Objective To investigate the influence of transient receptor potential cation channel 6 (TRPC6) on renal tubulointerstitial inflammation in mice with diabetic kidney disease (DKD) and its mechanism. Methods A total of 36 male C57/BL6J mice, aged 6 weeks, were randomly divided into control group (group A), DKD model group (group B), DKD+normal saline intervention group (group C), DKD+mitophagy activator intervention group (group D), DKD+negative control lentivirus transfection group (group E), and DKD+TRPC6 knockdown lentivirus transfection group (group F), with 6 mice in each group. The mice in groups A and B were respectively given intraperitoneal injection of 0.1 mmol/L citrate buffer and 10 g/L streptozotocin (hereinafter referred to as administration); the mice in groups C and D were respectively given normal saline and 10 mmol/L urolithin A by gavage in addition to the treatment in group B; the mice in groups E and F were respectively injected with negative control lentivirus and TRPC6 knockdown lentivirus via the tail vein in addition to the treatment in group B. The levels of fasting blood glucose (FBG), urinary albumin-to-creatinine ratio (ACR), and blood urea nitrogen (BUN) were measured at week 12 after administration; PAS staining was used for the observation and scoring of renal tubular injury; RT-qPCR was used to measure the mRNA expression levels of inflammatory factors [interleukin-1β (IL-1β), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-α (TNF-α)] in renal tissue; immunohistochemical staining was used to measure the protein expression level of TRPC6 in renal tissue, and Western blotting was used to measure the relative expression levels of TRPC6, LC3B, P62, PINK1, and Parkin in renal tissue; transmission electron microscopy was used to observe the change in the number of mitophagosomes in renal tubular cells of mice. HK-2 cells were divided into high glucose+TRPC6 siRNA transfection+DMSO intervention group (group G, treated with TRPC6 siRNA+35.0 mmol/L glucose+0.06% DMSO) and high glucose+TRPC6 siRNA transfection+mitophagy inhibitor intervention group (group H, treated with TRPC6 siRNA+35.0 mmol/L glucose+12 μmol/L oroxylin A), and then RT-qPCR was used to measure the mRNA expression levels of inflammatory factors (IL-1β, MCP-1, and TNF-α) in cells. Results At week 12 after administration, compared with group A, group B had significantly higher whole blood FBG, ACR, BUN, renal tubular injury score, mRNA expression levels of inflammatory factors, and protein expression levels of TRPC6 and P62 in renal tissue (t=2.77-13.61,P<0.05) and significantly lower protein expression levels of LC3B-Ⅱ/LC3B-Ⅰ, PINK1, and Parkin in renal tissue (t=3.33-14.63,P<0.05), with a reduction in the number of mitophagosomes in renal tubular cells. Compared with group C, group D had significantly lower levels of ACR and BUN, renal tubular injury score, mRNA expression levels of inflammatory factors, and protein expression level of P62 in renal tissue (t=2.40-23.50,P<0.05) and significantly higher protein expression levels of LC3B-Ⅱ/LC3B-Ⅰ, PINK1, and Parkin in renal tissue (t=5.74-12.50,P<0.05), with an increase in the number of mitophagosomes in renal tubular cells. Compared with group E, group F had significantly lower levels of ACR and BUN, renal tubular injury score, mRNA expression levels of inflammatory factors, and protein expression levels of TRPC6 and P62 in renal tissue (t=2.45-7.09,P<0.05) and significantly higher protein expression levels of LC3B-Ⅱ/LC3B-Ⅰ, PINK1, and Parkin in renal tissue (t=7.91-13.18,P<0.05), with an increase in the number of mitophagosomes in renal tubular cells. Group H had significantly higher mRNA expression levels of inflammatory factors than group G (t=5.40-7.27,P<0.05). Conclusion TRPC6 can aggravate renal tubulointerstitial inflammation by upregula-ting its expression and inhibiting mitophagy in renal tubular cells. Therefore TRPC6 inhibitors are promising for the treatment of DKD disease.

