Objective To investigate the effects of fentanyl citrate on pain in aged rats with hip fracture and its underlying mechanisms. Methods Thirty aged rats with hip fracture were divided into model group (n=10), fentanyl citrate group (n=10), and fentanyl citrate + Sar-SP group (n=10). Additionally, healthy rats from the same period were included as normal group (n=10).Rats in the fentanyl citrate group received intravenous tail injection of 10 μg/kg fentanyl citrate, while those in the fentanyl citrate + Sar-SP group underwent intrathecal injection of 10 μL Sar-SP for fentanyl citrate intervention. Rats in the normal and model groups received intravenous tail injection of an equal volume of saline. Pain threshold, weight-bearing capacity, temperature, and dorsoventral thickness of the hind paws were measured before treatment (0 h) and at 1, 6, 24, and 168 h post-treatment. Enzyme-linked immunosorbent assay (ELISA) was used to detect levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β), and glutamic acid (Glu) in the spinal cord tissue of rats. Immunohistochemical staining was employed to observe the positive expression rates of ionized calcium-binding adapter molecule 1 (Iba-1), glial fibrillary acidic protein (GFAP), and substance P (SP) in the spinal cord tissue. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was conducted to detect the relative expression levels of SP and tachykinin receptor 1 (TACR1) mRNA in the hippocampus tissue of rats. Western blot analysis was performed to assess the relative expression levels of vimentin (VIM), nuclear receptor corepressor 1 (NOCR), ciliary neurotrophic factor receptor (CNTFR), and epidermal growth factor receptor (EGFR) proteins in the spinal cord tissue. Results Compared with the normal group, rats in the model group exhibited decreased pain threshold and weight-bearing capacity, increased hind paw temperature and dorsoventral thickness, as well as elevated levels of TNF-α, IL-6, IL-1β, and Glu, increased positive expression rates of Iba-1 and GFAP, heightened positive expression rate and relative mRNA expression levels of SP and TACR1, and augmented relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 0 h before treatment and at 1, 6, 24, and 168 h post-treatment (P < 0.05). Compared with the model group, rats in the fentanyl citrate group showed increased pain threshold and weight-bearing capacity, decreased hind paw temperature and dorsoventral thickness, as well as reduced levels of TNF-α, IL-6, IL-1β, and Glu, decreased positive expression rates of Iba-1 and GFAP, lowered positive expression rate and relative mRNA expression levels of SP and TACR1, and decreased relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 1, 6, 24, and 168 h post-treatment(P < 0.05). Compared with the fentanyl citrate group, rats in the fentanyl citrate+Sar-SP group demonstrated decreased pain threshold and weight-bearing capacity, increased hind paw temperature and dorsoventral thickness, elevated levels of TNF-α, IL-6, IL-1β, and Glu, increased positive expression rates of Iba-1 and GFAP, heightened positive expression rate and relative mRNA expression levels of SP and TACR1, and elevated relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 1, 6, 24, and 168 h post-treatment(P < 0.05). Conclusion The improvement in pain in aged rats with hip fracture by fentanyl citrate may be associated with the reduction of SP expression in the spinal cord that inhibits glial cell activation and exhibits anti-inflammatory effects.

Objective: To investigate the hygienic status of the central air conditioner ventilation system in public places in urban areas of Ma'anshan City, Anhui Province, so as to provide insights into formulation of supervision and management interventions. Methods: A total of 15 public places with the central air conditioner ventilation system were randomly sampled from main urban areas in Ma'anshan City in 2022. Sampling and detection were performed following the standard GB/T 18204.5—2013 Examination methods for public places Part 5: Central air conditioning ventilation system, including total number of bacteria and total number of fungus on the inner surface of wind pipes, total number of bacteria and fungus, particulate matter (PM10) and β-hemolytic streptococci in the air supply system, and Legionella pneumophila in the cooling water, and the detection indicators were assessed following the WS 394—2012 Guideline for hygiene of the central air conditioner ventilation system in public places. The eligible rate of samples, the detection rate of L. pneumophila were analyzed. Results: A total of 368 samples were collected from 15 public places, and the qualified rate was 50.54%, no places had all eligible measurement indicators. The qualified rates of total bacteria and fungus numbers on the inner surface of wind pipes were 52.67% and 59.33%. The qualified rates of total bacterium number, total fungus number, PM10 and β-hemolytic streptococci were 12.00%, 28.00%, 90.00% and 96.00% in the air supply system. The qualified rates of samples in administrative workplaces, hotels, bathing places and malls (supermarkets) were 32.50%, 59.24%, 61.09% and 68.92%, the qualified rates of total bacteria on the inner surface of air ducts were 8.33%, 72.46%, 66.67% and 61.90%, and the qualified rates of total fungus numbers in air supply were 0, 21.70%, 33.30% and 71.40%, respectively, with statistical significance (P<0.05). A total of 18 cooling water samples were collected, and L. pneumophila was detected in three samples (16.67%). Conclusions Poor hygiene is seen in the central air conditioning ventilation systems in public places in main urban areas of Ma'anshan City. High attention needs to be paid to contamination of bacterium, fungus and L. pneumophila, and expansion of supervision coverage and improved supervision intensity are recommended.

