Objective:To evaluate the effective dose, efficacy and safety of remimazolam for induction of general anesthesia in super-elderly patients.Methods:Trial Ⅰ American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex, aged ≥80 yr, with body mass index of 18-25 kg/m 2, undergoing elective surgery with general anesthesia in the Zhejiang Provincial People′s Hospital from January to March 2022, were selected. Remimazolam 0.12 mg/kg or propofol 0.8 mg/kg was intravenously injected in the first patient, and the dose of remimazolam or propofol in the next patient was determined by using the modified Dixon′s up-and-down method. The difference between the two successive doses was 0.01 mg/kg for remimazolam and 0.05 mg/kg for propofol. A positive response was defined as achieving an anesthesia depth (BIS value ≤ 65) within 5 min of administration. If the response was positive, the next patient received a lower dose, or conversely if negative, a higher dose was given in the next patient. The 50% effective dose (ED 50) and 90% effective dose (ED 90) of remifentanil and propofol and their 95% confidence intervals ( CIs) were calculated by Probit method. Trial Ⅱ One hundred and forty-six American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged ≥80 yr, with a body mass index of 18-25 mg/kg, scheduled for elective surgery with general anesthesia from April to October 2023 in Zhejiang Provincial People′s Hospital, were selected and divided into 2 groups ( n=73 each) by using a random number table method: remimazolam group (R group) and propofol group (P group). R group was induced with intravenous remimazolam ED 90 and P group was induced with intravenous propofol ED 90, and the injection time was both 30 s. If the BIS value was still greater than 65 at 5 min after administration, remimazolam 0.05 mg/kg was intravenously added each time in R group and propofol 0.5 mg/kg was intravenously added each time in P group until the patient′s BIS value ≤65. The success of anesthesia induction, time for successful induction of anesthesia and rescue sedation were recorded. The occurrence of intraoperative injection pain, hypertension, hypotension, bradycardia, hypoxemia, intraoperative awareness and postoperative delirium, nausea and vomiting was also recorded. Results:Trial Ⅰ The ED 50 (95% CI) of remimazolam was 0.148 (0.139-0.157) mg/kg, and the ED 90 (95% CI) was 0.160 (0.153-0.202) mg/kg; the ED 50 (95% CI) of propofol was 0.824 (0.726-0.983) mg/kg, and the ED 90 (95% CI) was 0.916 (0.860-2.472) mg/kg. Trial Ⅱ Compared with group P, the time for successful induction of anesthesia was significantly prolonged, the incidence of intraoperative injection pain and hypotension was decreased ( P<0.05), and no significant change was found in the success rate of anesthesia induction, rate of rescue sedation, intraoperative hypertension, bradycardia, hypoxemia, postoperative delirium, and nausea and vomiting in group R ( P>0.05). Conclusions:The ED 50 and ED 90 of remimazolam for induction of general anesthesia are 0.148 and 0.160 mg/kg, respectively, in super-elderly patients. Compared to propofol, remimazolam has a slightly longer onset time, but it is safer when used for induction of general anesthesia in super-elderly patients.

Objective:To analyze the clinical efficacy of bone transport with unilateral external fixation in the treatment of massive tibial bone defects.Methods:A retrospective study was conducted to review the 21 patients with massive tibial bone defects who had been treated by bone transport with unilateral external fixation from February 2017 to January 2022 at Department of Trauma Orthopedics, Ganzhou People's Hospital. There were 14 males and 7 females with a mean age of (46.3 ± 11.3) years. Causes for bone defects: trauma ( n=5), resection of bone non-union ( n=9), resection of infected bone ( n=6) and resection of bone tumor ( n=1). The mean bone defect length was (8.3 ± 1.7) cm. Bone transport started from 10 to 12 days after operation, with a speed of 1 mm/d, and was completed in 4 times. X-ray films were reviewed every 2 weeks. The bone union time, external fixation time (EFT), external fixation index (EFI), docking site situation and complications were recorded. The clinical efficacy was assessed by Paley score. Results:All patients were followed-up for a mean time of (13.5 ± 5.5) months. The mineralization of regenerated bone was good. The bone union time was (9.6 ± 2.2) months, the EFT (10.3 ± 4.0) months, and the EFI (1.3 ± 0.4) months/cm. All docking sites got united. The docking sites were cleaned in 14 patients, of whom simple compression with external fixation was performed in 5 and bone grafts at the docking sites in 9. Postoperative nail tract infection was observed in 6 cases, tibial alignment deviation in 1 case, foot drop deformity in 5 cases, horseshoe varus foot deformity in 1 case, toe flexion deformity in 3 cases, and refracture after removing the external fixation in 1 case. By the Paley score, the bony outcomes were rated as excellent in 16 and as good in 5 cases. The functional outcomes were excellent in 10, good in 7, and acceptable in 4.Conclusion:Bone transport with unilateral external fixation is an effective treatment for massive tibial bone defects, showing advantages of easy operation and convenient carry.