Objective To establish a prognostic risk scoring model for patients with pancreatic ductal adenocarcinoma (PDAC) based on cell ferroptosis-related genes, and to investigate its application value. Methods The Cancer Genome Atlas (TCGA) database, Gene Expression Omnibus database, and Genotype-Tissue Expression database were used to obtain the transcriptome sequencing data of PDAC tissue and normal pancreatic tissues and the clinical data of PDAC patients including overall survival (OS), and the GeneCards database was used to obtain the data on cell ferroptosis-related genes. R software was used to identify the differentially expressed genes (DEGs) between PDAC tissue and normal pancreatic tissue. The univariate Cox regression analysis and LASSO regression were used to establish a prognostic risk scoring model for PDAC patients, and based on this risk scoring model, the PDAC cases in TCGA database were divided into low- and high-risk groups. The Kaplan-Meier survival curves were plotted to compare OS between the two groups. CCK-8 assay and Western blotting were used to further validate the association between the key genes of cell ferroptosis in the risk scoring model and cell ferroptosis in PDAC. Results A prognostic risk scoring model for PDAC patients was successfully established based on seven cell ferroptosis-related genes, i.e., SLC6A14, DKK1, KRT19, AURKA, EMP1, ANXA2, and LGALS3, and the Kaplan-Meier survival curve showed that the low-risk group had a significantly longer OS than the high-risk group (P<0.05). CCK-8 showed that compared with the negative control group, the AURKA knockdown group of AsPC-1 and BxPC-3 PDAC cell lines had a significantly lower viability on days 3-5 (t=4.57-12.84,P<0.05), and Western blotting showed that compared with the negative control group, the AURKA knockdown group of AsPC-1 and BxPC-3 cells had significantly lower relative protein expression levels of AURKA, SLC7A11, and GPX4 (t=4.22-11.79,P<0.05). Conclusion Downregulation of the AURKA gene may lead to the development and progression of PDAC by promoting ferroptosis in PDAC cells, and the risk scoring model based on cell ferroptosis-related genes has a significant reference value for the prognostic assessment of PDAC patients.

Objective To investigate the efficacy and safety of cold snare polypectomy (CSP) in the treatment of gastric polyps with a diameter of 5-10 mm. Methods A total of 161 patients with 313 polyps who were found to have sessile gastric polyps with a diameter of 5-10 mm by gastroscopy and underwent gastric polypectomy in Laoshan Campus, The Affiliated Hospital of Qingdao University, from 2021 to 2022 were enrolled, and according to the surgical procedure for polypectomy, they were divided into CSP group with 88 patients (162 polyps) and hot snare polypectomy (HSP) group with 73 patients (151 polyps). The two groups were compared in terms of the complete resection rate and en bloc resection rate of gastric polyps, immediate bleeding rate, the rate of use of titanium clip during surgery, delayed bleeding rate, delayed gastric perforation rate, postoperative infection rate, and various inflammatory indicators after surgery. Results There were no significant differences between the two groups in the complete resection rate and en bloc resection rate of gastric polyps, immediate bleeding rate, delayed bleeding rate, delayed gastric perforation rate, and postoperative infection rate (P>0.05), and compared with the HSP group, the CSP group had a significantly lower rate of use of titanium clip (χ²=13.482,P<0.05). Conclusion CSP is safe and effective in the treatment of gastric polyps with a diameter of 5-10 mm, and therefore, it holds promise for clinical application.

Objective To investigate the value of real-time tissue elastography (RTE) in evaluating donor liver quality and postoperative early allograft dysfunction (EAD) in liver transplantation patients. Methods A total of 58 patients who received liver transplantation in Organ Transplantation Center of our hospital from October 2020 to January 2022 were enrolled, and according to the recovery of liver function in the early stage after surgery, the patients were divided into EAD group and non-EAD group. The two groups were compared in terms of the indicators such as the routine ultrasound examination and RTE measurement of donor liver before liver transplantation, liver function and coagulation function of recipients before and after liver transplantation, and preoperative Model for End-Stage Liver Disease (MELD) score. The logistic regression analysis was performed for the indicators with significant differences, and the receiver operating characteristic (ROC) curve was plotted to calculate the area under the ROC curve (AUC) and assess the performance of related factors. Results Compared with the non-EAD group, the EAD group had significantly higher liver fibrosis (LF) index of donor liver and MELD score of recipients (t=4.822, 2.902,P<0.05). The logistic regression analysis showed that donor liver LF index >1.645 was a risk factor for EAD after liver transplantation, and the ROC curve analysis showed that donor liver LF index had an AUC of 0.840 in predicting EAD after surgery, with a sensitivity of 82.4%, a specificity of 73.2%, and a cut-off value of 1.645. Conclusion High LF index of donor liver before liver transplantation is a risk factor for EAD in recipients after liver transplantation, and RTE measurement for LF index of donor liver before li-ver transplantation has a certain value in assessing the quality of donor liver and predicting the onset of EAD.

Objective To investigate the clinical effect of arytenoid cartilage reposition with a suspension laryngoscope under general anesthesia in the treatment of cricoarytenoid joint dislocation. Methods Ten patients with cricoarytenoid joint dislocation who were admitted to our department from December 2012 to December 2020 were enrolled and underwent arytenoid cartilage reposition with a suspension laryngoscope under general anesthesia, and the patients were analyzed in terms of etiology, surgical timing, and treatment outcome. Results Among the ten patients, eight achieved successful reposition in a single attempt, one improved after two attempts, and one showed no response. Conclusion Arytenoid cartilage reposition with a suspension laryngoscope is an effective method for the treatment of cricoarytenoid joint dislocation, and the earlier the treatment, the better the treatment outcome.

