Objective To investigate the effect of different doses of esketamine combined with hydromorphone postoperative patient-controlled intravenous analgesia(PCIA)on depression in elderly pa-tients undergoing total knee arthroplasty.Methods A total of 180 elderly patients,44 males and 136 fe-males,aged 65-80 years,BMI 18.5-35.0 kg/m2,ASA physical status Ⅱ or Ⅲ,undergoing total knee arthroplasty(TKA)under elective general anesthesia combined with adductor block from J uly 2023 to Sep-tember 2023.Patients were divided into three groups by random number table method;control group(group C),esketamine 0.5 mg/kg group(group E1),and esketamine 1.0 mg/kg group(group E2),60 patients in each group.After operation,groups C,E1 and E2 were given hydromorphone 0.2 mg/kg,esketamine 0.5 mg/kg combined with hydromorphone 0.2 mg/kg,and esketamine 1.0 mg/kg combined with hydromor-phone 0.2 mg/kg to receive PCIA,respectively,and the three groups were diluted to 100 ml with normal saline.Parameters were set as follows.The background infusion rate was 1.5 ml/h,and the single press dose was 1.5 ml,and the locking time was 15 minutes.If the VAS pain score at rest was greater than or equal to 4 points and the analgesic effect of pressing the PCIA pump was not effective,then intramuscular injection of tramadol 0.1 g was used for remedial analgesia.Hamilton depression scale(HAMD)score was performed 1 day,3 and 7 days after surgery.Depressive state was classified as having HAMD score ≥ 8 points.VAS pain scores at rest were performed 1 day,3 and 7 days after surgery.The number of depression within 7 days after surgery,the number of effective(D1)and total(D2)pump compressions and D1/D2 within 3 days after surgery,the number of rescue analgesia,the occurrence of adverse reactions such as tra-madol dosage,dizziness,headache,multiple dreams,hallucinations,nausea and vomiting were recorded.Results Twenty-one patients(35％)in group C experienced depression,7 patients(12％)in group E1,and 8 patients(13％)in group E2 during 3 days after surgery.Eight patients(13％)in group C experi-enced depression,1 patients(2％)in group E1,and 2 patients(3％)in group E2 during 7 days after sur-gery.Compared with group C,the incidence of depression 3 and 7 days after surgery,rescue analgesia rate in group E1 were significantly decreased,the incidence of depression 3 and 7 days after surgery,dizziness,headache,and dreaminess within 3 days after surgery in group E2 were significantly decreased(P＜0.05).There were no significant differences in the incidence of depression and VAS pain scores between group El and group E2 at 1,3,and 7 days after surgery.Conclusion Esketamine 0.5 and 1.0 mg/kg for PCIA in elderly patients after TKA can improve postoperative depression,while esketamine 1.0 mg/kg can reduce the incidence of postoperative dizziness,headache,and multiple dreams.

Objective:To analyze the expression and clinical significance of reticulocalbin 3 (RCN3) in colon cancer by bioinformatics database and biological experiments.Methods:Colon cancer HT29 and SW620 cells and colon normal mucosal cells FHC were cultured. The expression of RCN3 in cells was verified by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot. The expression data of RCN3 in normal colon tissue and colon cancer tissue were obtained by Ualcan database. The co-expressed gene information of RCN3 from LinkedOmics database was obtained, and the biological processes and related functions of these RCN3 co-expressed genes through were analyzed by gene ontology analysis (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. The protein-protein interaction network of RCN3 related coding genes was constructed by using STRING database. Finally, the relationship between the expression of RCN3 and the clinical prognosis of patients with colon cancer was compared and analyzed according to GEPIA, Ualcan and Linked Omics biological database.Results:Western blot and qRT-PCR results showed that the mRNA and protein expression of RCN3 in HT29 and SW620 colon cancer cells was significantly higher than those in FHCcells ( all P<0.05). The analysis of biological database showed that the expression level of RCN3 in colon cancer tissue was higher than that in normal colon tissue ( P<0.05). GO enrichment analysis showed that RCN3 co-expression genes were mainly involved in the composition of extracellular matrix and extracellular domain structure, the binding process of extracellular matrix and multiple receptors, and the biological processes related to tumor development such as cell adhesion, immune response, and angiogenesis through extracellular domain structure. KEGG pathway analysis showed that RCN3 co-expression genes were mainly involved in ECM receptor interaction, cytokine receptor interaction, chemokine signaling pathway, phosphatidylinositol-3-kinase protein kinase B (PI3K-Akt) signaling pathway, phagosome signal, IgA related intestinal immune network signal, these signaling pathways always related to tumor invasion, migration and inflammatory immune response. The protein-protein interaction network analysis showed that the coding protein genes that directly interacted with RCN3 protein that included PRDX6, NOSIP, PCSK6, IMMP1L, PRRG2, FBXO47, FCGRT, FKBP9, PCDHGA12, and PNMAL1, which were mainly involved in the occurrence and development of colorectal cancer, liver cancer, gastric cancer, breast cancer, lung cancer, and ovarian cancer. Survival curve analysis showed that the overall survival rate of colon cancer patients with high expression of RCN3 was significantly lower than that of patients with low expression of RCN3 ( P<0.05). Conclusions:RCN3 is highly expressed in colon cancer tissues and cells, which is closely related to the occurrence, development and prognosis of colon cancer. It can be used as one of the markers for early screening and prognosis prediction of colon cancer.

