Objective:To compare the analgesic effects of sufentanil patient-controlled intravenous analgesia(PCIA)and liposomal bupivacaine incision local infiltration anesthesia(LIA)in the elderly patients undergoing single-or double-segment posterior lumbar surgery,and to provide the basis for selecting postoperative analgesia methods in the elderly patients undergoing lumbar surgery.Methods:A total of 124 elderly patients in our hospital scheduled for elective single-or double-segment posterior lumbar surgery under general anesthesia were selected and divided into sufentanil PCIA group(PCIA group)and liposomal bupivacaine incision LIA group(LIA group)in a 1∶1 ratio,with 62 patients in each group.After excluding those who withdrew from the trial midway,58 patients were finally included in PCIA group and 60 in LIA group.Thirty minutes before the end of surgery,the patients in PCIA group were treated with a analgesia pump regimen of sufentanil 1.5 μg·kg-1 combined with dexmedetomidine 1.5 μg·kg-1.At the end of surgery,the patients in LIA group received multi-point bilateral injections along the surgical incision by a spine surgeon using liposomal bupivacaine 266 mg(diluted in 40 mL of saline).The resting visual analog scale(VAS)pain scores(non-inferiority margin δ=10 mm)at 30 min,6 h,24 h,48 h,and 72 h postoperatively,the incidences of postoperative adverse reactions(such as nausea and vomiting,respiratory depression,pruritus,constipation,dizziness and drowsiness),the number of postoperative rescue analgesia interventions,anesthesia satisfaction scores at 48 and 72 h postoperatively,postoperative hospital stay,and wound healing status at discharge were recorded.Results:From 30 min to 48 h postoperatively,the resting VAS pain scores of the patients in LIA group were higher than those in PCIA group(P＜0.001),while the resting VAS pain scores at 72 h postoperatively in LIA group were lower than those in PCIA group(P＜0.001).At 30 min,24 h,and 48 h postoperatively,non-inferiority was established,indicating that the analgesic effect of liposomal bupivacaine incision LIA was not inferior to that of sufentanil PCIA.At 6 h postoperatively,non-inferiority was not established.At 72 h postoperatively,the analgesic effect of liposomal bupivacaine incision LIA was superior to that of sufentanil PCIA(P＜0.001).Compared with PCIA group,the incidence of postoperative nausea and vomiting of the patients in LIA group was decreased(P＜0.05).There were no significant differences in the incidences of postoperative dizziness and drowsiness,constipation,respiratory depression,and pruritus between two groups(P＞0.05).Compared with PCIA group,the postoperative hospital stay of the patients in LIA group was shortened(P＜0.001).There were no significant differences in the number of postoperative rescue analgesia interventions or wound healing grade between two groups(P＞0.05).The anesthesia satisfaction scores of the patients in LIA group at 48 and 72 h postoperatively were higher than those in PCIA group(P＜0.05).Conclusion:In the elderly patients undergoing single-or double-segment lumbar surgery,the analgesic effect of liposomal bupivacaine incision LIA is not inferior to that of sufentanil PCIA,with a lower incidence of postoperative adverse reactions and higher postoperative analgesia satisfaction scores.

The National Medical Products Administration has authorized sodium oligomannate for treating mild-to-moderate Alzheimer's disease.In this study,an LC-MS/MS method was developed and validated to quantitate sodium oligomannate in different biomatrices.The plasma pharmacokinetics,tissue distri-bution,and excretion of sodium oligomannate in Sprague-Dawley rats and beagle dogs were system-atically investigated.Despite its complicated structural composition,the absorption,distribution,metabolism,and excretion profiles of the oligosaccharides in sodium oligomannate of different sizes and terminal derivatives were indiscriminate.Sodium oligomannate mainly crossed the gastrointestinal epithelium through paracellular transport following oral administration,with very low oral bioavail-ability in rats(0.6％-1.6％)and dogs(4.5％-9.3％).Absorbed sodium oligomannate mainly resided in circulating body fluids in free form with minimal distribution into erythrocytes and major tissues.So-dium oligomannate could penetrate the blood-cerebrospinal fluid(CSF)barrier of rats,showing a con-stant area under the concentration-time curve ratio(CSF/plasma)of approximately 5％.The cumulative urinary excretion of sodium oligomannate was commensurate with its oral bioavailability,supporting that excretion was predominantly renal,whereas no obvious biliary secretion was observed following a single oral dose to bile duct-cannulated rats.Moreover,only 33.7％(male)and 26.3％(female)of the oral dose were recovered in the rat excreta within 96 h following a single oral administration,suggesting that the intestinal flora may have ingested a portion of unabsorbed sodium oligomannate as a nutrient.

