Down-regulation of DNA key protein-FEN1 inhibits OSCC growth by affecting immunosuppressive phenotypes via IFN-γ/JAK/STAT-1 / 国际口腔科学杂志·英文版

Oral squamous cell carcinoma (OSCC) escape from the immune system is mediated through several immunosuppressive phenotypes that are critical to the initiation and progression of tumors. As a hallmark of cancer, DNA damage repair is closely related to changes in the immunophenotypes of tumor cells. Although flap endonuclease-1 (FEN1), a pivotal DNA-related enzyme is involved in DNA base excision repair to maintain the stability of the cell genome, the correlation between FEN1 and tumor immunity has been unexplored. In the current study, by analyzing the clinicopathological characteristics of FEN1, we demonstrated that FEN1 overexpressed and that an inhibitory immune microenvironment was established in OSCC. In addition, we found that downregulating FEN1 inhibited the growth of OSCC tumors. In vitro studies provided evidence that FEN1 knockdown inhibited the biological behaviors of OSCC and caused DNA damage. Performing multiplex immunohistochemistry (mIHC), we directly observed that the acquisition of critical immunosuppressive phenotypes was correlated with the expression of FEN1. More importantly, FEN1 directly or indirectly regulated two typical immunosuppressive phenotype-related proteins human leukocyte antigen (HLA-DR) and programmed death receptor ligand 1 (PD-L1), through the interferon-gamma (IFN-γ)/janus kinase (JAK)/signal transducer and activator transcription 1 (STAT1) pathway. Our study highlights a new perspective on FEN1 action for the first time, providing theoretical evidence that it may be a potential immunotherapy target for OSCC.

Effect of lidocaine on dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients / 中华麻醉学杂志

Objective:To evaluate the effect of lidocaine on the dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱelderly patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, undergoing painless gastroscopy under general anesthesia, were divided into 2 groups using a random number table method: remimazolam group (group C) and lidocaine combined with remimazolam group (group L). Alfentanil 6 μg/kg was given at anesthesia induction in all the patients, and then lidocaine 2 mg/kg was intravenously injected in the patients in group L. Modified Dixon′s up-and-down method was used for the study. Remimazolam was intravenously injected at a dose of 0.18 mg/kg in the first patient, and the gastroscope was placed when the eyelash reflex disappeared and the modified observational alertness/sedation assessment score ≤3. Gastroscope insertion response was defined as swallowing, bucking, body movement and other responses affecting the quality of examination during the gastroscope insertion. The dose of remimazolam was increased/decreased by 0.02 mg/kg in the next patient if the gastroscope response was positive or negative, and the process was repeated until 9 turning points occurred. The median effective dose (ED 50) and 95% confidence interval ( CI) of remimazolam were calculated by probit method. Results:The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with alfentanil was 0.158 (0.133-0.183) mg/kg in group C. The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with fentanyl was 0.139 (0.127-0.151) mg/kg in group L. The ED 50 was significantly lower in group L than in group C ( P=0.003). Conclusions:Intravenous lidocaine in combination with alfentanil increases the efficacy of remimazolam for painless gastroscopy in elderly patients.

Effects of in-house made heat preservation socks on body temperature maintenance in elderly patients undergoing spinal surgery / 中华老年医学杂志

Objective:To examine the effects of in-house made heat preservation socks on body temperature maintenance in elderly patients undergoing posterior approach spinal surgery.Methods:This was a randomized, controlled trial.A total of 84 patients aged 65-75 years treated with posterior approach spinal surgery under general anesthesia were enrolled.Patients were randomly divided into two groups: the experimental group(n=42)and the control group(n=42). The two groups were treated with the same anesthesia procedure.The control group was given routine temperature management, while the experimental group used in-house made heat preservation socks in addition to routine temperature management during the entire surgical process.The anal temperature of patients was dynamically monitored with a disposable body temperature probe, and body temperature, heart rate, mean arterial pressure and oxygen saturation were recorded at the time of anesthesia induction and intubation(T 0), skin incision(T 1), 1 hour into surgery(T 2), 2 hours into surgery(T 3), the end of surgery(T 4), arrival at the post-anesthesia care unit(T 5), immediately after extubation(T 6)and 1 hour after extubation(T 7). The occurrence of intraoperative body temperature lower than 36℃, postoperative extubation time, incidence of shivering, postoperative incision infection rate and average length of stay were recorded.Changes in C-reactive protein and procalctonin levels were recorded. Results:There was no significant difference in sex composition, age, height, weight, body mass index and operative time between the two groups(all P>0.05). From T 2 to T 7, the body temperature of the experimental group was higher than that of the control group[T 2: (36.5±0.5)℃ vs.(36.3±0.3)℃, (36.6±0.6)℃ vs.(36.2±0.4)℃, (36.6±0.6)℃ vs.(36.2±0.4)℃, (36.6±0.6)℃ vs.(36.2±0.4)℃, (36.6±0.6)℃ vs.(36.2±0.4)℃, (36.6±0.5)℃ vs.(36.2±0.3)℃, t=2.229, 3.514, 3.823, 3.790, 3.722, 4.408, P=0.029, 0.001, 0.001, 0.001, 0.001, 0.000]. The incidence of intraoperative body temperature lower than 36 ℃ in the control group was higher than that in the experimental group(47.6% vs.21.4%, χ2=6.372, P=0.012). The incidence of postoperative shivering in the experimental group was lower than that in the control group(21.4% vs.59.5%, χ2=12.649, P<0.001). There was no significant difference between the two groups in postoperative incision infection rate, average length of stay and postoperative inflammatory infection indicators(all P>0.05). Conclusions:For elderly patients undergoing posterior spinal surgery, the in-house made heat preservation socks have favorable effects on body temperature maintenance and help reduce the occurrence of hypothermia and postoperative shivering.

