Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.

Objective To investigate the clinical features and risk factors of multidrug－resistant bacteria (multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012－2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23% . ESBLs, CR－AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time ＞20 d, level of consciousness (coma), occupancy of ICU ≥7 d, ventilation (invasive), number of antibiotics used≥3, combined use of antibiotics≥3, mechanical ventilation Time≥7 d were possible risk factors for MDROs infection in neurosurgical patients (P＜0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad－spectrum antibiotics, reduce unnecessary mechanical ventilation time, change to non－invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.

Objective: To investigate the impact of different doses of ropivacaine combined with spinal epidural anesthesia for maternal and neonatal renin activity, angiotensin II and aldosterone in the cesarean section system. Methods: From June 2015 to April 2017, 140 parturients undergoing cesarean section in the Maternal and Child Health Hospital of Anji County were selected in the research.Combined spinal-epidural ropivacaine were used in all patients during cesarean section anesthesia, and according to different dose of ropivacaine, the patients were divided into A group (8mg), B group(10mg), C group(12mg), D group(15mg), with 35 cases in each group.The analgesic effects of four groups and the changes of each index in the RAAS system of mother and baby in each time period were compared. Results: All fetuses were delivered smoothly.Compared the analgesic effect of four groups, the analgesic effect of IV grade in A group was the lowest percentage [17.14%(6/35)], B, C group had similar proportions [42.86%(15/35), 45.71%(16/35)], D group had the highest proportion [71.42%(25/35)], the maternal proportion of anesthesia effect of IV grade in D group was significantly better than those in A, B, C group, and the differences were statistically significant(χ²=20.90, 5.83, 4.77, all P<0.05). There was no significant change in the level of PRA in each period of A group.The PRA levels in B, C and D group at T1-T3 time were significantly lower than T0(t=14.64, 37.04, 3.97; 15.34, 29.93, 4.73; 25.83, 33, 5.23; 12.47, 8.94, 5.96, all P< 0.05). AT-II in A group at T1-T3 time was decreased, but there was no statistically significant difference compared with T0.AT-II levels in B, C, D group at T1-T3 time were significantly lower than that of T0(t=5.95, 5.98, 3.19; 5.86, 5.54, 4.77; 7.96, 5.47, 6.13; all P<0.05). No significant changes in ALD level of A group in every period of time; ALD levels in B, C, D group at T1-T3 time period were significantly lower than that of T0(t=3.75, 4.92, 2.47; 4.08, 5.77, 2.05; 3.94, 6.13, 3.55, all P<0.05). The fetal umbilical artery and vein of PRA, AT-II and ALD concentration were measured in maternal value range. Conclusion When combined with 10-15 mg ropivacaine for combined spinal epidural anesthesia, the RAAS system of mother and baby is more stable, and the effect of anesthesia and analgesia is better.

