Abstract:Objective To analyze the risk factors associated with bloodstream infections(BSIs)after kidney transplantation,and to establish and validate a quantitative risk prediction model for postoperative BSI.Methods A to-tal of 248 patients who underwent kidney transplantation between December 2020 and December 2023 were retrospectively analyzed.Patients were followed up for six months and divided into BSI and non-BSI groups according to postoperative infection status.Candidate variables were initially screened using the least absolute shrinkage and selection operator(LASSO)regression model,and significant predictors were further analyzed using multivariate logistic regression to identi-fy independent factors associated with BSIs.Sensitivity analyses were performed to evaluate model robustness.A risk pre-diction model was constructed and assessed by receiver operating characteristic(ROC)curve analysis,calibration curve,and decision curve analysis(DCA)to evaluate discrimination,calibration,and clinical utility.Results Postoperative BSIs occurred in 26 of 248 patients(10.97％).LASSO regression identified three variables with non-zero coefficients:diabetes mellitus,serum albumin(ALB),and platelet count(PLT).Multivariate logistic regression showed that diabetes mellitus(OR=2.504,95％CI:1.307-4.794,P＜0.05)was an independent risk factor for postoperative BSIs,while ALB(OR=0.475,95％CI:0.310-0.726,P＜0.05)and PLT(OR=0.609,95％CI:0.398-0.932,P＜0.05)were protective factors.Sensitivity analyses confirmed the stability of the model.The established logistic regression equa-tion was:logit=-11.259+2.504x1-0.475x2-0.609x3.The model demonstrated excellent predictive performance,with an AUC of 0.925(95％CI:0.884-0.955,Z=18.379,P＜0.001),sensitivity of 96.15％,and specificity of 87.20％.The Hosmer-Lemeshow test indicated good calibration(x2=0.641,P=0.196),and DCA showed positive net clinical benefit within the risk threshold range of0.11-0.81.Conclusion Diabetes mellitus,serum albumin,and platelet count are independent factors influencing the occurrence of bloodstream infections after kidney transplantation.The established quantitative prediction model demonstrates high accuracy,good calibration,and strong clinical applicability,providing a valuable tool for early risk assessment and individualized prevention of BSIs in kidney transplant recipients.

Abstract:Objective To study and analyze the differences in clinical characteristics,treatment plans,and short-term outcomes between patients with lupus nephritis and non-LN patients among first-time systemic lupus erythematosus patients in a real-world setting.Methods A retrospective analysis of 249 first-time SLE patient cases diagnosed at the Department of Rheumatology and Immunology,First Affiliated Hospital of Bengbu Medical University from January 2018 to January 2023.Patients were divided into the LN group(79 cases)and the non-LN group(170 cases)based on whether they had kidney involvement at the time of SLE diagnosis.The clinical features,treatment,and follow-up of both groups were compared.Results At the time of diagnosis,31.7％(79 cases)of the 249 first-time SLE patients developed LN.There were no statistically significant differences between the LN group and the non-LN group in terms of female proportion,age at onset,age at diagnosis,and disease duration(all P＞0.05).However,patients in the LN group had lower levels of hemoglobin,platelet count,serum albumin,complement C3,and complement C4 compared to those in the non-LN group(all P＜0.05).The incidence of arthritis was lower in the LN group than in the non-LN group,while the incidence of infection,pleurisy,and pericarditis was higher in the LN group than in the non-LN group(all P＜0.05).The positive rates of anti-dsDNA antibodies and anti-SSB antibodies were higher in the LN group than in the non-LN group(all P＜0.05).The SLEDAI-2000 score of LN group was higher than that of non-LN group(13.2 vs.7.4,P＜0.001),but the non-kidney SLEDAI-2000 score was lower than that of non-LN group(5.7 vs.7.4,P=0.007).The proportion of patients with severe SLEDAI-2000 score was higher than that of non-LN group,and the proportion of patients with mild SLEDAI-2000 score was lower than that of non-LN group(60.8％vs.12.9％,13.9％vs.55.3％,all P＜0.001).In the induction therapy,54 patients(80.6％)in the LN group and 80 patients(56.7％)in the non-LN group received immunosuppressive therapy,including biologies(80.6％vs.56.7％,P＜0.001).The incidence of adverse events related to infection was higher in the LN group than in the non-LN group within 12 months of treatment(28.4％vs.16.3％,P=0.043).During the follow-up period,the overall renal remission rate was higher in the LN group at 12 months compared to 6 months.At 12 months,43 patients(64.2％)achieved complete renal response,22 patients(32.8％)had partial renal response,and 2 patients(3.0％)showed no renal response.Their hemoglobin,platelet count,serum albumin,complement C3,and complement C4 levels improved significantly com-pared to before treatment(all P＜0.001).There were no statistically significant differences between the two groups in terms of mortality,tumor-related complications,and other follow-up outcomes(all P＞0.05).The proportion and time to achieving a low disease activity state or remission in both groups were not statistically significant,and there were no sig-nificant differences in the proportion and time of lupus disease activity recurrence(all P＞0.05).Conclusion In pa-tients with primary SLE,LN patients showed higher incidence of pericarditis,pleurisy,and infections,as well as higher positivity rates for Anti-dsDNA and Anti-SSB.Conversely,they exhibited lower activity of extrarenal diseases,lower incidence of arthritis,and lower serum albumin levels.After 12 months of induction therapy,LN patients demonstrated significantly improved overall renal response and related laboratory parameters,with short-term prognosis comparable to non-LN patients.

