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The tumor microenvironment includes blood vessels， lymph， nerves， non-malignant cells， and their metabolites at and near the tumor lesion site， which interact with cancer cells and promote cancer progression. Rapid proliferation of cancer cells increases oxygen consumption， or abnormalities in the structure and function of blood vessels in solid tumors lead to a decrease in oxygen supply， forming a hypoxia microenvironment. The existence of a hypoxia microenvironment is a typical pathophysiological feature of locally advanced solid tumors， widely present in various types of human malignant tumors. Hypoxia microenvironment is a sign of tumor microenvironment and an important and complex system in the breast tumor microenvironment. Its formation and development are closely related to the growth of breast cancer， occupying an important position in the research and treatment of breast cancer. With its advantages of multiple pathways and multiple targets， the effective monomer and compound of traditional Chinese medicine can better regulate the hypoxia microenvironment of breast cancer， inhibit the proliferation， invasion， and metastasis of breast cancer cells in the hypoxia environment， induce apoptosis， reverse their drug resistance， intervene in the metabolic reprogramming of breast cancer cells in the hypoxia environment， and inhibit their angiogenesis， thereby improving the quality of life of patients to a certain extent and prolonging the survival cycle of patients. This paper first summarized and discussed the effects of hypoxia microenvironment on proliferation， invasion， metastasis， drug resistance， immune function， metabolic reprogramming， non-coding RNA， iron death， and autophagy of breast cancer cells， which affected the occurrence and development of breast cancer， and it elaborated the mechanism behind it. Then， the paper elucidated the regulatory effect and mechanism of targeting the hypoxia microenvironment based on the two modes of effective monomer and compound of traditional Chinese medicine， so as to analyze and extract the deficiencies and directions of traditional Chinese medicine in regulating the hypoxia microenvironment and provide a theoretical reference for the effective treatment of breast cancer.
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Objective To screen the optimal regimen of Chinese medicine combined with hormones for the treatment of premature ovarian failure(POF)using network meta-analysis and to provide an evidence-based basis for the clinical treatment of POF.Methods The randomized controlled trials(RCTs)of Chinese medicine combined with hormones in the treatment of POF were retrieved from thhe domestic and oversea databases of CNKI,VIP,Wanfang,CBM,PubMed,Cochrane,Embase,and Web of Science.The quality of the literature was assessed using the tools for analysis of bias recommended by Cochrane Reviewer's Handbook and by Jadad scale scores.Rstudio and StataSE 15.1 statistical software were used to perform network meta-analysis and graphical presentation of the data.Results A total of 50 RCTs were included,covering 8 intervention methods.The overall risk of bias of the included studies was low,but the quality of the literature was generally low.The results of network meta-analysis showed that,in terms of the effective rate,the intervetion of 7 various Chinese medicines combined with hormone was superior to the conventional treatment(hormone replacement therapy,HRT)in the control group,and Nuangong Qiwei Powder+HRT was superior to the remaining 6 kinds of Chinese medicines combined with HRT;with reference to the values of the surface under the cumulative ranking curve(SUCRA),the efficiencies of the effective rate of the 8 intervention methods in descending order were Nuangong Qiwei Powder+ HRT(SUCRA=81.2),Zishen Yutai Pills + HRT(SUCRA=80.0),modified Zuogui Pills + HRT(SUCRA= 66.1),Ankun Zhongzi Pills + HRT(SUCRA=49.6),Kuntai Capsules + HRT(SUCRA=45.2),modified Erxian Decoction + HRT(SUCRA=39.5),Liuwei Dihuang Pills + HRT(SUCRA=37.4)and HRT(SUCRA=1.0).In terms of improving serum follicle-stimulating hormone(FSH)levels,modified Zuogui Pills + HRT was superior to the remaining 7 intervention methods;with reference to the values of the SUCRA,the efficiencies of the 8 intervention methods in descending order were modified Zuogui Pills + HRT(SUCRA=97.0),HRT(SUCRA= 77.9),Liuwei Dihuang Pills + HRT(SUCRA=76.6),Kuntai Capsules + HRT(SUCRA=46.5),Nuangong Qiwei Powder+HRT(SUCRA=38.9),Ankun Zhongzi Pills + HRT(SUCRA=29.9),modified Erxian Decoction + HRT(SUCRA=18.1),and Zishen Yutai Pills + HRT(SUCRA=15.1).Conclusion All kinds of Chinese medicines combined with HRT exert stronger effect on improving the primary outcome indicators than HRT alone for the treatment of POF.The intervention with Nuangong Qiwei Powder+HRT exerts the highest probability of the optimal regimen for enhancing the efficiency,and the intervention with Zuogui Pills + HRT exerts the highest probability of the optimal regimen for lowering the serum FSH level.However,due to the low quality of the included studies,more rigorously-designed,large sample-size,and high-quality randomized controlled trials need to be conducted in the future to provide conclusive evidence-based evidence.
