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Jie Liu,1,2,* Yongkai Wang,3,* Zhihui Jiang,4,* Guangqi Duan,1 Xiaowen Mao,5 Danping Zeng2 1Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 2Department of General Surgery and Urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China; 3Department of Hepatobiliary Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 4Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, People’s Republic of China; 5Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Danping Zeng, Department of General surgery and urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, No. 225, Xinyang Road, Nanning City, Guangxi Zhuang Autonomous Region, 530003, People’s Republic of China, Email zengdp000@icloud.com Xiaowen Mao, Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, 746 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, People’s Republic of China, Email xiaowenmao0927@163.comPurpose: The objective of this study was to develop and validate a nomogram for predicting the need for surgical intervention in pediatric intussusception after pneumatic reduction.Patients and Methods: This retrospective study analyzed the clinical data of children with acute intussusception admitted to four hospitals in China from January 2019 to January 2022. Based on the results of pneumatic reduction, the patients were divided into two groups: the successful reduction group (control group) and the failed reduction group (operation group). The total sample was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was performed to establish a predictive model for surgical risk.Results: A total of 1041 samples were included in this study, with 852 in the control group and 189 in the operation group. Among the total sample, 728 cases were used for training and 313 cases were used for validation. Logistic regression analysis of the training set identified age, time of abdominal pain, presence or absence of hematostoecia, C-reactive protein value from blood test on admission, and nested position indicated by B-ultrasound as independent predictors of intussusception intervention. Based on the five independent risk factors identified through multivariate logistic regression, a nomogram was successfully constructed to predict the failure of resetting by air enema under X-ray.Conclusion: A nomogram was developed to predict the need for surgical intervention after intussusception pneumatic reduction in children. The nomogram was based on clinical risk factors including age, time of abdominal pain, presence or absence of blood in stool, value of C-reactive protein in blood test on admission, and nested position indicated by B-ultrasound. Our internal validation demonstrated that this nomogram can serve as a useful tool for identifying risk factors associated with failure of air enema in children with intussusception.Keywords: pediatric, intussusception, pneumatic reduction, nomogram, surgical intervention

Qiaomin Xu,1 Xintong Zou,2 Jimin Wu,1 Gongchen Duan,1 Haiyan Lan,1 Liangrong Wang2 1Department of Anesthesiology, Lishui People’s Hospital, Lishui, 323000, People’s Republic of China; 2Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of ChinaCorrespondence: Liangrong Wang, The First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Lucheng District, Wenzhou City, Zhejiang Province, 325000, People’s Republic of China, Tel +86 13587884540, Email arerong1984@126.comBackground: Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough.Patients and methods: Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period.Results: The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05).Conclusion: Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction.Clinical Trial Registration Number: Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).Keywords: alfentanil, sufentanil, cough, anesthesia induction

Xiaofen Li,1 Jimin Wu,2 Haiyan Lan,2 Weifeng Shan,2 Qiaomin Xu,2 Xiaoli Dong,2 Gongchen Duan2 1Nursing Department, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, People’s Republic of China; 2Department of Anesthesiology, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, People’s Republic of ChinaCorrespondence: Gongchen Duan, Department of Anesthesiology, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, No. 1188, Liyang Street, Lishui, Zhejiang, 323000, People’s Republic of China, Tel/Fax +8618957093030, Email 981225178@qq.comPurpose: This study was performed to evaluate the effects of intraoperative intravenous lidocaine on postoperative delirium in elderly patients with hip fracture.Patients and methods: In total, 100 elderly patients undergoing hip fracture surgery were randomized to the lidocaine group (Group L) or saline (control) group (Group C). Before anesthetic induction, Group L received lidocaine at 1 mg/kg for more than 10 minutes followed by continuous infusion at 1.5 mg/kg/h until the end of surgery. Group C received normal saline, and the injection methods were consistent with those in Group L. General anesthesia was induced with propofol, sufentanil, and cis-atracurium. Anesthesia was maintained by propofol and remifentanil. The primary outcome was the incidence of postoperative delirium in the first 7 postoperative days. The secondary outcomes included the severity of delirium, onset and duration of delirium, emergence agitation, adverse events, total propofol dose, intraoperative opioid dosage, length of post-anesthesia care unit stay, extubation time, and patient satisfaction with postoperative pain management.Results: All 100 patients completed the study. The incidence of postoperative delirium was lower in Group L than in Group C (14% vs 36%, P = 0.011). The delirium severity scores were lower in Group L (3 [3– 4]) than in Group C (4 [4– 5]) (P = 0.017). In addition, the incidences of hypertension, tachycardia, and emergence agitation were significantly lower in Group L than in Group C. No cases of local anesthetic toxicity occurred in either group.Conclusion: Patients received lidocaine at 1 mg/kg for more than 10 minutes followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, which can reduce the incidence of postoperative delirium in elderly patients undergoing hip fracture. In addition, the used regimen of lidocaine would not increase the risk of local anesthetic toxicity.Keywords: lidocaine, postoperative delirium, hip fracture, elderly patients

