OBJECTIVE:To evaluate the pain-relieving and sedative efficacy and safety of sufentanil in patient-controlled intravenous analgesia after spinal column surgery.METHODS:60 patients undergoing selective spinal column surgery were randomized to either fentanyl group or sufentanil group.General anesthesia was performed for all the 60 cases,with tracheal catheter withdrawn and patient-controlled intravenous analgesia(PCIA) performed after completion of surgery when patients had regained consciousness.The analgesic efficacy within 24 hours was evaluated using visual analogue score(VAS),VRS score,Ramsay score and the adverse effects were recorded.RESULTS:In sufentanil group,effective analgesic efficacy was obtained,and the VAS score was significantly lower but the VRS score was significantly higher than in fentanyl group(P0.05).CONCLUSION:Sufentanil is proved to be safe and effective with reliable analgesic and sedative efficacy but fewer side effects for PCIA patients.

Common bile duct stones are among the most common diseases in elderly patients.In the past 20 years,minimally invasive techniques,including endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration,have been developed rapidly and provided more options for patients.Choosing appropriate treatment plans will help reduce postoperative complications and lead to better outcomes in elderly patients with common bile duct stones.

BACKGROUND:The key of intertrochanteric fractures in elderly patients is to select the appropriate fixation, but few clinical studies concerned different fixation methods for blood volume of blood circulation system in elderly patients with intertrochanteric fractures. OBJECTIVE:To compare the effects of proximal femoral intramedul ary nail and dynamic hip screw on blood volume of blood circulation system in elderly patients with intertrochanteric fractures.
METHODS:A total of 48 elderly patients with intertrochanteric fractures, who were treated in the Jiangyin Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to September 2014, were enrol ed in this study. These patients were assigned to two groups (n=24). Patients in the observation group received treatment with proximal femoral intramedul ary nail, and patients in the control group received treatment with dynamic hip screw. Postoperative blood loss, perioperative blood transfusion, preoperative and 3-day postoperative hemoglobin difference, incidence of postoperative complications, dominant blood loss, and hidden blood loss were compared between the two groups. Range of motion of the hip and Harris score of the hip were compared between the two groups at 4 and 12 months post surgery. RESULTS AND CONCLUSION:Intraoperative blood loss was less in the observation group than in the control group (P<0.05). No significant differences in perioperative blood transfusion and preoperative and 3-day postoperative hemoglobin were detected between the two groups (P>0.05). The operation time was significantly longer in the observation group than in the control group (P<0.05). The incidence of postoperative complications was significantly lower in the observation group than in the control group (P<0.05). No significant difference in length of hospital stay was detected between the two groups (P>0.05). Within the same time period, the range of motion of the hip and Harris score of the hip were better in the observation group than in the control group (P<0.05). The total amount of blood loss and dominant blood loss were less in the observation group than in the control group (P<0.05). These findings indicate that compared with the dynamic hip screw, proximal femoral nail fixation for intertrochanteric fracture has less intraoperative blood loss, lower incidence of postoperative complications, postoperative range of motion of the hip and better hip score. However, operation time of proximal femoral nail was long. There were no significant differences in hemoglobin difference and perioperative blood transfusion between the two fixation methods.

Objective To explore the effect of curcumin on the activity and migration of as well as c-kit mRNA expression in melanocytes.Methods Human epidermal melanocytes were isolated from the prepuce in adolescents and subjected to primary culture.To estimate the effect of curcumin on the proliferative activity of melanocytes, some melanocytes were randomly divided into several groups to be cultured in the MelM-2 medium with or without the presence of 5, 10, 20 or 30 μmol/L curcumin, the MelM-2 medium containing curcumin of 5-30 μmol/L served as the drug control groups, and the MelM-2 medium without curcumin served as the blank control group.After 24 and 48 hours of culture, MTS assay was performed to evaluate the proliferative activity of melanocytes.Some cultured melanocytes were randomly divided into 4 groups to be cultured in the MelM-2 medium with 0, 5, 10 and 20 μmol/L curcumin respectively for 48hours.Then, wound scratch assay was conducted to estimate the migratory activity of melanocytes, and real-time fluorescence-based quantitative PCR to quantify the mRNA expression of c-kit in melanocytes.Statistical analysis was carried out by factorial design analysis of variance (ANOVA), one-way ANOVA and least significant difference (LSD)-t test.Results The proliferative activity of melanocytes was significantly decreased at 24 and 48 hours in the 30-μmol/L curcumin group compared with the negative control group (0.783 ± 0.053 vs.1.000 ± 0.018 at 24 hours, 0.637 ± 0.015 vs.0.993 ± 0.064 at 48 hours, both P ＜ 0.05), while no significant differences were observed between the other curcumin groups and the negative control group (all P ＞ 0.05).The 48-hour treatment with curcumin could significantly inhibit the migration of melanocytes in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (all P ＜ 0.05).The mRNA expression level of c-kit was also significantly reduced at 48 hours in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (1.799 ± 0.372, 1.539 ± 0.224 and 1.026 ± 0.038 vs.3.371 ± 0.352, all P ＜0.05).Conclusion Curcumin at low concentrations (≤ 20 μmol/L) has no obvious cytotoxicity against melanocytes, but can inhibit the migration of and c-kit mRNA expression in melanocytes, while curcumin at 30 μmol/L can promote the apoptosis of melanocytes.

