Postoperative delirium (POD) is a common complication in older patients with hepatocellular carcinoma (HCC) that adversely impacts clinical outcomes. We aimed to evaluate the risk factors for POD and to construct a predictive nomogram. Data for a total of 1481 older patients (training set: n=1109; validation set: n=372) who received liver resection for HCC were retrospectively retrieved from two prospective databases. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. The rate of POD was 13.3% (148/1109) in the training set and 16.4% (61/372) in the validation set. Multivariate analysis of the training set revealed that factors including age, history of cerebrovascular disease, American Society of Anesthesiologists (ASA) classification, albumin level, and surgical approach had significant effects on POD. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.798 (95% CI 0.752-0.843) and 0.808 (95% CI 0.754-0.861) for the training and validation sets, respectively. The calibration curves of both sets showed a degree of agreement between the nomogram and the actual probability. DCA demonstrated that the newly established nomogram was highly effective for clinical decision-making. We developed and validated a nomogram with high sensitivity to assist clinicians in estimating the individual risk of POD in older patients with HCC.

Objective To analyze the characteristics of anemia in patients with acquired immunodeficiency syndrome (AIDS) complicated with talaromycosis marneffei (TSM). Methods Patients coinfected with AIDS and TSM in Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2016 and December 2020 were retrospectively included. Demographic data and anemia-related laboratory results were collected, and the type and degree of anemia of the patients were analyzed. Results A total of 383 patients were included and the prevalence of anemia was 84.33%(323/383).According to classification of anemia, mild, moderate and severe anemia accounted for 63.47%, 33.74% and 2.79%, respectively. According to erythrocyte morphology，microcytic anemia，normocytic anemia and macrocytic anemia accounted for 17.34%、80.80% and 1.86%, respectively. Compared with patients without anemia, patients with anemia had more women(14.24% vs 3.33%, χ2=5.492, P=0.019), more CD4+ ＜20 cells/μL(73.37% vs 60.00%, χ2=4.421, P=0.035), more white blood cell＜3×109/L(36.22% vs 16.67%, χ2=8.731, P=0.003)and more blood platelet ＜50×109/L(19.81% vs 8.33%, χ2=4.516, P=0.034). Conclusion The incidence of anemia in patients coinfected with AIDS and TSM is very high, especially in female patients with CD4+ ＜20 counts. For AIDS patients with anemia， physicians should pay more attention to these patients and treat them with fungi-medicine timely if necessary.

目的 探讨长链非编码RNA(lncRNA)与七氟烷麻醉副作用的关联.方法 采用小鼠模型分析七氟烷对海马锥体的影响,采用生物信息学方法分析GEO数据库中七氟烷处理的小鼠相关的lncRNA表达谱数据,筛选可能与七氟烷麻醉过程相关的lncRNA,并使用qPCR对lncRNA进行验证.结果 七氟烷处理可导致小鼠海马锥体神经元结构异常,增加细胞凋亡.基因芯片分析显示,在小鼠(GSE155770)中,七氟烷处理后27个lncRNA出现差异表达.qPCR验证发现,经七氟烷处理后,小鼠海马组织lncRNA Gm11525和Gm19439的表达水平提高.结论 不适量的七氟烷处理可引起海马锥体神经元结构改变和细胞凋亡,lncRNA可能参与了该病理性作用.

