Objective:To evaluate the effectiveness of fosaprepitant in preventing postoperative nausea and vomiting (PONV) following gynecological laparoscopic surgery.Methods:In this randomized parallel-controlled trial, 100 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, undergoing elective gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University, were selected and divided into 2 groups ( n=50 each) in a ratio of 1∶1 using blocked randomization: fosaprepitant group (group F) and tropisetron group (group T). At 30 min before anesthesia induction, fosaprepitant 150 mg was intravenously infused in group F, and tropisetron 5 mg was intravenously infused in group T, both diluted in 150 ml of normal saline. Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and cisatracurium. Anesthesia was maintained by intravenous infusion of remifentanil and propofol. Patient-controlled intravenous analgesia was performed with hydromorphone at the end of operation until 48 h after operation. Metoclopramide was given as rescue antiemetic. The PONV, requirement for antiemetic drugs and related adverse reactions were recorded within 24 h after surgery. Results:The incidence of PONV (10% vs 30%), the incidence of vomiting(2% vs 16%) and the rescue rate of antiemetic drugs(2% vs 12%)were significantly lower in group F than in group T ( P<0.05). There was no significant difference in the incidence of related adverse reactions between the two groups ( P>0.05). Conclusions:Intravenous infusion of fosaprepitant 150 mg at 30 min before anesthesia induction effectively prevents PONV in patients undergoing gynecological laparoscopic surgery, and the efficacy is superior to that of the conventional use of tropisetron.

OBJECTIVE To explore the association of the expressions of tissue forkhead box transcription factor(FOX)F2,angiopoietin-like protein 4(ANGPTL4)and FOXP3 with the pathological features and recurrence of the cervical cancer patients with human papillomavirus(HPV)infection undergoing radical hysterectomy.METHODS Totally 69 cervical cancer patients with HPV infection who underwent radical hysterectomy in Danzhou People's Hospital from Nov.2018 to Jul.2021 were randomly assigned as the cervical cancer group,meanwhile,72 patients who had cervical intraepithelial neoplasia(CIN)were chosen as the CIN group.The patients of the cer-vical cancer group were divided into the recurrence group with 25 cases and the no recurrence group with 44 cases according to the prognosis.The levels of tissue FOXF2,ANGPTL4 and FOXP3 were compared among the groups.The levels of FOXF2,ANGPTL4 and FOXP3 were compared among the cervical cancer patients with dif-ferent clinical pathological features,and the pathological features were compared among the patients with different treatment outcomes.The values of the three indexes in diagnosis of the postoperative recurrence in the cervical cancer patients with HPV infection undergoing radical resection were analyzed.RESULTS There were significant differences in the levels of tissue FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA between the cervical cancer group and the CIN group(P＜0.05).There were significant differences in the levels of FOXF2 mRNA,ANGPTL4 mR-NA and FOXP3 mRNA among the cervical cancer patients with HPV infection who varied in federation international of gynecology and obstetrics(FIGO)stage,lymphatic metastasis and infiltration depth(P＜0.05).There were significant differences in the FIGO stage,lymphatic metastasis,infiltration depth,FOXF2 mRNA level,ANGPTL4 mRNA level and FOXP3 mRNA level between the recurrence group and the no recurrence group(P＜0.05).The area under the curve(AUC)value of the joint detection of FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA was higher than that of the single detection in diagnosis of the postoperative recurrence in the cervical cancer patients with HPV infection under-going radical resection(P＜0.05).CONCLUSIONS The cervical cancer patients with HPV infection undergoing radi-cal resection show the abnormal expressions of tissue FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA.There is association between the three indexes and the FIGO stage,lymphatic metastasis and infiltration depth.The joint detection of the three indexes has high value in diagnosis of the postoperative recurrence.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the relationship between daily physical exercise and frailty state among elderly inpatients in internal medicine department.Methods:A cross-sectional study was conducted among eligible elderly patients who hospitalized at the internal medicine department of Beijing Hospital from September 2018 to March 2019.Frailty was screened using the FRAIL scale, and their pre-hospitalization daily physical exercise was assessed through a questionnaire upon admission.The statistical methods include correlation analysis and logistic regression univariate and multivariate analysis.Results:A total of 533 eligible elderly patients in internal medicine were included in the study, with 129(24.2%)frail, 296(55.5%)pre-frail, and 108(20.3%)non-frail patients.328 patients(61.5%)exercised more than 5 times a week, while 102 patients(19.1%)hardly exercised at all.Physical exercise frequency had negative correlation with the FRAIL frailty score( r=-0.576, P<0.001).Both univariate and multivariate logistic regression analysis shown daily physical exercise frequency was significantly associated with frailty( OR=0.56, 95% CI: 0.49-0.65, P<0.001)among elderly inpatients in internal medicine. Conclusions:For elderly inpatients in internal medicine department, daily physical exercise frequency is closely related to frailty status, serving as an independent factor in reducing the occurrence of frailty.Therefore, increasing the frequency of daily physical exercises is an effective measure to reduce the risk of frailty for this group of patients.

