Objective To investigate the clinical manifestation of convulsive status epilepticus (CSE) associated with the outcome of children contracted this illness in order to make an effort to prevent and treat those children. Method The patients with CSE admitted from October 1998 to October 2008 were prospectively and consecutively enrolled. All the patients met the diagnostic criteria set by International Anti-epilepsy Union (ILAE) in 1993. The prognosis predictors of outcome were analyzed with the Rank sum test, Chi-square analysis and Logistic regression analysis. Results A total of 169 patients with CSE were enrolled. Of them, 92 patients were from rural areas (54.4% ). The primary cause was central nervous system infection, and the minor ones were a reduction of dose or withdrawal of the antiepileptics, and cerebral hemorrhage. The duration of CSE before treatment was longer in rural patients than in urban residents ( P < 0.01) . The duration of CSE before treatment and the total persistence time of CSE was significantly associated with the mortality 14.2% . The source of patients, the duration before treatment, and respiratory depression were independent prognostic predictor variables of CSE (P < 0.05) .Conclusions The rural patients account for the major ratio of convulsive status epilepticus. Central nervous system infection is the primary cause. The duration before treatment and total persistence time of CSE are highly related to the mortality and morbidity.

BACKGROUND: During spinal orthopedic repair, the main difficulty is to maximize the correction of the deformity, simultaneously, to reduce the incidence of trauma and complications, especial y to avoid the corresponding spinal nerve injury. OBJECTIVE: To evaluate the curative effect of one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine. METHODS: We retrospectively analyzed the data of 42 cases of rigid angular kyphosis of thoracolumbar spine that were treated by one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation. Al patients received detailed imaging examination before and after operation. Kyphosis angle, Frankel grading and perioperative complications were recorded in al patients. X-ray films or CT films showed the bone graft fusion during fol ow-up. RESULTS AND CONCLUSION: Patients were fol owed up for 10-36 months after treatment. The average time of bone graft fusion was 5.1 months. Cobb’s angle of kyphosis was corrected from 78.4° (38°-110°) preoperatively to 7°(-8°-24°) at 10 days after treatment. The correction rate was 90%. The average angle during final fol ow-up was 7.9°, with an average loss of 0.9°. In 16 paresis patients, Frankel grading results showed grade B in 0 case, grade C in 3 cases, grade D in 5 cases, and grade E in 8 cases during final fol ow-up, showing significant improvement as compared with that pre-treatment (P < 0.05). Among 42 patients, 5 cases had complications. At 7 months after treatment, there were screw and titanium rod loosening at the distal end of the fusion segment in 1 case, cerebrospinal fluid leakage in 2 cases, transient double lower limb weakness in 1 case, pain in one side of lower limb in 1 case, and no severe complications appeared. These results verified that one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation could achieve satisfactory clinical outcomes in rigid angular kyphosis of thoracolumbar spine. The internal fixation was stable and with a high fusion rate and few complications. The medium-term effect was satisfactory.

Objective To investigate and analyze risk factors of re-fracture after operation of osteoporotic hip fracture.Methods Two hundred forty-seven patients receiving operation of osteoporotic hip fracture were retrospectively studied and followed up,and all patients were divided into re-fracture group (54 patients) and no-re-fracture group (193 patients).The related factors such as sex,age,body mass index (BMI),affected side,initial fracture site,operation type,perioperative blood loss,postoperative delirium,postoperative bedridden time,medical complications,Charlson comorbidity index,antiostoporosis therapy,hip function scores with Harris and functional independence measurement (FIM) scores were compared by single factor analysis and multivariate Logistic regression analysis.Results Single factor analysis and multivariate Logistic regression analysis both showed that the risk factors of re-fracture after operation of osteoporotic hip fracture included age,postoperative delirium,hypertension,diabetes mellitus,cerebrovascular disease,antiostoporosis therapy,hip function scores with Harris and FIM scores (P ＜ 0.05 or ＜ 0.01).Conclusions Risk factors of re-fracture after operation of osteoporotic hip fracture include passive factors of age,postoperative delirium and medical complications,and subjective factors of antiostoporosis therapy,hip function scores with Harris and FIM scores.Patients should receive medical treatment positively,enhance antiostoporosis therapy and rehabilitation training of hip function to prevent re-fracture.

