Volume 98  ·  Issue 10  ·  2018

China has entered a rapidly aging society, and the increasing prevalence of elderly patients and their pursuit of quality of life have led to a significant increase in the number of surgical operations. How to ensure rapid postoperative recovery and improve long-term quality of life of elderly patients is an urgent problem faced by multi-department medical teams during perioperative period. Failure to effectively block nociceptive stimulation to organs during perioperative period is the main cause of serious perioperative complications and mortality, and poses a challenge to the long-term quality of life and survival of patients^[1]。 Therefore, the core of ensuring rapid postoperative recovery and improving long-term quality of life of elderly patients lies in blocking or attenuating perioperative harmful stimulation to organs, and anesthesiologists play a crucial role in this respect.

The purpose of this study was to assess the efficacy of ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control in elderly patients with hip fracture.

One hundred and sixteen patients with hip fractures in Xuan Wu Hospital of Capital Medical University during Dec. 2015 to Dec. 2016 were included. These patients were randomized into 2 groups: control group (group C) (receiving the traditional analgesia: tramadol 50 mg and paracetamol 500 mg tid, po from admission to surgery), study group (group S) (receiving ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control from admission to surgery). Pain relief or pain intensity was assessed preoperatively at before administration of analgesia (T₀), 1 h after administration of analgesia (T₁), the second day after admission(T₂), in the morning of surgery day (before surgery) (T₃) using a visual analog scale. The satisfaction score with the analgesic regimen preoperatively was recorded. The amount of rescue analgesia, occurrence of adverse events (nausea, vomiting, respiratory depression, over sedation) and continuous fascia iliaca compartment block complications were also collected.

Pain scores (VAS) at passive movement of group S were significantly lower at T₁ (32±8), T₂ (32±8) and T₃ (34±7) than that at T₀ (73±12) (all P<0.05). VAS at rest of group S were significantly lower than those of group C at T₃ (t=3.488, P<0.05). VAS at passive movement of group S were significantly lower than those of group C at T_1,T_2,T₃ (P<0.05). The satisfaction score with the analgesic regimen was greater in group S (74±10) than that in group C (46±11) (t=-14.209, P<0.05). The incidence of rescue analgesia was lower in group S (0) than in group C (17.2%) (χ²=5.472, P<0.05). The occurrence of nausea and vomiting was 6.9% and 1.7% in group S, which were lower than that in group C (22.4%, 12.1%) (χ²=6.779, 2.416, all P<0.05). There were no obvious complications of continuous fascia iliaca compartment block in group S.

Ultrasound guided continuous fascia iliaca compartment block combined with oral analgesics preoperatively is an effective way of providing analgesia for elderly with hip fracture, which can improve the patient's comfort and satisfaction.

To investigate the effect of dexmedetomidine adding to ropivacaine for continuous femoral nerve block on the improvement of postoperative sleep quality in elderly patients after total knee arthroplasty.

One hundred and sixty patients aged 60 years or older in Jishuitan Hospital scheduled for single total knee arthroplasty between Nov. 2016 and Jun. 2017 were recruited. All patients received spinal anesthesia and were randomized to receive either combined ropivacaine and dexmedetomidine (0.2% ropivacaine 250 ml and 5 μg/kg dexmedetomidine, at a rate of 5 ml/h or 0.1 μg·kg ^-1·h^-1 dexmedetomidine, dexmedetomidine group) or only ropivacaine (0.2% ropivacaine, at a rate of 5 ml/h, controlled group) for continuous femoral nerve block as postoperative analgesia after surgery. The severity of postoperative pain was assessed with numeric rating scale at 4, 24, and 48 hours after surgery both at rest and with movement. Subjective sleep quality and delirium were evaluated daily during the first 3 days postoperatively.