Objective To investigate the efficacy of femoral neck system (FNS) for internal fixation versus arthroplasty in the treatment of Pauwels type Ⅲ femoral neck fracture. Methods A retrospective analysis was performed for the data of 96 patients with Pauwels type Ⅲ femoral neck fracture who received surgical treatment in our hospital from January 2019 to January 2021, and according to the surgical procedure, they were divided into FNS group with 39 patients and arthroplasty group with 57 patients. The two groups were compared in terms of general information, admission and surgery data, and Harris score of the hip joint at 12 months after surgery. Results Compared with the FNS group, the arthroplasty group had a significantly longer time of operation and a significantly greater intraoperative blood loss (t=9.27,t'=92.81,P<0.05), as well as significantly shorter length of hospital stay and postoperative weight-bearing time (t=14.61,23.21,P<0.05). There was no significant difference in Harris score at 12 months of follow-up between the two groups (P>0.05). At 12 months of follow-up, 5 patients in the FNS group and 6 in the arthroplasty group experienced postoperative complications, and there was no significant difference between the two groups (P>0.05). Conclusion For patients with Pauwels type Ⅲ femoral neck fracture, arthroplasty can shorten the length of hospital stay, achieve early weight-bearing and functional exercise, and reduce the time of lying in bed. An appropriate artificial prosthesis should be selected for arthroplasty according to the specific condition of the patient, so as to bring more benefits to the patient.

Objective To explore the value of computerized tomography (CT) and magnetic resonance imaging (MRI) imaging features in differential diagnosis of giant cell tumors with prominent aneurysmal bone cysts (GABCs) in the extremities and primary aneurysmal bone cysts (PABCs). Methods In this study, the CT and MRI imaging features of 20 patients with GABCs in the extremities and 21 patients with PABCs were retrospectively analyzed, and the age and sex of patients were collected. The differences in different indicators between the two groups were compared. The diagnostic sensitivity and specificity for GABCs and PABCs were calculated based on the age, transverse/longitudinal diameter ratio of the mass, subchondral bone involvement, deep edge lobulation of the lesion, and vascular shadow around the mass. Results There were significant differences in the age and transverse/longitudinal diameter ratio of the mass between the two groups (t=-3.956,-2.985,P<0.05). There were signi-ficant differences in the proportions of subchondral bone involved, deep edge lobulation of the lesion, and vascular shadow around the mass between the two groups (P<0.05). The sensitivity of age, transverse/longitudinal diameter ratio of the mass, subchondral bone involvement, and deep edge lobulation of the lesion in the diagnosis of GABCs was 75.0%, 65.0%, 68.0%, and 80.0%, respectively, and the specificity was 81.0%, 66.7%, 81.3%, and 61.3%, respectively. The sensitivity of vascular shadow around the mass in the diagnosis of PABCs was 52.4%, and the specificity was 95.0%. Conclusion Patient age and CT and MRI imaging features such as subchondral bone involvement, deep edge lobulation of the lesion, transverse/longitudinal diameter ratio of the mass, and vascular shadow around the mass can be used to distinguish GABCs from PABCs.

Objective To investigate the effect of ginkgolide B on hepatic ischemia-reperfusion injury in mice with fatty liver disease and its mechanism. Methods A total of 25 male C57BL/6J mice were fed with 60% high-fat diet for 16 weeks, and then they were divided into sham-operation group (laparotomy and suture), model group (occlusion of blood flow in the middle and left lobes of the liver for 1 h, followed by reperfusion for 6 h), ginkgolide B group (intraperitoneal injection of 25 mg/kg ginkgolide B twice, followed by the treatment in the model group), GW9662 group (intraperitoneal injection of 1 mg/kg GW9662 twice, followed by the treatment in the model group), and GW9662+ginkgolide B group (intraperitoneal injection of 25 mg/kg ginkgolide B+1 mg/kg GW9662 twice, followed by the treatment in the model group). At 6 h after administration and surgery, the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured for each group; Western blotting was used to measure the protein expression levels of Bax, Bcl-2, and PPARγ in liver tissue; oil red O staining was used to measure the degree of fatty changes in the liver, and HE staining was used to measure the degree of necrosis in liver tissue. Results Oil red O staining showed that the degree of fatty changes in the liver had reached the level of fatty liver disease in each group. The se-rum enzymatic analysis showed that the ginkgolide B group and the GW9662+ginkgolide B group had significantly lower serum le-vels of ALT and AST than the model group (P<0.05), and the ginkgolide B group had a significantly lower serum level of ALT than the GW9662+ginkgolide B group (P<0.05). HE staining showed that the ginkgolide B group had a significantly lower percentage of necrotic area in liver tissue than the model group and the GW9662+ginkgolide B group (P<0.05). Western blotting showed that the ginkgolide B group had a significantly lower expression level of Bax in liver tissue than the model group (P<0.05), as well as significantly higher expression levels of Bcl-2 and PPARγ than the model group and the GW9662+ginkgolide B group (P<0.05). Conclusion Ginkgolide B can alleviate ischemia-reperfusion injury in mice with fatty liver disease by upregulating PPARγ in liver tissue.

