OBJECTIVE: To explore clinical effective and safety of subarachnoid block (SA), adductor canal block (ACB), and femoral nerve block (FNB) for early analgesia in anterior cruciate ligament (ACL) reconstruction. METHODS: From September 2022 to October 2023, 90 patients with ACL rupture who received unilateral knee arthroscopic ACL reconstruction were selected and divided into ACB group, FNB group and SA group according to different anesthesia methods, with 30 patients in each group. There were 12 males and 18 females in ACB group, aged from 18 to 60 years old with an average of (33.3±13.8) years old;14 patients with gradeⅠand 16 patients with gradeⅡaccording to American Society of Aneshesiologists (ASA);13 patients on the left side and 17 patients on the right side. There were 15 males and 15 females in FNB group, aged from 18 to 60 years old with an average of (33.5±12.9) years old;15 patients with gradeⅠand 15 patients with gradeⅡ;16 patients on the left side and 14 patients on the right side. There were 16 males and 14 females in SA group, aged from 18 to 60 years old with an average of (31.0±12.6) years old;18 patients with grade I and 12 patients with gradeⅡ;17 patients on the left side and 13 patients on the right side. In ACB and FNB groups, the nerve block of ACB and FNB were performed under ultrasound guidance before SA anesthesia with 15 ml of 0.3% ropivacaine. Visual analogue scale (VAS) and quadriceps muscle strength at rest and passive movement were recorded and compared among 3 groups at 4, 8, 12, 16, 24 and 48 h after operation, as well as the dosage of tramadol injection analgesics, incidence of nausea and vomiting, nerve block time and other complications within 48 h after operation were compared. RESULTS: All patients were followed up for 11 to 20 (15.8±2.4) months. VAS at 4, 8, 12, 16, 24 and 48 h after operation of SA group was significantly higher than that of ACB and FNB groups, with statistical significance (P<0.05). There were no significant difference in VAS of rest and passive movement at 4, 8, 12, 16, 24 and 48 h after operation between ACB group and FNB group(P>0.05). At 4, 8, 12 and 16 h after operation, the quadriceps muscle strength in SA and ACB groups was higher than that in FNB group, with statistical significance (P<0.05);but there was no statistical significance in quadriceps muscle strength among three groups at 24 and 48 h after operation(P>0.05). One patient occurred nausea and vomiting in ACB group, 2 patients in FNB group and 5 patients in SA group, and no significant difference among three groups (χ²=0.352, P=0.171). The dosage of tramadol in SA group was (300.00±136.50) mg, which was higher than that in FNB group (168.33±73.70) mg and ACB(163.33±70.70) mg, and the difference was statistically significant (P<0.05). There was no significant difference in nerve block time between ACB group and FNB group (t=1.964, P=0.054). There was no puncture site bleeding, local anesthesia drug poisoning and hematoma formation among three groups. CONCLUSION Both FNB and ACB could provide good early analgesia after ACL reconstruction, but ACB group has little effect on quadriceps muscle strength. Patients could have early postoperative functional training without pain, which is more beneficial to the recovery of knee joint function, and could reduce the use of analgesic drugs, without serious complications, which is safe and reliable method.
Humans ; Male ; Female ; Nerve Block/methods* ; Adult ; Anterior Cruciate Ligament Reconstruction ; Adolescent ; Middle Aged ; Young Adult ; Analgesia/methods* ; Pain, Postoperative/drug therapy* ; Femoral Nerve