Objective: To investigate the effect of recombinant human keratinocyte growth factor 2 (rhKGF-2) on lung tissue of rabbits with severe smoke inhalation injury. Methods: A total of 120 New Zealand rabbits were divided into 5 groups by random number table after being inflicted with severe smoke inhalation injury, with 24 rats in each group. Rabbits in the simple injury group inhaled air, while rabbits in the injury+phosphate buffer solution (PBS) group inhaled 5 mL PBS once daily for 7 d. Rabbits in injury+1 mg/kg rhKGF-2 group, injury+2 mg/kg rhKGF-2 group, and injury+5 mg/kg rhKGF-2 group received aerosol inhalation of 1 mg/kg, 2 mg/kg, and 5 mg/kg rhKGF-2 (all dissolved in 5 mL PBS) once daily for 7 d, respectively. On treatment day 1, 3, 5, and 7, blood samples were taken from the ear central artery of 6 rabbits in each group. After the blood was taken, the rabbits were sacrificed, and the tracheal carina tissue and lung were collected. Blood pH value, arterial oxygen partial pressure (PaO₂), arterial blood carbon dioxide pressure (PaCO₂), and bicarbonate ion were detected by handheld blood analyzer. The expressions of pulmonary surfactant-associated protein A (SP-A) and vascular endothelial growth factor (VEGF) in lung tissue were detected by Western blotting. Pathomorphology of lung tissue and trachea was observed by hematoxylin-eosin staining. Data were processed with analysis of variance of two-way factorial design and Tukey test. Results: (1) Compared with those in simple injury group, the blood pH values of rabbits in the latter groups on treatment day 1-7 had no obvious change (P>0.05). The PaO₂ of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 5 and 7 were (75.0±2.4) and (71.0±4.5) mmHg (1 mmHg=0.133 kPa), respectively, which were significantly higher than (62.0±6.8) and (63.0±3.0) mmHg in simple injury group (q=4.265, 8.202, P<0.05 or P<0.01). The PaO₂ of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 7 was (82.0±4.9) mmHg, which was significantly higher than that in simple injury group (q=6.234, P<0.01). Compared with that in simple injury group, the PaCO₂ of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 3 was significantly decreased (q=4.876, P<0.01) and significantly increased on treatment day 5 (q=5.562, P<0.01); the PaCO₂ of rabbits in injury+5 mg/kg rhKGF-2 group was significantly increased on treatment day 5 and 7 (q=5.013, 4.601, P<0.05 or P<0.01). Compared with that in simple injury group, the serum bicarbonate ion of rabbits in injury+1 mg/kg rhKGF-2 group on treatment day 7 was significantly increased (q=5.142, P<0.01); the serum bicarbonate ion of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 5 and 7 were significantly increased (q=4.830, 6.934, P<0.01); the serum bicarbonate ion of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 5 were significantly increased (q=3.973, P<0.05). (2) The expressions of SP-A in lung tissue of rabbits in simple injury group and injury+PBS group in each treatment time point were close (P>0.05). The expressions of SP-A in lung tissue of rabbits in injury+2 mg/kg rhKGF-2 group and injury+5 mg/kg rhKGF-2 group on treatment day 3 were 0.091±0.007 and 0.101±0.009, respectively, significantly higher than 0.069±0.009 in simple injury group (q=10.800, 13.580, P<0.01). The expressions of SP-A in lung tissue of rabbits in injury+1 mg/kg rhKGF-2 group, injury+2 mg/kg rhKGF-2 group, and injury+5 mg/kg rhKGF-2 group on treatment day 5 and 7 were 0.127±0.008, 0.132±0.006, 0.194±0.006, 0.152±0.017, 0.166±0.004, 0.240±0.008, significantly higher than 0.092±0.003 and 0.108±0.005 in simple injury group (q=6.789, 12.340, 17.900, 9.875, 31.480, 40.740, P<0.01). (3) On treatment day 1 and 5, there was no significant difference in the expression of VEGF in lung tissue of rabbits among the 5 groups (P>0.05). Compared with those in simple injury group, the expressions of VEGF in lung tissue of rabbits in injury+2 mg/kg rhKGF-2 group on treatment day 3 and 7 were significantly increased (q=4.243, 8.000, P<0.05 or P<0.01), and the expression of VEGF in lung tissue of rabbits in injury+5 mg/kg rhKGF-2 group on treatment day 7 was significantly increased (q=20.720, P<0.01). (4) On treatment day 1, the injury of rabbits in each group was similar, with a large number of neutrophils infiltrated and abscess formed in the alveolar and interstitial tissue, thickened alveolar septum, some collapsed alveolar and atelectasis; large area of tracheal mucosa was degenerated and necrotic, with a large amount of inflammatory exudates blocking in the cavity. On treatment day 3, the inflammation of lung tissue and trachea in each group were improved, but the inflammation in simple injury group and injury+PBS group was also serious. On treatment day 5, the inflammation in lung tissue and trachea of rabbits in injury+2 mg/kg rhKGF-2 group and injury+5 mg/kg rhKGF-2 group were improved much obviously than those in the other groups. On treatment day 7, the inflammation in lung tissue of rabbits in injury+5 mg/kg rhKGF-2 group alleviated obviously than those in the other groups, most alveoli had no obvious exudative fluid, the alveolar cavity was intact and clear, the local alveolar dilated like a cyst, and the alveolar septum thinning; the improvement of inflammation of trachea was more obvious than the other groups, the tracheal mucosa tended to be more complete, and few neutrophils were infiltrated in the endotracheal cavity. Conclusions Atomization inhalation of rhKGF-2 can improve the PaO₂ level of rabbits with severe smoke inhalation injury, reduce airway inflammation, increase the expression of SP-A and VEGF in lung tissue, thus promoting the repair of lung tissue.