Objective To investigate the expression levels of nerve injury-induced protein 1 (Ninjl), interleukin-1β(IL-1β), and protein gene product 9.5 (PGP-9.5) in the ectopic endometrial tissues of patients with endometriosis (EMT) and their relationship with dysmenorrhea. Methods Ectopic endometrial tissues from 40 patients with ovarian EMT diagnosed by post-ope-rative gynecological pathological examination in our hospital from April 2020 to April 2021 were selected as group A. In situ endo-metrial tissues from 20 of these patients were obtained as group B. Normal endometrial tissues from 20 patients with uterine fi-broids in the same period were collected as group C. Group A was divided into a dysmenorrhoea subgroup and a non-dysmenorrhoea subgroup according to the presence or absence of dysmenorrhoea, with 20 patients per subgroup. The expression levels of Ninj1, IL-1β, and PGP-9.5 in the endometrial tissues of groups A, B, and C were measured by immunohistochemistry, and their correlation was analyzed. The expression level of IL-1β in the peripheral blood of patiens in groups A and C was measured by enzyme-linked immunosorbent assay. Results The expression level of IL-1β in the peripheral blood of patients in group A was signifi-cantly higher than that in group C (t=-4.184,P<0.05). The positive expression rates of three proteins in the endometrial tissues were significantly increased in groups A and B compared with group C (χ²=4.286-19.394, P<0.05)and in group A compared with group B (χ²=4.149-5.272,P<0.05). The positive expression rates of Ninjl and PGP-9.5 proteins in the endometrial tissues were significantly higher in the dysmenorrhoea subgroupthan in the non-dysmenorrhoea subgroup (χ²=8.533,11.905,P<0.05). The expression of Ninj1 was positively correlated with the expression of PGP-9.5 and IL-1β in the endometrial tissues of group A (r=0.733, 0.628,P<0.05). Conclusion Ninjl, IL-1β, and PGP-9.5 are highly expressed in the ectopic endometrial tissues,which may be involved in the occurrence and development of EMT. The positive expression rates of both Ninjl and PGP-9.5 in the endometrial tissues of the dysmenorrhoea subgroup were higher than those in the non-dysmenorrhoea subgroup, which may be closely related to the mechanism of EMT pain.

Objective To investigate the efficacy of intravitreal injection of Ozurdex^® in the treatment of refractory diabetic macular edema (DME) with different optical coherence tomography (OCT) patterns. Methods A total of 38 patients (41 eyes) who underwent fundus examination and were diagnosed with refractory DME in Department of Ophthalmology in our hospital from June 2018 to June 2020 were enrolled in this study, and according to the OCT pattern, they were divided into diffuse retinal thickening (DRT) group, cystoid macular edema (CME) group, and serous retinal detachment (SRD) group. Intravitreal injection of Ozurdex^® was performed for all diseased eyes as needed, and best corrected visual acuity (BCVA) and OCT measurements were performed before treatment and at 1, 3, and 6 months after treatment. The three groups were compared in terms of BCVA, central foveal thickness (CFT), the integrity of external limiting membrane, ellipsoid zone integrity, and the number of hyperreflective dots (HRDs) before and after treatment. Results All three groups had a significant improvement in BCVA at 1, 3, and 6 months after treatment (F_intra-group=15.334-42.187,P<0.05), and the DRT and CME groups had a significant reduction in CFT from 1 month to 3 months after treatment (F_intra-group=4.009,7.946,P<0.05), while for all three groups, CFT at 3 months after treatment was significantly lower than that at 6 months after treatment (F_intra-group=5.591-12.498,P<0.05). At 1, 3, and 6 months after treatment, there were significant differences in △BCVA and △CFT between the three groups (F_inter-group=7.020-20.553,P<0.05), and the SRD group showed the greatest improvement, followed by the CME group and the DRT group. There was no significant difference in the proportion of diseased eyes with different numbers of HRDs between the three groups at each time point (P >0.05), and at 1, 3, and 6 months after treatment, there was a significant change in the proportion of diseased eyes with different numbers of HRDs (H=23.645-39.117,P<0.001). At 6 months after treatment, there was a significant increase in the number of diseased eyes with complete ELM and ellipsoid zone between all diseased eyes (χ²=15.814,8.264,P<0.05). Conclusion Ozurdex^® can persistently alleviate macular edema in patients with refractory DME of different OCT patterns, significantly improve their visual function, and reduce inflammatory substances, with the most significant improvement in SRD patients.

