Objective:To evaluate the effects of rocuronium on limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.Methods:Ninety patients of both sexes, aged 50-80 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with body mass index<30 kg/cm 2, scheduled for elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block from January 2019 to October 2019, were divided into 3 groups ( n=30 each) using a random number table method: normal saline group (group S), rocuronium 0.6 mg/kg group (group RL) and rocuronium 1.2 mg/kg group (group RH). Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and rocuronium 0.6 mg/kg (group RL) or 1.2 mg/kg (group RH) or equal volume of normal saline (group S). Mechanical ventilation was performed after placement of laryngeal mask to maintain P ETCO 2 35-45 mmHg.Femoral nerve block was performed under ultrasound guidance.Anesthesia was maintained by inhaling 1% sevoflurane and intravenous infusion of propofol and remifentanil to maintain entropy index at 40-60 during operation.Patient-controlled intravenous analgesia was performed with sufentanil after surgery to maintain visual analogue scale score ≤ 4 points.When visual analogue scale score was > 4, flurbiprofen axetil 100 mg was intravenously injected.The vastus medialis muscle at the edge of the incision was obtained at 60 min after inflation to determine the expression of dystrophin by immunohistochemistry.Arterial blood samples were collected immediately after inflation of the tourniquet, at 60 min after inflation, and at 5 and 30 min after deflation for determination of the serum malondialdehyde (MDA) concentrations by the thiobarbituric acid method.The effective pressing times of the analgesic pump and consumption of sufentanil and flurbiprofen axetil were recorded within 48 h after operation.The occurrence of responses to tourniquet and residual muscle relaxation during recovery from anesthesia, the first postoperative off-bed time and postoperative length of hospital stay were recorded.The thigh girth was measured before operation and at 24 and 48 h after operation, and the difference after and before operation was calculated.The range of motion of knees of the operated limb and tourniquet-related complications in the early postoperative period (3 days) and in the long-term postoperative period (3 months) were recorded. Results:Compared with group S, the expression of dystrophin in skeletal muscle was significantly up-regulated, the concentration of serum MDA was decreased at 30 min after deflation, and the difference in thigh girth at 24 and 48 h after operation was decreased in group RH, and the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH and group RL ( P<0.05). Compared with group RL, the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH ( P<0.05). There was no significant difference in the incidence of responses to tourniquet, postoperative length of hospital stay, effective pressing times of the analgesic pump, postoperative consumption of sufentanil and flurbiprofen axetil, and the incidence of tourniquet-related complications in the early and long-term postoperative periods among the three groups ( P>0.05). No residual muscle relaxation was found during recovery from anesthesia in three groups. Conclusion:Rocuronium 1.2 mg/kg can reduce limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.