Purpose:This study aimed to investigate the epidemiology and etiological spectrums of BSI in Fujian over the past 6 years in the post antiretroviral treatment (ART) era.Methods:A retrospective, observational study was conducted to include positive BSI inpatients with HIV between September 2015 and August 2021 in Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Fujian, China. Demographic data and laboratory data including gender, age, blood cell counts, biochemistry results, CD4 and CD8 cell counts, HIV-RNA loads, pathogen isolates, procalcitonin (PCT) levels and c-reactive protein (CRP) levels were collected. Continuous variables were expressed as median (range) and Kruskal-Wallis or Mann-Whitney test was used to analyze the differences between groups. Categorical data were expressed as numbers (percentage) and the differences between groups were analyzed by Pearson's chi-squared test.Results:In total, 3681 HIV inpatients with blood culture data were included and 683 strains identified from 646 inpatients were further analyzed. The median age of patients was 38 years and male accounted for 86.84%. The pooled prevalence of BSI was 18.55% (12.01%-22.36% during the six-year period). The overall isolated rate of Talaromyces marneffei (TM) in blood culture was 12.42% (8.3%-15.00% during the study period). TM was the persistent dominant BSI pathogen from 2015 to 2021 (accounting for 63.04% to 71.43%), followed by Cryptococcus neoformans (responsible for 10.00% to 20.83%). Compared to patients with other organisms BSI, those with TM BSI were younger and had lower CD4 counts, WBC counts, HB and CRP level, but higher HIVRNA loads.Conclusion:BSI is still a major problem in the post ART era in hospitalized patients with HIV/AIDS in Fujian, China. TM is the predominant pathogen. This underlines the importance of an early diagnosis of opportunistic pathogen to avoid BSI in HIV-infected populations with a low immune status.

目的 研究不同压力CO2 气腹下对全麻腹腔镜子宫切除术围术期并发症及应激反应的影响.方法 选取2017 年10 月-2018 年10 月接受治疗的58 例CO2 气腹下行全麻腹腔镜子宫切除术患者为研究对象,根据气腹压力的不同将其分为A 组和B组各29例,A组气腹压力11 mm Hg,B组气腹压力14 mm Hg.比较两组患者CO2气腹前、CO2气腹后10 min、20 min、30 min及术毕5 min后的气道峰压(Ppeak)、呼气末CO2分压(PETCO2)、动脉二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、PH、血压(BP)、心率(HR)、皮质醇(Cor)及去甲肾上腺素(NE)水平;比较麻醉前、术后3d及术后7 d的用力肺活量(FVC)、1 s用力呼气容量(FEV1)、1秒率(FEV1/FVC).结果 在气腹后或术后某一时间点,两组患者的Ppeak、PETCO2、PaCO2、SBP、DBP、HR会出现升高趋势,PaO2水平、FVC％、FEV1％水平出现降低趋势,差异有统计学意义.与A组比较,B组患者在气腹后20 min、30 min Ppeak、PETCO2、PaCO2水平较高,围术期并发症较高,气腹后30 min B组患者的PaO2水平较低,但差异无统计学意义(P＞0.05),相同时间点两组间的SBP、DBP、HR、FVC％、FEV1％及FEV1/FVC％水平比较差异无统计学意义(P＞0.05).结论 高CO2气腹压力下进行全麻腹腔镜子宫切除术会增加围术期并发症,增强应激反应,不利于术后恢复.

Objective:To explore the effect of interference on expression of signal transducer and activator of transcription 3 (STAT3) by small interfering RNA (siRNA) on biological function of cholangiocarcinoma.Methods:Cholangiocarcinoma cell lines human cholangiocarcinoma cells1 (HUCCT1) and human cholangiocarcinoma cell (RBE) were cultured, siRNA-710, siRNA-551 and siRNA-2021 were constructed, Lipo 3000 transfection reagent was used to transfect siRNA into cholangiocarcinoma cells. The interference effect of siRNA on STAT3 expression was detected by polymerase chain reaction (PCR) and Western blotting, and siRNA-551 was selected for subsequent experiments. After 48 h of siRNA-551 transfection on cholangiocarcinoma cells, cell proliferation was tested by cell counting kit-8 (CCK-8) assay, apoptosis rate examined by flow cytometry, and the expression levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) were detected by Western blotting. One-way ANOVA of variance was used to analyze experimental results.Results:SiRNA-551 can significantly reduce the expression of STAT3 mRNA and protein in cholangiocarcinoma cells. After HUTT1 and RBE cholangiocarcinoma cells transfection with siRNA-551, the proliferation of cholangiocarcinoma cells in the STAT3 interference group [(74.49±0.96)%, (91.08±5.32)%] was lower than that of the blank control group [(100.00±5.52)%, (100.00±2.82)%, F=62.20, 6.57, P<0.05] and NC group [(90.99±1.87)%, (99.74±4.71)%, F=184.57, 4.45, P<0.05], The difference was statistically significant; the apoptosis rate of the interference group [(15.68±1.79)%, (11.30±0.67)%] was higher than that of the blank control group [(6.97±0.76)%, (6.12±0.37)%, F=60.01, 138.40, P<0.05] and NC group [(9.21±0.63)%, (6.22±0.21)%, F=34.77, 155.96, P<0.05], The difference was statistically significant; After HUCCT1 cholangiocarcinoma cells transfection with siRNA-551, The expression of IL-6 and VEGF protein in the interference group (0.23±0.07, 0.16±0.02) was low in the blank control group (0.62±0.34, 0.35±0.15, F=3.78, 4.90, P<0.05) and NC group (0.59±0.07, 0.47±0.39, F=37.46, 2.11, P<0.05), The difference was statistically significant; After RBE cholangiocarcinoma cells transfection with siRNA-551, the proliferation of cholangiocarcinoma cells in the STAT3 interference group (0.22±0.11, 0.80±0.08) was lower than that of the blank control group (0.51±0.11, 1.89±0.13, F=11.39, 151.69, P<0.05) and NC group (0.60±0.34, 1.46±0.48, F=3.39, 140.20, P<0.05), The difference was statistically significant. Conclusion:Interfering the expression of STAT3 in cholangiocarcinoma cells by siRNA has a tumor suppressor effect.