Objective To investigate the application effect of transcutaneous electrical acupoint stimulation (TEAS) combined with propofol in painless gastrointestinal endoscopy. Methods A total of 105 patients who underwent gastrointestinal endoscopy were randomly divided into propofol+fentanyl group (P+F group), propofol+TEAS group (P+T group), and propofol+placebo-TEAS group (P+P group), with 35 patients in each group. All patients were induced to deep sedation by the anesthesiologist using propofol before gastroscopy; the patients in the P+F group were given intravenously injected fentanyl 50 μg before gastroscopy, those in the P+T group received placement of electrodes at the acupoints at 30 minutes before examination and were given electrical stimulation till the end of the examination, and those in the P+P group received placement of electrodes at the acupoints alone without electrical stimulation. The patients were recorded in terms of pain score and the amount of propofol used du-ring examination, the time to recovery from anesthesia after examination, and the incidence rate of adverse reactions during or after examination, as well as the degree of satisfaction among patients and physicians. Results Compared with the P+P group, the P+F and P+T groups had a significant reduction in pain score (H=23.16,P<0.05). There was no significant difference in the incidence rate of hypoxemia between the P+F group and the other two groups (P>0.05), while the P+F group had significantly higher degrees of vertigo, nausea, and vomiting than the other two groups (H=40.97-44.79,P<0.05). Compared with the P+T and P+P groups, the P+F group had a significantly lower degree of satisfaction among the patients (H=21.80,P<0.05), and compared with the P+F and P+T groups, the P+P group had a significantly lower degree of satisfaction among the physicians (H=58.30,P<0.05). Conclusion TEAS combined with propofol can provide satisfactory sedation in gastrointestinal endoscopy and inhibit the discomfort caused by gastrointestinal endoscopy, and under the premise of ensuring the degree of satisfaction among patients, it can reduce the adverse reactions such as nausea and vertigo after examination caused by opioids.

Objective To investigate the therapeutic effect of remote rehabilitation after glucocorticoid injection in frozen shoulder (FS) patients. Methods A total of 63 FS patients who attended Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, from May 2022 to July 2023 were enrolled, and after glucocorticoid injection for 1 month, they were randomly divided into group A and group B. The patients in group A received rehabilitation treatment in the hospital, and those in group B received remote rehabilitation, once a day, 5 times a week for 4 weeks. The patients in both groups were assessed at the hospital before treatment and at 1, 3, 5, 8, 10, and 12 weeks after treatment, including Visual Analogue Scale (VAS) pain score, range of motion of shoulder joint (intorsion, extorsion, flexion, extension, and abduction angles), Activities of Daily Living score of shoulder joint, and satisfaction score of treatment outcome. Results For both groups, VAS score decreased significantly over the time of treatment (F=175.56, 215.78,P<0.05), and there was no significant difference in VAS score between the two groups at different time points of treatment (P>0.05). For both groups, the range of motion of shoulder joint increased significantly over the time of treatment (F=33.84-483.42,P<0.05), and at 3 and 5 weeks after treatment, group A had significantly larger intorsion, extorsion, and extension angles than group B (F=10.18-47.63,P<0.05); there was no significant difference in the range of motion of shoulder joint between the two groups at other time points (P>0.05). For both groups, the Activities of Daily Living score of shoulder joint increased significantly over the time of treatment (F=76.46, 92.02,P<0.05), and at 3 and 5 weeks after treatment, group A had a significantly higher score than group B (F=43.41, 65.76,P<0.05); there was no significant difference between the two groups at other time points (P>0.05). For both groups, the satisfaction score of treatment outcome increased significantly over the time of treatment (F=8.10, 12.84,P<0.05), and at 3 weeks after treatment, group A had a significantly higher score than group B (F=36.90,P<0.05); there was no significant difference between the two groups at other different time points (P>0.05). Conclusion For FS patients, remote rehabilitation after glucocorticoid injection can achieve a similar therapeutic effect to rehabilitation in hospital, and therefore, remote rehabilitation is a promising treatment regimen.