Efficacy observation of deep hyperthermia combined with recombinant human vascular endothelial inhibitor injection and AP regimen in treatment of advanced non-small cell lung cancer / 肿瘤研究与临床

Objective:To investigate the efficacy of deep hyperthermia combined with recombinant human vascular endothelial inhibitor injection and AP (pemetrexed + cisplatin) regimen in the treatment of advanced non-small cell lung cancer (NSCLC) and its effects on serum tumor marker levels and immune function of patients.Methods:In this prospective randomized controlled study, 106 patients with advanced NSCLC who were admitted to the Seventh People's Hospital of Hebei Province from January 2016 to January 2022 were included, and were divided into two groups according to the random number table method, with 53 cases in each group. The control group was treated with recombinant human vascular endothelial inhibitor injection combined with AP regimen. The observation group was given recombinant human vascular endothelial inhibitor injection combined with AP regimen and deep hyperthermia. After 4 consecutive cycles of treatment, the short-term efficacy of the two groups was observed. Chemiluminescence assay was used to detect the serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and cytokeratin fragment 19 CYFR21-1 before and after treatment. T lymphocyte subsets in peripheral blood were detected by flow cytometry. The occurrence of adverse reactions was compared between the two groups.Results:The objective response rates in observation group and control group were 58.49% (31/53) and 37.74% (20/53), the disease control rates in observation group and control group were 92.45% (49/53) and 75.47% (40/53), the observation group was higher than the control group ( χ2 = 4.53, P = 0.033; χ2 = 5.62, P = 0.018). The differences in serum carcinoembryonic antigen (CEA), glycoantigen 125 (CA125) and CYFR21-1 levels between the two groups before treatment were not statistically significant (all P > 0.05), they were lower in both groups after treatment than before treatment (all P < 0.05), and they were lower in the observation group after treatment than in the control group after treatment (all P < 0.05). The differences in peripheral blood CD3 +, CD4 + and CD8 + T-cell levels and CD4 + to CD8 + T-cell ratio (CD4 +/CD8 +) between the two groups before treatment and in the observation group before and after treatment were not statistically significant (all P > 0.05). Peripheral blood CD3 + and CD4 + T-cell levels and CD4 +/CD8 + in the control group after treatment were lower than before treatment (all P < 0.05), and the peripheral blood CD8 + T-cell level was higher than before treatment ( P < 0.05). CD3 + and CD4 + cell levels and CD4 +/CD8 + in the observation group after treatment were higher than those in the control group after treatment, CD8 + T-cell level was lower than the control group after treatment, and the differences were statistically significant (all P < 0.001). There were different degree of gastrointestinal reactions, bone marrow suppression, liver and kidney damage and cardiotoxicity in both groups during treatment, but the differences in the incidence of each adverse reaction between the two groups were not statistically significant (all P > 0.05). Conclusions:Deep hyperthermia combined with recombinant human vascular endothelial inhibitor injection and AP regimen in the treatment of advanced NSCLC can effectively reduce the serum tumor marker levels, improve the immunosuppression status of the body and enhance the recent efficacy, and the overall adverse reactions are controllable and well tolerated by patients.

Experimental study on measurement of short pulsed and high-dose-rate X-ray by therapeutic grade ionization chamber / 中华放射医学与防护杂志

Objective:To investigate the application of therapeutic grade ionization chamber to rapid measurement of short pulsed and high-dose-rate X-ray.Methods:The half-value layer of pulsed X-ray caused by an electron accelerator was measured by interpolation method and its equivalent energy was estimated. The cumulative doses from a certain amount of pulsed radiation at different distances in the same direction around the equipment were compared using the therapeutic grade ionization chamber and thermoluminescence measurement method . The relationship between the measurement result by using ionization chamber dosimeter and the distances away from source was analyzed. The cumulative doses from a certain amount of pulsed radiation at the same location at different frequencies were compared.Results:In working condition, 100 pulses of radiation were received accumulatively at 1 to 12 meters away from the outer wall of the equipment. The range of air Kerma was 0.08-9.65 mGy measured by using thermoluminescence dometers and 0.08 - 9.85 mGy using the ionization chamber dosimeters, respectively. The difference between both is within 10%. At different frequencies (1-10 Hz), there was no significant difference in X-ray air Kerma from 100 pulses measured by ionization chamber dosimeter at 2 m away from the front of the equipment ( P>0.05). Conclusions:The therapeutic grade ionization chamber dosimeter can be used for the rapid measurement of short pulsed X-ray radiation dose in the range of dose rates and pulse frequencies involved in the experimental accelerator device.

