Objective:To investigate the effects of gene silencing inducible cyclooxygenase-2 (COX-2) combined with hyperbaric oxygen (HBO) on neuronal cell edema, apoptosis, autophagy and neural functional recovery in rats with intracerebral hemorrhage.Methods:SPF-grade adult male SD rats ( n=96) were used to establish a cerebral hemorrhage model through stereotactic injection of thrombin VII into the caudate nucleus. They were randomized (random number) into 4 groups ( n=24/group): control group, hyperbaric oxygen (HBO) group, COX-2 RNAi group and combined group (COX-2 RNAi+HBO). The siRNA plasmid targeting silencing COX-2 gene expression was constructed. After group treatment, the four rats were randomly selected from each group for testing in each category. Postoperative day 1, 7, and 14 were assessed using the modified neurological severity score (mNSS) for evaluating neurofunctional deficits. On the 7th day, the water content of the brain tissue was measured using the dry/wet weight method. The blood-brain barrier permeability was assessed using the Evans method. Annexin V and TUNEL assays were employed to assess the apoptotic rate of neural cells. The mRNA expression level of COX-2 in brain tissue was determined using the RT-PCR method. The protein expression levels of Beclin-1, COX-2, aquaporin 4 (AQP-4), B cell lymphoma/lewkmia-2 (Bcl-2), caspase-3, hypoxia-inducible factor-1α (HIF-1α) and matrix metalloprotein-2/9 (MMP-2/9) were detected by Western blot (WB). SPSS software was used for data analysis. One-way ANOVA was used for inter group comparisons and LSD- t test was used for further pairwise comparison. Results:The SD rat intracerebral hemorrhage model and plasmid construction were successfully achieved. The mNSS scores were significantly decreased in COX-2 RNAi, HBO and combined groups compared with control group on the 7th day and 14th day (all P<0.01), especially in combined group ( P<0.01). The contents of Evans blue and the water content of brain tissue of all treatment groups were significantly lower than those in control group (all P<0.05), especially in combined group ( P<0.01). The apoptotic rate of neural cells decreased in all treatment groups compared with the control group (all P<0.05), and the combined group decreased the most ( P<0.01). The mRNA expression levels of COX-2 were significantly decreased in all treatment groups compared with the control group (all P<0.01), and combined group silenced COX-2 expression most obviously ( P<0.05). The results of WB showed that the protein expression levels of Beclin-1, COX-2, AQP-4, Caspase-3, HIF-1α, MMP-2/9 were significantly lower than control group (all P<0.05), while the expression of Bcl-2 was increased in all treatment groups (all P<0.01). Among them, the combined group exhibited the most pronounced trend ( P<0.01). Conclusions:Gene silencing of COX-2 in combination with hyperbaric oxygen therapy can effectively restore neurological function in rats with cerebral hemorrhage. The mechanism may be associated with reduced blood-brain barrier permeability, alleviated brain edema, and inhibition of neuronal apoptosis and autophagy.

OBJECTIVE: To evaluate the efficacy and safety of Wuda Granule (WDG) on recovery of gastrointestinal function after laparoscopic bowel resection in the setting of enhanced recovery after surgery (ERAS)-based perioperative care. METHODS: A total of 108 patients aged 18 years or older undergoing laparoscopic bowel resection with a surgical duration of 2 to 4.5 h were randomly assigned (1:1) to receive either WDG or placebo (10 g/bag) twice a day from postoperative days 1-3, combining with ERAS-based perioperative care. The primary outcome was time to first defecation. Secondary outcomes were time to first flatus, time to first tolerance of liquid or semi-liquid food, gastrointestinal-related symptoms and length of stay. Subgroup analysis of the primary outcome according to sex, age, tumor site, surgical time, histories of underlying disease or history of abdominal surgery was undertaken. Adverse events were observed and recorded. RESULTS: A total of 107 patients [53 in the WDG group and 54 in the placebo group; 61.7 ± 12.1 years; 50 males (46.7%)] were included in the intention-to-treat analysis. The patients in the WDG group had a significantly shorter time to first defecation and flatus [between-group difference -11.01 h (95% CI -20.75 to -1.28 h), P=0.012 for defecation; -5.41 h (-11.10 to 0.27 h), P=0.040 for flatus] than the placebo group. Moreover, the extent of improvement in postoperative gastrointestinal-related symptoms in the WDG group was significantly better than that in the placebo group (P<0.05). Subgroup analyses revealed that the benefits of WDG were significantly superior in patients who were male, or under 60 years old, or surgical time less than 3 h, or having no history of basic disease or no history of abdominal surgery. There were no serious adverse events. CONCLUSION The addition of WDG to an ERAS postoperative care may be a viable strategy to enhance gastrointestinal function recovery after laparoscopic bowel resection surgery. (Registry No. ChiCTR2100046242).
Humans ; Laparoscopy/adverse effects* ; Male ; Female ; Middle Aged ; Double-Blind Method ; Recovery of Function ; Drugs, Chinese Herbal/adverse effects* ; Treatment Outcome ; Gastrointestinal Tract/physiopathology* ; Defecation ; Aged ; Intestines/physiopathology*

