Laparoscopic cholecystectomy (LC) patients showed mild to moderate pain, non steroidal anti-inflammatory drugs (NSAIDS), opioids and antiepileptic drugs are used in routine treatment of postoperative pain in clinic. Although these drugs worked quickly, their adverse effects, such as drowsiness, post-operative nausea and vomiting (PONV), constipation and respiratory inhibition can lead to delayed discharge. Therefore, many researchers study the replacement treatment of postoperative pain. Pain after LC can be divided into superficial incision pain, deep visceral pain and shoulder referred pain. The species of drug are local anesthetics, steroid, tramadol and dexmedetomidine. There are 3 main types intraperitoneal administration time: before the establishment of pneumoperitoneum, at the time of pneumoperitoneum and immediately after removal of the gallbladder. Intraperitoneal administration is often applied to the fossa of gallbladder, liver diaphragm, liver and diaphragm gap or the sites near the hepatoduodenal ligament. The main methods of intraperitoneal administration are instillation, infiltration, spraying and flushing. Based on many studies, it is beneficial to use intraperitoneal administration in terms of pain reduction in the early stage after LC. The use of intraperitoneal administration could reduce the amount of analgesic and mitigate the associated complications.

Objective To investigate the differentially expressed genes of urine samples from renal fibrosis model and carry out bioinformatics analysis.Methods Rat renal fibrosis model was constructed with the method of unilateral ureteric obstruction.Urine were collected from the rats with unilateral obstructive nephropathy and sham group, respectively.Total RNA was extracted and sequencing library was established.Differential expression mRNA were analyzed by GO and KEGG pathway.Known pre-miRNA were detected and novel lncRNA family were classified.Results Compared with the sham group urine, 813 up-regulated mRNA/lncRNA and 213 down-regulated mRNA/lncRNA were collected from the urine of renal fibrosis rats.Conclusions There are significant differential expression profile in urine samples between renal fibrosis rat group and the shame group.With high-throughput transcriptome sequencing and bioinformatics analysis, the exciting possibility was raised for better understanding renal pathologies and development of new diagnostic biomarkers.

Objective To investigate the effect of our self-developed acetabular reduction clamp in the treatment of fractures of acetabular posterior column.Methods The data were retrospectively analyzed of the 32 patients who had been treated for acetabular posterior column fractures using our self-developed acetabular reduction clamp at Department of Minimally Invasive Surgery,Zhengzhou Orthopaedics Hospital from August 2016 to June 2018.They were 17 males and 15 females,aged from 18 to 62 years (average,41.3 years).According to the Letournel-Judet classification,there were 9 simple posterior column fractures,14 posterior column plus posterior wall fractures,4 T-shaped fractures and 5 double column fractures.The Kocher-Langenbeck (K-L) incision was used for simple posterior column and posterior column plus posterior wall fractures,and the K-L combined with anterior ilioinguinal approach for T-shaped and double column fractures.The displaced posterior column fracture was repositioned with our novel reduction clamp before pelvic reconstruction plate was used for fixation.The quality of fracture reduction,fracture union time,complications and hip function score at the last follow-up were recorded.Results This series of 32 patients were followed up for 7 to 20 months (average,12.9 months).According to the Matta scores for fracture reduction at the last follow-up,15 cases were excellent,16 good and one poor,yielding an excellent and good rate of 96.9％.The fracture union time ranged from 3 to 6 months (average,4.7 months).According to the modified Merle d'Aubign scores at the last follow-up,hip function was excellent in 18 cases,good in 11 and fair in 3,yielding an excellent and good rate of 90.6％.Postoperative symptomatic distraction injury to the sciatic nerve appeared in 2 patients,postoperative wound lipid liquefaction developed in one and heterotopic ossification of Brooker grade Ⅱ was observed in 2 patients during follow-up.Conclusion In the treatment of acetabular posterior column fracture with open reduction and internal fixation with pelvic reconstruction plate through the K-L approach,our novel acetabular reduction clamp can be used safely and effectively to assist fracture reduction,leading to satisfactory results.

Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.

This study was aimed to investigate the effect of Compound Danshen injection in treatment of dysphagia by electromyography (EMG) guided on new Renying point caused by bulbar paralysis after stroke.A total of 60 patients with dydphagia caused by cerebral palsy after stroke were randomly divided into the experimental group and the control group (30 patients in each group).Patients in the control group were conducted with routine treatment,local low frequency electrical stimulation and rehabilitation training.Patients in the experimental group were treated with acupoint injection therapy guided by EMG on the basis of treatment of the control group.Four weeks were one treatment course.Observations were made on changes of indexes,such as water swallow test,swallowing ability evaluation,and etc.between two groups.The results showed that the cure rate of the experimental group was 76.67％,which was higher than that of the control group (50.00％).The treatment efficiency of the experimental group (93.33％) was higher than that of the control group (80.00％),with statistical significance (P ＜ 0.05).It was concluded that clinical effects of EMG guided injection on new Renying point in the treatment of dysphagia caused by bulbar paralysis in the experimental group was better than that of the control group.It is worthy widely applied and distributed in clinical practices.

