Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.

Objective:In recent years,the prevalence of diabetic nephropathy(DN)has increased significantly.An increasing number of studies have shown that lymphocyte-associated inflammatory responses play a role in DN.This study aims to investigate the relationship between lymphocytes and DN in patients with autoimmune diabetes. Methods:The clinical data of 226 patients with Type 1 diabetes(T1D)and 79 patients with latent autoimmune diabetes in adults(LADA)were retrospectively studied and stratified according to the urinary albumin to creatinine ratio(ACR).Risk factors associated with DN were analyzed using correlation analysis and logistic regression. Results:In T1D and LADA patients,systolic blood pressure(SBP),uric acid duration,and diabetes duration in patients with normoalbuminuria were lower or shorter than those in patients with macroalbuminuria(P＜0.05).The lymphocyte count of T1D patients was significantly higher than that in LADA patients(P＜0.05),while the neutrophil to lymphocyte ratio(NLR)of T1D patients was significantly lower than that in LADA patients(P＜0.05).The lymphocyte count in the T1D patients with normoalbuminuria was lower than that those with macroalbuminuria(P＜0.05).The NLR was lower in the T1D patients with macroalbuminuria than those with microalbuminuria and normoproteinuria(all P＜0.01).Based on logistic regression analysis,lymphocytes were independently associated with DN in T1D after adjusting for various known risk factors such as course of disease,age,gender,dyslipidemia,hypertension,and smoking status.Analysis of the receiver operating characteristic curve of subjects predicting lymphocytes in normoalbuminuria showed that the area under the curve was 0.601(95% CI 0.510 to 0.693,P=0.039),and when the cutoff value of lymphocytes was 2.332,the sensitivity was 37.0%,and the specificity was 82.5%. Conclusion:Lymphocyte counts in autoimmune diabetic patients are closely associated with DN,suggesting that lymphocyte-mediated inflammation may be involved in the pathogenesis of DN in autoimmune diabetic patients.This study provides a possible perspective for using lymphocytes as a potential biomarker for the early identification of individuals at risk for DN and potential therapeutic targets for DN.

OBJECTIVES: There is a high coagulation state in pregnant women, which is prone to coagulation and fibrinolysis system dysfunction. This study aims to explore the latest coagulation markers-thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor compound (tPAI-C) in different stages of pregnancy, establish reference intervals (RIs) for healthy pregnant women of Chinese population, and to provide an effective and reliable reference for clinicians. METHODS: A total of 492 healthy pregnant women, who underwent pregnancy examination and delivery in the Department of Obstetrics, Second Xiangya Hospital of Central South University from October 2019 to October 2020, were enrolled for this study. They were assigned into the first trimester group, the second trimester group, the third trimester group, and the puerperium group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. Plasma levels of TM, TAT, PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer. The RIs for TM, TAT, PIC, and tPAI-C were defined using non-parametric 95% intervals, determined following Clinical and Laboratory Standards Institute Document C28-A3c (CLSI C28-A3c), and Formulation of Reference Intervals for the Clinical Laboratory Test Items (WS/T402-2012). RESULTS: TM and TAT levels increased gradually in the first, second, and third trimester women and decreased in the puerperium women (P<0.05 or P<0.01). PIC level of healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), but PIC level of pregnant and puerperium women did not differ significantly (P>0.05). tPAI-C level in healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), and tPAI-C level was significantly decreases in the puerperium women (P<0.01). The RIs for TM were as follows: Healthy non-pregnant women at 3.20-4.60 TU/mL, the first and second trimester at 3.12-7.90 TU/mL, the third trimester at 3.42-8.29 TU/mL, puerperium at 2.70-6.40 TU/mL. The RIs for TAT were as follows: Healthy non-pregnant women at 0.50-1.64 ng/mL, the first and second trimester at 0.52-6.91 ng/mL, the third trimester at 0.96-12.92 ng/mL, puerperium at 0.82-3.75 ng/mL. The RIs for PIC were as follows: Healthy non-pregnant women at 0.160-0.519 ng/mL, pregnant women at 0.162-0.770 μg/mL. The RIs for tPAI-C were as follows: Healthy non-pregnant women at 1.90-4.80 ng/mL, the first and second trimester at 2.03-9.33 ng/mL, the third trimester at 2.80-14.20 ng/mL, puerperium at 1.10-8.40 ng/mL. CONCLUSIONS The levels of 4 new coagulation markers TM, TAT, PIC, and tPAI-C in pregnant women are increased significantly during pregnancy and gradually return to normal after delivery. The RIs for TM, TAT, PIC, and tPAI-C in pregnant women by trimester are established according to CLSI C28-A3c, thus providing a clinical reference for clinician in judgement of thrombotic risk.
Biomarkers/blood* ; Blood Coagulation ; Female ; Humans ; Postpartum Period ; Pregnancy ; Reference Values

OBJECTIVES: Pregnant women in a special physiological period, the body's blood indicators will change to a certain extent. This study aims to explore the changes of serum immunoglobulin levels in healthy pregnant women and establish its reference interval (RI). METHODS: A total of 369 healthy pregnant women, who underwent pregnancy examination in the Department of Obstetrics, Second Xiangya Hospital of Central South University from August 2019 to October 2019, were enrolled for this study. They were divided into an early pregnancy group, a middle pregnancy group, and a late pregnancy group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. The levels of immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) were determined by immune transmission turbidities. The level of immunoglobulin E (IgE) was determined by electrochemiluminescence. The differences in immunoglobulin levels between pregnant women and non-pregnant women and among different gestational periods were analyzed, and the RI of serum immunoglobulin level during pregnancy was established. RESULTS: Compared to the non-pregnant women, the levels of serum IgG, IgM, IgA, and IgE in pregnant women were significantly decreased (all CONCLUSIONS The levels of immunoglobulin in pregnant women are decreased significantly. The establishment of RIs of IgG, IgM, IgA and IgE in healthy pregnant women could provide scientific basis for clinical decision-making.
Female ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Pregnancy ; Pregnant Women ; Reference Values

