Objective:To investigate the effects of dexmedetomidine combined with butorphanol for sedation and analgesia on postoperative intracranial pressure and prognosis in patients with severe traumatic brain injury.Methods:A prospective randomized controlled study was conducted on 60 patients with severe traumatic brain injury who were admitted to the ICU after emergency craniotomy surgery at the South Campus of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from August 2020 to December 2023. The patients were randomly assigned to two groups: the control group (C group, n = 30) and the dexmedetomidine combined with butorphanol group (DB group, n = 30). Based on the treatment recommendations from the 2016 Guidelines for the Management of Severe Traumatic Brain Injury, the DB group received a combination of dexmedetomidine and buprenorphine for sedation and analgesia. Dexmedetomidine was administered via intravenous infusion at a loading dose of 1 μg/kg over 10 minutes, followed by a continuous infusion of 0.4-0.7 μg/kg per hour. Butorphanol was given with a loading dose of 10 μg/kg, followed by a continuous infusion of 10-20 μg/kg per hour. The infusion rate was adjusted to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4 to ensure adequate sedation. Patients in the C group received a continuous infusion of an equal amount of 0.9% sodium chloride injection. RASS scores were evaluated in both groups every 4 hours and maintained for 72 hours. The blood pressure, heart rate, central venous pressure, intracranial pressure, RASS sedation scores, and Numerical Verbal Pain Scale pain scores were observed at each time point: upon admission to the ICU (T 1) as well as 24 hours (T 2), 48 hours (T 3), and 72 hours (T 4) after surgery. The number of ventilator days, length of stay in the ICU, and Glasgow Outcome Scale prognosis score at discharge were recorded for all patients. Additionally, the incidence of adverse events such as secondary pulmonary infections, rebleeding, secondary surgeries, and death during hospitalization was recorded. Results:The mean arterial pressure ( F = 69.02, P < 0.001), heart rate ( F = 127.19, P < 0.001), and intracranial pressure ( F = 53.36, P < 0.001) in the DB group were significantly lower compared with those in the C group. The RASS scores ( F = 8.00, P = 0.006) and Numerical Verbal Pain Scale scores ( F = 420.02, P < 0.001) in the DB group were significantly lower than those in the C group. Central venous pressure in the DB group was significantly higher than that in the C group ( F = 6.34, P = 0.015). In terms of clinical outcomes, the mortality rate in the DB group was significantly lower than that in the C group ( χ2 = 4.36, P = 0.037), and the Glasgow Outcome Scale prognosis score was significantly higher in the DB group ( t = 3.03, P = 0.004). The number of ventilator days ( t = 6.10, P < 0.001) and the length of stay in the ICU ( t = 7.71, P < 0.001) were significantly shorter in the DB group compared with the C group (both P < 0.05). There were no statistically significant differences in the incidence of pulmonary infections, rebleeding events, or secondary surgeries between the two groups (all P > 0.05). Conclusions:The combination of dexmedetomidine and butorphanol can effectively decrease postoperative intracranial pressure in patients with severe traumatic brain injury and improve their prognosis.

