Objective To explore the effect of enhanced recovery after surgery(ERAS)in perioperative period of complicated appendicitis in children.Methods A total of 248 children with complicated appendicitis who underwent laparoscopic surgery in Quanzhou Children's Hospital from January 2020 to January 2023 were selected and divided into control group and ERAS group according to random number table method,with 124 cases in each group.Both groups of patients underwent laparoscopic appendectomy.The control group received traditional treatment during perioperative period,while the ERAS group received treatment based on the concept of ERAS.The first postoperative exhaust/defecation time,hospital stay,visual analogue scale(VAS)score,postoperative complications and hospitalization satisfaction were compared between two groups.Results The time of first postoperative exhaust/defecation and hospital stay in ERAS group were significantly shorter than those in control group,total incidence of postoperative complications and postoperative VAS score were significantly lower than those in control group,and hospitalization satisfaction was significantly better than that in control group(P<0.05).Conclusion ERAS implementation during perioperative period of complicated appendicitis in children can promote early postoperative recovery,reduce postoperative pain,reduce the incidence of complications,and improve hospitalization satisfaction,which is worthy of clinical promotion and application.

Objective To discuss the efficacy of transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia.Methods A retrospective analysis was conducted on data of 27 children admitted to our hospital from September 2019 to September 2022 who underwent transumbilical single-incision laparoscopic assisted surgery.A curved incision on the right side of the umbilicus to 1/2 circumference was made.A 3.5 cm disposable single hole multi-channel port(Port)was inserted.The intestinal atresia was located under direct vision.The proximal hypertrophic intestinal tube was removed,and the distal intestinal tube to the mesenteric side was cut open.Intermittent single layer suture with 5-0 absorbable suture was performed for end-oblique incision anastomosis.Then the CO2 pneumoperitoneum was established,and the entire abdominal cavity was observed to deal with combined deformities.Results The surgery was successfully completed in all the 27 patients,without conversion to open surgery.During the surgery,15 cases of jejunal atresia and 12 cases of ileal atresia were confirmed.There were 8 cases of type Ⅰ,5 cases of type Ⅱ,12 cases of type Ⅲa,and 2 cases of type Ⅲb.During the surgery,there were 5 cases of meconium peritonitis,1 case of biliary atresia,2 cases of intestinal malrotation,1 case of Meckel's diverticulum,2 cases of cryptorchidism,and 1 case of inguinal hernia.The median surgical time was 110.0(90.0,122.5)min.The median postoperative feeding time was 11.0(7.0,14.5)d.No anastomotic leakage occurred.The median postoperative hospital stay was 18.0(15.0,33.5)d.One child underwent the second surgery.A total of 22 cases were followed up for 0.5-4 years(average,2.3 years)without re-operations.Conclusions Transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia is scarless and easy to operate.Combined with the use of a Port,it can reduce intestinal compression and facilitate traction.Laparoscopy can simultaneously handle combined deformities.

Objective:To explore the current status of compassion fatigue among emergency nurses, and analyze the path relationship between work stressors, psychological capital and compassion fatigue.Methods:Totally 453 emergency nurses from 19 general hospitals in Qingdao between March and April 2019 were selected using convenience sampling and investigated with the Nursing Job Stressor Scale (NJSS) , Professional Quality of Life (ProQOL) , and Psychological Capital Questionnaire (PCQ-R) .Results:The total scores of the 453 emergency nurses' work stressors and psychological capital were (103.68±17.56) and (82.20±16.70) . Their compassion satisfaction, burnout and secondary trauma scores were (31.67±7.48) , (26.89±6.03) , and (25.59±6.25) , respectively. The work stress of emergency nurses was negatively correlated with their psychological capital and compassion satisfaction ( P< 0.01) , but positively correlated with their job burnout and secondary trauma ( P< 0.01) ; their psychological capital was positively correlated with compassion satisfaction ( P< 0.01) , while negatively correlated with job burnout and secondary trauma ( P< 0.01) . Structural equations showed that psychological capital had a partial mediating effect between work stress and compassion fatigue, and the mediating effect was significant (mediating effec t=4.676; P< 0.05) . Conclusions:Nursing managers should identify compassion fatigue of emergency nurses in time and take corresponding interventions to improve their psychological capital, thereby reducing their compassion fatigue, stabilizing the emergency nursing team, and ensuring the quality of nursing.

Objective: To investigate the clinicpathologic features and probable mechanisms of massive subcortical heterotopia. Methods: Clinical data, histologic features and neuropathologic data were analyzed in five cases of massive subcortical heterotopia collected from Xuanwu Hospital, Capital Medical University from January 2014 to October 2017. Results: All five patients (three males and two females) had a history of refractory epilepsy with a mean period of 15.4 years (range 7 to 21 years). The median age at surgery was 28.6 years(range 20 to 39 years). Magnetic resonance imaging showed that the lesions were located in the temporal lobe (two cases), parietal lobe (one case), both temporal and occipital lobes (one case) and both temporal and parietal lobes (one case). Pathologic examination disclosed that massive gray matter in subcortical and deep white matter with various shape and size. Moreover, one case also showed subpial and periventricular heterotopias and polymicrogyria. Polymicrogyria or hippocampal sclerosis were seen in the remaining three cases. None of the five patients experienced seizure attacks during the follow-up period. Conclusions Heterotopia is malformations due to abnormal neuronal migration. Massive subcortical heterotopia due to widespread abnormal neuronal migration is relatively rare. The mechanism of heterotopia together with polymicrogyria needs further discussion.

