BACKGROUND: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA. METHODS: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects. RESULTS: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%). CONCLUSION: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.
Humans ; Oxycodone/therapeutic use* ; Sufentanil/therapeutic use* ; Randomized Controlled Trials as Topic ; Pain, Postoperative/drug therapy* ; Drug-Related Side Effects and Adverse Reactions ; Analgesia, Patient-Controlled

Objective:To investigate the perioperative efficacy of robot surgical system assisted anatomic and non-anatomic hepatectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 103 patients who underwent robot surgical system assisted hepatectomy in Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from March 2016 to December 2021 were collected. There were 54 males and 49 females, aged 56(range, 44?64)years. Of the 103 patients, 55 cases undergoing robot surgical system assisted anatomic hepatectomy were divided into the anatomic group, and 48 cases undergoing robot surgical system assisted non-anatomic hepatectomy were divided into the non-anatomic group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Propensity score matching and compari-son of general data of patients between the two groups after matching. Of the 103 patients, 94 cases were successfully matched, including 47 cases in the anatomic group and 47 cases in the non-anatomic group. The elimination of preoperative body mass index, preoperative platelet and preoperative albumin confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative conditions. After propensity score matching, the operation time and volume of intraoperative blood loss were 175(range, 120?240)minutes and 50(range, 50?100)mL in patients of the anatomic group, versus 155(range, 105?190)minutes and 100(range, 50?200)mL in patients of the non-anatomic group, showing significant differences in the above indicators between the two groups ( Z=1.97, 2.49, P<0.05). (3) Perioperative complications. After propensity score matching, cases with pleural fluid and/or ascites, case with biliary fistula, case with thrombosis, case with peritoneal infection, case with incision infection were 11, 1, 2, 4, 1 in patients of the anatomic group, versus 12, 0, 4, 1, 0 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with complications classified as grade Ⅰ, grade Ⅱ, grade Ⅲ, grade Ⅳ of the Clavien-Dindo classification were 33, 14, 0, 0 in patients of the anatomic group, versus 28, 14, 3, 2 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( Z=?1.38, P>0.05). Conclusions:Robotic surgical system assisted anatomic and non-anatomic hepatectomy are safe and feasible for clinical application. Compared with robot surgical system assisted non-anatomic hepatectomy, patients under-going robot surgical system assisted anatomic hepatectomy have long operation time and less volume of intraoperative blood loss.

OBJECTIVE:To study the effect of Shui medicine Asarum insigne polysaccharide on glycolipid metabolism,renal function and oxidative stress in rats with experimental type 2 diabetes,and provide reference for its development and use. METH-ODS:60 SD rats were randomly divided into normal control group,model control group,positive control group (Irbesartan tab-lets,0.02 g/kg) and A. insigne polysaccharide low-dose,medium-dose,high-dose groups (calculated by crude drug as 2,4,8 g/kg),10 in each group. Except for normal control group,rats in other groups were intraperitoneally injected streptozotocin 75 mg/(kg·d)to induce model with diabetes. After modeling,rats in each administration group were intraperitoneally injected relevant medicines,and rats in normal control group and model control group were intragastrically administrated 5% carboxymet hylcellu-lose sodium solution,twice a day,for 42 d. After administration,UV spectrophotometer was used to detect the glycogen content in liver tissue. Automatic biochemical analyzer was used to detect 24 h urine output,24 h urinary protein content of rats,levels of tri-glyceride (TG),cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C), creatinine (Cr),urea nitrogen (BUN) in serum,and levels of superoxide dismutase (SOD),glutathione peroxidase (GSH-Px), catalase(CAT),superoxide dismutase(ROS),malondialdehyde(MDA)in kidney tissue. RESULTS:Compared with normal con-trol group,glycogen content in liver tissue of rats in model control group was decreased(P<0.05);24 h urine output and 24 h uri-nary protein content were increased(P<0.05);levels of TG,TC,LDL-C in serum were increased(P<0.05),and HDL-C level was decreased (P<0.05);levels of SOD,CAT,GSH-Px in kidney tissue were decreased (P<0.05),and levels of ROS,MDA were increased(P<0.05). Compared with model group,except that there were no significant differences in the improvement of uri-nary protein content,HDL-C level in serum,24 h urine out-put in A. insigne polysaccharide low-dose group,above-men-tioned indexes in each administration group were obviously im-proved (P<0.05). CONCLUSIONS:A. insigne polysaccha-ride can regulate lipid metabolic disorders,and improve renal function and antioxidant capacity of rats.