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Objective To calculate median effective dose(ED50)of remimazolam combined with sufentanil for inhibition of nasopharyngeal airway insertion reaction in elderly patients.Methods Thirty-eight patients,aged≥65 years,BMI 18-25 kg/m2,ASA physical statusⅠ-Ⅲ,undergoing elective cata-ract surgery under nasopharyngeal airway were selected.Patients received intravenous sufentanil injections of 0.1 μg/kg,followed by intravenous remimazolam injection 3 minutes later,then nasopharyngeal airway in-sertion after 2 minutes.The initial dose of remimazolam was 0.2 mg/kg and adjusted by 0.01 mg/kg,based on the modified Dixon sequential method.A positive reaction was defined as head shaking,choking,body movement,an increase in HR＞20%of the basal value,or an increase in SBP or DBP＞20%of the basal value at the time of nasopharyngeal airway placement.The procedure was stopped after seven crossovers.The ED50,95%effective dose(ED95)of remimazolam,and 95%confidence intervals(CI)were calculated by probabilistic unit(Probit)regression analysis.Results When combined with sufentanil,the ED50 and ED95 of remimazolam for inhibition of nasopharyngeal airway insertion in elderly patients was 0.193 mg/kg(95%CI 0.191-0.195 mg/kg)and 0.209 mg/kg(95%CI 0.205-0.213 mg/kg),respectively.Conclusion The ED50 of remimazolam combined with sufentanil for inhibition of nasopharyngeal airway in-sertion reaction in elderly patients were 0.193 mg/kg(95%CI 0.191-0.195 mg/kg).
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Objective:To evaluate the effect of gender on dose-effect relationship of remimazolam combined with alfentanil in painless gastroscopy.Methods:Subjects who planned to undergo elective painless gastroscopy,aged 18-60 years old,body mass index 19-24 kg/m2,American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were enrolled.They were divided into male group and female group.The first subject in both groups received afentanil 5 μg/kg and remimazolam 0.2 mg/kg,and was implanted into a gastroscope 2 minutes later.Positive reactions were defined as body movement,coughing,swallowing and frowning during gastroscopy placement and examination.Remimazolam 0.05 mg/kg was used as a dose gradient by using modified Dixon's up-and-down method.The dose of the next subject was adjusted according to whether the subject had a positive reaction.If there was a positive reaction,the dose of the next subject was increased by one level of gradient,otherwise,the dose was decreased by one level of gradient,and so on.The process was terminated at the seventh intersection point of positive-negative reaction.And 50% effective dose(ED50),95% effective dose(ED95)and 95% confidence interval(CI)of remimazolam for inhibiting gastroscopic implantation reaction was calculated by Probit method.Results:A total of 46 subjects were included,with 23 subjects in each group.There was no significant difference in general data between the two groups.The ED50 of afentanil combined with remimazolam was 0.193 mg/kg(95% CI:0.145-0.286),and the ED95 was 0.293 mg/kg(95% CI:0.237-0.903)in male group.The ED50 of afentanil combined with remimazolam was 0.215 mg/kg(95% CI:0.155-0.293),and the ED95 was 0.316 mg/kg(95% CI:0.261-0.968)in female group.The ED50 and ED95(P＜0.05).Conclusion:When combined with 5 μg/kg of afentanil,remimazolam is more effective in inhibiting responses to gastroscopy inserting in male subjects than in female subjects.