The subjective sleep quality scores were 2(1-4), 2(1-4) and 4(2-8), 4(2-7) in dexmedetomidine group and controlled group respectively on the 1st and 2nd days after surgery. The scores of dexmedetomidine group were much better than those of controlled group (Z=-4.597, -4.183, both P<0.05). The difference was statistically significant. The NRS pain scores at rest were 2(1-2), 2(1-4), and 3(2-5), 3(2-6) in dexmedetomidine group and controlled group respectively at 24 and 48 hours after surgery. The scores of dexmedetomidine group were lower than those of controlled group (Z=-6.671, -4.010, both P<0.05). The difference was statistically significant. The NRS pain scores with movement were 1(1-2), 3(2-4), 3(2-3) and 3(2-4), 5(3-6), 5(4-7)in dexmedetomidine group and controlled group respectively at 4, 24 and 48 hours after surgery. The scores of dexmedetomidine group were lower than those of controlled group (Z=-7.167, -6.824, -7.473, all P<0.05). The difference was statistically significant. The incidence of 3-day delirium was lower in dexmedetomidine group (5%) than that in controlled group (15%) (χ²=4.444, P<0.05). The difference was statistically significant. There were no significant differences between groups regarding the incidences of adverse events.

Dexmedetomidine combined with ropivacaine for continuous femoral nerve block may improve subjective sleep quality, postoperative analgesia, and reduce delirium in the elderly after total knee arthroplasty.

To evaluate the efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment of lower back post-herpetic neuralgia.

One hundred and twenty-eight cases of lower back or anterior abdominal wall acute post-herpetic neuralgia patients were enrolled. They were randomly divided into two groups. Group A: oral treatment only with gabapentin+ celecoxib+ amitriptyline. Group B: while taking these drugs, patients were treated with radiofrequency pulses using a portable ultrasound device and the paravertebral puncture technique.In both groups, sudden outbreaks of pain were treated with immediate release 10 mg morphine tablets. Before and one week, two weeks, four weeks, eight weeks after treatment, visual analogue scale (VAS) was used for pain score, Pittsburgh sleep quality index scale (PSQI) was used to evaluate sleep quality, and morphine consumption was recorded. Eight weeks after treatment analgesic efficacy was evaluated. Treatment efficiency and significant efficiency was calculated while the occurrence of complications were documented.

In the control group, the VAS of T_1,T_2,T₃ and T₄ were 6.7 ±1.2, 5.2 ± 1.0, 3.3 ±1.1, 3.0±0.9.However, at the same time points, the VAS in the treatment group were 3.1±1.0, 2.2±0.7, 1.4±0.5, 1.2±0.5, respectively.The radio frequency group decreased significantly compared with the control group, the difference was statistically significant (t=17.925, 19.662, 12.580, 13.987, all P<0.05). Four weeks after treatment, the TNF-α in the control group was (11.04±2.36)ng/L, and the TNF-β in the radio frequency group was (8.07±2.13) ng/L. After the treatment, the TNF-α of the radio frequency group was lower than the control group, and the difference was statistically significant (t=-6.267, P<0.05). The IL-1β in the control group was (3.47±1.09) ng/L after treatment.The IL-1β in the radio frequency group was (1.96 ±0.56) ng/L, the IL-1β in the radio frequency group was lower than the control group and the difference was statistically significant (t=-8.266, P<0.05). Pearson correlation analysis showed that before and after the treatment of TNF-α were positively correlated with VAS score (r=0.455, 0.327, all P<0.05). IL-1β before and after treatment were positively correlated with VAS score (r=0.369, 0.357, all P<0.05). At T_1,T_2,T₃ and T₄, PSQI in the control group were 8.5±1.5, 7.3±1.4, 6.2±1.3 and 6.0±0.9 respectively.PSQI in the radio frequency group at the same time points were 6.5±1.4, 5.1±1.2, 4.0±1.1 and 3.9±0.5.Comparison between the two groups after treatment, radio frequency group was lower than the control group significantly, and the difference was statistically significant (t=7.798, 9.545, 10.335, 16.318, all P<0.05). Morphine consumption of the control group at T_1,T_2,T_3,T₄ were (22.5±2.2), (15.5±2.9), (6.8±1.5) and (4.2±0.9)mg.However, morphine consumption of the radio frequency group were (13.2±2.5), (7.2±2.7), (3.2±0.6) and (2.2±0.5)mg.Comparison between the two groups after treatment, morphine consumption of the radio frequency group decreased significantly than the control group, and the difference was statistically significant (t=22.341, 16.758, 17.827, 15.541, all P<0.05). During the operation , no error occurred with needle penetrating the abdominal cavity, chest, offal or blood vessels.

Ultrasound-guided spinal nerve posterior ramus pulsed radio frequency treatment of lower back or anterior abdominal wall post-herpetic neuralgia proves effective and can reduce patient morphine usage and lead to fewer adverse reactions.