Objective To evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) in laparoscopic radical gastrectomy for gastric cancer.Methods From May 2015 to July 2017,149 patients with gastric cancer in our department were prospectively enrolled and randomly divided into the ERAS group (n =75) and control group (n =74).Results In ERAS group compared to control group,the time to first passage of flatus was (51 ± 11)vs.(62 ± 11)h,first feeding time (46 ± 12) vs.(68 ±20)h,gastric tube removal time (13 ± 12)h vs.(70 ± 16) h,pain score on the first day after surgery (3.9 ±1.3) vs.(5.2 ±0.9),C-reaction protein level (8.5 ±2.6) mg/L vs.(10.1 ±3.0)mg/L,post-op hospital stay (6.9 ± 2.9) d vs.(11.2 ± 3.5) d,were all significantly different (all P ＜ 0.05).The postoperative complication rates was 25％ vs.28％ respectively,(x2 =0.101,P =0.750).Conclusions Enhanced recovery after surgery can promote the postoperative recovery and shorten the time of hospitalization in laparoscopic-assisted radical gastrectomy for gastric cancer.

Objective To identify the risk factors for postoperative complications after radical resection of rectal cancer, and study the influence of high ligation of the inferior mesenteric artery on postoperative complications of rectal cancer. Methods Clinical data of the patients who underwent radical resection of rectal cancer in the Affiliated Hospital of North Sichuan Medical College from January 2011 to December 2015 were analyzed. The χ 2test and t test were used for all the data. Results A total of 431 patients with rectal cancer were included, of which 80 cases were excluded, and finally 351 cases met the standard. Among them, 196 cases were in high ligation group, and 155 cases were in low ligation group. The total incidence of postoperative complications was 20.4 %(40/196) in the high ligation group and 27.1 %(42/155)in the low ligation group respectively,the difference of which was not statistically significant(χ2=1.336, P= 0.245). The incidence of anastomotic leakage was 10.2 % (20/196) in the high ligation group and 7.7 % (12/155) in the low ligation group respectively, and there was no significant difference between them (χ2=0.529, P= 0.467). Logistic regression analysis revealed that gender (OR= 2.102, 95 % CI 1.278-3.459, P=0.003), body mass index (OR= 2.492, 95 % CI 1.070-5.800, P= 0.027), with or without anemia before surgery(OR=2.203,95 % CI 1.085-4.472,P=0.029), and location of tumor(OR=2.861, 95 % CI 1.288-16.007,P=0.019) were independent risk factors for postoperative complications. Conclusions High ligation of the inferior mesenteric artery does not increase the incidence of postoperative complications after radical resection of rectal cancer. Anastomotic leakage after rectal cancer resection is related to gender, body mass index,with or without anemia before surgery,and location of tumor.

Objective To explore the anti-HBV activity of anodonta polysaccharides (AP) and dose-effect relationship in vitro.Methods HepG2.2.15 cells were cultured in vitro and incubated at 37℃ for nine days with AP at a dilution ratio of 1∶10.The expression of HBsAg and HBeAg were detected using ELISA and HBV-DNA copies were detected by real-time fluorescent quantitative PCR.Based on Thiele-type continued-fraction interpolation method,the anti-HBV activity of AP was studied,and the IC50 and the maximum inhibition rate were calculated.Results AP had significant inhibitory effect on the expression of HBsAg and HBeAg in HepG2.2.15 cells in vitro,as well as HBV DNA replication.By Thiele-type continued-fraction interpolation the equations of dose-effect relationship were obtained to determine the maximum inhibition rates of AP on HBeAg and HBsAg secretion being 47.7％ and 56.4％,and the IC50 inhibiting the expression of HBeAg being 143.7mg/L.AP was also able to inhibit HBV-DNA replication and the maximum inhibition rate was 17.8％ with the same method above.Conclusion Anodonta polysaccharides have anti-HBV activity.The thiele-type continued-fraction interpolation method is simple and practical and could be used as a new method for the analysis of drug activity.