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Ascites is the most frequent decompensating event of cirrhosis.At present,ascites recurs at a high rate due to lack of effective management strategy and is frequently complicated with spontaneous bacterial peritonitis,hepatorenal syndrome,and liver failure,which increase the fatality rate.Albumin treatment for hepatocirrhosic ascites has a long history,but it is limited as an acute or short-term treatment.In contrast,long-term albumin administration represents a completely different treatment paradigm.Results from several recent clinical studies indicate that long-term albumin treatment can be able to modify the disease courses of some decompensated cirrhosis when albumin is given at a sufficient dose for a sufficient time.In this review,we analyze the available data acquired from long-term albumin treatments,trying to establish a secure and effective management scheme involving maximal target popula-tion,albumin dose,administration time,and standards for albumin withdrawal,and thus provide references for the clinical practice.
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BACKGROUND:Berberine has the potential to induce osteogenic differentiation of various mesenchymal stem cells under normal conditions and special conditions such as high glucose,infection and inflammation.It is a natural small molecule drug that can induce bone formation in seed cells instead of growth factors,and has great application prospect in bone tissue engineering. OBJECTIVE:To review and summarize the research progress in the osteogenic mechanism and efficacy of berberine,especially its osteogenic potential under high glucose,infection and inflammation conditions,and its biological safety,so as to provide theoretical basis for its development and application in bone tissue engineering. METHODS:PubMed,WanFang,and CNKI were searched for relevant literature using the keywords of"berberine,bone defects,bone repair,bone regeneration,osteoinductive,osteoporosis,osteoblast,osteoclast,bone tissue engineering,bone,high glucose,diabetes,inflam*,infect*"in English and Chinese,respectively.A total of 105 literatures were selected for review. RESULTS AND CONCLUSION:Berberine can be used to treat multiple diseases including bone diseases,and it has the ability to promote bone regeneration.This article systematically reviews the mechanism of berberine on bone regeneration and in vivo and in vitro studies.Studies have shown that it can play a role in bone repair by promoting osteogenesis,inhibiting osteoclast formation and activity,and preventing osteoporosis.It shows excellent osteogenic differentiation potential mainly via Wnt/β-catenin,PI3K/AKT,EGFR/MEK/p38MAPK,cAMP/PKA/CREB,ERK and other signaling pathways.Berberine can also relieve the inhibition of osteogenic differentiation caused by high glucose,infection and inflammation,which provides more possibilities for the treatment of bone defects in patients with diabetes or infection and inflammation in the bone defect site.Berberine also has the advantages of low toxicity,low price,easy access(currently it can be synthesized),which is a relatively ideal bone induction potential drug.In recent years,the application of berberine in the treatment of bone defect tends to be localized,mainly through the combination with bone tissue engineering technology to improve bioavailability,and has shown good bone repair effect and excellent biological safety in animal experiments.In addition,preclinical experiments have shown splendid bone regeneration potential in the conditions of diabetes,local infection and inflammation.In the future,more studies are needed to fully reveal the osteogenic mechanism and biological safety of berberine,and seek the most suitable controlled release loading system to make artificial bone replacement materials with good mechanical strength,efficacy and biological safety.