Case report of pulmonary hypertension caused by filamin A mutation / 中华实用儿科临床杂志

The clinical data of a case of pulmonary arterial hypertension (PAH) caused by mutation of filamin A( FLNA) in the congenital heart disease center of Wuhan Asian Heart Hospital in September 2017 were subject to retrospective analysis.A 2-year-old girl had clinical characteristics of special face, backward growth and development, repeated pulmonary infections, repeated heart failure, congenital heart disease, and PAH.Genetic detection: FLNA mutation (exon34: c.5417-1G> A), which was a new pathogenic mutation.There were few reports of PAH caused by FLNA mutations.In this study, a new case of pulmonary hypertension caused by FLNA c. 5417-1G>A compound heterozygous shearing mutations was found, which enriched the FLNA mutation spectrum and prompted genetic detection was an important approach to detect the cause of PAH.

Correlation study of multimodal ultrasound characteristics with HCK and MRPL13 expression in breast cancer / 中华内分泌外科杂志

Objective:To investigate the correlation between hematopoietic cell kinase (HCK) and the expression level of the mitochondrial ribosomal protein L13 (MRPL13) and hematopoietic multimode ultrasound.Methods:204 female breast cancer patients treated by surgery in Quzhou people’s Hospital from Jan. 2017 to Sep. 2020 were selected as study subjects. Breast cancer tissues and adjacent normal tissues were extracted intraoperatively. Preoperative conventional ultrasound, shear wave elastography (SWE) and contrast-enhanced Ultrasonography (CEUS) were used to detect HCK and MRPL13 expression levels. Univariate analysis and binary Logistic regression were used to analyze the correlation between multi-mode ultrasonic features and HCK and MRPL13.Results:The positive expression ratios of HCK and MRPL 13 in breast cancer tissues were significantly higher than those in adjacent tissues ( χ2 was 5.625, 7.197; P was 0.018, 0.007) . In conventional ultrasound features, the proportions of HCK-positive breast cancer patients with irregular mass edges, microcalcifications, and grade II to III blood flow classification were significantly higher than those of HCK-negative patients ( χ2 was 7.437, 16.684, 23.262; P was 0.006, <0.001, <0.001) ; The proportion of MRPL13-positive breast cancer patients with a maximum diameter of ≥2 cm, irregular edges of the tumor, and grade II-III blood flow classification was significantly higher than that of MRPL13-negative patients ( χ2 was 4.676, 11.118, 8.389; P was 0.031, 0.001, 0.004) . For SWE signs, the proportion of HCK positive breast cancer patients with hard ring sign was significantly higher than that of HCK negative patients ( χ2=11.220, P=0.001) ; the proportion of MRPL13 positive breast cancer patients with hard ring sign and black hole sign was significantly higher than that of MRPL13. Those who were negative ( χ2 was 4.482, 8.775; P was 0.034, 0.003) . Among CEUS characteristics, the proportion of HCK-positive patients with high enhancement was significantly higher than that of HCK-negative patients ( χ2=7.356, P=0.007) ; the proportion of MRPL13-positive patients with high enhancement and late regression was significantly higher than that of MRPL13-negative patients ( χ2 was 9.165, 7.631; P was 0.002, 0.006) . The results of binary logistic analysis showed that there was microcalcification ( OR=4.619, 95% CI=2.657-8.119, P=0.009) , blood flow classification II to III ( OR=4.150, 95% CI=2.547-7.954, P=0.015) and high enhancement of CEUS ( OR=4.150, 95% CI=2.547-7.954, P=0.015) are independent risk factors for positive expression of HCK; blood flow grade II to grade III ( OR=4.213, 95% CI=3.145-8.557, P=0.012) , appearance of black hole sign ( OR=5.246, 95% CI=2.864-10.378, P<0.001) and high enhancement of CEUS ( OR=3.872, 95% CI=1.887~6.438, P=0.026) were the independent risk factors for the positive expression of MRPL13. Conclusion:The multimodal ultrasonographic features of breast cancer are helpful to predict the expression levels of HCK and MRPL13, so as to provide new imaging ideas for early diagnosis of breast cancer, the designation of treatment options and the preoperative non-invasive assessment of breast cancer prognosis.