Objective To identify the clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis(RCLM).Methods The clinical data of young RCLM patients at 45 years or under(n=40,as younger patient group)in Peking University First Hospital from January 2016 to January 2021 were reviewed,meanwhile,elder RCLM patient group were comprised of 82 patients older than 45-year-old in a 1:2 ratio.Proportions of categorical variables were compared between young patients and old patients.The clinicopathologic parameters were analyzed with univariate and multivariate Cox regression models and Kaplan-Meier method for demonstrating survival differences between the maximum diameter of liver metastasis and local therapy.Results One hundred and twenty-two RCLM patients were identified,the 1-,3-and 5-year survival rates of young patient group were 97.5%,47.5%,15.0%,those of elder patient group were 84.1%,26.8%,9.8%,respectively.The differences in BMI(P=0.008),primary tumor with obstruction and bleeding(P=0.006),synchronous rectal cancer liver metastases(P=0.005),the maximum diameter of liver metastasis>3 cm(P=0.019)were statistically significant between the two groups.And univariate and multivariate analyses showed that age(P=0.003),N stage(P=0.007),local therapy for liver metastases(P=0.047)and the maximum diameter of liver metastasis(P=0.030)were independent risk factors for influencing the prognosis of RCLM patients;curative resection or not of primary tumor(P=0.035)and the maximum diameter of liver metastasis(P=0.041)were independent risk factors for influencing the prognosis of young RCLM patients.Kaplan-Maier curve demonstrated survival differences between the maximum diameter of liver metastasis and local therapy for liver metastasis in RCLM patients(log-rank P=0.000).Conclusions Although with later staging of initial tumor station,young RCLM patients may obtain better survival benefit compared with old patients.Higher degree of lymph node metastasis,local therapy for liver metastases and the maximum diameter of liver metastasis>3 cm indicates poor prognosis in RCLM patients,and without curative resection of primary tumor and maximum diameter of liver metastasis are also considered as the independent poor prognostic factors of young RCLM patients.Local therapy for liver metastases appears to play an important role in the treatment strategy of RCLM patients.

The breakage pattern of unit particles during the production of oral solid dosage forms (OSD) is closely related to the quality of intermediate or final products. To accurately characterize the particles and study the evolution law of particle breakage, the Bonding model of the discrete element method (DEM) was used to investigate the breakage patterns of model parameters, particle shape and process conditions (loading mode and loading rate) on the dynamic breakage, force-time curve, breakage rate, maximum breakage size ratio and fracture strength of particles. The results showed that the particle breakage force was positively correlated with normal strength and bonded disk scale, negatively correlated with normal stiffness per unit area and tangential stiffness per unit area, and weakly correlated with tangential strength. The particle breakage rate was negatively correlated with the aspect ratio of the particles, and the maximum breakage size ratio was positively correlated with the aspect ratio of the particles; among the three loading modes, the breakage rate of compression breakage model was the largest, the breakage rate of shear breakage model was the second largest, and the breakage rate of wear breakage model was the smallest; the maximum breakage size ratio was positively correlated with the loading rate, the loading mode and the loading rate had no mutual influence on particle breakage rate, but had mutual influence on the maximum breakage size ratio. The research results will provide a theoretical basis for the shift of OSD from batch manufacturing to advanced manufacturing.

Objective To investigate the role of sphingosine kinase-1(SPHK1)in regulating migration and invasion of gastric cancer(GC)cells.Methods TIMER2.0,GEPIA and HPA databases were used to investigate SPHK1 expression in GC,and its association with prognosis of the patients was analyzed using Kaplan-Meier Plotter database.In 40 clinical GC and adjacent tissue samples,SPHK1 and MKI67 expressions were detected with immunohistochemistry,Western blotting,and RT-qPCR.Gene enrichment pathway analysis was conducted to explore the biological functions of SPHK1.In HGC-27 and MGC-803 cells,the effects of lentivirus-mediated SPHK1 knockdown or overexpression on cell migration and invasion and expressions of key proteins in the nuclear factor-κB(NF-κB)signaling were evaluated using cell scratch test,Transwell assays and Western blotting.The changes in tumorigenic capacity of the transfected GC cells were evaluated in nude mice.Results SPHK1 was highly expressed in GC tissues in negative correlation with overall survival,overall survival after progression,and relapse-free survival of the patients(all P<0.001).In clinical GC samples,SPHK1 and MKI67 expressions showed a positive correlation(P=0.00049)and were both significantly up-regulated(P<0.001).Gene enrichment pathway analysis suggested the involvement of SPHK1 in cell adhesion,migration,angiogenesis and the NF-κB pathway(P<0.05).In the cell experiment,SPHK1 knockdown significantly decreased while SPHK1 overexpression enhanced migration and invasion abilities of the GC cells.SPHK1 positively regulated the expressions of phosphorylated P65(P-P65),VEGFA and IL-17,and blocking the NF-κB pathway by PDTC significantly lowered migration and invasion ability of the cells.In nude mice,the GC cells with SPHK1 knockdown resulted in significantly reduced tumor size and mass,while the SPHK1-overexpressing cells showed enhanced tumorigenicity.Conclusion SPHK1 regulates migration and invasion of GC cells via the NF-κB signaling pathway and may serve as a potential diagnostic marker for GC progression.