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Objective:To explore the feasibility of long board detector of digital radiography(DR)in clinical application.Methods:The long board detector(detector)was erected and placed upright.The scale long ruler with marked metal lead wire was placed at 20 cm in front of the center of long axis of the board of detector,which paralleled medial axis.Three test cards of spatial resolution were respectively placed at three positions(upper,middle and lower)of detector,and they were stuck on the board of detector as 30cm intervals between each other and 45° position.The exposures were conducted at 100,150,and 200 cm of source image distance(SID).The incident doses were tested,which obtained from different SID spots of upper,middle and lower positions of detector.The spatial resolutions of 3 positions were determined through observed the images of cards.The ratio of the marked scale length with metal lead wire to actual length of lead wire was measured through the projection of the scale length,so as to obtain the amplification rate of different spot positions.The spatial distribution of effective focal plane on the direction of long axis of detector,and the morphological change of that were observed.Results:When SID spots were respectively 100,150 and 200cm,the amplification rates of images decreased with increasing SID.The difference of amplification rates among three SID spots was significant(F=223.80,P<0.001).There was significant difference in the corresponding radiation doses among different SID spots(F=7.57,P<0.05).The spatial resolution was constantly 1.8 LP/mm.There was heel effect along with the direction of short axis of detector.The effective focal spot on the direction of long axis of detector appeared up-down symmetrical display.Conclusion:The long board detector of DR equipment has realized the capture for the images of the overall length of spine or the overall length of lower limbs in one exposure,which can meet the clinical requirement,and improve the detection efficiency of X-ray.
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Objective:To analyze the eye lens dose and annual effective dose to interventional radiation workers in some hospitals of Xinxiang city from 2020 to 2022, and to ascertain the dose to interventional radiation workers.Methods:By using TLDs, the eye lens dose Hp(3) and annual effective dose Hp(10) were monitored for three consecutive years in six hospitals in Xinxiang city. The lens doses and annual effective doses to intervention radiation workers in different years in different-level hospitals and departments were analyzed. Results:From 2020 to 2022, a total of 117 people were monitored. The left eye lens dose range was 0.12-164.24 mSv, and the right eye lens dose range was 0.07-51.64 mSv. The average annual dose was 8.56 mSv for left eye lens and 4.49 mSv for right eye lens The average annual dose distribution in the MDL-5 mSv range for the left and right eye lens was 60.68% and 73.50%, respectively. 9.41% (11 people) of the left eye lens doses exceeded 20 mSv. The annual effective doses range was 0.11-31.27 mSv, with average annual dose of 2.56 mSv. The proportion of average annual effective doses mainly distributed in the range of MDL to 1.25 mSv was 52.14%, with 2.56% annual effective dose exceeding 20 mSv. There was no significant difference in left and right eye lens dose and annual effective dose between the tertiary hospitals and the secondary hospitals in three years ( P>0.05). Compared with different departments, the cumulative per capita dose in three years was statistically significant (left eye H=11.42, right eye H=13.72, annual effective dose H=25.94, P<0.05). The lens dose and annual effective dose in neurology department were lower than those in cardiology department and comprehensive intervention department ( Zcardiology department=-3.33, -3.78, -4.83, P<0.05; Zcomprehensive intervention department=-2.71, -2.63, -4.39, P<0.05). Conclusions:Most of the annual equivalent dose and annual effective dose to eye lens of the interventional radiation workers in Xinxiang city meet the national limits, but some of them have higher doses and exceed the national limits. It is suggested that the routine and continuous monitoring of eye lens doses to interventional radiologists should be strengthened while routine monitoring of annual effective dose, and attention should be paid to the eye lens and annual effective dose to interventional radiologists in secondary hospitals to improve the awareness of protection.
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Lung cancer， the most common malignant tumor， is characterized by a complex pathogenesis and high malignancy， and poses a significant threat to the health and lives of affected individuals. p53 signaling pathway plays a crucial role in the progression of lung cancer and is considered one of the potential targets for targeted therapy. In recent years， multiple studies have indicated that traditional Chinese medicine （TCM） can exert anticancer effects by modulating the p53 signaling pathway. Based on this， this article systematically summarizes the current status and progress of research on TCM intervening in lung cancer by regulating p53 signaling pathway. It was found that TCM formula and preparations， such as Qingjin desheng tablet， Tiaoqi xiaoji decoction， Bufei tongluo jiedu formula， Jianpi bushen formula and Yiqi fuzheng jiedu formula， can promote autophagy and apoptosis of lung cancer cells， inhibit the growth and metastasis of lung cancer cells and strengthen the immune function of the body by activating p53 signaling pathway， thereby inhibiting lung cancer. TCM monomers， such as pseudoginsenoside-Rh2， saikosaponin D， polyphyllin Ⅶ， dendrobiine， sophoridine， gambogic acid， triptolide and triptolide succinate monoester YJ-4， can accelerate cell apoptosis， inhibit the proliferation of lung cancer cells and regulate cell cycle by activating p53 signaling pathway， thereby inhibiting lung cancer.