OBJECTIVE:To investigate clinical efficacy and safety of Miao medicine Jinyin huashi granules combined with western medicine in the treatment of chronic calculous cholecystitis(CCC). METHODS:A total of 120 CCC patients in our hospi-tal during Jan. 2014-Jan. 2016 were randomly divided into control group and observation group,with 60 cases in each group. Con-trol group was given 50％ Magnesium sulfate solution 10 mL orally before meal,tid;amoxicillin 0.5 g orally,tid+Racanisodamine tablets 10 mg,tid+Compound dantong tablets 1 slice,tid,after meal. Observation group was additionally treated with Miao medi-cine Jinyin huashi granules 15 g,tid,on the basis of control group. Both groups were treated for consecutive 4 weeks. Clinical effi-cacies,the improvement of upper abdominal pain,nausea and greasy,calculus were observed in 2 groups. The thickness of gall-bladder,serum levels of IL-2 and IL-5,mRNA and protein expression of CYP7A1 and B-UCT were compared between 2 groups before and after treatment. The occurrence of ADR was recorded in 2 groups. RESULTS:Total response rate of observation group was 96.67％,which was significantly higher than 88.33％ of control group,with statistical significance (P<0.05). One d and one week after treatment,the improvement rates of upper abdominal pain were 63.33％ and 81.67％ in observation group, which were significantly than 36.67％ and 50.00％ of control group,with statistical significance(P<0.05). There was no statisti-cal significance in the improvement rate of nausea or greasy after treatment between 2 groups(P>0.05). The stone-free rate of ob-servation group was 33.33％ and significantly higher than 11.67％ of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in the thickness of gallbladder wall,serum levels of IL-2 or IL-15,mRNA and pro-tein expression of CYP7A1 or B-UCT between 2 groups(P>0.05). After treatment,the thickness of gallbladder wall,serum lev-els of IL-2 and IL-15 were all decreased significantly in 2 groups,while mRNA and protein expression of CYP7A1 and B-UCT were increased significantly;observation group was significantly better than control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Miao medicine Jinyin huashi granules combined with western medicine show significant therapeutic efficacy for CCC,can effectively improve right upper quadrant pain,nausea and greasy,decrease serum levels of IL-2 and IL-5 and up-regulate mRNA and protein expression of CYP7A1 and B-UCT with good safety.

OBJECTIVE:To compare antioxidant activity of different extraction parts from flower buds of Buddlejae flos in vi-tro. METHODS:Ethanol crude extract (ET) was extracted from flower buds of B. flos with 60% ethanol and diffused by water;and petroleum ether,ethyl acetate and n-butanol were used to extract ET to obtain PE,EA,BU and water samples(SH). Using di-butyl hydroxy toluene(BHT)as positive control,the antioxidant capacity of PE,EA,BU and SH were investigated by using 1, 1-diphenyl-2-picrylhydrazyl(DPPH),2,2′-azino-bis(3-ethyl benzothiazoline-6-sulfonic acid)diammonium salt(ABTS)free radi-cal scavenging method and ironion reduction/oxidation resistance ability (FRAP) method. IC50 and antioxdant equivalent TEAC were calculated. RESULTS:Compared with other samples,ET and EA had stronger antioxidant activity,and IC50 of EA scaveng-ing DPPH and ABTS free radical were 13.75,9.78 μg/ml,and those of ET were 14.93,11.41 μg/ml;scavenging ability of EA to DPPH free radical was stronger than that of BHT(IC50 was 18.71 μg/ml). TEAC of EA,ET and BHT were 1 657.67,1 586.25 and 1 581.68μmol/g. CONCLUSIONS:The ethyl acetate extract from flower buds of B. flos has good antioxidant activity.

