Objective: To investigate the effects of dexmedetomidine (DEX) on oxidative stress and systemic inflammatory response syndrome(SIRS) during cardiopulmonary bypass (CPB).Methods: Totally 62 patients scheduled for mitral valve replacement surgery were enrolled in this study and randomly assigned to DEX group with constant infusion of DEX (0.5 μg·kg-1 ·h-1 , n =31) and the control group with the same amount of 0.9% sodium chloride injection(n =31).A volume of 4 ml of jugular vein blood was respectively withdrawn before the induction of anesthesia (T0), at 10 min after aortic-off clamping(T1), the end of bypass(T2), 4h after bypass(T3),12h after bypass(T4) and 24h after bypass(T5).The serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6(IL-6), interleukin-8(IL-8) and interleukin-10(IL-10) were determined.Results: The serum CRP in both groups increased remarkably at T1-T5 , while the serum CRP in DEX group was significantly lower than those in the control group at T3-T5.The serum TNF-α increased remarkably in control group at T2-T4, while the serum TNF-α increased remarkably in DEX group at T2-T3;the serum TNF-α in DEX group was significantly lower than those in the control group at T3-T4.The serum IL-6, IL-8, IL-10 in both groups were increased remarkably at T2-T5, T1-T5,T1-T3, respectively.The serum IL-6 and IL-8 in the DEX group were significantly lower than those in the control group at T2-T4 while the serum IL-10 in the DEX group was significantly higher than that in the control group at T1-T3.The serum WBC in both groups at T3-T5 were higher than those at T0, while the serum WBC in the control group was significantly higher than that in the DEX group at T3-T5.However, the differences between the two groups at mechanical ventilation time, ICU observation time, the incidence of postoperative SIRS after 24h, hospitalization days, and the adverse reactions were not statistically significant.Conclusion: DEX has notable protective effects on systemic inflammatory response syndrome during extracorporeal circulation.

Objective To investigate the effect of analgesia with dezocine on CD4+ and CD8+ T lymphocytes in patients after pulmonary lobectomy.Methods Seveuty patients with early non-small-cell lung cancer were selected,and they were scheduled the pulmonary lobectomy.The patients were divided into control group and dezocine group by random digits table method with 35 cases each.The patients in dezocine group were given 0.5 mg/ml dezocine by patient-controlled analgesia (PCA) pump,and the patients in control group were given 0.9％ sodium chloride by PCA pump.The peripheral blood lymphocytes count and percentages of CD4+ T lymphocytes,CD8+ T lymphocytes,natural killer cell (NK cell) before anesthesia induction and 4,24,48 h after operation were detected.Results In control group,the peripheral blood lymphocytes count and NK cell 24 h after operation were (1.08 ± 0.21) × 109/L and 0.141 4 ± 0.021 8,which before anesthesia induction were (1.71 ± 0.33) × 109/L and 0.190 9 ± 0.022 8,and there were statistical differences (P ＜ 0.05).In dezocine group,the peripheral blood lymphocytes count and NK cell 24 h after operation were (1.14 ±0.28) × 109/L and 0.124 9 ± 0.027 6,which before anesthesia induction were (1.69 ± 0.28) × 109/L and 0.198 6 ± 0.027 5,and there were statistical differences (P ＜ 0.05).The CD4+ T lymphocytes 24 h after operation in dezocine group was significantly higher than that in control group (0.355 6 ±0.031 1 vs.0.273 5 ±0.029 4),and there was statistical difference (P ＜0.05).There was no statistical difference in CD8+ T lymphocytes between the 2 groups (P ＞ 0.05).Conclusion Analgesia with dezocine can notably improve immunosuppression in patients after pulmonary lobectomy.

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

OBJECTIVETo compare the obstetric and neonatal outcomes of singleton pregnancies originating from vanishing twin syndrome with those of singleton pregnancies originating from a single gestation following in vitro fertilization-embryo transfer (IVF-ET).

METHODSThis case-control study involved a total of 409 singleton deliveries after IVF-ET/freeze-thawed embryo transfer, including 44 survivors of vanishing twin syndrome (study group) and 365 singletons (control group). The duration of gestation, rate of preterm delivery, neonatal birth weight and proportion of low birth weight were compared between the two groups.

RESULTSOf all the singletons born, 10.8% originated from a vanishing twin gestation. No differences were found in the duration of gestation between the two groups. The mean gestational age was 38.29 ± 1.76 vs 38.45 ± 1.40 weeks (P=0.495) in the study group and controls group, with the rate of preterm delivery of 15.9% vs 10.13% (P=0.298), respectively. The mean birth weight was significantly higher in the control group (3261.8 ± 437.85 g vs 3086.8 ± 527.01 g, P<0.05), but the proportion of low birth weight (<2500 g) showed no significant difference between the study and control groups (6.82% vs 2.74%, P=0.316).

CONCLUSIONSThe survivors of vanishing twin syndrome are at a higher risk of having lower birth weight than singletons of single gestation following IVF-ET.