Objective To evaluate the clinical performance of high-risk human papillomavirus ( HR-HPV) E6/E7 mRNA test in female in different groups with atypical squamous cell of undetermined significance ( ASC-US) cytology.Methods 320 samples from female patients with ASC-US were detected with HR-HPV E6/E7 mRNA test and HR-HPV DNA test simultaneously, patients were examined with colposcopy and cervical biopsy.They were divided into two groups:younger than 30 years and 30 years and older.The statistical analysis were performed.Results There were no statistically significance in the positive rate of HR-HPV E6/E7 mRNA between two groups ( P>0.05) .In the group aged younger than 30 years, the positive rate of HR-HPV DNA was significantly higher than the group aged 30 years and older ( P<0.05),but the prevalence of CINⅡor greater was significantly lower than the other group (P<0.05).In the group aged younger than 30 years, the specificity of HR-HPV E6/E7 mRNA test for detection of CINⅡor greater was 68.0%,which was significantly higher (P<0.05) than that of HR-HPV DNA test 38.7%, meanwhile, the specificity of HR-HPV E6/E7mRNA test for detection of CINⅡor greater was significantly higher ( P<0.05) than that of HR-HPV DNA test ( 76.5% vs 69.4%) in the group aged 30 years and older.There were no statistically significance (P>0.05) in sensitivity, positive predictive value(PPV) and negative predictive value( NPV) between the two tests in each group.Conclusion Comparing to HR-HPV DNA test, HR-HPV E6/E7mRNA test is more suitable for triage of ASC-US including female patients who were younger than 30 years.

OBJECTIVE:To observe the efficacy and safety of mecobalamin combined with folic acid in the treatment of dia-betic peripheral neuropathy(DPN)with hyperhomocysteinemia. METHODS:Data of 40 DPN patients with high hyperhomocystein-emia were enrolled into high Hcy group and 30 DPN patients with normal Hcy were enrolled into normal Hcy group. Normal Hcy group was given diet control,hypoglycemic drugs or insulin for controlling glucose and other conventional treatment to make the fasting plasma glucose was lower than 7.0 mmol/L and 2 h postprandial glucose lower than 11.0 mmol/L;based on it,high Hcy group was given Mecobalamin injection 500 μg by intramuscular injection,once a day+Folic acid tablet 5 mg,once a day. 14 d was a treatment course and it lasted 2 courses. Clinical efficacy,Hcy level,the motor nerve conduction velocity(MNCV)and sen-sory nerve conduction velocity (SNCV) of tibial and peroneal nerve and total symptom scale (TSS) score before and after treat-ment in high Hcy group were observed and compared with normal Hcy group,and the incidence of adverse reactions in high Hcy group was recorded. RESULTS:After treatment,the total effective rate in high Hcy group was 75.0%;Hcy and TSS score in high Hcy group were significantly lower than before and higher than normal Hcy group,MNCV and SNCV of tibial and peroneal nerve were significantly higher than before and lower than normal Hcy group,the differences were statistically significant(P<0.05). Th incidence of adverse reactions of high Hcy group was 5.0%. CONCLUSIONS:Based on the conventional treatment,Mecobalamin combined with folic acid has good efficacy in the treatmen of DPN with hyperhomocysteinemia,it can significantly reduce plasma Hcy levels and improve nerve conduction velocity in patients with DPN,with good safety.

