OBJECTIVE:To investigate the influence of dexmedetomidine combined with fentanyl on analgesic effects and hemodynamics of orthopedics patients after surgery.METHODS:A total of 80 patients undergoing orthopedics surgery were randomly divided into observation group (40 cases) and control group (40 cases).Observation group was given patient-controlled analgesia (PCA) of Dexmedetomidine hydrochloride injection+Fentanyl citrate injection,maintaining analgesia for 48 h.Control group was given PCA of Fentanyl citrate injection,maintaining analgesia for 48 h.The MAP,SpO2,HR,VAS and the occurrence of ADR were observed in 2 groups from the application of multi-function monitor to connecting to PCA (T0),12 h after connecting (T1) and 48 h after connecting (T2).RESULTS:At T0,there was no statistical significance in VAS score between 2 groups (P＞0.05).VAS scores of 2 groups at T1-2 were significantly higher than at T0.Those of 2 groups at T1 were significantly higher than at T2;but the observation group was significantly lower than the control group,with statistical significance (P＜0.05).There was no statistical significance in MAP,SpO2 or HR between 2 groups at different time points (P＞0.05).The incidence of respiratory depression,sharp pain,nausea and vomiting,hypotension in observation group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:Dexmedetomidine combined with fentanyl show significant analgesic effect after orthopedics surgery,and have no effect on hemodynamics with good safety.

Bronchopulmonary dysplasia( BPD) is a chronic lung disease that commonly occurs in pre-term. Since the 1980s,with the advances in perinatal care,survival rate of preterm has been raised,while BPD continues to be a significant cause of morbidity and mortality for premature infants. However,the treatment effect of BPD is unsatisfactory. It is urgent to search for innovative ways to reduce the respiratory injury that caused by BPD as well as to improve the quality of life. In recent years,mesenchymal stem cells′( MSC) research has pro-vided a new way for the treatment of BPD. This review primarily summarizes the current status of the MSC ther-apies and its possible mechanism on BPD.

Objective To study the indications,feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones.Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016.Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group.There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract.A comparison was conducted to compare the duration of the procedures,the amount of perioperative bleeding,the postoperative complication rates and residual stone rates between the two groups.Results In the PTCD group,the average operation time was (77.0 ± 36.5) min,the amount of perioperative bleeding was (26.5 ± 54.1) ml,and the postoperative complication rate was 37.5 ％ (15/40).Complete lithotomy in one-stage was successful in 33 patients,and in two-stages in 1 patient.The residual stone rate was 15.0％ (6/40).In the T tube tract group,the average operation time was (82.5 ± 44.1) min,the amount of perioperative bleeding was (14.8 ± 21.0) ml,and the postoperative complication rate was 32.6％ (15/46).Complete lithotomy in one-stage was successful in 34 patients,and two-stages in 2 patients.The residual stone rate was 21.7％ (10/46).There were no significant differences in the residual stone rates,complication rates and operation time between the two groups (P ＞ 0.05).The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group,(P ＜ 0.05).Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group.Both approaches can be used for bile duct stones.

Abstract: Objective　To investigate the diagnostic value of joint detection of Mycobacterium tuberculosis rifampicin resistance gene (Xpert MTB/RIF), Mycobacterium tuberculosis ribonucleic acid (TB-RNA) and Mycobacterium tuberculosis deoxyribonucleic acid (TB-DNA) in bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis. Methods A total of 806 patients with suspected smear-negative pulmonary tuberculosis admitted to our hospital from May 2020 to July 2022 were selected, 506 patients diagnosed as bacterial negative pulmonary tuberculosis by clinical, X-ray and sputum samples were classified as bacterial negative pulmonary tuberculosis group, and the other 300 patients with non-tuberculous pulmonary disease were classified as non-tuberculous pulmonary disease group. XpertMTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of all patients were detected. With clinical, X-ray and sputum specimen examination of mycobacterium tuberculosis as the gold standard, the diagnostic efficacy of alveolar lavage solution Xpert MTB/RIF, TB-RNA and TB-DNA alone and in combination was analyzed. Results The positive detection rates of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of the smear-negative pulmonary tuberculosis group and the non-tuberculosis pulmonary disease group were 69.96% (354/506) and 2.67% (8/300), 61.46% (311/506) and 5.00% (15/300), and 63.64% (322/506) and 8.00% (24/300), respectively. The rates in the smear-negative pulmonary tuberculosis group were higher than those in the non-tuberculosis lung disease group, and the differences were statistically significant (χ2=342.005, 246.930, 235.687, P<0.01). Compared with the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Xpert MTB/RIF in the diagnosis of smear-negative pulmonary tuberculosis were 69.96%, 97.33%, 80.15%, 97.79% and 65.77%, respectively; those values of TB-RNA were 61.46%, 95.00%, 73.95%, 95.40% and 59.38%, respectively; those values of TB-DNA were 63.64%, 92.00%, 74.19%, 93.06% and 60.00%, respectively; those values of combined diagnosis with Xpert MTB/RIF, TB-RNA and TB-DNA were 61.26%, 100.00%, 75.68%, 100.00% and 60.48%, respectively; the specificity and positive predictive value of combined detection were higher than those of single detection (P<0.05). Conclusions The joint detection of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid can improve the diagnostic efficacy of smear-negative pulmonary tuberculosis and is worthy of clinical promotion and application.

