Objective:To evaluate the effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia in patients un-dergoing laparoscopic radical gastrectomy.Methods:Sixty patients who underwent elective laparoscopic radical gastrectomy were enrolled between May 2022 and October 2023 at Tianjin Medical University Cancer Institute&Hospital.Patients were assigned into two groups us-ing a random number table method:the control(group C)and the ultrasound-guided serratus anterior plane block(SAPB)(group S).Patient-controlled intravenous analgesia(PCIA)was administered at the end of the surgery.After surgery,visual analogue scale(VAS)of static pain scores was evaluated at 1,6,12,24,and 48 hours.PCIA pump was started at the VAS pain score≥4 after surgery,and sufentanil 0.1μg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA use,time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and the duration of hospitalization stay were recorded for the two groups.Results:VAS scores were significantly lower at postoperative 1,6,and 12 h in group S than in group C(P<0.05).Additionally,the number of effective uses of PCIA,and rescue analgesia were significantly lower in group S[(6.1±0.4)(2)]than in group C[(18.6±1.4)(17)](P<0.001).The time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and duration of hospital stay were shortened in group S than in group C(P<0.05).There were no significant differences in other parameters between these two groups.Conclusion:Ultrasound-guided SAPB can reduce postoperative pain and facilitate fast recovery in laparoscopic radical gastrectomy patients.

OBJE CTIVE To provide reference for improving rational drug use in medical institutions and strengthening individualized rational drug use monitoring. METHODS The hospital information system （HIS）was used to retrieve the patient ’s medical information and the doctor ’s medical information ；on the basis of pre-examination of prescriptions ，the chronic disease medication monitoring and visiting frequency monitoring modules were added to construct individualized rational drug use monitoring platform. Taking hypoglycemic drugs as an example ，the number of patients who were prescribed the drug ≥3 times a month in Karamay Central Hospital （hereinafter referred to as “our hospital ”）was compared before and after the operation of the individualized rational drug use monitoring platform （Jan. to Apr. 2018 regarded as before operation ，Jan. to Apr. 2019 and 2021 regarded as after operation ）. At the same time ，the number of risk prescriptions （repeatedly prescribing the same drug ≥3 times a day）and unreasonable prescriptions after the operation of the individualized rational drug use monitoring platform （Jan. to Apr. 2019 and Jan. to Apr. 2021）in our hospital were compared. RESULTS The proport ion of patients who were over prescribed Diformin tablets from Jan. to Apr. in 2021 was lower than the same period in 2018 significantly（16.65％ vs. 27.17％，P＜0.05）. From Jan. to Apr. 2019，35.3％ of the risk prescriptions in our hospital were unqualified prescriptions ；in the same period of 2021， the proportion of unqualified prescriptions in risk prescriptions in our hospital decreased to 12.82％ ，which was statistically significant compared with 2019（P＜0.05）. CONCLUSIONS Based on the actual situation of patients ，our hospital establishes the individualized rational drug use monitoring platform by using HIS to meet the actual needs of clinical drug use. The use of the platform has significantly reduced the number of patients visiting doctors many times and unreasonable prescriptions ，and promotes rational drug use. At the same time ，the platform also further strengthens the prescription review system of our hospital and improves the level of pharmaceutical care.

Objective:To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients ≥85 years with atrial fibrillation(AF).Methods:515 elderly patients with atrial fibrillation, including 73 patients aged 85 years or older(85~91), who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020, were retrospectively analyzed.Of those ≥85 years, 44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data, intraoperative conditions, antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results:Compared with the control group, there was no difference in AF types, history of ischemic stroke/transient ischaemic attack(all P>0.05), but there were higher incidences of coronary heart disease and renal insufficiency, more severe heart failure, higher CHA 2DS 2-VASC(6.0±1.5 vs.3.6±1.5), HAS-BLED(3.2±1.2 vs.2.3±1.3)scores( t values were 7.682 and 3.871, respectively, P<0.05), and a lower one-stop surgery rate(6 cases or 13.6% vs. 27 cases or 50.9%, χ2=10.517, P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device, rate of device replacement, compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group, respectively, but the difference was not statistically significant( P>0.05). During the 12-month follow-up, there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer. Conclusions:LAAC with Watchman is safe and effective for patients over 85 years with AF, but the decision on the procedure should be based on careful assessment of patients' cardiac and renal function and general health.

