As the key role in the development of day surgery and the whole process management， anesthesiologists have played a positive role in promoting the organization and management of day surgery and perioperative quality control. As the bridge between day surgery wards and operating rooms， anesthesiologists need to join the hospital?level day surgery management committee or related organizations， and participate in the unified management and quality control of day surgery throughout the hospital. By establishing standardized anesthetic preoperative evaluation system， setting anesthetic subspecialty groups for day surgery， improving day surgery access system and other measures， we can reduce the risks associated with perioperative anesthesia， which is of great significance for optimizing the allocation and dispatching of surgical resources throughout the hospital. At the same time， formulating anesthetic quality control indicators for day surgery has a positive effect on further promoting and improving the construction of day surgery quality control indicators. At the micro level， based on individualized enhanced recovery after surgery （ERAS） measures， focusing on multi?modal analgesia， multi?drug postoperative nausea and vomiting （PONV） and other management strategies， further implementing and refining perioperative anesthesia management processes and specific implementation plans to promote rapid recovery of day surgery patients and discharge on time.

Ambulatory medical care has undergone more than 20 years of development in China， gradually improving into a medical model that provides diagnosis and treatment services throughout the 24-hour hospitalization process. In the past decade， under the guidance of relevant national policies， the development scale and speed of ambulatory medical care have further expanded， providing more patients with efficient and low-cost diagnostic and treatment services， and playing a leverage role in the high-quality development of public hospitals. However， the development of ambulatory medical care is also facing challenges brought about by various factors such as the support of medical insurance policies， performance evaluation， and homogeneous development. Under the new situation and concepts of promoting the high-quality development of public hospitals and improving the medical service experience， the ambulatory medical service model has played a greater role in medical value. However， how to promote the stable and long-term development of ambulatory medical care is a valuable topic for discussion. The article aims to provide ideas for the further development of ambulatory medical care in the future by reviewing the development process and overview of ambulatory medical care in China.

The ambulatory surgery mode is a surgical diagnosis， treatment， and rehabilitation system based on the concept of rapid recovery. Ambulatory surgery in our country is in a state of rapid development， and the medical quality management of ambulatory surgery is also receiving increasing attention. This article elaborates on the perioperative management of ambulatory surgery， exploring the management details of daytime surgery from various aspects such as patient selection， surgical anesthesia selection， intraoperative management， postoperative pain relief， nausea and vomiting management， and discharge follow-up. Intended to establish a unified quality management model for ambulatory surgical anesthesia and conduct comprehensive quality improvement. We hope it could provide more appropriate methods for clinical ambulatory surgery management， promote the healthy， rapid， and efficient development of ambulatory surgery.

Objective To study the efficacy and safety of remimazolam tosilate in painless daytime hysteroscopic surgery. Methods A total of 300 patients （18 ~ 60 years， BMI 18.5 ~ 27 kg/m²， and ASA Ⅰ-Ⅱ） undergoing selected painless daytime hysteroscopic surgery were randomized into two groups. Group R received remimazolam tosilate at an initial dose of 0.2 mg/kg， and then single 0.05 mg/kg if needed according to bispectral index. Group P， according to the bispectral index， received propofol at an initial dose of 1.5 ~ 2 mg/kg， and single 0.5 mg/kg if needed. All the patients were intravenously given 5 μg sufentanil five minutes before hysteroscopy. The anesthesia-related indicators （anesthesia onset time， surgical duration， anesthesia recovery time， and time to leaving the operating room） and safety indexes （hypotension， hypoxia， nausea and vomiting， and doctor and patient satisfaction） were recorded. Results The incidence of hypotension and injection pain was significantly higher in group P （P < 0.01）. There were no significant differences between the two groups in surgical duration， awakening time， time to leaving the operating room， nausea and vomiting， and patient satisfaction （P > 0.05）. Conclusion Remimazolam can be used safely and effectively in painless daytime hysteroscopic surgery.

Objective To compare the effects of remimazolam vs propofol on the quality of recovery in elderly patients undergoing fundus daytime surgery after general anesthesia. Methods A total of 110 elderly patients undergoing day-time fundus surgery under laryngeal mask anesthesia were randomly divided into Remimazolam group and Propofol group. Patients in Remimazolam group were induced by remimazolam， sufentanil and rocuronium， and maintained by remimazolam and remifentanil. Patients in Propofol group were induced by propofol， sufentanil and rocuronium， and maintained by propofol and remifentanil. The level of sedation was monitored by bispectral index. After surgery， patients were antagonized by flumazenil in Remimazolam group but not in propfolgroup. The quality of patients' recovery was recorded before operation and three days after operation measured by quality of recovery-15 （QoR-15） scale. Intraoperative hemodynamic data，the time to consciousness loss during induction and awakening after operation，the time for laryngeal mask removal and the incidence of adverse events after admission to post anesthesia care unit were also recorded. Results The QoR-15 score in Remimazolam group 24 hours after operation was non-inferior to that in propofol group （133.3 ±11.1 vs. 135.0±10.3； mean difference （95% CI）1.7 （-3.9， 7.2）； approving for non- inferiority）. There was no significant difference in QoR-15 scores between the two groups before operation or any other setting points. Compared with Propofol group， the time to consciousness loss during induction was prolonged， and the time for awakening after operation and laryngeal mask removal were shortened in Remimazolam group（all P < 0.05）. Compared with Propofol group， the hemodynamics of patients in Remimazolam group was more stable （P < 0.05）. There was no significant difference in the total dosage of remifentanil， fluid， or in the incidence of adverse reactions in PACU between the two groups （P > 0.05）. Conclusion In elderly patients undergoing day-time fundus surgery， induction and maintenance of anesthesia with Remimazolam could achieve the similar quality of postoperative recovery with propofol. Compared with propofol， remimazolam provide more stable hemodynamics and shorter recovery time and extubated time， contributing to higher efficiency in recovery period.

