Objective To investigate the effects of fentanyl and remifentanil on the viability of human adenocarcinoma cell line A549.Methods Human adenocarcinoma A549 cells cultured in logarithmic growth phase were seeded in 75 ml culture bottles or 96-well plates.After being cultured for 24 h,the cells were randomly divided into 9 groups (n =30 each):4 fentanyl groups (groups F1-4 ),4 remifentanil groups (groups RF1-4 ) and control group (group C).Groups F1-4 were exposed to fentanyl with the final concentrations of 0.5,5.0,50.0 and 500.0 ng/ml respectively.Groups RF1-4 were exposed to remifentanil with the final concentrations of 0.5,5.0,50.0 and 500.0 ng/ml respectively.The viability of the cells was determined by methyl thiazolyl tetrazolium assay after being incubated for 24,48 and 72 h.The cell cycle progression and apoptosis were determined by flow cytometry after being incubated for 24 h.Results Compared with group C,the viability of A549 cells were gradually decreased at 72 h of incubation,the proportion of the cells in S phase was gradually decreased at 24 h of incubation,and the proportion of the cells in G2/M phase and apoptotic rate were gradually increased in groups F2-4 and in groups RF2-4 ( P ＜ 0.05).Conclusion Fentanyl and remifentanil with the final concentration ≥5 ng/ml can inhibit the viability of human adenocarcinoma cell line A549 in a dose-independent manner by inducing cell apoptosis and cell cycle arrest in G2/M phase.

OBJECTIVETo evaluate the erectile and ejaculatory function of sacral tumor patients after sacral nerve root resection and investigate the relationship of erectile and ejaculatory dysfunction (EED) with the level of sacral nerve injury.

METHODSThis retrospective study included 47 male patients aged 16 to 63 (32.6 +/- 6.8) years treated by sacral tumor resection between January 2008 and August 2013. According to the levels of the sacral nerve roots spared in surgery, the patients were divided into four groups: bilateral S1-S3 (n=16), unilateral S1-S3 (n=21), unilateral S1-S2 (n=6), and unilateral S1 (n=4). The patients were followed up for 12 to 41 (27.2 +/- 10.9) months by questionnaire investigation, clinic review, and telephone calls about their erectile and ejaculatory function at 3, 6 and 12 months after surgery and in August 2013.

RESULTSIn the bilateral S1-S3 group, the incidence rates of EED were 31.25% (5/16), 25% (4/16), and 12.5% (2/16) at 3, 6, and 12 months respectively after surgery, with recovery of erectile and ejaculatory function in August 2013. The incidence rates of EED in the unilateral S1-S3 group were 85.71% (18/21), 71.43% (15/21), 52.38% (11/21), and 42.86% (9/21) at 3, 6 and 12 months and in August 2013, respectively; those in the unilateral S1-S2 group were 100% (6/6), 83.33% (5/6), 83.33% (5/6), and 66.67% (4/6) at the four time points; and those in the unilateral S1 group were all 100% (4/4). No statistically significant differences were found in the incidence rate of EED among the patients of different ages or tumor types (P > 0.05).

CONCLUSIONThe incidence of postoperative EED in male patients treated by sacral tumor resection is closely related to the mode of operation. Sparing the S3 nerve root at least unilaterally in sacral tumor resection is essential for protecting the erectile and ejaculatory function of the patient.

Adolescent ; Adult ; Ejaculation ; physiology ; Erectile Dysfunction ; epidemiology ; etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Organ Sparing Treatments ; Peripheral Nervous System Neoplasms ; surgery ; Postoperative Complications ; epidemiology ; Postoperative Period ; Retrospective Studies ; Sacrum ; Spinal Nerve Roots ; injuries ; surgery ; Surveys and Questionnaires ; Young Adult

Abstract: Objective　To analyze the distribution characteristics of the main pathogens of HIV/AIDS patients with wound infections and provide basis for clinical diagnosis and treatment. Methods　The clinical data of 294 patients with positive secretions or pus specimens from 2016 to 2020 were analyzed retrospectively. Results　A total of 357 strains of pathogenic bacteria were isolated from 294 cases, of which 123 strains of Gram-negative bacilli (G-b), accounting for 34.5%, were mainly Escherichia coli (15.4%), Klebsiella pneumoniae (3.9%), and Pseudomonas aeruginosa (3.6%); Gram-positive bacilli (G+b) 14 strains, accounting for 3.9%; 108 Gram-positive cocci (G+c), accounting for 30.3%, of which 44 strains were coagulase-positive Staphylococcus aureus (12.3%), Coagulase-negative staphylococci were mainly Staphylococcus epidermidis (4.2%) and Staphylococcus hemolyticus (2.8%); 37 strains of fungi, accounting for 10.4%, were mainly Candida albicans (5.9%); 75 strains of Mycobacterium, accounting for 21.0%, including 41 strains of Mycobacterium tuberculosis (11.5%) and 34 strains of non-tuberculosis mycobacteria (9.5%). 52 of the 294 HIV/AIDS patients had mixed infections, accounting for 17.7%. There was significant difference in the distribution of G+c, G-b, mycobacteria and mixed infection among different specimen sources (P<0.05), and there was significant difference in the distribution of mycobacteria among different CD4+T lymphocyte counts (P<0.05). There was significant difference in the level of CD4+T lymphocytes between patients of different ages (P<0.05), and there was significant difference in the level of CD4+T lymphocytes from postoperative incision and other parts (P<0.05). Conclusions　Patients with HIV/AIDS are prone to combined wound infections with various pathogenic bacteria. We should strengthen the research on wound infection in HIV/AIDS patients, and timely send patients with a low number of CD4+T lymphocytes for secretion or pus culture, so as to carry out targeted treatment and improve the prognosis of patients.