Abstract:Objective To investigate the risk factors for diabetic foot(DF)in maintenance hemodialysis patients with diabetic kidney disease(DKD),providing guidance for early detection and intervention in clinical practice.Meth-ods A retrospective analysis was conducted on 95 DKD patients undergoing maintenance hemodialysis from January 2021 to September 2023 at a tertiary hospital dialysis center in Guangdong Province.Patients were divided into DF group(n=19)and non-DF group(n=76)based on the presence of diabetic foot.Clinical data including duration of diabetes,body mass index(BMI),C-reactive protein(CRP),serum creatinine,dialysis vintage,glycated hemoglobin(HbA1c),routine blood tests,pre-dialysis urea nitrogen,urea clearance(KT/V),and presence of lower limb arterial stenosis were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for DF.Results Among 95 DKD patients on hemodialysis,19(20％)had diabetic foot.Univariate analysis showed that the DF group had higher HbA1c and CRP levels and a higher proportion of patients with lower limb arterial stenosis com-pared to the non-DF group.Multivariate logistic regression analysis revealed that elevated CRP level(OR=1.081)and presence of lower limb arterial stenosis(OR=4.885)were independent risk factors for diabetic foot in DKD patients on hemodialysis(both P＜0.05).Conclusion In this cohort,the incidence of diabetic foot in DKD patients on mainte-nance hemodialysis was 20％.High CRP levels and concomitant lower limb arterial stenosis are independent risk factors for diabetic foot.Clinicians should closely monitor CRP levels and lower limb arterial disease in these patients to imple-ment early interventions and reduce the occurrence of diabetic foot.

Abstract:Objective To evaluate the knowledge-based question answering and case reasoning capabilities of mainstream Chinese large language models(LLMs)in occupational health and to explore their potential as tools for work-ers' occupational health information access.Methods Seven LLMs,including DeepSeek-R1,DeepSeek-v3.2,Dou-bao-Seed-1.6,Doubao-Seed-1.6-Thinking,GPT-4o,Kimi-k2,and Qwen3-Max,were assessed using a test set of 842 objective questions covering laws and regulations,occupational health monitoring,basic occupational health knowledge,occupational disease diagnosis,and integrated exercises,as well as a case set of 20 real-world occupational health scenarios containing 46 questions.Each model was tested independently for three rounds,and mean accuracy with standard deviation was calculated.Pearson x2 test compared performance across question types,paired t-test evaluated chain-of-thought reasoning efficacy,and case answers were scored by professionals.Results Except for GPT-4o(48.58％±7.12％),all models achieved＞70％mean accuracy,with DeepSeek-R1 performing best(75.79％±5.82％).Significant differences in accuracy among question types were observed(P＜0.05),following the trend single-choice＞true/false＞multiple-choice.Chain-of-thought models outperformed non-chain-of-thought models(t=10.69,P＜0.001).In case reasoning,Kimi-k2(80.28％±15.81％)and Doubao-Seed-1.6(78.82％±14.54％)showed superior performance,and models generally achieved higher accuracy on occupational disease diagnosis than on occupational law questions.Conclusion Mainstream Chinese LLMs demonstrate moderate accuracy in occupa-tional health question answering and real-world case reasoning,offering a technically feasible approach to improve work-ers' access to occupational health information.LLMs hold promise as intelligent tools to enhance occupational health litera-cy and reduce informational barriers.

