Objective To study the sedative and analgesic effects of butorphanol combined with midazolam on critically ill patients treated by mechanical ventilation. Methods Fifty-eight patients who received mechanical ventilation, sedation and analgesia in intensive care unit (ICU) of Affiliated Huaian No.1 Hospital of Nanjing Medical University from January 2012 to December 2013 were enrolled. The patients were divided into a single midazolam group (30 cases) and a combination of butorphanol and midazolam group (combination with butorphanol group, 28 cases) according to the difference in types of sedative. The sedation for patients in the single midazolam group was induced firstly by intravenous injection of 0.05-0.10 mg/kg midazolam and followed by continuous infusion of the same drug 0.05 - 0.15 mg·kg-1·h-1 with a micro injection pump. The patients in the combination with butorphanol group were given a loading dose of butorphanol 10μg/kg and followed by continuous infusion of 10-20μg·kg-1·h-1 butorphanol combined with 0.05 - 0.15 mg·kg-1·h-1 midazolam by a micro pump. The Ramsay anesthesia score and visual analogue scale (VAS) were used to evaluate the sedative and analgesic effects. According to the Ramsay score, the sedation depths of patients in the two groups were maintained at 2-4 grades, and reassessed every 1-2 hours. The mean arterial pressure (MAP), heart rate (HR) and pulse blood oxygen saturation (SpO2) were observed before and after the drug administration in two groups. Results There were no statistically significant differences in MAP, HR and SpO2 between single midazolam group and combination with butorphanol group before treatment [MAP (mmHg, 1 mmHg=0.133 kPa): 121.3±6.2 vs. 118.6±8.7, HR (bpm):129.5±14.1 vs. 125.5±16.3, SpO2:0.744±0.112 vs. 0.756±0.131, all P>0.05]. Compared with those before treatment, after treatment, the above indexes in two groups were significantly improved, the differences being statistically significant [single midazolam group:MAP (mmHg) 88.7±6.5 vs. 121.3±6.2, HR (bpm) 85.3±13.4 vs. 129.5±14.1, SpO2 0.937±0.056 vs. 0.744±0.112; combination with butorphanol group: MAP (mmHg) 82.6±7.3 vs. 118.6±8.7, HR (bpm) 89.6±14.7 vs. 125.5±16.3, SpO2 0.943±0.078 vs. 0.756±0.131, all P < 0.05], and the degree of improvement of the combination with butorphanol group was better than that of the single midazolam group. The initial acting time of drugs and the time awakening from anesthesia in the combination with butorphanol group were shorter significantly than those in the single midazolam group (minutes: 33.6±6.2 vs. 73.3±12.2, 71.8±19.3 vs. 103.5±30.1, both P < 0.05), and the incidence of adverse reaction was lower obviously than that in the single midazolam group (0 vs.13.3%, P < 0.05). Furthermore, the score of VAS in the combination with butorphanol group was lower significantly than that in single midazolam group (8.4±1.2 vs. 2.4±0.8, P < 0.05). Conclusions Butorphanol combined with midazolam for treatment of critically ill patients with mechanical ventilation is a very effective sedative method, which may improve the degree of patients' tolerance towards the measure and reduce the incidence of adverse reactions.

ObjectiveTo investigate the feasibility of using pulse oximetry plethysmographic waveform (POP) to identify the restoration of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR).Methods An observational research was conducted. A porcine model of ventricular fibrillation (VF) arrest was reproduced. After 3 minutes of untreated VF, animals received CPR according to the latest CPR guidelines, providing chest compressions to a depth of 5 cm with a rate of 105 compressions per minute and instantaneous mechanical ventilation. After 2 minutes of CPR, animals were defibrillated with 100 J biphasic, followed by continuous chest compressions. Data of hemodynamic parameters, partial pressure of end-tidal carbon dioxide (PETCO2) and POP were collected. The change in POP was observed, and the characteristics of changes of the waves were recorded during the peri-CPR period using the time and frequency domain methods.Results VF was successfully induced in 6 pigs, except 1 death in anesthesia induction period.① After VF, invasive blood pressure waveform and POP of the animals disappeared. PETCO2 was (18.83±2.71) mmHg (1 mmHg=0.133 kPa), and diastolic arterial pressure was (23.83±5.49) mmHg in compression stage. Animals attained ROSC within 1 minute after defibrillation, with PETCO2 [(51.83±9.35) mmHg] and diastolic arterial pressure [(100.67±10.97) mmHg] elevated significantly compared with that of compression stage (t1 = 8.737,t2 = 25.860, bothP = 0.000), with appearance of arterial blood pressure waveform.② Characteristic changes in POP were found in all experimental animals. During the stages of induced VF, compression, ROSC, and compression termination, POP showed characteristic waveform changes. POP showed disappearance of waveform, regular compression wave, fluctuation hybrid and stable pulse wave in time domain method; while in the frequency domain method waveform disappearance, single peak of compression, double or fusion peak and single peak of pulse were observed.Conclusion Analysis of POP using time and frequency domain methods could not only quickly detect cardiac arrest, but also show a role as a feasible, non-invasive marker of ROSC during CPR.