Objective To investigate the clinical features and treatment principles of inflammatory myofibroblastic tumor of the urinary bladder (IMTUB).Methods From April 2013 to October 2016,6 cases of IMTUB patients were analyzed retrospectively.All cases were presented with gross hematuria.4 cases underwent ultrasonography,of which 3 cases showed solid mass in bladder,1 case showed inflammatory change.6 cases underwent CT examination,3 cases with bladder cancer,1 case with bladder sarcoma,1 case with malignant transformation of adenoma,1 case with rich blood supply.No lymph node metastasis.Bladder occupying lesions were considered in 2 cases of MRI examination.5 cases of cystoscopy showed bladder solid mass.In 6 cases involved,2 patients received partial cystectomy,2 patients underwent transurethral resection of bladder tumor,1 patient underwent radical resection of urachal carcinoma and the other one was treated with chemotherapy.Results Immunohistochemical staining was positive in ALK (100.0％) 、Vimentin(100.0％) 、CK(100.0％) 、SMA (83.3％) 、EMA(66.7％) and Ki-67 (5％-30％),negative in S-100 and Desmin.Final pathological diagnosis was IMTUB.So far,neither recurrence nor metastasis has been detected for 6 ～ 42 months in 5 cases and the other one lost to follow-up.Conclusions IMTUB is a kind of rare benign tumor of bladder.The golden standard of diagnosis is pathological diagnosis.Surgical resection is the first choice for treatment.Recurrence and metastasis are after the surgery treatment.All patients should be followed up closely.

OBJECTIVETo investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap.

METHODSFrom January 2006 to January 2012,there were 21 patients in the study (including 15 males and 6 females), and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle ,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The tension skin flaps in the pedicle were designed triangularly (10 patients), spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm x 2.0 cm to 8.0 cm x 5.0 cm), and 16 patients with defects in the foot and inferior segment of leg, or around the ankle (the size from 6.0 cm x 4.0 cm to 13.0 cm x 7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted, including 5 dorsal neurocutaneous flaps of foot, 4 superficial peroneal neurocutaneous flaps, 4 saphenous neurocutaneous flaps, 3 sural neurocutaneous flaps, 2 superficial radial neurocutaneous flaps, 3 lateral neurocutaneous flaps of forearm. And the survival rate, appearance and sensory recovery of the flaps were analyzed.

RESULTSThe distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely, and the donor site all healed primarily. The follow-up time was from 3 months to 2 years (averaged 7 months), and all the flaps had recovered pain and warm sensation with perfect appearance.

CONCLUSIONThe tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap, and can also improve its appearance.

Adolescent ; Adult ; Female ; Foot Injuries ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Young Adult

Objective To evaluate the effect of ulinastatin on neuron apoptosis and CCAAT/enhancer-binding protein (CHOP) expression of spinal cord after peripheral nerve injury.Methods A total of 225 healthy male SPF C57BL/6J mice were divided into three groups by using a random number table:sham-operated group,peripheral nerve injury group and ulinastatin group (n=75).The models of unilateral sciatic nerve transection were established in the latter two groups.After the models being established,intraperitoneal injection ofulinastatin 0.2 mL (10 000 U/kg) was performed once daily for 3 consecutive d in ulinastatin group,and the equal volume of normal saline was given once daily for 3 consecutive d in sham-operated group and peripheral nerve injury group.One,3,7,14 and 28 d after surgery,L4-6 spinal cord segments were removed for pathological examination by HE staining,and for detection of neuron apoptosis and apoptotic index (AI) by TUNEL method;the expressions of CHOP,Bcl-2,Bax and cleaved caspase-3 proteins were determined by Western blotting and the ratio of Bcl-2/Bax was calculated,and the CHOP mRNA expression was detected by RT-PCR.Results HE staining showed that the injury of spinal cord in peripheral nerve injury group was more aggravated as compared with that in the sham-operated group,and the injury of spinal cord in ulinastatin group was more alleviated as compared with that in the peripheral nerve injury group.One,3,7,14 and 28 d after surgery,AI was significantly higher,Bcl-2 protein expression was down-regulated,cleaved caspase-3 and Bax protein expressions were up-regulated,Bcl-2/Bax ratio was lower,and CHOP protein or mRNA expressions were up-regulated in the peripheral nerve injury group and ulinastatin group as compared with those in the sham-operated group,with statistically significant differences (P＜0.05).As compared with those in the peripheral nerve injury group,AI was significantly lower,Bcl-2 protein expression was up-regulated,cleaved caspase-3 and Bax protein expressions were down-regulated,Bcl-2/Bax ratio was higher,and CHOP protein or mRNA expressions were down-regulated in ulinastatin group,with statistically significant differences (P＜0.05).Conclusion The mechanism by which ulinastatin protects spinal cord injury after peripheral nerve injury is related to down-regulation of CHOP expression and suppression of neuron apoptosis of spinal cord.

