Objective To investigate the correlation between the methylenetetrahydrofolate reductase(MTHFR)C677T polymorphism and disease in the course of Alzheimer's disease(AD),as well as whether whether it is af-fected by APOE gene.Methods A total of 74 AD patients,85 aMCI patients and 81 healthy controls(HC)were included.The levels of serum homocysteine(Hcy),folate,and vitamin B12,as well as the genotypes of MTHFR C677T and APOE,were determined.Logistic regression analysis was conducted to explore the relationship between MTHFR C677T polymorphism and the risk of AD and aMCI,as well as in different APOE ε4 subgroups.Results Compared with HC group,the serum Hcy levels in AD group and aMCI group were significantly higher(P＜0.001,P＜0.001),while serum folate levels in aMCI group was significantly lower(P=0.017).The serum fo-late level was significantly lower(P=0.038)in individuals with the MTHFR TT genotype compared to those with CC and CT genotypes,while the serum Hcy level was significantly higher(P=0.002).Regression analysis showed that the MTHFR TT genotype might increase the risk of aMCI in the subgroup of APOE e4 non-carriers(OR=3.670,95％CI=1.077-12.509,P=0.038),but not in APOE e4 carriers.Conclusion MTHFR C677T polymorphism plays an important role in Hcy metabolism,which leads to increased serum Hcy levels and decreased folate levels.In APOE ε4 non-carriers,the MTHFR TT genotype may increase the risk of aMCI.

Objective:To investigate the clinical characteristics of congenital esophageal atresia with gastric perforation, and to improve pediatricians′ understanding of this disease.Methods:The clinical data of five neonates with congenital esophageal atresia and gastric perforation treated in the neonatal intensive care unit of the Affiliated Hospital of Qingdao University from 2012 to 2022 were analyzed retrospectively.Results:Among the five neonates, four were boys and one was girl.The gestational age was 28 + 5 to 37 + 6 weeks, the birth weight was 1 100~2 350 g. All of them had dyspnea and feeding difficulties after birth.Gastric perforation occurred in three cases during invasive mechanical ventilation, one case during non-invasive ventilation, and one case during nasal catheter oxygen inhalation.Emergency primary gastric repair was performed, followed by secondary esophageal anastomosis.All the patients were cured and discharged from hospital. Conclusion:Gastric perforation is a rare complication of congenital esophageal atresia, which is more common in premature infants and low birth weight infants.Mechanical ventilation may promote the occurrence of gastric perforation.If gastric perforation is complicated, repair should be performed as soon as possible, and esophageal anastomosis surgery should be performed early after stability to improve the final outcome.

Objective:To investigate the clinical effects of different approaches of ultrasound-guided adductor canal block (ACB) in postoperative analgesia after total knee arthroplasty (TKA) and its impact on joint function recovery.Methods:Fifty-eight patients undergoing unilateral TKA at Nanjing First Hospital from March 2021 to March 2022 were randomly divided into two groups: group A (ultrasound-guided proximal ACB, n=29) and group B (ultrasound-guided distal ACB, n=29). Both groups received intravenous patient-controlled analgesia (PCIA) combined with ultrasound-guided ACB. The resting and exercise Visual Analog Scale (VAS) scores at various time points after surgery, the total amount of sufentanil used for PCIA, the effective compression times (P1) and actual compression times (P2) of PCIA, the analgesia satisfaction score, the number of additional tramadol analgesia cases, the quadriceps muscle strength and knee joint activity at various time points after surgery, and the complications were recorded for analysis. Results:The resting and exercise VAS scores at 4, 8, 12, 24, and 48 hours after surgery in the group B were lower than those in the group A (all P<0.05). The total amount of Sufentanil used for PCIA, P1 and P2, and the number of additional tramadol analgesia cases in the group B were less than those in the group A (all P<0.05). The analgesia satisfaction score in the group B was higher than that in the group A ( P<0.05). The quadriceps muscle strength at 24 hours after surgery and the knee joint activity at 24 and 48 hours after surgery in the group B were higher than those in the group A (all P<0.05). The incidence of nausea in the group B was lower than that in the group A ( P<0.05). Conclusions:Ultrasound-guided distal ACB is more effective in relieving postoperative pain after TKA, reducing the dosage of opioid drugs, improving quadriceps muscle strength and joint mobility, reducing the incidence of adverse reactions, and is conducive to the recovery of knee joint function.