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Lung cancer， the most common malignant tumor， is characterized by a complex pathogenesis and high malignancy， and poses a significant threat to the health and lives of affected individuals. p53 signaling pathway plays a crucial role in the progression of lung cancer and is considered one of the potential targets for targeted therapy. In recent years， multiple studies have indicated that traditional Chinese medicine （TCM） can exert anticancer effects by modulating the p53 signaling pathway. Based on this， this article systematically summarizes the current status and progress of research on TCM intervening in lung cancer by regulating p53 signaling pathway. It was found that TCM formula and preparations， such as Qingjin desheng tablet， Tiaoqi xiaoji decoction， Bufei tongluo jiedu formula， Jianpi bushen formula and Yiqi fuzheng jiedu formula， can promote autophagy and apoptosis of lung cancer cells， inhibit the growth and metastasis of lung cancer cells and strengthen the immune function of the body by activating p53 signaling pathway， thereby inhibiting lung cancer. TCM monomers， such as pseudoginsenoside-Rh2， saikosaponin D， polyphyllin Ⅶ， dendrobiine， sophoridine， gambogic acid， triptolide and triptolide succinate monoester YJ-4， can accelerate cell apoptosis， inhibit the proliferation of lung cancer cells and regulate cell cycle by activating p53 signaling pathway， thereby inhibiting lung cancer.
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ObjectiveTo investigate the entrance surface dose （ESD） of digital radiography （DR）adult examinees in a grade A tertiary hospital in Shanghai， to analyze the dose level of the DR adult examinees， and to provide data for the development of DR typical dose reference. MethodsA DR equipment in the hospital was selected and the irradiation parameters and dose were determined in two randomly selected age groups （15‒39 years and 40‒69 years） of DR adult examinees. The examinations included chest PA， chest LAT， abdominal AP， pelvic AP， lumbar AP， lumbar LAT， thoracic AP， and thoracic LAT. The number of examinees in each exposure position was 20. ESD and effective dose were calculated for each age group and each position. ResultsA total of 320 examinees were investigated. The 75th percentiles of ESD in different exposure positions were as follows： chest PA 0.19 mGy；chest LAT 0.96 mGy；abdominal AP 3.63 mGy；pelvic AP 3.16 mGy；lumbar AP 9.27 mGy；lumbar LAT 18.29 mGy；thoracic AP 6.85 mGy；and thoracic LAT 13.40 mGy. ConclusionsThe differences between the estimated ESD and effective dose were large in different exposure positions、in the same exposure positions、and in the same positions with different exposure types， and there were statistically significant differences in ESD of examinees with different exposure positions. The estimated typical values of different exposure positions were apparently lower than the diagnostic reference level.
