Objective:To compare the preventive effects of different doses of esketamine on remifentanil-induced hyperalgesia(RIH)in the patients underwent thoracoscopic pnlmonary lobectomy,and to provide the basis for the multimodal analgesia and rapid postoperative recovery.Methods:The prospective,double-blind,parallel-designed randomized controlled trial(RCT)were conducted,and 107 patients who underwent visual-assisted thoracoscopic pulmonary lobectomy were included.The patients were randomly divided into normal control group,low dose of esketamine group,and high dose of esketamine group using random number methods.Except the patients who were eliminated and those who dropped out of the study,there were 31 patients in normal control group,33 patients in low dose of esketamine group,and 33 patients in high dose of esketamine group.The patients in low dose of esketamine group were given the intravenous injection of 0.25 mg·kg-1 esketamine(diluted to 5 mL)during anesthesia induction;the patients in high dose of esketamine group were given the intravenous injection of 0.50 mg·kg-1 esketamine(diluted to 5 mL),and the patients in normal control group were given 5 mL intravenous injection of saline.The mechanical pain thresholds of the non-dominant forearm skin and skin around the surgical incision at different time points,numeric rating scale(NRS)scores,Ramsay sedation scores,perioperative analgesic drug dosages,and the incidences of adverse reactions such as postoperative delirium,nausea,and vomiting of the patients in various groups were recorded.Results:Compared with normal control group,the mechanical pain thresholds around the surgical incision skin of the patients in low and high doses of esketamine groups were increased(P＜0.05);compared with low dose of esketamine group,the extubation time of the patients in high dose of esketamine group was increased(P＜0.05).Two minutes after anesthesia induction administration,compared with normal control group,the mean arterial pressure(MAP)and heart rate(HR)of the patients in low and high doses of esketamine groups were increased(P＜0.05),but there were no significant differences in the MAP and HR of the patients between low dose of esketamine and high dose of esketamine group(P＞0.05);compared with normal control group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05),while there were no significant differences in the incidences of above adverse reactions in low dose of esketamine group(P＞0.05);compared with low dose of esketamine group,the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased(P＜0.05).Conclusion:Intravenous administration of esketamine with a dosage of 0.25 mg·kg-1 during anesthesia induction improves the postoperative mechanical pain threshold of the patients undergoing thoracoscopic pulmonary lobectomy,which exhibits effective prevention of RIH without an increase in incidences of adverse reactions during the perioperative period.

Objective:To examine the effect of brown midle borosilicate glass ampoules on the drug safety of ambr-oxol hydrochloride injection.Methods:By simulating the storage conditions of ambroxol hydrochloride injection,experimental studies were designed using inductively coupled plasma emission spectroscopy(ICP-OES)and scan-ning electron microscopy(SEM)to investigate element migration and internal surface detachment.Results:The Si content in the injections increased over time,and after 0 to 48 months of various stages of testing,the inner surface of the glass was intact,with no detachment or erosion;the migration of various target elements,such as Cd,Pb,As,Hg,etc.,into the injections took place,but the contents were in accordance with the limits set by the relevant regulations.Conclusion:Brown middle borosilicate glass ampoule packaging for ambroxol hydrochloride injection is safe and stable for 48 months.Brown middle borosilicate glass ampoule can be used as a good container for ambr-oxol hydrochloride injection.

Objective:To explore the clinical characteristics and complementary tests of a Chinese patient with central mixed phenotype acute leukemia and improve the awareness and diagnosis of MPAL among clinicians.Methods:Retrospectively analyzed a patient's clinical feature, laboratory examination, diagnosis and literature review who had headache as the first symptom and finally diagnosed with MPAL.Results:A 59-year-old female presented with recurrent headaches and can not relieved, at last , was confirmed as mixed phenotype acute leukemia by flow cytometry of cerebrospinal fluid、immunophenotyping and molecular biology of bone marrow. Remission was achieved after chemotherapy for lymphoid and myeloid leukemia.Conclusion:Patients with an unclear diagnosis of central nervous system disease, leukemia should be considered, and cerebrospinal fluid flow cytology and bone marrow biopsy should be refined.