Objective:To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor (CLST) and provide reference for clinical diagnosis and treatment of CLST.Methods:From January 1, 2016 to June 30, 2021, the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected. The clinical and pathological characteristics of CLST were analyzed in terms of lesion location (right colon, left colon, rectum) and morphological type (granular-homogeneous type, granular-mixed type, flat-elevated type, and pseudo-depressed type). One-way analysis of variance, Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results:A total of 266 patients with CLST and 296 CLST lesions were included. The most common maximum diameters of the lesions were 10 to 29 mm, accounting for 85.1% (252/296). The main morphological type was granular type, accounting for 81.4% (241/296), and the main pathological type was adenoma, accounting for 79.7% (236/296), and the most common histological type was low-grade intraepithelial neoplasia (LGIN), accounting for 81.1% (240/296). The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon ((24.20±16.97), (18.38±8.24) and (18.59±7.95) mm, respectively), and the difference was statistically significant ( F=6.62, P<0.001). The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon (22.0%, 11/50, 53.5%, 69/129 and 58.9%, 69/117, respectively), while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon (50.0%, 25/50; 29.4%, 38/129 and 24.8%, 29/117, respectively), and the differences were statistically significant ( χ2=20.06 and 10.67, both P<0.01). The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum (68.2%, 88/129; 87.2%, 102/117 and 92.0%, 46/50, respectively), while the incidence of serrated adenoma in CLST in the right colon was higher than that in the left colon and rectum (30.2%, 39/129; 12.8%, 15/117 and 4.0%, 2/50, respectively), and the differences were statistically significant ( χ2=19.25 and 20.85, both P<0.001). The CLST in left colon was mostly treated by endoscopic submucosa dissection (94.9%, 111/117), while the CLST in rectum was mostly treated by endoscopic mucosal resection (20.0%, 10/50), and the difference was statistically significant ( χ2=8.77, P=0.012). The maximum diameter of the pseudo-depressed type CLST was larger than that of the granular-homogeneous type, granular-mixed type and flat-elevated type ((24.18±14.07), (15.96±5.70), (23.49±13.80) and (21.21±8.02) mm), and the difference was statistically significant ( F=13.40, P<0.001). The incidence of adenoma in flat-elevated type CLST was higher than that of the granular-homogeneous type, granular-mixed type and pseudo-depressed type (92.1%, 35/38; 71.1%, 106/149; 86.9%, 80/92 and 15/17, respectively), and the difference was statistically significant ( χ2=14.13, P=0.003). The incidence of serrated adenoma in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (28.9%, 43/149; 10.9%, 10/92; 5.3%, 2/38 and 1/17, respectively), and the difference was statistically significant ( χ2=19.98, P<0.001). The incidence of adenocarcinoma in the pseudo-depressed type CLST was higher than that of the granular-homogeneous type, granular-mixed type and flat-elevated type (1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38, respectively), and the difference was statistically significant (Fisher′s exact test, P=0.049). The incidence of LGIN in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (90.6%, 135/149; 76.1%, 70/92; 65.8%, 25/38 and 10/17, respectively), while the incidences of high-grade intraepithelial neoplasia and carcinoma in the pseudo-depressed type CLST were higher than those of the granular-homogeneous type, granular-mixed type and flat-elevated type (6/17; 9.4%, 14/149; 21.7%, 20/92; 31.6%, 12/38 and 1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38), and the differences were statistically significant( χ2=21.58 and 16.81 and Fisher′s exact test, all P<0.05). Conclusions:The clinicopathological characteristics of CLST have certain specificity. The maximum diameter and malignant potential of the rectal CLST are both larger and higher than those of the colonic CLST. Although the granular-mixed type CLST is the granular type, it shows a larger maximum diameter and a higher degree of malignancy.

