases). The incidence rate of total liver toxicity was 23.6% after anti-fungus treatment. After 28 days of treatment, 29 patients survived in the caspofungin group (n=42) and 16 patients survived in the azole group (n=30). There were no significant differences in liver and renal function between the two groups before and after treatment. Logistic regression analysis showed that solid tumors (OR: 19.904, 95%CI: 1.944-203.808) and the median APACHE Ⅱ score were the independent risk factors for 28-day death in advanced patients with fungemia. Conclusions Fungemia is becoming more and more prominent in the GICU, which requires clinician’s constant attention in order to provide more basis for the treatment of fungemia in elderly patients.

Objective To observe the clinical features of senile patients suffering from fungemia of Candida parapsilosis, and the effect and safety of antifungal therapy in treatment of this disease in geriatric intensive care unit (GICU). Methods The clinical data of patients with fungi positive either in peripheral blood culture or catheter culture admitted to the GICU of Tianjin Medical University General Hospital from November 2012 to June 2015 were retrospectively analyzed, of them 45 cases were of infection of Candida parapsilosis (parapsilosis group) and 15 cases infection of non-Candida parapsilosis (non-parapsilosis group). The clinical features of the two groups were collected, such as sex, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, timing of antifungal therapy, number of patients mechanical ventilation, concomitant disease, catheter-related infection, method of catheter-indwelling, levels of creatinine (Cr), hemoglobin (Hb), platelet count (PLT), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), etc.; the differences in above indicators were compared between the two groups; multifactor Cox-regression-analysis was used to analyze the risk factors that could affect the patients' prognosis; the patients' survival rates on 7, 14 and 28-day were calculated and compared between the two groups, and the therapeutic effects of different anti-fungal drugs on patients' survival rates and liver function damage were recorded and compared. Results The non-parapsilosis group had a higher rate in mechanical ventilation than parapsilosis group [73.3% (11/15) vs. 33.3% (15/45), P < 0.05], and in the comparisons of other clinical features, there were no statistical significant differences between the two groups (all P > 0.05). There were no statistical significant differences in survival rates in the duration of 7, 14 and 28 days between the two groups[7 days: 82.2% (37/45) vs. 66.7% (10/15), 14 days: 75.6% (34/45) vs. 60.0% (9/15), 28 days: 66.7% (30/45) vs. 46.7% (7/15), all P > 0.05]. When the patients in parapsilosis group treated with echinocinomycin were compared with those treated with azolol, no statistical significant differences were found between the 2 types of therapy in the survival rates in the duration of 7, 14, and 28 days after treatment [7 days: 100.0% (23/23) vs. 82.4% (14/17), 14 days: 91.3% (21/23) vs. 76.5% (13/17), 28 days: 78.3% (18/23) vs. 70.6% (12/17), all P > 0.05]. Multifactor Cox-regression-analyses showed:diabetes [odds ratio (OR) = 0.268, 95% confidence interval (95%CI) = 0.077 - 0.928, P = 0.038), infection of Candida parapsilosis (OR = 0.260, 95%CI = 0.072 - 0.946, P = 0.041), APACHE Ⅱ score (OR = 1.241, 95%CI = 1.051 - 1.466, P = 0.011) and SOFA score (OR = 1.405, 95%CI = 1.005 - 1.966, P = 0.047) were the risk factors affecting the prognosis of the patients. When the patients in parapsilosis group treated with echinocinomycin were compared with those treated with azolol, there were no statistical significant differences in incidences of aggravation of liver damage and newly developed liver damage (aggravation of liver damage: 18.8% vs. 21.0%, newly developed liver damage: 6.2% vs. 10.5%, both P > 0.05). Conclusion The patients with fungemia in GICU are mainly the infection of Candida parapsilosis, and diabetes, infection of parapsilosis, APACHE Ⅱ score and SOFA score are the risk factors affecting the prognosis of the patients.

Objective To analyze the effect of Ziniliangxue compound in treating psoriasis vulgaris patients with clinical efficacy and serum IL-8, IL-17, IL-23.MethodsIn the control group were treated with routine treatment, in the experimental group were treated with Ziniliangxue compound treatment, effect of serum IL-8, IL-17, IL-23 and in the clinical effect of the two groups were compared.ResultsIn the observation group of patients with clinical curative effect total have efficiency (88.57%) was significantly higher than that of control group in patients with clinical efficacy in patients with total efficiency (65.71%), the difference has statistical significance (P<0.05);after treatment, the observe of serum IL-8(14.211±2.314), IL-17(12.643±1.232) and IL-23(12.856±1.321)were significantly better than the control of serum IL-8(17.653±2.512), IL-17(19.432±1.685) and IL-23(19.786±1.754), the difference has statistical significance (P< 0.05).ConclusionZiniliangxue compound on psoriasis vulgaris clinical treatment effect and can effectively reduce the patients serum IL-8, IL-17, IL-23 levels.It is worthy of clinical application.