Objective To investigate the forensic toxicological characteristics associated with etomidate abuse.Methods Blood and urine samples from six cases of etomidate abuse were quantitatively analyzed for etomidate and its metabolite etomidate acid.Relevant literature on etomidate abuse and poisoning was reviewed to summarize the pharmacological and toxicological effects of etomidate and case data.Results In the cases examined,the blood concentrations of etomidate and its metabolite,etomidate acid,were relatively low,ranging from 1.97～187.61 ng/mL and 12.29～316.31 ng/mL,respectively.Urine samples offered a broader detection window,with etomidate concentrations ranging from 1.65 to 700.89 ng/mL and etomidate acid concentrations from 295.26～214 483.52 ng/mL.Notably,in a sexual assault case,the victims's blood concentration of etomidate acid dropped below 6.98 ng/mL eight hours post-ingestion,while urinary concentration was still above 59 449.02 ng/mL.Conclusion Abuse of electronic cigarettes containing etomidate can result in severe overdoses.Given that etomidate is rapidly metabolized in vivo,it is essential to collect and analyze biological samples promptly,with a particular emphasis on detecting its metabolite,etomidate acid.

Objective To observe the clinical efficacy of oral use combined with targeted transdermal delivery of Osteoking in treating knee osteoarthritis(KOA)of cold-damp blockage type.Methods A total of 120 patients with KOA of cold-damp blockage type who admitted to Hunan Provincial Hospital of Integrated Traditional Chinese And West Medicine from September 2022 to September 2023 were randomly divided into the control group,oral use group,transdermal delivery group and combination group according to the random number table method,with 30 cases in each group.The control group was treated with Celecoxib Capsule orally,the oral use group was treated with Osteoking orally,the transdermal delivery group was treated with Osteoking by targeted transdermal delivery,and the combination group was treated with oral use combined with targeted transdermal delivery of Osteoking.One course of treatment covered 12 days,and all of the four groups were treated for two continuous courses.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndrome,Visual Analogue Scale(VAS)for pain,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)for joint function,36-Item Short Form Health Survey(SF-36)for quality of life(QOL),as well as the levels of serum interleukin 1β(IL-1β),interleukin 6(IL-6),and tumor necrosis factor α(TNF-α)were observed in the patients of each group.After treatment,the clinical efficacy and safety of patients in each group were evaluated.Results(1)After two courses of treatment,the total effective rate of the combination group was 96.67%(29/30),which was higher than those of the control group[73.33%(22/30)],oral use group and transdermal delivery group[both being 70.00%(21/30)],and the difference was statistically significant(P<0.05).However,no statistically significant difference of the total effective rate was presented among the control group,oral use group,and transdermal delivery group(P>0.05).(2)After treatment,the scores of TCM syndrome,VAS for pain and WOMAC for joint function in the four groups were decreased compared with those before treatment(P<0.01).The intergroup comparison showed that the scores of TCM syndrome,VAS for pain and WOMAC in the combination group were lower than those in the other three groups(P<0.05),while no statistically significant difference of the scores of TCM syndrome,VAS for pain and WOMAC were presented among the control group,oral use group,and transdermal delivery group(P>0.05).(3)After treatment,the QOL scores of the eight dimensions of SF-36 such as physical functioning(PF),bodily pain(BP),general health(GH),vitality(VT),role-physical(RP),social functioning(SF),role-emotional(RE),and mental health(MH)in the four groups were significantly increased compared with those before treatment(P<0.01).The intergroup comparison showed that the scores of each dimension of SF-36 in the combination group were significantly higher than those in the other three groups(P<0.05),while no statistically significant difference of the dimension score of SF-36 was presented among the control group,oral use group,and transdermal delivery group(P>0.05).(4)After treatment,the levels of serum inflammatory factors of IL-1β,IL-6,and TNF-α in the four groups were decreased compared with those before treatment(P<0.01).The intergroup comparison showed that the decrease of serum levels of inflammatory factors in the combination group were significantly superior to those in the other three groups(P<0.05),and the decrease in the control group and oral use group were all superior to those in the transdermal delivery group(P<0.05),while the difference between the control group and oral use group was not statistically significant(P>0.05).(5)During the trial,no serious adverse reactions were found in the patients of four groups,which is of high safety.Conclusion Oral use combined with targeted transdermal delivery of Osteoking is effective on improving the joint pain,joint function and QOL of patients with KOA of cold-damp blockage type,and can speed up the rehabilitation of patients.Its therapeutic mechanism may be related to the decrease of the expression level of inflammatory factors.

