Common bile duct stones are among the most common diseases in elderly patients.In the past 20 years,minimally invasive techniques,including endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration,have been developed rapidly and provided more options for patients.Choosing appropriate treatment plans will help reduce postoperative complications and lead to better outcomes in elderly patients with common bile duct stones.

OBJECTIVE:To evaluate the pain-relieving and sedative efficacy and safety of sufentanil in patient-controlled intravenous analgesia after spinal column surgery.METHODS:60 patients undergoing selective spinal column surgery were randomized to either fentanyl group or sufentanil group.General anesthesia was performed for all the 60 cases,with tracheal catheter withdrawn and patient-controlled intravenous analgesia(PCIA) performed after completion of surgery when patients had regained consciousness.The analgesic efficacy within 24 hours was evaluated using visual analogue score(VAS),VRS score,Ramsay score and the adverse effects were recorded.RESULTS:In sufentanil group,effective analgesic efficacy was obtained,and the VAS score was significantly lower but the VRS score was significantly higher than in fentanyl group(P0.05).CONCLUSION:Sufentanil is proved to be safe and effective with reliable analgesic and sedative efficacy but fewer side effects for PCIA patients.

Objective To explore the effect of curcumin on the activity and migration of as well as c-kit mRNA expression in melanocytes.Methods Human epidermal melanocytes were isolated from the prepuce in adolescents and subjected to primary culture.To estimate the effect of curcumin on the proliferative activity of melanocytes, some melanocytes were randomly divided into several groups to be cultured in the MelM-2 medium with or without the presence of 5, 10, 20 or 30 μmol/L curcumin, the MelM-2 medium containing curcumin of 5-30 μmol/L served as the drug control groups, and the MelM-2 medium without curcumin served as the blank control group.After 24 and 48 hours of culture, MTS assay was performed to evaluate the proliferative activity of melanocytes.Some cultured melanocytes were randomly divided into 4 groups to be cultured in the MelM-2 medium with 0, 5, 10 and 20 μmol/L curcumin respectively for 48hours.Then, wound scratch assay was conducted to estimate the migratory activity of melanocytes, and real-time fluorescence-based quantitative PCR to quantify the mRNA expression of c-kit in melanocytes.Statistical analysis was carried out by factorial design analysis of variance (ANOVA), one-way ANOVA and least significant difference (LSD)-t test.Results The proliferative activity of melanocytes was significantly decreased at 24 and 48 hours in the 30-μmol/L curcumin group compared with the negative control group (0.783 ± 0.053 vs.1.000 ± 0.018 at 24 hours, 0.637 ± 0.015 vs.0.993 ± 0.064 at 48 hours, both P ＜ 0.05), while no significant differences were observed between the other curcumin groups and the negative control group (all P ＞ 0.05).The 48-hour treatment with curcumin could significantly inhibit the migration of melanocytes in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (all P ＜ 0.05).The mRNA expression level of c-kit was also significantly reduced at 48 hours in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (1.799 ± 0.372, 1.539 ± 0.224 and 1.026 ± 0.038 vs.3.371 ± 0.352, all P ＜0.05).Conclusion Curcumin at low concentrations (≤ 20 μmol/L) has no obvious cytotoxicity against melanocytes, but can inhibit the migration of and c-kit mRNA expression in melanocytes, while curcumin at 30 μmol/L can promote the apoptosis of melanocytes.

BACKGROUND:The key of intertrochanteric fractures in elderly patients is to select the appropriate fixation, but few clinical studies concerned different fixation methods for blood volume of blood circulation system in elderly patients with intertrochanteric fractures. OBJECTIVE:To compare the effects of proximal femoral intramedul ary nail and dynamic hip screw on blood volume of blood circulation system in elderly patients with intertrochanteric fractures.
METHODS:A total of 48 elderly patients with intertrochanteric fractures, who were treated in the Jiangyin Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to September 2014, were enrol ed in this study. These patients were assigned to two groups (n=24). Patients in the observation group received treatment with proximal femoral intramedul ary nail, and patients in the control group received treatment with dynamic hip screw. Postoperative blood loss, perioperative blood transfusion, preoperative and 3-day postoperative hemoglobin difference, incidence of postoperative complications, dominant blood loss, and hidden blood loss were compared between the two groups. Range of motion of the hip and Harris score of the hip were compared between the two groups at 4 and 12 months post surgery. RESULTS AND CONCLUSION:Intraoperative blood loss was less in the observation group than in the control group (P<0.05). No significant differences in perioperative blood transfusion and preoperative and 3-day postoperative hemoglobin were detected between the two groups (P>0.05). The operation time was significantly longer in the observation group than in the control group (P<0.05). The incidence of postoperative complications was significantly lower in the observation group than in the control group (P<0.05). No significant difference in length of hospital stay was detected between the two groups (P>0.05). Within the same time period, the range of motion of the hip and Harris score of the hip were better in the observation group than in the control group (P<0.05). The total amount of blood loss and dominant blood loss were less in the observation group than in the control group (P<0.05). These findings indicate that compared with the dynamic hip screw, proximal femoral nail fixation for intertrochanteric fracture has less intraoperative blood loss, lower incidence of postoperative complications, postoperative range of motion of the hip and better hip score. However, operation time of proximal femoral nail was long. There were no significant differences in hemoglobin difference and perioperative blood transfusion between the two fixation methods.