Fullerene is an effective free radical scavenger and antioxidant. The fullerene derivatives obtained by chemical modification of fullerene have good water solubility and biological activities. Fullerene and its derivatives have many advantages in cell protection and antioxidant properties, antibacterial activity, antiviral activity, photodynamic activity, drug delivery and anti-tumor activities, playing an important role in the field of medicine. In recent years, great progress has been made in this field. In this review, we summarized the latest research progress and applications of fullerene and its derivatives in medicine field at home and abroad from four aspects of regulating tumor microenvironment, drug delivery, photodynamic therapy and anti-oxidative stress. At last, the future development and application of fullerene and its derivatives in the domain of medicine are prospected.
10.11665/j.issn.1000-5048.20180202

Objective To observe the changes in cytoskeleton (CSK) and glycosaminoglycan (GAG) synthesis following passage culture of articular chondrocytes and the correlation between CSK and GAG.Methods Eight male New Zealand White rabbits (8-month-old) were sacrificed by air embolism.After the chondrocytes from their knee joints were isolated by enzymolysis method,monolayer culture was performed.The chondrocytes of primary passage (P0) and passages 1 & 2 (P1,P2) were inoculated into 24-well plates with round cover slips put at the bottoms.Cell climbing slices were fixed after attachment of chondrocytes.The CSK proteins,actin,vimentin,tubulin and vinculin were stained by immuuofluorescence antibody on P0,P1 and P2 cell climbing slices,respectively.The CSK morphology was observed by laser confocal scanning microscopy and the fluorescence intensities of CSK proteins were detected by the fluorescence intensity software.The medium was changed for each generation after cell fusion and the GAG concentrations in the supernatants were measured at 24,36,48,60 h after medium change by alcian blue method.Results The intermediate filament networks became loosen and the dense distributions surrounding the nucleus decreased;more microtubule processes formed at the cell periphery with passage.The fluorescence intensity of actin of P1 chondrocytes was significantly increased than that of P0 (P ＜ 0.05),but there were no such significant differences between P0 and P2 or between P1 and P2 (P ＞ 0.05).The fluorescence intensities of vimentin and tubulin were significantly decreased with passage respectively,and there were such significant differences between any two of P0,P1 and P2 (P ＜ 0.05).The GAG concentrations in the supernatants were significantly decreased with passage at each time point,and there were such significant differences between any two of P0,P1 and P2 (P ＜ 0.05).Conclusions Passage culture of articular chondrocytes may lead to changes in morphology and protein expression intensity of the main components of CSK,and accordingly to decreased synthesis amount of GAG,one of the extracellular matrix of chondrocytes,indicating the changed characteristics of chondrocytes after passage and a certain correlation between CSK and GAG.

Objective: To examine the effects of obesity and central obesity on hypertension, so as to provide insights into the prevention and control measures of hypertension. Methods: From September to December 2018, residents at ages of 35 to 75 years were sampled using the multi-stage random sampling method in Baiyin District, Baiyin City, Gansu Province, and subjected to questionnaire surveys and physical examinations. The interaction between obesity/central obesity and hypertension was evaluated using logistic regression analysis. The synergy index ( SI ), relative excess risk due to interaction ( RERI ) and attributable proportion due to interaction ( AP ) were calculated using Excel compiled by Andersson et al. Results: A total of 6 246 questionnaires were allocated and 6 169 valid questionnaires were recovered, with an effective recovery rate of 98.77%. The respondents included 3 038 men ( 49.25% ) and 3 131 women (50.75%), with a mean age of ( 52.05±8.78 ) years. There were 832 respondents with obesity ( 13.49% ) and 2 278 with central obesity ( 36.93% ). The crude and standardized prevalence rates of hypertension were 35.89% and 33.05%, respectively. Multivariable logistic regression analysis showed that obesity ( OR=2.020, 95%CI: 1.705-2.393 ) and central obesity ( OR=1.622, 95%CI: 1.433-1.836 ) were statistically associated with hypertension. There was no multiplicative interaction between obesity or central obesity and hypertension ( OR=1.011, 95%CI: 0.655-1.560 ), and no additive interaction was detected between obesity or central obesityand hypertension ( SI=1.405, 95%CI: 0.815-2.424; RERI=0.658, 95%CI: -0.298 to 1.614; AP=0.201, 95%CI: -0.075 to 0.476 ). Conclusions Obesity and central obesity increase the risk of hypertension; however, no interaction is detected between obesity or central obesity and hypertension.