Objective:To investigate the effects of dexmedetomidine combined with butorphanol for sedation and analgesia on postoperative intracranial pressure and prognosis in patients with severe traumatic brain injury.Methods:A prospective randomized controlled study was conducted on 60 patients with severe traumatic brain injury who were admitted to the ICU after emergency craniotomy surgery at the South Campus of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from August 2020 to December 2023. The patients were randomly assigned to two groups: the control group (C group, n = 30) and the dexmedetomidine combined with butorphanol group (DB group, n = 30). Based on the treatment recommendations from the 2016 Guidelines for the Management of Severe Traumatic Brain Injury, the DB group received a combination of dexmedetomidine and buprenorphine for sedation and analgesia. Dexmedetomidine was administered via intravenous infusion at a loading dose of 1 μg/kg over 10 minutes, followed by a continuous infusion of 0.4-0.7 μg/kg per hour. Butorphanol was given with a loading dose of 10 μg/kg, followed by a continuous infusion of 10-20 μg/kg per hour. The infusion rate was adjusted to maintain a target Richmond Agitation-Sedation Scale (RASS) score of -3 to -4 to ensure adequate sedation. Patients in the C group received a continuous infusion of an equal amount of 0.9% sodium chloride injection. RASS scores were evaluated in both groups every 4 hours and maintained for 72 hours. The blood pressure, heart rate, central venous pressure, intracranial pressure, RASS sedation scores, and Numerical Verbal Pain Scale pain scores were observed at each time point: upon admission to the ICU (T 1) as well as 24 hours (T 2), 48 hours (T 3), and 72 hours (T 4) after surgery. The number of ventilator days, length of stay in the ICU, and Glasgow Outcome Scale prognosis score at discharge were recorded for all patients. Additionally, the incidence of adverse events such as secondary pulmonary infections, rebleeding, secondary surgeries, and death during hospitalization was recorded. Results:The mean arterial pressure ( F = 69.02, P < 0.001), heart rate ( F = 127.19, P < 0.001), and intracranial pressure ( F = 53.36, P < 0.001) in the DB group were significantly lower compared with those in the C group. The RASS scores ( F = 8.00, P = 0.006) and Numerical Verbal Pain Scale scores ( F = 420.02, P < 0.001) in the DB group were significantly lower than those in the C group. Central venous pressure in the DB group was significantly higher than that in the C group ( F = 6.34, P = 0.015). In terms of clinical outcomes, the mortality rate in the DB group was significantly lower than that in the C group ( χ2 = 4.36, P = 0.037), and the Glasgow Outcome Scale prognosis score was significantly higher in the DB group ( t = 3.03, P = 0.004). The number of ventilator days ( t = 6.10, P < 0.001) and the length of stay in the ICU ( t = 7.71, P < 0.001) were significantly shorter in the DB group compared with the C group (both P < 0.05). There were no statistically significant differences in the incidence of pulmonary infections, rebleeding events, or secondary surgeries between the two groups (all P > 0.05). Conclusions:The combination of dexmedetomidine and butorphanol can effectively decrease postoperative intracranial pressure in patients with severe traumatic brain injury and improve their prognosis.

Objectives To describe the Epstein Barr virus (EBV) infection of children in Hefei, analyze its epidemiological characteristics, and explore the factors affecting EBV infection. Methods The children as the outpatient in the department of our hospital were recruited as the research subjects from June 2018 to June 2021. Epidemiological data of the research subjects were collected from medical records and the laboratory tests were performed to detect the related serological indicators of EBV. The distribution characteristics of different serological antibodies of EBV were described. According to the types of serological antibodies, all research subjects were divided into three states: primary infection, previous infection and non-infection. Logistics regression was used to analyze the factors affecting the infection status. Results There were 480 children in this study. The mean age and body mass index of all research subjects were 8.7±1.5 years and 20.78±3.2kg/m2, respectively. There were 276 boys(57.50%) and 204 girls(42.50%). 67 children(12.92%) were positive for VCA-IgM antibody. 326 children(67.92%) were positive for VCA-IgG antibody. 290 children(60.42%) were positive for NA-IgG antibody and 25 children(5.21%) were positive for EA-IgG antibody. There was no significant distribution difference of serological antibodies in gender, season of onset, disease duration, fever, angina and enlargement of lymph nodes. However, there were significant distribution differences of serological antibodies among different body mass index(χ²=50.207, P<0.001) and age(χ²=48.295, P<0.001). According to the types of serological antibodies, all research subjects were divided into three states. There were 78(16.25%) children with primary infection, 335(69.79%) with previous infection and 67(13.96%) with non-infection. Only age was the main factor affecting infection status by Logistic regression analysis(P_{primary infection vs. non-infection}<0.001, OR_{primary infection vs. non-infection}=0.580; P_{previous infection vs. non-infection}=0.038, OR_{previous infection vs. non-infection}=2.347). Conclusion The previous infection by EBV is the mainly infection type in children aged 6 to 12 year. The positive VCA-IgG antibody accounts for the most in previous infection. Age is the important influencing factor on EB infection. The younger the age, the higher the probability of primary infection. Besides, the positive VCA-IgM antibody is the main pattern of primary infection in children.