Radical pelvic surgery is a surgical method mainly used to treat tumors in the pelvic cavity, and erectile dysfunction (ED) is a common sexual dysfunction after surgery. The incidence of ED after radical pelvic surgery is not uniformly understood due to differences in surgical approaches and methods of investigation. The main causes of postoperative ED include intraoperative neurovascular injury, psychosomatic factors and preoperative patient characteristics, with intraoperative injury to the neurovascular bundle being the most common. Studies have shown that the occurrence of postoperative ED can be prevented by active intervention, but still lack of effective treatment measures. This article reviews and summarizes the clinical epidemiological features and research progress in recent years on ED after radical pelvic surgery, and discusses specific measures for the prevention and treatment of postoperative ED.

Objective: Using propensity score matching method(PSM) to investigate the clinical effect of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma. Methods: A retrospective analysis was conducted on the clinical data of 324 patients diagnosed with advanced tonsillar squamous cell carcinoma and treated in Peking Union Medical College Hospital from 2000 to 2018, confirmed by pathology and without distant metastasis. Survival analysis was performed using Kaplan-Meier estimates, the Cox proportional hazards model, and propensity score matching(PSM). Results: Of the 324 patients, 102 were treated with non-surgery chemoradiotherapy treatment strategies and 222 with surgical plus radio(chemo)therapy treatment. Cox multivariate analysis showed that the non-surgery treatment group had a favorable prognosis than the surgical treatment group, however, these outcomes were not significantly different [overall survival(OS): adjusted Hazard Ratios(aHR): 0.92, 95% confidence interval(CI): 0.60-1.42; disease-specific survival(DSS): aHR: 0.71, 95%CI: 0.43-1.20; disease-free survival(DFS): aHR: 0.82, 95%CI: 0.53-1.28]. The new patient cohort consisted of 102 subpairs after PSM. There were no significant differences between two groups(OS: aHR: 0.85, 95%CI: 0.51-1.40; DSS: aHR: 0.62, 95%CI: 0.35-1.11; DFS: aHR: 0.80, 95%CI: 0.49-1.33). Conclusion: Our findings indicate that patients with non-surgical treatment do not have significantly better survival outcomes compared to surgical treatment group, while non-surgical treatment has advantages in improving the quality of life of patients, so comprehensive treatment based on radiotherapy and chemotherapy may be recommended for advanced tonsillar squamous cell carcinoma.
Carcinoma, Squamous Cell/therapy* ; Chemoradiotherapy ; Humans ; Quality of Life ; Retrospective Studies ; Tonsillar Neoplasms/therapy*