Guangyou Duan,1,&ast; Haibo Deng,2,&ast; Hong Fu,3 Lingzhi Wang,4 Hanyu Yang5 1Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing City, 400000, People’s Republic of China; 2Department of Anesthesiology, Huizhou Third People’s Hospital, Guangzhou Medical University, Guangzhou, 516002, People’s Republic of China; 3Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, People’s Republic of China; 4Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 051026, People’s Republic of China; 5Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangyou Duan, Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Road, Chongqing City, 400000, People’s Republic of China, Email duangy@hospital.cqmu.edu.cnPurpose: This study aimed to compare the electrolyte balance efficacies of two Gelatin-Balanced Crystalloid in clinical applications.Methods: A multi-center, prospective, randomized, single-blind, parallel controlled study was conducted among non-cardiac surgery patients, with clinical registration number ChiCTR2200062999. They were randomized into Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection (SG-MESAI) group (experimental group) and Succinylated Gelatin Injection (SGI) infusion group (control group). The same anesthetic induction technique, anesthetic method, and calculation method for the volume of colloid infusion were used in the two groups. Between-group differences in the changes in base excess (BE), Chloride ion (Cl−), bicarbonate radical (HCO3⁻) and other parameters were recorded at 15 min, 30 min after the infusion relative to the baseline. Hemodynamic indicators were determined at 30 min after colloid infusion. Safety follow-up was conducted by administering the following tests within 48 h± 12 h after surgery.Results: A total of 225 subjects (full analysis set) were finally enrolled, with 110 subjects in the experimental group and 115 subjects in the control group. The baseline data were comparable between the two groups. At 15 min after infusion, the mean changes in BE, Cl− and HCO3⁻ concentration in the experimental group were smaller than those of the control group (P< 0.001). At 30 min after surgery, the mean changes in BE, Cl−, HCO3⁻concentration and pH value were smaller in the experimental group than in the control group (P< 0.05). The incidences of adverse events and adverse reactions in the experimental group was less than the control group, but the difference was not statistically significant (P≥ 0.05). Besides, no serious adverse events or adverse reactions were reported in any subjects.Conclusion: Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection maintained the balance of BE, Cl−, HCO3⁻ and pH value in a better way than Succinylated Gelatin Injection in non-cardiac surgery patients under general anesthesia.Keywords: anesthesia, non-cardiac surgery, fluid therapy, drug clinical trial, succinylated gelatin, multiple electrolytes and sodium acetate injection

Haiyan Lan, Weifeng Shan, Yini Wu, Qiaomin Xu, Xiaoli Dong, Peiyi Mei, Gongchen Duan, Minji You, Linfei Jin, Jimin Wu Department of Anesthesiology, Lishui City People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, People’s Republic of ChinaCorrespondence: Jimin Wu, Department of Anesthesiology, Lishui City People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, No. 15, Dazhong Street, Lishui, Zhejiang Province, 323000, People’s Republic of China, Email wujimin2022@163.comObjective: To compare the efficacy and safety of ciprofol and propofol for sedation during hysteroscopy.Methods: A total of 149 patients undergoing hysteroscopy were randomly assigned to a ciprofol (Group C) or propofol group (Group P). All cases received intravenous sufentanil 0.1 μg/kg for analgesic preconditioning. Group C received an induction dose of ciprofol 0.4 mg/kg and a maintenance dosage of 0.6– 1.2 mg/kg/h to maintain BIS value between 40– 60. In Group P, propofol was started at 2.0 mg/kg and then maintained at 3.0– 6.0 mg/kg/h. The primary outcome was the successful rate of hysteroscopy. Secondary outcomes included the change of hemodynamic, respiratory adverse events, injection pain, body movement, recovery time, anesthetist’s satisfaction, time of disappearance of the eyelash reflex and the incidence of nausea and vomiting.Results: The success rate of hysteroscopy in each group was 100%. After drug administration, the incidence of hypotension in Group C was much lower than that in Group P (P< 0.05). The incidence of respiratory adverse events in Group C (4.0%) was much lower than that in Group P (31.1%) (P< 0.05). The incidence of injection pain and body movement in Group C was significantly lower than that in Group P (P< 0.05). The mean eyelash reflex disappearance time was less than 3 minutes in both groups. There was no statistically significant difference between the two groups in awakening times, anesthetist’s satisfaction and the incidence of nausea and vomiting. No serious adverse events occurred in any patients.Conclusion: Ciprofol proved to be a safer alternative to propofol for anesthesia during hysteroscopy. In comparison to propofol, ciprofol does not cause injection pain, exerts less impact on hemodynamics, and results in less respiratory depression.Keywords: ciprofol, propofol, sedation, anesthesia, hysteroscopy

Zhuoxi Wu,1,&ast; Mi Yang,1,&ast; Peng Zhao,1,2 Feng Zou,1 Jing Peng,1 Qiangting Deng,3 Guangyou Duan,4,&ast; Hong Li1,&ast; 1Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People’s Liberation Army of China, Chongqing, People’s Republic of China; 2Department of Anesthesiology, Chinese People’s Liberation Army of China (PLA) No. 964 Hospital, Changchun, People’s Republic of China; 3Editorial Office of Journal of Third Military Medical University, Army Medical University, People’s Liberation Army of China, Chongqing, People’s Republic of China; 4Department of Anesthesiology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong Li; Guangyou Duan, Email lh78553@163.com; dgy1986anesthesia@126.comBackground: Our previous study found that a long-term diet incorporating spicy foods can reduce the human basal pain threshold. Capsaicin is the pungent ingredient in chili peppers. Transient receptor potential vanilloid type1 is the capsaicin receptor expressed in the oral cavity and is the primary sensory neuron of the “pain” pathway. Few studies have examined the association between long-term spicy diet and chronic postsurgical pain (CPSP). Women who underwent elective cesarean section (eCS) have consistent characteristics of CPSP. This study aimed to investigate the relationship between a long-term spicy diet and the incidence of CPSP after eCS.Methods: Participants were divided into a low frequency group (LF, numerical rating scale (NRS)< 5) for spicy food consumption and a high frequency group (HF, NRS≥ 5) by receiver operator characteristic analysis. The primary outcome was the incidence of CPSP three months after eCS. Propensity score matching (PSM) analysis was performed between the two frequency groups. Stepwise logistic regression analysis was then performed.Results: Of the 1029 enrolled patients, data from 982 were analyzed 3 months after eCS. After PSM, the incidence of CPSP in the HF group (30.1% [108/359]) was higher than that in the LF group (19.8% [71/359]; P = 0.001). Compared with the LF group, the risk of CPSP in the HF group increased 1.61 times by 3 months (95% CI 1.18– 2.20, P = 0.003). PSM results found that 1 year, the incidence of CPSP in the HF group (15.2% [56/369]) was higher than that in the LF group (8.1% [30/369], P = 0.003).Conclusion: With an NRS≥ 5 as a boundary, women who consumed spicy food ≥ 2 days/week were more likely to have CPSP than those who consumed spicy food < 2 days/week.Keywords: long-term spicy diet, chronic postsurgical pain, capsaicin, TRPV1, cesarean section