Abstract:Objective To analyze lymphocyte subsets and serum BDG and GAL levels in patients with sepsis complicated by invasive fungal infection(IFI),and to explore the correlation between T lymphocyte profiles and IFI.Methods A retrospective case-control study was conducted,including 47 patients with sepsis and secondary IFI(sep-sis+IFI group),50 patients with sepsis alone(sepsis group),and 50 healthy controls.Serum(1,3)-β-D-glucan(BDG)was measured by immunoturbidimetry,and galactomannan(GAL)was detected using ELISA.Peripheral white blood cells were analyzed by an automated hematology analyzer,and lymphocyte subsets were assessed using flow cytome-try.Group differences were compared,correlations between lymphocyte subsets and BDG/GAL were analyzed using Spearman's method,and diagnostic performance was evaluated by receiver operating characteristic(ROC)curves.Re-sults Compared with controls,patients with sepsis and IFI had significantly lower absolute lymphocyte counts(P＜0.05).Spearman correlation analysis showed that BDG and GAL levels were negatively correlated with absolute CD45+lymphocyte and CD3+CD4+T-cell counts(BDG:r=-0.601,-0.507;GAL:r=-0.532,-0.612;all P＜0.05).ROC analysis revealed that the area under the curve(AUC)for diagnosing IFI using BDG+GAL,BDG+GAL+CD45+lymphocyte count,and BDG+GAL+CD45+lymphocyte count+CD3+CD4+T-cell count were 0.753,0.921,and 0.962,respectively.The corresponding sensitivities were 80.00％,80.85％,and 87.23％,and specificities were 60.00％,96.00％,and 98.00％.Conclusion Sepsis patients with IFI show significant immunosuppression,as indica-ted by reduced lymphocyte subsets.Combined detection of BDG,GAL,total lymphocyte count,and CD4+T-cell count provides high diagnostic accuracy for IFI in patients with sepsis.

Abstract:Objective To evaluate the clinical efficacy of bifid triple viable capsules combined with Kangfuxin liquid in patients receiving abdominal radiotherapy.Methods A total of 80 patients diagnosed with rectal or cervical cancer and undergoing abdominal radiotherapy at Jiangxi Provincial People's Hospital from June 2021 to December 2023 were enrolled and randomly assigned into two groups(n=40 each)using a random number table.Both groups received standard radiotherapy;the observation group received additional treatment with bifid triple viable capsules and Kangfuxin liquid enema,while the control group received Kangfuxin liquid retention enema alone.The incidence,grade,and onset time of acute radiation enteritis(ARE),as well as inflammatory cytokine levels and immune function indices,were com-pared between the two groups.Results All patients completed the study.The incidence of ARE was significantly lower in the observation group than in the control group(P＜0.05).The mean time to ARE onset was longer in the observation group(P＜0.05),while the duration of ARE was shorter but not significantly different between groups(P＞0.05).After radiotherapy,interleukin(IL)-6 and tumor necrosis factor-α(TNF-α)levels significantly increased in the observa-tion group(P＜0.05),whereas IL-6,IL-8,and TNF-α levels all increased in the control group(P＜0.05).Post-radiotherapy,CD8+T cells and CD4+/CD8+ratios in the observation group decreased significantly compared with pre-radiotherapy(P＜0.001),while CD4+T,CD8+T cells,and CD4+/CD8+ratios in the control group also declined sig-nificantly(P＜0.001).Notably,CD4+T cells and CD4+/CD8+ratios after radiotherapy were higher in the observation group compared with the control group(P＜0.001).Both groups showed lower CD4+/CD8+ratios post-radiotherapy than before treatment(P＜0.001).Conclusion The combined regimen of bifid triple viable capsules and Kangfuxin liq-uid demonstrates preventive and therapeutic benefits against acute radiation enteritis in patients undergoing abdominal ra-diotherapy,indicating potential for wider clinical application.

Abstract:Small cell lung cancer(SCLC)is a highly aggressive pulmonary malignancy,and the majority of pa-tients present with disseminated disease at the time of diagnosis.Currently,immunotherapy combined with chemotherapy is the first-line treatment for extensive-stage small cell lung cancer(ES-SCLC),yet patient prognosis remains subop-timal.Intrathoracic disease progression is one of the major factors limiting long-term survival.In recent years,thoracic radiotherapy has emerged as a promising treatment option for SCLC.This article reviews recent advances in thoracic radio-therapy for patients with ES-SCLC.

