Objective To investigate the impact of esketamine hydrochloride in combination with ultrasound-guided transverse thoracic muscle plane block on stress response and inflammatory levels in patients undergoing cardiac valve replacement under general anesthesia.Methods A total of 120 patients who underwent elective extra-corporeal circulation-supported median open heart valve replacement were selected and randomly assigned into four groups using the random number table method:general anesthesia alone(Group G),general anesthesia with intrave-nous administration of esketamine(Group E),general anesthesia with transverse thoracic plane block(Group T),and esketamine combined with transverse thoracic muscle plane block(Group ET);each group consisted of 30 cases.Patients in group E and group ET received a continuous infusion of esketamine hydrochloride injection at a rate of 0.2 mg/kg-1?h-1 until the completion of the surgical procedure,while patients in group G and group T received an equivalent volume of saline solution until the completion of the surgical procedure.After the induction of general anesthesia,patients in group T and group ET underwent ultrasound-guided bilateral transverse thoracic muscle plane block,while patients in group G and group E did not receive any specific intervention.All four groups received identical protocols for anesthesia induction and maintenance,with self-controlled intravenous analgesic pumps administered to all patients postoperatively.The following time points were recorded:1 day prior to surgery(T0),pre-induction of anesthesia(T1),1 minute post-tracheal intubation(T2),1 minute post-median sternotomy(T3),1 minute prior to initiation of cardiopulmonary circulation(T4),1 minute after cessation of cardiopulmonary circula-tion(T5),1 minute after completion of surgery(T6),1 day post-surgery(T7),2 days post-surgery(T8),and 3 days post-surgery(T9).Mean Arterial Pressure(MAP)and Heart Rate(HR)were continuously monitored from T1 to T6.The levels of blood glucose and lactate were measured and recorded at T1,T4 to T6.The levels of White Blood Cells(WBC)and C-Reactive Protein(CRP)were assessed at T0,as well as at T7 to T9.The occurrence of postoperative adverse reactions was documented in all four groups.Results(1)Comparison of hemodynamics among the four groups:Compared with group G,there was a significant decrease in MAP and HR at T3 in group T(P<0.05).At the T5 time point,MAP was lower in group ET compared to group E,while HR was higher in group ET compared to group T(P<0.05).(2)The lactate and blood glucose levels of the four patient groups after extracorporeal circulation transfer were higher than those at the T1 time point(P<0.05).Patients in group E had lower lactate values at the T5 time point and lower blood glucose values at the T6 time point compared to group G(P<0.05).Additionally,patients in group E exhibited lower lactate and blood glucose values at both the T5 and T6 time points compared to those in group T(P<0.05).(3)Compared to T0,the levels of white blood cells(WBC)and C-reactive protein(CRP)were increased in all four groups after surgery(P<0.05).At the T7 time point,the WBC levels in group E and group T were significantly lower than those in group G(P<0.05).Furthermore,compared to group E and group T,the level of WBC in group ET was significantly lower at T7,while the level of CRP was significantly lower at T8(P<0.05).(4)There were no significant differences observed in postoperative adverse reactions among the four groups(P>0.05).Conclusion Combining low-dose esketamine hydrochloride with transverse thoracic muscle plane block under general anesthesia during open heart valve replacement surgery can effectively stabilize the patient's hemodynamics,mitigate perioperative stress response and postoperative inflammation levels,thereby demonstrating significant clini-cal utility.

Thyroid Carcinoma, as one of the most common malignant tumors in the endocrine system and head and neck, has a rising incidence rate in the world in recent years, which seriously affects human health. Thyroid carcinoma is often divided into 4 pathological types: papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Among them, papillary carcinoma is the most common with low malignancy and undifferentiated carcinoma is extremely rare with the highest malignancy. BRAFV600E mutation has been found to be closely related to the genesis, development mechanism and prognosis of thyroid carcinoma, and is a current molecular research focus. Clinically, BRAFV600E mutation is often considered as a molecular marker affecting the prognosis of thyroid carcinoma. In this paper, the relevant literature in recent years was reviewed, mainly from the aspects of BRAFV600E mutation and thyroid carcinoma diagnosis, clinicopathological features, guidance of clinical treatment decision, prognosis and so on, to evaluate the clinical application value of BRAFV600E mutation.

Objective To investigate the effects of sepsis bundles in China.Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intertive care unit(1/11/2006-31/12/2007)was carried out.The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001.Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continu-ous phases consisting of education,trial,and application phase.A cohort of 43 patients with matched disease his-tory(1/1/2004-31/10/2006)was enrolled as control group.The percentages for categorical variables and mean±SD for continuous variables were reported.Chi-Square test.unpaired Student's t -test.paired-samples t test,univariate and multivariate logistic regression models were used.Statistical significance was defined as P＜0.05.Results There were very little significant differences in basic characteristics of patients between the two groups.Compared with control group,the differences in serrum lactate,fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant(P values were 0.024,0.009,0.045,and 0.000,respectively).Compared with control group,the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant(P values were 0.033 and 0.041,respectively).Compared with control group,the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were sig-nificant(P values were 0.017 and 0.040,respectively).Compared with control group,the reduction in absolute mortality was 23.30% in bundles group(P=0.019).Conclusions Implementation of sepsis bundles con-tributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.

Objective To observe the development of hematopoietic stem cell and the apoptosis of ICM(intermediate cell mass) in folic acid deficient zebrafish embryos and investigate the mechanism by which folic acid deficiency induces abnormal hematopoiesis.Method The folic acid deficient zebrafish model was induced by both using the dihydrofolate reductase antagonism methotrexate(MTX) and knock-down dihydrofolate reductase gene.The development of embryos was observed under microscope.The blood cells were detected by O-dianisidine staining.Whole-mount in situ hybridization and real-time PCR were performed to examine the expression of FLK-1,GATA1and GATA2.Apoptosis in intermediate cell mass(ICM) was examined by TUNEL(terminal-deoxynucleotidyl transferase mediated nick end labeling) method.Results The abnormal developments of ICMs were observed both in MTX treated embryos and DHFR knock-down embryos.O-dianisidine staining revealed that folic acid deficiency resulted in the decreasing number of blood cells.In folic acid deficient embryos,the expression of FLK-1、GATA1and GATA2 was reduced and the apoptosis in ICMs was increased.Conclusion The abnormal hematopoiesis in zebrafish induced by folic acid deficiency is related with the increasing apoptosis in ICMs and decreasing expressions of FLK-1,GATA1and GATA2.