Objective To investigate the role of sphingosine kinase-1(SPHK1)in regulating migration and invasion of gastric cancer(GC)cells.Methods TIMER2.0,GEPIA and HPA databases were used to investigate SPHK1 expression in GC,and its association with prognosis of the patients was analyzed using Kaplan-Meier Plotter database.In 40 clinical GC and adjacent tissue samples,SPHK1 and MKI67 expressions were detected with immunohistochemistry,Western blotting,and RT-qPCR.Gene enrichment pathway analysis was conducted to explore the biological functions of SPHK1.In HGC-27 and MGC-803 cells,the effects of lentivirus-mediated SPHK1 knockdown or overexpression on cell migration and invasion and expressions of key proteins in the nuclear factor-κB(NF-κB)signaling were evaluated using cell scratch test,Transwell assays and Western blotting.The changes in tumorigenic capacity of the transfected GC cells were evaluated in nude mice.Results SPHK1 was highly expressed in GC tissues in negative correlation with overall survival,overall survival after progression,and relapse-free survival of the patients(all P<0.001).In clinical GC samples,SPHK1 and MKI67 expressions showed a positive correlation(P=0.00049)and were both significantly up-regulated(P<0.001).Gene enrichment pathway analysis suggested the involvement of SPHK1 in cell adhesion,migration,angiogenesis and the NF-κB pathway(P<0.05).In the cell experiment,SPHK1 knockdown significantly decreased while SPHK1 overexpression enhanced migration and invasion abilities of the GC cells.SPHK1 positively regulated the expressions of phosphorylated P65(P-P65),VEGFA and IL-17,and blocking the NF-κB pathway by PDTC significantly lowered migration and invasion ability of the cells.In nude mice,the GC cells with SPHK1 knockdown resulted in significantly reduced tumor size and mass,while the SPHK1-overexpressing cells showed enhanced tumorigenicity.Conclusion SPHK1 regulates migration and invasion of GC cells via the NF-κB signaling pathway and may serve as a potential diagnostic marker for GC progression.

Objective To investigate the characteristics of mismatch negativity(MMN)in patients with total deafness of sudden hearing loss with different prognosis,and to assess whether MMN is associated with the progno-sis of sudden hearing loss patients.Methods Fifty-one cases of sudden hearing loss with unilateral total deafness were selected for pure tone audiometry(PTA)and auditory MMN examination before treatment,and 26 subjects with mornal hearing were included as the normal group.After routine treatment for 10 days according to the guide-lines for sudden hearing loss,PT A examination was performed to determine their recovery status,and they were di-vided into ineffective group and effective group according to prognosis.The characteristics of MMN latency and am-plitude in the effective group and the ineffective group were observed and compared with the normal control group.Results The MMN waveform was elicited normally in 51 patients with sudden hearing loss and 26 cases in the nor-mal group,of which 29 were in effective group and 22 were in ineffective group.There were significant statistical differences in MMN latency between the patients group and the normal group(P＜0.05).Anova showed no signifi-cant difference in MMN latency between the invalid group and the effective group(P＞0.05),and there was no sig-nificant difference in amplitude among the three groups(P＞0.05).Conclusion The MMN latency of sudden hear-ing loss patients was signifanty shortened.There were no differences in MMN latency and amplitude between the in-effective group and the effective group.

Outpatient humanistic care refered to providing a full process of caring medical services to outpatients. In order to standardize the human caring services for outpatients in medical institutions, promote the comprehensive service level of outpatient services, and improve the patient′s medical experience, Chinese Association for Life Care issued the group standard of Management Norms for Human caring of Outpatients in April 2023. This standard clarified the relevant terms and definitions of human caring for outpatients, specified the basic requirements for human caring, the humanistic quality and care responsibilities of outpatient staff, the outpatient care environment and facilities, the outpatient care process and measures, and quality management. It designed standardized and personalized full process care service norms, providing references for medical institutions at all levels to promote the development of human caring for outpatients.

