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.

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 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 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.

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 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.

BACKGROUND: Innovative coronavirus disease 2019 (COVID-19) vaccines, with elevated global manufacturing capacity, enhanced safety and efficacy, simplified dosing regimens, and distribution that is less cold chain-dependent, are still global imperatives for tackling the ongoing pandemic. A previous phase I trial indicated that the recombinant COVID-19 vaccine (V-01), which contains a fusion protein (IFN-PADRE-RBD-Fc dimer) as its antigen, is safe and well tolerated, capable of inducing rapid and robust immune responses, and warranted further testing in additional clinical trials. Herein, we aimed to assess the immunogenicity and safety of V-01, providing rationales of appropriate dose regimen for further efficacy study. METHODS: A randomized, double-blind, placebo-controlled phase II clinical trial was initiated at the Gaozhou Municipal Centre for Disease Control and Prevention (Guangdong, China) in March 2021. Both younger (n = 440; 18-59 years of age) and older (n = 440; ≥60 years of age) adult participants in this trial were sequentially recruited into two distinct groups: two-dose regimen group in which participants were randomized either to follow a 10 or 25 μg of V-01 or placebo given intramuscularly 21 days apart (allocation ratio, 3:3:1, n = 120, 120, 40 for each regimen, respectively), or one-dose regimen groups in which participants were randomized either to receive a single injection of 50 μg of V-01 or placebo (allocation ratio, 3:1, n = 120, 40, respectively). The primary immunogenicity endpoints were the geometric mean titers of neutralizing antibodies against live severe acute respiratory syndrome coronavirus 2, and specific binding antibodies to the receptor binding domain (RBD). The primary safety endpoint evaluation was the frequencies and percentages of overall adverse events (AEs) within 30 days after full immunization. RESULTS: V-01 provoked substantial immune responses in the two-dose group, achieving encouragingly high titers of neutralizing antibody and anti-RBD immunoglobulin, which peaked at day 35 (161.9 [95% confidence interval [CI]: 133.3-196.7] and 149.3 [95%CI: 123.9-179.9] in 10 and 25 μg V-01 group of younger adults, respectively; 111.6 [95%CI: 89.6-139.1] and 111.1 [95%CI: 89.2-138.4] in 10 and 25 μg V-01 group of older adults, respectively), and remained high at day 49 after a day-21 second dose; these levels significantly exceed those in convalescent serum from symptomatic COVID-19 patients (53.6, 95%CI: 31.3-91.7). Our preliminary data show that V-01 is safe and well tolerated, with reactogenicity predominantly being absent or mild in severity and only one vaccine-related grade 3 or worse AE being observed within 30 days. The older adult participants demonstrated a more favorable safety profile compared with those in the younger adult group: with AEs percentages of 19.2%, 25.8%, 17.5% in older adults vs. 34.2%, 23.3%, 26.7% in younger adults at the 10, 25 μg V-01 two-dose group, and 50 μg V-01 one-dose group, respectively. CONCLUSIONS: The vaccine candidate V-01 appears to be safe and immunogenic. The preliminary findings support the advancement of the two-dose, 10 μg V-01 regimen to a phase III trial for a large-scale population-based evaluation of safety and efficacy. TRIAL REGISTRATION http://www.chictr.org.cn/index.aspx (No. ChiCTR2100045107, http://www.chictr.org.cn/showproj.aspx?proj=124702).
Aged ; Antibodies, Viral ; COVID-19/therapy* ; COVID-19 Vaccines ; Double-Blind Method ; Humans ; Immunization, Passive ; Recombinant Fusion Proteins ; SARS-CoV-2

OBJECTIVE: To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention. METHODS: A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor. RESULTS: All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment ( CONCLUSION Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.
Female ; Fractures, Compression/surgery* ; Humans ; Kyphoplasty/adverse effects* ; Male ; Osteoporotic Fractures ; Retrospective Studies ; Risk Factors ; Spinal Fractures/surgery* ; Vertebral Body

Objective:To investigate the chemical constituents and antioxidant activities of Violae Herba from the Violaceae. Method:The 5 kg of Violae Herba was refluxing extracted with 3 times the amount of 95% ethanol for three times， then the extracting solution was combined， filtrated， concentrated under vacuum to get the total extract. Seven corresponding fractions were eluted with petroleum ether， dichloromethane， dichloromethane-methanol （50∶1， 10∶1， 5∶1， 2∶1） and methanol by silica gel column chromatography （60-100 mesh） on the total extract. Each fraction was isolated and purified by normal phase silica gel column chromatography， octadecylsilane chemically bonded silica （ODS） column chromatography， Sephadex LH-20 column chromatography and preparative high performance liquid chromatography （HPLC）， respectively. The structures of the obtained compounds were identified by spectroscopic methods of nuclear magnetic resonance （NMR）， mass spectroscopy （MS） and infrared spectroscopy （IR）. Meanwhile， some of these compounds isolated from Violae Herba were carried on the 1，1-diphenyl-2-picrylhydrazyl （DPPH） free radical scavenging experiment. Result:Fourteen compounds were isolated from the 95% ethanol extract of Violae Herba， including N-acetyl-1-ethyl ester glutamic acid （1）， N-acetyl glutamic acid-1-ethyl-5-methyl ester （2）， aurantiamide （3）， rel-（2α，3β）-7-O-methylcedrusin （4）， oleanolic acid （5）， α-tocopherol-quinone （6）， tectochrysin （7）， isoscopoletin （8）， esculetin （9）， 24-ethylcholesta-4，24（28）Z-dien-3-one （10）， stigmasta-4，25-dien-3-one （11）， β-sitostenone （12）， β-sitosterol （13）， （24R）-3β-hydroxy-ethylcholest-5-en-7-one （14）. Conclusion:Compound 2 is a new natural product， compounds 1， 4， 6， 7， 10-12 are isolated from the genus Viola for the first time. Compound 9 has significant antioxidant activity， while compounds 2， 6 and 8 have certain DPPH free radical scavenging activity.