Objective To comparing the safety and effectiveness of patient-controlled sedation and analgesia with topical anesthesia during strabismus surgery. Methods Sixty-eight patients were selected and randomly divided into two groups (n=34): patient-controlled sedation and analgesia (P group) and control group(C group). SBP, HR, Ramsay's score, cooperation score, satisfactory score, visual pain score(VAS) and side-effects such as agitation and low SpO2 during the surgery were measured. Results There were no significant changes of SBP, HR in P group from 10 minutes after the starting of operation to the end,while SBP, HR in C group were higher in all the procedure than those of the base value. Ramsay's score, cooperation score, satisfactory score of the patients in P group were higher than those in C group. VAS score, agitation and groan incidence were higher in C group than those of in P group. Conclusions Patient-controlled sedation analgesia with a combination of sufentanil and propofol is a safe and effective method for strabismus surgery.

Objective To investigate the optimum dose of dexmedetomidine when combined with propofol for induction of anesthesia.Methods One hundred and twenty ASA physical status Ⅰ or 1Ⅱ patients of beth sexes,aged 18-60 yr,with body mass index of 18.5-30.0 kg/m2,scheduled for elective ophthalmologic operation under general anesthesia,were randomly divided into 6 groups (n =20 each) using a random number table:normal saline group (NS group) and different doses of dexmedetomidine groups (D1-D5 groups).Different loading doses of dexmedetomidine 0.2,0.4,0.6,0.8 and 1.0 μg/kg (in normal saline 50 ml) were infused intravenously in D1-D5 groups,respectively.The equal volume of normal saline was infused over 15 min in group NS.After 10 min observation,target-controlled infusion (TCI) of propofol was started.The initial target plasma concentration was set at 3.2 μg/ml.Loss of consciousness was considered to be positive response.The median effective concentration (EC50) and 95％ confidence interval of propofol TCI required for loss of consciousness were calculated.After administration of dexmedetomidine,the development of adverse effects was recorded before propofol TCI.Results Compared with NS group,the EC50 of propofol TCI required for loss of consciousness was significantly decreased in D2-D5 groups,and no significant change was found in the EC50 of propofol TCI required for loss of consciousness in D1 group.The EC50 of propofol TCI was decreased gradually with the increasing doses of dexmedetomidine between D1 and D2 groups,between D2 and D3 groups,and between D4 and D5 groups,while there was no significant difference in the EC50 of propofol TCI required for loss of consciousness between D3 and D4 groups.The incidence of hypotension was 5％ (D3 group),11％ (D4 group) and 31％ (D5 group),and the incidence of bradycardia was 0 (D3 group),11％ (D4 group),and 19 ％ (D5 group).No hypotension and bradycardia developed in D1 and D2 groups.The incidence of hypotension and bradycardia was significant increased in D4 and D5 groups as compared with NS,D1,D2 and D3 groups.Conclusion The optimum dose of dexmedetomidine is 0.4μg/kg when combined with propofol for induction of anesthesia.

Objective:To observe the effectiveness of bone cement-enhanced proximal femoral nail antirotation (PFNA) in the treatment of severe osteoporotic intertrochanteric fracture.Methods:Between January 2016 and June 2017, 23 patients with severe osteoporotic intertrochanteric fracture were treated with bone cement-enhanced PFNA at Department of Orthopaedics, The Second Affiliated Hospital to Luohe Medical College. They were 9 men and 14 women with an average age of 85.3 years (range, from 80 to 91 years). According to AO/OTA-2018 classification, there were 2 cases of type 31-A1.3, 5 cases of type 31-A2.2, 13 cases of type 31-A2.3 and 3 cases of type 31-A3.3. According to Singh standard grading, 4 cases were rated as level 1, 16 cases as level 2 and 3 cases as level 3. The PFNA fixation was enhanced by bone cement in all. The operation time, amount of intraoperative bleeding, postoperative complications, fracture healing time and hip Harris scores at the last follow-up were recorded.Results:The operation time averaged 56.3 minutes (range, from 47 to 91 minutes) and the amount of intraoperative bleeding 197 mL (range, from 110 to 450 mL). All patients were followed up for 5 to 27 months (mean, 14.7 months). One patient who had been rated as good by the Harris hip score died 5 months after surgery because of acute suppurative obstructive cholangitis. All the 23 fractures achieved bony union. The healing time averaged 11.3 weeks (range, from 8 to 18 weeks). By the Harris scores at the last follow-up, 11 cases were excellent, 10 cases good and 2 cases fair, giving an excellent and good rate of 91.3%.Conclusion:Bone cement-enhanced PFNA can bring about good short-term outcomes for severe osteoporotic intertrochanteric fractures because it can improve the screw control and reduce the risk of internal fixation failure.

