Objective To evaluate the effect of neuraxial and general anaesthesia for total joint arthroplasty by meta-analysis.Methods We searched online Pubmed,Web of science,Cochrane li-brary,CNKI,CBM and searched the literature of the Chinese series journals.All randomized controlled trials (RCT)that met their standards of neuraxial and general anaesthesia for total joint ar-throplasty were collected.The quality of trials was strictly assessed.RevMan 5.3 software was used for data analysis.Results Twenty-one RCTs involving 1 874 cases were included.Compared with general anaesthesia,the pooled data showed that the neuraxial anaesthesia significantly reduced blood loss (WMD=-97.52,95% CI = - 1 73.60-- 21.44,P = 0.01 ),associated with lower risk of deep vein thrombosis (RR=0.68,95%CI=0.48-0.95,P =0.02)and pulmonary embolism (RR=0.58, 95%CI=0.35-0.91,P =0.03),decreased the number of postoperative nausea and vomiting (RR=0.74,95%CI=0.60-0.92,P =0.008).Subgroup analysis showed that compared with general anaes-thesia,the neuraxial anaesthesia associated with lower risk of deep vein thrombosis (RR=0.5 1,95%CI=0.38-0.69,P < 0.000 01 )and pulmonary embolism (RR = 0.34,95% CI = 0.18-0.65,P =0.001)in patients who did not receive chemical antithrombotic prophylaxis.Conclusion Neuraxial anaesthesia seems to improve the outcome of patients undergoing total joint arthroplasty and reduce postoperative complications.

Objective To investigate the expression of humanβ-defensin 2 (HBD-2) in gastric mucosa of Helico-bacter pylori (H. pylori) associated gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and the role of HBD-2 in gastric MALT lymphoma. Methods Forty gastric mucosa specimens from patients with H. pylori associated gastric MALT lymphoma were collected. And 36 gastric mucosa specimens from chronic superficial gastritis without H. pylori infection were included as control group. The expression of HBD-2 was detected by immunohistochemistry staining. Results The ex-pression of HBD-2 was significantly higher in H. pylori associated gastric MALT lymphoma than that of control group. (P＜0.01). The expression of HBD-2 was significantly decreased after the eradication of H. pylori (P＜0.01). The expression of HBD-2 was significantly higher in H. pylori associated gastric MALT lymphoma than that of lymphoma cells (P＜0.01). There was no expression of HBD-2 in lymphoma cells. Conclusion HBD-2 is possibly involved in the pathogenesis of H. pylori associated gastric MALT lymphoma. But whether it has anti-tumor effect is not clear.

This paper reviewed literature at home and abroad, clarified the definition of drug literacy, elucidated the association between drug literacy and secondary preventive drug in stroke patients, analyzed the feasibility and limitations of existing drug literacy assessment tools in stroke patients, summarized the research status of drug literacy in stroke patients, so as to provide reference for the evaluation and intervention of drug literacy in stroke patients in China.

Objective: Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology associated with venous sinus stenosis. This study aimed to develop a magnetic resonance venography (MRV)-based radiomics model for predicting a high trans-stenotic pressure gradient (TPG) in IIH patients diagnosed with venous sinus stenosis. Materials and Methods: This retrospective study included 105 IIH patients (median age [interquartile range], 35 years [27– 42 years]; female:male, 82:23) who underwent MRV and catheter venography complemented by venous manometry. Contrast enhanced-MRV was conducted under 1.5 Tesla system, and the images were reconstructed using a standard algorithm. Shape features were derived from MRV images via the PyRadiomics package and selected by utilizing the least absolute shrinkage and selection operator (LASSO) method. A radiomics score for predicting high TPG (≥ 8 mmHg) in IIH patients was formulated using multivariable logistic regression; its discrimination performance was assessed using the area under the receiver operating characteristic curve (AUROC). A nomogram was constructed by incorporating the radiomics scores and clinical features. Results: Data from 105 patients were randomly divided into two distinct datasets for model training (n = 73; 50 and 23 with and without high TPG, respectively) and testing (n = 32; 22 and 10 with and without high TPG, respectively). Three informative shape features were identified in the training datasets: least axis length, sphericity, and maximum three-dimensional diameter.The radiomics score for predicting high TPG in IIH patients demonstrated an AUROC of 0.906 (95% confidence interval, 0.836– 0.976) in the training dataset and 0.877 (95% confidence interval, 0.755–0.999) in the test dataset. The nomogram showed good calibration. Conclusion Our study presents the feasibility of a novel model for predicting high TPG in IIH patients using radiomics analysis of noninvasive MRV-based shape features. This information may aid clinicians in identifying patients who may benefit from stenting.