To explore the clinical features, etiological features and prognostic risk factors of long-term glucocorticoid users with community-acquired pneumonia (CAP).

A retrospective study included 100 long-term glucocorticoid users with CAP (G-CAP group) from 11 hospitals of China between January 2014 and December 2014, while 100 non-immunocompromised patients with community-acquired pneumonia were enrolled as controls (nICH-CAP group). Characteristics including age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate between the two groups were compared, and the prognostic factors of G-CAP were investigated using Logistic regression.

The peripheral blood lymphocytes[1.06(0.70, 1.68) vs 1.44 (0.87, 1.98)]in G-CAP group was less than nICH-CAP group (P<0.05). CT with pulmonary interstitial change (28.6% vs 9.9%), the proportion of patients with respiratory failure (25.0% vs 7.0%), mechanical ventilation (9.0% vs 2.0%), noninvasive mechanical ventilation (12.0% vs 2.0%), septic shock (9.0% vs 2.0%), and the hospital mortality rate (13.0% vs 3.0%) in G-CAP group were significantly higher than in nICH-CAP group (allP<0.05). Bacterial infection accounted for the highest proportion of infection (61.3%) in G-CAP group, but also virus infection (19.4%) and mixed infection (16.1%). Pseudomonas accounted for the highest proportion (47.4%) in bacterial infection of G-CAP. Logistic regression analysis showed that peripheral blood lymphocytes (OR=0.004, 95% CI: 0.000-0.234; P<0.05) and respiratory failure (OR=17.766, 95% CI: 4.933-131.0; P<0.05) were independent predictors of death in G-CAP group.

The proportion of severe pneumonia and the mortality rate of patients with G-CAP are higher than the patients with nICH-CAP. Lymphopenia and respiratory failure are associated with poor outcome of patients with G-CAP.

To investigate the clinical features and prognosis of patients with pulmonary sarcomatoid carcinoma (PSC).

The study retrospectively reviewed the clinical, radiological, pathological characteristics and prognosis of 76 patients with PSC who were treated in the First Affiliated Hospital of Medical School of Zhejiang University from January 2011 to December 2016. Gender, age, smoking history, tumor location, tumor size, lymph node metastasis, distant metastasis, TNM staging and treatment methods were analyzed to determine the factors affecting the prognosis of PSC patients.

The 76 patients with PSC consisted of 61 men and 15 women, the average age was (62.9±9.8) years old. Cough (31 cases, 40.8%), hemoptysis (29 cases, 38.2%) and chest pain (15 cases, 19.7%) were the main clinical manifestations; the average diameter of tumor was (4.7±2.3) cm; the peripheral type (48 cases, 63.2%), right lung (51 cases, 67.1%) and upper lobe of the lung (46 cases, 60.5%) were the common locations. The tumors usually were with a smooth margin, showing an irregular annular enhancement around the area, but the central part of the tumors were not enhanced obviously. The main pathologic type was pleomorphic carcinoma, and immunohistochemistry showed that vimentin and cytokeratin were usually expressed.Tumor size, lymph node metastasis, distant metastasis, TNM staging and early surgical treatment (P<0.05) were prognostic factors for survival, and distant metastasis and TNM staging (P<0.001) were independent prognostic factors affecting the prognosis of patients.

There are no specificity in the clinical and radiological features of PSC patients in our study, and the diagnosis of PSC depends mainly on pathological analysis. Distant metastasis and TNM staging are independent prognostic factors.

To investigate the changes of insulin-like growth factor 1 (IGF-1) axis in chronic kidney disease (CKD) and its role in skeletal muscle atrophy.

A total of 240 patients with CKD stage 1-5 (without dialysis treatment) were included between August 2016 and February 2017. Serum IGF-1 and IGF-1 binding protein-3 (IGFBP-3) were measured using chemiluminescence, and the influencing factors of serum IGF-1 and IGFBP-3 were analyzed. Besides, male Sprague-Dawley rats (200-250 g) were randomly assigned to the sham-operated control group (Control, n=15) and the 5/6 nephrectomy group (n=15) as CKD animal model. The expressions of local IGF-1 and IGF-1 receptor (IGF-1R) of skeletal muscles were evaluated at the level of transcription and protein by real-time PCR and Western blotting.