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AIM: To compare the effective optical zone(EOZ)and corneal high order aberrations(HOAs)after small incision lenticule extraction(SMILE)among low, moderate, and high myopic patients.METHODS:A total of 134 patients who had undergone SMILE at the Second People's Hospital of Foshan from February 2019 to February 2021 were recruited, with all right eyes enrolled. The patients were divided into low myopia group(SE >-3.00 D), moderate myopia group(-6.00 D< SE ≤-3.00 D), and high myopia group(SE ≤-6.00 D)according to the spherical equivalent(SE). The total HOA(tHOA), spherical aberration, coma, and EOZ were measured by Pentacam preoperatively and 1 mo postoperatively, and differences in tHOA, spherical aberration, coma, and EOZ among the three groups were analyzed.RESULTS: EOZ was smaller than programmed EOZ in all groups at 1 mo after SMILE. With the increase in corrected refractive error, the EOZ decreased further(P<0.05); The tHOA, spherical aberration, and coma were significantly higher than their corresponding preoperative values in all groups at 1 mo after surgery, and there were statistical differences in the spherical aberration of all the groups at 1 mo after surgery(P<0.05), except for that of the mild myopia group(P>0.05). The tHOA, spherical aberration and coma increased with corrected refractive errors; the difference in tHOA and spherical aberration was statistically significant among the three groups(all P<0.05). Coma in the high myopia group was significantly greater than that in the moderate myopia group and the mild myopia group(P<0.05). In addition, the coma in the moderate myopia group and the mild myopia group was not statistically significant(P>0.05).CONCLUSION: With the increase of the refractive power corrected by surgery, the postoperative EOZ reduced more after surgery, and the HOA of the cornea is increased; corneal HOA increases at 1 mo after SMILE.
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Objective To establish an HPLC method for the simultaneous determination of 10 components in the active parts of Uygur medicine Dracocephalum Moldavica L.Methods The determination was performed on a Shim-pack ODS(4.6 mm×250 mm,5 um)column with the mobile phase consisting of acetonitrile(A)-0.5%formic acid(B)in aqueous solution in a gradient elution mode(0-30 min,17%A;30-60 min,17%→ 28%A;60-78 min,28%A)at a flow rate of 1.0 mL·min-1.The temperature of the chromatographic column was 35℃and the detection was monitored by a UV detector at 330 nm.Results Cof-feic acid,p-coumalic acid,cynaroside,luteolin-7-O-β-D-glucuronide,apigenin 7-O-glucuronide,rosmarinic acid,diosmetin7-O-β-D-glucuronide,salvianolic acid A,tilianin,apigenin were well separated under this chromatographic condition,and the linear relation-ship were good in the concentration range examined(r＞0.999 2).The overall recoveries ranged from 91.83%to 106.43%with the RSD ranging from 0.38%to 2.22%.Conclusion The established content determination method is highly accurate and reproduci-ble,and suitable for the analysis and quality control of the active parts of Dracocephalum Moldavica L.
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AIM:To rapidly evaluate the effective-ness,safety and economy of dienogest in the treat-ment of endometriosis so as to provide evidence-based reference for clinical drug selection and deci-sion.METHODS:Retrieved from PubMed,Embase,Cochrane Library,CNKI,SinoMed,Wanfang and health technology assessment(HTA)organization websites,HTA report,systematic review/Meta-anal-ysis and pharmacoeconomic study were included during the inception to Sep 2023.Data extraction and quality evaluation were carried out for the lit-erature that met the inclusion and exclusion crite-ria,and the research results were summarized and analyzed qualitatively.RESULTS:Nine systematic re-view/Meta-analyses,and 2 pharmacoeconomic studies were included.The quality of Meta-analysis literatures was low,and the quality of economic re-search was good.In terms of effectiveness,com-pared with no treatment,dienogest can significant-ly reduce postoperative recurrence rate,VAS score,and improve pregnancy rate and effective rate;Di-enogest has similar therapeutic effects in terms of recurrence rate as GnRHa and COC;With regard to recurrence rate and pregnancy rate,dienogest is superior to danazol,gestrinone,and mifepristone.In terms of safety,compared with placebo,the inci-dence of vaginal bleeding and headache was signifi-cantly increased with dienogest,and there was no difference in bone loss;The incidence of vaginal bleeding caused by dienogest was significantly high-er than that of GnRHa,but the incidence of hot flashes and bone loss was lower.In terms of econo-my,dienogest has a more cost-effective advantage comparing with GnRHa,but does not have econom-ic benefits comparing with COC.CONCLUSION:Di-enogest has good effectiveness and safety in the treatment of endometriosis,and economically su-perior to GnRHa,but inferior to COC.