Objective:To investigate the status of family function and self-management in patients with chronic kidney disease in the early stage, and to analyze the correlation between the two.Methods:From May 2018 to November 2019, 242 early stage patients with chronic kidney disease in the Department of Nephrology of the Second Affiliated Hospital of Guangxi Medical University were selected as the research subjects. The family function assessment scale and self-management scale were used for investigation.Results:The average scores of family function in early stage of chronic kidney disease patients were (2.11±0.37) points, and the average scores of self-management were (2.29±0.63) points; family function was negatively correlated with self-management ( r value was -0.832, P <0.05). Multiple linear regression analysis showed that education level and family function were influencing factors of patient self-management ( t value was 15.916, 17.569, P <0.05). Conclusions:The family function and self-management of patients with chronic kidney disease need to be improved in the early stage. Family function can affect patients' self-management. Nursing staff should focus on the functions of communication and behavior control in the family functions of patients with early chronic kidney disease in order to improve their self-management ability.

Objective:To investigate the association between choroidal neovascularization (CNV) and the LIPC gene single nucleotide polymorphism (SNP) in a Chinese Han population from Shantou. Methods:A case-control study was designed.Two hundred and twenty-one patients with CNV who visited Shantou International Eye Center from January 2010 to December 2016 were enrolled and served as the CNV group, and 430 healthy volunteers matched in age and gender were enrolled and served as the normal control group.Each of 5 ml fasting peripheral blood of the subjects was extracted, and peripheral blood DNA was extracted after anticoagulation.PCR amplification was conducted on SNP loci of LIPC gene including rs10468017, rs920915 and rs2070895.After purification, genotyping was performed on the above SNP loci using the single base extension (SNaPshot) method.Hardy-weinberg equilibrium (HWE) test was used to determine the genotype frequency of the three SNPs of LIPC gene.The gene frequency and genotype frequency of the 3 loci between the CNV group and normal control group were compared.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong (No.11-004). Results:The genotype frequency distribution of rs10468017, rs920915 and rs2070895 of the three SNPs of LIPC gene reached genetic balance in the total samples ( P>0.05). The genotype frequencies of rs10468017 TT genotype, rs920915 CC genotype and rs2070895 AA genotype in CNV group were 3.62%, 5.43% and 12.22%, respectively, while those of normal control group were 2.56%, 5.58% and 14.19%, respectively, with no statistically significant difference (all at P>0.05). The minimum allele (T) frequency of rs10468017 was 18.1% and 17.2%, the minimum allele (C) frequency of rs920915 was 21.7% and 23.1%, and the minimum allele (A) frequency of rs2070895 was 33.7% and 38.7% in the CNV group and the normal control group, respectively (all at P>0.05). The odd ratio ( OR) values (95%confidence interval [ CI]) of rs10468017, rs920915 and rs2070895 in the CNV group and the normal control group were 1.06 (0.79-1.44), 0.92 (0.70-1.21) and 0.80 (0.63-1.02), respectively. Conclusions:The results from the present study do not indicate the association of LIPC SNPs (rsl0468017, rs920915 and rs2070895) with CNV in the Shantou Han population.