There was no significant correlation between changes of serum IGF-1 level and estimated glomerular filtration rate (eGFR) (r=-0.066, P=0.307). However, after multivariable adjustment, serum IGFBP-3 increased with decreasing of eGFR (r=-0.181, P=0.005) in adult CKD patients. In multivariate analysis, age, eGFR, serum cholesterol level and 24 h urinary protein quantification were independent factors of serum IGFBP-3 in patients with CKD (R²=0.243, P<0.001). Animal experiments showed that the expression of IGF-1 mRNA and protein decreased in skeletal muscles of CKD rats. Expressions of IGF-1R mRNA and protein were slightly reduced and phosphorylation of IGF-1R was severely impaired in skeletal muscles of CKD rats.

IGF-1 levels seem to be independent of renal function, but IGFBP-3 levels increased with decreasing of eGFR, which may cause a low affinity of IGF-1 with IGF-1R in skeletal muscles. Low affinity of IGF-1 with IGF-1R, as well as the decreasing of IGF-1 synthesis could lead to disorders of IGF-1R phosphorylation, and thus cause atrophy of skeletal muscles.

To investigate the association of blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder by cardiopulmonary coupling.

Performed according to strict inclusion and exclusion criteria, 88 new cases of essential hypertension who came from the international department and the cardiology department of china-japan friendship hospital were enrolled. Sleep stability and 24 h ambulatory blood pressure data were collected by the portable sleep monitor based on cardiopulmonary coupling technique and 24 h ambulatory blood pressure monitor. Analysis the correlation of blood pressure variability and sleep stability.

In the nighttime, systolic blood pressure standard deviation, systolic blood pressure variation coefficient, the ratio of the systolic blood pressure minimum to the maximum, diastolic blood pressure standard deviation, diastolic blood pressure variation coefficient were positively correlated with unstable sleep duration (r=0.185, 0.24, 0.237, 0.43, 0.276, P<0.05).

Blood pressure variability is associated with sleep stability, especially at night, the longer the unstable sleep duration, the greater the variability in night blood pressure.

To investigate the serum level of interleukin-38 (IL-38) and its clinical significance in patients with chronic obstructive pulmonary disease (COPD).

Totally 72 patients with acute exacerbation of COPD (AECOPD group) and 65 patients with stable COPD (S-COPD group) were recruited from Tianjin Chest Hospital from June 2016 to August 2017. In the same period 40 elderly healthy subjects were selected as control group (C group). The general data and laboratory examination results of these subjects were recorded. Serum IL-38 was measured by double antibody enzyme-linked immunosorbent assays (ELISA). The inter-group differences of above parameters were analyzed. Pearson correlation or Spearman rank correlation analysis was used to analyze the correlation between IL-38 and each variable, and multivariate stepwise regression analysis was used to determine the influencing factors of serum IL-38 in COPD patients.

The serum level of IL-38 was higher in AECOPD group than in S-COPD group[(57.88±13.72) vs (51.75±14.06) ng/L, P<0.05], and was higher in either of the two COPD groups than in C group[(46.37±13.18) ng/L](bothP<0.05). Correlation analysis of single factor showed that serum IL-38 levels were positively correlated with body mass index (r=0.190, P<0.05), and negatively correlated with C reactive protein (CRP), fibrinogen (FIB), forced expiratory volume in one second as a percentage of estimated value (FEV₁%pred) and the number of acute exacerbations in the past 1 year (r=-0.344, -0.176, -0.195, -0.229, all P<0.05). The CRP level and the number of acute exacerbations in the past 1 year were independent factors affecting the serum level of IL-38 (β=-0.204, -0.183, bothP<0.05) in patients with COPD.

IL-38 is compensatory increased in serum of patients with COPD and may be used as one of the serological markers for evaluation of COPD.

To evaluate in-hospital and mid-term outcomes of sequential versus separate grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center, propensity-matched study.

After propensity score matching, 120 pairs of patients undergoing first, scheduled, isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left anterior descending artery (LAD) territory were entered into a sequential group (sequential grafting of LIMA to the diagonal artery and then to the LAD) or a control group (separate grafting of LIMA to the LAD). The in-hospital and follow-up clinical outcomes and follow-up LIMA graft patency were compared.