Objective To evaluate the effect of tacalcitol on the proliferation,adhesion,migration and c-kit mRNA expression of cultured human epidermal melanocytes.Methods Cultured epidermal melanocytes from the prepuce of adolescent males were treated with various concentrations of tacalcitol.Then,cell proliferation was evaluated by tetrazolium salt (XTT) assay after 24,48 and 72 hours of treatment,adhesive activity by using fibronectin-coated culture plates after 72 hours,migratory activity by Transwell assay using a microporous membrane after 24 hours,and the c-kit mRNA expression was semiquantitatively analyzed by reverse transcription PCR after 72 hours of treatment.Statistical analysis was done by repeated-measure analysis of variance and completely random design analysis of variance.Results As repeated-measure analysis of variance showed,tacalcitol of 10-10,10-9,10-8,10-7 and 10-6 mol/L significantly promoted the proliferation of melanocytes (F =9.47,P ＜ 0.01),with significant differences in the promoting effect among various durations of treatment with different concentrations of tacalcitol (F =14.44,P ＜ 0.01),and with significant interaction effect between drug concentration and treatment duration (F =2.47,P ＜ 0.01).The highest proliferation level was observed in melanocytes treated with tacalcitol of 10-s mol/Lfor 72 hours.There was a significant increase in the adhesion rate of human epidermal melanocytes to fibronectin after treatment with tacalcitol of 10-8-10-7 mol/L for 72 hours (both P ＜ 0.01),number of melanocytes migrating through micropore membranes per high-power field (× 200) after treatment with tacalcitol of 10-9-10-8 mol/L for 24 hours (both P ＜ 0.01),and in the c-kit mRNA expression in melanocytes treated with tacalcitol of 10-9-10-7mol/L for 72 hours (all P ＜ 0.01).Conclusion Tacalcitol can promote melanocytes to proliferate,migrate,express c-kit mRNA,and adhere to fibronectin.

A total of 107 vitiligo patients were randomly divided into 3 groups.Group A received an intralesional injection of Bacillus Calmette-Guérin-polysaccharide nucleic acid (BCG-PSN) (n =34),group B Compound Glycyrrhizin Tablets (n =36) and group C both (n =37).Before treatment and 3 months after treatment,cellular immune function was detected for each group.Paired comparisons of 3 groups before and after treatment showed that CD4 +,CD4 +/CD8 + ratio increased (all P ＜ 0.05) and CD8 + decreased (P ＜0.05).After treatment,as compared with groups A and B,CD4 + increases (both P ＜ 0.05) and CD8 + decreased in group C (P ＜0.05).Group C had an efficiency rate of 91.9％ and it was higher than the other two groups (both P ＜ 0.05).An intralesional injection of BCG-PSN plus Compound Glycyrrhizin Tablets could improve immune function and treat vitiligo patients efficiently.

Objective To analyze the difference of macular retinal thickness between normal subjects and diabetic patients without retinopathy,and discuss the relationship between macular thickness and the course of diabetes,blood glucose level.Methods Twenty-two cases of patients with diabetic without retinopathy without retinopathy in our hospital of fourth Department of Internal medicine from April 2016 to November 2016 were selected as diabetic without retinopathy group,and another 22 normal pemons were selected as the normal group.The central subfield retinal thickness (CSRT),cube volume(CV) and cube average thickness(CAT) of all patients were determined by optical coherence tomography (OCT),and the difference of CSRT,CV and CAT between diabetic patients and normal group were analyzed.Then,the patients with diabetic retinopathy were sub-grouped according to the course of diabetes (group A,B,C,) and blood glucose status (group D and E),and the differences of CSRT,CV and CAT among them were compared.Results With the increase of diabetes duration in the diabetic without retinopathy group,CSRT,CV and CAT were gradually increased,and there was significant difference (P ＜ 0.05).With rising blood sugar in diabetics in the diabetic without retinopathy group,CSRT,CV and CAT were gradually increased,and there was significant difference (P ＜ 0.05).There were positive correlation between CSRT,CV,CAT and course,blood sugar of diabetes mellitus (all P ＜ 0.05).Conclusion Compared with normal population,CSRT,CV and CAT are significantly thickened in diabetes mellitus patients,and CSRT,CV and CAT are increased gradually with the increase of diabetes and blood glucose,which provide reliable reference for the diagnosis of early diabetic retinopathy.