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Objective:To investigate the long term outcome of artificial urinary sphincter implantation for patients with stress urinary incontinence.Methods:The data of 46 patients who underwent artificial urethral sphincter implantation in China Rehabilitation Research Center from April 2002 to April 2022 were retrospectively analyzed.The patients’ age ranged from 19-80 years old (median 45.6 years). There were 45 males and 1 female. The history of illness was 8 months to 33 years. The patients category were urethral injuries associated urinary incontinence ( n=24), neurogenic urinary incontinence ( n=9) and post-prostatectomy incontinence ( n=13). Preoperative daily pad usage was 3.5±1.0. The impact of incontinence on the quality of life (QOL)measured by the visual analogue scale (VAS)was 7.1±1.2. All 46 patients underwent artificial urethral sphincter implantation, of which 20 patients were treated with anticholinergic drugs (5 cases) or urinary tract related surgery (urethral stenosis incision in 2 cases, sphincterectomy in 3 cases, urethral dilation in 5 cases, urethral calculus lithotripsy in 1 case, and augmentation cystoplasty in 4 cases) before artificial urethral sphincter implantation. Of the 45 male patients, 25 patients had the transperineal approach and 20 had the trans-scrotal approach. The female case had a trans-retropubic approach. Different cuffs size was used based on individual circumference of bulbar urethra (45 male cases: 4.5cm in 16 cases, 4.0cm in 29 cases; one female case: 8.0cm). Long-term surgical efficacy was evaluated. Assessments included postoperative urinary continence (socially continent: one pad per day or less; complete dry: wearing no pads), artificial urinary sphincter status and complications. The influences of patients of different etiologies, surgical approaches and cuff size on surgical results were compared. Results:The mean follow-up time was 7.1 years ranged from 6 months to 19 years. At the latest visit, 32 patients (69.6%) maintained the primary functional artificial urinary sphincter. Three patients (6.5%) had artificial urinary sphincter revisions and maintained continence with the new device. 11 patients (23.9%) removed the artificial urinary sphincter because of post-complications. Thirty-five patients were socially continent, of which 16 patients were totally dry, leading to the overall social continent rate as 76.1%(35/46). There was a significant reduction in pad usage to 1.2±0.6 diapers per day ( P<0.001). The impact of incontinence on the QOL measured by the VAS dropped to 2.6±1.9 ( P<0.001). The complication rate was 32.6%(15/46), including infections ( n=4), erosions ( n=5), mechanical failure ( n=3), dysurie ( n=2) and urethral atrophy ( n=1). There were no significant differences in social continent rate between patients with different etiologies[75.0%(18/24)vs. 66.7%(6/9) vs. 84.6%(11/13)], perioperative complications [37.5%(9/24)vs. 33.3%(3/9) vs. 23.1%(3/13)] and device re-intervention rate[37.5%(9/24) vs. 33.3%(3/9)vs. 15.4%(2/13)]. There were no statistically significant differences in postoperative complete dry rate [32%(8/25)vs. 40%(8/20), P=0.76] and postoperative device failure free rate [60%(15/25)vs. 80%(16/20), P=0.20] between trans-perineal group and trans-scrotal group. There was no statistically significant difference in postoperative social continent rate between 4.5cm cuff and 4.0 cuff[75%(12/16) vs. 65.5%(19/29), P=0.74]. Conclusions:Artificial urethral sphincter implantation is an effective treatment for stress urinary incontinence due to intrinsic sphincter deficiency. There was no difference in the continent rate and complication rate between patients of different etiologies, different surgical approaches and cuff size selection.

OBJECTIVE To explore the difference in chemical components of essential oil from medicinal part （rhizome）and non-medicinal parts （fibrous roots ，stems，and leaves ）of Atractylodes chinensis，and to preliminarily evaluate their antibacterial activity in vitro . METHODS The essential oil was extracted from three parts of A. chinensis by steam distillation ，and their chemical components and relative contents were analyzed and identified by gas chromatography -mass spectrometry （GC-MS）. The antibacterial activities of essential oil （5 mg/mL） from different parts against Staphylococcus aureus ，S. albus and Bacillus subtilis were determined by paper diffusion method . The correlation between chemical components in essential oil and antibacterial activity was analyzed . RESULTS A total of 60 chemical constituents were identified from the essential oilof rhizome ，fibrous roots ，stems and leaves of A. chinensis， mainly composed of terpenes ，sesquiterpenoids，alcohols and ketones. There were 8 kinds of common components in the essential oil of rhizome ，fibrous root and stem and leaves ，which were elementol ，cadinene，agarospirol，valencian citrine ， caryophyllin，β-sesquidiene，γ-eucalyptol and β-eucalyptol. A total of 26 components were identified from the essential oil of rhizome，of which the relative content of 4-benzaldehyde was the highest （31.56%）；a total of 21 components were identified from the essential oil of fibrous roots ，among which the relative content of β-eucalyptol was the highest （44.39%）；a total of 42 components were identified from the essential oil of stems and leaves ，among which the relative content of β-sesquidiene was the highest（14.83%）. The essential oil from different parts had certain antibacterial effect on S. aureus，S. albus and B. subtilis. The order of antibacterial effect was rhizome ＞fibrous roots ＞stem and leaves ；the relative contents of β-caryophyllene，α-humulene and modhephene were positively correlated with inhibitory effects of essential oil against S. aureus and B. subtilis（P＜0.05 or P＜0.01）. The relative contents of atractylone ，zingiberene and agarospirol were positively correlated with the inhibitory effect of essential oil against B. subtilis（P＜0.05 or P＜0.01）. CONCLUSIONS There are significant differences in the chemical composition and contents of essential oil from medicinal and non -medicinal parts of A. chinensis，and all of them have antibacterial activity in vitro .