Objective:To evaluate the effect of esketamine on postoperative delirium (POD) in elderly patients undergoing general anesthesia.Methods:Two hundred and twenty-four elderly patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n=112 each) using a random number table method: esketamine group (S group) and control group (C group). Esketamine 0.5 mg/kg was intravenously injected before anesthesia induction in S group, while the equal volume of normal saline was given instead in C group.The Fuzzy Consciousness Assessment Scale (3D-CAM) was used to assess the occurrence of POD within 7 days after surgery.The consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded during operation.The rescue analgesia within 48 h after operation and occurrence of postoperative complications were recorded. Results:Compared with C group, the incidence of POD was significantly decreased, the intraoperative consumption of remifentanil was reduced, and the utilization rate of vasoactive drugs, rate of rescue analgesia and incidence of postoperative vertigo, nausea and vomiting within 48 h after surgery were decreased in S group ( P<0.05). Conclusions:Esketamine can reduce the development of POD in elderly patients.

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators.

OBJECTIVE: This study aims to prepare oriented scaffolds derived from a cartilage extracellular matrix (CECM) and silk fibroin (SF) and use to investigate their physicochemical property in cartilage tissue engineering. METHODS: Oriented SF-CECM scaffolds were prepared from 6% mixed slurry (CECM：SF=1：1) through modified temperature gradient-guided thermal-induced phase separation, followed by freeze drying. The SF-CECM scaffolds were evaluated by scanning electron microscopy (SEM) and histological staining analyses and determination of porosity, water absorption, and compressive elastic modulus of the materials. RESULTS: The SEM image showed that the SF-CECM scaffolds contained homogeneous reticular porous structures in the cross-section and vertical tubular structures in the longitudinal sections. Histological staining showed that cells were completely removed, and the hybrid scaffolds retained proteogly can and collagen. The composition of the scaffold was similar to that of natural cartilage. The porosity, water absorption rate, and vertical compressive elastic modulus of the scaffolds were 95.733%±1.010%, 94.309%±1.302%, and (65.40±4.09) kPa, respectively. CONCLUSIONS The fabricated SF-CECM scaffolds exhibit satisfactory physicochemical and biomechanical properties and thus could be an ideal scaffold in cartilage tissue engineering.
Cartilage ; Extracellular Matrix ; Fibroins ; Porosity ; Silk ; Tissue Engineering ; Tissue Scaffolds

[Objective] To explore whether diabetes mellitus (DM) can influence the early bacterial translocation (BT) and progression of acute necrotizing pancreatitis (ANP) for guiding the early clinical treatment.[Methods] 35 Wistar male rats were randomly allocated to 4 groups,Group ANP associatcd with DM (DM+ANP,n =10):DM underwent induction of ANP;Group DM (n =10):DM underwent laparotomy with only manipulation of the pancreas and duodenum;Group ANP (n =10):non-DM underwent induction of ANP;Group sham operation (SO,n =5):non-DM underwent SO.After 12 h of the induction of ANP or laparotomy,the following parameters were analyzed:bacterial culture and identification of portal vein blood,mesenteric lymph nodes (MLNs),pancreas and liver,and calculate the total incidence of BT;serum amylase and endotoxin levels of portal vein blood;histological assessment of pancreas and ileum lesions.[Results] All animals except 3 in group DM+ANP (mortality rates:30％) and 1 in group ANP (mortality rates:10％) survived the experiment.The total incidence of BT was 23/28 (82.1％) in group DM+ANP whereas 16/36 (44.4％) in group ANP (P =0.002).Gram-positive bacteria were 17/23 (73.9％),3/16 (18.8％) in group DM+ANP and group ANP,respectively (P =0.001).Amylase activity (2302 ± 346) U/L in group ANP increased significantly (P =0.000) compared with other groups.However,group DM+ANP (501 ± 142) U/L decreased significantly (P =0.001) in comparison to group SO.Regarding to endotoxin concentrations and the severity of pancreas and ileum lesions,group DM + ANP increased significantly compared with group ANP,group DM and group SO (P ＜ 0.05).[Conclusion] Gram-positive bacteria translocates more frequently than Gram-negative bacteria in the early period of DM+ANP rats.DM aggravates the progression of ANP and increases early bacterial translocation,endotoxemia and severity of pancreas and ileum lesions.

BACKGROUND: Cone-beam CT (CBCT) can show abnormal structures and shape of condyle, including thickened cortical bone and abnormal bone mineral density (BMD), which are closely associated with temporomandibular osteoarthrosis. How to identify the imaging changes of osteoarthrosis is a foundation to make correct diagnosis and treatment. However, there is still a lack of study on physiological changes of condyle in people with different ages and sexes.OBJECTIVE: To investigate the age-related changes of condyle using CBCT in poplulations with different ages and sexes.METHODS: CBCT data of 883 patients without temporomandibular osteoarthrosis were collected, and then divided into 22 groups by age (7-8, 9-10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26-27, 28-29, 30-35,36-40, 41-45), and the BMD of each point at the surface of condyle was measured using examvision software and analyzed statistically.RESULTS AND CONCLUSION: As age increases, the BMD of the anterior point and apex was increased and reached a peak, then kept on a stable stage, while showed a decreased tendency after 40 years old. The BMD of the posterior point was increased until a peak and then decreased, and became stable after 30 years old. The BMD of the anterior point and apex both was higher than that of the posterior point in male and female patients. The BMD of each point in females all was higher than that in males. Our results suggest that there are age-related changes in condyle BMD. The BMD on the functional surface is higher than that on the nonfunctional surface. Besides, the condyle development of in males is later than that in females, and all above findings provide reference for the diagnosis of temporomandibular osteoarthrosis.

