Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.

Objective To screen the critical genes related to the development of esophageal squamous cell carcinoma ( ESCC ) by weighted gene co-expression network analysis ( WGCNA ) and to verify by experiments.Methods Gene expression data of ESCC were downloaded from gene expression omnibus (GEO) database based on gene chip platform ( GPL) 570, GPL571, GPL96/97 or GPL14613 platform, respectively. Meanwhile, the obtained differentially expressed genes together with gene expression data of 81 ESCC patients from the cancer genome atlas ( TCGA ) and clinical data were analyzed by WGCNA to set up co-expression networks including mRNA and microRNA ( miRNA ) . The expression of miRNA in ESCC tissues and paracancerous tissues was examined by quantitative real-time polymerase chain reaction ( RT-PCR ) .And the expression of target protein Kruppel like factor 4 ( KLF4 ) and desmocollin 2 ( DSC2 ) were detected by immunohistochemistry .After ESCC cell line ECA-109 cells were transfected with miRNA-92b-3p mimic, cell cycle was tested by flow cytometry ,the cell invasion and migration ability was measured by Transwell chamber assay and scratch-wound assay.The expression of KLF4 and DSC2 was observed by confocal laser scanning microscopy and Western blotting .The target genes were verified by luciferase assay .T-test, rank sum test, chi-square test and Pearson correlation analysis were performed for statistical analysis .Results A total of 4023 differential expression gene ( DEG) and 328 differential expression miRNA ( DEM) were screened and 11 gene modules were set up by WGCNA .Among them, the brown modules were negatively associated with tumor grade and T stage (r=-0.340 and -0.268, P=0.002 and 0.016).Meanwhile, has-miR-92b and the potential target genes KLF4 and DSC2 were all in the brown module .Furthermore, the results of RT-PCR showed the expression of miRNA-92b-3p in ESCC tissues was higher than that in paracancerous tissues (3.052(1.652, 5.371) vs.0.985(0.558, 2.032)), and the difference was statistically significant (Z=-4.021,P<0.01). The results of immunohistochemistry demonstrated that the positive rates of KLF 4 and DSC2 in ESCC tissues were 43.3％(13/30) and 20.0％(6/30), respectively, which were lower than those of paracancerous tissues (70.0％(21/30) and 63.3％(19/30)), and the differences were statistically significant (χ2 =4.344 and 1.589, both P<0.05).After ECA-109 cells were transfected with miRNA-92b-3p mimics, the percentage of cells at G0/G1 phase decreased ((63.71 ±2.83)％vs.(54.62 ±4.00)％) and the percentage of cells at the S phase and G2/M phase increased ((31.81 ±2.88)％vs.(41.20％±2.87)％, and (3.87 ±1.75)％vs. (8.10 ±1.71)％, respectively), and the differences were statistically significant (t =3.215, 4.000 and 2.998;P=0.032, 0.016 and 0.040).The invasion and migration ability of the cells were significantly improved (79.67 ±27.54 vs.280.33 ±46.18, (69.72 ±3.91)％ vs.(84.90 ±5.25)％), and the differences were statistically significant (t=6.465 and 4.019, P=0.003 and 0.016).The results of Western blotting indicated that, compared with control mimic group , the expression of KLF4 and DSC2 was both dramatically downregulated after transfected with miRNA-92b-3p mimics transfected (1.00 ±0.23 vs.0.42 ±0.03, 1.00 ±0.20 vs.0.55 ± 0.21), and differences were statistically significant (t=4.470 and 5.493, P=0.042 and 0.032).The results of luciferase assay demonstrated that miRNA-92b-3p could directly bind KLF4 and DSC2. Conclusion WGCNA is an efficient systemic biological approach by which miRNA-92b-3p is identified as a new cancer-promoting gene .