Abstract:Objective To compare the clinical manifestations,laboratory findings,microbiological features,and outcomes of peritoneal dialysis-associated peritonitis(PDAP)between diabetic(DM)and non-diabetic(NDM)pa-tients undergoing peritoneal dialysis(PD).Methods Patients receiving maintenance PD who developed PDAP at the Department of Nephrology,Shantou Central Hospital,between January 2018 and December 2022 were retrospectively ana-lyzed.According to the presence or absence of diabetes mellitus,patients were divided into DM and NDM groups.Demo-graphic data,clinical vital signs at admission,laboratory parameters(hematology,biochemistry,inflammatory markers,electrolytes,and dialysate cytology),dialysate culture results,incidence of refractory peritonitis,and clinical outcomes were collected and compared between the two groups.Results A total of 155 PDAP patients were included,comprising 53 in the DM group and 102 in the NDM group.The DM group was significantly older than the NDM group(62.5±8.4 years vs.56.1±12.5 years,P=0.002),with a higher trend in systolic blood pressure(145.3±23.3 mmHg vs.136.6±29.8 mmHg,P=0.065).Compared with the NDM group,DM patients showed lower serum albumin(26.1±5.1 g/L vs.29.5±5.3 g/L,P＜0.001)and creatinine(752.9±253.8 μmol/L vs.883.4±284.0 μmol/L,P=0.007),but higher blood glucose(13.3±7.5 mmol/L vs.6.9±2.1 mmol/L,P＜0.001),triglycerides(1.7±0.9 mmol/L vs.1.4±1.1 mmol/L,P=0.002),and C-reactive protein levels(median 91.5 mg/L vs.52.9 mg/L,P=0.029),with lower serum sodium(133.4±3.9 mmol/L vs.135.3±3.9 mmol/L,P=0.007)and total cholesterol(median 3.6 mmol/L vs.4.3 mmol/L,P=0.017).There were no significant differences between the groups in peritonitis outcome(P=0.226)or incidence of refractory peritonitis(P=0.748).Simplified classification of dialysate culture results indicated a higher proportion of"other/mixed/unclassified"pathogens and a lower proportion of"negative/no growth"cases in the DM group,though the overall difference was not statistically significant(P=0.083).Conclusion In PDAP,concomi-tant diabetes mellitus is an independent factor associated with specific clinical and biochemical abnormalities.After adjust-ment for age and dialysis duration,DM patients still exhibited more pronounced malnutrition(hypoalbuminemia)and met-abolic disturbances(hypertriglyceridemia,hyponatremia).However,their more severe inflammatory response(elevated CRP)and lower serum creatinine may be largely attributable to confounding factors such as age rather than diabetes per se.Comprehensive management of PDAP patients with diabetes should emphasize nutritional support and correction of met-abolic abnormalities.

Abstract:Objective To investigate the characteristics of the vaginal microbiota in patients with different grades of cervical lesions-cervical squamous cell carcinoma(CSCC),low-grade squamous intraepithelial lesions(LSIL),and high-grade squamous intraepithelial lesions(HSIL)-and to analyze their correlation with high-risk human papilloma-virus(HR-HPV)DNA load.Methods A total of 300 patients were enrolled from January 2023 to December 2024 and categorized into LSIL,HSIL,and CSCC groups.Vaginal microbial composition was assessed via high-throughput se-quencing,and HR-HPV DNA load was simultaneously measured.Alpha diversity(Shannon index)and beta diversity metrics were used to evaluate microbial diversity.Spearman correlation analysis and multivariate regression models were applied to explore the relationships between HR-HPV DNA load and microbial abundance.Results In terms of micro-bial diversity,the LSIL group showed a significantly higher Shannon index compared to the HSIL and CSCC groups,indi-cating decreased microbial evenness with lesion progression.Regarding microbial composition,Lactobacillus abundance decreased from 60％to 20％,while Gardnerella and Prevotella increased from 10％and 5％to 40％and 30％,respec-tively.HR-HPV DNA load increased significantly with lesion severity and was negatively correlated with Lactobacillus(r=-0.45,P＜0.01)and positively correlated with Gardnerella(r=0.52,P＜0.01).Conclusion Vaginal microbi-ota dysbiosis is closely associated with HR-HPV infection and cervical lesion progression.Depletion of Lactobacillus and proliferation of pathogenic bacteria may promote lesion development by disrupting the local immune barrier and inducing inflammatory responses.Modulating the vaginal microbiota may offer a novel strategy for early prevention and intervention in cervical lesions.

