Objective:To evaluate the effect of buccal acupuncture on analgesia after tonsilloadenoidectomy in pediatric patients.Methods:This was a randomized controlled study. One hundred and twenty-six American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ pediatric patients, aged 3-12 yr, weighing 12-34 kg, with body mass index <30 kg/m 2, undergoing elective tonsilloadenoidectomy with general anesthesia, were divided into 2 groups ( n=63 each) by the random number table method: buccal acupuncture group (group B) and control group (group C). All pediatric patients received the same anesthesia induction and intraoperative anesthesia maintenance. The concentration of sevoflurane was adjusted to keep the fluctuation amplitude of vital sign parameters within 20% of the baseline value. After surgery, the drug was immediately stopped and the children were transferred to the postanesthesia care unit for resuscitation under general anesthesia. In group B, the bilateral neck points, upper neck points, hologram points on the head and Zhongjiao points were selected before removal of the tracheal catheter, and disposable acupuncture needles were inserted directly into the acupoints and remained for 20-30 min. Group C received no buccal acupuncture. The pain Assessment Scale (FLACC) was used to assess the severity of postoperative pain. The postoperative agitation score was evaluated by Aono four-point rating method to evaluate the occurrence of agitation. The effective pressing times of patient-controlled analgesia, rescue analgesia and occurrence of nausea and vomiting within 48 h after operation were recorded. The occurrence of bleeding, infection and broken needle at acupuncture sites was recorded. Results:Compared with group C, the effective pressing times of patient-controlled analgesia and incidence of nausea and vomiting were significantly decreased in group B ( P<0.05). There was no significant difference in the rate of rescue analgesia and incidence of postoperative agitation between the two groups ( P>0.05). No infection or broken needle was found at acupuncture sites after buccal acupuncture, only 2 cases had slight bleeding at the puncture site, and there was no abnormality after pressing in group B. Conclusions:Buccal acupuncture can enhance the analgesic effect after tonsilloadenoidectomy in pediatric patients.

Tear film hyperosmolarity plays a core role in the development of dry eye disease (DED) by mediating the disruption of ocular surface homeostasis and triggering inflammation in ocular surface epithelium. In this study, the mechanisms involving the hyperosmolar microenvironment, glycolysis mediating metabolic reprogramming, and pyroptosis were explored clinically, in vitro, and in vivo. Data from DED clinical samples indicated that the expression of glycolysis and pyroptosis-related genes, including PKM2 and GSDMD, was significantly upregulated and that the secretion of IL-1β significantly increased. In vitro, the indirect coculture of macrophages derived from THP-1 and human corneal epithelial cells (HCECs) was used to discuss the interaction among cells. The hyperosmolar environment was found to greatly induce HCECs' metabolic reprogramming, which may be the primary cause of the subsequent inflammation in macrophages upon the activation of the related gene and protein expression. 2-Deoxy-d-glucose (2-DG) could inhibit the glycolysis of HCECs and subsequently suppress the pyroptosis of macrophages. In vivo, 2-DG showed potential efficacy in relieving DED activity and could significantly reduce the overexpression of genes and proteins related to glycolysis and pyroptosis. In summary, our findings suggested that hyperosmolar-induced glycolytic reprogramming played an active role in promoting DED inflammation by mediating pyroptosis.

Objective:To evaluate the effects of propofol, dexmedetomidine and ketamine on oncentrations of β-amyloid peptide (Aβ) and tau in cerebrospinal fluid (CSF) of sleep-deprived rats.Methods:Forty SPF healthy male Sprague-Dawley rats, aged 3-4 months, weighing 230-280 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), sleep deprivation group (SD), propofol group (group P), dexmedetomidine group (group D) and ketamine group (group K). The sleep deprivation was induced using the improved multi-platform sleep deprivation model.Propofol 100 mg/kg, dexmedetomidine 100 mg/kg and ketamine 80 mg/kg were intraperitoneally injected at 72 h of sleep deprivation to maintain anesthesia for 3 h in P, D and K groups, respectively.Group C entered the large platform for 72 h free activity.The CSF was collected at 3 h of anesthesia for measurement of concentrations of Aβ and tau protein by enzyme-linked immunosorbent assay. Results:The concentrations of Aβ and tau protein in CSF were significantly higher in SD, P, K and D groups than in group C ( P<0.05). Compared with group SD, the concentrations of Aβ and tau protein in CSF were significantly increased in P and K groups, and the concentrations of Aβ and tau protein in CSF were significantly decreased in group D ( P<0.05). Conclusion:Dexmedetomidine can decrease the the concentrations of Aβ and tau protein in CSF of sleep deprived rats, while propofol and ketamine lead to the opposite effect.