Objectives The research aimed to determine the effects of different surgical procedures on postsurgical pain and early prognosis. We reviewed the perioperative data of patients who underwent single/two-port television-assisted thoracoscopic pulmonary nodule surgery in the day surgery ward of Nanjing Drum Tower Hospital. Methods The clinical and follow-up data of 693 patients undergoing thoracoscopic for pulmonary nodules in the day surgery ward under the centralized management model of our hospital were retrospectively analyzed during the period of January 2021 to December 2022. The patients were divided into a single-port and a two-port thoracoscopy group. The propensity-matching was used to balance the baseline data and analyze the differences in postoperative pain and prognosis of the patientsin the two groups. Results After propensity score matching， the single-port group had lower intraoperative fentanyl consumption ［0.5（0.35，0.50）mg vs. 0.5（0.40，0.50）mg， P = 0.034］， remifentanil consumption ［0.48（0.33，0.63）mg vs. 0.53（0.35，0.73）mg， P = 0.031］， intraoperative hemorrhage［20（10，50）mL vs. 50（20，50）mL， P = 0.001］， and Visual Analogue Scale on postoperative third day ［2（2，4）point vs. 3（2，4）point， P = 0.007］， which were statistically different. There were no statistically significant differences between the two groups in terms of postoperative rescue analgesia， chest drainage volume， length of hospitalization， pain on postoperative 1st， 5th， 9th， and 30th days， postoperative cough， pulmonary complications within 30 days after surgery， and unplanned hospital visits. Conclusion Compared with two-port thoracoscopy， single-port thoracoscopic day surgery for pulmonary nodules is a safe and feasible procedure that can significantly reduce the use of intraoperative opioid analgesics and the pain level of patients on postoperative 3rd day.

Objective To investigate the effects of gender on dosage of remimazolam and quality of recovery in patients undergoing ambulatory arthroscopic surgery at 24 hours postoperatively. Methods Fifty patients who underwent elective arthroscopic meniscus repair in a daytime surgery center were divided into two groups according to gender： 25 males （group M） and 25 females （group F）. The remimazolam dogages of loss of consciousness and anesthesia maintenance were recorded， and the effects of gender on the quality of recovery at 24 hours postoperatively and sleepquality were observed by using QoR-15 scale and Athens Insomnia Scale （AIS）. Results The doses of remimazolam at the time of loss of consciousness and anesthesia maintenance for patients were （0.13 and 0.15） mg/kg and 0.80 （0.60 and 0.96） mg/（kg·h） in group M， and 0.14 （0.12 and 0.16） mg/kg and 0.90 （0.79 and 1.12） mg/（kg·h） in group F. There were no statistical differences in the doses of remimazolam between the two groups （P > 0.05）. AIS scores did not differ on postoperative day one between the two groups （P > 0.05）， but there was a statistically significant difference on final awakening earlier than expectation in the female patients （P < 0.05）. Female patients had lower total QoR-15 scores and physiological comfort scores， and higher incidences of hypotension and PONV than male patients （P < 0.05）. Conclusions Gender had no significant effects on dosage of remimazolam during anesthesia induction and anesthesia maintenance in the patients receiving daytime arthroscopy. Female patients had final awakening earlier than expectation， and male patients had higher quality of recovery at 24 hours postoperatively.