OBJECTIVE:To study the effect of alcohol extract of Toddalia asiatica on the inflammation-associated cytokines of model rats with adjuvant arthritis(AA). METHODS:70 SD rats were randomly divided into a normal control group,a model con-trol group,a positive control chemical medicine group(Leflunomide tablets,0.012 g/kg),a positive control TCM group(Tripter-ygium glycosides tablets,0.012 g/kg)and the groups of low,medium and high-dose [1,4,6 g(crude drug)/kg] alcohol extract of T. asiatica,with 10 rats in each group. The rats in all groups except for the normal control group were given complete Freund’s complete adjuvant id for the establishment of AA models. At the same time,the rats in the drug administration groups were given corresponding drugs ig,while those in the normal control group and the model control group were given isometric normal saline ig,twice a day,for 28 consecutive days. The degree of toe swelling,arthritis index and the levels of interleukin(IL)-1β,IL-6, IL-10,tumor necrosis factor α(TNF-α)and prostaglandin E2(PGE2)in serum and synovial membranes of all groups of rats were determined. RESULTS:Compared to the normal control group,the model control group demonstrated higher degree of primary and secondary toe swelling,arthritis index and levels of IL-1β,IL-6,TNF-αand PGE2 in serum and joint synovial membrane,and low-er level of IL-10 therein(P<0.01). Compared to the model control group,all the above-mentioned indexes of the rats in drug ad-ministration groups significantly improved(P<0.05 or P<0.01). CONCLUSIONS:The alcohol extract of T. asiatica. has a preven-tive and therapeutic effect on the model rats with AA by regulating the expression of anti-inflammatory and proinflammatory cyto-kines in serum and synovial membrane.

Female ; Humans ; Papillomaviridae ; Uterine Cervical Neoplasms ; pathology ; virology ; Vaginal Smears

Objective To compare the efficacy of percutaneous and endoscopic treatment for the biliary stricture(BS) after liver transplantation (LT).Methods The result of percutaneous transhepatic cholangiography (PTC) and drainage ( PTC group) and endoscopic retrograde cholangiopancreatography (ERCP group) for the BS in 132 post-LT patients were analyzed retrospectively.Ninety-nine patients received PTC treatment,and 59 patients received ERCP treatment,26 patients converted to PTC treatment because of the poor efficacy or failure of the ERCP treatment.The operation success rate,complication rate,cure rate and remission rate of the two groups were compared with X2 test.Results The BS types of PTC and ERCP group were different significantly( P ＜ 0.01 ),with more non-anostomotic stricture in PTC group and more anostomotic stricture in ERCP group.The operation success rate of PTC group was higher than of ERCP group( 100％ vs 97％ ) (P ＜0.01 ),and the complication rate of PTC group was lower than of ERCP group.The overall cure and remission rate of PTC and ERCP group were not different significantly(32.3％ vs 45.8％,94.9％ vs 88.1％ ) (P ＞0.05).The cure and remission rate of PTC and ERCP treatment for each subtype of BS were not different significantly ( P ＞ 0.05 ).Conclusions The efficacy of PTC treatment for the post-LT BS is equivalent to that of ERCP treatment.PTC can be considered the first-line option for the post-LT BS.

Ursolic acid, a pentacyclic triterpene compound, naturally occurs in a large variety of plants, has at-tracted considerable interest owing to its significant biological activities. In recent years, more and more scientists have been working on the structural modification at the C-3 position , C_(12)-C_(13) double bond or C-28 position of ur-solic acid in order to improve their biological activities. Herein a brief introduction of the recent progresses on the chemical structural modification and the structure-activity relationship of ursolic acid and its derivatives are re-viewed.

Objective To evaluate patterns and timing of management for hepatic artery complications after orthotopic liver transplantation. Methods Between October 2003 and March 2007, the clinical data of 25 patients diagnosed as hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) were retrospectively analyzed. Treatment patterns included liver retransplantation and interventional therapy including thrombelysis, pereutaneous transluminal angioplasty and stent placement. Results There were 5 HAT cases, 3 patients were treated with thrombolysis, one patient recovered, one suffered from recurrent HAT and underwent retransplantation, and died of multiple organ failure, the third one died after thrombolysis. The remaining two HAT cases were treated with retransplantation because of liver failure and recovered. Among the 12 patients presented with HAS within 1 month posttransplantation, 2 patients received liver retransplantation because of graft failure and 10 patients were treated with interventions. 7 patients recovered after stent placement and 4 patients received late liver retransplantaton due to ischemic bile duct lesion. Two patients died of intraeranial hemorrhage and infection respectively among 6 liver retransplantations. Among the 8 patients suffering from late HAS (after 1 month postoperatively), 5 patients were treated with stent placement,and liver function improved. Two patients were treated conservatively and liver function was stable. The remaining one patient receiving late liver retransplantation due to ischemic bile duct lesion died postoperatively. Conclusion Individualized therapeutic regimens should be adopted in treating hepatic artery complications after orthotopic liver transplanatation, according to their periods, types and whether ischemic bile duct lesion exists. Liver retransplantation is the best treatment for HAT patients.Percutaneous interventional management is the first-line therapy for patients without irreversible graft dysfunction due to HAS, but liver retransplantation is the only option for patients with ischemic bile duct lesion due to HAS.