Objective:To discuss the clinical results of treatment for congenital muscular torticollis with different injection points of botulinum toxin type A and traditional conservative method, and to expound the safety and effectiveness of this way.Methods:From January 2018 to December 2018, 60 cases aged from one month to six months with congenital muscular torticollis who visited the outpatient clinic of plastic surgery in Children＇s Hospital of Quanzhou, a teaching hospital of FuJian Medical University, and there were 38 males and 22 females. The treatment groups were divided into two groups according to random number method that were treated with botulinum toxin type A: the single point group was given one point injection, and the three-point group was injected with three points, while the control group was treated with traditional conservative treatment (mainly manual stretching exercises). The number of cases in each group was 20.Results:The differences of muscle thickness and muscle length were repeatedly measured at different time points in the same group and variance analysis conducted. The results showed that there were statistical significances among the two indicators at different time points in each group ( P<0.05). Least significant difference (LSD) was further adopted for pairwise comparison between indicators at different time points in each group and the differences were statistically significant ( P<0.05). In the comparison of treatment effect of different groups after twelve months follow-up, the cure rate was 85% (17 cases) in the single point group, 95 % (19 cases) in the three-point group, and 80 % (16 cases) in the control group, there was no significant difference among three groups ( P>0.05). Conclusions:Local injection of botulinum toxin type A is a safe and effective treatment option for congenital muscular torticollis, which can achieve the same clinical effect as traditional conservative treatment.

Objective: By implementing the best practice of bedtime and position after diagnostic adult lumbar puncture,we hope to establish a scientific and standardized nursing routine for lumbar puncture, shorten the bed-rest time after lumbar puncture, and improve the comfort of patients. Methods: By reviewing literatures related to positions after adult lumbar puncture and post-dural puncture headache, six best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Neurology Department. Results: After two rounds of reviews, the results showed that except the 93.3% compliance with the new evidence, all other four criteria had 100% complacence. Comparing before and after applying the evidence, there was no statistically significant difference for the occurrence of post-dural puncture headache or dizziness(P>0.05), there was a statistically significant reduction of back pain from 28.3%(30/106) to 15.1%(18/119)(χ² value was 5.799, P<0.05) when the evidence was applied. Conclusions The best practice shows that patients needn′t lie on bed for 4 to 6 hours after lumbar puncture, the occurrence of back pain is lowered and the comfort level of the patient is improved in those who rest with pillow or activities.

Objective:To construct the intelligent medical cloud management platform of diabetes education clinic in ClassⅢ general hospital and observe the clinical effects.Methods:A total of 260 young and middle-aged patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Endocrinology in the First Affiliated Hospital of Henan University from June to December 2019 were selected by convenience sampling method. They were divided into the control group and the experimental group by the random number table method, with 130 cases in each group. Patients in the control group were given routine diabetes outpatient follow-up, while the experimental group was given group education, case management, behavioral intervention, condition supervision and online follow-up intervention based on the intelligent medical cloud management platform of the diabetes education clinic. The blood glucose control status and the self-management ability of the two groups before and after 3 months of intervention were compared.Results:After intervention for 3 months, fasting plasma glucose (FPG) , 2h plasma glucose of 75g oral glucose tolerance test (OGTT 2h PG) and hemoglobin A1c (HbA1c) of patients in two groups were reduced than those before intervention, and FPG, OGTT 2h PG and HbA1c levels in the experimental group were lower than those in the control group. The differences were statistically significant ( P<0.05) . The mean blood glucose (MBG) and mean amplitude of plasma glucose excursions (MAGE) in the experimental group were lower than those in the control group, and the difference was statistically significant ( P<0.05) . After 3 months of intervention, blood glucose was monitored 6 833 times in the control group and 7 279 times in the experimental group. The incidence of hypoglycemia in the experimental group was lower than that in the control group [0.77% (56/7 279) vs. 2.82% (193/6 833) , χ 2=85.885, P<0.05]. After 3 months of intervention, the scores of diet, exercise, blood glucose monitoring, prevention of complications and medical compliance in the two groups were all higher than those before intervention, and the scores of diet, exercise, blood glucose monitoring and medical compliance in the experimental group were higher than those in the control group. The differences were statistically significant ( P<0.01) . Conclusions:The construction and application of intelligent medical cloud management platform of diabetes education clinic can better improve blood glucose control and improve self-management ability of patients.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

OBJECTIVETo compare the characteristics of esophageal gastric varices in portal hypertension patients with and without spontaneous shunts.

METHODSClinical data of 118 patients with esophageal gastric varices undergoing portal vein computed tomographic angiography (CTA) and gastroscopy between January 2012 and August 2015 was retrospectively reviewed.