Objective This study aime to investigate the clinical status of opioid free with spontaneous breathing anesthesia in the treatment of palmar hyperhidrosis through thoracic sympathectomy under thoracoscopy. Methods A total of 93 patients with palmar hyperhidrosis who underwent elective surgery with general anesthesia were randomly divided into control group （group C） and observation group （group O）. In group C， patients were treated with propofol， sufentanil， and cisatracurium. In group O， patients were anesthetized with propofol， dexmedetomidine， and thoracic paravertebral block. The changes of vital signs and blood gas indicators between two groups before anesthesia （T₁）， at the time of skin incision （T₂）， after surgery （T₃）， and leaving the operating room （T₄） were observed. The visual analog scale （VAS） of patients immediately after awakening （P₁）， leaving the operating room （P₂）， 2 hours （P₃）， 6 hours （P₄）， and 24 hours after surgery （P₅） were recorded. The occurrence of perioperative anesthesia related complications， postoperative recovery time and patients′ satisfaction were also observed. Results There was no case of surgical interruption due to anesthesia or anesthesia methods changing during the perioperative period. And no significant difference in the changes of sedation and pain index was observed between two groups （P > 0.05）. However， in group O， the VAS scores were higher at P₁ and P₄ （P > 0.05）， PH was lower， PCO₂ and BG were higher at T₂ （P < 0.05）， and the incidence of perioperative hypertension and tachycardia was higher （P < 0.05）. There were no statistically significant difference in postoperative recovery time and patient′s satisfaction between these two groups （P > 0.05）. Conclusion The implementation of opioid free with spontaneous breathing anesthesia strategy in day surgery for palmar hyperhidrosis is safe and feasible but the application of this strategy has no significant advantages in clinical practice of day surgery.

Objective The study tried to compare the effectiveness and safety of target controlled infusion of sufentanil with traditional remifentanil in improving postoperative pain relief and recovery quality in patients undergoing daytime laparoscopic cholecystectomy. Methods This study is a prospective randomized controlled study， which selecting 100 patients who underwent laparoscopic cholecystectomy in the day ward of our hospital from October 2019 to October 2022 as the observation subjects. Patients were divided into two groups using a random digitization method， with 50 patients receiving intraoperative target controlled infusion of remifentanil （conventional group） and 50 patients receiving intraoperative target controlled infusion of sufentanil （study group）. Observe the postoperative pain， nausea and vomiting， spontaneous breathing recovery time， awakening time， extubation time， directional force recovery time， as well as changes in blood pressure and heart rate during the perioperative period （before anesthesia induction （T₀）， 5 minutes after anesthesia induction （T₁）， intubation operation （T₂）， skin incision （T₃）， abdominal observation （T₄）， and extubation （T₅） in two groups of patients. Results The visual analog scale （VAS） within 3 hours after surgery in the study group was lower than that in the control group （P < 0.05）. However， the recovery time of spontaneous breathing， awakening time， extubation time， and directional force recovery time in the research group were longer than those in the conventional group （P < 0.05）. After 5 minutes of anesthesia induction （T₁）， the blood pressure in the control group was lower than that in the study group. At extubation （T₅）， the blood pressure and heart rate in the control group were higher than those in the study group （P < 0.05）. There was no difference in the incidence of perioperative adverse events between the two groups of patients. Conclusions Targeted infusion of sufentanil for patients undergoing daytime laparoscopic cholecystectomy has the advantages of smoother hemodynamics and significant analgesic effects. However， early discontinuation of the medication is necessary due to the prolonged postoperative recovery time of patients.

Objective We tried to explore the optimal dose of esketamine combined sevoflurane for the daytime pediatric circumcision. Methods According to the random number table， children who underwent daytime circumcision were randomly divided into Group A （0.5 mL/kg esketamine）， Group B （0.75 mL/kgesketamine）， and Group C （1mL/kg esketamine） with 30 cases in each group. Each group were induced with sevoflurane inhalation anesthesia by mask and given a single intravenous dose of the corresponding esketamine after the eyelash reflex disappeared. The occurrence of intraoperative movement and esketamine bolus times was recorded. Heart rate （HR）， mean arterial pressure （MAP）， pulse oxygen saturation （SpO₂） and respiratory rate （RR） were monitored at the time of entry （T₀）， the beginning of surgery （T₁）， intraoperative ligation （T₂） and the end of surgery （T₃）. The times of opening eyes and talking after surgery were also recorded. Modified Alertness/Sedation Score （MOAA/S score） at 15 min， 30 min and 60 min after surgery， the Eastern Ontario Children's Hospital Pain Score （CHEOPS score）， Bieri Modified Facial expression score and verbal rating scale （VRS） score at the time of awakening， 2 h and 6 h after surgery were all recorded. Moreover， intraoperative and postoperative adverse reactions （respiratory depression， laryngeal spasm， agitation， nausea and vomiting， dizziness and diplopia ect.） were all marked. Results The incidence of intraoperative body movement andesketamine bolus times in Group B and C were all less than that in Group A （P < 0.05）. The time of opening eyes and talking in Group A and Group B were shorter than those in Group C （P < 0.05）. There was no significant difference in intraoperative vital signs， postoperative alertness score and pain score among the 3 groups （P < 0.05）. There was no significant difference in the incidence of adverse reactions among the 3 groups （P < 0.05）. Conclusion A does of 0.75 mg/kg esketamine combined with sevoflurane could effectively meet the anesthetic and analgesic needs of children's prepuce operation and shorten postoperative recovery time. It is the optimal dose and deserving promotion in daytime pediatric circumcision.