The two propensity score-matched groups had similar in-hospital and follow-up clinical outcomes. The number of bypass conduits ranged from 3 to 6 (with a mean of 3.5), and 91.3%(219/240)of the included patients received off-pump CABG surgery. No significant differences were found between the two propensity score-matched groups in the in-hospital outcomes, including in-hospital death and the incidence of complications associated with CABG (prolonged ventilation, peroperative stroke, re-operation before discharge, and deep sternal wound infection). During follow-up, 9 patients (4 patients from the sequential group and 5 patients from the control group) died, and the all-cause mortality rate was 3.9%. No significant difference was found in the all-cause mortality rate between the 2 groups[3.4% (4/116) vs 4.3% (5/115), P=0.748]. During follow-up period, 99.1% (115/116) patency for the diagonal site and 98.3% (114/116) for the LAD site were determined by coronary computed tomographic angiography after sequential LIMA grafting, both of which were similar with graft patency of separate grafting of in situ skeletonized LIMA to the LAD.

Revascularization of the left coronary system using a skeletonized LIMA resulted in excellent in-hospital and mid-term clinical outcomes and graft patency using sequential grafting.

To analysis the curative effect of emergency cholecystectomy (EC) and percutaneous transhepatic gallbladder drainage (PTGBD) followed by delayed cholecystectomy (DC) on the patients with moderate acute cholecystitis.

The perioperative dataof patients in EC group (n=47) and in PTGBD-DC group (n=49) were compared retrospectively.

Compared to PTGBD+ DC group, EC patients had a significantly more postoperative abdominal drainage time [(9.0±12.9) vs (3.4±2.1) days, P=0.041], more postoperative hospital stay after cholecystectomy [(8.2±3.2) vs (5.1±1.8) days, P=0.004], more intraoperative bleeding [(101±125) vs (33±37) ml, P=0.003], more patients of LC conversion to open cholecystectomy (OC) (19.1% vs 4.1%, P=0.021) and more patients of OC(14.9% vs 0, P=0.005). Also, there were higher incidence of respiratory failure(14.8% vs 2.0%, P=0.029), and admission for ICU(21.3% vs 2.0 %, P=0.003). Also, patients of total OC in non-biliary surgeons group were more than that of biliary surgeons group statistically(63.2% vs 14.3 %, P=0.001).

PTGBD followed by DC in the treatment of moderate acute cholecystitis was better than EC, especially in patients with complicated comorbidities and in non-biliary surgeons.

To summarize the experience in diagnosis and treatment of primary retroperitoneal liposarcoma.

The clinic data of 73 cases of primary retroperitoneal liposarcoma were reviewed. The age of patients was 23 to 75 years old, with a median age of 53 years. Forty-five cases were treated for the first time, and 28 cases were re-treated after local recurrence. All patients underwent ultrasonography, CT or MRI before operation and were diagnosed of primary retroperitoneal liposarcoma.

No lymph node and distant metastasis were found in all patients. The maximum diameter of the tumor was 3-40 cm, with a median diameter of 18.9 cm. Of the 45 patients with primary treatment, 6 patients were in T2 stage and 39 in T3 stage. Of the 28 patients with retreatment after local recurrence, 4 patients were in T1, 8 in T2, and 16 in T3 stage. All the 73 patients received surgery, 7 were treated with adjuvant radiotherapy, and 3 received adjuvant chemotherapy. One hundred and ten operations were performed in 73 patients. Sixty-seven cases were diagnosed of well differentiated liposarcoma, with 60 cases of lipoma-like liposarcoma and 7 cases of sclerosing liposarcoma. Nine cases were diagnosed of dedifferentiated liposarcoma, 16 cases were myxoid liposarcoma, and 2 cases were pleomorphic liposarcoma. Sixteen cases were mixed types. A total of 69 cases were followed up for 6 months to 13 years, with an average of 4 years. Sixty-six cases obtained complete resection, 34 cases relapsed, and the recurrence rate was 51.5% (34/66). Distant metastasis occurred in 4 cases. Fourteen cases died of tumor recurrence or distant metastasis and the rest were all alive. Four cases lost follow-up after 3 months. No matter in the initial treatment group or the retreatment group, the recurrence rate of combined organ resection is lower than that of simple tumor resection, and the average recurrence time was longer.

Primary retroperitoneal liposarcoma was rare in clinical experience. CT is the most effective method in the diagnosis of retroperitoneal liposarcoma, however pathological examination was still the key to the diagnosis. The main treatment of retroperitoneal liposarcoma was surgical resection. Complete resection was the objective of the operation, and the combined viscera resection was performed for those with invasion of other organs. Retroperitoneal liposarcoma had the characteristics of local recurrence after operation and insensitivity to radiotherapy and chemotherapy, but the recurrent tumor can still be resected.