Objective To analyze the effect of different doses of esketamine and different time in-tervals on reducing propofol injection pain(PIP)before intravenous propofol using factorial design.Methods A total of 360 elective general anesthesia surgical patients,167 males and 193 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ were selected.Randomized numerical table method was used to divide the patients into three groups:esketamine 0.05 mg/kg(group A),esketamine 0.075 mg/kg(group B),and esketamine 0.1 mg/kg(group C),120 cases in each group.Each group was further randomly divided into 3 subgroups with 40 cases in each.Groups A1,A2,and A3 received intrave-nous propofol after induction of anesthesia with intravenous esketamine 0.05 mg/kg at intervals of 30 sec-onds,45 seconds,and 1 minute respectively.Groups B1,B2,and B3 received intravenous propofol after induction of anesthesia with intravenous esketamine 0.075 mg/kg at intervals of 30 seconds,45 seconds,and 1 minute respectively.Groups C1,C2,and C3 received intravenous propofol after induction of anesthe-sia with intravenous esketamine 0.1 mg/kg at intervals of 30 seconds,45 seconds,and 1 minute respective-ly.The McCririck scale was used to evaluate the occurrence of PIP.The induced dose of propofol,postoper-ative nausea and vomiting,respiratory amnesia,irritability,confusion,depressed and other adverse reactions were recorded.Results Comparison of the use of different doses of esketamine or different time intervals on the reduction of PIP showed a statistically significant difference respectively(P＜0.05).There was an interaction between different doses of esketamine and different intervals(P＜0.05).There were no significant differences in propofol induction dose and adverse reactions such as,postoperative nausea and vomiting,respiratory amnesia,irritability,confusion,depressed in nine groups of patients.Conclusion Compared with esketamine 0.05 and 0.1 mg/kg and intervals of 30 seconds and 1 minute,the use of esket-amine 0.075 mg/kg and intervals of 45 seconds followed by intravenous propofol is effective in suppressing PIP without the occurrence of significant adverse effects.

OBJECTIVETo investigate the role of human Wnt7b gene in rat chondrocyte degeneration.

METHODSWnt7b gene obtained by PCR was cloned to PCDH-GFP. 293ft cell line was transfected with PCDH-GFP and PCDH-Wnt7b, and the supernatant and transfected cells were collected. The expression level of Wnt7b in 293ft cells was detected by Western blotting. The first passage of chondrocytes were isolated from articular cartilages of newborn born (within 24 h) SD rats were cultured in the supernatants from the transfected cells (at 10- and 50-fold dilutions). The cell morphology of the rat chondrocytes was observed under inverted microscope, and the protein expressions of MMP13, MMP3 and type II collagen and mRNA expressions of A-can, ADAMTS5, Col X and Sox9 were examined by Western blotting or real-time PCR.

RESULTSHuman Wnt7b gene cloned to PCDH-GFP was expressed efficiently in 293ft cell line. Rat chndrocytes cultured for 24 h in the supernatants from PCDH-Wnt7b-transfected 293ft cells underwent changes from a polygonal to a spindle-shaped morphology. The protein expression levels of MMP13 and MMP3 increased while type II collagen decreased significantly, and the mRNA levels of A-can and Sox9 were down-regulated while Col X and ADMATS5 up-regulated in ratchondrocytes after incubation in supernatants from PCDH-Wnt7b-transfected 293ft cells.

CONCLUSIONHuman Wnt7b gene can be expressed efficiently in 293ft cell line and can induce rat chondrocyte degeneration in vitro.

Animals ; Cartilage, Articular ; cytology ; Cell Line ; Chondrocytes ; pathology ; Humans ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Transfection ; Wnt Proteins ; genetics

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.

Objective:Based on the current medical environment, to learn about cognition status of doctor-patient relationship among medical students and analyze causes of the tension between doctors and patients.Methods:Using the self-designed questionnaire "Clinical Medical Students' Cognition Survey on Occupational Status and Doctor-Patient Relationship", a cross-sectional survey was conducted on 527 medical students from 5-year and 7-year clinical program in Batch 2014 in a medical university in Heilongjiang Province. The survey mainly analyzed the causes of the tension between doctors and patients from the level of medical staff, patients and their families, hospitals and society. SPSS 22.0 was used for descriptive statistics and chi-square test.Results:The results showed that 93.7% of the medical students believed that the current doctor-patient relationship was not harmonious. There were cognitive differences among medical students in different gender ( P=0.029), first contact clinical grade ( P=0.003) and professional identity ( P<0.001). Conclusion:Medical students have a poor evaluation towards the current doctor-patient relationship. In order to construct harmonious doctor-patient relationship in the future, we can try to take measures such as carrying out relevant courses of doctor-patient communication, improving the medical students' communication skills and enhancing their professional identity.