Objective:To investigate the mutation characteristics and clinical relevance of Gilbert syndrome (GS) and Crigler-Najjar syndrome (CNS) in relation to uridine diphosphate glucuronosyltransferase A1 (UGT1A1) gene.Methods:The characteristics of UGT1A1 gene mutation and their clinical relevance were analyzed by searching PubMed and Human Gene Mutation Databases.Results:A total of 163 mutation sites were found in the UGT1A1 gene since November 16, 2018. The following patterns existed at the above sites: (1) the numbers of gene mutations occurring between different exons of UGT1A1 was related to GS or CNS phenotypes, and were positively correlated with the length of the exon; (2) nonsense point mutations was mainly occurred in type I of CNS; (3) GS, Crigler-Najjar syndrome type II compound heterozygous mutation sites had a certain combination and distribution, among which - 3279t > G mutation was found in all four GS complex heterozygous compositions; (4) UGT1A1 gene mutation sites reported in Asia had marked aggregation in c.211-c.558.Conclusion:UGT1A1 gene mutation characteristics and clinical relevance varies with different mutation sites, reporting areas and populations. This study has reference value for basic research and clinical diagnosis and treatment of GS and CNS.

In industrial fermentation processes, bacteria have to adapt environmental stresses. Sometimes, such a self-adaption does not work and will cause fermentation failures, although such adaptation also can generate unexpected positive effects with improved fermentation performance. Our review introduces cell self-adaption to environmental variations or stress, process optimization based on such self-adaptions, with heterologous proteins production by Pichia pastoris and butanol fermentation as examples. Our review can sever as reference for fermentation optimization based on cell self-adaption.
Adaptation, Physiological ; Butanols ; metabolism ; Environment ; Fermentation ; Pichia ; cytology ; metabolism

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators.

Objective: To evaluate the efficacy and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily and dasabuvir (DSV) 250 mg twice daily combined with ribavirin in adult patients of Mainland China with chronic HCV genotype 1b infection and compensated cirrhosis. Methods: An open-label, multicenter, phase 3 clinical trial study was conducted in mainland China, Taiwan, and South Korea. Adult patients with compensated cirrhosis (Metavir score =F4) who were newly diagnosed and treated for hepatitis C virus genotype 1b infection with ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin for 12 weeks were included. Assessed SVR rate of patients obtained at 12 and 24 weeks after drug withdrawal. Efficacy and safety were evaluated in patients who received at least one time study drugs. Results: A total of 63 patients from mainland China were enrolled, 62 of whom (98.4%) had a baseline Child-Pugh score of 5 points. The overall rate of SVR12 and SVR24 in patients was 100% (95% CI: 94.3% to 100.0%). Most of the adverse events that occurred were mild. The incidence of common (≥10%) adverse events and laboratory abnormalities included elevated total bilirubin (36.5%), weakness (19.0%), elevated unconjugated bilirubin (19.0%) and conjugated bilirubin (17.5%), and anemia (14.3%). Three cases (4.8%) of patients experienced Grade ≥ 3 adverse events that were considered by the investigators to be unrelated to the study drug. None patients had adverse events leading to premature drug withdrawal. Conclusion Mainland Chinese patients with chronic HCV genotype 1b infection and compensated cirrhosis who were treated with OBV/PTV/r plus DSV combined with RBV for 12 weeks achieved 100 % SVR at 12 and 24 weeks after drug withdrawal. Tolerability and safety were good, and majority of adverse events were mild.