[Summary] To discuss blood glucose control in patients with type 2 diabetes undergoing insulin therapy.A randomized controlled trial was conducted in type 2 diabetics who were taking insulin and who had an HbA1C level ≥ 8％,with a 6-month follow-up period.70 diabetic patients were randomly and equally divided into control group who received standard care,and intervention group who received an individualized personalized medical treatment with health education.The main outcome measures were change of HbA1C,diabetes and medication knowledge,adherence to medications,family blood glucose monitoring,and insulin injection techniques.Questionnaire was used to evaluate the outcomes before and after the intervention.The medication and diabetes knowledge,medication adherence,the correct way for home blood glucose monitoring were significantly improved in intervention group,while remained unchanged in the control group.After 6 months,HbA1C values were significantly reduced in the intervention group while remained unchanged in the controls.The quality of life also significantly improved in the intervention group.

Objective To investigate the clinical characteristics of childhood purulent meningitis (PM)and the risk factors for its adverse outcome.Methods One hundred and nine children with PM were retrospective ana-lyzed,who were admitted to pediatric department in Xijing Hospital of the Fourth Military Medical University from Ja-nuary 2008 to July 201 6.They were divided into 5 age groups,the clinical features were compared among the different age groups.According to Glasgow prognostic score,all cases were then divided into 2 groups,the favorable outcome group and the adverse outcome group.All factors including normal information,disease history,clinical manifestations and laboratory examinations were compared between 2 groups.Results There were 72.5% (79 /1 09 cases)of the pa-tients younger than 3 years old.PMwas prone to spring and winter,and most children with PMhad preceding infection. The major clinical manifestations of PM were fever,convulsions and intracranial hypertension.The clinical manifesta-tions of PMwere different in different age groups,and convulsions were more commonly seen in less than 3 years old children,while headache,vomiting and meningeal stimulation had higher proportion in more than 3 years old children. The single factor analysis showed that there were repeated convulsions after admission (≥3 times),the cerebrospinal fluid (CSF)glucose(≤1 .5 mmol/L),CSF protein(≥1 g/L),CSF /blood glucose ratio and complications were signifi-cantly different between 2 groups(all P <0.05).While gender,age distribution,fever,intracranial hypertension,coma, limb movement disorder,meningeal stimulation,CSF cell count >500 ×1 06 /L,blood and CSF cultivate positive rate, co -infection,brain CT/MRI abnormality,electroencephalogram abnormality,treatment and duration of seizure more than 5 minutes were not significantly different(all P >0.05).Multivariate analysis showed that there were repeated convulsions after admission (≥3 times)(OR =27.84,P =0.048),CSF protein(≥1 g/L)(OR =28.44,P =0.027) and low CSF /blood glucose ratio (OR =22.1 5,P =0.041 )were independent risk factors for poor prognosis of PM. Conclusion PMhappens mostly in infantile period,with different clinical manifestations at different ages.The inde-pendent risk factors for poor prognosis were repeated convulsions after admission (≥3 times),CSF protein(≥1 g/L) and low CSF /blood glucose ratio.It indicates that if the high risk factors could be identified early,and then intervened immediately and followed up timely,it will be beneficial to improve the long -term prognosis.

Objective To investigate the changes of pathogens and antimicrobial susceptibility in patients with biliary tract infection during the past 30 years.Methods During the periods of 1981-1984,1988-1998 and 2003-2013,each 100 patients treated with common bile duct exploratoration were selected from every period.Biopsied bile specimens were performed with bacteria culture and antimicrobial susceptibility tests.This study reviewed the changes in bilary pathogens and antimicrobial susceptibility test.Results From 1981 to 1984,the most common pathogens were Escherichia coli (59.2％) and Klebsiella pneumonia (28.9％).Mixed infection of these pathogens accounted for 16.9％.From 1988 to 1998,the types of pathogens significandy increased.Escherichia coli (33.1％) and Klebsiella pneumonia (16.5％) accounted for less than 50％.Mixed infection with Escherichia coli and Pseudomonas aeruginosa was the most common type.From 2003 to 2013,gram-negative bacteria were still the main pathogens,accounting for 61.8％.Escherichia coli and Pseudomonas aeruginosa accounted for 20.1％ and 10.4％,respectively.Gram-positive bacteria increased sigrnificantly.Enterococcusfaecium (22.2％) ranked the first.Mixed infection increased (36％),of which more than 50％ was mixed pathogens of Escherichia coli and Enterococcusfaecium.The incidence of fungi infection also increased (5.6％).Conclusions There was a remarkable change of pathogen category in the biliary infections over the past years.With an increase of gram-positive bacteria and fungi infection in clinical practice,antimicrobial susceptability results could be considered in choosing appropriate drug to avoid bacterial resistance.