Glycolysis reprogramming in cancer-associated fibroblasts promotes the growth of oral cancer through the lncRNA H19/miR-675-5p/PFKFB3 signaling pathway / 国际口腔科学杂志·英文版

As an important component of the tumor microenvironment, cancer-associated fibroblasts (CAFs) secrete energy metabolites to supply energy for tumor progression. Abnormal regulation of long noncoding RNAs (lncRNAs) is thought to contribute to glucose metabolism, but the role of lncRNAs in glycolysis in oral CAFs has not been systematically examined. In the present study, by using RNA sequencing and bioinformatics analysis, we analyzed the lncRNA/mRNA profiles of normal fibroblasts (NFs) derived from normal tissues and CAFs derived from patients with oral squamous cell carcinoma (OSCC). LncRNA H19 was identified as a key lncRNA in oral CAFs and was synchronously upregulated in both oral cancer cell lines and CAFs. Using small interfering RNA (siRNA) strategies, we determined that lncRNA H19 knockdown affected proliferation, migration, and glycolysis in oral CAFs. We found that knockdown of lncRNA H19 by siRNA suppressed the MAPK signaling pathway, 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) and miR-675-5p. Furthermore, the lncRNA H19/miR-675-5p/PFKFB3 axis was involved in promoting the glycolysis pathway in oral CAFs, as demonstrated by a luciferase reporter system assay and treatment with a miRNA-specific inhibitor. Our study presents a new way to understand glucose metabolism in oral CAFs, theoretically providing a novel biomarker for OSCC molecular diagnosis and a new target for antitumor therapy.

Radiotherapy targeting cancer stem cells "awakens" them to induce tumour relapse and metastasis in oral cancer / 国际口腔科学杂志·英文版

Radiotherapy is one of the most common treatments for oral cancer. However, in the clinic, recurrence and metastasis of oral cancer occur after radiotherapy, and the underlying mechanism remains unclear. Cancer stem cells (CSCs), considered the "seeds" of cancer, have been confirmed to be in a quiescent state in most established tumours, with their innate radioresistance helping them survive more easily when exposed to radiation than differentiated cancer cells. There is increasing evidence that CSCs play an important role in recurrence and metastasis post-radiotherapy in many cancers. However, little is known about how oral CSCs cause tumour recurrence and metastasis post-radiotherapy. In this review article, we will first summarise methods for the identification of oral CSCs and then focus on the characteristics of a CSC subpopulation induced by radiation, hereafter referred to as "awakened" CSCs, to highlight their response to radiotherapy and potential role in tumour recurrence and metastasis post-radiotherapy as well as potential therapeutics targeting CSCs. In addition, we explore potential therapeutic strategies targeting these "awakened" CSCs to solve the serious clinical challenges of recurrence and metastasis in oral cancer after radiotherapy.

Application of ultrasound-guided obturator nerve block combined with general anesthesia in transarethral resection of bladder fumors for elderly patients / 中华老年医学杂志

Objective:To explore the clinical value of ultrasound-guided obturator nerve block combined with general anesthesia in transurethral resection of bladder tumors(TURBT)for the elderly.Methods:A total of 84 elderly bladder tumor patients were randomly selected from those admitted to our hospital from November 2017 to August 2019, and were divided into the observation group(n=43)and the control group(n=41)according to whether obturator nerve block was performed.Patients in the observation group were given general anesthesia combined with ultrasound-guided obturator nerve block, and those in the control group were given general anesthesia alone.The surgical conditions, postoperative complications, and rates of adverse reactions were compared between the two groups.Results:Patients in the observation group had a significantly shorter duration of operation, shorter indwelling urinary catheter use, fewer days stayed in hospital and less intraoperative blood loss, compared with the control group(all P<0.05). Besides, the incidence of obturator nerve injury in the observation group was also significantly lower than in the control group(4.65% vs.19.51%, χ2=4.420, P=0.036). There were 2 cases of bladder hemorrhage and 1 case of bladder perforation in the control group, but no case of bladder hemorrhage or bladder perforation occurred in the observation group.A total of 2 cases of tachycardia, 2 cases of nausea and vomiting, and 1 case of hypotension were seen in the control group; and 3 cases of tachycardia, 1 case of nausea and vomiting, and 2 cases of hypotension occurred in the observation group.The total incidence of adverse reactions was similar between the two groups(12.16% vs.13.95%, χ2=0.057, P=0.811). Conclusions:The use of ultrasound-guided obturator nerve block combined with general anesthesia in TURBT surgery can effectively enhance the inhibitive effect on obturator nerve reflex, and reduce the risk of obturator nerve injury during surgery.Therefore, it can ensure smooth operation of the surgery and has a very positive effect on promoting successful postoperative rehabilitation.

