Objective Surgical stress induces a series of endocrine and metabolic changes including glucose metabolism and insulin-resistance. The purpose of the present study was to investigate the changes in glucose transporter-4 (Glut-4) mRNA expression in skeletal muscle after cholecystectomy under epidural block. Methods One gram of the rectus abdominis muscle was taken while abdomen was being opened and closed in patients undergoing cholecystectomy under epidural block. Total RNA of the muscle cells was extracted by trizol one-step template. RT-PCR was used to determine the Glut-4 mRNA amplification products with ?-actin mRNA as an internal control. The Glut-4 mRNA expression was expressed by (desired gene/ ?-actin?100% . The plasma glucose and insulin levels were determined at the same time. Results Glut-4 mRNA expression was significantly reduced (P 0.05 ) . Conclusions The results indicated that the synthesis of Glut-4 is suppressed by surgical stress of cholecystectomy under epidural block leading to insulin resistance.

Objective To investigate the role of pentose phosphate pathway (PPP) after upper abdominal operationMethods Twenty-six patients undergoing upper abdominal surgery, were divided randomly into three groups: epidural block(EB,n=10), intravenous propofol anesthesia(PRO, n=10) and intravenous procaine balanced anesthesia(IPBA,n=6) The venous blood samples were collected to measure of erythrocytes hexokinase (HK), phosphofructokinase (PFK) and glucose-6-phasphate dehydrogenase (G-6PD), and activities, and plasma glucose before anesthesia induction, 60 min after incision,60 min after surgery, on the 1st and 2nd postoperative daysResults Compared with the values before anesthesia, the activities of erythrocyte HK and PFK decreased significantly on the 1st postoperative day in three groups (P

ObjectiveTo evaluate the effect of surgical treatment of distal tibial facture with minimally invasive perutaneous locking compression plate osteosynthesis.Methods38 patients with distal tibial fracture were treated with minimally invasive percutaneous locking compression plate(LCP) osteosynthesis.According to AO classification,twelve patients belonged to type A,fifteen type B,and eleven type C.ResultsAll patients were followed up for 6 to 19 months,with an average time of 9 months.The X-ray pictures showed that one-stage union was achieved in the patients,with a mean healing time of 16 weeks.No complications such as infection,non-union were found.The clinical outcomes were evaluated according to Mazur ankle joint function scoring.Twenty-nine were rated as excellent,six as good and three as fair,with the good-excellent rate of 92.1％.ConclusionMinimally invasive peteosynthesis is a kind of a good fixation in treatment of accelerating bone and soft tissue healing.

Objective To evaluate operative methods and the clinical effect for comminuted calcaneal fractures.Methods 21 cases(24 feet)of comminuted calcaneal fractures were treated by one stage bone grafting plus open reduction and internal fixation with plastic calcaneus titanium plate.The fractures were classified according to the Sanders system into Sanders Ⅱ,Ⅲ and Ⅳ subgroups.Results All cases were followed up for 9～20 months(14months in average).All cases recovered with good healing of fracture.According to Maryland score,the results were excellent in 14 feet,good in 7 feet,fair in 2 feet,and poor in 1 foot.The excellent and good rate was 87.5％.Conclusions By using the method of internal fixation with plastic calcaneus titanium plate,fracture site can be well exposed,which is helpful to recover calcaneus to its normal length,width,height,Gissane angle and Bohler angle.A reliable internal fixation is helpful for early stage functional excise after surgery,which can maximize the recovery of the ankle function.

Objective To evaluate the risk of cardiovascular adverse events using nonsteroidal anti-inflammatory drugs during the perioperative period.Methods A systematic review of formally published in English and Chinese literature was conducted by using computerized database on PubMed, Web of Science, Medline, Cochrane Library, CNKI and Wanfang database.The literature about controlled clinical study of nonsteroidal anti-inflammatory drugs in perioperative use, a prospective cohort study and a retrospective review were collected.The cardiovascular risk was evaluated by the number of adverse cardiovascular events cases (myocardial infarction, angina, myocardial ischemia, arrhythmia) occurred during the period of drug use.The relevant data was extracted and their heterogeneity was tested.Results A total of 8 articles including 15 623 patients met the inclusion criteria, including 5 articles (n=13 019) on non-selective nonsteroidal anti-inflammatory drugs, and 3 articles (n=2 604) about selective (cyclooxygenase 2) COX-2 inhibitors.Nonsteroidal anti-inflammatory drugs used in the perioperative or a short term would reduce the risk of adverse cardiovascular events (OR=0.59, 95%CI 0.45-0.77, P=0.000 1), non-selective nonsteroidal anti-inflammatory drugs using in the perioperative or a short term would reduce the risk of adverse cardiovascular events, the difference being statistically significant (OR=0.42, 95%CI 0.31-0.58, P＜0.001).A selective COX-2 inhibitor using in the perioperative or short-term might increase cardiovascular adverse events (OR=2.53, 95%CI 1.26-5.09, P=0.009).Conclusion Non-selective nonsteroidal anti-inflammatory drugs should be chosen for patients at high risk of adverse cardiovascular events during the perioperative period.

Under the background of " Internet+ medical treatment" and the continuous deepening of face recognition technology research, the face recognition industry has continued to mature, and face recognition has been initially applied in medical fields such as hospital management, auxiliary medical care, and epidemic prevention and control. At the same time, face recognition technology brings problems including error risk, technical cracking risk, privacy risk, equality risk, abuse risk, and other issues in practice, which seriously threaten the personal and property rights and interests of the public. On the basis of summarizing the specific application direction of face recognition technology in hospitals, the authors sorted out the legal regulation of face recognition in China, and proposed that it should be based on technology research and development, strengthen the " gatekeeper" responsibility of medical institutions, improve legal system and recommendations for strengthening judicial leadership in order to improve the legal regulations of face recognition technology, reduce the risk of infringement by medical institutions in the application of face recognition technology, and protect the legitimate rights and interests of citizens.

