Objective To explore the correlation between pre-pregnancy body mass index (BMI) and the risk of difficult airway during labor and delivery through grading changes of Mallampati test (MT). Methods A total of 354 primiparous women who delivered at Obstetrics and Gynecology Hospital of Fudan University from October 2020 to April 2021 were enrolled and categorized into low BMI, normal BMI, and high BMI groups based on pre-pregnancy BMI. Changes in MT grading were analyzed during early labor, postpartum (20 minutes to 1 hour after placental delivery), and 48 hours postpartum. A multifactor logistic regression model was used to analyze the factors increased MT grading postpartum. Results Among the 354 participants, 97 (27.4%) exhibited increased MT grading postpartum, with the proportion of women classified as MT grade 3-4 rising from 39 (11.0%) during early labor to 77 (21.8%) postpartum. By 48 hours postpartum, the number of women with MT grade 3-4 decreased to 21 (5.9%). Multifactor logistic regression analysis showed that low pre-pregnancy BMI (vs high BMI: OR＝2.15, 95%CI 1.02-4.53, P＝0.045) and snoring history during pregnancy (OR＝2.32, 95% CI 1.38-3.90, P＝0.001) were independent risk factors for postpartum MT grading elevation. Conclusions MT grading might increase postpartum in parturients, with low pre-pregnancy BMI and prenatal snoring history identified as significant risk factors for elevated MT grading after delivery.

Objective To evaluate the clinical efficacy and safety of nanoparticle albumin-bound paclitaxel (Nab-P) in the treatment of advanced non-small cell lung cancer (NSCLC). Methods Fifty-six over 65 years old patients with advanced NSCLC treated with Nab-P monotherapy in department of chemotherapy of the People's Hospital of Zhongshan City from January 2014 to January 2017 were analyzed retrospectively. The chemotherapy regimen was Nab-P 260 mg/m2, on d1 or d1 + d8, every 21 day for a cycle, imaging examination was made for efficacy evaluation after every 2 cycles. Results All 56 patients had been evaluated for efficacy, and received a total of 186 cycles of chemotherapy. All patients had been completed 2 cycles or more than 2 cycles of chemotherapy, and the median number of chemotherapy cycles was 3. The treatment response rate (RR) was 25.0 ％ and the disease control rate (DCR) was 76.8 ％. The median progression free survival (PFS) time was 4.7 months. The main adverse reactions were neutropenia, nausea and vomiting, fatigue and peripheral nerve toxicity. However, the vast majorities of adverse reactions were grade 1-2, and can be improved after treatment. Conclusions Nab-P is effective in the treatment of advanced NSCLC in elderly patients. The adverse reactions are mild and tolerant, and it is worthy to be popularized.

OBJECTIVE:To observe therapeutic efficacy of ulinastatin in the treatment of acute pancreatitis. METHODS:A to-tal of 80 acute pancreatitis patients were randomly divided into control group and observation group,with 40 cases in each group. Control group was given conventional treatment as gastrointestinal decompression,analgesia and spasmolysis,anti-infective treat-ment,fluid replacement,electrolyte disturbances balance,in vivo microcirculation improvement;observation group was additional given ulinastatin 100 000 U added into 5% Glucose injection 250 ml,ivgtt,bid,on the basis of control group,and then given medicine qd after improving symptoms;finally,stopped taking medicine immediately the symptom disappeared. Both groups was given 8d of treatment. Serum levels of IL-6 and TNF-α were observed in 2 groups before and after treatment,and clinical symp-tom,the time of sign and lab index improvement were also observed. Clinical efficacy was evaluated. RESULTS:After treatment, serum levels of IL-6 and TNF-α in observation group was significantly lower than in control group;the time of clinical symptom and sign,lab indicator improvement were significantly shorter than in control group,with statistical significance(P<0.01). The ef-fective rate (95.00%) of observation group was significantly higher than that (70.00%) of control group,with statistical signifi-cance(P<0.05). CONCLUSIONS:Ulinastatin can significantly reduce acute pancreatitis significantly,improve clinical symptom, promote disease recovery and clinical efficacy.