Objective:To analyze the clinical characteristics and prognosis of patients with myelodysplastic syndrome (MDS) with a bone marrow nucleated erythroid cell proportion of greater than or equal to 50% (MDS-E) .Methods:The clinical characteristics and prognostic factors of patients with MDS-E were retrospectively analyzed by collecting the case data of 1 436 newly treated patients with MDS diagnosed in the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences from May 2014 to June 2023.Results:A total of 1 436 newly diagnosed patients with complete data were included in the study, of which 337 (23.5%) patients with MDS-E had a younger age of onset and lower neutrophil and platelet counts compared with those in patients with an erythroid cell proportion of less than 50% (MDS-NE) (all P<0.05). The proportion of MDS cases with ring sideroblasts (MDS-RS) was higher in the MDS-E group than in the MDS-NE group, and multi-hit TP53 mutations were more enriched in the MDS-E group than in the MDS-NE group (all P<0.05). Among patients with MDS-RS, the frequency of complex karyotypes and the TP53 mutation rate were significantly lower in the MDS-E group than in the MDS-NE group (0 vs 11.9%, P=0.048 and 2.4% vs 15.1%, P=0.053, respectively). Among patients with TP53 mutations, the frequencies of complex karyotypes and multi-hit TP53 mutations were significantly higher in the MDS-E group than in the MDS-NE group (87.5% vs 64.6%, P=0.003 and 84.0% vs 54.2%, P<0.001, respectively). Survival analysis of patients with MDS-RS found that the overall survival (OS) in the MDS-E group was better than that in the MDS-NE group [not reached vs 63 (95% CI 53.3-72.7) months, P=0.029]. Among patients with TP53 mutations and excess blasts, the OS in the MDS-E group was worse than that in the MDS-NE group [6 (95% CI 2.2-9.8) months vs 12 (95% CI 8.9-15.1) months, P=0.022]. Multivariate analysis showed that age of ≥65 years ( HR=2.47, 95% CI 1.43-4.26, P=0.001), mean corpuscular volume (MCV) of ≤100 fl ( HR=2.62, 95% CI 1.54-4.47, P<0.001), and TP53 mutation ( HR=2.31, 95% CI 1.29-4.12, P=0.005) were poor prognostic factors independent of the Revised International Prognostic Scoring System (IPSS-R) prognosis stratification in patients with MDS-E. Conclusion:Among patients with MDS-RS, MDS-E was strongly associated with a lower proportion of complex karyotypes and TP53 mutations, and the OS in the MDS-E group was longer than that in the MDS-NE group. Among patients with TP53 mutations, MDS-E was strongly associated with complex karyotypes and multi-hit TP53 mutations, and among TP53-mutated patients with excess blasts, the OS in the MDS-E group was shorter than that in the MDS-NE group. Age of ≥65 years, MCV of ≤100 fl, and TP53 mutation were independent adverse prognostic factors affecting OS in patients with MDS-E.