Shuangqing Chen,1,2 Shicheng Liu,1 Siwei Xu,3 Shumin Cao,4,5 Zhaohui Han,1,2 Lingxin Kong,1,5 Dahu Ren,1,5 Guochen Duan6 1Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050057, People’s Republic of China; 2Graduate School, Hebei North University, Zhangjiakou, 075000, People’s Republic of China; 3Department of Thoracic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, 050057, People’s Republic of China; 4Department of Oncology, Hebei General Hospital, Shijiazhuang, 050057, People’s Republic of China; 5Graduate School, Hebei Medical University, Shijiazhuang, 050011, People’s Republic of China; 6Department of Thoracic Surgery, Children’s Hospital of Hebei Province, Shijiazhuang, 050000, People’s Republic of ChinaCorrespondence: Guochen Duan, Children’s Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +8613513380703, Email duanguoc@126.com Shicheng Liu, Hebei General Hospital, No. 348, Heping West Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +861309388955, Email 1309388955@qq.comBackground: The routine clinical nutritional and inflammatory indicators such as serum albumin, total cholesterol and lymphocytes have been widely investigated in the prognosis of small cell lung cancer (SCLC). The Naples prognostic score (NPS), based on nutritional and inflammatory status, has been identified as a prognostic impactor in several malignancies. However, the prognostic role of NPS in SCLC has not been elucidated. This study aims to evaluate the prognostic effect of NPS in SCLC patients.Patients and Methods: Patients with SCLC were recruited at Hebei General Hospital between April 2015 and August 2021. Pretreatment clinical and laboratory data were obtained. Participants were assigned into three groups according to NPS (group 0: NPS=0, group 1: NPS=1 or 2, group 2: NPS=3 or 4). Kaplan-Meier and Cox regression analysis were performed to assess the prognostic significance of NPS. The RMS package in R software was used to draw the nomogram predictive model.Results: A total of 128 patients were enrolled. The median progression-free survival (PFS) and overall survival (OS) was 7.2 and 12.3 months, respectively. The median PFS and OS was 12.3 vs 19.8 months, 7.6 vs 14.1 months and 6.0 vs 8.45 months for the three groups respectively. There were significant differences in both OS and FPS among the three groups. Survival analysis showed that NPS was significantly correlated with both OS and PFS (P< 0.05). Lower NPS is associated with longer OS and PFS. Multivariate analysis showed that NPS has an independent prognostic impact on OS (P< 0.05). The nomogram predictive model showed that NPS has good predictive power for survival rates.Conclusion: NPS is an independent prognostic factor for OS in SCLC patients. Low NPS may predict longer OS. Therefore NPS plays a vital role in the nomogram predictive model of survival rates in SCLC patients.Keywords: small cell lung cancer, Naples prognostic score, prognostic factor, nomogram predictive model

Mengyue Fu,1,&ast; Shi Chen,2,&ast; Rui Xu,1 Jie Chen,1 Xuehan Chen,1 Wanxia Gan,1 He Huang,1 Guangyou Duan1 1Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Anesthesiology, Chongqing Beibu Maternity Hospital, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangyou Duan; He Huang, Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China, Email duangy@hospital.cqmu.edu.cn; huanghe@cqmu.edu.cnPurpose: This study aimed to explore the effects of intravenous analgesia using tramadol on postoperative depression, anxiety, and sleep in women undergoing abdominal endoscopic surgery.Patients and Methods: Two hundred female patients (100 in each group) who underwent abdominal endoscopic surgery were recruited to randomly receive intravenous analgesia with sufentanil combined with tramadol (tramadol group) or sufentanil (control group). The primary outcome was the incidence of postoperative depression, which was assessed at 1, 2, and 3 days after surgery using the 13-item Beck Depression Inventory. The secondary outcomes were the incidence of anxiety and sleep quality, which were assessed using the 20-item Self-Rating Anxiety Scale and Richards–Campbell Sleep Questionnaire.Results: The incidence of depression (Beck depression scale≥ 4) during the 3-day follow-up in the control group was 51%, which was significantly higher than that in the tramadol group of 28% (relative risk [RR]=0.55; 95% confidence interval [CI], 0.38– 0.79; P=0.001). No difference was found in the incidence of anxiety state (Self-Rating Anxiety Scale≥ 40) between the tramadol and control groups (7%vs 5%; RR=1.40; 95% CI, 0.46– 4.25; P=0.552). All of the Richards–Campbell sleep scales of patients in the tramadol group at 1 (77.4± 15.2 vs 64.2± 20.1, P< 0.001), 2 (84.1± 14.9 vs 71.8± 18.8, P< 0.001), and 3 days (87.0± 12.2 vs 70.3± 21.0, P< 0.001) after surgery were higher than those in the control group.Conclusion: Intravenous analgesia using tramadol can effectively improve the postoperative depression and sleep status of women undergoing abdominal endoscopic surgery. Tramadol is recommended for use in postoperative analgesia when improving postoperative mood, and sleep is needed in clinical practice.Keywords: women, depression, anxiety, sleep, abdominal surgery

Wenfei Xue1 1, Xiaopeng Zhang2 2, Zhancong Niu3 3, Zhifei Xin2 2, Hua Zhang2 2, Qingtao Zhao1 12 2, Jie He2 2, Zhonghui Hu2 2, Guochen Duan1 1 1Study Office of Thoracic Surgery, Hebei Medical University, Shijiazhuang, 050017, People’s Republic of China; 2Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050000, People’s Republic of China; 3Department of Infectious Diseases, Hebei General Hospital, Shijiazhuang, 050000, People’s Republic of ChinaCorrespondence: Guochen DuanStudy Office of Thoracic Surgery, Hebei Medical University, No. 361, Zhongshan East Road, Changan District, Shijiazhuang, 050017, People’s Republic of ChinaTel +86 13513380703Email duanguoc@126.comBackground: The object of the study was to elucidate the relationship between the neutrophil–lymphocyte ratio (NLR) and the growth of pulmonary ground-glass opacity (GGO) in stage IA lung adenocarcinoma.Methods: All patients with GGO following surgical procedures were enrolled, with the time of follow-up and the variation tendency of GGO recorded. Meanwhile, laboratory parameters, age, gender, smoking history, histology, tumor size, and stage were recorded. Logistic regression was used to evaluate the value of NLR and the cutoff value was calculated by SPSS 22.0.Results: In the whole cohort, 30 cases of growing GGO and 43 cases of stable GGO undergoing surgical procedures were diagnosed as lung adenocarcinoma. There was significant statistical difference between the two groups. Multivariable analysis showed that NLR could predict the GGOs with growth (odds ratio 5.198, 95% confidence interval (95%CI: 1.583– 14.581, P=0.002). Receiver operating characteristics analysis for NLR showed the optimal cutoff value of 2.38, with a sensitivity of 60.0% and specificity of 81.4%.Conclusion: Our study demonstrated that the NLR appeared to have value as a promising clinical predictor of GGOs with growth. Further studies are needed to confirm this conclusion.Keywords: neutrophil–lymphocyte ratio, ground-glass opacity, early lung adenocarcinoma