Objective:To explore the strategies for reduction of irreducible intertrochanteric fractures according to our self-designed new classifications.Methods:A retrospectively study was conducted to analyze the data of 124 patients with irreducible intertrochanteric fracture who had been admitted to Department of Minimally Invasive Orthopaedics, Zhengzhou Orthopaedics Hospital from January 2019 to December 2021. There were 56 males and 68 females with a mean age of (76.8±13.2) years. According to the displacement pattern of the proximal head-neck fragment of the fracture, the irreducible intertrochanteric fractures of the femur were classified into 3 types. In type 1 (rotational type) of 65 cases, there were 24 cases of subtype 1.1 (the lesser trochanter attached to the distal fracture fragment), 8 cases of subtype 1.2 (the lesser trochanter attached to the proximal fracture fragment), and 33 cases of subtype 1.3 (the lesser trochanter floating). In type 2 (locked type) of 18 cases, there were 13 cases of subtype 2.1 (lesser trochanter floating), no case of subtype 2.2 (the lesser trochanter attached to the proximal fracture fragment), and 5 cases of subtype 2.3 (the lesser trochanter attached to the distal fracture fragment). In type 3 (reverse trochanter type) there were 41 cases. Under the guidance of our new classification, the patients were treated by fixation with intramedullary nails after reduction with corresponding techniques (like prying, clamping, pulling, and temporary fixation with Kirschner wires). Operation time, intraoperative blood loss, fracture reduction quality and Harris hip score at the last follow-up were recorded.Results:The operation time was (53.0±20.7) min and blood loss (132.1±81.3) mL in this cohort. According to the criteria proposed by Chang and Kim et al., the quality of fracture reduction was evaluated as excellent in 101 cases, as good in 17 cases, as fair in 4 cases, and as poor in 2 cases, resulting in an excellent and good rate of 95.2% (118/124). All the 124 patients were followed up for an average of (12.4±3.7) months. First-stage fracture union was achieved in 120 patients, and fracture union was achieved in 2 patients of type 3 with breakage of the main nail only after replacement of the intramedullary nail. The mean healing time for the 122 patients was (5.1±1.4) months. In addition, hemiarthroplasty was performed in 2 patients of type 1.3 whose femoral head had been cut by a head nail. Postoperatively, urinary tract infection occurred in 5 cases but responded to appropriate symptomatic treatment. The Harris hip score was (94.2±5.4) points at the last follow-up, and 103 cases were excellent, 17 cases good, and 4 cases poor, giving an excellent and good rate of 96.8% (120/124).Conclusion:It is easy to understand and master the new classification of irreducible intertrochanteric fractures based on the displacement of the proximal head and neck bone which can directly and effectively guide the intraoperative reduction, leading to satisfactory reduction and fixation.

Stroke is a major disease that endangers the health of human beings.Since 2015,mechanical thrombectomy has emerged as the primary therapeutic method for acute ischemic stroke.Present guidelines lean towards treating patients with mechanical thrombectomy within a therapeutic window,while the efficacy of thrombectomy beyond 24-hour remains a matter of contention.The authors manuscript undertook a retrospective review of extant clinical research,scrutinizing its safety and efficacy from the standpoint of research design,and offering a detailed synthesis concerning on predictive factors and imaging modalities for selection.

Ischemic stroke is characterized by high rates of prevalence,mortality and recurrence.Atrial fibrillation(AF)is the most common arrhythmia in adults.AF significantly increases the risk of ischemic stroke and stroke recurrence.This review summarized the current research progress on AF screening in ischemic stroke patients,the relationship between AF characteristics,biomarkers and ischemic stroke,as well as the research progress on secondary prevention strategies for patients with concomitant AF,aiming to assist clinicians detect AF at an early stage and prevent stroke recurrence.

Objective:To investigate the effect of follicular size on the clinical outcomes of frozen-thawed embryo transfer induced by human chorionic gonadotropin (hCG) of natural cycles on ovulation.Methods:Clinical data of 427 cycles of frozen-thawed single blastocyst transfer in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into 15-16 mm group (15≤diameter≤16 mm, n=66), 16-17 mm group (1620 mm group (diameter>20 mm, n=26), according to the maximum follicle diameter on the induction day of hCG ovulation induction. The estradiol and luteinizing hormone (LH) levels, and clinical pregnancy rate, abortion rate and live birth rate were compared in five groups. Results:There were statistically significant differences in estradiol and LH levels among the five groups on the day of hCG induction (all P<0.05). Estradiol levels in 15-16 mm group to >20 mm group gradually increased on the day of hCG induction, and estradiol level in 15-16 mm group was significantly lower than those in 17-18 mm group, 18-20 mm group and >20 mm group (median: 1 002.3 vs 1 103.3 vs 1 171.2 vs 1 539.0 pmol/L), with statistical significances ( P=0.034, P<0.001, P=0.002). On the day of hCG induction, LH levels in 15-16 mm group to >20 mm group showed a decreasing trend, and LH level in 15-16 mm group was significantly higher than those in 17-18 mm group and >20 mm group (median: 37.73 vs 28.24 vs 24.11 U/L), with statistically significant differences ( P=0.007, P=0.006). There were no significant differences in clinical pregnancy rate, abortion rate and live birth rate in 15-16 mm group to >20 mm group (all P>0.05). Conclusion:In the natural cycle protocol of hCG induced ovulation, the small follicle group could achieve similar clinical outcomes compared with normal sized follicles in the single blastocyst transfer of frozen-thawed embryos.