Objective To evaluate the effects of OPRM1All8G and CYP3A4*18B genetic polymorphism and the interaction on postoperative analgesia with fentanyl in the patients undergoing radical resection of lung cancer.Methods One hundred and thirty-nine patients (native of Henan province),aged 40-64 yr,weighing 40-70 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of lung cancer under general anesthesia,were enrolled in this study.The polymorphic sites of the OPRM1All8G and CYP3A4*18B allele were analyzed by using polymerase chain reaction technique and ABI 3130 Genetic Analyzer.The patients were divided into wild homozygote group (group AA,group *1/*1),heterozygote group (group AG,group * 1/*18B) and mutation homozygote group (group GG,group *18B/*1SB) according to their genotypes.The patients were divided into 7 groups according to the interaction between the two genes:AA plus *1/*1 group (group Ⅰ),AA plus *1/*18B group (group Ⅱ),AG plus *1/*1 group (group Ⅲ),AG plus *1/*18B group (group Ⅳ),GG plus * 1/*1 group (group Ⅴ),GG plus *1/*18B group (group Ⅵ) and *18B/*18B group (group Ⅶ).Patientcontrolled intravenous analgesia with fentanyl was started at the end of surgery to maintain the visual analogue scale ≤ 3 points.The amount of fentanyl used within 24 and 48 h after surgery was recorded,and the occurrence of adverse reactions within 48 h after surgery was observed.Results The amount of fentanyl used within 24 and 48 h after surgery was significantly higher in group GG than in group AA (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly lower in group *18B/*18B than in group *1/*1 (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly higher in Ⅱ and Ⅳ groups than in group Ⅰ,in group Ⅲ than in group Ⅱ,in group Ⅴ than in Ⅰ-Ⅳ groups,and in group Ⅵ than in Ⅱ and Ⅳ groups,and was significantly lower in group Ⅶ than in Ⅰ-Ⅵ groups (P＜ 0.05).There was no significant difference in the incidence of adverse reactions within 48 h after surgery between groups (P＞0.05).Conclusion OPRM1A1l8G and CYP3A4*18B genetic polymorphism and the interaction are the genetic factors contributing to individual variation in fentanyl pharmacodynamics in the patients undergoing radical resection of lung cancer.

Objective To investigate the interpersonal disturbances and its related factors among college students.Methods The field questionnaire survey was conducted among 730 college students with stratified-cluster sampling method in Zhengzhou University.The self-administered anonymous survey instruments included the Interpersonal Relationships Integrated Diagnosis Questionnaire,Parental Bonding Instrument questionnaire,Self-Rating Anxiety Scale and Pittsburgh Sleep Quality Index.Results ①Detection rate of interpersonal relationship disturbance was 47.8％ in 730 college students.Severe interpersonal disturbances accounted for 16.3％.The most serious problem was communication and making friends disturbance which accounted for 58.5％ of the total.②)There were statistical differences of conversation scores ((2.15± 1.66),(2.53± 1.83),(2.22± 1.79)) among different major college students (medical,engineering,liberal arts) (P＜0.05).A statistical difference was found in making friends((2.76±1.89),(3.18± 1.92)) and getting along with opposite gender ((2.23 ± 1.82),(1.81 ± 1.66)) between male and female (P＜ 0.05).There were significant differences of conversation ((2.58 ± 1.84),(2.02 ± 1.65)),making friends ((3.28 ± 1.93),(2.78 ±1.88)) and getting along with opposite gender ((2.16± 1.75),(1.77± 1.69)) between grade one and three students(P＜0.05).③The interpersonal disturbances were significantly related to parental bonding styles,anxiety and sleep quality.④The results of logistic regression showed that anxiety was the main risk factor (B =1.42,OR=4.4,95％ CI =1.74-9.86,P＜0.01) and maternal parenting style and sleep quality were protective factors(P＜0.01)of interpersonal disturbances.Conclusion The interpersonal disturbance,which are severe and affected by multiple factors in college students,should be paid attention by school,society and family to improve their learning and growing environment in order to promote their physical and mental health.

Objective To analyze risk cause on adverse apparatus events of medical institution for causing the attention of medical institutions and reducing or exempting the occurrences. Methods Through the analysis risk cause on adverse apparatus events of medical institutions, the major factors of causing the medical institutions adverse apparatus events and the ways of solving the problems were found. Results The ways and countermeasure of solving medical institutions adverse apparatus events are brought forward. Conclusion It is preventable in adverse apparatus events of medical institutions.