Objective To analyze the effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy.Methods A total of 120 elderly patients undergoing thoracoscopic lobectomy were included and divided into control group(group C),2 μg·kg-1·min-1 methoxamine group(M1 group),3 μg·kg-1·min-1 methoxyamine group(M2 group)and 4 μg·kg-1·min-1 methoxamine group(M3 group)according to random number table.The mean arterial pressure(MAP),heart rate,central venous pressure(CVP)and pulse pressure variation(PPV)of patients before anesthesia(T0),after anesthesia induction(T1),before one-lung ventilation(T2),after one-lung ventilation for 5 minutes(T3),immediately after lobectomy(T4),after one-lung ventilation(T5)and after supine position(T6)were compared.The lactic acid value and oxygenation index of patients at T0 and T6 in each group were compared.The amount of crystal,colloid,urine and blood loss of patients in each group were recorded.The incidence of complications such as hypertension,hypotension,tachycardia,bradycardia,pulmonary edema and hypoxemia during operation,and pulmonary infection,atelectasis and acute kidney injury within 7 days after operation were counted.Results Compared with group C,MAP and CVP at T1 of patients in M2 group and M3 group significantly increased(P<0.05),PPV at T1 of patients in M1 group and M2 group significantly decreased(P<0.05),while heart rate of patients in M3 group significantly decreased(P<0.05).There was no significant difference in oxygenation index or lactic acid value at T0 of patients between group C and other groups(P>0.05),oxygenation index at T6 of patients in M2 group was significantly higher than those in group C and M3 group(P<0.05),lactic acid value at T6 of patients in M3 group was significantly higher than that in M2 group(P<0.05).Compared with group C,the dosage of colloid and crystal in other three groups significantly decreased(P<0.05).Compared with group C,the incidence of hypertension and bradycardia in M3 group significantly increased(P<0.05),while the incidence of hypotension in M2 group and M3 group significantly decreased(P<0.05).There was no significant difference in the incidence of postoperative complications between the four groups(P>0.05).Conclusion The application of 3 μg·kg-1·min-1 methoxamine combined with restricted fluid infusion in thoracoscopic lobectomy for elderly patients can maintain hemodynamic stability and ensure good tissue perfusion,which is a safe circulation management strategy for elderly patients.

Obstructive sleep apnea hypopnea syndrome(OSAHS)is the common sleep-related breathing disorders,which is prone to develop into multi-organ and multi-system damages.OSAHS can be categorized as"snoring syndrome"in traditional Chinese medicine(TCM).Professor ZHANG Zhong-De,a national famous Chinese medical practitioner,advocates to treat OSAHS with the method of uniform regulation of five zang organs,and emphasizes the importance of pathogenesis of imbalance of the five zang-organs.In his view,failure of lung qi in dispersing and descending is the basic pathogenesis of OSAHS,spleen and stomach failing in transporting and transforming as well as internal retention of phlegm-damp is the key pathogenic factors of OSAHS,and heart-kidney yang deficiency and liver blood insufficiency contribute to the fundamental pathogenesis of OSAHS.In the course of OSAHS,the yin and yang,qi and blood of the five zang organs become imbalanced,which leads to the progression of the disease.The treatment based on syndrome differentiation for OSAHS aims at restoring the state of balance.Following the principle of uniform regulation,methods of invigorating spleen,ventilating lung,warming heart and kidney,and nourishing liver blood are used for the uniform regulation of five zang organs,so as to keep the dynamic balance among the organs and to cure the disease.