The essence of hepatic fibrosis is the imbalance of the formation and degradation of extracellular matrix in the liver tissue. Hepatic fibrosis is a necessary stage for the progression of various chronic liver diseases to cirrhosis. Early inhibition of the occurrence and development of hepatic fibrosis is very important in the treatment of liver diseases. Platelets release a variety of cytokines， which promote hepatocyte proliferation and liver parenchyma regeneration while activating endothelial cells， inducing leukocyte recruitment， aggravating microvascular dysfunction， and participating in the process of liver fibrosis. In this paper， the research progress of antiplatelet drugs in hepatic fibrosis is reviewed， in order to provide new diagnosis and treatment ideas for hepatic fibrosis.

Objective To explore the mechanism of short-chain fatty acids in alleviating γδT cell-mediated inflammatory response. Methods A certain concentration of short-chain fatty acids was used to intervene in rat intestinal-derived γδT cells. CCK-8 was used to detect the effect of shortchain fatty acids on γδT activity. ELISA was used to detect the content of the IL-17A， RT-qPCR was utilized to detect the expression of the IL-17A， and flow cytometry was applied to analyze the IL-17⁺γδT cell frequency. The effect of SCFAs on IL-17A and NF-κB signaling pathway in γδT cells were observed by Western blot. Results CCK-8 assay showed that the concentration of sodium acetate was less than or equal to 0.5 mmol/L， and the concentrations of sodium propionate， sodium butyrate， and mixed short-chain fatty acids were less than or equal to 0.25 mmol/L， indicating no inhibitory effect on the proliferation of γδT cells. ELISA and RT-qPCR showed that the treatment of γδT cells with sodium propionate， sodium butyrate， and mixed short-chain fatty acids significantly decreased the levels of IL-17A compared with the control group. Flow cytometry revealed a significant decrease in the proportion of IL-17⁺γδT cells under the treatment of sodium propionate， sodium butyrate， mixed shortchain fatty acids， and TSA intervention. Western blot found that sodium propionate， sodium butyrate， and mixed shortchain fatty acids could inhibit the expression of IL-17A and IKK， as well as the phosphorylation level of NF-κB. Conclusion Shortchain fatty acids could inhibit the activation of IL-17A and NF-κB signaling pathway in γδT cells， thereby alleviating the inflammatory response in the body.

Objective To investigate the effect of MAPK on intestinal obstruction during pregnancy. Methods A total of 105 SPF Wistar rats （female = 70 and male = 35） were selected. After placing all the rats in the same cage， 33 female rats were pregnant， and 8 rats were assigned to the control group and the other 25 rats were used to established bowel obstruction model. A total of 24 rats were successfully modelled， which were divided into model group（n = 8）， up-regulation group（n = 8）， and down-regulation group（n = 8）. Results Compared with the model group， MAPK expression， VIP， GAS， TNF-α， IL-6 levels， TLR4， Myd88， NF-κBmRNA were increased and MOT， IL-4， IL-10 levels were decreased in up-regulation group； MAPK expression， VIP， GAS， TNF-α， IL-6 levels， TLR4， Myd88， NF-κB mRNA were decreased and MOT， IL-4， IL-10 levels were increased in down-regulation group （P < 0.05）. Conclusion MAPK down-regulation reduced inflammatory response and improved bowel obstruction in pregnancy， and the mechanism may be related to the inhibition of TLR4/Myd88/NF-κB pathway.

Objective To constructed a TA-siRNA nanogel to target the inhibition of Schwann cell death. Methods The study used the transcriptome sequencing data of GEO database GSE244328 for bioinformatics analysis to screen pyroptosis-related genes and evaluated the expression level of specific genes through polymerase chain reaction and protein imprint analysis. Mouse Schwann cells from the American ATCC were used， and LPS was used to simulate inflammatory stimulation. Self-assembled TA-siRNA nanogels were prepared， and CCK8 kit experiments， cytoskeleton staining， and scratch experiments were used to evaluate the cell function of TA-siRNA nanogels. GraphPad Prism 8， ImageJ， and R 4.2.1 were used for statistical difference analysis， with P < 0.05 as the statistical difference standard. Results The Gzmb gene was significantly （P < 0.05） highly expressed during the pyroptosis of Schwann cells. TA-siRNA nanogel had excellent biocompatibility with a size of 68.65 ± 7.35 nm and a potential of -36.48 mV， which could be effectively internalized by Schwann cells and did not lead to the elongation and deformation of Schwann cells （P > 0.05）. TA-siRNA nanogel could effectively inhibit the Gzmb gene of Schwann cells， thus inhibiting the death of Schwann cells and increasing the survival rate and activity of Schwann cells （P < 0.05）. Conclusion Given the role of Schwann cells in PNI， TA-siRNA nanogel inhibition of Schwann cell pyroptosis may be a potential treatment strategy for PNI in the future.