A total of 107 vitiligo patients were randomly divided into 3 groups.Group A received an intralesional injection of Bacillus Calmette-Guérin-polysaccharide nucleic acid (BCG-PSN) (n =34),group B Compound Glycyrrhizin Tablets (n =36) and group C both (n =37).Before treatment and 3 months after treatment,cellular immune function was detected for each group.Paired comparisons of 3 groups before and after treatment showed that CD4 +,CD4 +/CD8 + ratio increased (all P ＜ 0.05) and CD8 + decreased (P ＜0.05).After treatment,as compared with groups A and B,CD4 + increases (both P ＜ 0.05) and CD8 + decreased in group C (P ＜0.05).Group C had an efficiency rate of 91.9％ and it was higher than the other two groups (both P ＜ 0.05).An intralesional injection of BCG-PSN plus Compound Glycyrrhizin Tablets could improve immune function and treat vitiligo patients efficiently.

Objective To evaluate the effect of tacalcitol on the proliferation,adhesion,migration and c-kit mRNA expression of cultured human epidermal melanocytes.Methods Cultured epidermal melanocytes from the prepuce of adolescent males were treated with various concentrations of tacalcitol.Then,cell proliferation was evaluated by tetrazolium salt (XTT) assay after 24,48 and 72 hours of treatment,adhesive activity by using fibronectin-coated culture plates after 72 hours,migratory activity by Transwell assay using a microporous membrane after 24 hours,and the c-kit mRNA expression was semiquantitatively analyzed by reverse transcription PCR after 72 hours of treatment.Statistical analysis was done by repeated-measure analysis of variance and completely random design analysis of variance.Results As repeated-measure analysis of variance showed,tacalcitol of 10-10,10-9,10-8,10-7 and 10-6 mol/L significantly promoted the proliferation of melanocytes (F =9.47,P ＜ 0.01),with significant differences in the promoting effect among various durations of treatment with different concentrations of tacalcitol (F =14.44,P ＜ 0.01),and with significant interaction effect between drug concentration and treatment duration (F =2.47,P ＜ 0.01).The highest proliferation level was observed in melanocytes treated with tacalcitol of 10-s mol/Lfor 72 hours.There was a significant increase in the adhesion rate of human epidermal melanocytes to fibronectin after treatment with tacalcitol of 10-8-10-7 mol/L for 72 hours (both P ＜ 0.01),number of melanocytes migrating through micropore membranes per high-power field (× 200) after treatment with tacalcitol of 10-9-10-8 mol/L for 24 hours (both P ＜ 0.01),and in the c-kit mRNA expression in melanocytes treated with tacalcitol of 10-9-10-7mol/L for 72 hours (all P ＜ 0.01).Conclusion Tacalcitol can promote melanocytes to proliferate,migrate,express c-kit mRNA,and adhere to fibronectin.

Objective To investigate the changes of pathogens and antimicrobial susceptibility in patients with biliary tract infection during the past 30 years.Methods During the periods of 1981-1984,1988-1998 and 2003-2013,each 100 patients treated with common bile duct exploratoration were selected from every period.Biopsied bile specimens were performed with bacteria culture and antimicrobial susceptibility tests.This study reviewed the changes in bilary pathogens and antimicrobial susceptibility test.Results From 1981 to 1984,the most common pathogens were Escherichia coli (59.2％) and Klebsiella pneumonia (28.9％).Mixed infection of these pathogens accounted for 16.9％.From 1988 to 1998,the types of pathogens significandy increased.Escherichia coli (33.1％) and Klebsiella pneumonia (16.5％) accounted for less than 50％.Mixed infection with Escherichia coli and Pseudomonas aeruginosa was the most common type.From 2003 to 2013,gram-negative bacteria were still the main pathogens,accounting for 61.8％.Escherichia coli and Pseudomonas aeruginosa accounted for 20.1％ and 10.4％,respectively.Gram-positive bacteria increased sigrnificantly.Enterococcusfaecium (22.2％) ranked the first.Mixed infection increased (36％),of which more than 50％ was mixed pathogens of Escherichia coli and Enterococcusfaecium.The incidence of fungi infection also increased (5.6％).Conclusions There was a remarkable change of pathogen category in the biliary infections over the past years.With an increase of gram-positive bacteria and fungi infection in clinical practice,antimicrobial susceptability results could be considered in choosing appropriate drug to avoid bacterial resistance.