Objective To compare the efficacy of transversus fascia plane block combined with rectus sheath block(TFP-RSB)and transversus fascia plane block(TFP)in alleviating postoperative pain and in-flammation in patients with type 2 diabetes undergoing gynecologic laparoscopic total hysterectomy.Methods A total of 90 patients with type 2 diabetes who underwent gynecologic laparoscopic total hysterecto-my in the Second Hospital of Shanxi Medical University from December 2021 to September 2022 were ran-domly divided into the TFP-RSB group(n=30),the TFP group(n=30),and the blank control group(n=30).The TFP-RSB group received ultrasound-guided TFP-RSB for postoperative analgesia,and the TFP group received TFP block after surgery.The drug was 0.375％ropivacaine.Both groups received combined with pa-tient-controlled intravenous analgesia(PCIA)and those in the control group were treated with PCIA only.The efficacy of perioperative analgesia,postoperative sleep quality and Visual Analog Scale(VAS)scores at 6 h,12 h,and 24 h after operation were compared among the three groups.The levels of IL-6 and Apelin-13 were measured before surgery and at 6 h,12 h,and 24 h postoperatively,and blood glucose was measured at 6 h,12 h,and 24 h postoperatively.Results The blood glucose levels at 6 h,12 h,and 24 h after operation in the TFP-RSB and the TFP groups were lower than those in the blank control group(P＜0.05).The blood glucose in the TFP-RSB group was lower than that in the TFP group at each time point after operation(P＜0.05).There was no statistical difference in the dosage of sedatives and analgesics used during surgery between the TFP-RSB group and the TFP group(P＞0.05).VAS scores at 12 h and 24 h postoperatively were generally lower in the TFP-RSB group compared to the TFP group(P＜0.05),as well as compared to the blank control group(P＜0.05).There was no significant difference in VAS scores at 6h postoperatively between the TFP-RSB and TFP groups(P＞0.05),but both were lower than the blank control group(P＜0.05).The con-sumption of sufentanil at 24 h postoperatively was slightly lower in the TFP-RSB group than in the TFP group(P＜0.05).The PQSI sleep quality in the TFP-RSB group was better than that in the TFP and the blank control groups(P＜0.05).The levels of inflammatory factor IL-6(at 6 h,12 h,and 24 h postoperative-ly)were generally lower in the TFP-RSB group compared to the TFP group and the blank control group(P＜0.05),with no significant difference between the TFP group and the blank control group at 24 h postopera-tively(P＞0.05).Apelin-13 levels were lower at all postoperative time points compared to preoperative levels in all three groups(P＜0.05).Serum Apelin-13 levels at 6 h,12 h,and 24 h postoperatively were lower in the TFP-RSB group than in the TFP group(P＜0.05),and both were lower than the blank control group(P＜0.05).The incidence of postoperative nausea and vomiting was lower in the TFP group(26.6％)than in the blank control group(50.0％),but the difference was not statistically significant(P＞0.05).The incidence in the TFP-RSB group(3.3％)was lower than in the TFP group(26.6％)and the blank control group(50.0％),P＜0.05.Conclusion Compared with TFP block,TFP-RSB block has better postoperative analge-sia effect,less blood glucose fluctuations,and more obvious inhibitory effect on inflammatory response in dia-betic patients undergoing gynecological laparoscopic total hysterectomy.

Objective To compare the analgesic effects of ultrasound-guided adductor canal block(ACB)under different concentrations of ropivacaine combined with lateral femoral cutaneous nerve block(LFCNB)after total knee arthroplasty(TKA)and their influence on the knee joint function.Methods Ninety patients un-dergoing primary unilateral TKA under subarachnoid block were selected and randomly divided into three groups:0.20％ropivacaine(group A),0.25％ropivacaine(group B),and 0.30％ropivacaine(group C).All groups conducted ACB+LFCNB preoperatively.Postoperative visual analog scale(VAS)scores,sufentanil consumption at postoperative 24 h,time to first rescue analgesia,postoperative range of motion(ROM)of the knee joint,quadriceps strength and postoperative complications were recorded.Results Compared with the group A,the resting and moving VAS scores at postoperative 4,8,12,24 h in the group B and C were de-creased(P＜0.05),the sufentanil consumption amount within postoperative 24 h was decreased(P＜0.05),the first rescue analgesia time was prolonged(P＜0.05),ROM on the operation day was increased(P＜0.05).The above results had no statistical difference between the group B and group C(P＞0.05).There were no statistically significant differences in knee ROM on postoperative 1,2 d,postoperative quadriceps strength and complications incidence rates among the three groups(P＞0.05).Conclusion In the application of ACB+LFCNB in the patients with TKA,compared with 0.20％ropivacaine,0.25％and 0.30％ropivacaine could improve early postoperative pain and facilitate the postoperative functional recovery of the knee joint.Additionally,0.25％ropivacaine could provide the same analgesic efficacy as 0.30％ropivacaine.