Objective:To evaluate the precision of Pentacam AXL in measuring the parameters required for intraocular lens (IOL) calculation and compare the results with those obtained with Lenstar LS900.Methods:A cross-sectional study was designed.Seventy patients (91 eyes) with age-related cataract treated in Xiamen Eye Center Affiliated to Xiamen University from March to August, 2017 to receive cataract surgery were collected.Biometry measurements in 91 eyes of 70 cataract patients were performed by the same examiner with Pentacam AXL and Lenstar LS900 before surgery.The axial length (AL), keratometry (K) and anterior chamber depth (ACD) were obtained.The differences between the two devices were analyzed by paired-samples t test and Pearson correlation analysis.Differences and correlation of biometry measurements obtained with two biometers were analyzed.The agreement of the two biometers was analyzed by Bland-Altman plot.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Xiamen Eye Center Affiliated to Xiamen University (No.XMYKZX-LW-2017-003). Results:The mean values of AL were (23.39±1.34)mm and (23.42±1.36)mm, mean keratometry (Km) values were (43.96±1.53)D and (44.00±1.51)D, respectively, and the ACD values were (2.89±0.38)mm and (2.88±0.37)mm respectively measured by Pentacam AXL and Lenstar LS900, and the differences were not statistically significant ( P= 0.906, 0.855, 0.811), but all of the three biometrey measurements showed good linear correlation ( r = 0.999, 0.975, 0.991; all at P<0.05). AL, Km and ACD between Pentacam AXL and Lenstar LS900 showed good agreements analyzed by Bland-Altman plot, and the respective 95% limits of agreement (95%LoA) for AL and ACD were -0.11 to 0.07 mm and -0.09 to 0.12 mm, while 95% LoA for Km was -0.70 to 0.62 D. Conclusions:Pentacam AXL can provide accurate parameters for IOL calculation, which has a good agreement with Lenstar LS900, and the AL and ACD parameters can be used interchangeably.

Objective: To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods: A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation. Results: Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (F_group=73.602, P<0.001; F_time=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.

BACKGROUND:With the development of stem cellresearch and regenerative medicine, a growing number of technique applications of bone marrow mesenchymal stem cells have been used for treatment of femoral head necrosis. Simple grafting and injection of bone marrow mesenchymal stem cells has a poor effect, which is combined with scaffold materials as cells carrier plays a better role.
OBJECTIVE:To review the research progress of bone marrow mesenchymal stem cells and carriers in the treatment of femoral head necrosis and to look into the future development prospects.
METHODS:A computer-based online search of PubMed (1989/2013) and CNKI (1989/2013) was performed for articles with the key words“osteonecrosis of the femoral head, avascularnecrosis, bone marrow mesenchymal stem cells, carrier or scaffold material”in English and Chinese, respectively. The advantages and limits of various carries and scaffolds were summarized.
RESULTS AND CONCLUSION:Ideal carriers can promote and induce ability of bone marrow mesenchymal stem cells to repair the femoral head. There is a variety of existing carriers, including autologous cancellous bone, al ograft bone, natural biological materials, organic materials, bio-ceramic, nano-materials. Since each material has its own advantages and limitations, composite materials have begun to be used in searching for ideal carriers and scaffolds, and there are however stil some issues that remain to be solved, such as lacking of unified standard of production, specification and making process;how to control and prevent the immune response and inflammation after implantation;how to ensure that the degradation rate of scaffold matches the generation rate of bone and cartilage in the femoral head;and how to identify the cytotoxicity, biocompatibility and therapeutic effects after implantation.