Objective To determine the 50%effective dose (ED 50) of dexmedetomidine for sedation in the brachial plexus block, so as to provide reference for clinical. Methods Twenty-three patients underwent the brachial plexus block using an ultrasound guided technique. After blocked for 30 min, the dexmedetomidine was infused by a intravenous continuous pump,and an observer' s assessment of alertness/sedation score (OAA/S) and auditory evoked potential index (AEPI) were used for monitoring the depth of sedation. The dexmedetomidine was adjusted according to the response of the previous patient using a up-and-down sequential method until the sequential response curve appeared seven fold points. The initial dexmedetomidine of the first patient was 1μg/kg. Each time the dosage increased/decreased by 0.1μg/kg. The OAA/S score of no more than 3 was defined an effective sedation. Results The ED50 of dexmedetomidine for sedation was 0.78μg/kg (95%CI 0.66-0.86μg/kg). The AAI was positively correlated to the OAA/S score, and linear regression equation was Y=-1.43+0.109 X, R2=0.919. Conclusion The ED50 of dexmedetomidine for sedation in the brachial plexus block is 0.78μg/kg (95%CI 0.66-0.86μg/kg).

Objective To investigate the relationship between the mutation of ERG11 gene,a target of azole antifungal drugs (fluconazole,itraconazole,voriconazole),and azole-resistance in Candida albicans isolates from patients with AIDS.Methods Ninety-three Candida albicans strains were isolated from patients with AIDS.DNA was extracted from these isolates,and ERG11 gene was amplified by PCR followed by bidirectional sequencing.DNAman software was used to compare the resultant sequence with the reference sequence of ERG11 gene (GenBank accession no.X13296).Then,different base sequences were translated into amino acid sequences to determine whether missense mutations occured.Results A total of 40 mutation sites were identified in these isolates,including 27 silent mutations and 13 missense mutations.One or no missense mutation was detected in Candida albicans strains resistant to 1 antifungal agent,while those resistant to 2 or 3 antifungal agents simultaneously harbored 2 or 3 missense mutations.Conclusion The missense mutations in ERG11 gene are probably connected with azole resistance in Candida albicans.

Objective To measure the effect of one-stage transplantation of reverse-flow vascular pedicle fibular grafts in treatment of infected nonunion of the distal tibia.Methods From January 2001 to December 2012,23 patients sustaining the infected nonunion of the distal tibia were transplanted with reverse-flow vascular pedicled fibular grafts in one-stage.There were 13 males and 10 females,aged 26 to 59 years (mean,38.7 years).Tibial nounion based on the Jain-Sinha classification was rated as Type A in 6 patients and Type B in 17 patients.After the operation,the patients received 2-3 weeks of intravenous antibiotic treatment and then 4-week oral antibiotic therapy.Wound healing,limb and ankle joint fucntion and outcomes in fibular transplantation were observed.Results Duration of follow-up was 16-46 months (mean,28.6 months).There were no exudates and ulcerations of the skins.Smooth healing was achieved in all the patients except that fibular fracture was noted in one patient healed after cast immobilization.Healing time ranged from 12 to 28 weeks (mean,15.6 weeks).Limb function evaluated with Ennecking system had (87 ± 11) ％ restoration.According the Olerud-Molander scoring system,ankle function was excellent in 16 patients and good in 7 patients,with the excellent-good rate of 100％.Conclusion One-stage reverse-flow vascular pedicle fibular grafting is an optional procedure for treatment of infected nonunion of the distal tibia,due to the technique is easy and effective.

Objective To investigate the role of large-diameter magnetic resonance imaging (MRI) simulation in target volume delineation in radiotherapy for nasopharyngeal carcinoma (NPC).Methods Eighteen patients with NPC underwent computed tomography (CT) simulation and MRI simulation scans and localization in the same body position,with SOMATOM Sensation Open 40-row 82-cm large-diameter CT simulator and Siemens 3T MRI MAGNETOM Skyra 70-cm large-diameter simulator,respectively.The gross tumor volume (GTV) and parotid glands were delineated on all images according to the ICRU Report 50/62,and MRI was applied to observe the changes in GTV and parotid volume during radiotherapy.Paired t-test was applied to analyze the differences between GTVCT and GTVMRI and between GTVnx-CT and GTVnx-MRI.Results GTVMRI decreased significantly compared with GTVCT,and the average volume decreased from (213.64±84.59) cm3 to (199.68±84.69) cm3(p=0.006).As for the volume of primary lesions in the nasopharynx,GTVnx-MRI was significantly smaller than GTVnx-CT,and the volume decreased from (95.75± 24.76) cm3 to (88.12±26.25) cm3 (P =0.001);as for the volume of cervical lymph nodes,GTVnd-MRI was significantly smaller than GTVnd-CT,and the volume decreased from (117.89± 72.69) cm3 to (111.56± 70.69) cm3 (P=0.018).The targets delineated by CT and MRI did not overlap completely,with major differences in skull base bone and cervical soft tissue.The volume of both parotid glands delineated on MRI image was higher than that delineated on CT image,with a major difference in the deep lobe.MRI showed that GTV was reduced by 82.64± 16.87％ during radiotherapy,and the volumes of the left and right parotid glands were reduced by (32.7± 23.95) ％ and (34.7± 21.72) ％,respectively.Conclusions The delineation of target volume based on MRI simulation is more accurate than that based on CT simulation and can achieve a smaller volume range,which helps to guide target volume delineation in radiotherapy for NPC accurately.