Objective:To investigate the difference in the efficacy of extended trochanteric osteotomy (ETO) and subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH).Methods:Forty patients (51 hips) who underwent primary THA for Crowe type IV DDH from April 2012 to August 2020 at the First Affiliated Hospital of Soochow University and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were classified into ETO (extended greater trochanteric osteotomy) group and SSO(subtrochanteric shortening osteotomy) group. There were 12 patients (14 hips) in the ETO group, with 3 males and 9 females, aged 49.9±16.7 years old (range, 22-75 years old) and 28 patients (37 hips) in the SSO group, with 7 males and 21 females, aged 50.3±14.0 years (range, 22-76 years). In both groups, Harris hip score (HHS), leg length discrepancy, limp, Trendelenburg sign were used to evaluate the functional results and anteroposterior radiographs of the pelvis were taken at each follow-up to assess bone healing at the osteotomy site, periprosthetic osteolysis, bone ingrowth and periprosthetic loosening. Complications were recorded and analyzed.Results:All 51 hips were followed up for at least 24 months. The operative time and total blood loss was 116.8±14.2 vs. 128.3±19.2 min and 650.8±191.4 vs. 808.3±151.3 ml in the ETO group and the SSO group with significant difference ( t=2.04, P=0.047; t=3.08, P=0.003) respectively. At the follow-up of 24 months the HHS of ETO and SSO groups were 94.8±6.3 vs. 93.9±4.9 points and the leg length discrepancy was 4.6±2.2 vs. 5.2±3.0 mm. The positive rate of Trendelenburg's sign was 7% vs. 16% and the incidence of limp was 17% vs. 29% in the ETO group and the SSO group with no significant difference ( t=0.54, P=0.591; t=0.68, P=0.499; P=0.657; P=0.693). The length of femoral shortening in the ETO group and SSO group was 30.8±4.1 vs 35.3±7.9 mm with significant difference ( t=2.02, P=0.049). Time for bone healing at the osteotomy site was 5.8±1.5 vs. 6.0±1.4 months and the incidence of intraoperative femoral fractures was 36% and vs. 65% with no significant difference ( t=0.45, P=0.657; χ 2=3.52, P=0.061). Bone in-growth (or bone on-growth) fixation was obtained for all acetabular and femoral prostheses, with no hips of prosthesis displacement, periprosthetic osteolysis, or dislocation. Conclusion:Total hip arthroplasty for Crowe type IV DDH can achieve satisfactory clinical efficacy with similar functional recovery and rate of complication in extended trochanteric osteotomy and subtrochanteric shortening osteotomy. However, the extended greater trochanter osteotomy can reduce the operation time, blood loss and length of femoral shortening.

OBJECTIVE To qualitatively analyze the chemical constituents from Tianzhi granules and their constituents absorbed into blood， and to provide reference for elucidating pharmacodynamic material basis of Tianzhi granules. METHODS UPLC-ESI-Q-TOF-MS/MS was adopted. The analysis was performed on an Agilent Eclipse Plus C18 column with mobile phase consisted of 0.5% formic acid solution-acetonitrile （gradient elution） at the flow rate of 0.3 mL/min； the column temperature was 40 ℃ ；the injection volume was 10 μL. Mass spectrometry was applied for the qualitative analysis under positive ionization mode and ESI ion source. Data were collected with MS-DIAL4.60， and then chemical constituents of the extract from Tianzhi granule （by 0.5% methanol） were analyzed by comparing with relevant literature， SciFinder， PubChem， MassBank， TCMSP， TCM-ID and other databases. The blank serum， administered serum and Tianzhi granule extract were compared to analyze the constituents absorbed into the blood. RESULTS One hundred compounds were preliminarily identified from Tianzhi granules， including 46 flavonoids， 8 organic acids， 8 alkaloids， 6 terpenes， 6 coumarins， 2 quinones， 1 steroids， 7 glycosides and 16 others. Based on it， 10 prototype constituents absorbed into blood were identified preliminarily， including genistein， melatonin A， chrysin-7-O- β-glucuronide， apigenin-7-O-glucuronide， wogonin， 6-O-methylbaicalin are flavonoids， 2-hydroxyquinoline and isonacolline are alkaloids， 7-hydroxycoumarin is coumarins，1-indanol is others. CONCLUSIONS 2-hydroxyquinoline， 7-hydroxycoumarin， genistein， melatonin A， isonocolline， chrysin-7-O-β-glucuronide， apigenin-7-O-glucuronide， wogonin and 6-O-methylbaicalin may be the pharmacodynamic material basis of Tianzhi granules.

Objective:To study the therapeutic effects of transcranial direct current stimulation（tDCS）combined with hyperbaric oxygen（HBO）in the treatment of dyskinesia in stroke patients with hemiplegia.Methods:A total of 90 stroke patients with hemiplegia admitted to the Department of Rehabilitation of the First Hospital of Shanxi Medical University between March 2019 and March 2021 were selected. They were divided into observation group and control group according to the random number table method，with 45 patients in each group. All patients underwent conventional rehabilitation treatment. The control group was treated with tDCS，and the observation group was treated with tDCS on the basis of HBO therapy. The lower limb motor ability，balance ability，activity of daily living，nerve defects and surface electromyography parameters were compared between the two groups.Results:After treatment，the Fugl-Meyer Assessment Scale（FMA-L）scores and Berg Balance Scale（BBS）scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the ellipse area of the center of gravity trajectory when eyes opened and closed was significantly reduced in the two groups，and the ellipse area of the observation group was significantly smaller than that of the control group. The differences were statistically significant（ P < 0.05）. After treatment，the National Institutes of Health Stroke Scale（NIHSS）scores of the two groups were significantly reduced，and the observation group had significantly lower scores than the control group. Barthel Index scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the integrated electromyogram（iEMG）was significantly increased in the two groups，and the observation group had significantly higher iEMG than the control group. The synergistic contraction rate（CR）was significantly reduced，and it was significantly lower in the observation group than in the control group. The differences were statistically significant（ P < 0.05）. Conclusion:The combined treatment of tDCS and HBO can effectively improve the motor ability of stroke patients with hemiplegia，restore their balance ability and muscle activity，and promote the nerve function recovery and quality of life.