Objective To study the rhubarb phenol and P38 inhibitor suppression on light aging of human skin HaCaT induced by UVB. Methods The potential of cell proliferation of the different concentrations of rhubarb phenol and P38 inhibitor (SB203580) on human skin HaCaT was detected by MTT method. The cells was divided into the control group, the model group, the rhubarb phenol group, the SB203580 group by random number table method after the 24 h incubation. The 10-6 mol/L rhubarb phenol and 10-7 mol/L SB203580 were added to the rhubarb phenol group and SB203580 group for 24h, The competence of cultured cell proliferation which was irradiated with UVB of intensity of 0.61mW/cm2, mutiply time of 7 min and distance of 10 cm for 24 h except the control group; Western Blot method detected rhubarb phenol and P38 inhibitor of the influence of P38, P-P38, TNF-α, IL-6 protein. Results Compared with control group, the cell proliferation in UVB group significantly reduced (P<0.01); Compared with UVB group, the expression of the P-P38 (0.419 ± 0.029, 0.398 ± 0.015 vs. 0.497 ± 0.051), TNF-α (0.435 ± 0.025, 0.411 ± 0.021 vs. 0.509 ± 0.040) and IL-6 (0.457 ± 0.027, 0.432 ± 0.018 vs. 0.478 ± 0.036) in rhubarb phenol and P38 inhibitor group significantly reduced (P<0.01). Conclusions The rhubarb phenol and P38 inhibitor could significantly suppress HaCaT cells light aging, and its mechanism may be related with inhibiting P38 signaling pathways, and inhibiting the secretion of inflammatory cytokines.

Objective To study the pinoresinol diglucoside (PDG) on gene regulation role of ESF-1 cells in collagen secretion, to reveal PDG repair mechanisms on scalded skin.Methods The cells cultured in vitro were divided into the control group, the estradiol group and the three different PDG doses groups. The concentration of the high, medium and low dose groups were 100, 10, 1μmol/L, and that of estradiol group were 10-3μmol/L. The activity of proliferation was detected by MTT. Then collagen type I (Col I), collagen typeⅢ (ColⅢ), tissue inhibitors of metalloproteinase 1 (TIMP-1), tissue inhibitors of metalloproteinase 2 (TIMP-2) and matrix metalloproteinase 1 (MMP-1) expression levels of mRNA after administration of cells were detected by RT-PCR.Results Compared with the control group, the proliferation of ESF-1 cells (0.559 ± 0.027, 0.552 ± 0.034vs. 0.489 ± 0.027,P<0.05) in the estradiol and medium-dose PDG was significantly higher. The expression level of mRNA of ColⅠ(0.958 ± 0.021, 0.929 ± 0.031, 0.916 ± 0.015vs. 0.844 ± 0.022), ColⅢ (0.783 ± 0.038, 0.918 ± 0.021, 0.855 ± 0.017vs. 0.678 ± 0.024), TIMP-1 (0.939 ± 0.025, 0.889 ± 0.036, 0.853 ±  0.015 vs. 0.780 ± 0.023), TIMP-2 (0.507 ± 0.024, 0.655 ± 0.037, 0.572 ± 0.025vs. 0.405 ± 0.062) in the estradiol, low-, medium-dose PDG groups were significantly higher than those in the control group (P<0.05 or P<0.01). Besides, the MMP-1 (0.343 ± 0.038, 0.407 ± 0.046, 0.435 ± 0.037vs.0.519 ± 0.041) mRNA expression level in the middle and low dose PDG groups significantly decrease (P<0.05 orP<0.01). Conclusions The PDG could enhance the activity of ESF-1 cell proliferation, increase the expression of related collagen and tissue inhibitor of metalloproteinases and inhibit that of matrix metalloproteinases to repair scalded skin.