Objective To investigate the clinical efficacy of prucalopride in the treatment of severe chronic constipation.Methods The clinical data of 60 patients with severe chronic constipation [slow transit constipation (STC), functional defecation disorder (FDD) and constipation-predominant irritable bowel syndrome (IBS-C)] who were admitted to the Third Affiliated Hospital of Nanjing University of Chinese Medicine from February to August 2014 were prospectively analyzed.A prospective, clinical observational study was performed.Treatment plans included that patients withdrew the initial treatments of laxative and exema and took orally 2 mg prucalopride once daily for 2 weeks, and continued to be treated by oral prucalopride if frequency of the spontaneous complete bowel movement (SCBM) per week was satisfactory (or improvement of symptoms was more than 50％) till 4 weeks, and then were followed up after stopping prucalopride.If improvement of symptoms was less than 50％ after 2-week treatment, other treatment plans were performed according to symptoms of patients from week 3 to week 6 : (1) for patients with STC, prucalopride + two chain bacillus subtilis probiotic capsules were administered orally if patients were satisfied with frequency of SCBM per week and without improvement of abdominal distension;prucalopride + Chinese herb decoction were administered orally if patients had improvement of frequency of SCBM per week with abdominal distension or poor stool output;oral prucalopride + acupuncture were administered if patients were unsatisfied with frequency of SCBM per week or less bowel movements and without improvement of abdominal distension or poor stool output.(2) For patients with FDD, oral prucalopride + acupuncture + biofeed-back therapy were administered.(3) For patients with IBS-C, prucalopride + two chain bacillus subtilis probiotic capsules were administered orally if patients had abdominal distension;prucalopride Chinese herb decoction were administered orally if patients had improvement of frequency of SCBM per week and no improvement of abdominal distension or poor stool output.All patients used a diary for recording the frequency of SCBM per week, stool consistence, exertion in defecation and adverse reactions, which was submitted to doctors for inputting data at the return visit weekly.Results There was good overall medicine compliance in patients.Of 60 patients, 43 patients completed treatments (21 with STC, 11 with FDD and 11 with IBS-C).After 2-week treatment, there were 19 patients with satisfied therapeutic effects, 14 with improvement of constipation and 10 with poor therapeutic effects.After 4-week treatment, constipation in 17 patients was cured, constipation in 18 patients was improved,and constipation in 8 patients was not improved.Nineteen of 60 patients were complicated with adverse reactions within 1 week of the medication, including 6 patients dropping out of the trial due to medication withdrawal and others with improvement by symptomatic treatment or spontaneous remission.Conclusions Prucalopride is effective for the treatment of severe chronic constipation with a good toleration, and it can improve the overall satisfaction of patients combined with Chinese herb decoction and acupuncture.

BACKGROUND:The form and structure of antigen-extracted xenogeneic cancel ous bone through series of physical and chemical treatment are similar to human tissue. OBJECTIVE:To detect the biocompatibility of antigen-extracted xenogeneic cancel ous bone matrix prepared by three different ways. METHODS:The antigen-extracted xenogeneic cancel ous bone scaffold materials which were prepared through physical, chemical and physical-chemical combined methods and hydroxy apatite biological ceramic materials were implanted into the dorsum subcutaneous tissue. Histological observation was done at 4, 8 and 12 weeks after surgery. The antigen-extracted xenogeneic cancel ous bone scaffold materials which were prepared through physical, chemical and physical-chemical combined methods respectively was used to culture sheep bone marrow mesenchymal stem cells for 7 days. Cel adhesion, growth, proliferation and stroma secretion were observed. RESULTS AND CONCLUSION:At 4 weeks after surgery, a strong inflammatory reaction was detected around materials in four groups. At 12 weeks, the xenogeneic bone materials prepared through physical and physical-chemical combined methods and hydroxy apatite biological ceramic materials internal pore and surrounding tissue inflammation disappeared basical y, with the presence of thimbleful inflammation cells. The material degradation was more than at 8 weeks. The xenogeneic bone materials prepared through chemical methods material internal pore and surrounding tissue inflammation stil existed, suggesting that the xenogeneic bone materials prepared through physical and physical-chemical combined methods exhibited good histocompatibility. A smal amount of orderly osteoblasts existed around hydroxy apatite biological ceramic materials and physical-chemical prepared materials, with a smal amount of bone. These suggested that there was a tendency for ectopic bone formation. The xenogeneic cancel ous bone materials prepared through physical or physical-chemical combined methods have better cytocompatibility. However, scaffold materials prepared through chemical method have poor cytocompatibility and they are not qualified for the safety standards of biological materials.

