Objective To evaluate the effects of different sequences of intravenous administration on sufenta-nyl-induced cough during induction of general anesthesia.Methods One hundred patients,aged 20 ~60 years,weig-hing 45 ~82 kg,ASA Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were equally randomized to two groups by using a random number table:sufentanyl-propofol group(group SP)and propofol-sufentanyl group(group PS).In group SP,sufentanyl 0.4μg/kg was injected intravenously over 5s,and then propofol 2mg/kg was injected intravenously.In group PS,propofol 2mg/kg was injected intravenously,and then sufentanyl 0.4μg/kg was injected intravenously over 5s.The occurrence,intensity and the time of cough were recorded within 1 min after sufentanyl injection.Results The incidence of cough was 38%(19 /50)in group SP which was significantly higher than the 12%(6 /50)in group PS(χ2 =9.013,P <0.01);The time of cough was (20.6 ±5.8)s in group SP and (18.8 ± 8.4)s in group PS,which had no statistical significance(t =1.247,P >0.05).Conclusion Administration in the propofol-sufentanyl sequence can effectively reduce the occurrence of sufentanyl-induced cough as compared with that in the sufentanyl-propofol sequence during induction of general anesthesia.

Objective To investigate the effects and possible mechanism of action of inhibiting hepatitis B virus X protein (HBx) expression on liver cancer metastasis. Methods The suppression of HBx expression in MHCC97H cells was performed by siRNA interference technique, and the effects of HBx suppression on the metastasis of MHCC97H cells were detected by Matrigel invasion assays and in a lung-metastasis mouse model. The expression levels of related epithelial-mesenchymal transition (EMT) and apoptosis proteins were examined by Western blotting. Results Introduction of HBx-siRNA into MHCC97H cells inhibited the expression of HBx and the ability to metastasize,downregulated the expression of Twist and N-cadherin, and upregulated E-cadherin expression. These changes resulted in inhibiting EMT of MHCC97H cells. Meanwhile, apoptosis involved in the Twist-P53 pathway was also found. Conclusions Inhibiting expression of HBx can decrease the metastatic a-bility of MHCC97H cells by changing EMT and inducing apoptosis.

Objective To investigate the health seeking intention and its influencing factors among patients with type 2 diabetes in Chongqing Chronic Disease Management System.Methods Multistage cluster random sampling was used to investigate basic information,diabetes-related treatment situation including first heal seeking and reasons for choosing medical institutions in the last year.Relative risk ratios (RRR) and its influencing factors were analyzed with the method of multi-nominal Logistic regression,as community as a reference.Results Over the past year,38.02％ of type 2 diabetes patients preferred to hospitals above the county level,36.78％ preferred to pharmacy or clinics,and 25.21％ preferred to community health service centers.Univariate analysis showed that different education levels,family income levels,health insurance and therapies were significantly different from health seeking intention.Multi-nominal Logistic regression results indicated that higher educational level (RRR =2.39,95％ CI:1.20-4.78),higher income level (RRR =3.37,95％CI:1.44 -7.88),applying to specific diseases medical insurance (RRR =3.32,95 ％CI:1.72-6.42),the use of insulin and oral hypoglycemic agents (RRR =5.02,95％CI:1.15-22.00) of respondents were more inclined to the hospitals above the county level,rather than community health services.Conclusions Health seeking intention of type 2 diabetes patients preferred to hospital above the county level in Chongqing.Type 2 diabetes was an important disease of non-infectious chronic diseases,while the patients preferred go to utilize hospitals rather than community services.

