Objective:To evaluate the effect of multimodal non-drug treatment during induction of general anesthesia on emergence delirium (ED) in the preschool children.Methods:A total of 210 pediatric patients of either sex, aged 3-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, undergoing elective operation for snoring with expected operation time <2 h, were involved in this study. The patients were divided into 2 groups according to the parity of the numbers randomly generated by the computer: multimodal non-drug treatment group (group N, n=102) and control group (group C, n=108). In group N, multiple modes of non-drug intervention (including parents′ company, carrying favorite toys, watching favorite video programs with portable multimedia devices, etc) were used during anesthesia induction, and the children left their parents and entered the operating room after completion of general anesthesia. The children directly entered the operating room with the medical staff for anesthesia induction (without parents′ company and other intervention measures) in group C. The patients were endotracheally intubated and received combined intravenous-inhalational anesthesia and general anesthesia in both groups. The anxiety was evaluated by modified Yale preoperative anxiety scale (m-YPAS) score at 24 h before operation (T 0) and immediately before induction of general anesthesia (T 1). The Pediatric Anesthesia Emergence Delirium scale score (PAED score, ED was defined as PAED score > 12), FLACC scale score and Ramsay Sedation Scale score were recorded when orientation recovered after admission to postanesthesia care unit (T 2) and at 6, 24 and 72 h after operation. The patients were divided into ED group and non-ED group (NED group) according to the occurrence of ED, and the risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify ED-related risk factors and construct the prediction model. The accuracy of the prediction model was evaluated by the receiver operating characteristic curve. Results:Compared with group C, the m-YPAS at T 1 and PAED score and incidence of ED at T 2 were significantly decreased ( P<0.05), and no significant change was found in FLACC score and Ramsay sedation score at all time points in group N ( P>0.05). Age, m-YPAS score at T 1, multimodal non-drug treatment during anesthesia induction, FLACC score at T 2 and Ramsay sedation score at T 2 were the risk factors for ED ( P<0.05). The area under the receiver operating characteristic curve was 0.944, the 95% confidence interval was 0.914-0.974, with a Yonden index of 0.779, sensitivity of 94.9%, specificity of 83%, and the cutoff value of 0.14. Conclusions:Multimodal non-drug treatment during induction of general anesthesia can effectively reduce the development of ED in the preschool children.

OBJECTIVE To prepare Neuritic acid oral emulsion ，to optimize its formulation and preparation technology ，and to investigate its stability. METHODS Neuritic acid oral emulsion was prepared by mechanical method. On the basis of single factor experiment ，the appearance ，centrifugal stability ，centrifugal stability constant （Ke）and particle size of the emulsion as indexes，the formulation was optimized by orthogonal design ，taking the dosage of oleic acid ，octylphenol polyoxyethylene ether-10 and propylene glycol as factors ，the preparation technology was optimized by taking emulsification temperature ，shear time，pressure of high-pressure homogenization and cycle times of high-pressure homogenization as factors. The content of neuritic acid was determined by high performance liquid chromatography. The stability of Neuritic acid oral emulsion was investigated by high temperature test ，accelerated test and long-term test. RESULTS The optimal formulation and preparation technology were as follows：neuritic acid of 1 g，oleic acid of 5％ ，octylphenol polyoxyethylene ether- 10 of 4％ ，propylene glycol of 2％ ， emulsification temperature of 60 ℃ ，shear time of 2 min，homogenization pressure of 40 MPa and cycle times of twice. After three experiments ，the average particle size of Neuritic acid oral emulsion was 158.05 nm（RSD＝1.58％，n＝3），the average Ke was 0.39（RSD＝1.49％，n＝3），and the appearance was uniform milky white ，there was no stratification. The results of high temperature test showed that Neuritic acid oral emulsion was prone to stratification in high temperature environment ，and the content of neuritic acid increased. The results of accelerated test and long-term test showed that there was no significant change in the appearance or the content of neuritic acid when Neuritic acid oral emulsion was placed at room temperature for 6 months. CONCLUSIONS The formulation and preparation technology are stable and feasible ，and can be used for the preparation of Neuritic acid oral emulsion. Neuritic acid oral emulsion should not be placed in high temperature environment. It has good stability at room temperature for 6 months.