Objective To investigate the expression of connective tissue growth factor(CTGF),coll agen I and collagen Ⅲ in sacroiliac joint(SIJ)of patients with spondyloarthropathy(SpA).Methods Thirty patients with SpA,including 17 patients with grade Ⅱ saeroiliitis and 13 patients with grade Ⅰ sacroiliitis,were performed on CT guided needie biopsy of SIJ.After sacroiliitis were confirmed by staining with hematoxylin and eosin in sacroiliac joint tissue sample,immunohistochemical assay was performed to determine the expression of CTGF,collagen Ⅰ and collagen Ⅲ in sacroiliac ioint tissue.Univariate Chi-square test was used for data comparison between multiple groups and t-test was used for two group data comparison.Results Contrast to healthy controls,CTGF were found upexpressed on the cytoplasm of inflammatory cells in pannus and bone marrow of sacroiliac tissue samples of patients with SpA,while collagen I and collagen Ⅲ were found up-expressed in bone,cartilage and ligament tissue[(57.9±42.4)/HP vs(2.7±2.5)/HP P<0.05,0.298±0.080 vs 0.044±0.024 and 28.254±41.165 vs 0.105±0.054.P<0.05 respectively].Conclusion CTGF,collagen Ⅰ and collagen Ⅲ are up-expressed in SIJ of SpA patients.CTGF may play an important role in articular cartilage fibrosis and ossification of SpA.

Objective To investigate the influence of enteral nutrition (EN) emulsion containing slowrelease starch on blood sugar level in patients with craniocerebral injury. Methods Totally 120 patients with severe craniocerebral injury complicated with hyperglycemia joined this open study and were randomized into control group and study group. Study group was given EN emulsion containing slow-release starch ( Fresubin Diabetes)and control group was given routine EN emulsion ( Fresubin), both for 15 days. Fasting blood glucose (FBG),2-hour postprandial glucose (2hPG), and glycosylated hemoglobin (HbA1c) were examined before EN support and 7 days and 15 days after EN support. Results In the study group, the levels of 2hPG before EN support and on the seventh and fifteenth day after EN support were ( 12.26 ± 2. 36 )mmol/L, (9.76 ± 2.90 ) mmol/L, and (9.78 ± 1.86) mmol/L, respectively. The levels of 2hPG after EN support were both significantly lower than that before EN support (P ＜ 0. 05). However, the levels of FBG and HbA1c in the study group were not significantly different before and after EN support ( P ＞ 0. 05 ). In the control group, the levels of 2hPG on the seventh and fifteenth day after EN support were ( 11.70 ± 2. 80) mmol/L and ( 11.39 ± 2. 44 ) mmol/L, respectively, which were significantly higher than those in study group ( P = 0. 033, P = 0. 020). The levels of FBG and HbA1c werenot significantly different between the study group and the control group ( P ＞ 0. 05 ). Conclusion EN emulsion containing slow-release starch may promote the control of blood sugar in patients with craniocerebral injury complicated with hyperglycemia and improve the level of postprandial blood sugar in those patients.