Objective To investigate Aconitum sinomontanum Nakai has anti-hepatoma activity.Methods Cell experiment:HepG2 cells were divided into blank group(0.9％NaCl)and experimental-L,-M,-H groups(2,4,8 mg·mL-1 Aconitum sinomontanum Nakai).The 24,48,72 h cell proliferation activity was detected by methyl thiazolyl tetrazolium(MTT)method.Animal experiments:BALB/C mice inoculated with H22 cells were divided into model group(0.9％NaCl),cisplatin group(2 mg·kg-1 cisplatin),lappaconitine hydrobromide group(4 mg·kg-1 lappaconitine hydrobromide)and high-dose group(8 mg·kg-1 Aconitum sinomontanum Nakai).BALB/C mice were selected as control group(0.9％NaCl).After 14 days of continuous administration,the tumor inhibition rate of Aconitum sinomontanum Nakai was detected.The indexes of inflammation,liver cancer and liver function related factors in serum of mice in each group were detected by enzyme-linked immunosorbent assay(ELISA).The apoptosis protein of tumor tissue was detected by immunohistochemistry.Results The median inhibitory concentration(IC50)of trichloromethane in HepG2 cells for 24,48 and 72 h were 5.71,4.37 and 2.12 mg·mL-1,respectively.The expression levels of alpha-fetoprotein(AFP)in serum were 8.84±0.35,12.04±0.76,10.14±1.01,9.53±0.79 and 9.33±1.06 in control group,model group,cisplatin group,lappaconitine hydrobromide group and high-dose group,respectively.The tumor inhibition rates of cisplatin group,lappaconitine hydrobromide group and high-dose group were 48.40％,50.71％and 52.58％,respectively.The expression levels of B-cell lymphoma-2(Bcl-2)in model group,cisplatin group,lappaconitine hydrobromide group and high-dose group were 101.09±7.15,65.92±6.11,67.12±7.88 and 62.60±10.75,respectively;the expression levels of pro-apoptotic protein Bel-2 associated X protein(Bax)were 48.57±15.50,89.09±8.54,60.40±3.24 and 108.79±3.17,respectively.Compared with the model group,the above indexes in cisplatin group,hyperaconitine hydrobromide group and high-dose group had statistical significance(P＜0.01,P＜0.05).Conclusion Aconitum sinomontanum Nakai has significant anti-liver cancer activity,inhibits the proliferation of hepatoma cells,induces apoptosis,and thus exerts anti-hepatocarcinoma activity.

Objective To investigate Aconitum sinomontanum Nakai has anti-hepatoma activity.Methods Cell experiment:HepG2 cells were divided into blank group(0.9％NaCl)and experimental-L,-M,-H groups(2,4,8 mg·mL-1 Aconitum sinomontanum Nakai).The 24,48,72 h cell proliferation activity was detected by methyl thiazolyl tetrazolium(MTT)method.Animal experiments:BALB/C mice inoculated with H22 cells were divided into model group(0.9％NaCl),cisplatin group(2 mg·kg-1 cisplatin),lappaconitine hydrobromide group(4 mg·kg-1 lappaconitine hydrobromide)and high-dose group(8 mg·kg-1 Aconitum sinomontanum Nakai).BALB/C mice were selected as control group(0.9％NaCl).After 14 days of continuous administration,the tumor inhibition rate of Aconitum sinomontanum Nakai was detected.The indexes of inflammation,liver cancer and liver function related factors in serum of mice in each group were detected by enzyme-linked immunosorbent assay(ELISA).The apoptosis protein of tumor tissue was detected by immunohistochemistry.Results The median inhibitory concentration(IC50)of trichloromethane in HepG2 cells for 24,48 and 72 h were 5.71,4.37 and 2.12 mg·mL-1,respectively.The expression levels of alpha-fetoprotein(AFP)in serum were 8.84±0.35,12.04±0.76,10.14±1.01,9.53±0.79 and 9.33±1.06 in control group,model group,cisplatin group,lappaconitine hydrobromide group and high-dose group,respectively.The tumor inhibition rates of cisplatin group,lappaconitine hydrobromide group and high-dose group were 48.40％,50.71％and 52.58％,respectively.The expression levels of B-cell lymphoma-2(Bcl-2)in model group,cisplatin group,lappaconitine hydrobromide group and high-dose group were 101.09±7.15,65.92±6.11,67.12±7.88 and 62.60±10.75,respectively;the expression levels of pro-apoptotic protein Bel-2 associated X protein(Bax)were 48.57±15.50,89.09±8.54,60.40±3.24 and 108.79±3.17,respectively.Compared with the model group,the above indexes in cisplatin group,hyperaconitine hydrobromide group and high-dose group had statistical significance(P＜0.01,P＜0.05).Conclusion Aconitum sinomontanum Nakai has significant anti-liver cancer activity,inhibits the proliferation of hepatoma cells,induces apoptosis,and thus exerts anti-hepatocarcinoma activity.