Abstract:Objective To establish a scientific and standardized nursing risk assessment system for adverse reac-tions associated with novel contrast agents used in hepatic contrast-enhanced ultrasound,aiming to guide clinical nursing evaluation and intervention.Methods A preliminary index framework for the risk assessment system was developed through literature review and expert group discussions.An expert consultation questionnaire was then designed.Fifteen ex-perts from tertiary hospitals in Guangdong,Hubei,and Zhejiang provinces participated in two rounds of Delphi consulta-tions.The experts' enthusiasm,authority,and coordination were analyzed,along with the mean importance scores,coeffi-cients of variation,and full-score rates for each indicator.Results Both rounds of expert questionnaires achieved a 100％effective response rate.The expert authority coefficients were 0.91 and 0.93,and the Kendall's coordination coeffi-cients were 0.52 and 0.64,respectively.In the second round,the mean importance scores of tertiary indicators ranged from 3.00 to 4.80,with coefficients of variation between 0.09 and 0.31 and full-score rates between 40.0％and 93.33％.The final assessment system comprised 4 primary indicators,14 secondary indicators,and 34 tertiary indica-tors.Conclusion This study developed a scientific,reliable,and systematic nursing risk assessment framework for eval-uating adverse reactions to novel contrast agents in hepatic contrast-enhanced ultrasound.The system provides a practical reference for clinical nurses to formulate targeted and evidence-based nursing strategies.

Abstract:Objective To analyze the impact of using cryopreserved-thawed immotile sperm obtained via testic-ular sperm extraction on ICSI embryo quality and pregnancy outcomes,providing evidence for the clinical application of sperm cryopreservation from testicular sources in human sperm banks and reproductive centers.Methods A retrospec-tive analysis was conducted on clinical application data from 100 cases of cryopreserved testicular sperm stored at the Guangdong Human Sperm Bank between July 2017 and December 2024.Patients were divided into three groups based on sperm motility before freezing and after thawing:Group A(motile before and after freezing,n=64),Group B(motile be-fore freezing but immotile after thawing,n=9),and Group C(immotile before and after freezing,n=27).Embryo de-velopment and pregnancy outcomes were compared among groups.Results The cleavage rate[100.00(87.50,100.00)％,100.00(88.89,100.00)％,100.00(100.00,100.00)％],high-quality embryo rate[28.57(60.71,55.77)％,0.00(0.00,12.50)％,16.67(0.00,25.00)％],clinical pregnancy rate(44.83％,50.00％,16.67％),and live birth rate(34.48％,50.00％,16.67％)showed no significant differences among Groups A,B,and C(P＞0.05).However,the fertilization rate in Group C[50.00(37.50,81.67)％]was significantly lower than in Group A[88.89(70.00,100.00)％]and Group B[100.00(88.89,100.00)％](P＜0.05).Conclusion Immotile testicular sperm retain fertilization potential after cryopreservation and thawing,and can achieve comparable pregnancy out-comes to motile sperm when used for ICSI.Cryopreservation of testicular sperm represents an effective fertility preservation strategy for patients with non-obstructive azoospermia.

Abstract:Objective To analyze the characteristics of peripheral blood natural killer(NK)cells and their sub-sets in children with aplastic anemia(AA),and to explore the potential role of NK cells in the pathogenesis and progres-sion of pediatric AA.Methods Children diagnosed with AA at our hospital from March to September 2024 were en-rolled.Age-and sex-matched healthy children served as controls.Flow cytometry was used to determine the proportions of various lymphocyte populations in peripheral blood,including T cells,B cells,NK cells,and natural killer T(NKT)cells.Descriptive analyses were performed to examine relationships between NK cell subsets and hematopoietic parame-ters.Continuous variables were expressed as median(interquartile range,IQR)and compared using the Mann-Whitney U test.The Benjamini-Hochberg method was applied for false discovery rate(FDR)correction,with P＜0.05 consid-ered statistically significant.Results Seven AA patients were included.Compared with controls,AA patients had signifi-cantly lower proportions of NK cells(10.8％vs.28.2％,P=0.026 2)and NKT cells(0.92％vs.3.20％,P=0.000 6).Among NK cell subsets,the proportion of CD56^bright NK cells increased(19.0％vs.1.82％,P=0.000 6),whereas CD56^dim NK cells decreased(43.7％vs.89.8％,P=0.000 6).No significant differences were observed in T or B cell proportions(P＞0.05).Descriptive analysis suggested that CD56^dim NK cell levels tended to increase synchronous-ly with absolute neutrophil counts and the proportion of bone marrow erythroid cells.Conclusion Children with A A ex-hibit reduced peripheral NK and NKT cell counts,with NK cell subset distribution skewed toward immature cells.These changes may be associated with impaired hematopoiesis,suggesting that NK cells play a potential role in the pathogenesis of pediatric A A and warrant further investigation.

