Objective To explore the efficacy and safety of dexmedetomidine combined with propofol on double-balloon enteroscopy.Methods Forty cases of patients ASA Ⅰ-Ⅱ grade who underwent double-balloon enteroscopy were divided into dexmedetomidine combined with propofol group (combine group) and propofol group by random digits table with 20 cases each group.Combine group was given load 0.7 μg/kg (intravenous infusion for 10 min) before induction and 0.2 μg/ (kg·h) continuous infusion during the surgery.All the patients were used propofol by target concentration with 2.5-4.0 mg/L for target-controlled infusion heart rate (H R),mean arterial pressure (MAP),respiratory rate (RR),peripheral oxygen saturation (SpO2) were recorded before examination(T0),eye lash reflex time(T1),during the perform (T2),the end of check (T3),sedation score,induction time,recovery time,total propofol amount,rates of adverse reaction and satisfaition were recorded.Results The induction time,recovery time was no statistically significant difference between two groups (P ＞ 0.05).The RR,SpO2 was no statistically significant difference between two groups at different time points (P ＞0.05).The HR at T1,T2 in combine group was significantly lower than that at T0 and in propofol group same period[(65.8 ± 7.3),(68.6 ± 8.2) times/min vs.(84.6 ± 7.1) and (77.6 ± 7.2),(89.6 ± 8.4) times/min,P ＜ 0.05].The MAP at T1 in combine group was significantly higher than that at T0 and in propofol group same period [(88.9 ± 9.4) mm Hg (1 mm Hg =0.133 kPa) vs.(81.3 ± 4.5) and (73.5 ± 6.8) mm Hg,P ＜ 0.05],at T2 was significantly lower than that in propofol group [(80.6±6.6) mm Hgvs.(88.5 ±7.6) mm Hg,P＜0.05].Sedation score 1 score 18 cases,2 scores 2 cases in combine group; 1 score 3 cases,2 scores 17 cases in propofol group,the difference was statistically significant (P ＜ 0.05).Combine group apnea two cases,moving,choking three cases,propofol group were eight cases and seven cases,the difference was statistically significant (P ＜ 0.05).The total propofol amount in combine group was significantly lower than that in propofol group [(421 ± 76) mg vs.(638 ± 89) mg,P ＜ 0.05].Conclusion Dexmedetomidine composite target controlled infusion of propofol used for double-balloon enteroscopy can produce good narcotic analgesic which is safe and effective anesthesia.

Objective To investigate the therapeutic mechanism of the recipe of effective components from Yangxin Tongmai Formula (YTF) for myocardial ischemia by observing its effect on angiogenesis. Methods The breeding egges were divided into 6 groups: YT Ⅱ group treated with serum containing the recipe of effective components from YTF, YT Ⅰ group treated with serum containing YTF, SBW group treated with serum containing Shexiang Baoxin Pill, bFGF group treated with serum containing recombinant bovine basic fibroblast growth factor, KX group treated with blank control serum, and blank control group, 25 eggs in each group. The survival rate of chicken embryo, growth shape and vessel count of CAM model in each group were observed after 0, 24, 48, 72 and 96 hours. Results After treatment for 96 hours, the survival rate in b-FGF group and YT II group was higher than that in the other groups. The vasculature growth was rapidly in the medication group after culturing for 72 hours, and more apparent after 96 hours, especially in the b-FGF group and YT-Ⅱ group. The vessel count in b-FGF group, YT-Ⅱ group, YT-Ⅰ group and SBW group was in-creased as compared with that in KX group and blank control group (P < 0. 05), and ranged in the order as follows: b-FGF group > YT-Ⅱ group > YT-Ⅰ group > SBW group > KX group > blank control group. Conclusion YT-Ⅱ has the sim-ilar effect on improving angiogenesis as YT-Ⅰ, SBW and b-FGF, and its effect is better than that of YT-Ⅰ and SBW.

Objective To provide the effective and convenient medical MOOC and remote medical education by comparatively analyzing domestic and foreign medical MOOC.Methods The following items were comparatively an-alyzed, including the number of medical MOOC, the universities offering medical MOOC, the languages used in teaching medical MOOC, the identification of MOOC, and the development of domestic and foreign medical MOOC on platforms of Coursera, edX, China university MOOC and people's health MOOC.Results The domestic medical MOOC still had a longer way to go than foreign medical MOOC in their number, scale and identification.Conclu-sion Domestic medical workers should grasp the opportunity to provide more effective and convenient medical MOOC platform.