Objective: To evaluate the safety and efficacy of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily combined with dasabuvir 250mg, twice daily in non-cirrhotic Chinese adult patients with newly diagnosed and treated chronic HCV genotype 1b infection. Methods: A randomized, double-blind, placebo-controlled, multicenter phase 3 clinical trial was conducted in mainland China, Korea, and Taiwan.Safety and efficacy of OBV/PTV/r plus DSV administered for 12 weeks were evaluated in a newly diagnosed and treated (interferon alpha /pegylated interferon alpha) and ribavirin non-cirrhotic adults with chronic HCVgenotype 1b infection. Patients randomly received OBV/PTV/r plus DSV for 12 weeks (Group A), or placebo for 12 weeks (Group B) followed by an open-label phase of OBV/PTV/r plus DSV for 12 weeks. Sustained response (SVR12) rate obtained at 12 weeks and (SVR24) 24 weeks after discontinuation of treatment, and the incidence of adverse events and laboratory abnormalities after double-blind and open-label phase treatment were assessed. Results: A total of 410 cases of Chinese patients were included and randomly assigned to group A and B (with 205 cases in each group) in a 1:1 ratio. The rates of SVR12 and SVR24 were 99% (95% CI: 94.8% - 99.8%) in the newly diagnosed patients in group A (205 patients) and the rates of SVR12 and SVR24 were 100% in treated patients (95% CI: 96.3% - 100%). Different baseline characteristics had no effect on SVR12 and SVR24 rates. Most of the adverse events occurred were mild, asymptomatic, and≥ 3 laboratory abnormalities during treatment were rare, including elevation of alanine aminotransferase (2 cases in double-blind stage A group), aspartate aminotransferase (Double-blind stage A (3 cases) and total bilirubin (1 case in open-label phase B group); however, those mild adverse events could be recovered after drug withdrawal or discontinuation. only1 person discontinued drugs due to adverse events (Group B, open-label phase). Conclusion The 12 weeks treatment course of OBV/PTV/r combined with DSV produced 99% ~ 100% rates of SVR12 and SVR24 in non-cirrhotic Asian adult patients with newly diagnosed and treated chronic HCV genotype 1b infection, and the tolerance and safety were good.

Objective To assess the outcomes of ischemic stroke patients with atrial fibrillation (AF).Methods Six thousand six hundred and ninety-five patients with acute ischemic stroke,admitted to our hospital from May 2005 to December 2013,were recruited consecutively.These patients were divided into combined AF group (n=583) and non-combined AF group (n=6112).The clinical data,including stroke subtypes,stroke severity,risk factors of stroke,NIHSS scores and Barthel index,and outcomes,including mortality,unfavourable prognosis and recurrence at 3,12,and 36 months after stroke were analyzed.Results The prevalence rate of AF in the patients enrolled in this study was 8.7％ (583/6695).There was a higher frequency of AF in female than that in male,with significant difference (45.8％ vs.33.0％,P＜0.05).The patients from combined AF group were older than those without AF.The percentage of severe stroke in AF patients (34.8％) was significantly higher than that in non-combined AF group (8.3％,P＜0.05).The patients with AF were less likely than the patients without AF to have hypertension (63.8％ vs.73.3％),diabetes (24.9％ vs.32.3％),dyslipidemias (26.1％ vs.31.5％),artery stenosis (17.2％ vs.23.4％),current smoking (22.6％ vs.39.0％),and alcohol consumption (7.5 ％ vs.18.9％),with significant differences (P＜0.05).After adjusting age,gender,stroke subtype,and severity,and risk factors,multivariate analysis showed that there was a higher recurrence risk in combined AF group at 3 months after stroke than that in non-combined AF group (P＜0.05);patients with AF had significantly higher mortality,dependency,and recurrence rates at 12 and 36 months after stroke than those without AF (P＜0.05).Conclusion The long-term prognosis of patients with stroke complicated with AF is poor;therefore,normalized anticoagulant therapy should be taken to decrease the recurrence rate and burdens of stroke in China.

Objective:To discuss the curative effect of bifid triple viable capsules in the patients after laparoscopic cholecystecto-my ( LC) . Methods:Totally 100 cases of patients with LC were selected and divided into the observation group and the control group at random. The patients in the two groups underwent LC under the general anesthesia, and were given routine medical treatment after the operation. The patients in the observation group were additionally given bifid triple viable capsules, 630mg per time, twice a day for 1 week as the treatment course. The changes in the occurrence of diarrhea, alteration of intestinal flora and plasma D-lactic acid of the patients and drug adverse reactions in the two groups were observed and compared after the medical treatment. Results:One week after the operation, the occurrence of diarrhea and alteration of intestinal flora of the patients in the observation group were lower than those in the control group (P<0. 05), and compared with those before the treatment, the plasma D-lactic acid levels of the patients in the two groups were declined (P<0. 05 or P<0. 01), and the declining rate in the observation group was much higher than that in the control group (P<0. 05). Totally 3 and 5 cases of drug adverse reactions were appeared in the observation group and the control group, respectively with no significant difference (P>0. 05). Conclusion: The application of bifid triple viable capsules in the pa-tients after LC can effectively reduce the plasma D-lactic acid levels, occurrence of diarrhea and alteration of intestinal flora with prom-ising security, which is good for the postoperative recovery of the patients.