Objective To investigate the effect of different antibacterial agents combined with tigecycline in patients with multidrug-resistant Acinetobacter baumannii (MDRAB)-related ventilator-associated pneumonia (VAP), and to provide options for better treatment of the disease in clinical practice. Methods A retrospective analysis was performed for the clinical data of the patients with MDRAB-related VAP who were admitted from January 2016 to August 2023 in Qingdao municipal Hospital, and according to the treatment regimen, they were divided into tigecycline group (group A) with 56 patients, cefoperazone-sulbactam combination therapy group (B group) with 42 patients, and carbapenem combination therapy group (group C) with 24 patients. The three groups were compared in terms of infection and related outcome measures. Results There were no significant diffe-rences in the type of pathogene infected and infection sites between the three groups (P>0.05). Groups B and C had a significantly higher bacterial clearance rate than group A (χ²=5.38,4.48,P<0.05), and there was no significant difference in in-hospital mortality rate between the three groups (P>0.05). Conclusion Tigecycline combined with cefoperazone-sulbactam or carbapenem achieves a higher bacterial clearance rate than tigecycline alone in MDRAB-related VAP, and combined medication is a relatively good treatment option.

Objective To investigate the learning curve threshold for robot-assisted mitral valve replacement, and to provide guidance for clinical practice. Methods A retrospective analysis was performed for the clinical data of 37 patients who underwent robot-assisted mitral valve replacement in Department of Cardiovascular Surgery in our hospital from December 2014 to December 2017, and the patients were ordered based on date of surgery. The cumulative sum (CUSUM) was calculated for time of operation, duration of cardiopulmonary bypass (CPB), and aortic cross-clamp time, and the CUSUM learning curve was modeled by curve fitting. The patients were divided into two groups based on the highest CUSUM of time of operation, and the two groups were compared in terms of general information, time of operation, duration of CPB, aortic cross-clamp time, total drainage volume (the sum of retrosternal drainage volume and thoracic drainage volume) during the 3 days before surgery, length of hospital stay, use of drugs and blood products in the perioperative period, and whether secondary thoracotomy was performed. Results The fitting curve reached the top at the 9th case on the time of operation, and the highest numbers of CPB and aortic cross-clamp time were 12 and 11, respectively. The patients were divided into two groups at the 9th case, and there were significant differences between the two groups in total drainage volume and the amount of red blood cell and plasma used after surgery on days 2 and 3 (Z=2.21-2.55,P<0.05). Conclusion The minimum number of cases is 9 for robot-assisted mitral valve replacement to develop from the learning stage to the proficiency stage. Changes in patient conditions should be closely monitored during the learning stage to actively improve their prognosis.

Objective To construct a perioperative and postoperative home nutritional intervention regimen for children with hepatoblastoma, and to evaluate its clinical application effect. Methods Semi-structured interviews, literature research, and Delphi methods were used to construct a perioperative and postoperative nutritional intervention regimen for children with he-patoblastoma. A total of 31 children with hepatoblastoma who underwent surgery in our hospital from January 2019 to August 2021 were enrolled as control group, and 31 children with hepatoblastoma who underwent surgery from September 2021 to December 2023 were enrolled as experimental group. The children in the control group received routine diagnosis, treatment, and nursing, and those in the experimental group received the nutritional intervention regimen in addition to the intervention in the control group. The two groups were compared in terms of nutritional status, blood biochemical parameters (serum albumin, serum prealbumin, and blood hemoglobin), body height, body weight, and body mass index at 1 week before surgery and at 1 week, 1 month, and 3 months after surgery, and the clinical guiding significance and practical effect of the nutritional intervention regimen was assessed. Results At 1 and 3 months after surgery, compared with the control group, the experimental group had a significant reduction in the numbers of children with mild-to-moderate malnutrition and severe malnutrition (Z=-2.799,-3.697,P<0.05) and significant increases in the levels of serum albumin and blood hemoglobin (F=4.870-111.680,P<0.05). At 1 and 3 months after surgery, both groups had significant increases in serum albumin and hemoglobin compared with the data at 1 week before surgery (F=60.247-1 270.148,P<0.05), and compared with the control group, the experimental group had significantly greater changes in body weight at 1 and 3 months after surgery (compared with the data at 1 week before surgery) (Z=-2.405,-4.716,P<0.05). Conclusion This study successfully constructs a perioperative and postoperative home nutritional intervention regimen for children with hepatoblastoma, and it is shown that this intervention regimen can improve the nutritional status, blood biochemical parameters, and physical development of children, with good scientificity and practicality.