Objective:To evaluate the association between smoking and the risk of type 2 diabetes (T2DM) incidence among Asian adults based on the prospective studies.Methods:Prospective studies conducted on Asian adults through May, 2019 were retrieved from the following databases: SinoMed, CNKI, VIP, WanFang, PubMed, Web of Science, Embase, and Cochrane Library. Then data were extracted on smoking status, smoking quantity, the number of newly-onset T2DM cases, and effect sizes.Results:A total of 31 studies were included. There were 2 159 787 investigators, 599 340 (27.75%) smokers, and 124 883 (5.78%) T2DM cases identified during the mean follow-up period of 8.3 years. Compared with non-smokers, the combined relativerisk ( RR) and 95% confidence interval ( CI) of current smokers and quitting smokers were 1.52 (1.34- -1.72) ( P<0.001) and 1.22 (1.09- -1.37) ( P=0.047), respectively. The RR and 95% CI of light smokers (<20/day), moderate smokers (20- -29/day), and heavy smokers (≥30/day) were 1.31(1.21- -1.53) ( P=0.001),1.42(1.14- -1.76)( P=0.212), and 2.17(1.50- -3.16) ( P=0.198), respectively. In males and females, the RR and 95% CI were 1.15 (1.08- -1.21) ( P<0.001) and 1.20 (1.11- -1.30) ( P=0.038), respectively. In addition, compared with non-smokers, the RR and 95% CI of current smokers were 1.57 (1.22- -2.03) ( P<0.001) and 1.47 (1.30- -1.66) ( P=0.063) during the follow-up periods of less than and more than 8.0 years, respectively, while the RR and 95% CI of quitters were 1.23 (1.06- -1.43) ( P=0.091)and 1.20 (1.07- -1.34) ( P=0.041), respectively. Conclusions:Prospective studies based on Asian adults have shown that smoking significantly increases the risk of diabetes incidence. That is, as cigarette consumption increases, the risk of diabetes increases accordingly. Moreover, compared to males, the risk for female smokers is greater. In addition, longer durations of smoking cessation are associated with a lower risk of T2DM.

Objective To compare the effects of propofol and midazolam on the prognosis of patients treated with noninvasive positive pressure ventilation.Methods A prospective,single-blind,randomized controlled trial (RCT) was conducted in 90 patients who were treated with noninvasive ventilation for acute dyspnea in the ICU of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from October 2014 to December 2016.They were randomly divided into three groups according to the digital table,with 30 cases in each group.The control group was not given sedation treatment.The propofol group was given propofol 0.5 ～ 1 mg/kg,and then administered by intravenous infusion of 1 mg · kg-1 · h-1 with a micropump.The midazolam group was given midazolam 0.05-O.1 mg/kg,and then with intravenous infusion of 0.05-0.1 mg · kg-1 · h-1 maintaining the patients'sedation goals(Ramsay score of 2).The vital signs and blood gas analysis indicators were recorded.The incidence of tracheal intubation,the incidence of hospital infection,length of ICU and hospital stay,mortality and sedation-related complications were compared.Results The tracheal intubation rate in the propofol group was similar to that in the midazolam group (20.0％ vs.23.3％,x2 =2.65,P ＞ 0.05),while the tracheal intubation rate (46.7％) in the control group was significantly higher (x2 =4.21,4.17,all P ＜ 0.05).The length of ICU and hospital stay in the pmpofol group [(7 ± 3)d and (15 ± 5) d] and midazolam treatment group[(8 ± 4) d and (16 ± 4) d] were significantly shorter than those in the control group[(13 ± 4) d and (20 ± 6) d] (t =2.384,2.371,2.392,2.389,all P ＜ 0.05).The mortality rates of 30d (20.0％,6/30) and 90d (30.0％,9/30) in the control group were higher than those in the propofol group(10.0％,3/30;20.0％,6/30),and the midazolam group (13.3％,4/30;23.3％,7/30),but the differences were not statistically significant(P ＞ 0.05).The incidence rates of hospital infection in the pmpofol group and midazolam group were 6.6％ (2 cases) and 10.0％ (3 cases),which were significantly lower than 33.3％ (10 cases) in the control group (x2 =4.32,4.23,all P ＜ 0.05).Conclusion The use of mild sedation in patients of acute dyspnea treated with noninvasive positive pressure ventilation can improve the patients' tolerance rate,reduce the rate of tracheal intubation and the incidence of hospital infection,and decrease the length of ICU and hospital stay,without significant adverse reactions.There was no significant difference between propofol and midazolam.