Background With the widespread use of integrase strand transfer inhibitors (INSTIs) in the clinical setting, transmission of INSTIs-resistance mutations may increase. Data regarding transmitted drug resistance mutations (TDRM) to INSTIs in Chinese HIV patients are limited. The aim of this study was to summarize the INSTIs TDRM, including the frequency of protease inhibitors (PIs) and reverse transcriptase (RT) inhibitors (RTIs) mutations in treatment-naïve patients in Southeast China. Methods HIV-1 positive patients were retrospectively selected between April 2018 and October 2020 from the Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Southeast China. Individuals who were antiretroviral therapy-naïve and received antiretroviral drug resistance testing at baseline were included. Clinical data including demographic data, CD4 counts, HIV-RNA loads, and drug resistance mutations were collected. Results A total of 147 patients were enrolled. INSTIs TDRM was rare, with only one primary integrase mutation E138K observed in one sample and one secondary mutation E157Q detected in another sample. The overall prevalence of INSTIs TDRM was 1.36%. A substantial proportion of patients harbored common INSTIs-associated polymorphic variants. Two samples harbored the T215S, M184V and K70E mutations related to nucleoside RTIs (NRTIs). Twelve patients carried nonnucleoside RTIs (NNRTIs)-resistance mutations. Two individuals harbored PIs-resistance mutations: Q58E in one patient and M46I, I54V, V82A, L10F, and Q58E mutations in another patient. The total TDRM rate for RTIs and PIs was 10.20% (15/147), but only 0.68% (1/147) was according to the WHO recommendations on TDRM. Conclusion The rate of INSTIs TDRM was low among therapy-naïve HIV patients in Southeast China. INSTIs as a first-line regimen are suitable for untreated HIV-1 patients in Southeast China. But special attention must be still paid to INSTIs TDRM in clinical practice.

目的:探讨盐酸羟考酮注射液复合右美托咪定静脉麻醉用于经T管胆道镜窦道取石术的麻醉效果.方法:选取2016年1月 ～2018年12月胆管结石患者60例为研究对象,随机分为观察组与对照组,各组30例.对照组采用局部麻醉,观察组采用盐酸羟考酮注射液复合右美托咪定静脉麻醉.比较两组术前、术中不同时间点MAP、HR以及SpO2水平,比较术后1 h两组VAS评分,比较两组术中、术后不良反应发生情况.结果:观察组术中不同时间点MAP、HR波动较小.术前两组MAP、HR、SpO2水平比较差异无统计学意义(P>0.05);手术开始时、取石时、手术结束时观察组MAP、HR显著低于对照组,差异有统计学意义(P<0.05).在不同时间点,两组SpO2比较,差异均无统计学意义(P>0.05).观察组术后VAS评分(1.5±0.4)分,对照组(2.6±0.6)分,两组比较差异有统计学意义(P<0.05).两组均顺利完成手术.联合组术中1例发生体动,无呼吸抑制,术后无恶心、呕吐不良反应,对照组术中有8例发生体动,无呼吸抑制,术后2例发生恶心,无呕吐.对照组不良反应发生率高于对照组,差异有统计学意义(P<0.05).结论:经T管窦道纤维胆道镜取石术中采用盐酸羟考酮注射液复合右美托咪定静脉麻醉麻醉效果好,对患者血压、心率等影响小,术中、术后不良反应发生率低.