Effect of red light combined with hot compress on peripheral neuropathy of diabetes / 中国基层医药

Objective@#To investigate the effect of red light combined with hot compress on diabetic peripheral neuropathy (DPN).@*Methods@#From June 2017 to June 2018, 110 patients with DPN admitted to the Department of Endocrinology, Hangzhou Hospital of Traditional Chinese Medicine were selected in the study.The patients were divided into study group (55 cases) and control group (55 cases) according to the random number table method.All patients were given DPN basic care and treatment, with red light in the control group, and red light combined with hot compress in the study group.The motor nerve conduction velocity (MCV) and the sensory nerve conduction velocity (SCV) of the ulnar nerve, median nerve and common peroneal nerve were compared between the two groups before and after treatment.The total scores of the Toronto clinical scoring system (TCSS) were compared between the two groups before and after treatment.The efficacy of the two groups was compared.@*Results@#Before treatment, there were no statistically significant differences in MCV [(40.45±5.33)m/s vs.(40.14±5.08)m/s, t=0.312, P=0.755; (41.15±5.51)m/s vs.(40.86±5.23)m/s, t=0.283, P=0.778; (42.27±5.84)m/s vs.(41.94±5.75)m/s, t=0.299, P=0.766] and SCV [(39.38±4.82)m/s vs.(39.08±4.60)m/s, t=0.334, P=0.739; (40.13±5.45)m/s vs.(39.86±5.15)m/s, t=0.267, P=0.790; (41.18±5.78)m/s vs.(40.89±5.46)m/s, t=0.278, P=0.782] between the ulnar nerve, median nerve and common peroneal nerve in the two groups.After treatment, the ulnar nerve, median nerve and common peroneal nerve of the two groups were treated.The MCV[(48.77±7.25)m/s vs.(44.62±6.30)m/s, t=3.204, P=0.002; (49.35±7.46)m/s vs.(45.36±6.45)m/s, t=3.001, P=0.003; (49.26±7.13)m/s vs.(46.35±6.22)m/s, t=2.281, P=0.025] and SCV[(47.67±6.52)m/s vs.(43.57±5.61)m/s, t=3.535, P=0.001; (47.77±6.63)m/s vs.(44.31±5.14)m/s, t=3.059, P=0.003; (48.33±7.17)m/s vs.(45.12±6.41)m/s, t=2.475, P=0.015] of the two groups were increased, while which of the study group increased more significantly.Before treatment, there was no statistically significant difference in the total scores of TCSS between the two groups [(10.15±1.23)points vs.(10.45±1.51)points, t=1.142, P=0.256]. After treatment, the total scores of TCSS decreased in the two groups, while which of the study group decreased more significantly[(7.22±0.85)points vs.(8.15±0.96)points, t=5.379, P=0.000]. After treatment, the effective rate of the study group was 87.27%, which of the control group was 63.64%, the difference was statistically significant(χ2=8.295, P=0.004).@*Conclusion@#The combination of red light and hot compress on DPN has a more prominent clinical effect, which is worthy of wide application.

Effect of red light combined with hot compress on peripheral neuropathy of diabetes / 中国基层医药

Objective To investigate the effect of red light combined with hot compress on diabetic peripheral neuropathy (DPN).Methods From June 2017 to June 2018,110 patients with DPN admitted to the Department of Endocrinology,Hangzhou Hospital of Traditional Chinese Medicine were selected in the study. The patients were divided into study group (55 cases) and control group (55 cases) according to the random number table method.All patients were given DPN basic care and treatment,with red light in the control group,and red light combined with hot compress in the study group.The motor nerve conduction velocity ( MCV) and the sensory nerve conduction velocity (SCV) of the ulnar nerve,median nerve and common peroneal nerve were compared between the two groups before and after treatment.The total scores of the Toronto clinical scoring system ( TCSS) were compared between the two groups before and after treatment.The efficacy of the two groups was compared.Results Before treatment,there were no statistically significant differences in MCV [(40.45 ± 5.33)m/s vs.(40.14 ± 5.08)m/s,t=0.312,P=0.755;(41.15 ± 5.51)m/s vs.(40.86 ± 5.23)m/s,t=0.283,P=0.778;(42.27 ± 5.84)m/s vs.(41.94 ± 5.75)m/s, t=0.299,P=0.766] and SCV [(39.38 ± 4.82) m/s vs.(39.08 ± 4.60) m/s,t=0.334,P=0.739;(40.13 ± 5.45)m/s vs.(39.86 ± 5.15)m/s,t=0.267,P=0.790;(41.18 ± 5.78)m/s vs.(40.89 ± 5.46) m/s,t=0.278, P=0.782] between the ulnar nerve,median nerve and common peroneal nerve in the two groups.After treatment,the ulnar nerve,median nerve and common peroneal nerve of the two groups were treated.The MCV[(48.77 ± 7.25)m/s vs.(44.62 ± 6.30)m/s,t=3.204,P=0.002;(49.35 ± 7.46)m/s vs.(45.36 ± 6.45)m/s,t=3.001,P=0.003;(49.26 ± 7.13)m/s vs.(46.35 ± 6.22)m/s,t=2.281,P=0.025] and SCV[(47.67 ± 6.52)m/s vs.(43.57 ± 5.61)m/s,t=3.535,P=0.001;(47.77 ± 6.63)m/s vs.(44.31 ± 5.14) m/s,t=3.059,P=0.003;(48.33 ± 7.17)m/s vs.(45.12 ± 6.41)m/s,t=2.475,P=0.015] of the two groups were increased,while which of the study group increased more significantly.Before treatment,there was no statistically significant difference in the total scores of TCSS between the two groups [(10.15 ± 1.23) points vs.(10.45 ± 1.51) points,t=1.142,P=0.256].After treatment,the total scores of TCSS decreased in the two groups, while which of the study group decreased more significantly[(7.22 ± 0.85)points vs.(8.15 ± 0.96)points,t=5.379,P=0.000].After treatment,the effective rate of the study group was 87.27%,which of the control group was 63.64%,the difference was statistically significant (χ2 =8.295,P=0.004).Conclusion The combination of red light and hot compress on DPN has a more prominent clinical effect,which is worthy of wide application.

