OBJECTIVE:To observe the effects of dexmedetomidine hydrochloride on extubation stress response in elderly pa-tients during general anesthesia recovery period. METHODS:80 patients underwent general anesthesia of abdominal surgery were randomly divided into observation group and control group,with 40 cases in each group. Both groups received routine anesthesia before surgery and during surgery. 10 min before the end of surgery,observation group was given intravenous pump of dexmedeto-midine hydrochloride diluted to 10 ml 0.5 μg/kg,and control group was given constant volume of 10 ml 0.9% Sodium chloride so-lution. HR,MAP and SaO2 levels of 2 groups were compared before the induction of anesthesia (T0),at the moment of intrave-nous injection of dexmedetomidine hydrochloride or 0.9%Sodium chloride solution(T1),at the moment immediately before extuba-tion(T2),at the moment of extubation(T3),1 min after extubation(T4),5 min after extubation(T5)and 10 min after extubation (T6). Ramsay sedation score of 2 groups were compared at T0,T2,T4,T5 and T6;cough score,restlessness score,awake time(t1) and extubation time(t2)were also compared between 2 groups. RESULTS:Compared with at T0,the fluctuation of HR and MAR in 2 groups decreased significantly and became stable gradually at T4,T5 and T6,and HR and MAP of observation group at T1-T6 were significartly lower than those of control group,with statistical significance(P<0.05);but there was no statistical significance in SaO2 (P>0.05). There was statistical significance in Ramsay sedation score between 2 groups at T2,T4,T5 and T6 (P<0.05). The cough score and restlessness score of observation group were significantly lower than those of control group,and t1 and t2 were significantly shorter than those of control group,with statistical significance(P<0.05). CONCLUSIONS:Dexmedetomidine hydro-chloride can relieve extubation stress reaction in elderly patients during general anesthesia recovery period with good safety.

OBJECTIVE:To study the distribution characteristics of germacrone from zedoary turmeric oil (ZTO) in each tis-sue of mice,and to provide reference for further application of zedoary turmeric oil. METHODS:30 KM mice were given zedoary turmeric oil 0.5 mL;6 mice were randomly selected 1,2,4,8,12 h after medication,respectively. The contents of germacrone in heart,liver,spleen,lung and kidney tissues were determined by HPLC. 15 KM mice were selected,medication and sampling method were same as above;3 mice were collected at each time point respectively. The fluorescence intensity of germacrone in above sections were observed by fluorescence. The same number of mice were selected as control in 2 trials. RESULTS:The con-centration of germacrone in each tissue 1-4 h increased gradually as time and reached the peak value at 4 h. The contents of ger-macrone in liver and spleen were significantly higher than in heart and lung. The concentrations of germacrone in each tissue were ranked as liver>spleen>kidney>heart>lung. The results of fluorescence intensity observation was same as above results. CON-CLUSIONS:Results of 2 methods show same distribution characteristics of germacrone in mice tissues,and indicate that ger-macrone is distributed more in liver,spleen and kidney tissues and less in heart and lung.

