Objective To evaluate the antidepressant action of melatonin in stress model of depres-sion and the effects of the melatonin on depressive-like behavior.Methods Forty male Wistar rats were ran-domly divided into four groups(n=10):controls group(CON),chronic unpredictable mild stress group (CUS),chronic unpredictable mild stress group + melatonin group(CUS+MT)and chronic unpredictable mild stress group +ketamine group(CUS+KET).The rats in CUS group,CUS+MT group and CUS+KET group were given different stress stimulation for 42 days to establish the chronic mild unpredictable stress ani-mal model.Sucrose preference experiments was used to detect the depression model and the level of depres-sion was tested by forced swim test.The influence of Short-term low doses of melatonin on the level of BDNF and GluR1 in the prefrontal cortex,was detected by immunohistochemistry(IHC)on 58 day after the start of the experiment.Results (1)The CUS showed depressant-like behavior,and the percent sucrose uptake scores and the cumulative immobility time of the CUS group were decreased significantly(P<0.05).(2)After injection melatonin 14 d,the cumulative immobility time of CUS+MT group((60.70±18.56)s)and CUS+KET group((56.43±20.46)s)were decreased significantly in comparison to the CUS group(146.34±34.10) s).It was observed a highly significant(P<0.05)decrease of and up-regulation of the BDNF cells in CUS+MT group((1 328.99±282.46)/mm2)and CUS+KET group((1 224.76±116.53)/mm2)in comparison to the CUS group,the number of BDNF cells in CUS+MT group was increased significantly in comparison to the CUS+KET group;(3)After administration drug 14 days,the number of GluR1 cells of CUS+KET((807.82± 153.25)/mm2)but not CUS+MT((632 ± 156.34)mm2)significantly increased compared with CUS ((807.82±193.25)/mm2).Conclusion The results indicate that the melatonin induce an antidepressant-like action like ketamine.The antidepressant effects of melatonin may be related with the level of BNDF.

Objective:To evaluate the dose-effect relationship of compound lidocaine hydrochloride for transverse abdominal plane-rectus abdominis sheath block (TAP-RSB) for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.Methods:Elderly patients of either sex, aged≥65 yr, with body mass index <30 kg/m 2, of American Society Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical colon cancer surgery with general anesthesia, were selected.After induction of general anesthesia, compound lidocaine hydrochloride was given under ultrasound guidance for bilateral TAP block (20 ml on each side) and for bilateral RSB (10 ml on each side), with the initial concentration of 0.4%.Each time the concentration increased/decreased in the next patient depending on whether or not the analgesia was effective.The ratio between the two successive concentrations was 1.00∶1.15.The analgesic effects were evaluated by the Numerical Rating Scale at 1 h intervals from the time of postoperative admission to the post-anesthesia care unit until 8 h after TAP-RSB (Numerical Rating Scale ≤ 3 was considered as effective analgesia). The probit method was used to calculate the half effective concentration (EC 50) and 95% effective concentration (EC 95) and 95% confidence interval of compound lidocaine hydrochloride. Results:The EC 50 and EC 95(95% confidence interval)of compound lidocaine hydrochloride for TAP-RSB were 0.289% (0.232%-0.352%) and 0.404% (0.345%-0.970%), respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia. Conclusions:The EC 50 and EC 95 of compound lidocaine hydrochloride for TAP-RSB are 0.289% and 0.404%, respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.

Objective To establish female and male bovine collagen-induced arthritis(CIA)models and compare the effects of gender differences on joint and extra-articular manifestations of the CIA model.Methods The CIA model was induced by injection of bovine type Ⅱ collagen and Freund's complete adjuvant into female and male SD rats.The general condition,arthritis index,foot swelling,serum proinflammatory factors and plasminogen activator inhibitor levels,spleen index,knee and ankle joint pathologies,right rear paw bone destruction,and pulmonary interstitial lesions were evaluated.Results The arthritis index of female CIA rats was significantly higher than that of male CIA rats on day 21 after initial immunization(P＜0.05),but no significant difference was found in the degree of foot swelling between the two groups at any time point(P＞0.05).Serum tumor necrosis factor α,interleukin-1β,and the spleen index of female CIA rats were significantly higher than those of male CIA rats(P＜0.05,P＜0.001).No significant difference was found in plasminogen activator inhibitor levels(P＞0.05).The scores of inflammatory cell infiltration and synovial hyperplasia in the knee and ankle pathologies of female CIA rats were significantly higher than those of male CIA rats(P＜0.05),and cartilage damage of the knee joint and bone damage of the right rear paw of female CIA rats were significantly higher than that of male rats(P＜0.05).Both male and female CIA rats showed pulmonary interstitial inflammatory cell infiltration and mild fibrosis,but the pulmonary interstitial lesions in females were more severe than those in males.Conclusions Female and male CIA models established in SD rats have arthritis and pulmonary interstitial lesions,but the lesion degree in female CIA rats is more serious.When using CIA models for RA-related research,attention should be focused on the effect of gender differences.

Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.

Objective:To investigate the influencing factors for textbook outcome (TO) after hepatectomy for hepatolithiasis.Methods:The retrospective case-control study was conducted. The clinicopathological data of 216 patients with hepatolithiasis who were admitted to The First Affi-liated Hospital of Anhui Medical University from January 2015 to March 2023 were collected. There were 69 males and 147 females, aged 61(range, 22-85)years. Observation indicators: (1) treatment situations; (2) TO after hepatectomy; (3) Influencing factors for TO after hepatectomy. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Logistic regression models were used for univariate and multifactorial analyses. Results:(1) Treatment situations. All the 216 patients underwent hepatectomy, including 45 cases of laparoscopic hepatectomies and 171 cases of open hepatectomies, 161 cases of anatomical hepatectomies and 55 cases of non-anatomical hepatectomies. All the 216 patients underwent intraoperative choledochoscopy exploration and lithotripsy. There were 170 patients with normal Oddi sphincter function and 46 patients with Oddi sphincter dysfunction. All the 216 patients underwent biliary drainage, including 198 cases of external T-tube drainage and 18 cases of internal bile-intestinal drainage. The operation time was (226±75)minutes and volume of intraoperative blood loss was (106±82)mL. There were 29 patients with perioperative blood transfusion and 14 patients with intraoperative severe adverse events. There were 189 patients achieved immediate stone clearance. Of 183 patients with intraoperative bile cultures, 76 cases were positive for bacteria culture. (2) TO after hepatectomy. Of 216 patients, 93 cases had postoperative complications, all of which were successfully discharged after active treatment. One patient had surgery-related death within 90 days after surgery, and the cause of death was liver failure. Five patients were readmitted within 90 days after surgery, and 18 patients had postoperative stone residual. Of 216 patients, 164 cases achieved TO postoperatively and 52 cases did not achieve TO postoperatively. (3) Influencing factors for TO after hepatectomy. Results of multivariate analysis showed that cholangitis, stone distribution, surgical approaches, anatomical hepatectomy, immediate stone removal and postoperative review of choledochoscopy were independent influencing factors for TO after hepatectomy in patients with hepatolithiasis ( P<0.05). Conclusion:Cholangitis, stone distribution, surgical approaches, anatomical hepatectomy, imme-diate stone removal and postoperative review of choledochoscopy are independent influencing factors for TO after hepatectomy in patients with hepatolithiasis.

Objective:To develop and validate a nomogram model for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) based on preoperative enhanced computed tomography imaging features and clinical data.Methods:The clinical data of 210 patients with HCC undergoing surgery in the Second Affiliated Hospital of Anhui Medical University from May 2018 to May 2022 were retrospectively analyzed, including 172 males and 38 females, aged (59±10) years old. Patients were randomly divided into the training group ( n=147) and validation group ( n=63) by systematic sampling at a ratio of 7∶3. Preoperative enhanced computed tomography imaging features and clinical data of the patients were collected. Logistic regression was conducted to analyze the risk factors for HCC with MVI, and a nomogram model containing the risk factors was established and validated. The diagnostic efficacy of predicting MVI status in patients with HCC was assessed by receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC) of the subjects in the training and validation groups. Results:The results of multifactorial analysis showed that alpha fetoprotein ≥400 μg/ml, intra-tumor necrosis, tumor length diameter ≥3 cm, unclear tumor border, and subfoci around the tumor were independent risk factors predicting MVI in HCC. A nomogram model was established based on the above factors, in which the area under the curve (AUC) of ROC were 0.866 (95% CI: 0.807-0.924) and 0.834 (95% CI: 0.729-0.939) in the training and validation groups, respectively. The DCA results showed that the predictive model thresholds when the net return is >0 ranging from 7% to 93% and 12% to 87% in the training and validation groups, respectively. The CIC results showed that the group of patients with predictive MVI by the nomogram model are highly matched with the group of patients with confirmed MVI. Conclusion:The nomogram model based on the imaging features and clinical data could predict the MVI in HCC patients prior to surgery.