Objectives:This study aimed to assess the efficacy and safety of bendamustine in combination with rituximab (BR regimen) for the treatment of newly diagnosed indolent B-cell non-Hodgkin's lymphoma (B-iNHL) and elderly mantle cell lymphoma (eMCL) .Methods:From December 1, 2020 to September 10, 2022, a multi-center prospective study was conducted across ten Grade A tertiary hospitals in Shandong Province, China. The BR regimen was administered to evaluate its efficacy and safety in newly diagnosed B-iNHL and eMCL patients, and all completed at least four cycles of induction therapy.Results:The 72 enrolled patients with B-iNHL or MCL were aged 24-74 years, with a median age of 55 years. Eastern Cooperative Oncology Group (ECOG) performance status scores of 0-1 were observed in 76.4% of patients, while 23.6% had scores of 2. Disease distribution included follicular lymphoma (FL) (51.4% ), marginal zone lymphoma (MZL) (33.3% ), eMCL (11.1% ), and the unknown subtype (4.2% ). According to the Ann Arbor staging system, 16.7% and 65.3% of patients were diagnosed with stage Ⅲ and stage Ⅳ lymphomas, respectively. Following four cycles of BR induction therapy, the overall response rate was 98.6%, with a complete response (CR) rate of 83.3% and a partial response (PR) rate of 15.3%. Only one eMCL patient experienced disease progression during treatment, and only one FL patient experienced a relapse. Even when evaluated using CT alone, the CR rate was 63.9%, considering the differences between PET/CT and CT assessments. The median follow-up duration was 11 months (range: 4-22), with a PFS rate of 96.8% and an OS rate of 100.0%. The main hematologic adverse reactions included grade 3-4 leukopenia (27.8%, with febrile neutropenia observed in 8.3% of patients), grade 3-4 lymphopenia (23.6% ), grade 3-4 anemia (5.6% ), and grade 3-4 thrombocytopenia (4.2% ). The main non-hematologic adverse reactions such as fatigue, nausea/vomiting, rash, and infections occurred in less than 20.0% of patients.Conclusion:Within the scope of this clinical trial conducted in China, the BR regimen demonstrated efficacy and safety in treating newly diagnosed B-iNHL and eMCL patients.

Objective:To compare the clinical efficacy between bone transport technique combined with bone grafting plus internal fixation and simple bone transport technique in the treatment of large segmental bone defects at lower limbs after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 42 patients with large segmental bone defects at lower limbs after trauma who had been treated at Department of Trauma Orthopaedics, Honghui Hospital Affiliated to Medicine College, Xi'an Jiaotong University from September 2015 to September 2019. The patients were divided into 2 groups according to the different methods of repairing bone defects. In group A of 18 patients subjected to bone transport combined with bone grafting plus internal fixation, there were 11 males and 7 females with an age of (35.2±10.3) years, and 12 tibial defects and 6 femoral defects; in group B of 24 patients subjected to simple bone transport, there were 15 males and 9 females with an age of (37.3±9.4) years, and 17 tibial defects and 7 femoral defects. The external fixation time (EFT), external fixation index (EFI), total cure time and complications were recorded and compared between the 2 groups. At the last follow-up, the Ennecking score for limb functional recovery (score/total score 30) and Self-rating Anxiety Scale (SAS) were used to evaluate respectively the functional recovery of the limbs and postoperative anxiety.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). There was no statistically significant difference in the number of surgeries between the 2 groups ( P>0.05). The EFT [(5.9±1.5) months], EFI [(0.45±0.09) months/cm], total treatment time [(16.2±2.4) months], Ennecking score for limb functional recovery (87.0%±8.6%), SAS score [(43.2±9.0) points], and complications per capita [(0.4±0.2) times/case] in group A were significantly better than those in group B [(15.3±4.2) months, (1.19±0.28) months/cm, (19.7±3.5) months, (77.3%±9.2%), (58.2±9.3) points, and (1.2±0.5) times/case] (all P<0.05). Conclusion:In the treatment of large segmental bone defects at lower limbs, compared with simple bone transport technique, bone transport technique combined with bone grafting plus internal fixation has advantages of shorter external fixation time and overall cure time, a lower rate of complications, and better functional recovery of the limbs.