Objective To investigate the efficacy and safety of nalbuphine for dural puncture epidural labor analgesia. Methods A total of 319 primiparous women with a full-term single fetus who received trial of labor were enrolled, and according to the drug used for analgesia, they were divided into sufentanil group (group A with 160 women) and nalbuphine group (group B with 159 women). The women in both groups were given dural puncture epidural labor analgesia, during which 3 mL of 1.5% lidocaine was injected after epidural catheter placement, and then the women in group A were given injection of 0.5 mg/L sufentanil combined with 1 mg/L ropivacaine, while those in group B were given injection of 0.3 g/L nalbuphine combined with 1 mg/L ropi-vacaine, with an initial volume of 6-15 mL. After 30 minutes, an electronic analgesia pump was connected for both groups, and sufentanil and nalbuphine were used for patient-controlled epidural analgesia, respectively. The following indicators were collected and observed: Onset time of analgesia, time of first patient-controlled analgesia (PCA) pressing, number of effective PCA pres-sings, and amount of ropivacaine used; Visual Analogue Scale (VAS) score and Ramsay sedation score before analgesia (T0), at 30 minutes after analgesia (T1), at the time of uterine opening (T2), and during labor (T3); incidence rates of adverse reactions in parturients, including pyrexia, nausea and vomiting, skin pruritus, and postoperative headache; the incidence rate of fetal heart rate deceleration, the proportion of neonates with 1 min Apgar score ≤7 points, umbilical arterial blood gas analysis, and neonatal neurological and adaptive capacity scores. Results Compared with group A, group B had significant reductions in the incidence rates of vomiting and nausea, skin pruritus, fetal heart rate deceleration, and neonatal 1 min Apgar score ≤7 (χ²=4.159-5.628,P<0.05) and significant increases in the number of effective PCA pressings and the amount of ropivacaine used (χ²=8.594,6.363,P<0.05), as well as a significant increase in VAS score of the parturients at T2 and T3 (F=45.314,26.717,P<0.05), while there were no significant differences in the other indicators between the two groups (P>0.05). Conclusion For dural puncture epidural labor analgesia, nalbuphine has a similar analgesic effect to sufentanil in the first stage of labor, with a poorer effect in the second stage of labor, but it can reduce analgesia-related adverse reactions in parturients and has a relatively favorable safety profile in neonates.

Objective To explore the correlations of genotype and phenotype of myopathic form of carnitine palmitoyltransferase Ⅱ (CPT Ⅱ) deficiency and to improve the clinical understanding of the disease. Methods The clinical data of a case of myopathic form of CPT Ⅱ deficiency were analyzed, including the results of gene detection, diagnosis, treatment, and follow-up. The literature was reviewed to summarize the clinical characteristics, diagnosis, and treatment of CPT Ⅱ deficiency. Results The patient, a 10-month-old girl, was admitted to the hospital with acute enteritis. The blood creatine kinase and myoglobin were significantly increased in the auxiliary examination. Her father had a history of weakness after regular exercise and myoglobinuria. Both the father and the daughter carried the heterozygous pathogenic mutation c.989dupTp. (Ile332fs) in the CPT2 gene, which confirmed the diagnosis of myopathic form of CPT Ⅱ deficiency. After treatment with infection control and supplementation of a large amount of carbohydrates, creatine kinase and myoglobin returned to normal levels. Following discharge, follow-up showed that the patient was in good condition. Conclusion Myopathic form of CPT Ⅱ deficiency is a common disease that affects the lipid metabolism in skeletal muscle and is a common cause of hereditary myoglobinuria. However, its symptoms can be quite subtle and are frequently overlooked in clinical practice. When a patient exhibits repeated increases in creatine kinase as well as exercise intolerance, myoglobinuria, or positive family history, the disease should be taken into consideration.

Objective To investigate the clinical features and diagnosis and treatment of RAS-associated autoimmune lymphoproliferative disorder (RALD). Methods We reported the clinical data of a case of RALD diagnosed and treated in our hospital in 2019, and reviewed relevant literature on RAS variation retrieved using the keywords “NRAS”, “KRAS”, and “RALD” through PubMed, CNKI, and Wanfang Data between January 2000 and November 2023. Results The patient was hospitalized due to recurrent fevers for 1.5 months with a 1.5 years history of thrombocytopenia. The physical signs included an appearance of mild anemia, an abdominal bulge, a hard liver palpable up to 5 cm below the costal margin, and the spleen edge up to 3 cm below the costal margin. CD4^-CD8^- cells accounted for 2.3% of lymphocytes. The degranulation of NK cells decreased. Gene sequencing detected a somatic mutation in exon 2 of the NRAS gene c.38G>A(p.G13D). A total of 32 cases of RALD were retrieved, including 13 cases caused by NRAS somatic mutations and 19 cases caused by KRAS somatic mutations. The main clinical features of the 32 patients included splenomegaly, autoimmune anemia, thrombocytopenia, hypergammaglobulinemia, mononuc-leosis, a normal or slightly elevated proportion of double-negative T cells. Conclusion RALD is characterized by hepatosplenomegaly and autoimmunity, and gene testing is helpful for its diagnosis.