Objective:To analyze the current situation of health education among medical staff at all levels of hospitals in Beijing, for references in improving the level of hospital health education.Methods:From July to November 2022, a stratified random sampling method was used to select medical staff from hospitals at all levels in Beijing as the survey subjects. A self-designed questionnaire was used to investigate the frequency of health education conducted by medical staff in six dimensions. The Likert 5-level scoring method was used to assign scores to the frequency of health education, and latent profile analysis was conducted on each score to explore the categories of health education conducted by medical staff.Results:2 792 questionnaires were effectively collected, among which 2 792 medical staff were surveyed, including 1 009 doctors, 1 609 nurses, and 174 technicians and pharmacists. The scores for the frequency of health education conducted in six dimensions: health education in the media or outside the hospital, health knowledge lectures in the hospital, outpatient health education, inpatient health education, health education during follow-up, and health prescriptions were (1.45±0.68) points, (1.68±1.01) points, (2.65±1.65) points, (2.76±1.74) points, (3.24±1.58) points, and (2.59±1.71) points respectively. According to latent profile analysis, healthcare personnel conducting health education could be divided into four categories: low development group (46.6%, 1 300 people), high development group (4.6%, 129 people), inpatient/follow-up development group (19.4%, 541 people), and outpatient/follow-up development group (29.4%, 822 people). The hospital level and profession of medical personnel in each category were different, and the differences were statistically significant( P<0.001). Conclusions:Medical staff in Beijing mainly carry out health education at such stages as patient follow-up, inpatient, and outpatient, but there is insufficient health education accessible in the media or outside the hospital. There are differences in the health education situation of medical personnel at different levels of hospitals and professions. It is recommended to build an efficient health education management system, actively explore new media-based health education channels, and reasonably allocate health education resources to comprehensively improve the health education of medical staff.

BACKGROUND:Gold nanoparticles are of great significance in the development of multifunctional transdermal drug delivery systems.Smaller gold nanoparticles can penetrate the dermis through the intercellular pathway,but are limited to their easy agglomeration and colloidal morphology,which makes it difficult to exert effects on low delivery efficiency. OBJECTIVE:To develop an ultrasound-optimized hydrogel delivery system by combining phase change nanodroplets with bio-adhesive hydrogel for percutaneous delivery of gold nanoparticles. METHODS:The ultrasound-responsive nanodroplets loaded with gold nanoparticles were prepared by the emulsion solvent evaporation method and loaded into the polydopamine-modified methylacryloyl gelatin hydrogel to prepare a composite hydrogel scaffold.The structure and chemical composition of the ultrasound-responsive nanogold carrier were characterized.The microstructure,porosity,permeability,rheology,in vitro hemostasis,and antibacterial properties of the composite hydrogel were characterized.The cell compatibility of the hydrogel scaffold was evaluated by live/dead staining,and the optimization effects of low-intensity pulsed ultrasound on the permeability,porosity,and mechanical properties of hydrogel were evaluated. RESULTS AND CONCLUSION:(1)Transmission electron microscopy and ultraviolet-visible spectroscopy proved the successful construction of nanogold carriers.The particle size and potential results demonstrated that the synthesized nanoscaled ultrasonic responsive carrier had good stability.(2)Live/dead cell staining proved that the prepared composite hydrogel scaffold had certain biocompatibility.(3)Scanning electron microscopy exhibited that the prepared composite hydrogel scaffold had a porous network structure,and numerous pores of about 2 μm appeared inside the macropores after the addition of nanodroplets and ultrasonic irradiation.The permeability experiment displayed that low-intensity pulsed ultrasound could optimize the porosity and permeability of hydrogel materials.The hemostatic performance of the composite hydrogel scaffold was better than that of the hemostatic sponge and polydopamine@methylacrylylated gelatin hydrogel scaffold.Under the irradiation of low-intensity pulsed ultrasound,the composite hydrogel scaffolds had good antioxidant effects and antibacterial properties.(4)Thermal imaging results manifested that gold nanoparticles were encapsulated in ultrasound-responsive nanobubbles,and more uniform dispersion could be obtained under ultrasonic excitation.(5)The results of the mechanical property test demonstrated that the storage modulus of the hydrogel increased before and after loading gold nanoparticles-nanodroplets,which showed stronger mechanical properties.The elongation at break was 122%,and the ductility was better than that without gold nanoparticles-nanodroplets(P<0.05).(6)These findings indicate that the composite hydrogel scaffold has good biocompatibility,antibacterial property,oxidation resistance,and hemostatic effect.