Objective:To observe the path and anatomic distribution of cutaneous branch of second dorsal metacarpal artery(SDMA) from the back of hand to the web of the fingers, and to explore the feasibility and clinical effect on the transfer of free flap of SDMA.Methods:Between June 2018 and September 2018, with perfusion of red latex, 22 hand specimens were dissected to explore the course, vessel calibre and distribution of cutaneous branches of SDMA, and to discover the existence of an innervation of cutaneous nerve in Department of Hand Surgery of Tangshan Second Hospital. Later on, from February 2019 to July 2020, 2 thumb pulp defects of 2 patients were reconstructed with the free flaps of SDMA. One defect was in the left thumb and the other in the right, both were male and compression injuries. Size of thumb pulp and a skin defect was at 3.5 cm×2.0 cm in 1 patient, and 2.0 cm×2.5 cm in the other. There was no neurovascular injury, but 1 patient had a distal phalangeal fracture and a nail bed laceration. The sizes of the flaps were 3.8 cm×2.3 cm and 2.8 cm×2.5 cm. Functional exercises started from 3 weeks after surgery. Patients attended postoperation follow up regularly by outpatient visit, telephone or internet interviews. Follow-up observations included the appearance, texture, sensory recovery of the flaps and thumb functions.Results:Multiple perforating branches (4-9 branches) were found from SDMA, which distributed in the distal 1/3 of SDMA in the anatomic study. It was found that the outer diameter of SDMA was 0.76 mm±0.25 mm at the intersection of extensor tendon of index finger and that of the digital web artery was 0.71 mm±0.12 mm. The length of digital web artery was 11.00 mm±1.27 mm. The 2 surgically transferred flaps were all survived. One patient showed the function of thumb in excellent with two-point discrimination (TPD) at 7.0 mm, at 18 months of follow-up. The other patient showed good thumb movement, soft and elastic skin of the flap and with a 7.5 mm in TPD, at 15 months of follow-up. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the results of the 2 flaps were all excellent.Conclusion:The flap of SDMA has a constant cutaneous nerve and a long vascular pedicle with an ideal vessel size. It is suitable for free transfer and can be used to reconstruct soft tissue defects of thumb.

Objective To explore the guiding value of thromboelastography(TEG)in the formulation of personalized anticoagulation regimen after knee arthroscopy.Methods A total of 50 patients who underwent knee arthroscopy in our hos-pital from April to August 2023 were randomly divided into two groups.Twenty-seven patients with routine anticoagulation were selected as the control group,and 23 patients with personalized anticoagulation were selected as the experimental group.Conventional anticoagulation was a prophylactic dose of low molecular weight heparin calcium(LMWHC)selected according to body weight,once a day to 7 days after surgery.Personalized anticoagulation was performed according to the prophylactic dose of LMWHC until postoperative day 3.On postoperative day 3,LMWHC was changed to aspirin according to the TEG return index(MA>70 mm,α Angle>72°,K value<1 min),and the initial prophylactic dose was 100 mg/d.LMWHC was changed to rivaroxaban when R<5 min,and the prophylactic dose was 10 mg/d until postoperative day 7.Pa-tients with hypocoagulation or subcutaneous ecchymosis stopped the drug first,and if it was further aggravated,component blood transfusion was performed according to the TEG results.The difference of Caprini score in perioperative period,the correlation between TEG and CCT on postoperative day 1,and the accuracy of predicting thrombosis on postoperative day 7 were compared between the two groups using the receiver operating characteristic curve(ROC).Results There was a sig-nificant difference in Caprini score between the two groups at 7 days after operation(P<0.05),suggesting that the adjust-ment of anticoagulant drugs in the experimental group was effective at 3 days after operation.Pearson correlation evaluation showed that there was a strong positive correlation between maximum coagulation intensity(MA)in TEG and platelet(Plt)in CCT at day 1 after surgery(P<0.05).Thrombosis was found in the control group at 7 days after operation,all of which were CMVT and disappeared after therapeutic antithrombotic therapy.MA was included in the ROC curve for model analysis.The area under the ROC curve(AUC)of the control group was 0.819,and the AUC of the experimental group was 0.508.It was found that the control group model had higher accuracy in predicting the formation of CMVT.Conclusion Individu-alized anticoagulation under TEG monitoring can effectively reduce the occurrence of CMVT after knee arthroscopy,which has guiding value for anticoagulation and thrombosis prevention.