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Objective To investigate the influence of type 2 diabetes mellitus(T2DM)on cognitive function and the effective connectivity with in the default mode network(DMN)in the brain.Methods A total of 93 hospitalized patients diagnosed with T2DM were enrolled in this study as T2DM group from The First Affiliated Hospital of Guangzhou University of Chinese Medicine during September 2021 to December 2022.Simultaneously,108 healthy individuals were recruited from the community as normal control(NC)group.The cognitive functions were evaluated in the two groups.A random dynamic causal modeling approach was employed to analyze the effective connectivity within DMN in both groups.Additionally,Pearson correlation analysis was performed to examine the association between differential connectivity,clinical indicators,and cognitive scores in both groups.Results In comparison to the NC group,T2DM individuals exhibited statistically significant reductions in scores in the auditory verbal learning test(AVLT)for immediate recall and the digit symbol substitution test(DSST)(P＜0.05).Additionally,they displayed a notable decrease in effective connectivity from the left lateral parietal cortex(LLPC)to the posterior cingulate cortex(PCC),as well as from the LLPC to the right lateral parietal cortex(RLPC)within the DMN(P＜0.05).Pearson correlation analysis unveiled a negative association between HbA1c levels and the strength of effective connectivity from LLPC to PCC.Conversely,a positive correlation was observed between AVLT(immediate)scores and the strength of effective connectivity from LLPC to PCC and LLPC to RLPC.Additionally,DSST scores displayed a positive correlation with the strength of effective connectivity from LLPC to PCC(P＜0.05).Conclusion Patients with T2DM display compromised effective connectivity from LLPC to PCC and LLPC to RLPC within the DMN network,and this alteration may associated with cognitive impairment.
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@#Objective To investigate the effect of propofol or different doses of remimazolam on effective dose(ED50)of sufentanil in elderly patients with tracheal intubation response by sequential method.Methods Elderly patients,American Society of Anesthesiologists(ASA)Ⅰ and Ⅱ,aged 65-80 years,undergoing elective surgery under general anesthesia with endotracheal intubation from October to December 2022 were selected and randomly divided into 4 groups:Group P(propofol 2mg/kg)and group R1,R2 and R3(remimazolam 0.2,0.3 and 0.4mg/kg)were administered intravenously.During anesthesia induction,sufentanil was given with the dose set by Dixon sequential method,followed by intravenous injection of propofol or corresponding dose of remimazolam and cisatracurium 0.15mg/kg.Tracheal intubation was performed when train of four(TOF)count was 0.If the tracheal intubation response is positive,the sufentanil dose of the next patient is increased by 1 concentration gradient,otherwise,the sufentanil dose is decreased by 1 concentration gradient,and the ratio between adjacent concentrations is 1∶1.1,until 7 turning points appear and the study is terminated.Probit regression analysis was used to calculate the median ED50 and 95%effective dose(ED95)of sufentanil for suppressing tracheal intubation response in elderly patients,and the corresponding 95%CI.The incidence of hypotension,bradycardia,injection pain and other adverse reactions were recorded.Results A total of 113 elderly patients were included in this study,including 24,28,30 and 31 patients in P,R1,R2 and R3 groups,respectively.The ED50 and ED95 and corresponding 95%CI of sufentanil for suppressing tracheal intubation response in elderly patients with propofol 2 mg/kg or remimazolam 0.2,0.3,0.4mg/kg were:The ED50 and ED95 of group P were 0.236μg/kg(95%CI:0.218-0.256)and 0.266μg/kg(95%CI:0.250-0.398),respectively.The ED50 and ED95 of group R1 were 0.284μg/kg(95%CI:0.265-0.309)and 0.329μg/kg(95%CI:0.306-0.478),respectively.The ED50 and ED95 of R2 group were 0.239μg/kg(95%CI:0.221-0.260)and 0.282μg/kg(95%CI:0.261-0.415),respectively.The ED50 and ED95 of R3 group were 0.198μg/kg(95%CI:0.182-0.211)and 0.231μg/kg(95%CI:0.216-0.303),respectively.The incidence of hypotension,bradycardia and injection pain in R1,R2 and R3 groups were lower than those in P group(P<0.05).The ED50 of sufentanil in group R2 was similar to that in group P,but the incidence of hypotension and injection pain in group R2 was lower than that in group P.Conclusion With the increase of the dose of remimazolam,the ED50 of sufentanil to inhibit tracheal intubation reaction in elderly patients gradually decreased,and in the case of similar ED50,the incidence of hypotension,bradycardia and injection pain induced by remimazolam was lower than that induced by propofol,so remimazolam induction was more advantageous in general anesthesia for tracheal intubation in elderly patients.