Objective:To investigate the clinical effects of ulnar artery perforator chain flaps in repairing wounds on distal forearm or wrist with vascular anastomosis.Methods:The retrospective observational study method was used. From March 2015 to July 2019, a total of 11 serious trauma patients on distal forearm or wrist with vascular injury were admitted to the Second Hospital of Tangshan, including 8 male patients and 3 female patients, aged from 25 to 62 years, with an average age of 45 years. Vascular anastomosis and tendon repair were performed in all patients, and fracture reduction and fixation were conducted in 9 patients, of which 8 patients underwent external fixation of radius. The residual wounds were located in palmar distal forearm in 5 patients, palmar wrist in 4 patients, dorsal distal forearm in 1 patient, and dorsal wrist in 1 patient, with wound sizes ranged from 4.5 cm×3.0 cm to 10.0 cm×6.0 cm after the last debridement. The wounds were repaired with ulnar artery perforator chain flaps, with the flap sizes ranged from 5.2 cm×3.5 cm to 11.0 cm×7.0 cm. The wound in flap donor site of 1 patient was sutured directly, the wounds in flap donor sites of the other 10 patients were repaired with free skin grafts from ipsilateral thigh after being sutured partially, and the sizes of free skin grafts ranged from 4.0 cm×2.0 cm to 8.5 cm×5.0 cm. The survivals of flaps, skin grafts, and injured limbs after operation were observed. The appearances of the flaps and donor sites of flaps were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the satisfaction degrees of patients for the appearances of injured limbs were evaluated based on Michigan Hand Function Questionnaire.Results:All flaps, skin grafts, and injured limbs survived after operation, without wound infection and blister formation. All patients were followed up for 8 to 26 months, the appearances of the flaps were good and not bloated, with similar color, texture, and thickness to the surrounding skin. The donor sites of flaps repaired with skin grafts were smooth, with circle scar at the edges. At the final follow-up, the static two-point discrimination distances of the flaps was 10-15 mm; 7 patients were strongly satisfied with the appearances of the injured limbs, and the remaining 4 patients were satisfied with the appearances of flaps.Conclusions:The ulnar artery perforator chain flap has constant vascular anatomy and reliable blood supply, with simple operation, which provides a good treatment method for repairing wounds on distal forearm or wrist with vascular anastomosis. It is especially suitable for the patients with radius fracture fixed by external fixator.

Objective:To investigate the effect of low-dose esketamine on pruritus during combined spinal-epidural block for labor analgesia.Methods:A total of 46 primigravida with full-term singleton pregnancy who underwent combined spinal-epidural block between November 2021 and April 2022 at Songshan Lake Central Hospital of Dongguan City were included in this study. These primigravida were divided into an experimental group and a control group ( n = 23 per group) using the random number table method. Five minutes prior to the administration of combined spinal-epidural block for labor analgesia, the experimental group received an intravenous injection of 0.125 mg/kg of esketamine, while the control group received an equal volume of 0.9% normal saline. Subsequently, 3 μg of Sufentanil was intrathecally injected, and an epidural catheter was inserted for patient-controlled analgesia. Pruritus grade, Visual Analogue Scale score, Ramsay sedation score, modified Bromage score, mean blood pressure, and heart rate were recorded before analgesia, 30 minutes after analgesia, and at the time of full dilation of the cervix. The duration of the active phase of the first stage of labor, the duration of the second stage of labor, the rate of instrumental delivery, the cesarean section rate, and neonatal Apgar score were recorded. Results:After 30 minutes of analgesia, the number of cases presenting with various grades of pruritus in the experimental group (no/mild/moderate/severe cases: 17/4/0/0, respectively) was significantly lower than that in the control group (no/mild/moderate/severe cases: 7/7/4/1, respectively; Z = -3.04, P < 0.01). By the time the cervices were fully dilated, the number of cases presenting with various grades of pruritus in the experimental group (no/mild/moderate/severe cases: 19/2/0/0, respectively) remained significantly lower than that in the control group (no/mild/moderate/severe cases: 10/5/4/0, respectively; Z = -2.75, P < 0.01). There were no statistically significant differences between the two groups in terms of Visual Analogue Scale score, Ramsay sedation score, modified Bromage score, mean blood pressure, heart rate, the duration of the active phase of the first stage of labor, the duration of the second stage of labor, the rate of instrumental delivery, and neonatal Apgar score (all P > 0.05). Conclusion:Low-dose esketamine may be effective in alleviating pruritus during combined spinal-epidural block for labor analgesia.