Objective:To determine expression levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and serum glial fibrillary acidic protein (GFAP) in patients with acute cerebral infarction and their clinical significance.Methods:A total of 80 patients with acute cerebral infarction in Chongqing Cancer Hospital from January 2014 to February 2016 were enrolled as an observation group.Another 80 healthy people served as a control group.The expression levels of UCH-L1 and GFAP in the 2 groups were detected.Results:Sensibility and specificity for UCH-L1 and GFAP were 75.0％,87.5％ and 81.3％,90.0％,respectively.Receiver operating characteristic curve areas of UCH-L1 and GFAP were 0.670 and 0.757,respectively.There were no significant significance in age,gender,drinking,smoke,diabetes,and hyperlipidemia in the 2 groups (P＞0.05).High blood pressure rate in the observation group was higher than that in the control group (P＜0.05).Spearson/Pearson analysis showed that serum UCH-L1 and GFAP levels were positively correlated with hypertension,but they were negatively correlated with sex,age,diabetes,hyperlipidemia,alcohol consumption,smoking,and other factors.General data at different time in the observation group was not statistically different (P＞0.05).The expression levels of UCH-L1 and GFAP in the observation group was higher than that in the control group (P＜0.05).UCH-L1 and GFAP levels at different time in the 2 groups were not statistically different (P＞0.05).UCH-L1 and GFAP levels in the light,medium,and heavy groups were higher than those in the control group (P＜0.05),while UCH-L1 and GFAP levels in the medium and heavy groups were higher than those in the light group (P＜0.05).There was significant difference between levels of UCH-L1 or GFAP and infarction size at different time in the observation group (P＜0.05).The results of Pearson correlation analysis showed that the levels of serum UCH-L1 and GFAP were positively correlated (r=0.634,P=0.001).Conclusion:The levels of serum UCH-L1 and GFAP are significantly increased at the early stage of acute cerebral infarction,and they have a certain correlation with the severity of cerebral infarction,which can provide a basis for early clinical diagnosis and treatment.

Ardipusilloside-I is a natural triterpenoid saponin, which was isolated from Ardisia pusilla A. DC. The aim of the study was to evaluate the stimulation of ardipusilloside-I on gastrointestinal motility in vitro and in vivo. The experiment of smooth muscle contraction directly monitored the contractions of the isolated jejunal segment (IJS) in different contractile states, and the effects of ardipusilloside-I on myosin were measured in the presence of Ca²⁺-calmodulin using the activities of 20 kDa myosin light chain (MLC₂₀) phosphorylation and myosin Mg²⁺-ATPase. The effects of ardipusilloside-I on gastro emptying and intestinal transit in constipation-predominant rats were observed, and the MLCK expression in jejuna of constipated rats was determined by western blot. The results showed that, ardipusilloside-I increased the contractility of IJS in a dose-dependent manner and reversed the low contractile state (LCS) of IJS induced by low Ca²⁺, adrenaline, and atropine respectively. There were synergistic effects on contractivity of IJS between ardipusilloside-I and ACh, high Ca²⁺, and histamine, respectively. Ardipusilloside-I could stimulate the phosphorylation of MLC₂₀ and Mg²⁺-ATPase activities of Ca²⁺- dependent phosphorylated myosin. Ardipusilloside-I also stimulated the gastric emptying and intestinal transit in normal and constipated rats in vivo, respectively, and increased the MLCK expression in the jejuna of constipation-predominant rats. Briefly, the findings demonstrated that ardipusilloside-I could effectively excite gastrointestinal motility in vitro and in vivo.
Animals ; Ardisia ; Atropine ; Blotting, Western ; Epinephrine ; Gastric Emptying ; Gastrointestinal Motility* ; Histamine ; In Vitro Techniques ; Muscle, Smooth* ; Myosin Light Chains* ; Myosin-Light-Chain Kinase* ; Myosins* ; Phosphorylation* ; Rats ; Saponins