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta,and provide clinically useful information for the prevention and treatment of BPV.Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively.According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV),patients were divided into four groups,and clinical data,biochemical indicators and drug use were compared among 4 groups.Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV.Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study.Their dialysis duration was (48.4±36.1) months,and the median of interdialysis SBP-CV was 8.07％ (5.72％,11.34％).According to the quartile of SBP-CV,the patients were divided into four groups:low BPV group (SBP-CV≤5.72％,253 cases),middle BPV group (5.72％ ＜ SBP-CV≤8.07％,252 cases),high BPV group (8.07％ ＜ SBP-CV≤11.34％,253 cases) and extremely high BPV group (SBP-CV ＞ 11.34％,252 cases),and the dialysis duration,diabetes,ultrafiltration,interdialysis weight gain rate (IDWGR),serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P ＜ 0.05).Logistic multiple regression analysis showed that high IDWGR (OR=1.216,95％CI 1.108-1.435,P ＜ 0.001) was an independent risk factors for interdialysis BPV in MHD patients,while high ultrafiltration volume (OR=0.436,95％CI 0.330-0.575,P ＜ 0.001) and calcium channel antagonists used (OR=0.686,95％CI 0.477-0.986,P=0.042) were independent protective factors.Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients,while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.

Effect of Dexmedetomidine on postoperative impairment of cognitive function in elderly patients undergoing thoracoscopic surgery under wireless analgesia / 中华老年医学杂志

Objective To investigate the effect of Dexmedetomidine on postoperative impairment of cognitive function in elderly patients undergoing thoracoscopic surgery under wireless analgesia.Methods Eighty elderly patients undergoing thoracoscopic surgery in our hospital from May 2017 to April 2018 were randomly divided into the S group(n=40)receiving Sufentanil under wireless analgesia,and the DS group receiving Dexmedetomidine as add-on to the therapy for S group.The mini-mental state examination(MMSE) score,postoperative pain degree,and serum levels of interleukin(IL)-1,IL-6 and tumor necrosis factor(TNF)-α,as well as adverse reactions were compared between the two groups,preoperatively and postoperatively.Results MMSE score was higher in the DS group than in the S group at 1 and 3 days after operation[(26.85±1.20)vs.(26.33±1.33),(26.65± 1.16)vs.(26.00± 1.29),t =1.795 and 2.370,P =0.038 and 0.010].Pain visual analog scale(VAS)score was lower in the DS group than in the S group at 6 and 12 hours after operation[(4.32±0.64)vs.(4.65±0.77),(4.01±0.45)vs.(4.23±0.59),t=2.138 and 1.875,P=0.018 and 0.032,respectively].At 1 and 3 days after operation,IL-1,IL-6 and TNF-α levels were higher in SD group than in S group (P ＜ 0.05).But,at 5 and 7 days after operation,there was no significant difference in the expression levels of IL-1,IL-6 and TNF between the two groups (P ＞0.05).The incidence of nausea was lower in DS group than in S group(2.5％ vs.15.0％,x2 =3.914,P=0.048),while the incidence of bradycardia was higher in the DS group than in the S group(17.5％ vs.2.5 ％,x2 =5.000,P =0.025).Conclusions Dexmedetomidine not only effectively alleviates the postoperative pain and improves cognitive function in elderly patients undergoing thoracoscopic management under wireless analgesia,but also reduces postoperative inflammatory levels.

Current situation and demands for diabetes knowledge in prediabetes patients at different self-management levels / 中南大学学报(医学版)

To understand the current situation regarding the knowledge and demand for patients with prediabetes at different self-management levels, and to provide guide for improving their knowledge.
 Methods: A total of 312 prediabetes patients from 3 hospitals in Changsha were enrolled in this survey. The questionnaires covered diabetes self-management behavior scale and prediabetes knowledge status and demand questionnaire. Diabetes knowledge acquisition and demand were analyzed among patients with different levels of self-management.
 Results: The score of self-management behavior for patients with prediabetes was 39.1±13.9. The rate of knowledge acquisition was low and the rate of demand was high. The knowledge acquisition rate was high and the knowledge demand rate was low in patients with high levels of self-management. As for the contents of health education, the dietary collocation and method for glucose detection were highly needed by all self-management levels of patients.
 Conclusion: Prediabetes patients' self-management level are low. Health education to patients with prediabetes should be based on individualized demands.