Previous studies have shown that postoperative cognitive dysfunction (POCD) is related to multiple factors including age, postoperative trauma, inflammation, postoperative pain, and anesthesia, among which postoperative pain is thought to play an important role in the development of POCD. This review summarizes the recent findings in the study of the role of postoperative pain in the pathogenesis of POCD in light of nerve injuries, neural remodeling and stress, and the progress in the prevention and treatment of POCD in elderly patients. It is of vital important to assess the postoperative pain and formulate adequate analgesic regimens for effective prevention and management of POCD to protect the brain functions of elderly patients.
Aged ; Cognitive Dysfunction ; etiology ; Humans ; Inflammation ; Pain, Postoperative ; complications ; therapy ; Postoperative Complications

Objective To investigate the neuroprotective effect and possible mechanism of nicorandil in mice under deep hypothermic low flow (DHLF). Methods A total of 105 3-week-old male C57/BL-6 mice were randomly divided into 7 groups: sham operation, model, nicorandil (5, 10, and 20 mg/kg), nicorandil 20 mg/kg + LY294002, and LY294002 groups (n = 15 in each group). A DHLF model was induced. At 24 h after reperfusion, the brain tissues of mice were taken out for HE and TUNEL staining. The pathological changes of cerebral cortical neurons and apoptosis were observed. Western blot was used to detect the expression levels of the total Akt, phospho-Akt (p-Akt), Bcl-2, and Bax. Results HE pathological staining showed that cortical neuronal injury was reduced, the phenomena of cel membrane depression, nuclear condensation, concentrated dye, and the blurring of the nucleus were decreased significantly in nicorandil group. The morphology of neurons was basicaly restored to normal. TUNEL staining showed that the apoptosis index in various dose groups of nicorandil was decreased significantly compared with the model group (al P < 0. 05). Western blot analysis showed that the expression levels of p-Akt and Bcl-2 proteins increased significantly in various dose groups of nicorandil compared with the model group (al P < 0. 05), and the expression level of Bax protein was decreased significantly (al P < 0. 05 ). After adding the phosphatidylinositol 3-kinase (PI3K) specific inhibitor LY294002, there was no significant difference in neurons pathological injury in the cortex compared with the model group. There was no significant difference in the apoptosis index, and the expression levels of p-Akt, Bcl-2, and Bax compared with the model group. Conclusions Nicorandil has a certain neuroprotective effect in mice under DHLF. Its mechanism may be associated with the activation of PI3K/Akt signaling pathway, and then further regulation of the downstream protein Bcl-2 and Bax expression.

Objective To investigate the clinical application value of strong ion gap(SIG)generated by the third generation equa-tion following pH and the anion gap(AG)in critically ill patients.Methods On the basis of the determination results of blood gas and blood biochemistry,the equation in the Stewart-Figge methodology was adopted to calculate SIG.Results (1)There were sta-tistically significant differences in K+ ,Na+ ,HCO3 - ,AG,pH,PO4 3 - ,ALB,SIG and Cr between the critical illness groups and the control group(P <0.05).(2)The SIG mean value ratio the death group to non-death group was 3.04,the difference was the big-gest,P <0.05,AG and Cr took the second place.Conclusion SIG as a new indicator in combination with other biochemical and blood gas indicators,such as the HCO3 - ,AG,pH,PO4 3 - ,Cr and lactic acid can reflect the situation of the acid-base disorders in critically ill patients and plays a strong indicative role in predicting the disease development trends.

To understand the Escherichia coli (E .coli) O157∶ H7 isolated from cow in Zhengzhou ,Henan Province ,a total of 146 samples of cow fecal and milk were collected in the different farms ,and E .coli O157∶ H7 was detected with mul-tiplex polymerase chain reaction (PCR) in our laboratory .Then the biochemical characteristics ,growth dynamic ,the biofilm formation ,and the toxin genes of the E .coli O157∶ H7 isolates were analyzed .The results showed that 2 strains of E .coli O157∶H7 were found ,with the detection rate of 1 .4% ,and the isolates were named as L1 and L2 in current study ,respec-tively .The E .coli O157∶H7 clinical isolates had the same biochemical characteristics with that of the typical E .coli .The L1 and L2 isolates presented similar growth curve ,which entered into the log phase earlier than that of the standard strain .L1 strain formed thick ,confluent ,complete biofilm after 48 hours post-inoculation ,and the biofilm of L2 strain was formed com-pletely in 36 hours .The two E .coli O157∶ H7 isolates were positive with eaeA and hlyA genes ,and the L1 strain also carried the Stx2 virulence gene .Our results reinforce the epidemiological data of E .coli O157∶H7 ,and underscore the need for more effective surveillance of animal-derived E .coli O157∶H7 isolates in Zhengzhou City ,China .

Objective To Investigate the application value of strong ion gap(SIG),anion gap(AG)and other four indicators in the trauma disease.Methods Blood was taken from trauma patients admitted to hospital immediately,with the heparin anticoagulation,misce bene.Blood gas was measured.Creatinine(Cr),phosphorus and albumin(ALB)was measured simultaneously.Results Betwean traumatic group and control group,there was signifrcant difference in SIG,AG,potential HCO3-,and other 5 item(P4mmol/L.