Abstract:Objective To evaluate the effects of liposomal bupivacaine(LB)and ropivacaine(R)for brachial plexus block on rebound pain in patients undergoing arthroscopic shoulder surgery.Methods Ninety patients scheduled for elective arthroscopic rotator cuff repair were randomly divided into LB group(n=45)and R group(n=45).Prior to general anesthesia,ultrasound-guided interscalene brachial plexus block was performed.The LB group received 10 mL liposomal bupivacaine(133 mg)plus 10 mL saline,and the R group received 10 mL ropivacaine(75 mg)plus 10 mL sa-line.Outcomes included incidence of rebound pain,time to first analgesic request,numerical rating scale(NRS)pain scores at 6 h(T1),12 h(T2),18h(T3),24h(T4),and 48 h(T5)after surgery,number of effective patient-con-trolled intravenous analgesia(PCIA)presses within 48 h,requirement of rescue analgesia,and postoperative complica-tions.Results The incidence of rebound pain was significantly lower in the LB group(20.5％)compared with the R group(47.6％)(P=0.008).The median time to first analgesia was longer in the LB group[43.0(18.0,48.0)h]than in the R group[12.0(7.5,18.0)h](P＜0.001).At 12 h,18 h,and 24 h postoperatively,both resting and movement NRS scores were lower in the LB group(P＜0.05).The number of PCIA presses at 0-24 h and 24-48 h was significantly lower in the LB group(P＜0.001 and P=0.010,respectively).Rescue analgesia at 24 h was required in fewer patients in the LB group(9.1％)compared with the R group(38.1％)(P=0.001).No significant differences were observed in other NRS scores or incidence of complications between groups(P＞0.05).Conclusion Liposomal bupivacaine for brachial plexus block can effectively reduce the incidence of rebound pain,prolong analgesic duration,and improve postoperative pain outcomes in patients undergoing arthroscopic shoulder surgery.

Abstract:Objective To investigate the effect of different local anesthetics for incision infiltration after cranioto-my under general anesthesia on patient-controlled intravenous analgesia(PCIA)after craniotomy under general anesthe-sia.Methods Sixty patients undergoing elective temporal lobe epilepsy lesion resection between June 2024 and May 2025 were enrolled and randomly divided into two groups(n=30 each)using a random number table.In the ropivacaine group(L group),patients received 0.5％ropivacaine(100 mg/10 mL ropivacaine hydrochloride injection+10 mL nor-mal saline)for scalp infiltration before incision.In the liposomal bupivacaine group(B group),patients received 0.665％liposomal bupivacaine(133 mg/10 mL liposomal bupivacaine+10 mL normal saline)for scalp infiltration.Postoperative analgesia was managed with a standardized PCIA protocol for 48 h.Pain intensity was assessed using the vis-ual analogue scale(VAS)at 4,12,24,and 48 h postoperatively.Additional endpoints included the number of PCIA pump presses,number of patients requiring rescue analgesics,and incidence of analgesia-related adverse events(nause-a,vomiting,dizziness,somnolence,fever).Results In the early postoperative period(4 h and 12 h),no significant differences in VAS scores were observed between groups(P＞0.05).However,at 24 h and 48 h postoperatively,analge-sia in the B group was significantly superior to that in the L group,with lower VAS scores(P＜0.05).The frequency of PCIA pump presses was markedly reduced in the B group compared with the L group(P＜0.05).The proportion of pa-tients requiring rescue analgesics was significantly lower in the B group(P＜0.05).The overall incidence of postoperative adverse events was also significantly lower in the B group compared with the L group(P＜0.05).Conclusion Liposom-al bupivacaine scalp incision infiltration is a safe and effective method for postoperative analgesia in craniotomy patients.Compared with ropivacaine,it provides superior pain control,reduces the need for additional analgesics,and lowers the incidence of adverse events.