Objective:To study the prevalence of pre-excitation and Wolff-Parkinson-White (WPW) syndrome in adolescents in Beijing area.
Methods: A total of 19 484 adolescents at the age of (15-20) years from Xicheng district of Beijing and the freshmen from Peking University were enrolled for our survey; 12-lead electrocardiography (ECG) screening was conducted and the diagnosis, classification of pre-excitation, WPW syndrome were recorded. The follow-up study was performed in relevant patients.
Results: There were 19 389 qualiifed ECG obtained, among them, 30 (0.15%) patients with ventricular pre-excitation and WPW syndrome identiifed including 17 male (0.17%) and 13 (0.13%) female, the prevalence between male and female was similar (χ2=0.495,P>0.05). There were 6/19389 (0.03%) patients with palpitation and 2 (0.01%) documented by super-ventricular tachycardia. There were 16/30 (53.33%) patients with type A and 14(46.7%) with type B ventricular pre-excitation, the prevalence between male and female was similar (χ2=4.693,P>0.05). The patients were followed-up at the mean of 2.5 (1.5-3) years and no malignant arrhythmia events occurred.
Conclusion: In this cohort survey, prevalence of pre-excitation and WPW syndrome is about 0.15% in adolescents from (15-20) years in Beijing area; the prevalence is similar between male and female subjects.

OBJECTIVETo provide a scientific basis for the drug-combination and aim to examine whether astragaloside IV has the impact on the cytochrome P450 enzymes.

METHODTolbutamide, chlorzoxazone, coumarin, nifedipine, and phenacetin were as probe substrates of rat CYP2C9, CYP2E1, CYP2A6, CYP3A4, and CYP1A2, and were incubated in rat liver microsomes with astragaloside IV. Triplicate samples were run to generate IC50 value by incubating P450 probe substrates in the presence of five concentrations of astragaloside IV in the incubation mixture. The K(i) values were determined by fitting the probe substrate at various inhibitor concentrations to the equations for competitive inhibition, noncompetitive inhibition, noncompetitive inhibition, and mixed-type inhibition.

RESULTIC50 and K(i) values were estimated, and the types of inhibition were determined. Among the five probe substrates, astragaloside IV might not significantly affect CYP2E1, CYP2A6 and CYP1A2-mediated metabolism in rats, but was a competitive inhibitor of CYP2C9 (IC50 35.40 micromol x L(-1), K(i) 42.88 micromol x L(-1)), and was a uncompetitive inhibitor of CYP3A4 (IC50 88.24 micromol x L(-1), K(i) 33.31 micromol x L(-1)).

CONCLUSIONThese results suggested that astragaloside IV inhibited CYP2C9 and CYP3A4, which provided useful information for safe and effective use of astragaloside IV.

Animals ; Cytochrome P-450 Enzyme Inhibitors ; Cytochrome P-450 Enzyme System ; chemistry ; metabolism ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Enzyme Inhibitors ; chemistry ; pharmacology ; Kinetics ; Male ; Microsomes, Liver ; chemistry ; drug effects ; enzymology ; Rats ; Rats, Sprague-Dawley ; Saponins ; pharmacology ; Triterpenes ; pharmacology

ObjectiveTo investigate the short-term effect of biofeedback combined with pelvic floor muscle training(PFM) on female stress urinary incontinence (SUI) and significance of the surface EMG activity of PFM.MethodsAccording to clinical symptoms, 69 women with SUI were divided into three groups: mild(n=26), moderate(n=24) and severe(n=19) groups. Biofeedback combined with PFM was performed on all patients for 12 weeks. Urinary diary, the score of International Continence Inquiring Committee's Questionnaire (ICI-Q-SF) and the surface EMG activity of PFM were recorded before and after treatment.ResultsIn all groups, the times of voiding (TOV), leakage times(LT) and the scores of ICI-Q-SF were significantly lower after treatment than those before treatment, the vigor of the surface EMG activity of the pelvic floor muscles was significantly higher than that before treatment (P<0.05). The difference value of TOV, LT, the scores of ICI-Q-SF, vigor, the peak value and energy and the efficiency in the mild group were significantly higher than those in other groups after treatment.ConclusionBiofeedback combined with PFM is a simple, effective treatment for SUI, especially for the mild ones; the surface EMG activity of PFM is important for curative effect assessment.