Zhonghui Hu,1,2,* Wenbo Wu,1,3,* Xiaopeng Zhang,1 Ping Li,4,* Hua Zhang,1 Huien Wang,1 Wenfei Xue,1 Zhiguo Chen,5 Qingtao Zhao,1 Guochen Duan1,5 1Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China; 2Graduate School, Hebei Medical University, Shijiazhuang, People’s Republic of China; 3Graduate School, Hebei North University, Zhangjiakou, People’s Republic of China; 4Department of Thoracic Surgery, Zigong First People’s Hospital, Zigong, People’s Republic of China; 5Department of Thoracic Surgery, Hebei Children’s Hospital, Shijiazhuang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guochen DuanHebei Children’s Hospital, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, 050000, People’s Republic of ChinaTel +86 311 13380703Email duanguoc@126.comQingtao ZhaoHebei General Hospital, No. 384 Heping West Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of ChinaTel +86 311 85988756Email tao11182004@163.comPurpose: Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in advanced non small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC) and operable NSCLC. However, there were no studies of the correlation between ALI and operable SCLC. Therefore, this study is aimed to explore the relationship between ALI and the prognosis of operable SCLC.Patients and Methods: A total of 48 patients with SCLC who underwent surgery at Hebei General Hospital and Zigong First People’s Hospital were screened between 2016 and 2020. ALI was calculated as follows: body mass index (BMI, kg/m2)×serum albumin (ALB, g/dL)/neutrophil to lymphocyte ratio (NLR). Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of ALI. Patients were divided into two groups according to the cutoff point of ALI: low ALI group with ALI< 48.2 and high ALI group with ALI≥ 48.2. Kaplan-Meier and Cox regression analysis were performed to assess the potential prognostic factors associated with OS.Results: The optimal cutoff value of ALI was determined as 48.2. The low ALI group displayed more adverse clinical characteristics and poorer survival rates. Multivariate analysis revealed that ALI and Charlson comorbidity index (CCI) were significantly correlated with OS.Conclusion: Low ALI was correlated with poor prognosis in patients with SCLC who underwent surgery. Preoperative ALI might serve as a potential prognostic marker for patients with operable SCLC.Keywords: ALI, SCLC, surgery, prognosis

Guangyou Duan,* Kai Wang,* Taotao Peng, Zhuoxi Wu, Hong Li Department of Anesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong LiDepartment of Anesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, People’s Republic of ChinaTel +8613608380123Fax +862368774997Email lh78553@163.comObjective: The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine.Methods: A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were > 6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use.Results: In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43– 0.56]) and matched cohort (0.49 [95% CI: 0.42– 0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13– 0.33; P< 0.0001) and 0.30 (95% CI,0.19– 0.47; P< 0.0001), respectively. In addition, low-dose dexmedetomidine (0.2– 0.4 μg·kg− 1·h− 1) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31– 0.44; P< 0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P< 0.0001) than that in the medium- (0.4– 0.6 μg·kg− 1·h− 1) and high-dose (0.6– 0.8 μg·kg− 1·h− 1) groups.Conclusion: Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2– 0.4 μg·kg− 1·h− 1) is most effective for prevention of postoperative sleep disturbance.Keywords: dexmedetomidine, intraoperative use, postoperative sleep disturbance

Guiying Yang, Xiaohang Bao, Jing Peng, Jie Li, Guangming Yan, Sheng Jing, Hong Li, Guangyou Duan Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People’s Republic of ChinaCorrespondence: Hong Li; Guangyou DuanDepartment of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of ChinaTel +8618323376014Fax +862368774997Email lh78553@163.com; dgy1986anesthesia@126.comPurpose: This study aimed to compare the analgesic outcomes between primary and repeated cesarean delivery.Patients and Methods: We performed a retrospective analysis based on the medical records of a teaching hospital in China from January 2018 to March 2019. We collected data on demographic characteristics, perioperative complications, anesthesia, and surgical factors for cesarean delivery patients. We also recorded the postoperative analgesic strategy, pain intensity (assessed by the number rating scale) during the first 48 hrs after surgery, hospital cost, and hospital stay. Postoperative inadequate analgesia was defined by a score of ≥ 4 in the number rating scale. Analgesic outcomes after cesarean delivery between primiparas and multiparas were compared using propensity score matching analysis. Moreover, subgroup logistic analysis for different age groups (≥ 35 and < 35 years) was performed to investigate the effect of the maternal category on postoperative inadequate analgesia.Results: A total of 1543 patients were included in the analysis and 571 pairs (1142 patients) were matched in the primiparas and multiparaparas group according to their propensity score. In both the non-matched and matched cohort, the incidence of inadequate analgesia in the primiparas group was lower than that in the multiparas group (16.7% vs. 24.0%, P < 0.001 and 16.1% vs. 23.5%, P = 0.002; respectively). The multiparas group was identified as being at risk of inadequate analgesia after cesarean delivery in both age groups (age ≥ 35 years, odds ratio: 2.18, 95% confidence interval: 1.20– 3.95; age < 35 years, odds ratio: 1.43, 95% confidence interval 1.08– 1.89).Conclusion: Multiparas that undergo a repeat cesarean delivery had a significantly higher risk of inadequate postoperative pain treatment than primiparas. The maternal category should be considered when formulating the postoperative analgesia strategy after cesarean delivery.Keywords: cesarean delivery, analgesia, primipara, multipara