Objective:To investigate the clinical efficacy of B-mode ultrasound guided percutaneous extensor tendon insertion reconstruction in the treatment of tendinous mallet fingers.Methods:A retrospective analysis was performed on the data of patients with mallet finger deformity admitted to the Department of Hand Surgery of Jinan People’s Hospital from February 2010 to January 2019. Under the guidance of B-mode ultrasound, the extensor tendon was sutured percutaneously with PDS II monofilament suture, pulled to the base of the distal phalanx, which was drilled with a 1.0 mm Kirschner’s wire to reconstruct the insertion of the extensor tendon. The active and passive extension angles of the affected fingers and the wound healing were observed after operation. Evaluation of finger function using Crawford’s method.Results:A total of 58 cases were enrolled, including 48 males and 10 females, aged 20-53 years. 49 patients were followed up for 6 to 15 months after operation, with an average of 11 months, and 9 patients were lost to follow-up. The active extension angle of the affected finger changed from 46.5°±7.2° before operation to 6.4°±0.5° after operation, and the difference was statistically significant before and after operation ( t=38.89, P<0.001). The passive extension angle decreased from 3.2° ±0.3°before operation to 0.9° ±0.2°after operation, and the difference was statistically significant before and after operation ( t=44.65, P<0.001). There were no complications such as exposed knots and skin necrosis. Evaluation by Crawford method: excellent in 29 cases, good in 12 cases, and fair in 8 cases. Conclusions:Percutaneous ultrasound-guided extensor finger tendon insertion reconstruction, minimally invasive surgery, in the treatment of tendon mallet finger function recovered well, and the effect was satisfactory.

Objective:To investigate the clinical efficacy of B-mode ultrasound guided percutaneous extensor tendon insertion reconstruction in the treatment of tendinous mallet fingers.Methods:A retrospective analysis was performed on the data of patients with mallet finger deformity admitted to the Department of Hand Surgery of Jinan People’s Hospital from February 2010 to January 2019. Under the guidance of B-mode ultrasound, the extensor tendon was sutured percutaneously with PDS II monofilament suture, pulled to the base of the distal phalanx, which was drilled with a 1.0 mm Kirschner’s wire to reconstruct the insertion of the extensor tendon. The active and passive extension angles of the affected fingers and the wound healing were observed after operation. Evaluation of finger function using Crawford’s method.Results:A total of 58 cases were enrolled, including 48 males and 10 females, aged 20-53 years. 49 patients were followed up for 6 to 15 months after operation, with an average of 11 months, and 9 patients were lost to follow-up. The active extension angle of the affected finger changed from 46.5°±7.2° before operation to 6.4°±0.5° after operation, and the difference was statistically significant before and after operation ( t=38.89, P<0.001). The passive extension angle decreased from 3.2° ±0.3°before operation to 0.9° ±0.2°after operation, and the difference was statistically significant before and after operation ( t=44.65, P<0.001). There were no complications such as exposed knots and skin necrosis. Evaluation by Crawford method: excellent in 29 cases, good in 12 cases, and fair in 8 cases. Conclusions:Percutaneous ultrasound-guided extensor finger tendon insertion reconstruction, minimally invasive surgery, in the treatment of tendon mallet finger function recovered well, and the effect was satisfactory.