Objective To explore the effect of bispectral index (BIS) monitoring on hemodynamics patients undergoing laparoscopic cholecystectomy under laryngeal mask anesthesia.Methods 110 patients with laparoscopic cholecystectomy were randomly divided into the control group and the observation group according to digital table method.The control group was administered according to the experience of anesthesiologists,the observation group was administered according to BIS monitoring.The hemodynamic indexes,the dosage of anesthetic drug and recovery time of two groups were analyzed.Results After pulling out the laryngeal mask,the HR (74.13±6.99)beats/min,MAP (78.54±8.01)mmHg and COR (321.23±15.35)nmol/L of the observation group were significantly higher than HR (94.21±9.53)beats/min,MAP(98.67±10.21)mmHg and COR (463.24±20.01)nmol/L of the control group,the differences were statistically significant (t=12.60,11.50,41.76,all P<0.05).The amount of propofol induction (1.65±0.21)mg/kg,dosage of propofol (323.13±15.64)mg and remifentanil (401.21±20.11)μg of the observation group were lower than those of the control group [(2.39±0.34)mg/kg,(414.32±20.34)mg,(469.54±22.39)μg],and the recovery time of the observation group (6.89±1.01)min was significantly better than (10.21±1.42)min of the control group,the differences were statistically significant (t=13.73,26.36,16.84,14.13,all P<0.05).Conclusion The effect of BIS monitoring in laryngeal mask anesthesia for laparoscopic cholecystectomy is significant,which can reduce intraoperative anesthetic dosage,promote hemodynamic stability,reduce the stress response of patients,shorten recovery time,the anesthesia is more safe and reliable.

Objective To compare the outcomes of endovascular treatment between intracranial large artery atherosclerosis stroke (LAA) and cardioembolic stroke (CE) in Chinese patients with acute anterior circulation ischemic stroke.Methods Patients with acute anterior circulation ischemic stroke treated with the Solitaire stent retriever were enrolled.The patients were divided into either a LAA group or a CE group according to etiological subtype.The outcomes were compared between 2 groups.Multivariable logistic regression analysis was used to determine the independent risk factors for poor outcome (defined as the modified Rankin Scale score ＞2 at 90 d after onset).Results A total of 126 patients were enrolled in the study,including 62 (49.2％) in the LAA group and 64 (50.8％) in the CE group.The proportions of poor outcome at 90 d (59.0％ vs.41.0％;x2 =5.482,P =0.019) and symptomatic intracerebral hemorrhage at 72 h (12.5％ vs.1.6％;Fisher exact test P =0.033) in the CE group were significantly higher than those in the LAA group.Multivariate logistic regression analysis showed that high baseline National Institutes of Health Stroke Scale scores was independently associated with poor outcome (odds ratio [OR] 1.119,95％ confidence interval [CI] 1.026-1.221;P =0.011),good collateral circulation was was independently associated with good outcome (OR 0.227,95％ CI 0.097-0.788;P =0.016),and etiological subtype was not independently associated with outcome (OR 1.280,95％ CI O.454-3.633;P =0.630).Conclusion Etiological subtype is not associated with outcome in patients with acute anterior circulation ischemic stroke treated with the Sofitaire stent retriever.

Objective To explore the mechanism and regulative function of betulin on anti-aging genes related of normol human dermal fibroblasts (ESF-1), and to reveal the repairing mechanism of betulin on wrinkles. Methods The cultured cell in vitro were divided into the control group, the estradiol group and the betulin high, medium and low dose groups. Competence of ESF-1 cells was detected by MTT. Expression of mRNA of collagen type I and Ⅲ (ColⅠand Col Ⅲ), tissue inhibitors of matrix metalloproteinase 1 and 2 (TIMP-1 and TIMP-2), matrix metalloproteinase 1 (MMP-1) was detected by RT-PCR. Results Compared with the control group, the proliferation of ESF-1 cells (0.455 ± 0.037, 0.445 ± 0.040 vs. 0.385 ± 0.601) in the estradiol group and the medial-dose betulin group were increased (P<0.05). Compared with the control group, the expression of mRNA of ColⅠ (0.960 ± 0.012, 0.929 ± 0.015 vs. 0.842 ± 0.014), Col Ⅲ (0.892 ± 0.009, 0.824 ± 0.022 vs. 0.768 ± 0.025), TIMP-1 (0.938 ± 0.026, 0.878 ± 0.035 vs. 0.796 ± 0.022), TIMP-2 (0.557 ± 0.025, 0.506 ± 0.036 vs. 0.436 ± 0.063) in the estradiol group and the medial-dose betulin group were increased (all P<0.01). Conclusion Betulin based on increasing the competence of ESF-1 cells, promoting collagen synthesis and the expression level of related-proteinase is to suspend the development of wrinkles.