Mengchen Li,1 Qiaoli Liu,1 Yanli Teng,1 Liuyang Ou,1 Yuanlin Xi,1 Shuaiyin Chen,1,* Guangcai Duan1,2,* 1Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 2Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical College, Xinxiang, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shuaiyin Chen; Guangcai DuanDepartment of Epidemiology, College of Public Health, Zhengzhou University, No.100 Kexue Avenue, Zhengzhou, Henan 450001, People’s Republic of ChinaTel +86 1 352 340 8394Fax +86 6 778 1453Email sychen@zzu.edu.cn; gcduan@yeah.netBackground: Multi-drug-resistant Escherichia coli poses a great threat to human health, especially resistant to ampicillin (AMP), but the mechanism of drug resistance is not very clear.Purpose: To understand the mechanism of resistance of E. coli to beta-lactam antibiotics by inducing drug resistance of sensitive bacteria in laboratory.Methods: Clinical sensitive E. coli strain was induced into resistance strain by 1/2 minimum inhibitive concentration (MIC) induced trails of AMP. The drug resistance spectrum was measured by modified K-B susceptibility test. Whole-genome sequencing analysis was used to analyze primary sensitive strain, and resequencing was used to analyze induced strains. Protein tertiary structure encoded by the gene containing single nucleotide polymorphism (SNP) was analyzed by bioinformatics.Results: After 315 hrs induced, the MIC value of E. coli 15743 reached to 256 μg/mL, 64 times higher than that of the sensitive bacteria. During the induction process, the bacterial resistance process is divided into two stages. The rate of drug resistance occurs rapidly before reaching the critical concentration of 32 μg/mL, and then the resistance rate slows down. Sequencing of the genome of resistant strain showed that E. coli 15743 drug-resistant strain with the MIC values of 32 and 256 μg/mL contained four and eight non-synonymous SNPs, respectively. These non-synonymous SNPs were distributed in the genes of frdD, ftsI, acrB, OmpD, marR, VgrG, and envZ.Conclusion: These studies will improve our understanding of the molecular mechanism of AMP resistance of E. coli, and may provide the basis for prevention and control of multi-drug-resistant bacteria and generation of new antibiotics to treat E. coli infection.Keywords: Escherichia coli, ampicillin, drug resistance

Shujie Wang1,*, Erhei Dai2,*, Xiaoyuan Jiang3, Lijun Zeng3, Qiaoxiang Cheng2,3, Ying Jing3, Lingfei Hu3, Zhe Yin3, Bo Gao3, Jinglin Wang3, Guixin Duan4, Xuehui Cai1, Dongsheng Zhou3 1State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin 150069, People’s Republic of China; 2Department of Laboratory Medicine, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang, Hebei 050021, People’s Republic of China; 3State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, People’s Republic of China; 4Animal Science and Technology College, Heilongjiang Bayi Agricultural University, Daqing 163000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dongsheng ZhouState Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No. 20 Dongdajie Street, Fengtai District, Beijing 100071, People’s Republic of ChinaTel +86 106 694 8503Email dongshengzhou1977@gmail.comXuehui CaiState Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, No. 678 Haping Road, Xiangfang District, Harbin 150069, People’s Republic of ChinaTel +86 4 515 105 1766Email aci139@sina.comBackground: Multiple incompatibility (Inc) groups of plasmids have been identified in Enterobacteriaceae species, but there are still quite a few sequenced plasmids that could not be assigned to any known Inc groups.Methods: One IncFIIpKF727591β plasmid p205880-qnrS and two IncpKPHS1 plasmids p11219-CTXM and p205880-NR1 were fully sequenced in this work. Detailed genomic comparison was applied to all available sequenced plasmids of IncFIIpKF727591 or IncpKPHS1 group.Results: p205880-qnrS carried a novel transposon Tn6396, which was an ISKpn19-compsite transposon and represented a prototype transposable element carrying a minimum core qnrS1 module. p11219-CTXM harbored a novel transposon Tn6559, which was generated from integration of a truncated IS903D–blaCTX-M-14–ISEcp1 unit into the Tn3-family cryptic unit transposon Tn1722. Two Inc groups, IncFIIpKF727591 and IncpKPHS1, of plasmids from Enterobacteriaceae species were proposed, and IncFIIpKF727591 was further grouped into two subgroups IncFIIpKF727591α and IncFIIpKF727591β. Each of the 11 IncFIIpKF727591 plasmids carried multiple accessory modules including at least one resistance module, and the relatively small IncFIIpKF727591 backbones could acquire a wealth of foreign genetic contents. The modular structures of plasmid backbones were conserved within each of IncFIIpKF727591α and IncFIIpKF727591β subgroups but dramatically different, although with similar gene organizations, between these two subgroups. The IncpKPHS1 backbones were conserved with respect to modular structures, and only four of the 14 IncpKPHS1 plasmids carried accessory modules, two of which contained resistance genes.Conclusion: A genomic comparison of sequenced IncpKPHS1 or IncFIIpKF727591 plasmids provides insights into modular differences and genetic diversification of these plasmids, some of which carries antimicrobial resistance genes.Keywords: plasmids, IncFIIpKF727591, IncpKPHS1, Tn6396, Tn6559