Objective:To study the therapeutic effects of transcranial direct current stimulation（tDCS）combined with hyperbaric oxygen（HBO）in the treatment of dyskinesia in stroke patients with hemiplegia.Methods:A total of 90 stroke patients with hemiplegia admitted to the Department of Rehabilitation of the First Hospital of Shanxi Medical University between March 2019 and March 2021 were selected. They were divided into observation group and control group according to the random number table method，with 45 patients in each group. All patients underwent conventional rehabilitation treatment. The control group was treated with tDCS，and the observation group was treated with tDCS on the basis of HBO therapy. The lower limb motor ability，balance ability，activity of daily living，nerve defects and surface electromyography parameters were compared between the two groups.Results:After treatment，the Fugl-Meyer Assessment Scale（FMA-L）scores and Berg Balance Scale（BBS）scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the ellipse area of the center of gravity trajectory when eyes opened and closed was significantly reduced in the two groups，and the ellipse area of the observation group was significantly smaller than that of the control group. The differences were statistically significant（ P < 0.05）. After treatment，the National Institutes of Health Stroke Scale（NIHSS）scores of the two groups were significantly reduced，and the observation group had significantly lower scores than the control group. Barthel Index scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the integrated electromyogram（iEMG）was significantly increased in the two groups，and the observation group had significantly higher iEMG than the control group. The synergistic contraction rate（CR）was significantly reduced，and it was significantly lower in the observation group than in the control group. The differences were statistically significant（ P < 0.05）. Conclusion:The combined treatment of tDCS and HBO can effectively improve the motor ability of stroke patients with hemiplegia，restore their balance ability and muscle activity，and promote the nerve function recovery and quality of life.

Objective:To investigate the effect of hyperbaric oxygen therapy combined with Bosentan on the serum expressions of NT-proBNP and galectins-3 in children with congenital heart disease (CHD) and severe pulmonary arterial hypertension (PAH).Methods:The clinical data of 80 children with CHD and severe PAH admitted to the Department of Cardiology of Children’s Hospital of Shanxi from January 2015 to December 2019 were collected. According to the treatment, the children were divided into observation group ( n=40) and control group ( n=40). The control group was given Bosentan and conventional treatment, and the observation group was given hyperbaric oxygen therapy on the basis of the treatments in the control group. The therapeutic effects of the two groups were observed after three courses of treatment. Mean pulmonary arterial pressure (MPAP), mean systemic arterial pressure (MSAP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and pulmonary artery pressure/aortic pressure (Pp/Ps) were measured by echocardiography before and after treatment. Two milliliters of radial artery blood were collected on an empty stomach before and after treatment, and partial pressure of carbon dioxide (PaCO 2), partial pressure of oxygen (PaO 2), and oxygenation index (OI) were measured by blood gas analyzer. Cardiac output (CO) per minute and cardiac index (CI) were calculated by echocardiography. Serum levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and galectins-3 were detected by ELISA. The therapeutic effect, hemodynamic indexes, cardiac function, and the levels of NT-proBNP and galectins-3 were observed. Results:After three courses of treatment, the total effective rate in the observation group (90.0%) was significantly higher than that in the control group (70.0%), and the difference was statistically significant ( P<0.05). The levels of MPAP, MSAP, SVR, PVR, and Pp/Ps in the two groups were decreased after treatment, and those in the observation group decreased more significantly after treatment than those in the control group, with statistically significant differences ( P<0.05); PaO 2, OI, CI, and CO in the two groups were significantly higher than those before treatment, and those in the observation group were significantly higher than those in the control group after treatment ( P<0.05). The levels of serum NT-proBNP and galectins-3 in the two groups were significantly decreased, and the levels of serum NT-proBNP and galectins-3 in the observation group were significantly lower than those in the control group after treatment ( P<0.05). Conclusion:Hyperbaric oxygen combined with Bosentan therapy is effective in treating patients with CHD and severe PAH. It can significantly improve the hemodynamics indexes of pulmonary circulation and cardiac function, reduce the expression levels of NT-proBNP and galectins-3, and is conducive to prognosis.