Day surgery, as a new perioperative management model that is safe, efficient, and consumes a small amount of medical resources, has been widely recognized in recent years. With the requirements of China's new healthcare system reform and the promotion of national policies, there is a significant increase in hospitals carrying out day surgery, and they are about to enter a new stage of rapid development. Adequate preoperative evaluation of patients undergoing day surgery is an important link in improving perioperative care during day surgery. This article reviews the importance, location and personnel, methods, timing and content of day surgery preoperative evaluation, and current situation of day evaluation in China, in order to provide reference for clinical workers related to day surgery.

Objective:To retrieve, evaluate, and integrate the best evidence for preoperative evaluation and management of adult day surgery patients.Methods:The guidelines, evidence summary, systematic review, expert consensus and randomized controlled trial on preoperative evaluation and management of adult day surgery patients were systematically searched on Guidelines International Network, Chinese Clinical Guidelines Library, Clinical Practice Guideline of Canadian Medical Association, Scottish Intercollegiate Guidelines Network, Yimaitong, New Zealand Guidelines Group, China Ambulatory Surgery Alliance, National Institute for Health and Clinical Excellence, Chinese Medical Journal Network, Agency for Healthcare Research and Quality, UpToDate, Cochrane Library, Australian Joanna Briggs Institute Evidence-Based Healthcare Center Database, British Medical Journal (BMJ) Best Practice, PubMed, Web of Science, CINAHL, Elsevier, Embase, Medline, WanFang Data, China National Knowledge Infrastructure, China Biomedical Literature Database and other databases. After conducting methodological quality evaluation, evidence was extracted and integrated based on the theme. The search period was from the establishment of the database to May 15, 2023. Two researchers trained in evidence-based knowledge conducted a rigorous literature quality evaluation, evidence extraction, and integration of all included literature.Results:A total of 12 articles were included, including two guidelines, six evidence summaries, three expert consensus and one randomized controlled trial. A total of 24 pieces of evidence were collected from five aspects, including evaluation timing and evaluation method, evaluation personnel, evaluation location, evaluation content, education and training, and quality improvement.Conclusions:The best evidence for preoperative evaluation and management of adult day surgery patients provides evidence basis for clinical medical and nursing staff to conduct preoperative evaluation and management comprehensively and effectively.

Objective:To investigate the relationship between brain derived neurotrophic factor (BDNF) gene polymorphism and the change of grey matter volume (GMV) and fractional amplitude of low-frequency fluctuation (fALFF) in cerebral small vessel disease (CSVD) patients with subcortical ischemic depression (SID).Methods:Eighty-seven CSVD patients in the First Affiliated Hospital of Anhui Medical University were enrolled from July 2017 to November 2020 and divided into CSVD-SID group [Geriatric Depression Scale (GDS) score>10] and CSVD-non - depression group (CSVD-ND group, GDS score≤10) according to GDS. Both GMV and fALFF were calculated based on structural and functional magnetic resonance imaging data, and the interactions between SID diagnosis and BDNF gene on brain function and structure alteration were explored.Results:GMV was significantly increased in the posterior default network (pDMN; such as posterior cingulate gyrus/precuneus and middle temporal gyrus) in the CSVD-SID group compared with the CSVD-ND group. On GMV property, significant interactions between BDNF gene and SID were found in the cuneus ( F=25.50, P<0.001), precuneus lobe ( F=13.61, P<0.001) and cerebellum ( F=17.23, P<0.001). In the aspect of fALFF, the brain functional activity in the superior frontal gyrus was significantly increased in the CSVD-SID group compared with that in the CSVD-ND group (0.363±0.648 vs -0.427±0.514,cluster size=48 voxels, t=5.63, P<0.001). But there was no significant interaction between diagnosis and BDNF genotype on brain function. Conclusions:Both the GMV and fALFF were increased in CSVD-SID, mainly located in the pDMN and frontal lobe. Significant interaction was found between CSVD-SID and BDNF genotype on GMV.