Objective To evaluate the role of hypoxia inducible factor?1α ( HIF?1α) in reduction of apoptosis in cortical neurons of rats by sevoflurane preconditioning and the relationship with Slit2∕Robo signaling pathway. Methods Primary cortical neurons obtained from neonatal Sprague?Dawley rats were seeded in 6?well (2 ml∕well) or 96?well plates (100 μl∕well) at a density of 1×106∕ml, and randomly divided into 4 groups ( n=24 each ) using a random number table: control group ( C group ) , anoxia?reoxygenation ( A∕R ) group, sevoflurane preconditioning group ( SP group ) and HIF?1α inhibitor 2?methoxyestradiol group ( H group ) . The neurons were subjected to O2?glucose deprivation for 90 min followed by restoration of O2?glucose supply for 24 h. In group SP, the neurons were exposed to 2%sevoflurane for 2 h followed by 5 min washout with phosphate buffered saline for 3 times, and then sevoflurane preconditioning was performed immediately. In group H, sevoflurane preconditioning was performed with 5μmol∕L 2?methoxyestradiol at 72 h of incubation. The apoptosis in neurons was assessed using AnnexinⅤ?FITC∕PI assay, and apoptosis rate ( AR) was calculated. The amount of lactic dehydrogenase ( LDH) released was measured using colorimetric method. The expression of Slit2, Robo1 and Robo4 mRNA and protein was detected by fluorescent quantitative real?time polymerase chain reaction or Western blot. Results Compared with group C, the amount of LDH released and AR were significantly increased, Silt2 and Robo1 mRNA and protein expression was up?regulated, and no significant change was found in Robo4 mRNA and protein expression in A∕R group. Compared with group A∕R, the amount of LDH released and AR were significantly decreased in SP and H groups, and Silt2 and Robo1 mRNA and protein expression was up?regulated, and no significant change was found in Robo4 mRNA and protein expression in SP group. Compared with group SP, the amount of LDH released and AR were significantly increased, and Silt2 and Robo1 mRNA and protein expression was down?regulated in H group. Conclusion HIF?1α mediates reduction of apoptosis in cortical neurons of rats by sevoflurane preconditioning, and the mechanism is associated with Slit2∕Robo1 signaling pathway, but not with Slit2∕Robo4 signaling pathway.

Objective To explore the effect of irbesartan on cardiac endothelial-mesenchymal transition (EndMT) in diabetic rats.Methods The model of diabetic rat was induced by intraperitoneal injection with streptozotocin (STZ,35 mg/kg) in spontaneous hypertensive rats (SHR).Diabetic rats were divided into diabetic group and the Irbesartan treated group.The pathological changes were investigated by fluorescence microscope and electron microscope.The EndMT was studied in human aortic endothelial cells (HAEC) exposure to high glucose.The concentration of angiotensin Ⅱ in the supernatant was detected by radioimmunoassay.Immunofluorescence staining was performed to detect the co-localization of CD31 and FSP1.Results The significant myocardial fibrosis was presented in the diabetic group.Endothelial protrusions were prominent feature in myocardial microvascular of diabetic rat compared with the control group rats.Double staining of HAEC showed co-localization of CD31 and FSP1,which was decreased by the treatment of Irbesartan (P ＜ 0.05).When HAEC was exposed to high glucose,it showed some cells acquired spindle-shaped morphology and lost CD31 staining,and FSP1 and α-SMA protein expression levels were markedly upregulated,which attenuated by the treatment of Irbesartan.Conclusion Irbesartan might prevent diabetes from myocardial fibrosis via inhibition of EndMT in diabetic rats.

OBJECTIVE:To optimize the technology conditions of water-soluble chitosan on Huang'e gel water extract solu-tion. METHODS:Using the comprehensive scores of transmittance ratio,impurity removal rate,naringin retention rate as indexes, Box-Behnken response surface method was used to optimize the amount of water-soluble chitosan,shocking time and temperature in clarifying technology,and verification test was conducted. RESULTS:The clarification effect was the best when the volume ra-tio of TCM extract solution with proportion ≥1.3 to amount of 0.01 g/mL water-soluble chitosan was 2.2,shocking for 100 min at 70 ℃. In the verification test,the average transmittance ratio was 87.3%,impurity removal rate was 41.5%,and naringin reten-tion rate was 131.38%. The measured values of comprehensive scores were 97.35%,98.92% and 98.04%,showing relative error of -0.87%,0.73% and -0.16% with the predicted values(98.27%),respectively. CONCLUSIONS:The method can effectively optimize the clarification technology parameters of water-soluble chitosan on Huang'e gel water extract solution.

Objective: To confirm early (6 hours) exercise in patients with partial hepatectomy is safe and feasible. Methods: The control group included 211 patients who qualified for partial liver resection before the accelerated rehabilitation surgery (ERAS), 218 patients with partial hepatectomy who met the entry criteria after the implementation of ERAS were taken as test group, get out of bed 24 hours after routine mission in control group, activity of 6 hours after operation in ERAS group. To observe the time of getting out of bed and the incidence of postoperative complications in 2 groups. Results: Comparison with control group, early exercise time of patients in ERAS group after surgery. The incidence of postoperative complications decreased was 14.3% (31/218) while 34.6%(73/211) of the control group. The difference was statistically significant (χ²=299.3, 18.270, P < 0.01). And did not increase the risk of falls, incision pain, postoperative bleeding. Conclusion Liver partial resection is safe and effective for patients with 6 hours post-operative exercise, worth clinical application.