OBJECTIVEThis research aimed to fabricate a hydroxyapatite (HA)-chitosan scaffold via simulated body fluid (SBF) biomimetic mineralization and determine how mineralization time affects scaffold construction and cell compatibility.

METHODSThe HA-chitosan scaffolds were fabricated by freeze-drying technique and then subjected to precalcification, also known as alternative soaking method. Afterward, precalcificated scaffolds were placed into the SBF to conduct the mineralization process. Mineralization time was set at 7, 14, and 21 days, corresponding to three experimental groups. Pure chitosan scaffolds acted as the control group, and the physical and chemical properties of the four groups were tested. Osteogenic-induced adipose-derived stem cells (ADSCs) were seeded into the scaffolds to investigate the scaffolds' cell compatibility.

RESULTSThe mineral substance of the 14-day group exhibited a uniform distribution. The crystal composition of the mineral substance suited the HA's features. The compressive elastic modulus increased along with the extension of mineralization time. The 21-day group showed a statistically significant increase in compressive elastic modulus compared with the control group (P < 0.05). The cell proliferation level of the 14-day group was significantly the highest among the three experimental groups (P < 0.05). The calcium ion and the type I collagen had the highest secretion amount when the cells were seeded into the 14-day group.

CONCLUSIONThe SBF biomimetic mineralization method can be used to fabricate HA-chitosan bone-tissue-engineering scaffolds. The biological compatibility, as well as the chemical and physical properties, reached the optimum levels at day 14.

Objective To explore the biological function of rhoptry protein 38(ROP38)of Toxoplasma gondii,and to iden?tify the reactogenicity of the recombinant protein(rROP38). Methods The ROP38 was amplified by RT?PCR from T. gondii RH strain,and was cloned into prokaryotic expression vector pET?28a(+). The recombinant plasmid was transformed into E. co?li BL21(DE3)competent cells. Then the rROP38 was analyzed by SDS?PAGE and identified by Western blot. Results SDS?PAGE showed that rROP38 was efficient expression with a molecular weight of about 43 kD. Western blot showed that rROP38 reacted with antibody of His tag or human positive antibody,which indicated that ROP38 had good reactogenicity and could be a serological diagnostic antigen. Conclusion The study successfully obtains the rROP38 of T. gondii with good reactogenicity.

?????Objective???This?research?aimed?to?fabricate?a?hydroxyapatite?(HA)-chitosan?scaffold?via?simulated?body?fluid?(SBF)?biomimetic?mineralization?and?determine?how?mineralization?time?affects?scaffold?construction?and?cell?compatibility.?Methods???The?HA-chitosan?scaffolds?were?fabricated?by?freeze-drying?technique?and?then?subjected?to?precalcification,?also?known?as?alternative?soaking?method.?Afterward,?precalcificated?scaffolds?were?placed?into?the?SBF?to?conduct?the?minerali-zation?process.?Mineralization?time?was?set?at?7,?14,?and?21?days,?corresponding?to?three?experimental?groups.?Pure?chitosan?scaffolds?acted?as?the?control?group,?and?the?physical?and?chemical?properties?of?the?four?groups?were?tested.?Osteogenic-induced?adipose-derived?stem?cells?(ADSCs)?were?seeded?into?the?scaffolds?to?investigate?the?scaffolds’?cell?compatibility.?Results???The?mineral?substance?of?the?14-day?group?exhibited?a?uniform?distribution.?The?crystal?composition?of?the?mineral?substance?suited?the?HA’s?features.?The?compressive?elastic?modulus?increased?along?with?the?extension?of?mineralization?time.?The?21-day?group?showed?a?statistically?significant?increase?in?compressive?elastic?modulus?compared?with?the?control?group?(P<0.05).?The?cell?proliferation?level?of?the?14-day?group?was?significantly?the?highest?among?the?three?experimental?groups?(P<0.05).?The?calcium?ion?and?the?typeⅠcollagen?had?the?highest?secretion?amount?when?the?cells?were?seeded?into?the?14-day?group.?Conclusion???The?SBF?biomimetic?mineralization?method?can?be?used?to?fabricate?HA-chitosan?bone-tissue-engineering?scaffolds.?The?biological?compatibility,?as?well?as?the?chemical?and?physical?properties,?reached?the?optimum?levels?at?day?14.