Objective:To evaluate the efficacy of subomohyoid anterior suprascapular nerve block (SSNB) in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods:Sixty 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 Ⅰor Ⅱ, scheduled for elective arthroscopic shoulder surgery, were divided into 2 groups ( n=30 each) using a random number table method: SSNB group (S group) and interscalene brachial plexus block group (I group). Before induction, 0.375% ropivacaine hydrochloride 15 ml was injected between C 5-C 6 nerve roots in group I and around the anterior suprascapular nerve in group S under ultrasound guidance.Diaphragmatic excursion, occurrence and degree of diaphragmatic paralysis, decrease in SpO 2, dyspnea, Horner syndrome and sensory block in the C 5-T 1 dermatomes were assessed at 30 min after injection.The intraoperative consumption of remifentanil, extubation time, and length of post-anesthesia care unit stay were recorded.Quality of Recovery-15 score for patient′s satisfaction with analgesia, effective pressing frequency of analgesic pump, requirement for rescue analgesia, nausea and vomiting and nerve block-related complications within 24 h after surgery were recorded. Results:Compared with group I, the incidence of diaphragmatic paralysis was significantly decreased, the degree of diaphragmatic paralysis was reduced, diaphragmatic excursion was increased, the amplitude of decrease in SpO 2 was reduced, the incidence of dyspnea and Horner syndrome was decreased, extubation time was shortened ( P<0.05), and no significant change was found in the incidence of sensory block in the C 5-T 1 dermatomes, intraoperative consumption of remifentanil, effective pressing frequency of analgesic pump, requirement for rescue analgesia, score for patient′s satisfaction with analgesia, incidence of nausea and vomiting, length of post-anesthesia care unit stay, or Quality of Recovery-15 score in group S ( P>0.05). Conclusions:The subomohyoid anterior SSNB not only provides reliable perioperative analgesia, but also reduces the risk of diaphragmatic paralysis when used in the patients undergoing arthroscopic shoulder surgery with general anesthesia.

OBJECTIVE To investigate the allocation of antipsycho tics in regions with different economic levels in Shandong province，and to provide reference for strengthening the management of antipsychotics allocation and promoting the balance of regional allocation. METHODS The procurement information of the secondary and tertiary public medical institutions in Shandong province from 2016 to 2019 was collected from the Drug Centralized Bidding and Procurement Information Platform of Shandong Provincial Medical Institutions. The procurement varieties of antipsychotics ，allocation proportion and procurement cost per 10 000 people were analyzed in area with different economic levels in Shandong province. RESULTS From 2016 to 2019，there were 18 kinds of antipsychotics purchased by secondary and tertiary public medical institutions in Shandong province （9 kinds of first- and second-generation antipsychotics respectively ），and the average number of purchased varieties were 3.50-4.42. The average number of purchased varieties in undeveloped areas （3.59-4.48 kinds）were slightly higher than that in developed areas （3.41-4.36 kinds）. In these four years ，average allocation proportion of antipsychotics was 17.19％，and most of them showed a fluctuating increase （the average annual increase ranged 4.64％-38.34％）. The allocation proportion of second-generation antipsychotics was higher in developed areas than that in undeveloped areas. The purchasing cost per 10 000 people showed an upward trend of fluctuation ， ranging from 2.45 to 7 440.20 yuan. Among the 18 antipsychotics procured from 2016 to 2019，61.11％，61.11％，83.33％ and 72.22％ of them were procured by developed areas with higher procurement costs per 10 000 people than by undeveloped areas. The total procurement cost of essential medicine per 10，000 people in developed areas （11 382.99-39 650.90 yuan）was also higher than that in undeveloped areas （8 353.15-30 561.77 yuan）. CONCLUSIONS The allocation proportion of antipsychotics is low in Shandong province ，and the allocation proportion of second-generation antipsychotics in developed areas are higher than that in undeveloped areas.