Objective To investigate the effect of gestational diabetes， maternal weight gain during pregnancy and feeding methods on early neurodevelopmental delays in offspring. Methods The study used a retrospective cohort study to analyze the general information of 8023 mothers and their offspring. Logistic and linear regression models were used to analyze the associations between gestational diabetes， maternal weight gain during pregnancy， feeding methods， and neurodevelopmental delays in their offspring. Results In this study， the average maternal age in the cohort was （29.46 ± 4.57） years， and the pre?pregnancy BMI was （21.38 ± 3.09）. Among the newborns， 4450（55.5%） were male， 4351（54.2%） were breastfed， and 735（9.2%） were low birth weight. After adjustment， artificial feeding was positively correlated with delayed neurobehavioral development ［OR = 1.70， （95% CI： 1.24 ~ 2.33）］. Moreover， gestational diabetes， inadequate gestational weight gain and artificial feeding negatively correlated with developmental quotient ［β = -0.44， 95% CI： -0.87 ~ -0.008； β = -0.73， 95% CI： -1.25 ~ -0.22； β = -0.80， 95% CI： -1.34 ~ -0.26］. Maternal gestational diabetes was significantly associated with delay in gross motor skills and social abilities in their offspring. Inadequate maternal weight gain during pregnancy was associated with delay in all five domains of neurodevelopment in their offspring. Moreover， artificial feeding was associated with all five domains of neurodevelopmental delays in the offspring. Conclusion Maternal inadequate weight gain during pregnancy and artificial feeding are risk factors for neurodevelopmental delay in offspring. Maternal gestational diabetes was associated with delayed gross motor and social skill in their offspring.

Objective To explore the factors influencing the short?term adverse clinical outcome in patients hospitalized with grade 2/3 cirrhosis ascites. Methods 82 patients with grade 2/3 cirrhosis ascites in Kunming Third People's Hospital from December 2021 to February 2023 were used as research objects. Demographic data and first clinical data were collected. The clinical outcomes of the patients within 90 days after admission were followed up. Influencing factors of adverse clinical outcome were investigated by single factor screening and binary logistic regression analysis， including hospitalization over 28 days， unplanned readmission within 28 days， and death within 90 days （including death within 28 days）. Finally， the diagnostic efficacy of the influencing factors were judged by ROC curve. Results （1）MELD?Na score （OR = 1.087， 95%CI： 1.006 ~ 1.175） and GGT （OR = 1.004， 95%CI： 1.002 ~ 1.007） were independent risk factors for hospitalization longer then 28 days， unplanned readmission within 28 days of admission and death within 28 days， respectively， all P < 0.05. BUN was an independent risk factor for all three conditions， with an OR of 1.111 （95% CI： 1.005 ~ 1.227）， 1.115 （95%CI： 1.003 ~ 1.214） and 1.208 （95%CI： 1.057 ~ 1.382）， all P < 0.05. （2）low serum chloride （OR = 0.875， 95%CI： 0.802 ~ 0.954） and low total CO₂ （OR = 0.821， 95%CI： 0.690 ~ 0.976） were independent riak factors for death within 90 days， all P < 0.05. （3）The area under ROC curve of BUN combined with GGT predicted death within 28 days was 0.891； The area under curve of serum chloride combined with total CO₂ predicted death within 90 days was 0.821， P < 0.05. Conclusion BUN combined with GGT had better predictive value for death within 28 days， serum chloride combined with total CO₂ had better predictive value for death within 90 days.

Objective To explore the effect of using invisible appliances to correct Class Ⅱ malocclusion on the temporomandibular joint. Methods Seventy patients with Class II malocclusion were selected and divided into an observation group （n = 35） and a control group （n = 35） using the envelope method. The observation group received invisible orthodontic treatment， while the control group received self-locking bracket orthodontic treatment. The changes in temporomandibular joint angles and gaps and so on between the two groups were observed. Results The changes before and after correction of the lower internal angle at the intersection of the long axis of the upper central incisor and the anterior skull base plane （U1-SN）， angle between the long axis of the upper central incisor and the line connecting the nasal root point and the upper alveolar seating point （U1-NA） in the observation group were （11.05 ± 1.01） ° and （4.75 ± 0.76） °， respectively， which were significantly higher than those in the control group （P < 0.05）. The changes in maxillary central incisors， maxillary lateral incisors， mandibular central incisors， and mandibular lateral incisors before and after treatment in the observation group were （0.51 ± 0.21） mm， （0.40 ± 0.15） mm， （0.40 ± 0.13） mm， and （0.20 ± 0.05） mm， respectively， which were significantly lower than those in the control group （P < 0.05）. The changes in Plaque Index （PLI）， Gingival Index （GI）， and Exploration Depth （PD） before and after correction in the observation group were （0.44 ± 0.19） points， （0.41 ± 0.13） points， and （0.38 ± 0.10） mm， respectively， which were significantly lower than those in the control group （P < 0.05）. Conclusion Invisible appliances have good application value in correcting Class Ⅱ malocclusion， which is beneficial for improving the temporomandibular joint of patients.