Objective To investigate the effects of parenteral nutrition with ω-3 fatty acids on nutrition,inflammatory response,immunity and prognosis in criticallyill cancer patients.Methods 60 critically ill cancer patients were randomly divided into study group and the control group,30 cases each.All Patients were given isonitrogen and isocalorie enteral and parenteral nutrition for 2 weeks,which added ω-3 fatty acids in the study group by parenteral nutrition.The indicators of nutrition,inflammation,immune function were detected weekly.prognostic indicators (mortality,intensive care unit [ICU] length of stay,infectious complications) were compared.Results The indicators of nutrition,inflammatory reaction and immune function of study group were significantly improved than control group,and length of stay in ICU of study group was shorter than control group.There were less mortality and morbidity of infection complications in the study group compared with control group,but difference were not significant (P =0.13 and P=0.165).Conclusion ω-3 fatty acids supplementation of parenteral nutrition in critically ill cancer patients can improve nutritional status and immune function,reduce inflammatory response,shorten ICU length of stay,but not significantly improve ICU mortality and reduce infectious complications.

Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.

Objective To investigate the relationship between occupational chronic psychological stress with heat shock protein 70 (HSP70) and tumor necrosis factor-alpha (TNF-α).Methods Using case-control study design,we selected 622 cases in 20 to 60 years old and unrelated patients with metabolic syndrome as the case group between October 2011 and October 2012 at two hospitals of Ningxia hui autonomous region.At the same time,we selected 600 healthy people from health check-up crowd in the above two hospitals as control group.The the research objects were sex,age,nation,height,weight,smoking,drinking,exercise,and so on.After informed consent,all the research objects were collected fasting venous blood samples 10 ml in order to proceed laboratory testing of biochemical indicators.The expression of HSP70 and TNF-α in serum was determined by ELISA.Using the revised occupational stress inventory (OSI) to survey the occupational chronic psychological stress factors and stress level of research object.The correlation of occupational chronic psychological stress scores with HSP70 and TNF-α was investigated by partial correlation analysis.We built a multivariate linear regression equation With HSP70 and TNF alpha as the independent variable and occupational chronic psychological stress scores as the dependent variable,using equation of the determination coefficient R2 to judge the degree of fitting equation.Results The total points of chronic stress factors in all respondents was (136.65± 16.19).Among them,the mild stress level group was 313,moderate was 588,severe was 321,chronic heart stress factors scores were (119.96± 13.30),(135.33±3.23),(155.33± 13.55) points,respectively.In the case group subjects,the expression of HSP70 in mild,moderate and severe occupational chronic psychological stress levels were (29.88± 30.08),(36.38± 30.08),(27.16±23.77) ng/ml (F=6.85,P=0.001).The control group were (27.64±9.89),(39.78±29.77),(3.94 ± 3.09) ng/ml (F=125.71,P＜0.001).Multiple linear regression analysis showed the expression of psychological stress and HSP70 was a negative linear relationship,while positive linear relationship with TNF-α,the fitting of the regression equation was y=-0.07x1 +0.01 1x2+ 136.88.Partial correlation analysis results showed that the occupational chronic psychological stress scores and negatively correlated with HSP70 (r=-0.11,P＜0.001) and was positively related with TNF-α (r=0.11,P＜0.001).In all survey respondents,the expression of HSP70 in mild,moderate and severe occupational chronic psychological stress levels group were (28.49±20.10),(37.99±29.96),(17.98±21.77) ng/ml (F=64.08,P＜0.001).The expression of TNF-α were (133.61± 129.51),(171.23± 133.69),(169.31± 196.09) pg/ml (F=6.93,P=0.001).Conclusion The expression levels of HSP70 and TNF-α in serum were affected by occupational chronic psychological stress.While the level of occupational chronic psychological stress increased,the expression level of HSP70 in serum reduced,the expression level of TNF-α raised.