Objective To discuss decision of the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction.Methods The length of esophageal resection margin of intraoperative,postoperative and pathological large slice under the microscope of 50 cases adenocarcionma of esophagogastric junction underwent radical gastrectomy were measured,and the proximal invasive length of esophagus in large pathological slice were also measured,and the relationship between it and pathological factors was analyzed.Determined the minimum safety cut edge distance.Results In 46 of 50 patients,proximal intramural spread of the tumor was observed.The invasive length of tumor from 0.1 cm to 3.5 cm.The invasive length of tumor was <1.0 cm with 11 patients,1.0-1.5 cm with 19 patients,1.5-3.0 cm with 15 patients,in only 1 patient was the distance of spread 3.5 cm.Invasive length of adenocarcionma of esophagogastric junction had a significant difference between the groups in different pathological factors(P<0.001).Conclusion The length of 3.5 cm is the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction(SiewertⅡ,Ⅲ type) by abdominal incision.

OBJECTIVE:To improve the quality of pharmacist consultation,provide real-time,precise and whole-process medi-cine guidance and to promote rational drug use. METHODS:The functions of electronic pharmacy consultation system(EPCS)in our hospital were introduced,and its effects were evaluated. RESULTS:The system had several modules as multiple dimensional knowledge assistant system,real-time prescription checking engine,electronic consultation record method,pharmacist workload and quality statistical analysis. EPCS provided convenient information access,prescription auditing,consultation record and statisti-cal analysis so as to improve consultation efficiency and accuracy. Compared with before using EPCS,EPCS had enhanced speed of inquiring information by 3.75 times,prescription auditing by 4 times,consultation record by 6 times and statistical analysis by 20 times;return visit rate to potients increased from 0.03% to 0.34%. The number of consulting questions increased month by month. The type of consultation question,the identity of the consultant and others could be classified statistically based on the sys-tem. CONCLUSIONS:EPCS helps pharmacist to build a more scientific and effective consultation platform,and promotes rational drug use in the hospital.

OBJECTIVE:To introduce the experience on how to build modern pharmaceutical logistics and dispensing system in outpatient pharmacy,and to provide reference for the construction of modern outpatient pharmacy. METHODS:The pharmaceuti-cal logistics system could be constructed by setting up secondary warehouse,pharmaceutical supply chain management system (PSCMS) and electronic drug storage system (EDSS);pharmaceutical dispensing system could be constructed through allocating automatic drug dispensing machine with different functions reasonably to carry out dispensing way of different modes combination, building automated pharmacy management system and developing emergency plan for the system fault of the automated pharmacy. The effects of logistics and dispensing system in our hospital were evaluated through comparing related index before and after the application of the systems. RESULTS:With the aid of PSCMS,the drug purchase information could be collected and calculated au-tomatically,the frequency and working time of the purchase were reduced by 50% and 75% respectively,and the accuracy of the purchase plan was increased by 12.5%;with the EDSS,the position and number information of the drugs could be acquired imme-diately,and the complementation and inventory time were decreased by 67% and 58% respectively;the time for manual dispens-ing was reduced by 68%,and the incidence of internal mistakes was decreased by 76.7%;under new dispensing system,the pre-scription could be distributed automatically and intelligently,the rate of automatic prescription processing was increased to 72.7%, and the average waiting time to pick up drugs was controlled to below 10 min. CONCLUSIONS:The pharmacists’working effi-ciency and the quality of pharmaceutical care have been improved by the modern pharmaceutical logistics and dispensing system, which settle the foundation for the transformation of the pharmaceutical care mode.