Objective To determine the biological effectiveness of 125I radioactive seeds with continuous low dose rate radiation on the human esophageal cancer cell line KYSE150 in vitro and explore the underlying cellular mechanisms.Methods The cells were divided into three cell groups:control group,single dose radiation group (SDR) and 125I radioactive seeds with continuous low dose rate radiation group (125 I-CLDR).The KYSE150 cells were exposed to radiation of X-ray at a high dose rate of 1.052 Gy/min or 125I radioactive seeds at a low dose rate of 2.77 cGy/h.The responses of KYSE150 cells to two modes of irradiation were evaluated by the colony-forming assay,cell apoptosis as well as cell cycle analysis.Furthermore,the expression levels of γ-H2AX and Bax were detected by Western blot.Results KYSE150 cells were more radiosensitive to 125I-CLDR than SDR.The relative biological effectiveness (RBE) for 125I-CLDR related to SDR was 1.56.Compared with SDR,125I-CLDR yielded more proportions of the early and late apoptosis rate (t =4.07,11.08,P ＜0.05) as well as cells at G2/M phase (t =11.25,P ＜0.05).Moreover,γ-H2AX and Bax expression levels in 125I-CLDR significantly increased compared with SDR.Conclusions Compared with the high dose rate X-ray radiation,the continuous low dose rate radiation of 125I radioactive seeds had stronger inhibition effect on KYSE150 esophageal cancer cells by impairing clonogenic capacity,inducing apoptosis and G2/M cell cycle arrest,and increasing radiosensitivity.

Objective To observe the migration and distribution of OECs in injured spinal cord and discuss their relation with the recovery of spinal cord function. Methods The rats were contused by a force of 10 g · 25 mm with NYU-impactor at T10 level. The OECs acutely isolated from green fluorescence protein (GFP) rats were purified, identified and then transplanted into the injured site and the rostral and caudal parts of the spinal cord one week after injury, with total volume of the transplanted OECs for 90 000/μl. Within 13 weeks after transplantation, the migration and distribution of OECs were qualitatively observed on the cryo-sections under fluorescence light microscope. The area and the length of OECs distribution were semi-quantitatively determined. The locomotor function of the spinal cord was appraised by BBB score. Results OECs were located collectively in the transplanted site at early stage after transplantation and then spread gradually mainly along the long axis of the cord. OECs could be found in the cavity of the contused spinal cord. The area and the length of OECs distribution were increased from 1.33 mm2 and 4.23 mm respectively at one week to 3.30 mm2 and 7.68 mm respectively at 13 weeks after transplantation. In the meantime, the locomotor function was gradually improved. Conclusion OECs can migrate within the contused spinal cord, as may contribute to the recovery of locomotor function.

Objective To observe the expression of brain-derived neurotrophical factor (BDNF) in injury spinal cord after transplantation olfactory ensheathing cells (OECs), and to investigate the mechanism of OECs repairing spinal cord injury.Methods OECs from GFP transgenic rats were separated and cultured for transplantation. Spinal cord injury rats were separated two groups by random digits table. In experimental group, OECs suspension were transplanted into injured spinal cord following spinal cord injury. In control group, DMEM was transplanted into the injured spinal cord after spinal cord injury. Motor function was evaluated per week after transplantation. The expression levels of BDNF mRNA and protein were detected by using RT-PCR and immunohistochemistry respectively, and compared with those from normal SD rats.Results Motor function of two groups was improved gradually after transplantation. The motor function scores in experimental group was obviously higher than in control group at 21st day after transplantation (P<0.05). A lot of survival GFP OECs distributed around impaired myeloid tissue. At 21st day after transplantation, BDNF mRNA and protein expression in experimental group were strongest (P<0.05), and stronger in control group than in normal group (P<0.05).Conclusion The transplantation of OECs can repair the injured spinal cord by increasing the expression of BDNF mRNA and protein to improve local microenvironment.

This article discusses 4 methods of deepening reformation entirely to improve quality of running a school in medical college in comprehensive university,such as how to enhance framework adjustment of specialty and construct scientific and reasonable framework of specialty,how to strengthen basic foundation of teaching,improve condition of running a school,how to deepen teaching reformation and reform pattern of students'cultivation,and how to strengthen teaching management and establish system of quality control.All these methods were detailed in this article to offer certain practical experience for other similar medical colleges in comprehensive universities.

Project and tutor system applied in experimental teaching is one important teaching reform project,which achieved significant teaching effect. The paper analyzes the necessity of project and tutor system,implies compiling teaching materials,training for teaching staff and improvement of experimental conditions,and values effective implementation and the summarization and perfection of teaching work.