Objective:To investigate the effect of hyperbaric oxygen combined with RNA interference (RNAi) technology targeting aquaporin-4 (AQP-4) on improving cognitive function in rats with traumatic brain injury (TBI), and to explore its mechanism.Methods:Totally 112 adult male SD rats were randomly divided into four groups: control group, hyperbaric oxygen(HBO) group, AQP-4 RNAi group and combined treatment group, with 28 rats in each group.The TBI model of rat was established by hydraulic percussion and siRNA targeting aquaporin 4 was constructed. Rats were given corresponding intervention according to their groups.Then the modified neurological severity scores(mNSS)was evaluated on the 7th day and 21th day after operation. Morris water maze test was carried out from the 21st day to 25th day after operation and the percentage of target quadrant and daily escape latency were recorded.The changes of the brain permeability of blood-brain barrier and moisture in brain tissues were measured by Evans blue fluorometry and a wet-dry-weighing technique respectively. The protein expression levels of AQP-4, Caspase-3, Bcl-2, MMP-2 and MMP-9 were detected by Western blot method. The mRNA expression of AQP-4 in TBI brain tissue was measured by RT-PCR method, and the apoptosis rate of TBI brain cells was detected by TUNEL and AnnexinV methods on the 7th day after operation. SPSS 23.0 and Graphpad Prism 7.0 softwares were used for data analysis.One-way ANOVA was used for inter group comparison.Repeated measurement ANOVA was used for Morris results, and the LSD- t test was used for pairwise comparisons. Results:The results of mNSS showed that there were significant differences among the groups on the 7th day and 21st day after operation ( F=4.89, 7.59, both P<0.05). The scores of each treatment group were lower than that of the control group, and the effect of the combined treatment group was the best (7th day: t=3.98, -7.75, both P<0.05; 21st day: t=47.82, 7.94, both P<0.05). The results of Morris water maze test showed that the time and group interaction of rats in the target quadrant residence time and escape latency were not statistically significant( F=1.83, 8.42, both P>0.05). The escape latency and the percentage of stay in the target quadrant in the combined treatment group were better than those in other groups on the 24th and 25th day after operation (all P<0.05). Evans blue staining showed that the contents of Evans blue in AQP-4 RNAi group, hyperbaric oxygen group and combined treatment group were lower than that in the control group(all P<0.05), and that in the combined treatment group was the lowest( t=6.19, P<0.05). The results of dry-wet specific gravity method showed that the water content of brain tissue in the combined treatment group((68.15±1.52)%) was the lowest, and that in the AQP-4 RNAi group((76.71±1.06)%) was lower than that in the HBO group ((80.23±1.43)%)( t=4.38, P<0.05). The results of Western blot showed that the protein levels of AQP-4, Caspase-3, MMP-2 and MMP-9 in the combined treatment group were significantly lower than those in other groups(all P<0.05), while the expression of Bcl-2 was increased in the combined treatment group( P<0.05). RT-PCR results (gray value ratio) showed that AQP-4 mRNA levels in AQP-4 RNAi group(0.61±0.21), HBO group (0.83±0.12), combined treatment group(0.22±0.05) and CON group (1.31 ± 0.25) were significantly different( F=175.05, P<0.05), while the AQP-4 mRNA levels decreased in AQP-4 RNAi group which was better than that in hyperbaric oxygen group ( t=5.25, P<0.05). The decrease was the most obvious in the combined treatment group ( t=58.94, P<0.05). The results of TUNEL and AnnexinV showed that the treatment groups were more effective than the control group in inhibiting neuronal apoptosis, especially in the combined treatment group ( P<0.01). Conclusion:The combination of targeted AQP-4 RNAi and hyperbaric oxgen can effectively promote the recovery of neurological and cognitive function, and the mechanism may be related to protecting the integrity of blood-brain barrier, alleviating brain edema and inhibiting apoptosis of nerve cells after TBI.

Objective:To investigate the influencing factors of post-dialysis hypertension in maintenance hemodialysis (MHD) patients.Methods:This study was a cross-sectional and retrospective study. The patients receiving hemodialysis from January 9, 2017 to January 14, 2017 in 5 hemodialysis centers of Beijing area were selected. Post-dialysis hypertension was defined as an event characterized by an average increase of more than 15 mmHg in post-dialysis mean artery pressure (MAP) compared to intradialytic 3 h MAP during 3 consecutive hemodialysis sessions. Post-dialysis stable blood pressure was defined as an event characterized by an increase of less than 15 mmHg or a decrease of less than 10 mmHg in post-dialysis MAP compared to intradialytic 3 h MAP, with the exception of patients with post-dialysis hypertension and post-dialysis hypotension. The patients were divided into hypertension group and stable blood pressure group based on whether they had post-dialysis hypertension, and the differences of clinical data between the two groups were compared. The influencing factors of post-dialysis hypertension were analyzed by multivariate unconditional logistic regression.Results:A total of 491 MHD patients were enrolled in this study, including 65 patients (13.2%) in the hypertension group, 406 patients (82.7%) in the stable blood pressure group and 20 patients (4.1%) in the hypotension group. The age, blood calcium before dialysis and the proportion of patients using 1.75 mmol/L Ca 2+ dialysate in the hypertension group were higher than those of the stable blood pressure group, and pre-dialysis serum intact parathyroid hormone and pre-dialysis serum uric acid in the post hypertension group were lower than those of the stable blood pressure group (all P<0.05). The age, pre-dialysis serum intact parathyroid hormone, pre-dialysis serum calcium, pre-dialysis serum uric acid, dialysate Ca 2+ concentration of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and post-dialysis serum calcium, pre-dialysis total serum cholesterol, application of β receptor blocker, gender of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. Multivariate logistic regression analysis showed that using 1.75 mmol/L Ca 2+ dialysate was the independent influencing factor of post-dialysis hypertension (with using 1.50 mmol/L Ca 2+ dialysate as reference, OR=2.930, 95% CI 1.282-6.694, P=0.011). The age and pre-dialysis serum calcium of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and pre-dialysis serum sodium and pre-dialysis serum uric acid of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. The older age ( OR=1.046, 95% CI 1.000-1.093, P=0.049) and higher pre-dialysis serum calcium ( OR=21.847, 95% CI 2.111-226.075, P=0.010) were the independent influencing factors of post-dialysis hypertension when the 1.50 mmol/L Ca 2+ dialysate was used. Conclusions:The independent influencing factor of post-dialysis hypertension is using 1.75 mmol/L Ca 2+ dialysate, while the independent influencing factors of post-dialysis hypertension are the older age and the higher pre-dialysis serum calcium level when the dialysate Ca 2+ concentration was 1.50 mmol/L.