0bjective To investigate the relationships between the peripheral lung cancer and pulmonary vessels or bronchi by 16-row muhislice computed tomography(MSCT)and analyze the related factors.Methods Fifty-four patients with peripheral lung cancer confirmed pathologically underwent contrast-erdaanced MSC TI Multiplanar reformation(MPR)and maximum intensity projection(MIP)in all patients were used to demonstrate the relationships between the peripheral lung cancer and pulmonary vessels,bronchi.The relationships were categorized five types:Type 1,erupted at the edge of nodule. Type 2,erupted at the center of nodule.Type 3,penetrated through the nodule.Type 4,contacting the nodule but stretched or encased.Type 5,contacting the nodule but smoothly compressed.The pathology type,stage,size,density and location of the peripheral lung cancer were recorded and the relationships with five types were evaluated by using Chi-square test and correlation analysis.Results (1)Tumor-bronchi relationship:type 1(33,61.1%)was more often seen in≥2.0 cm and solid lesions with stage Ⅱ-Ⅳ.while Type 2(14,25.9%)was often seen in<2.0 am and part-solid or non-solid lesions with stage Ⅰ.(2)Tumor-PA relationship:Type 1 was more often seen in≥2.0 am and solid lesions with stage Ⅱ-Ⅳ.while Type 2 was often seen in part-solid or non-solid lesions with stage Ⅰ.(3)Tumor-PV relationship:type 4 was the most common type(29,53.7%).Type 2(13,24.1%)was more often seen in part-solid or non-solid lesions.(4)Tumor-bronchi relationship and tumor-PA relationship had a positive correlation(r=0.5265,P<0.01).Conclusions MSCT can demonstrate the relations between the peripheral lung cancer and bronchi.PA and PV.It is useful for the differential diagnosis and prognosis evaluation of the lung csncer.

The robustness of sliding mode control is utilized to improve the adaptability of the control system to changes in vascular mechanical properties of different patients.Adaptive sliding mode control is designed to adapt the controller to the needs of different virtual environment simulations through an adaptive mechanism,thereby weakening the chattering of sliding mode control.The extrapolation prediction algorithm is invoked under the adaptive sliding mode control to reduce the effects of delay on the control and improve force feedback transparency.The experimental results demonstrate that adaptive sliding mode predictive control can enhance system stability,force feedback control accuracy,and fidelity of force feedback control system for flexible surgical instruments.The study has important theoretical significance and practical value for the design of systems with flexible control objects and the improvement of force feedback fidelity.

Objective:To explore clinical value of nucleic acid detection for hepatitis B virus (HBV) screening in hospitalized patients.Methods:This cross-sectional study collected and analyzed plasma samples from patients admitted to 10 domestic medical institutions from July 2021 to December 2021. Serological immunoassay and nucleic acid screening were used to simultaneously detect hepatitis B markers such as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e Antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb),and HBV DNA. Statistical analysis was performed on the serology, nucleic acid test results and clinical information of the patients.Results:Of the 8 655 collected samples, HBsAg was positive in 216 (2.50%) samples,HBV DNA was positive in 238 (2.75%) samples ( P>0.05); 210 (2.43%) samples were positive for both HBsAg and HBV DNA, 28 (0.32%) were HBsAg negative and HBV DNA positive, 6 cases (0.07%) were HBsAg positive and HBV DNA negative. Conclusion:These results indicate that the HBV DNA testing is equally effective as hepatitis B virus serological detection for hepatitis B virus screening in hospitalized patients.

Objective:To compare the cost-effectiveness of hospitalized Chinese patients undergoing nucleic acid screening strategies for hepatitis B and hepatitis C, immunological screening strategy, and no screening strategy under different willingness to pay (WTP). The results might aid to decision-making for the optimal strategy.Methods:In this study, nucleic acid screening, immunological screening and no screening were used as screening strategies, and China′s GDP in 2021 (80 976 yuan) was used as the threshold of WTP to construct a Markov model. After introducing parameters related to the diagnosis and treatment of hepatitis B and C in inpatients, a cohort population of 100 000 inpatients was simulated by TreeAge Pro 2021 software, the total cost, total health effects, incremental cost-effectiveness ratio and average cost-effectiveness ratio of different screening strategies were calculated, and cost-effectiveness analysis was conducted. Univariate and probabilistic sensitivity analysis were used to assess the impact of parameter uncertainty on the final results.Results:Compared with the non-screening strategy, the incremental total cost of the hepatitis B immunological screening strategy for cohort patients was 11 049 536 yuan, and the incremental cost-effectiveness ratio was 24 762 yuan/quality-adjusted life years (QALY), while the total incremental cost of nucleic acid screening was 19 208 059 yuan, and the incremental cost-effectiveness ratio was 29 873 yuan/QALY; the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 834 yuan/QALY. Compared with the non-screening strategy, the incremental cost-effectiveness ratio of hepatitis C immunological screening strategy was 5 731 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening strategy was 8 722 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 591 yuan/QALY. The results of probabilistic sensitivity analysis showed that when the cost of nucleic acid testing exceeded 214.53 yuan, it was not cost-effective to perform hepatitis B nucleic acid screening under the WTP as 1 fold GDP. When the cost of nucleic acid testing exceeded 132.18 yuan, it was not cost-effective to conduct hepatitis C screening under the WTP as 1 fold GDP.Conclusions:Nucleic acid screening strategy can achieve more cost-effectiveness and is worthy of vigorous promotion. Compared with no screening, both the nucleic acid and immunological screening strategies are cost-effective, and hepatitis nucleic acid screening is the optimal strategy for hospitalized patients.