Objective To investigate the forensic toxicological characteristics associated with etomidate abuse.Methods Blood and urine samples from six cases of etomidate abuse were quantitatively analyzed for etomidate and its metabolite etomidate acid.Relevant literature on etomidate abuse and poisoning was reviewed to summarize the pharmacological and toxicological effects of etomidate and case data.Results In the cases examined,the blood concentrations of etomidate and its metabolite,etomidate acid,were relatively low,ranging from 1.97～187.61 ng/mL and 12.29～316.31 ng/mL,respectively.Urine samples offered a broader detection window,with etomidate concentrations ranging from 1.65 to 700.89 ng/mL and etomidate acid concentrations from 295.26～214 483.52 ng/mL.Notably,in a sexual assault case,the victims's blood concentration of etomidate acid dropped below 6.98 ng/mL eight hours post-ingestion,while urinary concentration was still above 59 449.02 ng/mL.Conclusion Abuse of electronic cigarettes containing etomidate can result in severe overdoses.Given that etomidate is rapidly metabolized in vivo,it is essential to collect and analyze biological samples promptly,with a particular emphasis on detecting its metabolite,etomidate acid.

Objective:To evaluate the effectiveness of fosaprepitant in preventing postoperative nausea and vomiting (PONV) following gynecological laparoscopic surgery.Methods:In this randomized parallel-controlled trial, 100 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, undergoing elective gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University, were selected and divided into 2 groups ( n=50 each) in a ratio of 1∶1 using blocked randomization: fosaprepitant group (group F) and tropisetron group (group T). At 30 min before anesthesia induction, fosaprepitant 150 mg was intravenously infused in group F, and tropisetron 5 mg was intravenously infused in group T, both diluted in 150 ml of normal saline. Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and cisatracurium. Anesthesia was maintained by intravenous infusion of remifentanil and propofol. Patient-controlled intravenous analgesia was performed with hydromorphone at the end of operation until 48 h after operation. Metoclopramide was given as rescue antiemetic. The PONV, requirement for antiemetic drugs and related adverse reactions were recorded within 24 h after surgery. Results:The incidence of PONV (10% vs 30%), the incidence of vomiting(2% vs 16%) and the rescue rate of antiemetic drugs(2% vs 12%)were significantly lower in group F than in group T ( P<0.05). There was no significant difference in the incidence of related adverse reactions between the two groups ( P>0.05). Conclusions:Intravenous infusion of fosaprepitant 150 mg at 30 min before anesthesia induction effectively prevents PONV in patients undergoing gynecological laparoscopic surgery, and the efficacy is superior to that of the conventional use of tropisetron.

OBJECTIVE To explore the association of the expressions of tissue forkhead box transcription factor(FOX)F2,angiopoietin-like protein 4(ANGPTL4)and FOXP3 with the pathological features and recurrence of the cervical cancer patients with human papillomavirus(HPV)infection undergoing radical hysterectomy.METHODS Totally 69 cervical cancer patients with HPV infection who underwent radical hysterectomy in Danzhou People's Hospital from Nov.2018 to Jul.2021 were randomly assigned as the cervical cancer group,meanwhile,72 patients who had cervical intraepithelial neoplasia(CIN)were chosen as the CIN group.The patients of the cer-vical cancer group were divided into the recurrence group with 25 cases and the no recurrence group with 44 cases according to the prognosis.The levels of tissue FOXF2,ANGPTL4 and FOXP3 were compared among the groups.The levels of FOXF2,ANGPTL4 and FOXP3 were compared among the cervical cancer patients with dif-ferent clinical pathological features,and the pathological features were compared among the patients with different treatment outcomes.The values of the three indexes in diagnosis of the postoperative recurrence in the cervical cancer patients with HPV infection undergoing radical resection were analyzed.RESULTS There were significant differences in the levels of tissue FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA between the cervical cancer group and the CIN group(P＜0.05).There were significant differences in the levels of FOXF2 mRNA,ANGPTL4 mR-NA and FOXP3 mRNA among the cervical cancer patients with HPV infection who varied in federation international of gynecology and obstetrics(FIGO)stage,lymphatic metastasis and infiltration depth(P＜0.05).There were significant differences in the FIGO stage,lymphatic metastasis,infiltration depth,FOXF2 mRNA level,ANGPTL4 mRNA level and FOXP3 mRNA level between the recurrence group and the no recurrence group(P＜0.05).The area under the curve(AUC)value of the joint detection of FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA was higher than that of the single detection in diagnosis of the postoperative recurrence in the cervical cancer patients with HPV infection under-going radical resection(P＜0.05).CONCLUSIONS The cervical cancer patients with HPV infection undergoing radi-cal resection show the abnormal expressions of tissue FOXF2 mRNA,ANGPTL4 mRNA and FOXP3 mRNA.There is association between the three indexes and the FIGO stage,lymphatic metastasis and infiltration depth.The joint detection of the three indexes has high value in diagnosis of the postoperative recurrence.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.