Birth Weight ; Case-Control Studies ; Embryo Transfer ; Female ; Fertilization in Vitro ; Fetal Resorption ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin ; Premature Birth ; Risk Factors

Objective To compare the changes of four flavonoid glycosides in the leaves of Hippophae rhamnoides L . before and after fermentation .Methods The water extract of Hippophae rhamnoides L .leaves and its fermented tea were con-centrated and desiccated .The dry extracts were dissolved in 70％ ethanol .The chromatographic separation was performed with RP-HPLC method on an Extend-C18 column (4 .6 mm × 250 mm ,5 μm) .Acetonitrile-0 .1％ formic acid was selected as mobile phase at the flow rate of 1 .0 ml/min .The detection wavelength was 356 nm and the column temperature was 30 ℃ .Results The rutin content was high in the leaves of Hippophae rhamnoides L .After fermentation ,isoquercitrin content was increased , while the contents of rutin and narcissoside were reduced and isorhamnetin-3-O-glucoside stayed unchanged .There was a good linear relationship between the concentration and peak areas of the four compounds (r>0 .9997) .The average recoveries were between 96％-103％ .Conclusion This established method is rapid and reliable ,which can be used for the quality control of Hippophae rhamnoides L .leaves and its fermented tea .

Objective To compare the pregnancy and obstetric outcomes in elective single versus two cleavage-stage embryo transfer. Methods Fresh cleavage-stage embryo transfer cycles between January, 2014 and October, 2015 were reviewed, including 39 single embryo transfer (eSET) cycles and 200 double embryo transfer (DET) cycles. The clinical pregnancy rates, implantation rates, multiple pregnancy rates, live birth rate, and obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups. Results The baseline characteristics were comparable between the two groups. The estradiol level on the day of trigger and the oocyte number were significantly higher in eSET group than in DET group (10654.4 pmol/L vs 8284.2 pmol/L and 8.4 vs 7.0, respectively). No significant difference was found in the pregnancy rate (56.4% vs 66.0%) or live birth rate (48.7% vs 51.5%) between the two groups, and their implantation rates differed significantly (56.4% vs 37.8%). No multiple pregnancies occurred in eSET group while the rate of multiple pregnancies was 22.7% in DET group. The gestational age and mean birth weight were significantly higher in eSET group (P<0.05), and the preterm delivery rate after DET was nearly three times of that after eSET, although this difference was not statistically significant. Conclusions Elective single embryo transfer can be performed without compromising the live birth rates. Multiple pregnancy rates can be significantly reduced with eSET, which also results in a higher chance of delivering a term singleton live birth compared with DET.

Objective To compare the pregnancy and obstetric outcomes in elective single versus two cleavage-stage embryo transfer. Methods Fresh cleavage-stage embryo transfer cycles between January, 2014 and October, 2015 were reviewed, including 39 single embryo transfer (eSET) cycles and 200 double embryo transfer (DET) cycles. The clinical pregnancy rates, implantation rates, multiple pregnancy rates, live birth rate, and obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups. Results The baseline characteristics were comparable between the two groups. The estradiol level on the day of trigger and the oocyte number were significantly higher in eSET group than in DET group (10654.4 pmol/L vs 8284.2 pmol/L and 8.4 vs 7.0, respectively). No significant difference was found in the pregnancy rate (56.4% vs 66.0%) or live birth rate (48.7% vs 51.5%) between the two groups, and their implantation rates differed significantly (56.4% vs 37.8%). No multiple pregnancies occurred in eSET group while the rate of multiple pregnancies was 22.7% in DET group. The gestational age and mean birth weight were significantly higher in eSET group (P<0.05), and the preterm delivery rate after DET was nearly three times of that after eSET, although this difference was not statistically significant. Conclusions Elective single embryo transfer can be performed without compromising the live birth rates. Multiple pregnancy rates can be significantly reduced with eSET, which also results in a higher chance of delivering a term singleton live birth compared with DET.

OBJECTIVE: To explore the relationship between the Helicobacter pylori (H.pylori) infection and gastric mucosa change and blood-lipid in people undergoing the physical examination in Changsha. METHODS: A total of 2 264 people undergoing physical examination were divided into an H. pyloripositive group (n=1 068) and an H. pylori-negative group (n=1 196). Gastric mucosa change was diagnosed by gastroscopy, blood-lipid and blood sugar were detected, and the statistical analysis was performed. RESULTS: The incidence rate of H.pylori infection was 47.2%. The incidence rate of gastric mucosal erosion, gastric ulcer, duodenal ulcer, gastric mucosal atrophy, gastric polyp, dyslipidemia, increase of triglyceride were (TG) and decrease of the high density lipoprotein cholesterol (HDL-C) in the H.pylori-positive group were all higher than those in the H.pylori-negative group (P<0.01 or P<0.05). In the H. pylori-positive group, the level of TG in people with gastric mucosal erosion, gastric ulcer and duodenal ulcer was higher than that in people with normal gastric mucosa or mild gastritis, and HDL-C was lower than that in people with normal gastric mucosa or mild gastritis. CONCLUSION H. pylori infection can induce the gastric mucosa injury and dyslipidemia, which may result in the occurrence and development of coronary heart disease by increasing TG and decreasing HDL-C, thus increasing the risk of atherosclerosis.
Adenomatous Polyps ; Cholesterol, HDL ; blood ; Duodenal Ulcer ; microbiology ; physiopathology ; Dyslipidemias ; microbiology ; Gastric Mucosa ; microbiology ; pathology ; Gastritis ; microbiology ; physiopathology ; Helicobacter Infections ; physiopathology ; Helicobacter pylori ; Humans ; Lipids ; blood ; Physical Examination ; Stomach Neoplasms ; Stomach Ulcer ; microbiology ; physiopathology ; Triglycerides ; blood