Objective To investigate the clinical effect and mechanism of compound azintamide combined with bifidobacteria triple viable capsules in the prevention and treatment of antibiotic-associated diarrhea (AAD) in the elderly. Methods A retrospective analysis was performed for 62 elderly patients with or comorbid with infectious diseases who were admitted to Department of Geriatrics, Taian 88 Hospital, from October 2019 to February 2021 and received intravenous drip of antibiotics, and according to the treatment method, they were divided into observation group with 32 patients (treated with compound azintamide combined with bifidobacteria triple viable capsules) and control group with 30 patients (treated with bifidobacteria triple viable capsules alone). The drugs were used in addition to antibiotics for 14 d. The two groups were compared in terms of the incidence rate of AAD, time to the onset of diarrhea, number of times of diarrhea per day, and duration of diarrhea during treatment, as well as related biochemical parameters before treatment and on day 14 of treatment, including hemoglobin (Hb), plasma albumin (Alb), total protein (TP), and the serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and complement C3 and C4. Results Compared with the control group, the observation group had a significantly lower incidence rate of AAD during treatment (χ²=5.77,P<0.05), as well as a significantly long time to the onset of diarrhea, a significant reduction in the mean number of times of diarrhea per day, and a significantly shorter duration of diarrhea (t=8.72-16.20,P<0.05). Compared with the control group on day 14 of treatment, the observation group had significantly greater changes in the serum levels of CRP, IL-6, C3, and C4 (t=-97.39--29.05,P<0.05), and the differences in the levels of blood Hb, plasma Alb, and plasma TP before and after treatment in the observation group were significantly lower than those in the control group (t=25.96-87.98,P<0.05). Conclusion Compound azintamide combined with bifidobacteria triple viable capsules has a marked clinical effect in the prevention and treatment of AAD in the elderly by improving nutritional status, enhancing immune function, and alleviating inflammatory response.

Objective To investigate the degree of satisfaction with talent introduction and related influencing factors in a hospital, and to promote the high-quality development of the hospital by improving the quality of medical staff construction and the level of healthcare talent introduction. Methods Based on the satisfaction theory, the Minnesota Employee Satisfaction Scale and Employee Satisfaction Survey Scale were used to determine seven independent variables and one dependent variable for this study. The independent variables were satisfaction with performance evaluation (A), satisfaction with salary and benefits (B), sa-tisfaction with career development (C), satisfaction with work conditions (D), satisfaction with work relationships (E), and satisfaction with talent policies (F) at the micro level and satisfaction with urban living environment at the macro level (G), and the dependent variable was willingness to join (H). A questionnaire survey was conducted among 350 talents introduced. The t-test or a one-way analysis of variance was used to analyze the differences in variables A-H in terms of sex, education level, job type, professional title, and introduction method, and the Pearson correlation coefficient was used to investigate the correlation between va-riables A-H. A regression analysis was performed for the influencing factors for willingness to join among talents, and a model was established for these influencing factors. Results There were no significant differences in variables A, C, and E between the talents with different education levels (P>0.05), while there were significant differences in variables B, D, F, G, and H (F=2.724-3.152,P<0.05). There were no significant differences in variables A, B, C, E, F, and H between the talents with diffe-rent job types (P>0.05), while there were significant differences in variables D and G (F=2.384,2.947,P<0.05). The correlation analysis of variables A-H showed a high correlation between any two variables (r=0.647-0.875,P<0.05). The regression analysis showed that B and E had a significant impact on H (P<0.05), while variables A, C, D, F, and G had no significant impact on H (P>0.05). Conclusion Salary and benefits and work relationships are the main influencing factors for talent introduction in tertiary public hospitals, with a significant impact on talent introduction. The hospital should enhance the attractiveness of salary and benefit policies, strengthen team cohesion and cooperation, and strive to create good working relationships, in order to enhance the sense of belonging among introduced talents.

Ovarian cancer is one of the most malignant gynecological tumors. Platinum-based chemotherapy is an important part of ovarian cancer treatment, with platinum resistance as a difficult problem in ovarian cancer treatment. Platinum resis-tance is a complex process involving a variety of mechanisms. This article reviews the molecular mechanisms of platinum resistance in ovarian cancer cells and the advances in treatment, in order to provide a reference for the clinical treatment of this disease.