Objective:To compare the clinical effects of acute shortening-lengthening technique with antibiotic calcium sulfate-loaded bone transport technique for the treatment of segmental tibial defects after trauma.Methods:The clinical data of 58 patients with large tibial defects treated by Ilizarov technique in Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from May 2014 to December 2019 were retrospectively analyzed. Thirty patients were treated by acute shortening-lengthening (group A), and they were divided into those who were successful in one-time shortening during operation (group A1) and those who needed gradual shortening after operation (group A2) according to different shortening conditions. And 28 patients by antibiotic calcium sulfate-loaded bone transport (group B). The external fixation time (EFT) and external fixation index (EFI) of the two groups were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. The measurement data of normal distribution were expressed as ± s, and t-test was used for comparison between groups; the count data were expressed as n(%), and the chi-square test, Fisher exact probability method or Mann-Whitney U test were used for comparison between groups. Results:Patients were followed for(27.5±5.1)months. There was no significant difference in EFT, EFI, bone defect healing and limb functions between the two groups( P>0.05). The incidence of Grade-Ⅱ[41.2% (7/17)], Grade-Ⅲ [47.1% (8/17)] pin-tract infection in group A1 and Grade-Ⅱ[46.2% (6/13)], Grade-Ⅲ pin-tract [53.8% (7/13)] in group A2 was significantly higher than those in group B[14.3% (4/28)], [17.9% (5/28)] ( P<0.05). The number of complications per capita in group A1 [(1.4±0.3) times/case] and in group A2 [(1.5±0.3) times/case]was significantly higher than that in group B [(1.1±0.5) times/case]. Conclusions:Patients can be cured successfully by both acute shortening-lengthening and bone transport techniques. Compared with acute shortening-lengthening group, the complication incidence in antibiotic calcium sulfate-loaded bone transport group was lower, especially, the infection-related complications. Therefore, antibiotic calcium sulfate-loaded bone transport technique has a greater application prospect in patients with large segmental bone defects caused by infection or osteomyelitis.

OBJECTIVE: To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics. METHODS: The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m² referred to obese individuals, 25≤BMI < 30 kg/m² referred to overweight individuals, 18.5≤BMI < 25 kg/m² referred to normal individuals, BMI < 18.5 kg/m² referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors. RESULTS: A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m².Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m², 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m², amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m², 24.7%) and 22 obese individuals (BMI≥30 kg/m², 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia. CONCLUSION In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.
Humans ; Body Mass Index ; Overweight/epidemiology* ; Retrospective Studies ; Arthritis, Rheumatoid/epidemiology* ; Obesity/epidemiology* ; Diabetes Mellitus ; Hypertension/complications* ; Fatty Liver/complications* ; Hyperlipidemias/complications* ; Osteoporosis/complications* ; Anemia