Qiaoli Liu, Mengchen Li, Yanli Teng, Haiyan Yang, Yuanli Xi, Shuaiyin Chen, Guangcai Duan Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People’s Republic of ChinaCorrespondence: Shuaiyin Chen; Guangcai DuanDepartment of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, People’s Republic of ChinaTel +86 1 352 340 8394Fax +86 6 778 1453Email sychen@zzu.edu.cn; gcduan@zzu.edu.cnBackground: Bacterial dysentery is an intestinal infectious disease caused by Shigella. The resistance of Shigella species to ampicillin has increased rapidly. Besides resistance, bacteria in a state of tolerance to antibiotics can also lead to the failure of infectious diseases therapy.Purpose: The genetic mechanism of antibiotic tolerance remains largely unexplored. The current study aimed to investigate the mechanisms of antibiotic tolerance and to provide novel strategies for the prevention of drug resistance of Shigella.Methods: We exposed Shigella to lethal doses of ampicillin to obtain tolerant strain. The tolerant strain was sequenced to screen non-single-nucleotide polymorphisms and Indels. We also quantitated the relative expression of gene by RT-PCR.Results: There was one nonsynonymous mutation in the 2252304 loci of the cfa gene (G to A/Val to Met) and 10 Indels in the noncoding regions of different genes. The expression of the cfa gene was 7.56-fold higher in the tolerant strain than in the wild-type strain.Conclusion: Our results showed that Shigella could be tolerated to ampicillin, and the cfa gene might be associated with antibiotic tolerance by increasing its expression. Our data suggest that cfa gene might be a target for overcoming drug tolerance, delaying the occurrence of drug resistance to some extent.Keywords: Shigella, tolerance, cfa, gene mutation

Ningbo Li,1 Shanna Guo,1 Qingli Wang,2 Guangyou Duan,3 Jiaoli Sun,1 Yi Liu,1 Jin Zhang,1 Cong Wang,1 Changmao Zhu,1 Jingyu Liu,4 Xianwei Zhang1 1Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; 2Department of Anesthesiology, Wuhan General Hospital of Guangzhou Military, Wuhan, China; 3Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China; 4Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China Purpose: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare inherited disorder whose core clinical features consist of no response to noxious stimuli and inability to sweat under any conditions. Our goal was to characterize the details of phenotypic and genotypic features in Chinese CIPA patients.Patients and methods: Personal data and clinical information were investigated by interview and physical examination. DNA was extracted from blood samples of patients and their available familial members and subjected to genetic analysis.Results: A total of 41 Han Chinese CIPA patients from 35 unrelated families were recruited. The distribution of patients was mainly in the central and southern regions of China, with a male to female ratio of 3:1 and a mortality rate of 7.3%. Heterogeneity of clinical features, including pain insensitivity, temperature sensation, and complications, were cataloged. Interestingly, some patients had “visceral pain” sensation, and there was a significant difference in temperature perception and thermal pain between individuals. The incidence of bone and joint fractures was 49%. The characteristics of 19 mutations of NTRK1 in 41 patients, with five novel mutations, were identified. More than 63% of patients had the splice mutation, c.851–33 T>A, which strongly suggests that it may be a common pathogenic site in Han Chinese patients.Conclusion: Current findings expand our knowledge about the spectrum of phenotypic features and the racial characteristics of NTRK1 mutations of CIPA patients in the Han Chinese population. Keywords: congenital insensitivity to pain with anhidrosis, HASN IV, phenotype, NTRK1, mutation, Chinese

Guangyou Duan,1,* Xiaohang Bao,1,* Guiying Yang,1 Jing Peng,1 Zhuoxi Wu,1 Peng Zhao,1 Zhiyi Zuo,2 Hong Li1 1Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China; 2Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA *These authors contributed equally to this work Introduction: This study aimed to compare the postoperative analgesic effects of tramadol and hydromorphone for secondary cesarean delivery (CD) as well as their anti-anxiety and anti-depression properties.Methods: A total of 106 patients receiving secondary CD under spinal anesthesia were randomly allocated to the tramadol group (n=53) and the hydromorphone group (n=53). Each group received patient-controlled intravenous analgesia using flurbiprofen 4 mg/kg combined with tramadol (4 mg/kg) or hydromorphone (0.04 mg/kg) immediately after the surgery. Postoperative pain numerical rating scale (NRS) for incision and visceral pain, hospital anxiety and depression scale (HADS), early walking time and length of hospital stay were assessed.Results: Patients in the tramadol and hydromorphone groups exhibited equivalent incision pain NRS at different time points (P>0.05). Visceral pain in the tramadol group was higher than that in the hydromorphone group at postoperative 4 hours (2.9 [1.2] vs 2.3 [1.4], P=0.011) and 8 hours (2.4 [1.1] vs 1.8 [1.1], P=0.028). One week after the surgery, the patients in the tramadol group, as compared to the hydromorphone group, had lower anxiety scores (1.9 [3.5] vs 3.6 [4.1], P=0.033) and depression scores (0.8 [1.3] vs 2.7 [4.1], P=0.023). In addition, early walking time (25.3 [7.0] hours vs 29.3 [9.6] hours, P=0.016) and length of hospital stay (2.9 [0.8] days vs 3.3 [0.8] days, P= 0.008) after the surgery in the tramadol group were less than those in the hydromorphone group.Conclusion: Postoperative intravenous analgesia with tramadol or hydromorphone for secondary CD provides comparable analgesic effects on incision pain. Tramadol is less effective in controlling visceral pain compared to hydromorphone. However, tramadol can help to alleviate anxiety and depression in the early postpartum period, improve patients’ early mobilization and shorten their hospital stay.Clinical trial number and registry URL: No: ChiCTR-IIR-17011043; URL: www.chictr.org.cn. Keywords: anxiety, caesarean section, depression, postoperative pain, tramadol

Strategic vegetation placement can significantly alter airflow patterns and turbulence, fostering desired wind environments. By comparing scenarios where vegetation is placed upstream, downstream or absent (treeless) relative to a single building using large-eddy simulation, this study provides detailed insights into the sensitivity of flow dynamics to the positioning of the vegetation. Upstream vegetation more significantly disrupts the flow patterns around the building obstacle, altering vertical wind profiles and modifying wake circulations, compared to downstream vegetation. A small shear layer developed at the plant top for upstream vegetation markedly influences turbulent kinetic energy (TKE) on both the leeward and windward sides of the building, shifting the inflection point in vertical TKE profiles by up to 0.13 H. By contrast, smaller tree-building separations lead to an effective merging of their aerodynamic profiles, whereas larger separations confine the streamwise breadth of turbulent fluxes, amplifying flux exchanges in the spanwise direction. Spectral analyses reveal that upstream vegetation consistently results in higher power spectral densities of the streamwise turbulence in the residential area than downstream vegetation. While small-scale spanwise velocity fluctuations are found to be comparably energetic at the building's windward side for upstream vegetation, the power becomes substantially concentrated on large-scale eddies in the building wake region, providing specific insights into modulating turbulent eddy motions within the residential zone. [ABSTRACT FROM AUTHOR]