Status of new ultrasonic technology combined with breast imaging-reporting and data system for ultrasound in evaluating breast lesions / 中国介入影像与治疗学

Nowadays,breast imaging-reporting and data system for ultrasound (BI-RADS-US) is widely used in the clinic.With the rapid development of ultrasound technology,such as elastography,CEUS,three-dimensional ultrasonography and MicroPure technology,the combination of new ultrasonic technology with BI-RADS-US plays a more important role in improving the ability of ultrasound in diagnosis of small breast lesions and the diagnosis efficiency for breast cancer.The status of new ultrasonic technology combined with BI-RADS-US in evaluating benign and malignant breast lesions were reviewed in this article.

Effect of parecoxib sodium combined with dexmedetomidine on postoperative levels of plasma excita-tory aminoacid and beta-amyloid protein in jugular bulb venous of elderly patients / 中华麻醉学杂志

Objective To investigate the effect of parecoxib sodium combined with dexmedetomi-dine on postoperative levels of plasma excitatory aminoacid and beta-amyloid protein(β-AP)in jugular bulb venous of elderly patients. Methods A total of 135 patients of either sex, aged 65-79 yr, weighing 47-76 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective open reduc-tion and internal fixation after tibial fracture and hip replacement, were divided into 3 groups(n=45 each) using a random number table: parecoxib sodium group(group P), dexmedetomidine group(group D)and parecoxib sodium combined with dexmedetomidine group(group PD). In group P, parecoxib sodium 40 mg (diluted to 5 ml in normal saline)was injected intravenously at 15 min before induction of anesthesia. In group D, dexmedetomidine was intravenously infused at a loading dose of 05 μg∕kg over 15 min starting from 15 min before induction of anesthesia, followed by an infusion of 05 μg·kg-1·h-1until the end of surgery. In group PD, parecoxib sodium 40 mg(diluted to 5 ml in normal saline)was intravenously injec-ted at 15 min before induction of anesthesia, and dexmedetomidine was intravenously infused at a loading dose of 05 μg∕kg over 15 min followed by an infusion of 05 μg·kg-1·h-1until the end of surgery at the same time. At 15 min before induction of anesthesia(T0), at the end of surgery(T1)and at 24, 48 and 72 h after surgery(T2-4), jugular bulb venous blood samples were taken for determination of concentrations of glutamate and aspartate in plasma(by reversed phase high-performance liquid chromatography)and β-AP(by enzyme-linked immunosorbent assay). Cognitive function was assessed at 1 day before surgery and 7 days after surgery using a battery of neuropsychologic tests including Wechsler Memory Scale, Digit Span (Forward and Backward), visual recognition and associative learning, Wechsler Adult Intelligence Scale and Trail Making Test Part A. The occurrence of postoperative cognitive dysfunction was recorded at 7 days after surgery. Results Compared with P and D groups, the concentrations of plasma glutamate at T2-3, plasma aspartate at T2and β-AP at T1and incidence of postoperative cognitive dysfunction were significantly decreased in group PD(P< 005). Conclusion The mechanism by which parecoxib sodium combined with dexmedetomidine decreases the occurrence of POCD may be related to inhibiting the levels of excitatory aminoacid and β-AP in brain tissues of elderly patients.

The standard operating techniques for diagnostic interventional pulmonology based on rapid on-site evaluation / 天津医药

With the organic combination of rapid on-site evaluation (ROSE) and interventional pulmonary diagnostic technology, we can build a complete The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation. With the help of ROSE, changing the ways, methods and modalities of interventional pulmonary diagnostic technology to obtain the target lesions is the core of this system. In this statement, the most commonly used standard operating techniques in The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation are described in detail, including double-hinge curette operating technique, transbronchial lung biopsy (TBLB) technique, and transbronchial brushing technique.

Effect of flurbiprofen axetil pretreatment on mesenteric traction syndrome in elderly patients under-going abdominal surgery / 中华麻醉学杂志

Objective To evaluate the effect of flurbiprofen axetil pretreatment on mesenteric trac-tion syndrome in elderly patients undergoing abdominal surgery. Methods Sixty patients of both sexes, aged 65-86 yr, with body mass index of 18.8-25.6 kg∕m2, of American Society of Anesthesiologists phys-ical status Ⅰor Ⅱ, scheduled for elective gastrointestinal tract surgery under general anesthesia, were di-vided into 2 groups(n=30 each)using a random number table: flurbiprofen axetil group(group F)and normal saline group(group NS). Flurbiprofen axetil 50 mg was intravenously injected during anesthesia in-duction in group F, while the equal volume of normal saline was given instead in group NS. Immediately af-ter anesthesia induction, immediately after mesenteric traction and at 10, 15 and 30 min after mesenteric traction, arterial blood samples were collected for measurement of plasma 6-keto-prostaglandin F1α concen-trations using enzyme-linked immunosorbent assay. The occurrence of mesenteric traction syndrome was re-corded within 30 min after mesenteric traction. Results Compared with group NS, the plasma 6-keto-pros-taglandin F1α concentrations were significantly decreased at each time point, and the incidence of mesen-teric traction syndrome was decreased during each period after mesenteric traction in group F(P<0.05). Conclusion Flurbiprofen axetil pretreatment can effectively prevent the development of mesenteric traction syndrome in elderly patients undergoing abdominal surgery.