Objective To compare early outcomes of the minimally invasive aortic valve surgery (MIAVS) through right parasternal mini-thoracotomy with conventional mitral valve surgery (AVS),and evaluate feasibility and safety of MIAVS.Methods From January 2017 to December 2017,60 patients undergoing elective AVS in Nanjing First Hospital were prospectively enrolled in this study.There were 32 male and 28 female patients with their age of 28-72 (46.5 ± 10.2)years.Using a random number table,all the patients were randomly divided into a port-access MIAVS group (MIAVS group,n =20) and a conventional AVS group (conventional group,n =60).MIAVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery,femoral vein and right internal jugular vein cannulation through right the 3rd in tercostal space with 5-6 cm right parasternal incision in length.Special MIAVS operative instruments were used for mitral valve repair or replacement.Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy.Perioperative clinical data,morbidity and mortality were compared between the 2 groups.Results There was no death in-hospital or shortly after discharge in this study.CPB time [(106.0 ± 21.0) minutes vs (73.0 ± 15.0) minutes] and aortic cross-clamping time [(78.0 ± 10.0) minutes vs (47.0 ± 7.0) minutes] of MIAVS group were significantly longer than those of conventional group (P ≤ 0.05).Postoperative mechanical ventilation time [(7.0 ±4.2) hours vs (10.2 ±5.3)hours],length of intensive care unit (ICU) stay [(19.0 ± 4.0) hours vs (27.5 ± 8.0) hours] and postoperative hospital stay [(8.5 ± 2.5) days vs (13.0 ± 3.0) days] of MIAVS group were significantly shorter than those of conventional group (P ≤ 0.05).Chest drainage volume within postoperative 12 hours [(100.0 ±40.0)ml vs (410.0 ±80.0)ml] and the percentage of patients receiving blood transfusion (15.0％ vs 55.0％) of MIAVS group were significantly lower than those of conventional group (P ≤0.05).Patients were followed up for 1-12 months,and the follow-up rate was 96.7％.There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P ＞ 0.05).Conclusions Minimally invasive aortic valve surgery through right right parasternal mini-thoracotomy is a safe and feasible procedure for surgical treatment of mitral valve diseases.MIAVS can achieve similar clinical outcomes as conventional AVS,with more quickly recovery and less blood transfusion,and is a good alternative to conventional AVS.

Objective To explore the role and mechanism of thymosin β4 (Tβ4) in the treatment of non-alcoholic fatty liver disease (NAFLD).Methods Forty male C57BL/J6 mice were divided into normal group,NAFLD group,low dose Tβ4 group and high dose Tβ4 group with 10 mice in each group.NAFLD mice model was established by feeding with high fat and high sugar diet for 16 weeks.The mice in low-dose Tβ4 group and high dose Tβ4 group were intraperitonealy injected with Tβ4 at 0.05 mg · kg-1 · d-1 and 0.20 mg · kg-1 · d-1,respectively,for eight weeks.The liver function indexes and serum tumor necrosis factor-α (TNF-α) level were detected;the pathological changes of liver tissue were observed under optical microscope and non-alcoholic fatty liver disease activity score (NAS) was evaluated.The protein expression levels of nuclear factor-κB p65 (NF-κB p65) and nuclear factor κB inhibit protein a (IκBa) at the protein level in liver tissue were measured by Western blotting method.The expression of TNF-α in liver tissue was detected by immunohistochemistry.Mean integral absorbance (MIA) was calculated.T test was performed for groups comparison.Results The levels of alanine aminotransferase (ALT),γ-glutamine transferase (GGT) and serum TNF-α levels of high dose Tβ4 group were all lower than those of NAFLD group ((28±17) U/L vs.(76±29) U/L,(61±39) U/L vs.(102±56) U/L,(144.1± 48.2) ng/L vs.(187.3±58.8) ng/L,respectively),and the differences were statistically significant (t=4.52,2.78 and 2.30,all P＜0.05).The NAS of low dose Tβ4 group and high dose Tβ4 group were both lower than that of NAFLD group (3.7±40.4,2.3±0.3 vs.4.6±0.3),and the differences were statistically significant (t=5.69 and 17.14,both P＜0.01).The relative expression level of Tβ4 protein of NAFLD group was lower than that of normal group (0.2±0.1 vs.1.4±0.6),and the difference was statistically significant (t=6.24,P＜0.01).The relative expression levels of Tβ4 and IκBa of high dose Tβ4 group were higher than those of NAFLD group (1.0±0.3,0.5±0.3 vs.0.2±0.1),and the differences were statistically significant (t=8.00 and 3.00,both P＜0.01).The relative expression level of NF-κB p65 in liver tissue of high dose Tβ4 group was lower than that of NAFLD group (0.6±0.3 vs.1.5±0.7),and the difference was statistically significant (t=3.74,P＜0.01).The MIA of high dose Tβ4 group was lower than that of NAFLD group (0.4±0.2 vs.0.7±0.3),and the difference was statistically significant (t=2.63,P＜ 0.01).Conclusion Tβ4 can effectively treat NAFLD probably through inhibiting the NF-κB pathway.