Objective:This multi-centre study was conducted to assess the efficacy of various preoperative/pre-transfusion screening methods for blood transmitted disease.Methods:From July 2021 to December 2021, plasma samples of patients admitted to 10 hospitals were collected for screening preoperative/pre-transfusion blood transmitted disease. Nucleic acid detection technology was used to detect hepatitis B virus (HBV) DNA, hepatitis C virus (HCV) RNA and human immunodeficiency virus (HIV)(1+2) RNA, and the results were compared with the immuno-serological methods. χ 2 test and Kappa test were used to analyze the efficacy of these two methods. Results:A total of 8 655 valid specimens were collected from 10 hospitals. There was a statistically significant difference in the positive detection rate of HCV between the two methods ( P<0.001). There was no significant difference in the positive detection rate of HBV and HIV assessed by the two methods ( P>0.05), but the number of positive cases detected by HBV DNA and HIV RNA (218 and 4 cases) was significantly higher than the corresponding serological results (216 and 2 cases). At the same time, there were HBV, HCV and HIV immuno-serological omissions by the immuno-serological methods, among which 28 cases were HBsAg negative and HBV DNA positive, 2 cases were HCV antibody negative and HCV RNA positive, and 2 cases were HIV antigen/antibody negative and HIV RNA positive. In addition, in the 66 samples with inconsistent results from the two detection methods, 83.3% (55/66), 68.2% (45/66), 63.6% (42/66) and 62.1% (41/66) of patients aged was>45 years, tumor, surgery and male, respectively. Conclusions:Compared with immuno-serological tests, nucleic acid tests have the advantage in terms of sensitivity on detecting HBV, HCV and HIV infection and could reduce missed detection. The risk of transmission can be reduced by adding HBV, HCV, and HIV nucleic acid tests to preoperative/pre-transfusion immuno-serological tests screening for patients over 45 years of age and tumor patients.

BACKGROUNDStatin therapy has affected glucose homoeostasis of type 2 diabetes patients, which could be related with bile acids metabolism. Whether bile acid metabolism and the expression of farnesoid X receptor (FXR), liver X receptor-α (LXR-α) and sterol regulatory element-binding protein (Srebp)-1c is regulated by hyperglycemia, or whether simvastatin therapy led to higher glucose is related with down-regulated expression of FXR in diabetic rats remained unclear.

METHODSForty male Wistar rats were randomly divided into four groups: normal control rats, insulin resistance rats, diabetic model rats, and the late simvastatin induced diabetic rats. Normal control rats were fed with standard diet, others were fed with high-fat diet. Diabetic model rats were induced by a single intraperitoneal injection of streptozotocin (STZ). The late simvastatin induced diabetic rats started simvastatin administration after STZ induced diabetic model rats. Characteristics of fasting blood glucose (FPG), lipid files and total bile acids (TBAs) were measured and the oral glucose tolerance test (OGTT) was performed after overnight fasting at the eighth weekend. RNA and protein levels of FXR, LXR-α and Srebp-1c were tested by Western blotting and reverse transcription polymerase chain reaction (RT-PCR).

RESULTSThe insulin resistance rats showed higher glucose, lipid files and lower expression of FXR compared with normal control rats (P > 0.05). The diabetic model rats showed significantly higher glucose, lipid files, TBA and lower expression of FXR compared with insulin resistance rats (P < 0.05). The late simvastatin induced diabetic rats displayed higher glucose and TBA and lower expression of FXR compared with diabetic model rats (P < 0.05).

CONCLUSIONSChanges in bile acid homeostasis, including the alterations of bile acid levels and bile acid receptors, are either a cause or a consequence of the metabolic disturbances observed during diabetic models. Statin therapy induced hyperglycemia may be related with FXR, SHP, LXR-α and Srebp-1 pathways.

Animals ; Blood Glucose ; drug effects ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Glucose Tolerance Test ; Homeostasis ; drug effects ; Insulin Resistance ; physiology ; Liver X Receptors ; Male ; Orphan Nuclear Receptors ; metabolism ; Rats ; Rats, Wistar ; Receptors, Cytoplasmic and Nuclear ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Simvastatin ; therapeutic use ; Sterol Regulatory Element Binding Protein 1 ; metabolism