Objective Common bile duct stones are common in elderly patients.The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach.This study evaluated the safety and efficacy of LTM-CBDE in the elderly (≥65 years) patients with choledocholithiasis and compared the results in the elderly with those in younger patients.Methods In this retrospective analysis,128 patients underwent LTM-CBDE from March 2007 to December 2013.The patients were divided into two groups:aged ≥65 years (n=50,the elderly group) versus aged ＜65 years (n=78,the younger group).The preoperative morbidity rate,American Society of Anesthesiologists (ASA) score,previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate were compared between the both groups.Results The preoperative morbidity (41 vs.28) and ASA score (2.5± 0.7 vs.1.8±0.6) were higher in the elderly group than in he younger group (x2=26.063,t=-6.030,P =0.000,in both).No significant differences in previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate (P＞0.05) were found between the two groups from March 2007 to December 2013.Conclusions LTM-CBDE is a safe and effective treatment procedure for elderly patients with choledocholithiasis.For LTM-CBDE-suitable patients,we recommend LTM-CBDE as the treatment of choice.

Objective To analyze the difference of macular retinal thickness between normal subjects and diabetic patients without retinopathy,and discuss the relationship between macular thickness and the course of diabetes,blood glucose level.Methods Twenty-two cases of patients with diabetic without retinopathy without retinopathy in our hospital of fourth Department of Internal medicine from April 2016 to November 2016 were selected as diabetic without retinopathy group,and another 22 normal pemons were selected as the normal group.The central subfield retinal thickness (CSRT),cube volume(CV) and cube average thickness(CAT) of all patients were determined by optical coherence tomography (OCT),and the difference of CSRT,CV and CAT between diabetic patients and normal group were analyzed.Then,the patients with diabetic retinopathy were sub-grouped according to the course of diabetes (group A,B,C,) and blood glucose status (group D and E),and the differences of CSRT,CV and CAT among them were compared.Results With the increase of diabetes duration in the diabetic without retinopathy group,CSRT,CV and CAT were gradually increased,and there was significant difference (P ＜ 0.05).With rising blood sugar in diabetics in the diabetic without retinopathy group,CSRT,CV and CAT were gradually increased,and there was significant difference (P ＜ 0.05).There were positive correlation between CSRT,CV,CAT and course,blood sugar of diabetes mellitus (all P ＜ 0.05).Conclusion Compared with normal population,CSRT,CV and CAT are significantly thickened in diabetes mellitus patients,and CSRT,CV and CAT are increased gradually with the increase of diabetes and blood glucose,which provide reliable reference for the diagnosis of early diabetic retinopathy.

BACKGROUND:Donor selection for high-risk acute leukemia is still controversial.OBJECTIVE:To compare the therapeutic efficacy of the unrelated donor peripheral blood and matched sibling allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia.METHODS:Total 65 patients with high-risk acute leukemia treated during January 2008 to January 2016 were included,in which 30 patients chose the unrelated donor peripheral blood stem cell transplantation (UD), and other 35 chose the matched sibling allogeneic hematopoietic stem cell transplantation (MS) according to the wishes of patients and their own situation. After treatment, the chi-square test, Kaplan-Meier survival analysis method, and other methods were used to compare the implanted and hematopoietic reconstitution, the occurrence of graft-versus-host disease, relapse mortality and long-term survival between the two groups.RESULTS AND CONCLUSION:The implantation rate, platelet hematopoietic reconstitution time, the incidence of acute and chronic graft-versus-host disease, and its type exhibited no significant differences between the two groups (P > 0.05).The relapse rate, total death rate, and transplant-related mortality rates were 10.0%, 50.0%, and 40.0% in the UD group and 20.0%, 48.6%, and 25.7% in the MS groups, respectively, and the intergroup difference was insignificant (P > 0.05).The expected 2-year cumulative disease-free free survival and overall survival rates were (49.4±9.2)% and (52.6±9.2)% in the UD group and (53.9±8.5)% and (53.9±8.5)% in the MS group, respectively, and the intergroup difference was also insignificant (P > 0.05). Our experimental findings show that unrelated donor peripheral blood stem cell transplantation can be used as an effective alternative in the absence of sibling donors.