Objective To analyze the effect and prognosis of COMP gene mutation on the treatment of carpal tunnel syndrome with ultrasound?guided dental crochet knife. Methods A total of 35 carpal tunnel syndrome patients with Cartilage oligomeric matrix protein gene mutation （COMP） who were treated in the outpatient department from June 2022 to June 2023 were selected as the control group. Another 40 patients with carpal tunnel syndrome without mutation of COMP gene who received treatment during the same period were selected as the observation group. All patients were treated with ultrasound?guided lower tooth crochet knife. The Transverse carpal ligament thickness， paresthesia score， muscle loss score and transverse carpal ligament thickness were compared between the two groups. Pisiform cross section median nerve cross section area， pisiform cross section median nerve cross section area， CSA）， Anterior and posterior diameter of median nerve in cross section of uncinate bone （D）， clinical efficacy and incidence of adverse events. Results After treatment， compared with observation group， paresthesia score， hand function satisfaction score， TTCL， CSA and D in control group were all increased， while muscle loss score was decreased， with statistical difference （P < 0.05）. In addition， the total clinical efficiency increased significantly and the incidence of adverse effects decreased significantly in the observation group. The prognosis of carpal tunnel syndrome patients with COMP gene mutation was evaluated according to the satisfaction degree of hand function， which showed that compared with the good prognosis group， the hand function score of the poor prognosis group increased significantly， with statistical difference （P < 0.05）. Before treatment， there was no significant difference in clinical manifestations between the two groups （P > 0.05）. Conclusions The application of ultrasound?guided crochet in carpal tunnel syndrome patients with COMP gene mutation plays an important role in the development of carpal tunnel syndrome.

Objective To investigate the effects of intraoperative electroacupuncture analgesia on the stress response to tracheal intubation in patients undergoing general anesthesia for thyroid surgery. Methods A total of 60 patients scheduled for elective combined general anesthesia and thyroid surgery at the Affiliated TCM Hospital of Guangzhou Medical University from June 2022 to June 2023 were randomly assigned to either the control group （Ctr group） or the electroacupuncture group （EA group）. Both groups underwent tracheal intubation under general anesthesia. In the EA group， electroacupuncture was applied at bilateral Neiguan （PC6）， Quchi （LI11）， and Lieque （LU7） acupoints for 15 minutes before tracheal intubation and before extubation， in addition to routine general anesthesia and analgesia. Hemodynamic parameters including systolic blood pressure （SBP）， mean arterial pressure （MAP）， diastolic blood pressure （DBP）， and heart rate （HR） were observed at different time points in both groups （before intubation： T₀； 1， 5， 10， 15， and 30 minutes after intubation： T₁， T₅， T₁₀， T₁₅， T₃₀； 1 minute before extubation： EXBT1； 1 and 5 minutes after extubation： EXAT₁， EXAT₅）. The total amount of opioid analgesics used intraoperatively and any adverse reactions were recorded. Results Significant statistical differences were observed between the EA group and Ctr group in SBP at T₁-T₁₅， EXAT₁， and EXAT₅； MAP at T₅-T₁₅ and EXAT₁； DBP at T₁₅ and EXAT₁； HR at T₁， T₅， EXAT₁， and EXAT₅ （P < 0.05）. During T₁-T₁₅， the SBP， MAP， DBP， and HR in the EA group showed a decreasing trend and were lower compared to the Ctr group. The SBP， MAP， and DBP fluctuations were smaller in the EA group compared to the Ctr group， while the HR fluctuations were larger in the EA group after intubation but smaller after extubation. There was no significant difference in the total amount of opioid analgesics used intraoperatively between the two groups （P > 0.05）. The incidence of adverse reactions such as nausea and vomiting differed significantly （P < 0.05）， while the incidence of rash and hypertension did not differ significantly between the two groups （P > 0.05）. Conclusion Intraoperative electroacupuncture analgesia can effectively attenuate the vascular stress response induced by tracheal intubation and extubation in patients undergoing thyroid surgery and reduce the occurrence of opioid-related adverse reactions.

Objective Based on computer three?dimensional finite element technology， this study investigates the biomechanical properties of different internal fixation materials for Haraguchi typeⅡ ankle fractures， determines the optimal internal fixation material for ankle fractures， and provides basic theoretical support for clinical practice. Methods Using computer three?dimensional finite element technology， a three?dimensional finite element model was established for the fixation of Haraguchi typeⅡ posterior ankle fractures using three different internal fixation materials： posterior ankle hollow screw fixation and inner ankle hollow screw （Group A）， posterior ankle support steel plate fixation and inner ankle hollow screw （Group B）， and posterior ankle reconstruction steel plate fixation and inner ankle hollow screw （Group C）. Biomechanical analysis was performed on the model to compare the advantages and disadvantages of the internal fixation materials in each group. Results The maximum principal stress and tibial stress of the two steel plate fixation models were significantly lower than those of the three hollow screw fixation model group， while the stress of the reconstructed steel plate group was lower than that of the supporting steel plate group； Among the three models， the stress reconstruction of the hollow screw at the inner ankle was the smallest in the steel plate group and the largest in the hollow screw group； The total displacement range of the tibia is the largest in the hollow screw group， followed by the supporting steel plate group， and the smallest in the reconstruction steel plate group. Conclusion Reconstructing steel plates to fix Haraguchi typeⅡ ankle fractures has the strongest biomechanical stability and is a relatively ideal fixation method， which has certain guidance for clinical practice.

