Aim To study the mechanisms of N-demethyl-clarithromycin-induced apoptosis in human cervical cancer cell line HeLa. Methods MTT, photomicroscopical observation, DNA agarose gel electrophoresis, LDH release and Western blot were used for apoptosis assay. Results N-demethyl-clarithromycin inhibited growth of HeLa in a time-dependent manner. Apoptotic bodies were found with Hoechst 33258 staining after treatment with 60 ?mol?L-1 N-demethyl-clarithromycin. DNA fragmentation was observed in N-demethyl-clarithromycin treated HeLa cells. The Akt inhibitor and the ERK inhibitor (PD98059) increased cell death. The expression of anti-apoptotic protein Akt, phosphorylated-Akt, ERK and phosphorylated-ERK decreased. Conclusion N-demethyl-clarithromycin induces HeLa apoptosis through Akt and ERK expression and phosphorylation.

There is no specific treatment for post-polio syndrome. The common applied therapies include mediciation, exercise, cogni-tive behavioural therapy, physiotherapy, occupational therapy, Traditional Chinese Medicine, assistive technology, psychological and social factors adjustment, interdisciplinary comprehensive rehabilitation, and so on.

Objective To study and summary the treatment of talus fracture. Methods Fifteen patients with talus fracture were treated by limited cut off reduction by leverage and hollow lag screw under C arm X-Ray machine January 2008 to November 2014, of whom there were 11 males and 4 females, aged 15-61 years old. Seven patients sufferred from talus fracture because of traffic accidents, 4 patients because of falls, 2 patients because of crush injury, and 2 patients because of sprains. Hawkins typing:Ⅰtype in 1 patient, Ⅱ type in 6 patients, Ⅲ type in 6 patients of Ⅲ type, and Ⅳ type in 2 patients. Results Followed up for 6 months to 4 years (mean 1.5 years), fracture healed better. Hawkins grading standard:9 patients showed excellent (1 patient ofⅠtype, 5 patients ofⅡtype, 3 patients ofⅢtype), and two patients showed good (Ⅲtype). The excellent and good rate was 11/15. Necrosis of talus occurred in one patient, and degenerative joint disease occured in one patient. Conclusions Minimally invasive internal fixation with hollow lag screw under C arm X-Ray machine in the treatment of talus fracture has a small injury to the periosteum and the blood supply of small soft tissue. It can fix reliably and can pressurize the fracture fragments, and is conducive to fracture healing.

Objective:To evaluate the relationship between postoperative delirium and preoperative frailty in elderly patients undergoing non-cardiac surgery.Methods:Elderly patients undergoing non-cardiac surgery at our hospital from March 2019 to July 2022 were collected and their age, comorbidities, gender, smoking history, type of surgery, preoperative albumin, duration of surgery, duration of anesthesia, postoperative hypotension, educational level, nutritional status, American Society of Anesthesiologists (ASA) Physical Status classification, postoperative admission to ICU or not, intraoperative bleeding and preoperative frailty status were collected. The patients were divided into delirium group and non-delirium group according to whether postoperative delirium occurred. The risk factors for postoperative delirium were analyzed by multivariate logistic regression analysis, and the receiver operating characteristic curve was drawn to analyze the value of risk factors in predicting postoperative delirium.Results:There were 74 cases in delirium group and 321 cases in non-delirium group, and the incidence of postoperative delirium was 18.7%. There were statistically significant differences in terms of age ≥70 yr, education level of junior high school and below, poor nutritional status, ASA Physical Status classification Ⅲ, postoperative admission to ICU, proportion of frailty and intraoperative bleeding volume between delirium group and non-delirium group ( P<0.05). The results of logistic regression analysis showed that age, educational level, nutritional status, ASA Physical Status classification, intraoperative bleeding and frailty were all independent risk factors for delirium ( P<0.05). The area under the receiver operating characteristic curve of preoperative frailty predicting postoperative delirium was 0.672 (95% confidence interval 0.605-0.740). Conclusions:Preoperative frailty is an independent risk factor for postoperative delirium in elderly patients undergoing noncardiac surgery, which can predict the occurrence of postoperative delirium to some extent.

Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are the effective methods for treating carotid artery stenosis, but postoperative restenosis remains a challenge. The pathogenesis of postoperative restenosis is currently not fully understood. However, multiple factors, including biomarkers, imaging features, and surgical related factors, have been proven to be associated with postoperative restenosis and can predict the occurrence of postoperative restenosis. This article reviews the predictors of restenosis after carotid endarterectomy and carotid artery stenting.