OBJECTIVE: To explore the role of IL-21 in the pathogenesis of myasthenia gravis (MG) and its influence on the the class switch of anti-AChR antibodies. METHODS: Blood was taken from 26 patients and 18 healthy controls, and the expression of IL-21R mRNA in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR. The expression of IL-21R on B lymphocytes was measured by flow cytometry, while the concentrations of serum IL-21 and the levels of anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3) were tested by ELISA. RESULTS: The serum concentration of IL-21 in the MG group was higher than that in the control group (31.686±8.499 pg/mL, 15.147±6.366 pg/mL) and the difference was significant (P<0.01). IL-21R mRNA expressed on PBMCs in the MG group was higher than that in the control group (0.139±0.052, 0.101±0.022), and the difference was significant (P<0.05). There was no difference between ocular MG and generalized MG subgroup (P>0.05). Compared with the control group, the expression of IL-21R on B lymphocytes also increased in the MG group (P<0.05). In the anti-AChR-Ab positive MG group, the serum concentration of IL-21 showed positive correlation with anti-AChR-IgG(P<0.05),but no correlation with its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05). Expression of IL-21R mRNA in the PBMCs showed no correlation with the level of serum anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05); however the expression of IL-21R in B lymphocytes showed positive correlation with anti-AChR-IgG and it's isotype IgG(1) and IgG(3) (P<0.05,P<0.01,P<0.05), but no correlation with IgG(2) (P>0.05). CONCLUSION IL-21 might induce the class switch of anti-AChR antibodies to IgG(1) and IgG(3) isotype through IL-21R on B lymphocytes which promotes the pathogenesis of the MG.
Adolescent ; Adult ; Autoantibodies ; classification ; immunology ; Female ; Humans ; Immunoglobulin Class Switching ; immunology ; Immunoglobulin G ; classification ; Interleukins ; blood ; genetics ; Male ; Middle Aged ; Myasthenia Gravis ; blood ; immunology ; RNA, Messenger ; blood ; genetics ; Receptors, Cholinergic ; immunology ; Receptors, Interleukin-21 ; blood ; genetics ; Young Adult

Objective To investigate the expression of transforming growth factor beta (TGF-β) and Smad signaling in ankylosing spondylitis (AS) and to explore their roles in the pathogenesis. Methods Fiftythree patients with AS were included in the study. In these 53 cases, 30 patients were performed computed tomography-guided needle biopsy in sacroiliac joint. Serum TGF-β_1 was determined by enzyme-linked immunosorbent assay (ELISA). Immunohistological studies were performed with the streptavidin-peroxidase conjugated methods to assess the expression of TGF-β_1, p-smad3 and Smad7 in sacroiliac joint tissue sample.One-way ANOVA, two independent samples t test and kolmogoorov-Simimov test were used to do statistical analysis. Results In 53 cases patients with AS, 20 cases were with high level Erythro-cyte sedimentation rate(ESR) and C-reactive protein (CRP), while those of the other 33 cases were normal. Serum average TGF-β_1level [ (15.9±5.6) ng/ml ], in patients with high level ESR/CRP [(5.4±5.8) ng/ml ] was significantly increased as compared to the controls and patients with normal ESR/CRP [(4.1±3.6) ng/ml] (P<0.05). There was no expression of TGF-β_1 could be detected in the pannus and bone marrow in SI joints tissue of 30 cases with AS, while decreased level of smad7 expression was detected. In addition, p-smad3 expression was found in the nuclear. Conclusion TGF-β_1 signaling may play an important role in the inflammatory erosion and cartilage fibrosis of sacrojlitis in AS.

Digital usage technology has infiltrated into all kinds of social fields with progress of high technology.We have been in digital informal times.It is absolute to change traditional experimental teaching model.Animal experiments of our west surgical course have been done in simulating operating room with digital modern teaching method.The experiment results have been improved.