Objective:To explore the clinical effects of pedicled omental flap transplantation in repairing secondary rejection wounds after brain pacemaker implantation.Methods:A retrospective observational study was conducted. From January to August 2021, 5 patients with secondary rejection wounds after brain pacemaker implantation who met the inclusion criteria were admitted to the Wound Repair Center of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, including 3 males and 2 females, aged 56-69 years, with the wound developed at the pulse generator implantation site in the chest in 2 cases, at the connection site of the wire and electrode behind the ear in 2 cases, and at both the chest and the back of the ear in 1 case. All the wounds were repaired by pedicled omental flap transplantation. The wound area after debridement was 2-15 cm 2. After operation, the wound healing and related complications (pain, infection, incisional hernia, omental flap necrosis, etc.) were observed. During follow-up, the recurrence of the wound was observed. Results:The wounds of all 5 patients healed within 2 weeks after operation, without related complications. During follow up of 12-18 months, 1 patient got a recurrence of rejection wound behind the left ear 4 months after surgery and eventually had the brain pacemaker removed; the other 4 patients had no recurrence of wounds.Conclusions:Pedicled omental flap transplantation can repair the secondary rejection wounds after brain pacemaker implantation safely and effectively, with few postoperative complications.

Objective Interleukin 6(IL-6)is an important cytokine featuring pleiotropic activity in the cardiac microenviron-ment and improves cardiomyocyte regeneration to favor cardiac repair after injury.Thereby this study aimed to investigate the effects of IL-6 on murine embryonic cardiomyocyte proliferation and unveil the possible developmental changes.Methods Single cardiomyocyte was obtained from mouse through enzyme dissociation at the early embryonic developmental stage(EDS)and late embryonic developmental stage(LDS).The cells were cultured for 24 h in 20％DMEM and then treated with 10 ng/mL IL-6 or 50 ng/mL IL-6 for 24 h.The effect of IL-6 on cardiomyocyte proliferation was comprehensively studied by tracing BrdU+α-acti-nin+nuclei and BrdU+α-actinin+mononuclear cardiomyocyte with immunofluorescence staining.Western blot was performed to unveil the changes in phosphorylation levels of the key proteins under IL-6 treatments.Results The 10 ng/mL IL-6 did not change the proliferation capacity of EDS myocardium,but significantly promoted the proliferation capacity of LDS myocardi-um.The 50 ng/mL IL-6 significantly inhibited the proportion of EDS BrdU+α-actinin+monocytes,and increased the proportion of LDS BrdU+α-actinin+nuclei and BrdU+α-actinin+monocytes.This might be related to the various effects of IL-6 at differ-ent concentrations on signal transduction pathways of EDS and LDS cardiomyocytes:10 ng/mL IL-6 and 50 ng/mL IL-6 inhibi-ted the phosphorylation of Akt in EDS cardiomyocytes,and had no significant effect on the phosphorylation of STAT3 and ERK.In LDS,10 ng/mL IL-6 and 50 ng/mL IL-6 inhibited phosphorylation of Akt and increased the phosphorylation of STAT3,but had no significant effect on the phosphorylation of ERK.Finally,the basic phosphorylation states of these three proteins were detected and the total protein amount and phosphorylation levels of STAT3,Akt and ERK showed a development-dependent decline.Conclusion IL-6 influenced the fetal cardiomyocyte proliferation in a developmental-and dose-dependent manner.It might be related to the developmental changes in the basic status of the target signaling pathways.These observa-tions provided new knowledge of cardiac proliferation and might propose new clues for the microenvironment in cell therapy.