To evaluate the effect of Penehyclidine Hydrochloride Injection on pulmonary ischemia-reperfusion in aortic dissection surgery.

This study was a prospective randomized controlled trial. Between September 2015 and October 2017 in the Second Affiliated Hospital of Zhengzhou University, 60 patients with aortic dissection underwent total arch replacement surgery were randomly divided into penehyclidine hydrochloride group (group A 30 cases) and control group (group B 30 cases). Patients in group A were infused with penehyclidine hydrochloride 0.05 mg/kg after entering the operating room. Patients in group B were infused with the same dose of 0.9% normal saline. Serum tumor necrosis factor (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1) and oxygenation index (OI) before anesthesia (T1), before cardiopulmonary bypass (T2), 1 h after cardiopulmonary bypass (T3), the end of cardiopulmonary bypass (T4), 4 h after surgery (T5) and 24 h after surgery (T6) were measured. The time of postoperative ventilator support and ICU staywas recorded.

At the time of T4, T5 and T6, the serum levels of TNF-α[(0.10±0.08), (0.13±0.02), (0.23±0.17) mg/L], IL-6[(0.23±0.08), (0.34±0.07), (0.54±0.17) mg/L]and IL-1[(0.62±0.14), (1.02±0.27), (1.44±0.40) mg/L]in group A were significantly lower than those in group B[(0.30±0.09), (0.51±0.19), (0.86±0.02) mg/L; (0.73±0.19), (1.33±0.13), (1.98±0.13) mg/L; (0.93±0.19), (1.43±0.66), (2.04±0.45) mg/L]. The OI was higher in group A[(446.7±267.0), (386.7±169.5), (391.7±227.9) mmHg]than that of group B[(341.2±145.2), (299.5±98.7), (275.0±127.3) mmHg](P<0.05). The time of ventilator support and ICU stay after operation was (3.6 ±1.2)d, (8.4 ± 2.0) d in group A, which was shorter than that in group B[(4.3 ± 1.8), (10.0 ± 2.2) d], and there were statistical differences between the two groups (allP<0.05).

In total arch replacement, intravenous penehyclidine hydrochloride injection may decrease the release of serum TNF-α, IL-6, IL-1, improve oxygenation index, reduce lung ischemia-reperfusion injury, shorten the time of ventilator support and ICU stay after operation, and thus improve the prognosis of patients.

To investigate the distinct effects of intermittent and continuous administration of parathyroid hormone (PTH) on bone and mesenchymal stem cell (MSC).

Six weeks old mice with C57/BL6J background and SOX9-creERT/Td-tomato/Osteocalcin-GFP genotype were divided into 6 groups: intermittent administration and withdraw group (subcutaneous injection with PTH 500 μg·kg ^-1·d^-1), continuous administration and withdraw group (subcutaneous implantation of PTH pump, 80 μg·kg ^-1·d^-1, with a rate of 0.25 μl/h), control administration and withdraw group, with 8 mice in each group. Serum calcium level and bone mineral density (BMD) were measured after two weeks′ treatment and two weeks after drug withdraw. Histopathology and immunofluorescence analyses were performed to assess the effects of PTH on bone and mesenchymal stem cell.

Serum calcium level increased transiently in intermittent group[(1.36±0.03) mmol/L]and increased gradually in continuous group[up to (2.33±0.03) mmol/L], but reduced to normal level (1.12-1.27 mmol/L) 14 days after drug withdraw. BMD of both intermittent[(0.047±0.002) g/cm²]and continuous[(0.046±0.001) g/cm²]PTH administration groups increased compared with control group[(0.044±0.001) g/cm²], but there was no significant difference among three groups 2 weeks after drug withdraw. Femoral histopathology showed that bone mass, trabecular number and little fibrous tissue hyperplasia in intermittent PTH group increased. Osteoblasts number increased, but lining cells decreased. There was no significant difference in osteocyte and osteoclast numbers. After withdrawing of intermittent PTH, osteocyte and osteoblast number declined significantly, but there was an increased number of lining cells. Continuous PTH caused very high amount of fibrosis, and osteoclast number increased significantly, while osteoblast and osteocyte number increased slightly. After withdrawing of continuous PTH, fibrosis disappeared significantly, and lining cell number increased. Immunofluorescence staining in the epiphyseal-metaphyseal regions in fibula showed intermittent PTH increased undifferentiated Td-Tomato MSC, but declined significantly after withdrawing. Undifferentiated Td-Tomato MSC in continuous PTH increased slightly and decreased after drug withdraw.