Objective To investigate the relationship between occupational chronic psychological stress with heat shock protein 70 (HSP70) and tumor necrosis factor-alpha (TNF-α).Methods Using case-control study design,we selected 622 cases in 20 to 60 years old and unrelated patients with metabolic syndrome as the case group between October 2011 and October 2012 at two hospitals of Ningxia hui autonomous region.At the same time,we selected 600 healthy people from health check-up crowd in the above two hospitals as control group.The the research objects were sex,age,nation,height,weight,smoking,drinking,exercise,and so on.After informed consent,all the research objects were collected fasting venous blood samples 10 ml in order to proceed laboratory testing of biochemical indicators.The expression of HSP70 and TNF-α in serum was determined by ELISA.Using the revised occupational stress inventory (OSI) to survey the occupational chronic psychological stress factors and stress level of research object.The correlation of occupational chronic psychological stress scores with HSP70 and TNF-α was investigated by partial correlation analysis.We built a multivariate linear regression equation With HSP70 and TNF alpha as the independent variable and occupational chronic psychological stress scores as the dependent variable,using equation of the determination coefficient R2 to judge the degree of fitting equation.Results The total points of chronic stress factors in all respondents was (136.65± 16.19).Among them,the mild stress level group was 313,moderate was 588,severe was 321,chronic heart stress factors scores were (119.96± 13.30),(135.33±3.23),(155.33± 13.55) points,respectively.In the case group subjects,the expression of HSP70 in mild,moderate and severe occupational chronic psychological stress levels were (29.88± 30.08),(36.38± 30.08),(27.16±23.77) ng/ml (F=6.85,P=0.001).The control group were (27.64±9.89),(39.78±29.77),(3.94 ± 3.09) ng/ml (F=125.71,P＜0.001).Multiple linear regression analysis showed the expression of psychological stress and HSP70 was a negative linear relationship,while positive linear relationship with TNF-α,the fitting of the regression equation was y=-0.07x1 +0.01 1x2+ 136.88.Partial correlation analysis results showed that the occupational chronic psychological stress scores and negatively correlated with HSP70 (r=-0.11,P＜0.001) and was positively related with TNF-α (r=0.11,P＜0.001).In all survey respondents,the expression of HSP70 in mild,moderate and severe occupational chronic psychological stress levels group were (28.49±20.10),(37.99±29.96),(17.98±21.77) ng/ml (F=64.08,P＜0.001).The expression of TNF-α were (133.61± 129.51),(171.23± 133.69),(169.31± 196.09) pg/ml (F=6.93,P=0.001).Conclusion The expression levels of HSP70 and TNF-α in serum were affected by occupational chronic psychological stress.While the level of occupational chronic psychological stress increased,the expression level of HSP70 in serum reduced,the expression level of TNF-α raised.

Objective To investigate the impact of exogenous of triiodothyronine (T3) on the liver hyperplasia of mouse. Methods Forty-ifve healthy speciifc pathogen free (SPF) C57BL/6 mice were divided into group A, B and control group using random number table method with 15 mice in each group. Mice in group A, B were respectively injected with 2 ml exogenous T3 solutions 10, 5μg/kg intraperitoneally. Mice in control group were injected with 2 ml normal saline. Three mice of each group were put to death respectively on day 0, 7, 14, 21, 42 after treatment. The total liver weight of the mice was measured after death. The proliferation of liver cells was detected by immunohistochemistry. The experimental data were compared using t test or analysis of variance. Results Compared with control group, the liver weight of mice in group A increased signiifcantly on day 7, 14, 21, 42 after treatment (t=3.298, 6.760, 7.119, 6.128;P<0.05) , and the liver weight of mice in group B increased signiifcantly on day 14, 21, 42 after treatment (t=4.188, 4.570, 2.978;P<0.05). The increased liver weight in group A was signiifcantly more than that in group B on day 7, 14, 21, 42 after treatment (t=4.935, 4.303, 4.033, 4.480;P<0.05). The liver weight in group A, B rose to the top on day 21 after treatment (F=21.480, 11.244;P<0.05). Compared with control group, the liver cell count in group A increased signiifcantly on day 0, 7, 14, 21, 42 after treatment (t=28.383, 23.842, 40.194, 31.059, 15.841;P<0.05), and the same with group B (t=9.097, 7.680, 20.597, 42.192, 14.415;P<0.05). The increased liver cell count in group A was signiifcantly more than that in group B (t=8.016, 4.872, 10.719, 9.514, 7.831;P<0.05). The liver cell count rose to the top in group A on day 14 after treatment (F=169.190, P<0.05) and rose to the top in group B on day 21 after treatment (F=90.460, P<0.05). Extensive proliferation of liver cells was observed both in group A and B after treatment. Conclusions Exogenous T3 can effectively promotes the liver hyperplasia of mouse, and the hyperplasia becomes more signiifcant as the T3 concentration rises.