Objective:To investigate the clinical efficacy of B-mode ultrasound guided percutaneous extensor tendon insertion reconstruction in the treatment of tendinous mallet fingers.Methods:A retrospective analysis was performed on the data of patients with mallet finger deformity admitted to the Department of Hand Surgery of Jinan People’s Hospital from February 2010 to January 2019. Under the guidance of B-mode ultrasound, the extensor tendon was sutured percutaneously with PDS II monofilament suture, pulled to the base of the distal phalanx, which was drilled with a 1.0 mm Kirschner’s wire to reconstruct the insertion of the extensor tendon. The active and passive extension angles of the affected fingers and the wound healing were observed after operation. Evaluation of finger function using Crawford’s method.Results:A total of 58 cases were enrolled, including 48 males and 10 females, aged 20-53 years. 49 patients were followed up for 6 to 15 months after operation, with an average of 11 months, and 9 patients were lost to follow-up. The active extension angle of the affected finger changed from 46.5°±7.2° before operation to 6.4°±0.5° after operation, and the difference was statistically significant before and after operation ( t=38.89, P<0.001). The passive extension angle decreased from 3.2° ±0.3°before operation to 0.9° ±0.2°after operation, and the difference was statistically significant before and after operation ( t=44.65, P<0.001). There were no complications such as exposed knots and skin necrosis. Evaluation by Crawford method: excellent in 29 cases, good in 12 cases, and fair in 8 cases. Conclusions:Percutaneous ultrasound-guided extensor finger tendon insertion reconstruction, minimally invasive surgery, in the treatment of tendon mallet finger function recovered well, and the effect was satisfactory.

Objective:To investigate the clinical efficacy of B-mode ultrasound guided percutaneous extensor tendon insertion reconstruction in the treatment of tendinous mallet fingers.Methods:A retrospective analysis was performed on the data of patients with mallet finger deformity admitted to the Department of Hand Surgery of Jinan People’s Hospital from February 2010 to January 2019. Under the guidance of B-mode ultrasound, the extensor tendon was sutured percutaneously with PDS II monofilament suture, pulled to the base of the distal phalanx, which was drilled with a 1.0 mm Kirschner’s wire to reconstruct the insertion of the extensor tendon. The active and passive extension angles of the affected fingers and the wound healing were observed after operation. Evaluation of finger function using Crawford’s method.Results:A total of 58 cases were enrolled, including 48 males and 10 females, aged 20-53 years. 49 patients were followed up for 6 to 15 months after operation, with an average of 11 months, and 9 patients were lost to follow-up. The active extension angle of the affected finger changed from 46.5°±7.2° before operation to 6.4°±0.5° after operation, and the difference was statistically significant before and after operation ( t=38.89, P<0.001). The passive extension angle decreased from 3.2° ±0.3°before operation to 0.9° ±0.2°after operation, and the difference was statistically significant before and after operation ( t=44.65, P<0.001). There were no complications such as exposed knots and skin necrosis. Evaluation by Crawford method: excellent in 29 cases, good in 12 cases, and fair in 8 cases. Conclusions:Percutaneous ultrasound-guided extensor finger tendon insertion reconstruction, minimally invasive surgery, in the treatment of tendon mallet finger function recovered well, and the effect was satisfactory.

Objective:In combination with 3D printing technology and degradable composite materials, to discuss the preparation method of tissue engineering ossicles for middle ear hearing reconstruction.Methods:Domestic polymer (polylactic acid-glycolic acid copolymer, PLGA) and degradable ceramic material (β-tricalcium phosphate, β-TCP) were selected and prepared by low temperature deposition method according to the design ratio to Program according to the outline design code of the required scaffold to generate appropriate print files, and then the self-developed low-temperature deposition printing device was used to prepare tissue-engineered osseous scaffolds in accordance with the print files in a low-temperature environment. The scaffolds was freeze-dried and sterilized for later use after printing. Light microscopy and scanning electron microscopy were used to observe the apparent characteristics and internal structure of the scaffolds and to check its pore size, porosity and mechanical properties.Results:After printing, a degradable scaffold was obtained. Under the optical microscope, it was a small cylindrical shape with a diameter of 1.5 mm and a length of 6.0 mm, and its surface had micropores. The degradable scaffold had a horizontal and vertical interlaced warp and weft structure, the wire spacing was 1.2 mm, and the pores were connected to each other. The surface could see circular or quadrangular pores with a pore size of about 100-400 μm. The diameter of the inter-pore cross-linked channels was about 50 μm and the diameter of the surrounding circular micropores was about 10-40 μm. β-TCP particles with a size of about 700 nm were attached to the surface of the PLGA material. The average porosity of the whole scaffolds was (83.43±0.01)%, and the content of BMP-2 loaded was about 0.7 μg/mm 3. After freeze-drying, the mechanical strength of the scaffold was moderate, and there was no obvious deformation during stretching and compression, which met the mechanical requirements of tissue engineering ossicles. Conclusions:Using the low-temperature deposition printing method and strictly controlled processes and conditions, a polymer-degradable ceramic ossicle tissue engineering scaffold can be prepared for implantation experiments. The scaffold has suitable porosity and mechanical properties, and can be loaded with osteoinductive factors.