Abstract:As a crucial component of perioperative analgesia.Nerve block plays a critical role in optimizing anal-gesic efficacy and reducing opioid consumption.There is a growing clinical demand for ultra-long-acting local anesthet-ics that offer both prolonged analgesic efficacy and a favorable safety profile.Liposomal bupivacaine(LB),a representa-tive of novel ultra-long-acting sustained-release local anesthetics,has been increasingly applied in perioperative nerve block due to its prolonged analgesic effect.This review summarizes the pharmacological characteristics,current clinical applications,and recent advances of LB in nerve block,aiming to provide a reference for clinical practice.

Abstract:Objective To evaluate the efficacy and safety of ultrasound-guided rectus sheath block with two dif-ferent local anesthetics for postoperative analgesia in abdominal surgery.Methods A total of 90 patients who underwent abdominal midline incision surgery under general anesthesia at the Shaoxing Second Hospital Medical Community General Hospital between November 2023 and July 2024 were enrolled.Patients were randomized into three groups(n=30 each):liposomal bupivacaine group(Group A),bupivacaine hydrochloride group(Group B),and control group(Group C).Group A received ultrasound-guided bilateral rectus sheath block with 10 mL(133 mg)liposomal bupivacaine plus 10 mL normal saline per side;Group B received 20 mL of 0.25％bupivacaine hydrochloride per side;Group C did not un-dergo nerve block.The primary outcome was the visual analogue scale(VAS)score at 48 h postoperatively.Secondary outcomes included VAS scores at PACU and 12,24,and 72 h postoperatively,patient-controlled analgesia(PCA)press times and drug consumption at 24 and 48 h,rescue analgesia use,length of hospital stay,and adverse events.Results Compared with Group C,both Groups A and B had significantly lower VAS scores at PACU and at 12,24,48,and 72 h postoperatively(P＜0.05).Group A had significantly lower VAS scores at 24 h and 48 h than Group B(P＜0.05).PCA press times and drug consumption at 24 h and 48 h were significantly reduced in Groups A and B compared with Group C(P＜0.05).Group A showed lower PCA press times and drug consumption at 48 h compared with Group B(P＜0.05).No significant differences were found among the three groups in rescue analgesia requirements or hospital stay(P＞0.05).The incidence of anesthesia-related adverse events,including nausea,vomiting,dizziness,and pruritus,did not differ significantly among groups(P＞0.05).No puncture-related complications occurred in Groups A or B.Conclusion Ultrasound-guided rectus sheath block with liposomal bupivacaine provides superior analgesia within 72 h after abdominal midline incision surgery compared with bupivacaine hydrochloride,without increasing adverse events.

Abstract:With the widespread implementation of Enhanced Recovery After Surgery(ERAS)protocols,perioper-ative pain management has become a key component in thoracic and abdominal surgery.Traditional local anesthetics have a short duration of action(usually less than 8 hours),which is insufficient to cover the peak period of postoperative acute pain,leading to increased opioid consumption and higher risk of related adverse effects.Ultra-long-acting local anes-thetics achieve sustained drug release through lipid-based or polymer-based carrier systems,extending analgesic dura-tion to over 72 hours and significantly improving postoperative recovery quality.This review systematically summarizes the mechanisms of action,clinical applications,safety,and technical challenges of ultra-long-acting local anesthetics in thoracic and abdominal surgery,and discusses future directions to optimize perioperative analgesic strategies.