Objective To establish a mouse model of biliogenic severe acute pancreatitis (SAP) by using a self-made device for retrograde injection of sodium taurocholate into common bile duct,and to investigate the improvement of the device on retrograde injection of sodium taurocholate into common bile duct and its safety.Methods Thirty-six adult male ICR mice were randomly divided into biliogenic SAP model group and sham group,with 18 mice in each group.A 40 U disposable insulin syringe,a 200 μL tips and a 25 μL micro-syringer were used as basic materials for making the mouse common bile duct injection device [National Utility Model Patent (ZL 2014 2 0694365.4)].In model group,3.5％ sodium taurocholate (1 mL/kg) was injected retrogradely into the common bile duct of mice,whilst in sham group,the mice underwent the injection of equal amount of normal saline instead.Six mice in each group were sacrificed at 6,24 and 48 hours after operation,and the abdominal aortic blood was collected.Serum amylase (AMY),alanine aminotransferase (ALT),creatine kinase-MB (CK-MB),serum creatinine (SCr),oxygenation index (PaO2/FiO2) as well as serum Ca2+ were.determined.Pathological change in pancreas was observed under conventional light microscopy after hematoxylin and eosiu (HE) staining,and the impairment was evaluated by a widely used score system.Results The injection device was easily placed into mouse common bile duct under macroscopic observation.Six hours after operation,the levels of serum AMY,ALT and SCr in model group were significantly higher than those in sham group,and peaked at 24 hours,and they slightly decreased at 48 hours,which were still significantly higher than those of the sham group [24-hour AMY (U/L):7 325 ± 1 154 vs.1 737 ± 197,24-hour ALT (U/L):176.0±5.0 vs.38.3 ± 2.0,24-hour SCr (tmol/L):46.3 ± 1.5 vs.17.8 ±0.6,all P ＜ 0.01].The level of CK-MB at 6 hours in the model group was significantly higher than that of the sham group,and peaked at 48 hours (U/L:749.8±42.2 vs.383.3±35.5 at 6 hours,3 340.1 ± 203.6 vs.704.6 ± 63.5 at 48 hours,both P ＜ 0.01).PaO2/FiO2 at 6 hours after the operation in model group was significantly lower than that of sham group,then it began to rise at the similar level in sham group at 48 hours [mmHg (1 mmHg =0.133 kPa):327.5±33.8 vs.424.8±31.0 at 6 hours,P ＜ 0.01;429.8 ±41.8 vs.464.7±43.3 at 48 hours,P ＞ 0.05].Ca2+ level in model group was continuously decreased after operation,and it was significantly lower than that of sham group at 48 hours (mmol/L:1.58 ± 0.14 vs.2.45 ± 0.21,P ＜ 0.01).The pancreatic edema was obvious after operation in sham group,with the observation time prolongation,the changes were gradually improved;pancreatic focal necrosis was found at 6 hours after operation in model group,and it was secondary aggravated,and pancreatic lobule structure disappearance and inflammatory cells extensive infiltration was found at 48 hours.Pathological score of the model group was significantly higher than that of sham group at each time point,and peaked at 48 hours (13.3 ±0.3 vs.3.0±0.1,P ＜ 0.01).Conclusion It is a highly efficient and low-cost way to induce biliogenic SAP in mice by retrograde injection of 3.5％ sodium deoxycholate into common bile duct via the self-made injection device,and the model conformed to the clinical characteristics of biliogenic SAP.

Objective To evaluate the methodological performance of the new enzymatic method for detecting glycated hemo-globin(HbAIc)and its influencing factors.Methods HbAIc was detected by the enzymatic method.The precision,anti-interfer-ence,recovery rate,accuracy and the influence of pre-processing(anti-coagulation,preservation,centrifugation)on the detection re-sults were evaluated,its correlation with HPLC and the bias degree were analyzed.Results The within-run coefficients of variation (CVs)for high,middle and low value QC samples in the enzymatic assay were 1.04%,1.26% and 1.37% respectively and the be-tween-run CVs were 1.83%,2.24% and 2.64%,respectively;the enzymatic method showed the linear correlation with HPLC(r=0.996,P <0.01);the HbA1c target value concentrations were 5.20%,6.40%,7.60%,8.80%,10.00% and 11.20% respectively, the recovery rates were 100.15%,98.91%,98.84%,98.20%,103.62% and 99.82% respectively;the interference test showed that this method had no significant interference on the detection results when glucose <15.50 mmol/L,UA<516.00 μmol/L,bili-rubin <217.00 μmol/L,triglyceride<10.20 mmol/L,urea<11.50 mmol/L,albumin<50 g/L and globulin <50 g/L.The HbA1c detection results in the samples with anti-coagulation by heparin sodium,EDTA-2K and sodium citrate stored for 3 d under -20-20 ℃ had no obvious change (P >0.05);the sample was centrifuged at 500,1 000 r/min(R=15 cm)for different time(1,2,5,10 min)and at 2 000 r/min for 1 min,their detection results had statistical differences compared with the sample centrifuged=3 000 r/min for 5 min (P <0.05).Conclusion The precision,anti-interference,accuracy and linearity range of the enzymatic method all conform to the clinical requirement.Compared with the conventional method,its correlation is good with small deviation,which can entirely satisfy the demand of the HbAIc detection in clinic.

Ureteral calculi after lingual mucosal ureteral reconstruction are rare. In this paper, we reported a case of a male patient who had undergone robotic-assisted laparoscopic lingual mucosal right ureteroplasty. Calculi were found in the right reconstructed ureteral segment 4 months after surgery. Then the patient underwent transurethral ureteroscopic holmium laser lithotripsy combined with a stone retrieval basket, and postoperative urological CT showed no residual calculi in the right ureter. No recurrence of right ureteral calculi or complications were observed during 20 months of follow-up.