Objective:To investigate the relationship between electrocardiographic (ECG) changes and prognosis of paraquat poisoning patients, so as to provide evidence for the condition assessment in paraquat poisoning patients.Methods:In January 2022, The clinical data of paraquat poisoning patients were retrospectively analyzed in the First Affiliated Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2021. The patients' basic information (age, sex, underlying disease, and occupation) and the ECG within 24 hours were collected, and the data were statistically analyzed by SPSS 22.0. One variable analysis and multivariable logistic regression analysis were used to analyze the risk factors related to prognosis determine in their ECG. The receiver operating characteristic (ROC) curve were used to evaluate the diagnostic value of ECG indexes in patients with paraquat poisoning.Results:A total of 145 patients with paraquat poisoning were finally enrolled in this study, there were 84 patients survived and 60 patients died. One variable analysis revealed that heart rate ( P=0.000) , QTc changes ( P=0.000) , and ST-T changes ( P=0.007) of ECG had statistically significant differences in the prognosis of paraquat poisoning patients between the survival group and the death group. Multifactorial logistic results showed that heart rate ( OR=1.059, 95% CI: 1.033~1.086) and QTc ( OR=1.015, 95% CI: 1.000~1.029) were independent risk factors for death diagnosis of patients with paraquat poisoning ( P<0.05) . ROC curve analysis revealed that the area under the cure (AUC) of the prediction model constructed based on heart rate and QTc was 0.832 (95% CI: 0.765~0.899) , with the best diagnostic efficacy. Conclusion:Heart rate, QTc and the prediction model constructed based on both can be used as prognostic indicators for the diagnosis of patients with paraquat poisoning, and which have reference value for clinical prognosis diagnosis.

Objective:To investigate the relationship between electrocardiographic (ECG) changes and prognosis of paraquat poisoning patients, so as to provide evidence for the condition assessment in paraquat poisoning patients.Methods:In January 2022, The clinical data of paraquat poisoning patients were retrospectively analyzed in the First Affiliated Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2021. The patients' basic information (age, sex, underlying disease, and occupation) and the ECG within 24 hours were collected, and the data were statistically analyzed by SPSS 22.0. One variable analysis and multivariable logistic regression analysis were used to analyze the risk factors related to prognosis determine in their ECG. The receiver operating characteristic (ROC) curve were used to evaluate the diagnostic value of ECG indexes in patients with paraquat poisoning.Results:A total of 145 patients with paraquat poisoning were finally enrolled in this study, there were 84 patients survived and 60 patients died. One variable analysis revealed that heart rate ( P=0.000) , QTc changes ( P=0.000) , and ST-T changes ( P=0.007) of ECG had statistically significant differences in the prognosis of paraquat poisoning patients between the survival group and the death group. Multifactorial logistic results showed that heart rate ( OR=1.059, 95% CI: 1.033~1.086) and QTc ( OR=1.015, 95% CI: 1.000~1.029) were independent risk factors for death diagnosis of patients with paraquat poisoning ( P<0.05) . ROC curve analysis revealed that the area under the cure (AUC) of the prediction model constructed based on heart rate and QTc was 0.832 (95% CI: 0.765~0.899) , with the best diagnostic efficacy. Conclusion:Heart rate, QTc and the prediction model constructed based on both can be used as prognostic indicators for the diagnosis of patients with paraquat poisoning, and which have reference value for clinical prognosis diagnosis.