BACKGROUND: Chronic kidney disease is a severe threat to human health with no ideal treatment strategy. Mature mammalian kidneys have a fixed number of nephrons, and regeneration is difficult once they are damaged. For this reason, developing an efficient approach to achieve kidney regeneration is necessary. The technology of the combination of decellularized kidney scaffolds with stem cells has emerged as a new strategy; however, in previous studies, the differentiation of stem cells in decellularized scaffolds was insufficient for functional kidney regeneration, and many problems remain. METHODS: We used 0.5% sodium dodecyl sulfate (SDS) to produce rat kidney decellularized scaffolds, and induce adipose-derived stem cells (ADSCs) into intermediate mesoderm by adding Wnt agonist CHIR99021 and FGF9 in vitro. The characteristics of decellularized scaffolds and intermediate mesoderm induced from adipose–derived stem cells were identified. The scaffolds were recellularized with ADSCs and intermediate mesoderm cells through the renal artery and ureter. After cocultured for 10 days, cells adhesion and differentiation was evaluated. RESULTS: Intermediate mesoderm cells were successfully induced from ADSCs and identified by immunofluorescence and Western blotting assays (OSR1 + , PAX2 +). Immunofluorescence showed that intermediate mesoderm cells differentiated into tubular-like (E-CAD + , GATA3 +) and podocyte-like (WT1 +) cells with higher differentiation efficiency than ADSCs in the decellularized scaffolds. Comparatively, this phenomenon was not observed in induced intermediate mesoderm cells cultured in vitro. CONCLUSION: In this study, we demonstrated that intermediate mesoderm cells could be induced from ADSCs and that they could differentiate well after cocultured with decellularized scaffolds.
Animals ; Blotting, Western ; Fluorescent Antibody Technique ; Humans ; In Vitro Techniques ; Kidney ; Mesoderm ; Nephrons ; Rats ; Regeneration ; Renal Artery ; Renal Insufficiency, Chronic ; Sodium Dodecyl Sulfate ; Stem Cells ; Ureter