Objective:To compare the accuracy of two methods in reducing leg length discrepancy(LLD)during hip hemiarthroplasty.Methods:We retrospectively analyzed 89 patients of hip hemiarthroplasty who suffered from femoral neck fracture.There were 47 patients in the new method group(NM), and 42 patients in the traditional method group(traditional method, TM)which comparing the position of the greater trochanter tip and the center of the femoral head.In the NM group, the distance from the center of femoral head to the lesser trochanter(L)and the diameter of femoral head(D)of the healthy side hip were measured on preoperative anteroposterior pelvic X-ray film, and the ratio(R)of D to L was calculated.During operation, the diameter of the femoral head(d)was measured with a caliper, and the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter according to the ratio R of the healthy side.The difference of postoperative LLD between the two groups and the incidences of |LLD| in each range were compared.Results:In the NM group, the maximum LLD was 11.10 mm and the minimum LLD was -4.0 mm, with an average of(4.4±3.2)mm, 80.9%(38/47)| LLD | < 6 mm, 93.6%(44/47)| LLD | < 10 mm, 6.4%(3/47)| LLD | ≥ 10 mm.In the TM group, the maximum LLD was 13.2 mm and the minimum LLD was -8.3 mm, with an average of (6.2±5.1)mm, 42.9%(18/42)|LLD|<6 mm, 69.0%(29/42)|LLD| <10 mm, 31.0%(13/42)|LLD|≥10mm.The differences of patients of the mean postoperative LLD and the incidences of |LLD| in each range between two the groups were statistically significant( t=-2.036、 χ2=14.629, P=0.046、0.001). Conclusions:The new method is simple, convenient, more accurate and can obtain a more satisfactory LLD compared with the traditional method which refers to the relative position of the great trochanter tip and the center of the femoral head.

Objective To evaluate the short-term clinical efficacy of three dimension printed titanium augments for the reconstruction of acetabular bone defects in revision total hip arthroplasty.Methods The retrospective study was conducted.To retrospectively analyze clinical data of 21 patients who were underwent revision total hip arthroplasty with severe acetabular bone defects reconstructed by three dimension printed titanium augment from March 2016 to September 2017 from Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.There were 9 males and 12 females,age (58.9 ± 6.3) years,51-67 years,body mass index (23.8 ± 2.9) kg/m2.According preoperative CT scan of hip joints,three dimension printed titanium augments were designed for acetabular defects personality.The data including the vertical distance from centre of rotation to the interteardrop line in X-ray examination,preoperative Harris score,final follow-up Harris score of hip postoperatively,and complications were recorded.Outpatient visits ranged from 11.8 to 19.6 months.Measurement data were expressed as (Mean ± SD),and t test was used before and after surgery.Results For X-ray examination,the average vertical distance from centre of rotation to the interteardrop line was (6.1 ± 1.2) cm preoperatively and (2.8 ± 0.7) cm postoperatively,and the difference was statistically significant (P ＜ 0.01).The hip Harris score increased from preoperative (47.5 ± 6.4) scores to the last follow-up (84.6 ± 5.9) scores,and the difference was statistically significant (P ＜ 0.01).The final follow-up data showed the acetabular prosthesis and augments were stable,while there were no hip joint dislocation,periprosthetic joint infection,loosening of acetabular components and other complications.Conclusion Three dimension printed augments can reconstruct severe acetabular bone defects and restore the hip rotation centre.

Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects.Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University from March 2014 to September 2016 were analyzed retrospectively.There were 13 males and 18 females,aged (67.5 ±7.8) years,with an age range of 52-79 years.All patients underwent two-staged revision,taking preoperative and intraoperative joint puncture fluid,intraoperative infection of soft tissue for bacterial culture was to clear medication.In first stage,prosthesis removed,debridement performed and antibiotic spacer implanted were performed.Antibiotics were used for 8 to 12 weeks for infection.In second stage,total hip arthroplasty revision was performed while infection was controlled.Harris hip scores,Short form 36 health status scores (SF-36),white blood cell counts,C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)were compared between preoperative and postoperative follow-up in all patients,and postoperative complications were recorded.Postoperative outpatient follow-up was 30.1 to 59.3 months,and reviewed every 12 months after 3 months,6 months,and 12 months.The follow-up deadline was April 2019.Measurement data were expressed as mean ± standard deviation (Mean ± SD).The t test was used to compare the preoperative and postoperative follow-up.Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up.Preoperative Harris hip score,SF-36,white blood cell count,CRP and ESR were (39.4 ± 5.6) scores,(398.8 ± 39.2) scores,(12.5 ± 0.6) × 109/L,(63.3 ± 10.1) mg/L and (83.7 ± 12.5) mm/h,respectively.The last follow-up oftbe above indicators were (76.9 ±9.3) scores,(649.3 ±67.5) scores,(9.1 ±0.5) × 109/L,(5.3 ± 1.7) mg/L and (10.2 ± 1.6) mm/h,respectively.The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes.One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia.The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis.One patient was performed revision again and the other was not performed any operation for poor health condition.The remaining 26 patients had no complications.Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly.The early and intermediate-term clinical effects of the surgical treatment is satisfied.

Objective To evaluate the development of cerebral anoxia during controlled hypoten-sion with nicardipine or urapidil after carotid endarterectomy in patients. Methods Forty-four patients of either sex, aged 48-64 yr, scheduled for elective carotid endarterectomy under general anesthesia, requi-ring controlled hypotension after operation, were divided into nicardipine group ( group N ) and urapidil group ( group U) using a random number table method, with 22 patients in each group. Nicardipine at 2. 5μg·kg-1 ·min-1 was intravenously infused in group N, and urapidil 2μg·kg-1 ·min-1 was intravenously infused in group U. After systolic blood pressure was decreased to 130-140 mmHg, the consumption of nicardipine was adjusted to 0. 2 - 0. 5 μg·kg-1 ·min-1 and the consumption of urapidil to 1-2μg·kg-1 ·min-1 in group N and group U, respectively, to maintain systolic pressure at 130-140 mmHg. Heart rate ( HR) , cardiac index ( CI) , bispectral index ( BIS) value, regional cerebral oxygen saturation (rSO2) and end-tidal pressure of carbon dioxide (PETCO2) were recorded after entering the operating room ( baseline) , at the beginning of controlled hypotension ( T1 ) , and at 5, 10, 20, 30, 60 and 120 min af-ter systolic blood pressure was decreased to the target hypotension ( T2-7 ) . Development of cerebral anoxia( the relative decrease in rSO2>12％ of the baseline value) was recorded in controlled hypotension period. Results Compared with the value at T1 , the HR at T2,3 and CI at T3-7 were significantly increased ( P<0. 05), and no significant change was found in rSO2, PETCO2 or BIS value at the other time points in group N (P>0. 05), and rSO2 was significantly decreased at T3-7 (P<0. 05), and no significant change was found in HR, CI, PETCO2 or BIS value at the other time points in group U (P>0. 05). Compared with group N, the HR at T2,3, CI at T3-7 and rSO2 at T3-7 were significantly decreased in group U (P<0. 05). The incidence of cerebral anoxia was significantly higher in group U than in group N ( P<0. 05) . Conclu-sion Controlled hypotension with nicardipine is recommended after carotid endarterectomy in order to avoid the development of cerebral anoxia in the patients.