ObjectiveTo investigate the influencing factors of portal vein thrombosis (PVT) after splenectomy in patients with portal hypertension.MethodsClinical data of 67 patients with liver cirrhosis and portal hypertension undergoing splenectomy + endoscopicvariceal ligation in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between March 2012 and April 2015 were retrospectively studied. Among the 67 patients, 47 were males and 20 were females with the average age of (47±8) years old. Thirty-five patients underwent laparoscopic splenectomy and 32 patients underwent open splenectomy. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into the PVT group and the non-PVT group according to whether PVT developed after surgery. The influencing factors of PVT in two groups were compared. The comparison of the influencing factors of PVT was conducted usingt test or chi-square test.ResultsEleven cases developed PVT after splenectomy with the incidenceof 16% (11/67) including 6 cases of laparoscopic splenectomy and 5 of open splenectomy. The incidence of PVT was associated with Plt and the concentration of D-dimer in blood circulation. Blood Plt of the PVT group was (739±39) ×109/L, which was significantly higher than (318±51)×109/L of the non-PVT group (t=14.678,P<0.05). The concentration of D-dimer of the PVT group was (7.4±1.1) mg/L, which was significantly higher than (4.0±0.9) mg/L of the non-PVT group (t=5.458, P<0.05). The incidence of PVT was not associated with surgical procedure (χ2=0.028,P>0.05).Conclusion The incidence of PVT after splenectomy is associated with Plt and the concentration of D-dimer and is not associated with surgical procedure.

ObjectiveTo investigate the application value of laparoscopic splenectomy combined with endoscopic variceal ligation in cirrhosis and portal hypertension.MethodsSixty-three patients with cirrhosis and portal hypertension undergoing laparoscopic splenectomy combined with endoscopic variceal ligation in Lingnan Hospital, the Third Afifliated Hospital of Sun Yat-sen University between September 2011 and September 2014 were included in the prospective study. The patients were randomized into the laparoscopy group and the laparotomy group according to different surgical procedures. Among the 28 patients in the laparoscopy group, 25 were males and 3 were females with the age ranging from 40 to 69 years old and the median of 55 years old. Among the 35 patients in the laparotomy group, 32 were males and 3 were females with the age ranging from 43 to 69 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients of two groups underwent endoscopic variceal ligation during the splenectomy. The duration of operation, intraoperative blood loss, length of hospital stay, treatment costs and incidence of postoperative complications of two groups were observed. The comparison of the observed indexes of two groups was conducted usingt test and the rate comparison was conducted using Fisher's exact test.ResultsAll the patients completed the surgery successfully. The duration of operation and the intraoperative blood loss were (113±8) min and (204±52) ml for the laparoscopy group, and were (106±6) min and (226±63) ml for the laparotomy group where no significant difference was observed (t=1.97,-0.75;P>0.05). The length of hospital stay and treatment costs of laparoscopy group were (6.0±1.2) and (35 000±3 000) RMB, which were signiifcantly lower than (11.2±2.7) and (45 000±1 000) RMB of laparotomy group (t=-4.87,-6.81;P<0.05). Eight patients in the laparoscopy group developed complications, among them, 7 were with portal venous thrombosis and 1 was with recurrent hemorrhage. Seventeen patients in the laparotomy group developed complications, among them, 10 were with portal venous thrombosis and 7 were with fat liquefaction of incisions. The incidence of fat liquefaction of incisions in laparoscopy group was signiifcantly lower than that of the laparotomy group (P=0.035).ConclusionLaparoscopic splenectomy combined with endoscopic variceal ligation can achieve the similar curative effect with laparotomy and has the advantages of small operational wound, quick recovery, less complications, as well as shorter length of hospital stay and lower total treatment costs.