Objective To explore the application value of artificial intelligence（AI） based retinal microvascular analysis in the diagnosis of diabetes retinopathy （DR）， diabetes nephropathy （DN） and other diabetes complications. Methods From January to December 2022， 305 subjects from the Health Medicine Department and Endocrine Department of the Eastern Theater Command General Hospital of PLA were divided into healthy control group （n = 119）， diabetes without DR group （n = 100）， and diabetes with DR group （n = 86） according to the condition of diabetes and its complications. The group of diabetes with DR was further divided into the group without DN （n = 50） and the group with DN （n = 36）. Clinical data， laboratory test indicators， and fundus photography results of all the subjects were collected. Independent sample t-test， Kruskal Wallis H-test， and logistic regression analysis were used for data analysis. Results There were statistically significant differences in FBG， 2hPBG， HbA1c， central retinal artery equivalent （CRAE）， and retinal arteriovenous ratio （AVR） among the three groups （all P < 0.05）. In patients with diabetes complicated with DR， there were statistically significant differences in the history of diabetes， total number of bleeding， total area of exudation， maximum area of exudation and total number of exudation between non-DN group and DN group （all P < 0.05）. There was correlation between retinal microvascular indicators and diabetic retinopathy. When the total area of retinal hemorrhage， total area of exudation， and maximum area of exudation increased， the risk of diabetic retinopathy increased. Conclusion AI-based retinal microvascular analysis has value in providing prompt indication and assisting with the diagnosis of complications in diabetic patients.

Objective To investigate the clinical value of serum total type I procollagen amino terminal peptide （PINP） and type I collagen carboxyl terminal peptide （β?CTX） combined detection for early prediction of delayed healing of long bone fractures. Methods Serum PINP and β?CTX levels were measured in 156 patients with long bone fracture at 1， 4， 8， 12 weeks after operation. The patients were divided into a delayed healing group （30 cases） and a normal healing group （126 cases） according to the healing status of the fracture. Logistic regression was used to analyze the influencing factors of delayed union of limbs long bone fractures， and ROC curve was used to analyze the early prediction efficiency of postoperative serum PINP and β?CTX combined detection on delayed union of limbs long bone fractures. Results The serum PINP and β?CTX levels in both groups showed an increasing trend after fracture surgery， reaching a peak at 8 weeks after treatment， and then decreasing. The levels of serum PINP and β?CTX in the delayed healing group were lower than those in the normal healing group at 4， 8 and 12 hours after fracture operation， and the difference was statistically significant （P < 0.05）. Multivariate Logistic regression analysis showed that postoperative serum PINP and β?CTX levels were independent risk factors for delayed healing of limb long bone fractures （P < 0.05）. ROC curve showed that the AUC of postoperative serum PINP and β?CTX combined detection in predicting delayed union of long bone fractures was 0.861 （P < 0.05）. Conclusion Postoperative serum PINP and β?CTX levels are closely related to delayed union of limb long bone fractures， and the combined detection of PINP and β?CTX is helpful to early prediction of delayed union of limb long bone fractures.

Objective To investigate the serum selenium and urinary iodine level and their correlation with thyroid nodule in patients in Guangzhou. Methods The general information， thyroid function and autoantibodies， blood selenium， and urinary iodine level of patients from thyroid nodule group （n = 150） and control group （n = 76， without nodule） were collected. Based on ultrasonographic features， the thyroid nodule group was further divided into subgroups based on the number of nodules and TI-RADS classification （single nodule group vs. multiple nodule group； diameter < 1 cm group vs. diameter ≥ 1 cm group； TR < 4 group vs. TR ≥ 4 group）. The difference of selenium and iodine among different groups were investigated. Results （1）The thyroid nodule group had significantly advanced age， and higher BMI， incidence of family history of thyroid nodule， incidence of depression， and level of FT3， TGAb， and TPOAb （P < 0.05）， but lower selenium and iodine level （P < 0.05）. （2）Compared to the single nodule group， the multiple nodule group had a higher average age （P < 0.05）； compared to the TR < 4 group， the TR ≥ 4 group had younger age， and level of selenium and iodine （P < 0.05）. （3）Logistic regression analysis showed that older age， overweight and obesity， positive family history， depression and lower selenium level were positively correlated with thyroid nodule. Age > 40 years was positively associated with multiple nodules. Lower selenium level was positively associated with TI-RADS classification ≥ 4. Conclusion Patients with thyroid nodule in Guangzhou may have clinical characteristics of older age， more prominent overweight and obesity， higher incidence of family history of thyroid nodule， more obvious depression and lower selenium level. Patients with multiple nodules are older， and the higher TI-RADS classification； the lower selenium level.