Objective: To explore the effects of hypertonic sodium saline (HSS) resuscitation on the liver damage of rats at early stage of severe scald. Methods: Fifty-six SD rats were divided into sham injury group (SI, n=8), lactated Ringer′s solution group (LRS, n=24), and group HSS (n=24) according to the random number table. Rats in group SI were sham injured without resuscitation, while rats in the other two groups were reproduced deep partial-thickness to full-thickness scald model with 30% total body surface area on the back. Rats in group LRS were resuscitated with LRS, while rats in group HSS were resuscitated with 300 mmol/L sodium ion solution according to the Parkland formula. Blood of abdominal aorta and liver of 8 rats in group SI immediately post injury and in the other two groups at post injury hour (PIH) 2, 8, and 24 respectively were collected. Then liver water content was determined by dry-wet weight method. Serum content of alanine aminotransferase (ALT) and aspartate transaminase (AST) was detected by automatic biochemical analyzer. Serum content of tumor necrosis factor α (TNF-α), interleukin-1 (IL-1), and high mobility group box 1 (HMGB1) was determined by enzyme-linked immunosorbent assay. Liver content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected by ultraviolet spectrophotometer. Pathologic changes of liver were observed by HE staining. Data were processed with one-way analysis of variance and SNK test. Results: (1) At PIH 2, 8, and 24, liver water content of rats in group LRS was higher than that in group SI and group HSS (P<0.05 or P<0.01). (2) At PIH 2, serum ALT content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum ALT content of rats in group HSS and group LRS was higher than that in group SI (P<0.05 or P<0.01), and serum ALT content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, 8, and 24, serum AST content of rats in group HSS and group LRS was higher than that in group SI (with P values below 0.01). At PIH 2 and 8, serum AST content of rats in group HSS was lower than that in group LRS (P<0.05 or P<0.01). (3) At PIH 2 and 8, serum TNF-α content of rats in group LRS was (123±39) and (153±38) pg/mL respectively, higher than that in group SI [(60±18) pg/mL] and group HSS [(85±10) and (94±16) pg/mL respectively, with P values below 0.01]. At PIH 8, serum TNF-α content of rats in group HSS was higher than that in group SI (P<0.05). At PIH 24, serum TNF-α content of rats in the three groups was similar (with P values above 0.05). At PIH 2, 8, and 24, serum IL-1 content of rats in group LRS was (122±35), (141±30), and (122±31) pg/mL respectively, and that in group HSS was (80±12), (93±15), and (80±11) pg/mL respectively, all higher than that in group SI [(40±17) pg/mL, with P values below 0.01]; serum IL-1 content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, serum HMGB1 content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum HMGB1 content of rats in group LRS was (0.386±0.146) and (0.590±0.188) ng/mL respectively, higher than that in group SI [(0.050±0.027) ng/mL] and group HSS [(0.143±0.038) and (0.309±0.095) ng/mL respectively, with P values below 0.01]. At PIH 24, serum HMGB1 content of rats in group HSS was higher than that in group SI (P<0.01). (4) At PIH 2, 8, and 24, liver MDA content of rats in group HSS and group LRS was higher than that in group SI and their liver SOD content was lower than that in group SI (with P values below 0.01); liver MDA content of rats in group HSS was lower than that in group LRS and their liver SOD content was higher than that in group LRS (with P values below 0.01). (5) Compared with those of rats in group SI, liver cells of rats in group LRS showed massive steatosis at each time point, and liver cell-edema appeared at PIH 8 and 24; while liver cells of rats in group HSS showed little steatosis only at PIH 8 and 24, and the liver cell-edema never appeared. Conclusions Compared with LRS, HSS resuscitation can alleviate liver injury of rats at the early stage of severe scald through relieving inflammatory mediators and reducing degree of oxidative stress, etc.

Objective To explore the clinical characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan.Methods From January 2009 to January 2016,63 patients with injury to the distal tibiofibular syndesmosis were treated.Their injuries were characterized according to the anatomic characteristics on their ankle axial CT scan images as pronation-extorsion type (28 cases),supination-extorsion type (11 cases) and abduction type (24 cases).Specific strategies of reduction and fixation depended on the specific characteristics of distal tibiofibular syndesmosis separation.After 12 months postoperatively,the reduction quality was assessed by Burwell-Charnley's radiological evaluation system and the function of ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system.Results The patients were followed up for 6 to 48 months (average,19.3 months).Anatomical reduction was achieved in 19 cases,good reduction in 7 and fair reduction in 2 in the pronation-extorsion type,yielding an excellent to good rate of 92.8％;anatomical reduction was achieved in 6 cases,good reduction in 4 and fair reduction in one in the supination-extorsion type,yielding an excellent to good rate of 90.9％;anatomical reduction was achieved in 17 cases,good reduction in 6 and fair reduction in one in the abduction type,yielding an excellent to good rate of 95.8％.By the AOFAS system,the pronation-extorsion type scored 88.6 points,the supination-extorsion type 89.4 points and the abduction type 86.6 points.Conclusion In the treatment of distal tibiofibular syndesmosis separation,reduction and fixation strategies should depend on analysis of the characteristics on the ankle axial CT scan,so as to achieve positive outcomes.