Objective To investigate the difference of blood supply in different areas of the normal femoral head in adults.Methods A retrospective study analyzed the DCE-MRI parameters data of 2 5 normal adults (25 right hips)in our hospital.The femoral head was assumed to be a sphere.On T1 WI of DCE-MRI,the right femoral head was divided into three parts equally in coronal,sagittal, and transverse plane respectively.Time to peak(TTP),maximum of enhancement at first past(fEmax),maximum of enhancement (Emax)were measured in three parts and compared in coronal,sagittal and transverse plane respectively.Results (1 )In coronal plane,there were no significant differences between the three parts in TTP,fEmax and Emax.(2 )In transverse plane,fEmax and Emax were lower in the transverse superior zone than that in the transverse central zone significantly (P＝0.024 and P＝0.001)and the transverse inferior zone(P＝0.005 and P＝0.018).TTP was higher in the transverse superior zone than that in the transverse central zone and the transverse inferior zone(P＝0.005 and P＝0.018).(3)In sagittal plane,fEmax and Emax were lower in the sagittal lateral zone than that in the sagittal centralzone (P＝0.019 and P＝0.041)and sagittal medial zone (P＝0.047 and P＝0.01 1).TTP was higher in the sagittal lateral zone than that in the sagittal central zone and the sagittal medial zone(P＝0.014 and P＝0.010).There were no significant differences between other paired zones of the any values.Conclusion DCE-MRI can show the microcirculation in the normal adult femoral head in a non-invasive way.According to DCE-MRI parameters,there are poor perfusions on the transversesuperior and sagittallateral zones of the normal femoral head in adults.

Objective: To explore the influence of group psychological counseling on the mental health of children with mother s authoritarian parenting. Methods: From November 2022 to February 2023, 76 students from grades 4 to 6 whose mother showed authoritarian parenting style, while fathers adopted no authoritative, authoritarian or democratic parenting style and who scored ≥65 on the total MHT were selected using the Parenting Style Questionnaire (PBI) and the Mental Health Diagnostic Test (MHT). All the participants and their mothers were randomly assigned to the intervention and control groups. Before and after the intervention, participants filled out questionnaires on parental bonding instrument and mental health test. Control group: regular delivery of mental health education information, 2 times per week, for 8 weeks, without any other intervention. Intervention group: group counseling activities were conducted once a week. Each intervention lasted 1.5-2 hours and lasts for 8 weeks. Before and after the intervention, participants filled in the family parenting style and mental health screening questionnaires. Results: After the intervention, compared with the control group, students in the intervention group showed a significant decrease in the total scale score of the MHT, learning anxiety, social anxiety, allergic tendency, physical symptoms, fear tendency, and impulsive tendency ( t=-0.43, -1.04 , -0.81, P >0.05). After intervention, the intervention group students showed a significant decrease in psychological diagnosis test scores, learning anxiety, anxiety towards others, allergic tendencies, physical symptoms, phobic tendencies, and impulsive tendencies compared to the control group students ( t=-20.00, -5.06, -2.09, -3.36, -6.15, -4.76, -5.15, P <0.05). Conclusion Rregular group psychological counseling can effectively improve the academic anxiety, social anxiety, allergic tendencies, physical symptoms, fearful and impulsive tendencies of students whose mothers with authoritarian parenting style, and greatly improve their mental health.

Objective To investigate the antimicrobial susceptibility of spectinomycin?minocycline?azithromycin and sparfloxacin to mycoplasma(Uu and Mh)and therapeutic effect of spectinomycin to my-coplasma infection in genitourinary tract.Methods①The susceptibility test:each of the4drugs was divided into two concentrations.One was at1?g/mL(sensitive concentration)and the other was at4?g/mL(resistant concentration).If mycoplasma does not grow in both concentrations,it means the drug tested is sensitive.If it grows in both concentrations,the drug tested is resistant.If mycoplasma grows in lower concentration and does not in higher concentration,it means moderate sensitive.②Treatment regimen:Spectinomycin was injected,2g/d IM,for7-10days as a course of treatmeant.Patients were followed-up7days later and2~4weeks after treatment.Results①Among1658specimens,519were found Uu positive,and61Mh positive.The resis-tance rates of Uu to4different drugs were:7.7%for minocycline,21.4%for sparfloxacin,13.9%for azithromycin and7.3%for spectinomycin.Whereas,those of Mh were:18.0%,45.9%,54.1%,and29.5%re-spectively.②The clinical effect of spectinomycin was:out of43treated patients,37(86.0%)cured,4(9.3%)markedly improved,2(4.7%)failed.Total effective rate was95.3%and so was the elimination rate of my-coplasma.Conclusion The resistant rate of mycoplasma to spectinomycin is lower than that to minocycline?azithromycin and sparfloxacin,and the former is widely used in the treatment of mycoplasma(especially Uu)infection,with a satisfactory clinical effect.