Turbulent flow and boundary-layer (BL) characteristics over cylindrical obstacles have been understudied compared to the flow dynamics around cubic roughness in the urban BL literature. Using large-eddy simulation, we investigate a turbulent BL flow developed over two vertically oriented cylindrical obstacles aligned downstream. For widely separated cylinders, the wake flow undergoes periodic oscillations akin to vortex shedding behind an isolated cylinder. As the height-to-width aspect ratio (AR) of the canyon bounded by the cylinders increases, the streamline geometry exhibits a clear transition from isolated to wake interference and skimming regimes. Two-point autocorrelation functions of velocities confirm a strong coupling of canyon flow with the roughness sublayer for wider canyons, while with evident decoupling as the canyon narrows. The length scales, which measure the spatial correlation in the flow, decrease in both lateral and vertical directions with increasing AR. Turbulent kinetic energy and momentum fluxes below the roughness sublayer present pronounced monotonic scaling with AR (with R-squared values up to 0.84 and 0.98, respectively), resulting in a consistent variation in the surface roughness aerodynamic parameters, the roughness length (z0) and zero-plane displacement (d), with AR. Quantitative differences in the results with respect to those well-established for street canyons are analyzed, with the similarities highlighted. The results offer insights into boundary-layer flow parameterization concerning cylinder-occupied surface roughness. [ABSTRACT FROM AUTHOR]

Pipeline junction plays a pivotal role in fluid mixing for biomedical, chemical, and industrial processes. This study introduces an I–L junction for pipeline systems, fostering concurrent flow between branch-pipe injection and the main pipe bulk flow. In contrast to the conventional T-junction with perpendicular injection, the I–L design demonstrates high potential in mitigating vibration-induced fatigue risks, given an optimal branch-to-main pipe diameter ratio, rd. Using unsteady Reynolds-averaged Navier–Stokes equations, the study assesses fluid mixing across a broad range of rd (1 / 12 – 1 / 2.5). The streamline geometry undergoes a transition from well-defined symmetric vortices to unsteady oscillations when the pipe diameters diverge beyond 1/4, arising from vortex shedding in the wake of the branch pipe. Despite the conventional T-junction showing a more homogeneous velocity distribution in the streamwise direction, its turbulent kinetic energy (TKE, both modeled and calculated from the resolved-scale velocities) near the junction is an order of magnitude larger, implying high overall inhomogeneity in the flow. The TKE decays rapidly to an equivalent level compared to the proposed I–L junction approaching discharge, indicating that the peaking of TKE in the T-junction does not significantly contribute to enhanced fluid mixing. Conversely, it can likely result in harmful vibrations inside the pipeline. While the turbulence statistics remain qualitatively unchanged for r d < 1 / 4 , an enlarged discrepancy in pipe diameters beyond r d < 1 / 6 yields more favorable mean surface pressure coefficient, C P ¯ . The results provide insights into pipeline design, recommending an optimal pipe diameter ratio for enhanced mixing of successively collected fluids while retaining improved system reliability. [ABSTRACT FROM AUTHOR]

The use of weak passwords is a significant vulnerability in computer information system security, and this issue is also present in the digital applications of grain storage information systems. Simple hashing algorithms have obvious limitations when dealing with weak passwords. Based on the actual application of grain storage software systems, this paper proposed a method to enhance weak password protection by using a hashing algorithm as the foundation, combined with the introduction of salt values and high-order reflections for strengthening, along with multiple rehashing operations. Validation and analysis showed that this method increased the hashing strength of weak passwords, and effectively prevented dictionary attacks or rainbow table attacks, which could achieve the effective protection for the transmission and storage of weak passwords. Additionally, it had low complexity, and was easy to implement. It also had an average computational latency of approximately 2.5 ms, which was imperceptible to users. This method is suitable for the construction and management of digital grain storage information systems, providing robust security protection.

Yan-fei Lu,1,&ast; Ji-min Wu,2,&ast; Hai-yan Lan,2 Qiao-min Xu,2 Shu-qi Shi,2 Gong-chen Duan2 1Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, People’s Republic of China; 2Department of Anesthesiology, Lishui People’s Hospital, Wenzhou Medical University Lishui Hospital, Lishui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gong-chen Duan, Department of Anesthesiology, Lishui People’s Hospital, Wenzhou Medical University Lishui Hospital, No. 1188, Liyang Street, Lishui, Zhejiang, 323000, People’s Republic of China, Tel/Fax +8618957093030, Email 981225178@qq.comBackground: Ciprofol is a new intravenous sedative / anesthetic drug. In recent years, many clinical studies have also confirmed the sedative effect of ciprofol. However, more clinical research is still needed on its clinical application characteristics in special populations.Objective: The aim of this study was to compare the clinical effects of ciprofol and propofol in general anesthesia induction of elderly patients.Methods: 60 elderly (aged ≥ 75 years) patients underwent hip fracture surgery were randomly into two groups of a 1:1 ratio. Group C (ciprofol group): 0.3mg/kg ciprofol was infused. Group P (propofol group): 1.5mg/kg propofol was infused. The observation period was from the infusion of test drug to 5 min after endotracheal intubation. The primary outcomes included the incidence of severe hypotension and hypotension during the observation period. The secondary outcomes were as follows: the success rate of general anesthesia induction, the number of additional sedation, the time of loss of consciousness (LOC), Δ MAP, Δ HR, adverse events and the frequency of vasoactive drugs used.Results: Finally, 60 subjects completed the study. Compared with Group P, the incidence of severe hypotension in Group C was lower (26.7% vs 53.3%, P = 0.035), the incidence of hypotension was also lower (36.7% vs 63.3%, P = 0.037), Δ MAP in Group C was significantly lower (31.4 ± 11.4 vs 39.6 ± 15.7, P = 0.025), the frequency of ephedrine used and the incidence of injection pain in Group C were also significantly lower.Conclusion: Ciprofol showed similar efficacy to propofol when used for general anesthesia induction in elderly patients underwent hip fracture surgery and could maintain more stable blood pressure.Keywords: Ciprofol, elderly, Hip fracture surgery, general anesthesia, hypotension