Objective:To investigate the predictive value of controlling nutritional status (CONUT) score in the prognosis of patients with advanced diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was performed. The clinical data of 654 patients newly diagnosed with advanced DLBCL diagnosed in 7 medical centers in Huaihai Lymphoma Working Group from October 2009 to January 2022 were retrospectively collected. All the patients received rituximab-based immune chemotherapy regimens. The patients were randomly assigned to the training set (458 cases) and the validation set (196 cases) in a 7:3 ratio. The clinicopathological data of patients were collected, and the CONUT score was calculated based on albumin, lymphocyte count, and total cholesterol. The optimal critical value of CONUT scote was determined by using MaxStat method. Kaplan-Meier method was used to draw survival curves; Cox proportional hazards model was used to make univariate analysis and multivariate analysis on the factors influencing overall survival (OS). The efficacy of CONUT score in combination with the International prognostic index (IPI) and an enhanced IPI (NCCN-IPI) in predicting OS was evaluated by using receiver operating characteristic (ROC) curves.Results:The median follow-up time of 654 patients was 38.1 months (95% CI: 35.3 months- 40.9 months), and the 5-year OS rate was 49.2%. According to the MaxStat method, the optimal critical value for CONUT score was determined to be 6 points. All the patients were classified into the normal nutritional status group (CONUT score ≤ 6 points, 489 cases) and the poor nutritional status group (CONUT score > 6 points, 165 cases). The results of the multivariate analysis showed that CONUT score > 6 points, male, lactate dehydrogenase >240 U/L, high white blood cell count, low hemoglobin level and age > 60 years were independent risk factors for OS of patients with advanced DLBCL (all P < 0.05). Patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group in the overall cohort of advanced DLBCL. Subgroup analysis revealed that among patients with Eastern Cooperative Oncology Group-performance status (ECOG PS) score < 2 points, IPI low-intermediate risk, IPI intermediate-high risk, NCCN-IPI low-intermediate risk, and NCCN-IPI intermediate-high risk, the patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group (CONUT score ≤ 6 points) (all P < 0.05). Conclusions:CONUT score has a certain value in the assessment of the prognosis of patients with advanced DLBCL, and its predictive efficacy is further improved when combined with IPI and NCCN-IPI.

Objective This study aims to establish a non-puerperal mastitis (NPM) rat model by simulating hyperprolactinemia and immune-inflammatory states, and to evaluate its local inflammatory characteristics in the mammary gland, thereby laying the foundation for research on the diagnosis and treatment of this clinically challenging disease. Methods Twelve SPF-grade Wistar female rats were evenly divided into a control group and a model group. During the experiment, the control group received no experimental treatment or medication. The model group received daily subcutaneous injections of 100 mg/kg metoclopramide hydrochloride for 7 consecutive days. Serum prolactin (PRL) levels were measured using ELISA on the 10th, 20th, and 30th days after the first injection. After 7 days of injections, 200 μL of lactating SD rat milk was mixed with 200 μL of complete Freund's adjuvant to prepare an oil-in-water emulsion, which was administered by multiple subcutaneous injections into the back of the Wistar rats for the initial immunization. Seven days after the initial immunization, the emulsion was injected subcutaneously into the third, fourth, and fifth mammary glands for the final immunization. After the final immunization, the rats were observed for 28 days for changes in mammary gland appearance, and the size of mammary nodules was calculated. On the 3rd, 7th, 14th, and 28th days, hematoxylin-eosin (HE) staining was used to analyze mammary tissue morphology. Immunohistochemistry was employed to detect CD138 expression levels. ELISA was used to measure the levels of interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, and inducible nitric oxide synthase (iNOS) in mammary tissue to comprehensively assess the model. Results Rats in the model group exhibited mammary skin ulceration and foul odor at the ulcer sites. Palpation and ultrasound revealed the formation of mammary nodules. HE staining showed that on the 3rd day after the final immunization, normal ductal and lobular structures in the mammary glands disappeared, with significant infiltration of plasma cells. On the 7th day, ductal dilation, epithelial necrosis and detachment, and pronounced periductal plasma cell and lymphocyte (predominantly T-lymphocytes) infiltration were observed. On the 14th day, there was a proliferation of fibrofatty tissue, small blood vessels, and granulation tissue, with scattered plasma cells in the interstitium. By the 28th day, inflammatory cell infiltration and fibrous tissue proliferation were reduced, with granuloma formation. Serum PRL levels in the model group were significantly increased on the 10th day (P<0.05) and the 20th day (P<0.001). IL-6 and TNF-α levels in mammary tissue were higher in the model group compared to the control group on the 3rd, 7th, 14th, and 28th days (P<0.05). IL-1β levels were higher on the 3rd, 7th, and 14th days compared with the control group (P<0.01) but lower than the control group on the 28th day (P>0.05). iNOS levels were significantly higher on the 7th day after the final immunization (P<0.001). Conclusion A successful NPM model was established in rats, which exhibited typical pathological features such as local mammary masses, abscesses, ulcers, ductal dilation and plasma cell infiltration. This model can serve as a foundation for further research into the diagnosis and treatment of this clinically challenging disease.