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@#Objective To prepare recombinant human papillomavirus 58 L1 protein virus-like particles(HPV58 LI VLPs)in Pichia pastoris and immunize mice with the purified product to evaluate the immunogenicity of HPV58 L1 VLPs.Methods The HPV58 L1 multi-copy expression plasmid was constructed and transformed into Pichia pastoris KM71.The highly expressed Pichia pastoris engineering strain was screened and cultured in 5 L fermenter.The expressed HPV58 L1 VLPs were isolated and purified,which were then used to immunize 80 female BALB/c mice at different doses by intraperitoneal injection.After four weeks,the immune effect was evaluated by median effective dose(ED_(50)).Results Restriction analysis results showed that HPV58 L1 expression vectors were constructed correctly.Western blot,amino acid sequencing and transmission electron microscopy(TEM) results showed that HPV58 L1 protein was correctly expressed in Pichia pastoris and could self-assemble into VLPs at a diameter of about 50 nm.After purification by ion exchange and size exclusion chromatography,the HPV58 L1 VLPs reached a purity above 95%,and the ED_(50) in mouse model was 0.009 μg.Conclusion Recombinant HPV58 L1 VLPs with good immunogenicity were successfully prepared by using Pichia pastoris.
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@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.
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Osteoporosis （OP） is a common bone disease affecting the quality of life and causing huge medical burden to the patients and society. The occurrence of OP is mainly caused by excessive bone resorption and insufficient bone formation， which are directly influenced by external calcium ion balance. Calcium imbalance can impair bone integrity， reduce the calcium supply to the bone， and lower the calcium content in the bone， thus triggering OP. Drugs are the main anti-OP therapy in modern medicine， which， however， may cause adverse reactions and drug dependence. Chinese medicines have good clinical effects and high safety in treating OP， being suitable for long-term use. Recent studies have shown that Chinese medicines can alleviate estrogen deficiency， regulate bone cell and calcium metabolism， which is crucial for the formation and development of OP. The transient receptor potential cation channel superfamily V members 5 and 6 （TRPV5 and TRPV6， respectively） affect bone homeostasis by mediating the transmembrane calcium ion transport in the intestine （TRPV6） and kidney （TRPV5）. Therefore， TRPV5/6 is one of the key targets to understand the anti-OP mechanisms of the effective parts of Chinese medicines， which is worthy of further study. This paper summarizes the research results about the anti-OP effects of Chinese medicines in the last two decades， especially the mechanism of regulating calcium metabolism， aiming to provide new ideas for the basic research， clinical application， and drug development of OP treatment.
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@#Embryology is a critical subdiscipline in medical education, focusing on human body organ development and providing a foundation for understanding developmental anatomy. However, traditional teaching methods using static 2D graphics in textbooks may hinder students’ comprehension of the complex 3D embryonic growth processes. To address this, multimedia approaches, such as animations, videos, and interactive tools, have been explored for effective embryology education. This scoping review identifies five key elements of successful multimedia teaching in embryology: multimodal integrated instructional content, cognitive load-reduction strategies, cognitive engagement and physical interactivity, learner-controlled multimedia instruction, and development of tacit knowledge. These strategies promote active learning, enhance students’ understanding, and foster critical thinking skills. Future research should focus on evaluating the impact of multimedia approaches on students’ engagement, attitudes, and competency development. Embracing multimedia in embryology education can improve medical students’ clinical understanding and support effective medical practice.