Pelvic fragility fractures are increasing with the aging population in China, characterized by high incidence, high mortality and high morbidity just as geriatric hip fractures. In diagnosis of a pelvic fragility fracture in the elderly, the patient＇s age, comorbidities, osteogenic factors, clinical manifestations and imaging examinations should be taken into consideration, as well as the special anatomical features and morphologies resulted from degenerative anatomy of the pelvis in the aged. Standard pelvic X-rays and CT scans may confirm the diagnosis in most cases, but MRI may prevent missing a fracture of malfunctioning pelvis or an insidious fracture line on the posterior ring. Fragility fractures of pelvis (FFP) classification, base on X-ray and CT checks, is a common guiding system in current clinic. Usually, conservative treatment is indicated for fractures of FFP types Ⅰ-Ⅱ while surgery for those of FFP types Ⅲ-Ⅳ. As far as possible, minimally invasive reduction and simultaneous fixation of the anterior and posterior rings are recommended. This article intends to review the characteristics, classification and development of minimally invasive techniques concerning pelvic fragility fractures in recent years, and to discuss the future trends in treatment of geriatric pelvic fractures.

Objective:To evaluate the clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fracture in adults.Methods:A retrospective study was conducted of the 20 adult patients with AO type A3 forearm diaphyseal fracture who had been treated by Acumed intramedullary nailing from January 2016 to November 2018 at PLA General Hospital. They were 18 males and 2 females, aged from 18 to 56 years (average, 36.5 years). There were 6 radius diaphyseal fractures, 9 ulna diaphyseal fractures and 5 diaphyseal fractures of both forearm bones. The clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fractures were evaluated by recording the perioperative complications, fracture union time, forearm rotation range at 12-month follow-up, and Disability of the Arm, Shoulder and Hand Questionnaire (DASH) scores for the upper limb function.Results:The 20 patients were followed up for 12 to 18 months (mean, 15.8 months). Bony union was achieved in all the patients after 3 to 4 months (average, 3.3 months). Partial rupture of the extensor pollicis longus tendon happened during operation in one patient and at 3 months post-operation in another due to fixation irritation, and linear ossification of interosseous membranes was observed in one patient with diaphyseal fractures of both forearm bones. 12-month follow-ups showed that, in the 20 patients, forearm pronation ranged from 80° to 90° (average, 89°), supination from 60° to 90° (average, 86.3°) and DASH scores from 0 to 37 (average, 6.5).Conclusions:In the treatment of AO type A3 forearm diaphyseal fracture in adults, Acumed intramedullary nailing can lead to successful fracture union and excellent rotational activity at one year after operation. Therefore, adult AO type A3 forearm diaphyseal fracture can be listed as an indication for Acumed intramedullary nailing.

Objective To explore the feasibility of establishing an acute pericardial effusion animal model guided by ultrasound. Methods Six experimental pigs were anesthetized. A PTC needle was injected and guided to the right ventricular anterior wall under real-time high frequency ultrasound,40 ml and 80 ml normal saline were respectively infused into the pericardial cavity within 5 minutes. Ultrasonography and pathologic examination were applied to confirm this porcine model. The amount of the fluid was estimated by ultrasound at 1 hour and 8 hours after infusion. Results With ultrasound guidance,the PTC needle smoothly entered the pericardial cavity and the saline was successfully injected. The fluid dispersed from local to the entire pericardial cavity. Pericardial effusion last within 8 hours and no significant change of the fluid amount was found (all P ＞0.05). This acute pericardial effusion model was successfully established with a rate of 100%. Conclusions It is feasible to establish an animal model of acute pericardial effusion under the guidance of ultrasound. This method is safe,rapid and effective. It can provide a suitable animal model for the study of acute pericardial effusion.

Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.