Premature infants are at high risk of vitamin D deficiency, thereby commonly treated with vitamin D supplementation after birth. However, the nutritional status of vitamin D in premature infants is not optimistic due to the fact of high incidence of vitamin D deficiency. Studies have found that vitamin D is associated with a variety of diseases in premature infants, including metabolic bone disease, respiratory distress syndrome, bronchopulmonary dysplasia, neonatal necrotizing enterocolitis and infection. Clinicians should be aware of the importance of vitamin D for premature infants and prescribe vitamin D supplementation as early as possible with the dose reference of serum 25-hydroxyvitamin D level.

Objective:To preliminary investigate the impact of the diagnosis-related groups (DRG) payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders (NMOSD), and to propose potential improvement strategies.Methods:A single-center, retrospective study. From October 1, 2020, to September 30, 2022, 44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University (Xi'an First Hospital) were included in the study. Among them, there were 11 males and 33 females, with an average age of (40.8±20.2) years. According to the implementation time of DRG payment, patients were divided into two groups: group A, which consists of cases one year before the implementation of DRG payment from October 1, 2020 to September 30, 2021, and group B, which consists of cases one year after the implementation of DRG payment from October 1, 2021 to September 30, 2022, with 20 and 24 cases, respectively. Detailed information such as hospitalization duration, treatment methods, and hospitalization costs of the two groups of patients was collected. Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups. For intergroup comparison, t-test was used for normally distributed data, and Mann-Whitney U test was used for skewed distributed data. Results:Among the 44 patients, 5 cases (5/24, 20.8%) received plasma exchange (PE) treatment, all of whom were in group B. The numbers of patients who received and did not receive intravenous immunoglobulin (IVIG) treatment were 9 and 11 in group A, respectively, and 7 and 12 in group B (except for 5 cases who received PE treatment), respectively. Compared with group A, there was no significant decrease in hospitalization duration ( t=0.004) and total hospitalization costs ( Z=0.036), as well as costs for western medicine ( Z=0.036), examinations ( Z=0.011), laboratory tests ( Z=0.040), treatments ( Z=0.017), and nursing ( Z=3.131) in group B, and the differences were not statistically significant ( P>0.05). For patients receiving PE treatment, except for the cost of western medicine ( Z=0.062, P=0.804), the other costs ( Z=8.288, 5.013, 11.400, 10.925, 9.126) were significantly higher than those of patients not receiving PE treatment, and the hospitalization duration ( t=20.474) was significantly prolonged, with statistically significant differences ( P<0.05). The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B, with statistically significant differences ( Z=7.690, 10.314; P<0.05). There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B ( Z=0.137, P>0.05). Conclusions:There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment, especially for patients receiving PE treatment. It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.

Objective:To investigate the clinical characteristics of vascular neuro-ophthalmology in patients with central retinal artery occlusion (CRAO).Methods:A single-center, prospective clinical study. From January 2018 to December 2020, 49 eyes of 49 CRAO patients of The Neuro-ophthalmology Department of Xi'an First Hospital were included in the study. Data on patient demographic characteristics, vascular risk factors, disease characteristics, digital subtraction angiography (DSA) imaging characteristics of internal carotid arteries, treatment, treatment-related adverse events, and 1-month follow-up vascular events were collected. All patiens were examined by visual acuity, head CT and or magnetic resonance imaging. At the same time, 35 cases of internal carotid artery vascular DSA were examined; 14 cases of head and neck CT angiography were examined. The anatomical variation of the extracranial segment of the internal carotid artery was divided into tortuous, tortuous, and coiled; the aortic arch was divided into type Ⅰ , type Ⅱ , type Ⅲ, and bovine type. Intravenous thrombolysis, arterial thrombolysis, conservative treatment were performed. The follow-up time was1 month after treatment. Functional vision was defined as vision ≥20/100. Vascular events were strokes, cardiovascular events, deaths and neovascular glaucoma during follow-up.Results:Among 49 eyes of 49 cases, 40 eyes were male (81.6%, 40/49), and 9 eyes were female (18.4%, 9/49); the average age was 60.7±12.9 years. There were 33, 17, and 16 cases with hypertension, type 2 diabetes, and cerebrovascular disease, respectively; 27 and 34 cases had a history of smoking and tooth loss, respectively. Taking antihypertensive, hypoglycemic, antiplatelet aggregation/anticoagulation, and hypolipidemic drugs were 15, 5, 8, and 5 patients, respectively. There were 11 cases of transient amaurosis before the onset, and 17 cases of CRAO after waking up. There were 33 cases (67.3%, 33/49) with infarction of the affected side of the brain tissue. DSA was performed in 35 cases, and the stenosis rate of the internal carotid artery on the affected side was 70%-99% and 100% were 3 (8.6%, 3/35) and 4 (11.4%, 4/35) cases, respectively. The ophthalmic artery on the affected side originated from the external carotid artery in 5 cases (14.3%, 5/35). There were 17 (54.8%, 17/31) and 2 (6.5%, 2/31) cases of tortuousity and kinking in the extracranial segment of the internal carotid artery. There were 15 (42.9%, 15/35), 6(17.1%, 6/35), and 2 (5.7%, 2/35) cases of aortic arch type Ⅱ, type Ⅲ, and bovine type, respectively. Intravenous thrombolysis and arterial thrombolysis were performed in 13 and 29 cases, respectively. Complications occurred in 2 cases during treatment; 3 cases of symptoms fluctuated after treatment, and 10 cases of asymptomatic new infarcts occurred in imaging studies. Forty-eight cases were treated with antiplatelet aggregation/anticoagulation and hypolipidemic treatment. At discharge and 1 month after treatment, the recovery of functional vision was 7 and 17 cases, respectively. One month after treatment, 1 case died because myocardial infarction; 2 cases of neovascular glaucoma occurred.Conclusion:The proportion of CRAO patients with vascular risk factors and internal carotid artery abnormalities on the affected side is relatively high; the prognosis is relatively good after intravenous thrombolysis and/or arterial thrombolysis and secondary stroke prevention.