OBJECTIVE: To analyze health related quality of life (HR-QoL) and physical function of outpatient department patients with rheumatoid arthritis (RA), and to analyze disease activity influence in HR-QoL and functional capacity as well as the divergences between different disease activity standards. METHODS: The demographic and clinical data of 207 RA cases from Department of Rheumatology and Immunology, Peking University Third Hospital from Jan 2021 to Jul 2021 were collected. RA-specific quality of life (RA-QoL) and the medical outcome 36-item short form health survey (SF-36)were collected to estimate the quality of life. The t test was used for the quantitative data in accordance with normal distribution. RESULTS: A total of 207 cases were included, with RA-QoL score of 7.8±7.1, physical component summary (PCS) score of 63.8±23.8, and mental component summary (MCS) score of 71.7±21.0. According to disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR), there were 119 patients (59.5%) with remission and low disease activity, and 125 patients (62.5%) with simplified disease activity index (SDAI). The HR-QoL of the patients with remission or low disease activity was significantly better than that of the patients with moderate or high disease activity. The physical function (76.7±17.2 vs. 86.4±15.0, t=2.855, P < 0.01), bodily pain (67.8±8.5 vs. 77.7±15.6, t=4.277, P < 0.01) and health transition (52.8±22.3 vs. 63.9±24.1, t=2.134, P < 0.05) in the low disease activity (LDA) group were lower than those in the complete remission (REM) group according to DAS28-ESR. Other domains of SF-36 and RA-QoL had no differences between these two groups. PCS in the LDA group was lower than that in the REM group (68.3±15.2 vs. 77.3±15.2, t=2.716, P < 0.01), but MCS was not different between the two groups. Determined by SDAI, the RA-QoL score in the LDA group was significantly higher than that in the REM group (9.4±7.1 vs. 6.0±4.8, t=-2.260, P < 0.05), the various dimensions of physical function in the SF-36 score and the PCS score (69.9±16.4 vs. 81.4±15.1, t=3.879, P < 0.05) were lower than that in the REM group, and the MCS score was lower than that in the REM group (67.9±19.3 vs. 74.5±18.8, t=2.721, P < 0.01). CONCLUSION The RA-QoL and SF-36 scores of RA patients in outpatient clinics were better, and the MCS was higher than the PCS. Treat-to-target is essential to improve HR-QoL. SDAI can better indicate the HR-QoL of each domain in REM and LDA RA patients.
Humans ; Quality of Life ; Cross-Sectional Studies ; Severity of Illness Index ; Arthritis, Rheumatoid ; Remission Induction

Objective:To introduce our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate by comparison with conventional bone transport in the treatment of distal tibial osteomyelitis with bone defects involving the articular surface.Methods:The clinical data of 34 patients were retrospectively analyzed who had been treated at Department of Orthopaedics, Honghui Hospital for distal tibial osteomyelitis with bone defects involving the articular surface from September 2014 to September 2019. They were divided into 2 groups according to their way of repairing bone defects. In the modified group of 14 cases subjected to the treatment using the modified hybrid bone transport technique, there were 9 males and 5 females, with an age of (39.4±7.3) years. In the conventional group of 20 cases subjected to the treatment using conventional bone transport technique, there were 12 males and 8 females, with an age of (41.2±6.6) years. The external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS) were recorded and compared between the 2 groups. Healing of bone defects and function were evaluated at the last follow-up according to the criteria of Association for the Study and Application of the Method of Ilizarov (ASAMI) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-posterior foot score, respectively. Complications were recorded according to the Paley classification.Results:There was no significant difference in the general data between the modified group and the conventional group, showing they were comparable ( P>0.05). Thirty-four patients were followed up for 18 to 32 months (average, 27 months) after operation. The modified group had significantly shorter EFT [(3.9±1.6) months] than the conventional group [(9.8±2.2) months], and significantly lower EFI [(0.48±0.09) months/cm] than the conventional group [(1.42±0.32) months/cm] ( P<0.05). The SAS [(48.1±4.7) points] in the modified group was significantly lower than that in the conventional group [(61.2±6.2) points], and the number of complications per capita in the former [(0.8±0.4)/case] was significantly smaller than that in the latter [(1.42±0.32)/case] ( P<0.05). There were no significan differences in the healing of bone defects or AOFSA ankle-posterior foot score ( P>0.05). In the modified group and the conventional group, respectively, 13 versus 12 patients were satisfied while 1 versus 8 patients unsatisfied, 1 versus 8 patients had grade-Ⅱ infection while 13 versus 12 patients did not, and 1 versus 9 patients had grade-Ⅲ infection while 13 versus 11 patients did not. There were significant differences between the 2 groups in the above indexes (all P<0.05). Conclusion:In the treatment of distal tibial osteomyelitis with bone defects involving the articular surface, compared with conventional bone transport technique, our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate may lead to better clinical efficacy due to the advantages of shorter external fixation time, lower external fixation index and fewer complications.