Background Previous studies have confirmed that screen exposure is widespread in preschool children and is related to children's emotional and behavioral problems. Most of the existing studies focus on normal preschool children, but the research on screen exposure and emotional and behavioral problems of preschool autistic children is relatively rare. Objective To investigate the screen exposure and the abnormal detection of emotional and behavioral problems in preschool children with autism, and to explore the association between screen exposure and emotional and behavioral problems in preschool children with autism. Methods Preschool children with autism who met the diagnostic and Statistical Manual of Mental Disorders (DSM-V) autism diagnostic criteria and visited the Department of Child Development and Behavior of the Third Affiliated Hospital of Zhengzhou University from February to August 2022 were selected as the autism group. At the same time, children with normal development in kindergartners in Zhengzhou were selected as the normal control group. The screen exposure questionnaire and the Strengths and Difficulties Questionnaire (parent version) were completed by the main caregivers of the children in the two groups. Results There were significant differences between the two groups in terms of screen time, parents' response to screen management, and screen deprivation (P

ObjectivesVirtual power plant is usually composed of distributed generator (DG). When the system lacks power grid support, practical and reasonable comprehensive operation strategies and accurate control methods are needed to ensure the smooth operation of virtual power plant.MethodsAn operation strategy based on system fluctuation value was proposed. Then, aiming at the problem of generation control of distributed generators in the system, a distributed finite-time controller was designed. The amplitudes of voltage and frequency were adjusted to nominal values within a finite time, and the active power was distributed among each DG unit. Different from the traditional centralized control strategy, the proposed control method is based on distributed junction, which only requires information exchange between adjacent DG units through sparse communication network.ResultsThe feasibility of the proposed control method and its robustness to the uncertainty of model parameters and load variation were verified by simulation experiments.ConclusionsCompared with previous studies, the proposed operation strategy divides the system operating conditions in more detail, effectively improving the stability and security of the system.

Abstract [Objective] This study aims to investigate the effects of drought stress on the distribution of carbon (C), nitrogen (N), and phosphorus (P) elements and stoichiometry in organs of Pinus yunnanensis seedlings, and to provide a theoretical basis for water management in the cultivation of P . yunnanensis. [Methods] The contents of C, N, and P in organs of 1-year-old P . yunnanensis seedlings under drought stress were determined by potted water control method and four drought treatments. [Results] (1) Compared with the appropriate water treatment, the C content in leaves, stems, and fine roots of P . yunnanensis seedlings was decreased under drought stress, but was increased in coarse roots. N content was decreased in coarse roots and increased in fine roots. P content was increased in leaves and decreased in stems. (2) The variation coefficient of element content was P>N>C. The contents of C and N showed the greatest variability in fine roots. The variability of P content was the highest in leaves and the lowest in coarse roots. (3) There was a significant negative correlation between N content and coarse roots, a significant positive correlation between stems and fine roots, and a significant positive correlation between N and P contents in stems and coarse roots. [Conclusion] Under drought stress, growth of P . yunnanensis seedlings is restricted by N elements, and the utilization efficiency of N and P is increased. The overall variability of C, N, and P content in coarse and fine roots is higher than leaves and stems. The root system is more sensitive to changes in soil water status.

Abstract Objectives We hope to offer a comprehensive understanding of the advancements and patterns in research on PND. Methods: We performed a thorough search on the Web of Science Core Collection to locate relevant studies published from 1969 to 2022 and utilized four distinct tools, namely VOSviewer (J Data Inf Sci, 2017, 2, 1; J Am Soc Inf Sci, 1973, 24, 265; Amer Doc, 1963, 14, 10 and Scientometrics, 2010, 82, 581), CiteSpace (Scientometrics, 2010, 84, 523), Scimago Graphica, and R‐bibliometrix which allowed us to examine various aspects. Results: We included a total of 6787 articles and reviews for analysis which described PND research, the sources, and the subfields; highlighted the significant developments in this field; identified three main directions in PND.Conclusion: This study highlights the rapid growth of research on PND in recent years and provided an overview of previous studies in the field of PND, thereby establishing the overall landscape of PND research and identifying potential avenues for future investigations. Methods We performed a thorough search on the Web of Science Core Collection to locate relevant studies published from 1969 to 2022. To perform bibliometric analysis and network visualization, we utilized four distinct tools, namely VOSviewer (J Data Inf Sci, 2017, 2, 1; J Am Soc Inf Sci, 1973, 24, 265; Amer Doc, 1963, 14, 10 and Scientometrics, 2010, 82, 581), CiteSpace (Scientometrics, 2010, 84, 523), Scimago Graphica, and R‐bibliometrix. These tools allowed us to examine various aspects, including the yearly publication output, the contribution of different countries or regions, the involvement of active journals, co‐citation analysis, publication status, keywords, and terms, as well as scientific categories. We hope to offer a comprehensive understanding of the advancements and patterns in research on PND. The insights gained from this study can assist researchers and clinicians in enhancing the management and implementation of their work in this field. Results In this study, we included a total of 6787 articles and reviews for analysis. First, publication trends and contribution by country analysis described PND research. Second, a historical analysis described PND research, the sources, and the subfields. Third, an analysis of keywords highlighted the significant developments in this field. Fourth, an analysis of research themes identified three main directions in PND. Conclusion In summary, the research volume exhibits exponential growth over time. Furthermore, the majority of contributions originate from Western countries and China. The interdisciplinary nature of the field is evident, with its roots in biology and medicine and further branching into psychology and social sciences. POCD, delirium‐predominant associated clinical management were major research themes about PND.