Effects of remote ischemic preconditioning combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction / 中华老年医学杂志

Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction.Methods Sixty ASA Ⅱ or Ⅲ patients aged 65-76 years [mean (70.4±6.3) years],weighing 50-75 kg,with moderate and severe pulmonary dysfunction,who were scheduled for elective radical operation for esophageal cancer,were randomly divided into 3 groups (n=20,each) by using a random number table:the control group (group C),RIPC group (group OR) and RIPC plus dexmedetomidine group (group ORD).At 10 min after endotracheal intubation,group ORD was induced by three cycles of 5 min of lower extremity ischemia followed by 5 min of reperfusion,at the same time a loading dose of dexmedetomidine 0.5 μig / kg was infused iv over 15 min,and then was infused at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.Group OR was induced by three cycles of 5 min of lower extremity ischemia followed by 5min of reperfusion without dexmedetomidine.Group C received only the equal volume of normal saline.Blood samples were obtained from radial artery immediately before anesthesia induction (T0),before one lung ventilation (T1),at 1 h after one lung ventilation (T2),the end of surgery (T3) and 24 h after operation (T4).Blood gas analysis was done at T1,T2,and T3.Plasma superoxide dismutase (SOD) activity and concentration of malonyldialdehyde (MDA),matrix metallo-proteinase-9 (MMP-9),interleukin-6(IL-6) and white blood cell (WBC) and neutrophil granulocyte (PMN) counts were measured at T0,T2,T3 and T4.The complications including pulmonary infection and atelectasis were recorded at 1,3 and 7 days after operation.Results At T2-3,PaO2 was higher in groups of OR and ORD than in group C Group ORD had higher PaO2 than did group OR [(265±15) mmHg,(305±23) mmHg vs.(231±17) mmHg,(273±21)mmHg,(312±24) mmHg vs.(242±18) mmHg,F=34.791 and 31.813,P＜0.01].At T2-3,RI was lower in groups of OR and ORD than in group C,and group ORD had lower RI than did group OR [(1.48±0.16),(1.14 ±0.14) vs.(1.86±0.18);(1.35±0.13),(0.96±0.09) vs.(1.73±0.15),F=119.260 and 164.855,P＜0.01].At T3-4,SOD activity was higher in group OR and ORD than in group C,and group ORD had higher SOD activity than did group OR [(83.6 ± 7.8) U/mg prot,(97.6± 9.5) U/mgprot vs.(70.5±7.4) U/mgprot;(73.5 ± 6.3) U/mgprot,(87.7 ± 8.9) U/mgprot vs.(61.6 ± 5.4) U/ mgprot,F=94.540 and 90.839,P＜0.01].At T3-4.plasma concentration of MDA,MMP-9,WBC and PMN counts were lower in group OR and ORD than in group C,and the above indices were lower in group ORD than in group OR [(7.5 ± 1.4) nmol/mgprot,(5.8 ± 1.0) nmol/mgprot vs.(9.5 ±1.5) nmol/mgprot;(8.2± 1.5) nmol/mgprot,(6.5 ± 1.0) nmol/mgprot vs.(10.1 ±1.6) nmol/mgprot;(205±23) μg/L,(173±21) μg/L vs.(237±26) μg/L,(179±16) μg/L,(158±12) μg/L vs.(203± 20) μg/L;(8.0±0.5) ×109/L,(7.2±0.6) × 109/L vs.(9.2±0.8)×109/L;(9.4±0.7) ×109/L,(8.2±0.6)×109/Lvs.(11.2±0.8) ×109/L;(7.4±0.7) ×109/L,(6.5±0.5) ×109/Lvs.(8.3 ±0.8) ×109/L,(7.8±0.8) ×109/L,(6.7±0.6) ×109/L vs.(9.2±0.9) ×109/L,F=98.872,52.723;198.307,47.622,20.319,36.935,18.197,35.036,respectively,all P＜0.01].At T2-4,IL-6 level was lower in groups of OR and ORD than in group C,and group ORD had lower IL-6 level than did group OR [(105±14) ng/L,(86±12) ng/L vs.(127±18) ng/L;(125±19) ng/L,(101±16) ng/ L vs.(156±22) ng/L;(110±16) ng/L,(89±12) ng/L vs.(132±20) ng/L,F=85.449,139.848,124.129,respectively,P＜0.01].The incidences of postoperative pulmonary infection and atelectasis were lower in group OR and ORD than group C,and group ORD had lower incidences of postoperative pulmonary infection and atelectasis than did group OR (x2 =6.303 and 14.545,P ＜ 0.05).Conclusions RIPC combined with dexmedetomidine can improve pulmonary function in elderly patients with thoracotomy and pulmonary dysfunction,may relieve the inflammatory reaction and oxidation reaction during perioperative period and finally help to improve the prognosis of patients.