Objective:To explore the early effects and safety of using a hybrid fixation strategy with 3D-printed porous tantalum metal augments to reconstruct substantial bone defects in complex primary total knee arthroplasty (TKA).Methods:A retrospective analysis was performed on the clinical data from August 2019 to September 2023, encompassing 20 patients (21 knees) with significant bone loss who underwent hybrid fixation with 3D-printed porous tantalum augments. The procedures were conducted at two medical centers: the First Affiliated Hospital, School of Medicine, Zhejiang University (11 cases) and Xiangya Hospital of Central South University (9 cases). The study cohort comprised 6 males (6 knees) and 14 females (15 knees), with a mean age of 61.05±11.23 years (range, 42-80 years). The distribution of cases was 7 on the left side and 14 on the right side. All cases were categorized as type 3 according to the Anderson Orthopaedic Research Institute (AORI) classification system. The cohort included 19 unilateral and 1 bilateral case, with 5 involving complex primary replacements (3 with Charcot arthropathy, 1 with syphilitic arthropathy, and 1 with severe valgus deformity) and 16 revision surgeries (13 for aseptic loosening and 3 for infection). Preoperative assessments included routine CT scans and digital three-dimensional reconstructions to identify large metaphyseal defects exceeding 50% of the metaphyseal area or those thicker than 10 mm. For such defects, 3D-printed standardized porous tantalum augments were implemented. In cases of extensive cavitary bone defects or severe metaphyseal defects where the medial and lateral defects collectively exceeded 80% of the metaphyseal region or where the residual bone stock was insufficient for screw fixation of standardized augments, 3D-printed personalized custom-made porous tantalum augments were employed for hybrid fixation and repair. Comparative analyses were conducted on pre- and postoperative imaging data (prosthesis positioning and complications), knee range of motion (ROM), visual analogue scale (VAS) for pain, and Knee Society score (KSS).Results:Of the cases, 17 were repaired using standardized 3D-printed porous tantalum augments, while 4 underwent repairs with customized augments for hybrid fixation. Follow-up averaged 26.5±15.0 months (range, 12-62 months). There was a significant increase in knee ROM, improving from 72.8°±31.9° preoperatively to 113.2°±6.8° at 12 months postoperatively ( P<0.05). VAS scores decreased from 6.6±1.4 preoperatively to 2.5±1.0 at 12 months postoperatively ( P<0.05). Similarly, KSS improved from 52.8±6.4 preoperatively to 80.7±7.9 at 12 months postoperatively ( P<0.05). There were no incidences of prosthesis displacement, poor bone integration, or postoperative infections. Conclusion:The hybrid fixation strategy employing 3D-printed porous tantalum augments has been found to be effective in addressing significant bone defects in TKA. The follow-up results indicate a satisfactory biological integration of the porous tantalum metal augments with the host bone, which has resulted in substantial improvements in pain relief and knee joint functionality.

OBJECTIVETo investigate the epidemiological characteristics of human infections with avian influenza A (H7N9) in China and to provide scientific evidence for the adjustment of preventive strategy and control measures.

METHODSDemographic and epidemiologic information on human cases were collected from both reported data of field epidemiological investigation and the reporting system for infectious diseases.

RESULTSA total of 433 cases including 163 deaths were reported in mainland China before June 4, 2014. Two obvious epidemic peaks were noticed, in March to April, 2013 and January to February, 2014. Confirmed cases emerged in 14 areas of China. Five provinces, including Zhejiang, Guangdong, Jiangsu, Shanghai, and Hunan, reported about 85% of the total cases. Median age of the confirmed cases was 58 years (range, 1-91), with 70% as males. Of the 418 cases with available data, 87% had ever exposed to live poultry or contaminated environments. 14 clusters were identified but human to human transmission could not be ruled out in 9 clusters.

CONCLUSIONHuman infections with avian influenza A (H7N9) virus showed the characteristics of obvious seasonal distribution, with certain regional clusters. The majority of confirmed cases were among the elderly, with more males seen than the females. Data showed that main source of infection was live poultry and the live poultry market had played a significant role in the transmission of the virus.

Adaptation, Psychological ; Aged ; Animals ; China ; epidemiology ; Demography ; Environmental Pollution ; Female ; Humans ; Influenza A Virus, H7N9 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; transmission ; Male ; Meat ; Poultry ; Research Design