Objective:To investigate the risk factors for poor outcome and recurrence at 1 year after first-ever ischemic stroke in non-diabetic patients.Methods:Using Xi'an Stroke Registry Research Database, the clinical data of patients with non-diabetic first-ever ischemic stroke diagnosed in 4 tertiary A hospitals in Xi'an from January to December 2015 were collected. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. Prognosis (functional outcome and recurrence) was followed up at 1 year after diagnosis. Functional outcome was assessed using the modified Rankin scale. 0-2 was defined as good outcome and >2 as poor outcome. Recurrence was defined as new focal neurological dysfunction caused by cerebral infarction or cerebral hemorrhage events during follow-up and confirmed by cranial CT or MRI. Multivariable logistic regression analysis was used to identify the independent influencing factors of clinical outcomes at 1 year. Multivariable Cox proportional hazard model was used to identify the independent influencing factors of recurrence within 1 year. Results:A total of 1 214 non-diabetic patients with first-ever ischemic stroke were included. One year follow-up showed that 210 patients (17.3%) had a poor outcome, 88 (7.2%) of them died, and 47 (3.9%) had recurrence. Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.065, 95% confidence interval [ CI] 1.042-1.090; P<0.001), atrial fibrillation ( OR 3.170, 95% CI 1.588-6.327; P=0.001), white blood cell count ( OR 1.106, 95% CI 1.006-1.216; P=0 037), baseline NIHSS score ( OR 1.210, 95% CI 1.147-1.277; P<0.001), and stroke associated-pneumonia (SAP; OR 3.677, 95% CI 1.451-9.316; P=0.006) were independently associated with poor outcomes. Multivariate Cox proportional hazards regression analysis showed that baseline NIHSS score (hazard ratio [ HR] 1.055, 95% CI 1.003-1.109; P=0.036) and SAP ( HR 7.067, 95% CI 3.154-15.836; P<0.001) were independently associated with recurrence. Kaplan-Meier survival curve analysis showed that the 1-year recurrence rate of patients with severe stroke was significantly higher than that of patients with mild to moderate stroke (log-rank test, P<0.001), and the 1-year recurrence rate of patients with SAP was significantly higher than that of patients without SAP (log-rank test, P<0.001). Conclusion:Age, atrial fibrillation, white blood cell count, baseline NIHSS score and SAP are the independent predictors of poor outcomes at 1 year after first-ever ischemic stroke in non-diabetic patients. Baseline NIHSS score and SAP are the independent predictors of recurrence within 1 year after first-ever ischemic stroke in non-diabetic patients.

Recombinant human interferon beta (rhIFN-β) is a glycoprotein produced by genetically engineered cells and has anti-virus, anti-tumor and immunoregulation functions. Although studies have shown that other subtypes of IFN such as IFN-γ affects cell proliferation and differentiation to some extent, the effect of rhIFN-β on chondrogenic differentiation of human bone marrow mesenchymal stem cells (hMSCs) is less known. In this study we studied the effect of rhIFN-β on the chondrogenic differentiation of hMSCs by inducing hMSCs into cartilage pellet via adding IFN-β1a into regular TGF-β3 chondrogenic differentiation medium. We collected the induced pellets and then detected GAG content, assessed pellets size, observed agreecan using alcian blue staining, and analyzed the expression of Sox and CollangenⅡusing real-time PCR and Western blotting. Addition of 100 ng/mL IFN-β1a to regular TGF-β3 chondrogenic differentiation medium could improve the concentration of GAG, increase the size of pellets, promote the formation of aggrecan and up-regulate the expression of CollangenII and Sox9. IFN-β1a combined with TGF-β3 could promote chondrogenic differentiation of hMSCs.