Objective To observe the effect of extracorporeal shock wave (ESW) combined with intervertebral foramen injection on the lumbar facet joint syndrome.Methods Ninety-three patients presenting the syndrome were randomly divided into acombined group,ashock wave group and acontrol group,each of 31,according to a random number tab.All three groups were given a nonsteroidal anti-inflammatory drug,the shock wave group was additionally treated with a course of ESW,while the combined group received the shock wave treatment and lumbar intervertebral foramen injection.The three groups were assessed using theOswestry disability index (ODI),theRoland Morris Disability Questionnaire (RMDQ)and a life quality scale (QOL-SF36) beforetreatment and after 1,4 and 8 weeks of treatment.Pain was reported using a visual analogue scale (VAS).Results Theaverage VAS,ODI,RMDQ and QOL-SF36 scores of the three groups had all improved after the treatment.After one week the average scores of VAS (2.6±1.4),ODI (15.9±8.3),RMDQ (9.9±5.4) and QOL-SF36 (74.6±17.1) of the combined group had improved significantly more than those of the control group [VAS (4.3± 1.3),ODI(22.8± 6.9),RMDQ (14.9±7.7) and QOL-SF36 (61.6±17.7)].Fourweeks after the treatment,the averageVAS,ODl,RMDQ andQOL-SF36 scores [(2.5±1.3),(15.1±7.3),(9.8±5.1) and (76.8±16.8)] of the shock wave group had improved significantly more than those of the control group [(3.9 ± 1.4),(20.3 ± 8.2),(13.9 ± 8.1) and (67.2±20.6)].Such significant improvements lasted until 8 weeks after the treatment.ConclusionsESW combined with intervertebral foramen injection can relieve the pain oflumbar facet joint syndrome,improve lumbar vertebral function and patients' quality of life.It is worthy of clinical application.

Objective To observe the clinical efficacy of combining buprenorphine with joint mobilization in the treatmeut of periarthritis of the shoulder.Methods A total of 103 patients were randomly divided into groups A,B and C.Group A received buprenorphine and joint mobilization;group B was treated with the non-steroidal antiinflammatory drug loxoprofen sodium and joint mobilization;group C received only joint mobilization.One week,3 weeks and three months after the treatment,the subjects used a visual analogue scale (VAS) to rate their level of discomfort,and Constant-Murley scores (CMS) and the degree of shoulder activity were quantified in all 3 groups.Any differences in the intensity of joint mobilization were also observed.Results The VAS ratings,CMS and the degree of activity of the shoulder joint improved significantly in all three groups after the treatment.One week after the treatment,the average VAS score of group A (2.8±1) was significantly lower than that of groups B (3.8±1) and C (4.5± 1.3),but group A's average CMS (60.1±10.7) had increased to significantly more than those of groups B (48.8± 11.0) and C (44.9±9.7).At the same time,the average shoulder joint rear protraction,90° extorsion abduction,internal rotation and external rotation angles of group A were all significantly bigger than those of groups B and C.The differences were maintained until at least three months after the treatment.One week after the treatment,the intensity of the joint mnobilization of group A was significantly higher than in groups B and C,with that discrepancy also continuing until at least 3 months after the treatment.Conclusions Buprenorphine combined with joint mobilization is very effective in the treatment of periarthritis of the shoulder.It is simple,safe and elicits good patient compliance.It is worthy of pronotion among shoulder periarthritis patients.

Adult ; Aged ; Agranulocytosis ; chemically induced ; Antineoplastic Agents, Alkylating ; administration & dosage ; adverse effects ; therapeutic use ; Brain Neoplasms ; secondary ; therapy ; Carcinoma, Non-Small-Cell Lung ; pathology ; Chemoradiotherapy ; Dacarbazine ; administration & dosage ; adverse effects ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Dose-Response Relationship, Drug ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Remission Induction ; Survival Rate ; Vomiting ; chemically induced