Clinical data of 26 patients with proton pump inhibitor dependent gastroesophageal reflux disease (GERD) who underwent anti-reflux mucosectomy (ARMS) in Nanjing Drum Tower Hospital from July 2017 to December 2020 were reviewed, and the GERD questionnaire (GERD-Q) score, the short-form reflux-qual (RQS) score, esophageal motility and 24 h esophageal pH parameters before and after ARMS were compared. With a median follow-up period of 18.4 months (6-27 months), 23 (88.5%) patients reported symptomatic improvement and 15 (57.7%) patients discontinued the use of proton pump inhibitors. After ARMS, the mean scores of GERD-Q (6.23 VS 13.19, P=0.004) and RQS (26.67 VS 10.98, P<0.001) were significantly improved, the mean DeMeester score (10.69 VS 53.15, P<0.001), the mean acid exposure time percentage (3.56% VS 9.92%, P<0.001) and the mean number of acid reflux episodes (36.9 VS 139.9, P=0.001) were lower, and the mean rest pressure at lower esophageal sphincter (LES) (25.19 mmHg VS 13.63 mmHg, P<0.001) and the mean distal contractile integral (1 819.15 mmHg·s·cm VS 1 007.67 mmHg·s·cm, P<0.001) were significantly increased compared with those before surgery. ARMS has significant short-term efficacy in the treatment of proton pump inhibitor dependent GERD, which can effectively improve reflux symptoms and life quality of patients, and strengthen the rest pressure of LES and peristalsis of the esophageal body.

Objective To synthesize a novel 18 F labeled probe targeting translocator protein ( TSPO) ligand 2-( 5, 7-diethyl-2-( 4-( 2-fluoroethoxy ) phenyl ) pyrazolo [ 1, 5-a ] pyrimidin-3-yl )-N, N-diethylacet-amide (VUIIS1008), and evaluate its biodistribution and imaging in rheumatoid arthritis (RA) model. Methods The tosylate substrate was labeled with 18 F using a tosyloxy for fluorine nucleophilic aliphatic substitution to obtain 18 F-VUIIS1008. The labeling efficiency, radiochemical purity, and stability in vitro were determined. In vitro cellular uptake and competitive binding assay were performed on RAW264.7 mac-rophage cells. Biodistribution and microPET/CT imaging were investigated on RA mice established by Com-plete Freund's Adjuvant. Two-sample t test was used to analyze the data. Results 18 F-VUIIS1008 was syn-thesized with the labeling yield up to (41.00±5.00)％, the radiochemical purity>98.00％, and the specific radioactivity >1. 52 × 108 MBq/mmol. 18 F-VUIIS1008 was highly stable with the radiochemical purity >98. 00％ at 4 h after incubation in mouse serum. In vitro, it also exhibited high specific TSPO binding in RAW264.7 macrophage cells. The uptake ratio was (14.00±0.30)％ at 1 h after incubation, and decreased significantly ((4.00±0.70)％;t=12.894, P<0.05) after adding excessive unlabeled VUIIS1008. The half maximal inhibitory concentration (IC50) of 18F-VUIIS1008 binding to TSPO was 0.05 nmol/L in RAW264.7 macrophage cells. In vivo distribution results showed that the uptake of 18 F-VUIIS1008 in the left arthritic ankles reached the peak value of (1.33±0.02) percentage activity of injection dose per gram of tissue (％ID/g) at 1 h after injection. The radioactivity ratio of left ankle arthritic tissue to blood ( A/B) and to normal muscle ( A/M) was 4.40±0.22 and 1.65±0.07 respectively. MicroPET/CT imaging demonstrated that 18F-VUIIS1008 could specifically target and retained in the inflammation site. Conclusion 18 F-VUIIS1008 can be easily synthe-sized with high radiochemical purity and can clearly visualized in RA imaging with low background, suggesting its potential as a novel promising molecular probe targeting TSPO for RA PET imaging.