The working principle and structural composition of the transcranial magnetic stimulator were introduced.The failures of the transcranial magnetic stimulator in some hospital were summarized from 2018 to 2022.The causes for common failures of the transcranial magnetic stimulator were analyzed with the fishbone diagram,and some suggestions were put forward on its daily utilization management.The maintenance thoughts for two common failures were described in detail including flow control alarm and no magnetic field output.References were provided for daily management and maintenance of the transcranial magnetic stimulator.[Chinese Medical Equipment Journal,2023,44(9):110-113]

Objective To evaluate the rationality of the drug utilization in patients with chronic obstructive pulmonary disease (COPD) in our hospital.Methods The methods of drug utilization review (DUR) and drug utilization evaluation (DUE)were used to analyze the drug utilization of 27 patients with COPD in our hospital.Results There were 37 main therapeutic drugs in 27 patients,and drug utilization index (DUI) of 13 cases were more than 1,DUI of 13 cases were less than 1,while DUI of 11 cases were equal to 1.The top DDDs of drugs (DDDs) in terms were cefodizime injection,meropenem for injection,ambroxol injection,pantoprazole injection,rabeprazole sodium enteric-coated tablets,furosemide tablets and spironolactone tablets.During the therapeutic process,routine blood tests (77.78％ and 84.62％),liver function (100.00％ and 62.50％),renal function (92.59％ and 72.73％) and cardiac function (81.84％ and 75％) were monitored and abnormal remonitoring was performed.24 cases (88.89％) of the patients showed obvious improvement and 22 cases (81.84％) complications were controlled after treatment.Conclusion A more comprehensive evaluation of drug utilization in patients with COPD can be achieved by using DUR plus DUE method,helping to find out the irrational drug use and promote the rational use of medicines in hospital.

Objective:To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. Methods:From January 2006 to January 2012,there were 21 patients in the study (in-cluding 15 males and 6 females),and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The ten-sion skin flaps in the pedicle were designed triangularly (10 patients),spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm×2.0 cm to 8.0 cm×5.0 cm),and 16 patients with defects in the foot and inferior segment of leg,or around the ankle (the size from 6.0 cm×4.0 cm to 13.0 cm×7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted ,including 5 dorsal neurocutaneous flaps of foot,4 superficial peroneal neurocutaneous flaps,4 saphenous neurocutaneous flaps,3 sural neurocutaneous flaps,2 superficial radial neurocutaneous flaps,3 lateral neurocutaneous flaps of forearm. And the survival rate,appearance and sensory recovery of the flaps were analyzed. Results:The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely ,and the donor site all healed primarily. The follow up time was from 3 months to 2 years (averaged 7 months),and all the flaps had recovered pain and warm sensation with perfect appear-ance. Conclusion:The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap,and can also improve its appearance.

Objective:To identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Methods:A total of 200 elderly patients of both sexes, aged>65 yr, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, scheduled for elective thoracic surgery, were enrolled in the study.Data regarding patient age, gender, body mass index (BMI), American Society of Anesthesiologists physical status, history of hypertension, history of diabetes mellitus, operation method, type of operation, operation time, intraoperative blood loss, use of intraoperative nerve block and use of dexmedetomidine in patient-controlled intravenous analgesia (PCIA) were collected.The patients were followed up after operation, the occurrence of postoperative pain at 48 h after operation was recorded, and patients′ subjective sleep quality at 48 h after operation was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Patients were divided into 2 groups according to PSQI score: non-postoperative sleep disturbances group (PSQI score<5) and postoperative sleep disturbances group (PSQI score≥5). A multivariate logistic regression was used to identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Results:A total of 169 patients were included in this study, and the incidence of postoperative sleep disturbances was 45%.The results of logistic regression analysis showed that history of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min and moderate and severe postoperative pain were risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery, and use of intraoperative nerve block and use of dexmedetomidine during PCIA were protective factors for postoperative sleep disturbances in elderly patients ( P<0.05). Conclusion:History of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min, moderate and severe postoperative pain are risk factors and use of intraoperative nerve block and use of dexmedetomidine during PCIA are protective factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.