Objective To explore the impacts of illness perception and coping style on social participation in patients receiving surgery for Stanford type A aortic dissection， so as to provide reference for making intervention measures. Methods A total of 214 patients with Stanford type A aortic dissection who had received surgical treatment were selected by convenience sampling. Brief Illness Perception Questionnaire（BIPQ），Medical Coping Modes Questionnaire（MCMQ）， and Impact on Participation and Autonomy questionnaire（IPA） were used for survey. Bootstrapping was used to analyze the association of social participation with illness perception and coping style. Results For the patients， IPA score was （51.74 ± 16.50） points， BIPQ score was （49.74 ± 12.61）， and the subscales scores of correspondence to confrontation， avoidance， and acceptance-resignation were （22.87 ± 5.18）， （14.96 ± 3.05） and （10.80 ± 3.93）， respectively. Illness perception was positively correlated with social participation（P < 0.01）， confrontation was negatively correlated with illness perception and social participation（P < 0.01）， surrender was positively correlated with illness perception and social participation（P < 0.01）. confrontation and acceptance-resignation play a parallel mediating role between illness perception and social participation（P < 0.01）， accounting for 29.65% and 16.05% of the total effect， respectively. Conclusions Social participation is at a medium and below level in the patients receiving surgery for Stanford type A aortic dissection， coping style is intermediary variable for illness perception and social participation. By increasing the positive illness perception in the patients， medical staff can instruct them to cope actively with their disease and to enhance their social participation.

Objective To determine the efficacy of micro-needle knife therapy versus placebo （sham micro-needle knife） for cervicogenic headache. Method A total of 60 eligible patients with cervicogenic headache were assigned to two groups with 30 cases in each group by using a random number table. Treatment group received micro-needle knife therapy and placebo group received sham micro-needle knife. Results After 4 weeks of intervention， the pain index score was significantly lower in the treatment group （1.27 ± 0.583） than that of the placebo group （3.37 ± 0.765）； the cervical range of motion was significantly lower in the treatment group A （1.20 ± 0.407） than that of the placebo group （2.47 ± 0.681）； the headache duration was significantly lower in the treatment group （3.33 ± 0.661） than that of the placebo group （5.30 ± 0.988）； the headache frequency was significantly lower in the treatment group （1.50 ± 0.682） than that of the placebo group （2.73 ± 0.691）， and the differences in the data of the two groups were statistically significant. The duration of headache （3.93 ± 0.739） and frequency of headache （1.96 ± 0.556） were significantly lower in the treatment group than that of the placebo group at follow-up， and the difference was statistically significant （P < 0.05）. The occurrence of adverse reactions was not statistically significant in the two groups（P > 0.05） Conclusions Micro-needle knife therapy could effectively improve the pain level of cervicogenic headache patients， reduce the headache duration and headache frequency， and improve the mobility of cervical spine. Acupuncture-related adverse events during treatment were infrequent in both groups and it′s safe for cervicogenic headache.

The improvingclinical outcomes of pancreas transplantation for diabetes， especially the use of combined pancreas-kidney transplantation for diabetes complicated with end-stage renal disease，have led to more transplant centers performing this surgery. However， the complexity of the procedure and various complications have resulted in decreased survival rates for both patients and grafts， particularly due to the high incidence of early postoperative vascular complications. Contrast enhanced ultrasound has emerged as a superior modality for post-transplant evaluation in pancreas transplantation. This article provides a comprehensive review of the application of contrast enhanced ultrasound in post-transplant vascular assessment， donor pancreas evaluation， thrombosis detection， prediction of insulin secretion capacity， rejection reaction and complications. This review aim to provide valuable insights for the clinical application and further research of pancreas transplantation.

In-stent restenosis is one of the main causes of postoperative complications after percutaneous coronary intervention and a challenge in the field of intervention.Sodium-glucose cotransporter 2 inhibitors （SGLT2i）are new oral hypoglycemic agents used in the treatment of diabetes in recent years. In addition to lowering bloodglucose， they also have the effects of lowering blood pressure， improving blood lipids， and reducing weight， thereby protecting cardiovascular function. Recent studies have shown that SGLT2i can reduced the occurrence of in-stent restenosis and significantly improved the prognosis of patients with coronary heart disease receiving interventional therapy.This article reviews the clinical studies and mechanisms of SGLT2i in the prevention of restenosis after percutaneous coronary intervention， providing new ideas for improving the clinical prognosis of patients with coronary heart disease.