Objective To evaluate the effects of low pneumoperitoneum pressure under deep muscle relaxation on inflammatory factors,oxidative stress and morphology of distal greater omental capillary endothelial cells in patients undergoing laparoscopic radical gastrectomy(LAG)for gastric cancer.Methods Sixty patients with LAG were selected from January to June 2022,45 males and 15 females,aged 40-75 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ.Patients were randomly divided into two groups:low pneumoperitoneum pressure group(group PL)and the control group(group PH),30 patients in each group.Both groups were treated with deep muscle relaxation condition(PTC=1 or 2),and the pneumo-peritoneum pressure was set at 10 mmHg in group PL,and 14 mmHg in group PH.The duration of pneumo-peritoneum maintenance,surgical time,anesthesia time,extubation time,PACU stay time,postoperative hospitalization time,the number of effective PCIA compressions and total PCIA compressions within 48 hours after surgery,and number of relief analgesia were recorded.The plasma concentrations of interleukin-1 β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α),contents of malondialdehyde(MDA),superoxide dismutase(SOD),and reduced glutathione(GSH)were recorded 5 minutes before induction,5 minutes before abdominal closure,and 24 hours after surgery.The morphology of capillary en-dothelial cells in the omental membrane was observed 5 minutes after opening abdomen and 5 minutes before abdominal closure.Results Compared with group PH,the number of effective PCIA compressions and total PCIA compressions in group PL were significantly reduced within 48 hours after surgery(P＜0.05),the concentration of IL-6 was significantly decreased in group PL 5 minutes before abdominal closure and 24 hours after surgery(P＜0.05),the content of MDA was significantly decreased in group PL 5 minutes be-fore abdominal closure(P＜0.05).The endothelial cell of the greater omental capillaries was slightly edematous and unevenly thick,while the nuclear contractile function was slightly weakened and the vascular lumen was moderately narrowed in group PL 5 minutes before abdominal closure.By contrast,the group PH showed obvious swelling of the endothelial cells with significant intracellular fluid accumulation and severe edema,while the vascular lumen turned to be extremely narrow and the nucleus became severe swelling.Conclusion The use of deep muscle relaxation with low abdominal pressure at 10 mmHg in laparoscopic surgery for gastric cancer can diminish inflammation and oxidative stress,alleviating postoperative pain,re-duce the pneumoperitoneum pressure-induced damage on capillary endothelial cells,and leading to better early postoperative recovery.

With the steady progress of the rule of law for Internet in China, " Internet+medicine" is drawing greater attention and legislative demand. The enactment of E-commerce Law in early 2019 has provided rich legal connotations of " Internet+" commerce scenario, clarifying its legal subject scope and legal service scope.The authors analyzed the legal system of medical E-commerce, and the legal obligations of medical E-commerce. From the following four aspects of legitimate business conduct, consumer rights protection, platform responsibility and intellectual property protection, the authors held that the current legal regulation of medical E-commerce is plagued by major setbacks as follows.These setbacks include incomplete legislation, low legal ranking, ambiguous subject definition and legal guidance, as well as lack of behavior regulation and unclear legal obligations.In this regard, the state is recommended to advocate the enactment of the Pharmaceutical E-commerce Law, speed up the revision of a series of laws and regulations, and improve the supporting service policies as a whole, so as to strengthen the rule of law regulation of future pharmaceutical E-commerce.

The aim of this study was to clone the goat RPL29 gene and analyze its effect on lipogenesis in intramuscular adipocytes. Using Jianzhou big-eared goats as the object, the goat RPL29 gene was cloned by reverse transcription-polymerase chain reaction (RT-PCR), the gene structure and expressed protein sequence were analyzed by bioinformatics, and the mRNA expression levels of RPL29 in various tissues and different differentiation stages of intramuscular adipocytes of goats were detected by quantitative real-time PCR (qRT-PCR). The RPL29 overexpression vector pEGFP-N1-RPL29 constructed by gene recombination was used to transfect into goat intramuscular preadipocytes and induce differentiation. Subsequently, the effect of overexpression of RPL29 on fat droplet accumulation was revealed morphologically by oil red O and Bodipy staining, and changes in the expression levels of genes related to lipid metabolism were detected by qRT-PCR. The results showed that the length of the goat RPL29 was 507 bp, including a coding sequence (CDS) region of 471 bp which encodes 156 amino acid residues. It is a positively charged and stable hydrophilic protein mainly distributed in the nucleus of cells. Tissue expression profiling showed that the expression level of this gene was much higher in subcutaneous adipose tissue and inter-abdominal adipose tissue of goats than in other tissues (P < 0.05). The temporal expression profile showed that the gene was expressed at the highest level at 84 h of differentiation in goat intramuscular adipocytes, which was highly significantly higher than that in the undifferentiated period (P < 0.01). Overexpression of RPL29 promoted lipid accumulation in intramuscular adipocytes, and the optical density values of oil red O staining were significantly increased (P < 0.05). In addition, overexpression of RPL29 was followed by a highly significant increase in ATGL and ACC gene expression (P < 0.01) and a significant increase in FASN gene expression (P < 0.05). In conclusion, the goat RPL29 may promote intra-muscular adipocyte deposition in goats by up-regulating FASN, ACC and ATGL.
Animals ; Lipogenesis/genetics* ; Adipogenesis/genetics* ; Goats/genetics* ; Adipocytes ; Cell Differentiation/genetics* ; Sequence Analysis ; Cloning, Molecular