Objective To compare the analgesic effect of the ultrasound-guided modified-fascia iliaca compartment block with ultrasound-guided fascia iliaca compartment block injection in the treat-ment of elderly patients with hip fracture.Methods Sixty elderly patients with hip fracture,17 males and 43 females,falling into ASA physical status Ⅱ or Ⅲ,were randomly divide into two groups (n=30 each):ultrasound-guided modified fascial iliaca compartment block group (group M)and ultra-sound-guided fascial iliaca compartment block group (group F).The patients in group M received M-FICB using ultrasound-guided injection of 0.4% ropivacaine 5 ml in obturator nerve,15 ml in the fas-cial iliac space.The patients in group F received ultrasound-guided injection of 0.4% ropivacaine 20 ml in the fascial iliac space.FICB or MFICB was performed 20 min before epidural anesthesia in group F or group M respectively.The time of ultrasound-guided nerve block was recorded,and the onset time of femoral nerve,lateral femoral cutaneous nerve and obturator nerve block were recorded in the two groups.Visual analogue pain scores (VAS)were recorded before nerve block (T0 ),after nerve block,10 min (T1 ),20 min (T2 ),placing spinal anesthesia position (T3 ),and postoperative 24 h (T4 ).Results The onset time of obturator nerve block in group M was significantly shorter than that in group F [(4.1±1.4)min vs (10.1 ±3.9)min,P <0.05].The time of ultrasound-guided nerve block has no difference between the two groups [(2.2 ± 0.5 )min vs (2.1 ± 0.5 )min].Compared with group F,the VAS scoress at T1-T3 were lower in group M (P <0.05).Compared with T0 ,the VAS scores at T1-T4 decreased in both groups (P < 0.05 ).Conclusion Ultrasound-guided fascia iliaca compartment block is more effective in reducing the VAS scores during the supine position and reducing postoperative pain.

Objective:To investigate the feasibility and safety of the X-ray guided obstructive double J tube replacement in ureter.Methods:The clinical data of 44 patients with double J tube obstruction who underwent double J tube replacement from April 2016 to August 2019 were analyzed retrospectively. Among the 44 cases, there were 3 males and 41 females, aged from 27.0 to 70.0 (54.6±11.2) years. The time since last double J tube placement, the method of transurethral remove of double J tube, the method of double J tube replacement, the location of double J tube obstruction and postoperative complications were collected, and the success rate of operation was calculated. According to the different positions of calcium salt deposition in double J tubes, the obstructive double J tubes were divided into bladder end type, renal pelvis end type, two-end type and whole partial type. The replacement method was differentiated according to different types of double J tube obstruction. The cut-off end method was to cut off the obstructed bladder end of double J tube by scissors, and the internal unobstructed double J tube could be seen. The guide wire could be introduced into the renal pelvis through the double J tube, and the new double J tube could be replaced. This method was only used for bladder end type double J tube obstruction. The thine guide wire method was to replace the common guide wire which could not pass through the renal pelvis end obstruction with the microguide wire, so that it could pass through the end of the double J tube of the renal pelvis end obstruction or through the side hole, enter into the renal pelvis, withdraw the original double J tube, and then replace the new double J tube. This method was suitable for renal pelvis end type double J tube obstruction, or combined with cut-off end method for two-end type double J tube obstruction. In the auxiliary sheath method, the obstructed double J tube was used as the support, the vascular sheath tube was sent into the ureter, and the guide wire was sent to the renal pelvis through the sheath tube to replace the new double J tube. This method was suitable for all types of double J tube obstruction.Results:A total of 47 X-ray-guided double J tube replacements were performed in 44 patients. In the removal of double J tube, 37 cases of direct method and 10 cases of indirect method were used, and the overall success rate of double J tube removal was 100% (47/47). The time from the last double J tube placement was (4.2±1.3) months. There were 23 cases of bladder end type obstruction, 8 cases of renal pelvis end obstruction, 5 cases of two-end type obstruction, and 11 cases of whole partial type obstruction.The success rate of replacing double J tubes by cut-off end method, thin guide wire method and auxiliary sheath method was 76.0% (19/25), 50.0% (2/4) and 77.8% (14/18), respectively. After the failure of the cut-off end method or the thin guide wire method, 4 cases were further replaced by the thin guide wire method or auxiliary sheath method, and 3 cases were successful. Therefore, the overall success rate of double J tube replacement was 80.9% (38/47). The double J tubes were inserted by percutanous pyelostomy in 9 patients who failed to replace double J tube successfully. Among the 44 cases, there were 4 cases of urethral orifice pain and discomfort, and 2 cases of gross hematuria, all of which relieved spontaneously.Conclusion:It is feasible and safe to replace the obstructive double J tube in ureter under X-ray guidance.