Intermittent PTH increased undifferentiated Td-Tomato MSC and osteoblast number, and might transform lining cell into osteocytes and osteoblasts, and thus lead to bone formation. Continuous PTH increased undifferentiated Td/Tomato MSC, osteoblast and osteocyte number slightly, but high amount of fibrosis and osteoclasts can be seen, leading to metabolic bone disease. However, lining cell ascended after drug withdraw, which may be beneficial to bone remodeling.

The diagnosis and treatment of central nervous system tuberculosis has been difficult globally, and the mortality and disability rates are high in all systems of tuberculosis, and more pronounced in developing countries^[1]。 Central nervous system tuberculosis is widespread and variable, and how to make early and effective diagnosis and treatment is the key to improve prognosis, otherwise this disease is easily life-threatening or leads to irreversible neurological sequelae. In addition, the mortality rate of tuberculosis in the central nervous system remains high. The incidence of tuberculosis in the central nervous system from high to low is tuberculous meningitis, cerebral parenchymal tuberculosis and spinal cord tuberculosis, the latter is also known as tuberculous myelitis, accounting for only 3% of systemic tuberculosis^[2]It is rarely reported at home and abroad, even in countries where CNS tuberculosis is common^[3]。 The clinical data of 10 patients with spinal tuberculosis are summarized and analyzed as follows.

Carbon monoxide (CO) poisoning can cause damage to brain, heart, lung and other organs, and its morbidity and mortality rate are the forefront of occupational and non-occupational poisoning in China. In the United States, thousands of people seek medical attention each year after developing CO poisoning, and hundreds of them die, resulting in a cost of more than $1 billion a year^[1]。 1912 Douglas et al.^[2]The classical theory of the relationship between CO poisoning and hemoglobin (Hb) was put forward, that is, the S-type oxygen separation curve shifted left during CO poisoning, the oxygen carrying capacity of Hb decreased, and the oxygen bound by carboxyhemoglobin (COHb) was not easily released, which eventually caused tissue hypoxia. 1917 Haldane^[3]It is suggested that high concentration or high partial pressure oxygen is the best antagonist to alleviate the toxic effect of CO. Since then, the hypoxia mechanism centered on COHb theory has been widely accepted and has also become a reasonable cause for oxygen therapy.

Mucor belongs to the subclass Zygomycetes in the subphylum Zygomycetes. Mucormycosis is a relatively rare invasive fungal infection, which has acute onset, rapid progress, difficult diagnosis and treatment, and the mortality rate is 40% ~70%^[1]。 A five-year study in the United States (2001-2006) showed that the annual incidence of mucormycosis in patients undergoing organ transplantation and hematopoietic stem cell transplantation was 0.07% and 0.29%, respectively^[2]。 Invasive pulmonary fungal infections were reported from 1998 to 2007 in China as pulmonary aspergillosis 37.9%, pulmonary candidiasis 34.2%, pulmonary cryptococcosis 15.6%, pneumocystomycosis 4.8% and pulmonary mucormycosis 2.1%^[3]。 In addition to the common immunosuppressed population, the risk factors of Mucor infection also include some special factors, such as diabetic ketoacidosis, iron overload caused by blood transfusion and trauma^[4]。

chronic kidney disease-mineral bone disorder (CKD-MBD) is a complication accompanied by gradual loss of renal function, which consists of calcium and phosphorus metabolism disorders, vascular calcification and renal osteodystrophy. All these factors were found to be associated with morbidity and mortality in large clinical studies of chronic kidney disease^[1,2,3,4]。 Therefore, it is of great significance to construct a good animal model of CKD-MBD for in-depth study of CKD-MBD disease development, pathological mechanism and drug targeted therapy. As a common animal for studying diseases, mice are widely favored in constructing CKD-MBD models because their genes are highly similar to those of humans, and they reproduce rapidly, are genetically stable and cheap to raise. Therefore, this paper mainly summarizes the establishment methods of CKD-MBD rat model in recent years from two aspects: surgical intervention and chemical induction.