RESULTSPortal vein CTA results showed that spleno-renal or gastro-renal shunts were detected in 24 out of 118 cases. The average portal vein diameters (PVD) of patients with and without spontaneous shunt were (12.48±2.79) mm and (13.58±3.46) mm, respectively (P>0.05). The average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt [294.00 (0.00~2400.00) mm2 vs. 26.00 (0.00~1620.00) mm2, respectively, (P<0.001]. Compared with patients without spontaneous shunt, the location of esophageal varices was lower and the degree was less serious in patients with spontaneous shunt (P<0.05). No matter with history of uppergastrointestinal bleeding, the average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt (P<0.05). For patients having no history of splenectomy, the average portal vein diameter (PVD) in those with spontaneous shunt was significantly smaller than that in those without shunt (P<0.05).

CONCLUSIONThe portal vein diameter of patients without splenectomy and with spontaneous shunts is shorter and their esophageal varices are less serious; the gastric veins are large and wriggly in patients with spontaneous shunts.

Angiography ; Esophageal and Gastric Varices ; physiopathology ; Gastroscopy ; Humans ; Hypertension, Portal ; physiopathology ; Portal Vein ; pathology ; Retrospective Studies ; Spleen ; Tomography, X-Ray Computed

Objective To evaluate the effect of dexmedetomidine on liver injury in the rats with ob?structive jaundice. Methods Forty?five healthy male Sprague Dawley rats, weighing 250-300 g, aged 8-9 weeks, were divided into 3 groups ( n=15 each) using a random number table: sham operation group ( S group) , obstructive jaundice group ( OJ group) and dexmedetomidine group ( D group) . Obstructive jaun?dice was induced in rats by division and double ligation of the common bile duct in OJ and D groups. Dexmedetomidine 100 μg∕kg was injected intraperitoneally at 72 h after establishment of the model in group D. At 3, 5 and 24 h after administration, blood samples were collected from hearts for determination of the plasma alanine aminotransferase (ALT) and C?reactive protein (CRP) levels. After blood sampling at each time point, the specimens from the external right lobe of the liver were obtained for detection of the expres?sion of Toll?like receptor 4 ( TLR4) mRNA ( by real?time polymerase chain reaction) and TLR4 content ( by enzyme?linked immunosorbent assay) in liver tissues and for pathological examination of liver tissues ( with light microscope) . Results Compared with group S, the plasma ALT and CRP levels were significantly increased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly up?regulated, and TLR4 content in liver tissues was significantly increased in OJ and D groups ( P<0?05) . Compared with group OJ, the plasma ALT and CRP levels were significantly decreased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly down?regulated, and TLR4 content in liver tissues was significantly decreased in group D ( P<0?05) . The degree of damage to liver tissues was significantly attenuated in group D compared with group OJ, and was aggrava?ted in group D compared with group S. Conclusion Dexmedetomidine can reduce liver injury in the rats with obstructive jaundice.

Dengue virus (DENV) envelope [E] protein is the major surface protein of the virions that indued neutralizing antibodies. The domain III of envelope protein (EDIII) is an immunogenic region that holds potential for the development of vaccines; however, the epitopes of DENV EDIII, especially neutralizing B-cell linear epitopes, have not been comprehensively mapped. We mapped neutralizing B-cell linear epitopes on DENV-1 EDIII using 27 monoclonal antibodies against DENV-1 EDIII proteins from mice immunized with the DENV-1 EDIII. Epitope recognition analysis was performed using two set of sequential overlapping peptides (16m and 12m) that spanned the entire EDIII protein from DENV-1, respectively. This strategy identified a DENV-1 type- specific and a group-specific neutralizing epitope, which were highly conserved among isolates of DENV-1 and the four DENV serotypes and located at two regions from DENV-1 E, namely amino acid residues 309-320 and 381-392(aa 309-320 and 381-392), respectively. aa310 -319(310KEVAETQHGT319)was similar among the four DENV serotypes and contact residues on aa 309 -320 from E protein were defined and found that substitution of residues E309 , V312, A313 and V320 in DENV-2, -3, -4 isolates were antigenically silent. We also identified a DENV-1 type-specific strain-restricted neutralizing epitope, which was located at the region from DENV-1 E, namely amino acid residues 329-348 . These novel type- and group-specific B-cell epitopes of DENV EDIII may aid help us elucidate the dengue pathogenesis and accelerate vaccine design.
Amino Acid Sequence ; Animals ; Antibodies, Neutralizing ; immunology ; Dengue ; virology ; Dengue Virus ; chemistry ; genetics ; immunology ; Epitope Mapping ; Epitopes, B-Lymphocyte ; chemistry ; genetics ; immunology ; Humans ; Mice ; Molecular Sequence Data ; Viral Envelope Proteins ; chemistry ; genetics ; immunology