Objective This study aims to establish an approach to integrate autonomous maximal smile(AMS)3D facial image with digital 3D dental models to demonstrate the digital orthodontic set-up in the 3D facial context.Methods Using Geomagic Studio software,the AMS 3D facial image and pre-treatment dental model were manually and globally registered.Subsequently,the pre-treatment dental model was substituted with the predicted post-treatment dental model.The intraoral region of the AMS 3D facial image was removed,achieving a conjunctive display of the AMS 3D facial image and the post-treatment dental set-up.The distances between four groups of corresponding landmark pairs on the AMS 3D facial image and the pre-treatment dental set-up were calculated,and the accuracy of the registration operation was evaluated by paired t-test.Results The novel approach effectively facilitated the integration of AMS 3D facial images with the pre-treatment and predicted post-treatment 3D dental models.The average distances between the pairs of points were(1.19±0.55)mm and(1.55±0.59)mm for the two registrations,respectively.Notably,no statistically significant difference was observed be-tween the two measurements(P>0.05),indicating a high agreement(intraclass correlation coefficient=0.914).Conclu-sion This study established an approach to integrate AMS 3D facial images with digital 3D dental models.Through this approach,the digital orthodontic set-up design can be displayed in the context of a 3D facial image,which may help to improve the quality of outcome set-up in digital orthodontics,such as clear aligner therapy.

OBJECTIVE: To compare the treatment costs on type 2 diabetes between patients with and without specific diseases health insurance, and to identify the influencing factors related to specific diseases health insurance application. METHODS: A structured questionnaire was used to investigate basic information, diabetes-related pharmacy, outpatient and inpatient treatment costs. SAS9.1 software was used for statistical analysis. The enumeration data was analyzed by using Chi-square test, and variables of statistical difference were bought into Logistic regression model through stepwise method. Continuous variables were represented by median(inter-quartile range)[M(Q)], and were analyzed by using Wilcoxon test. RESULTS: Compared with patients without specific disease health insurance in outpatient group, patients with specific disease health insurance had higher annual per capita total cost [2160(3081) vs 1000(2100) yuan, P<0.01] and lower out-of-pocket expense ratio [54.04% vs 93.78%, P<0.01]. Patients with middle or high level income (OR=1.94 and 2.11), participated in urban employee basic medical insurance (OR=4.19) and duration of disease >5 years (OR=2.04) were more likely to succeed in specific diseases health insurance application. CONCLUSION To reduce the financial burden of patients with type 2 diabetes, government should make huge efforts to promote specific disease health insurance policies, and encourage patients to apply for it. Meanwhile, medical insurance department and medical institutions should reinforce supervision and simplify the application process. To improve the availability of specific disease health insurance, the number and coverage of designated retail pharmacies should be increased. Besides, government should pay more attention to low-income patients and those with short duration diabetes, so as to enhance their ability to resist economic risks and reflect the fairness of specific disease health insurance.
Diabetes Mellitus, Type 2 ; drug therapy ; economics ; Health Care Costs ; Hospitalization ; Humans ; Insurance Coverage ; Insurance, Health ; Logistic Models ; Retrospective Studies

Objective : To investigate the achieved intrusion amount of the maxillary incisors and the influencing factors in clear aligner cases treated with extraction of premolars. Methods : This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. Thirty adult female patients who underwent extraction of the bilateral maxillary first premolars followed by clear aligner therapy were included. CBCT data before and after treatment were obtained, and three-dimensional reconstruction with registration alignment was performed. A spatial coordinate system was established, and the achieved intrusion amount was measured, followed by calculation of the intrusion efficacy. The factors related to the achieved intrusion amount were investigated through multiple linear regression analysis. Results : The overall efficacy of maxillary incisor intrusion was 54%, with the maxillary central incisors (48%) lower than the lateral incisors (59%), which was statistically significant (P<0.001). Regression analysis showed that the designed intrusion amount and the stepwise intrusion design were positively correlated with the achieved intrusion amount. The designed retroclination amount and use of class Ⅱ intermaxillary elastics were negatively correlated with the achieved intrusion amount. The initial overbite, overjet, crowding, upper central incisor inclination, amount of the first series of aligners, canine attachment type, posterior teeth attachment type and bite ramps had no significant correlation with the achieved intrusion amount. Conclusion In maxillary first premolar extraction cases treated with clear aligners, the upper central incisors have lower efficacy of intrusion movement than the lateral incisors. The achieved intrusion amount of maxillary incisors was influenced by multiple factors, which should be considered comprehensively for better vertical control in such cases.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.