Objective To establish antemortem and postmortem injury models in nude mice,observe the morphological changes of the wounds and the changes of the microbial communities in the wounds at different time points after the injury,and analyze the differences between antemortem and postmor-tem wounds.Methods Abdominal injury models were established in 48 BALB/c nude mice,which were classified into antemortem injury,4 h and 72 h postmortem injury groups,and the gross manifesta-tions and histopathological changes were observed on days 1,3,5,8,11 and 15 after injury.The mi-crobial communities in the wounds were analyzed by 16S rRNA sequencing technology.QIIME 2 soft-ware was used to calculate Shannon and Observed species indices.The Kruskal-Wallis test was used to determine statistical differences in α-diversity between groups.Jaccard similarity coefficients were calculated by using R v4.3.0 software and applied to the principal co-ordinates analysis to demonstrate inter-sample differences.Permutational multivariate analysis of variance(PERMANOVA)was used to analyze the differences between groups in the composition of bacterial colonies,and R2 values were calculated.Results On days 8,11 and 15 after injury,the antemortem and postmortem injuries could not be differentiated by morphological examination;the Shannon index and Observed species index were statistically different between the antemortem injury group and the 72 h postmortem injury group;the Jaccard similarity coefficient of the microbial community was statistically different between the an-temortem injury group and the 72 h postmortem injury group.The PERMANOVA R2 value gradually increased with the extension of time(0.22-0.61).Conclusion Through the analysis of the wound mi-crobial community,the microbial composition of wounds at different time points can be identified and compared,which provides a new perspective and method for the differentiation of antemortem injuries from postmortem injuries,with good application prospects.

Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) is an important basis for judging suspected occupational diseases and occupational contraindications. There are crossing over or overlap between occupational contraindications and diagnostic criteria of poisoning damage. Occupational contraindications have different meanings with the degree and range of common diseases or symptoms and the frequency of physical examination during employment conflicts with the current standard. Based on the practice of occupational health examination in a large population, the present study analyzed relevant articles and put forward some suggestions for revision, in combination with clinical medicine, occupational health standards, and diagnostic standards of occupational diseases. The modification could provide a reference for the revision of Technical Specifications for Occupational Health Surveillance and the practice of occupational health examination.
Humans ; Occupational Health ; Occupational Diseases ; Occupational Health Services ; Workplace ; Reference Standards ; Occupational Medicine

Objective: To explore the effect of primary and acquired resistance to anti-human epidermal growth factor receptor 2 (HER-2) on the overall survival of patients with HER-2 positive advanced breast cancer. Methods: The clinical characteristics of HER-2 positive patients with advanced breast cancer admitted to Cancer Hospital of Chinese Academy of Medical Sciences from January 1998 to December 2018 were collected, and their neoadjuvant/adjuvant and advanced three-line chemotherapy were summarized. Among them, targeted drugs for HER-2 included trastuzumab, pertuzumab, T-DM1, RC48-ADC, lapatinib, pyrotinib, allitinib, sipatinib, seratinib. Based on the duration of benefit from anti HER-2 treatment, the patients were divided into two groups: primary anti HER-2 resistance group and acquired anti HER-2 resistance group. In this study, the overall survival (OS) was used as the main end point. Kaplan-Meier analysis and Cox proportional risk regression model were used to analyze the effects of different drug resistance mechanisms on the overall survival. Results: The whole group of 284 patients were included. The median age of recurrence and metastasis was 48 years old, 155 (54.6%) were hormone receptor (HR) positive and 129 (45.4%) were HR negative, 128 cases (45.1%) were premenopausal and 156 cases (54.9%) were postmenopausal, 277 cases (97.5%) had a score of 0-1 in ECoG PS and 7 cases (2.5%) had a score of more than 2 in the first diagnosis of relapse and metastasis. There were 103 cases (36.3%) in the primary drug resistance group and 181 cases (63.7%) in the secondary drug resistance group. The median overall survival time of the two groups was 24.9 months and 40.4 months, respectively, with statistical significance (P<0.001). Conclusion: Primary resistance to HER-2 is one of the factors of poor prognosis in HER-2 positive breast cancer, and its mechanism needs to be further explored.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Breast Neoplasms/pathology* ; Drug Resistance ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Prognosis ; Receptor, ErbB-2/metabolism* ; Trastuzumab/therapeutic use* ; Treatment Outcome