Abstract:Objective To analyze and compare the effects and clinical significance of hysteroscopic electrosurgi-cal resection and cold knife resection on endocrine function and fertility in women of reproductive age with endometrial pol-yps.Methods A retrospective analysis was conducted on 232 patients diagnosed with endometrial polyps at Hangzhou Hospital of Traditional Chinese Medicine from October 2020 to October 2023.Based on the surgical method,patients were divided into a control group(n=104,electrosurgical resection)and a study group(n=128,cold knife resection).Both groups were followed up for one year postoperatively.The study compared menstrual and endometrial conditions,recur-rence,hormone levels[estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),progesterone(P)],postoperative complications,and pregnancy outcomes between the two groups.Results There were no statistically significant differences between the two groups in terms of age,BMI,disease duration,gravidity,number of intrauterine surgeries,polyp diameter,or number of endometrial polyps(P＞0.05).In the perioperative period,the study group had significantly shorter operative time,less intraoperative bleeding,and shorter postoperative vaginal bleeding duration com-pared to the control group(P＜0.05),while hospitalization duration was similar(P＞0.05).Regarding menstrual and endometrial parameters,there were no significant intergroup differences in intermenstrual bleeding,time to menstrual re-covery,endometrial thickness,PBAC score before surgery,menstrual cycle length,or duration of menstruation(P＞0.05).However,both groups showed extended menstrual cycles and reduced PBAC scores and menstruation duration postoperatively,with the study group showing more significant improvement(P＜0.05).Regarding hormone levels,no significant differences were observed preoperatively(P＞0.05).Postoperatively at 1,3,and 6 months,both groups ex-hibited decreased levels of E2,FSH,and LH,and increased P levels compared to baseline,with changes more pro-nounced in the study group(P＜0.05).The incidence of complications(27.88％vs.12.50％)and recurrence(15.38％vs.7.03％)were significantly lower in the study group than in the control group(P＜0.05).The pregnancy rate among patients desiring fertility was higher in the study group(72.92％)compared to the control group(61.45％),although this difference was not statistically significant(P＞0.05).Conclusion Hysteroscopic cold knife resection of endometrial polyps provides favorable clinical outcomes,effectively reduces postoperative recurrence,improves menstrual patterns and sex hormone profiles,and may enhance fertility outcomes and perioperative recovery in women of reproductive age.

Abstract:Objective To investigate the etiological characteristics of severe community-acquired pneumonia(SCAP)in children and to construct a predictive model for poor outcome(PO).Methods A total of 240 pediatric pa-tients diagnosed with SCAP between January 2021 and December 2023 were enrolled according to inclusion and exclusion criteria.Clinical data and etiological findings were collected.Based on whether the children experienced a poor prognosis(PO),they were divided into a PO group and a non-PO group.Univariate and multivariate Cox proportional hazards re-gression analyses were performed to identify independent risk factors associated with PO.A nomogram model was then de-veloped using R software.Model performance was evaluated using the area under the ROC curve(AUC),concordance in-dex(C-index),calibration curve,and decision curve analysis(DCA),with internal validation conducted via the boot-strap method.Results A total of 350 pathogens were identified in the 240 children,including 212 bacterial strains(60.57％),70 viruses(20.00％),60 Mycoplasma pneumoniae(17.14％),and 8 Chlamydia pneumoniae(2.29％).Mixed infections were observed in 88 cases(25.14％).Variables with significant differences in univariate analysis were included as independent variables,and PO occurrence was the dependent variable in the multivariate logistic regression a-nalysis.The results showed that mixed infection,altered mental status,hemoglobin(Hb)＜90 g/L,albumin(ALB)＜30 g/L,and neutrophil-to-lymphocyte ratio(NLR)≥3.5 were independent risk factors for PO in children with SCAP(P＜0.05).The predictive model had a C-index of 0.754(95％CI:0.677-0.830).The Hosmer-Lemeshow good-ness-of-fit test showed x2=3.525,P=0.897,indicating good model calibration.DC A revealed that when the thresh-old probability ranged from 32％to 94％,the model provided a high net clinical benefit.Conclusion Mixed infections,altered consciousness,Hb＜90 g/L,ALB＜30 g/L,and NLR≥3.5 are associated with poor prognosis in children with SCAP.The nomogram-based predictive model established in this study may help clinicians identify high-risk patients early and implement timely interventions to improve outcomes.

Abstract:Large-conductance calcium-activated potassium(BKCa)channels are crucial ion channels widely expressed throughout the human body.These channels have a complex structure and play essential roles in various physio-logical functions through allosteric activation.BKCa channels participate in the regulation of critical biological processes such as blood pressure,heart rate,and neural transmission.Abnormal activation or inactivation of BKCa channels can lead to prolonged action potential duration,excessive contraction of smooth muscle,or aberrant neuronal discharges,con-tributing to multiple pathological conditions.This review provides a brief overview of the structural features,functional properties,regulatory mechanisms,and physiological and pathological roles of BKCa channels,as well as their association with related diseases.The aim is to offer a comprehensive understanding and novel perspectives for further in-depth re-search into BKCa channels.