BACKGROUND: The treatment strategy for femoral neck fractures has not been confirmed, and choosing internal fixation or arthroplasty remains controversial. After internal fixation, the occurrence of bone nonunion and osteonecrosis of femoral head makes its long-term treatment outcomes far from satisfactory. Can we improve the functional recovery through high-quality reduction, accurate fixation and active postoperative exercise? If so, it may be favorable for the elderly with femoral neck fractures, especially for those combined with other serious diseases.OBJECTIVE: To compare the quality of life in the elderly with femoral neck fractures after internal fixation and hemiarthroplasty.METHODS: 148 patients with femoral neck fractures aged more than 60 years old in the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2013 were analyzed retrospectively. The operation time,intraoperative blood loss, hospitalization time, mortality rate, reoperation rate and postoperative quality of life were compared between internal fixation and hemiarthroplasty in the patients with undisplaced femoral neck fractures (Garden type I or II) displaced femoral neck fractures (Garden type III or IV), respectively.RESULTS AND CONCLUSION: (1) Among 148 patients, 137 cases completed follow-up, and the follow-up rate was 92.6%. (2) The operation time, intraoperative blood loss and hospitalization time in the internal fixation group were significantly superior to those in the hemiarthroplasty group in patients with displaced or undisplaced femoral neck fractures (P < 0.05). (3) There was no significant difference in the mortality rate between two groups, and the reoperation rate in the internal fixation groups was slightly higher than that in the hemiarthroplasty group. (4) The Harris and SF-36 scores in both groups were increased with time, and the difference between two groups was decreased with time, which became equal at 2.5 years postoperatively (P > 0.05). Besides, the time of the patients with undisplaced femoral neck fractures in the internal fixation group achieving the same quality of life with the hemiarthroplasty group was earlier than that of displaced ones. (5) These results suggest that internal fixation holds short operation time, simple operation skills and less trauma in the treatment of femoral neck fractures, and with the development of technology, it can achieve the early functional recovery. Thereafter, it is an effective method for senile femoral neck fractures.

Objective To retrospectively analyze the clinical and pathological characteristics of breast cancer in women ≤ 40 years of age.Methods One hundred and thirty one young (≤ 40 years) female patients with breast cancer pathologically confirmed in the General Hospital of PLA from January 1 st 2008 to December 31st 2012 (young group) were collected,and 262 elderly (41-69 years) female patients with breast cancer in the same period (old group) were collected as control using the random number table method.The clinicopathological characteristics involved TNM staging,histological grade,the expression levels of estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (Her-2) and clinical stage of the two groups were contrastively analyzed.Results Compared with elderly patients,young female patients with breast cancer had lower positive rate of ER or PR (64.9％ vs.76.7％;x2 =6.171,P =0.013),higher positive rate of Her-2 (26.7％ vs.15.3％;x2 =7.415,P =0.006) and higher histological grade (grade Ⅱ 38.2％ vs.35.1％;grade Ⅲ 55.7％ vs.49.6％;x2 =6.835,P=0.033).There were no significant differences in T stage (x2 =1.764,P =0.623),N stage (x2 =0.129,P =0.988),clinical stage (x2 =4.916,P =0.178),molecular subtype (x2 =7.475,P =0.058) and different surgical procedures (x2 =0.913,P =0.339) between the two groups.Conclusion Young (≤ 40 years) female patients with breast cancer have specific clinical and pathological characteristics including higher histological grade,higher positive rate of Her-2,lower positive rate of ER or PR and higher degree of malignancy,who should be diagnosed and treated as soon as possible.

Objective To study the influence of postoperative chemotherapeutic regimens on menstruation in pre-menopausal patients with breast cancer. Methods 120 pre-menopausal patients with breast cancer from Jan 2010 to Dec 2012 were followed-up. The occurrence rate and recovery rate of chemotherapy-induced amenorrhea (CIA) were analyzed. The relationship between different chemotherapeutic regimens and CIA of various age groups was analyzed. Results 120 women were followed-up, 94 (78.3 %) patients developed CIA. The frequency of CIA in younger patients (≤ 35 years) was significantly lower than that in patients older than 35 years (P < 0.05). 50 (53.2 %) patients returned to normal menses. The recovery situation of CIA was significantly different among various age groups (P < 0.05). The difference of the occurrence rate of CIA was not statistically significant between the patients who received anthracycline-based chemotherapy and docetaxel-based chemotherapy (P > 0.05). Conclusions Age is an important influence factor of the CIA. Chemotherapy has less influence on the menstruation of younger patients (≤35 years) and most amenorrhea is reversible. The effects of sequential addition of taxanes in chemotherapy and anthracyclines alone on menstruation have no significant difference.