Objective:To evaluate the effect of obesity on the displacement of a left-sided double-lumen tube (DLT) during positional changes.Methods:This was a prospective cohort study. Six hundred and two patients who underwent elective chest surgery and required insertion of a left-sided DLT from February 2020 to November 2023 in our hospital were selected and divided into 2 groups based on the body mass index (BMI): obesity group (BMI≥28 kg/m 2,n=208) and non-obesity group (18.5 kg/m 2≤BMI<28 kg/m 2,n=394). General characteristics of patients, history of chest surgery, DLT model, depth of DLT placement in supine position, height/depth of placement (H/D) ratio, and distance of DLT displacement were recorded. DLT displacement was defined as a displacement distance of ≥15 mm. The logistic regression was used for analysis of the relationship between BMI and left DLT shift during positional changes. The receiver operating characteristic curve was used to evaluate the accuracy of BMI in predicting the left-sided DLT displacement during positional changes. Results:Compared with non-obese group, the depth of DLT placement was significantly reduced, the H/D ratio was increased, the distance of DLT displacement was increased, and the incidence of DLT displacement was increased in obese group ( P<0.05). The results of binary logistic regression analysis showed that a BMI≥28 kg/m 2 was an independent risk factor for DLT displacement ( OR value [95% confidence interval]=4.18 (2.36-7.38), P<0.001). The sensitivity of BMI in predicting the left-sided DLT displacement during positional changes was 77.4%, and the specificity was 69.6%, with an optimal cutoff value of 27.48 kg/m 2 and an area under the receiver operating characteristic curve of 0.757. Conclusions:Obesity can increase the probability of the left-sided DLT displacement during positional changes.

Objective:To compare the effects of left paratracheal pressure (LPP) and cricoid pressure (CP) during mask ventilation in obese patients.Methods:Sixty patients of either sex, aged 18-60 yr, with 28 kg/m 2≤body mass index<35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: LPP group and CP group. In LPP group, pressure was applied beside the trachea, above the clavicle towards the vertebral direction, while in CP group, pressure was applied downwards to the cricoid cartilage, with a force of pressure between 25-35 N. The spatial relationship between the esophagus, trachea, and cricoid cartilage, the presence of air shadows in the gastric antrum during mask ventilation, and the cross-sectional area (CSA) of the gastric antrum before and after mask ventilation as well as the airway pressure during mask ventilation were observed. Results:In both groups, the esophagus was located in the left of the trachea in the supraclavicular region. There were no statistically significant differences in the airway pressure during mask ventilation and the CSA of the gastric antrum prior to mask ventilation between the two groups ( P>0.05). Compared to LPP group, the proportion of patients with air shadows in the gastric antrum during mask ventilation was significantly increased, and the CSA of the gastric antrum was increased after mask ventilation in CP group ( P<0.05). Conclusions:Compared to CP, LPP can decrease the development of air entering the stomach during mask ventilation and reduce the CSA of the gastric antrum after mask ventilation in obese patients.

Objective:To study the emergency cerebral hemorrhage grading scale (EDICH) score and the modified emergency intracerebral hemorrhage grading scale (mEDICH) score on the adverse prognosis of patients with cerebral hemorrhage 90 days after discharge.Methods:The clinical data of 248 patients with cerebral hemorrhage in the Department of Neurosurgery, Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2022 to December 2022 were retrospectively analyzed. According to the modified Rankin scale (mRS) 90 days after discharge, patients were divided into a good prognosis group (212 cases) and a poor prognosis group (36 cases). Independent-samples t-test and rank-sum test were used to compare the basic information, vital signs, laboratory tests, imaging characteristics, EDICH score and mEDICH score of the two groups. Multivariate Logistic regression was used to analyze the risk factors affecting the poor prognosis of patients with cerebral hemorrhage. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of EDICH score and mEDICH score for the poor prognosis of patients with intracerebral hemorrhage 90 days after discharge.Results:The diameter of intracerebral hematoma (5.53±0.32) cm, the rate of intraventricular hemorrhage (61.11%,22/36) and the rate of subtentorial hemorrhage (27.78%, 10/36) in poor prognosis group were significantly higher than those in good prognosis group (3.50±0.07) cm, intraventricular hemorrhage (30.19%, 64/212) and infratentorial hemorrhage (14.15%, 30/212), the differences were statistically significant ( t=6.19, P<0.001; χ 2=12.99, P<0.001; χ 2=4.22, P=0.040). GCS scores in the poor prognosis group were lower than those in the good prognosis group ( H=72.01, P<0.001). EDICH scores and mEDICH scores in the poor prognosis group were higher than those in the good prognosis group (EDICH score: H=65.79, P<0.001; mEDICH score: H=76.56, P<0.001). Multivariate Logistic regression analysis showed EDICH score ( OR=5.869,95% CI 3.451-9.981, P<0.05) and mEDICH score ( OR=10.353,95% CI 4.842-22.137, P<0.05)could predict the prognosis of patients with cerebral hemorrhage 90 days after discharge. ROC curve analysis showed that the sensitivity and specificity of EDICH score and mEDICH score were 0. 861,0.889 and 0. 821,0.953, respectively, but the predictive effect of mEDICH score was significantly better than that of EDICH score ( Kappa values were 0. 787 and 0. 494, respectively). The predicted results are highly consistent with the actual results. Conclusion:MEDICH score can accurately predict the prognosis of patients with intracerebral hemorrhage 90 days after discharge, which has clinical application value.