目的 探讨OPRM1 A118G基因多态性对肝门部胆管癌患者舒芬太尼术后镇痛效应的影响.方法 50例静吸复合全麻下行肝门部胆管癌患者,术后采用病人自控镇痛舒芬太尼注射液2μg·kg-1·h-1.记录患者术后24 h、48 h的舒芬太尼用量及不良反应,并检测患者OPRM1 A118G基因型,评估不同基因型患者舒芬太尼的镇痛效应.结果 50例患者中,AA、AG及GG基因型比例分别为44％、40％及16％,A、G等位基因的频率分别为64％和36％.与AA基因型患者24 h、48 h的舒芬太尼用量47.12±11.39μg,88.76±19.27μg,相比,AG基因型患者均明显增加60.02±21.45μg,103.92±27.66μg,差异均有统计学意义(P<0.040,P<0.009),GG基因型患者分别为77.93±31.87μg及121.90±29.88μg,差异亦有统计学意义(P=0.031,P=0.002),恶心、呕吐及呼吸抑制发生率三组间无差异.结论 OPRM1 A118G基因多态性影响肝门部胆管癌患者对舒芬太尼的镇痛效果.

Interleukin-1 receptor antagonist (IL-1ra) is a naturally occurring anti-inflammatory antagonist of the proinflammatory cytokine IL-1, a critical factor in many inflammatory diseases. The aim of the present study was to investigate the role of IL-1ra in hepatitis B-related acute-on-chronic liver failure (HB-ACLF). Serum cytokine concentrations were measured using a Q-Plex array in 31 patients with HB-ACLF, 28 patients with acute hepatitis B (AHB), 31 patients with chronic hepatitis B (CHB) and 15 healthy control patients (HCs). Additionally, peripheral blood mononuclear cells (PBMCs) from patients with HB-ACLF were incubated with PBS or lipopolysaccharide and/or different concentrations of recombinant human IL-1ra (rhIL-1ra) in vitro. Cytokines in the supernatant were measured using a Q-Plex array. The median serum IL-1ra level in patients with HB-ACLF was 186.46 (350.22) pg/ml, which was significantly higher than all other groups (AHB, P=0.012; CHB, P<0.001; HCs, P<0.001). However, the ratio of IL-1ra/IL-1 beta was significantly lower in the HB-ACLF group compared with the AHB group (P=0.048). Median serum IL-1ra levels in patients with AHB were also significantly increased compared with those in the CHB (P<0.001) and HC (P<0.001) groups. Patients who succumbed to mortality within 3 months of the study were found to have significantly lower IL-1ra concentrations (P=0.02) and IL-1ra/IL-1 beta ratios (P=0.007) compared with surviving patients with HB-ACLF. Furthermore, serum IL-1ra concentrations were negatively associated with the Model for End-stage Liver Disease score (r=-0.870; P<0.001). Cytokine secretion by PBMCs in vitro was significantly inhibited in a dose-dependent manner by rhIL-1ra (125-500 ng/ml; all P<0.05). These results suggest that IL-1ra is associated with the development of liver inflammation, which is reduced in patients with HB-ACLF and inversely associated with disease severity.

目的 比较盐酸羟考酮注射液与舒芬太尼注射液对胰腺癌根治术后患者的镇痛效果及不良反应.方法 将80例ASA Ⅰ～Ⅱ级静吸复合全麻下行胰腺癌根治术患者随机均分为盐酸羟考酮组、舒芬太尼组,每组40例,分别于术毕前10 min患者自控镇痛盐酸羟考酮注射液1.00 mg·kg-1·h-1及舒芬太尼注射液2.00 μg· kg-1·h-1.采用VAS记录患者术后4h、8h、12h、24 h及48 h的疼痛评分,评估患者对镇痛的总体满意度及不良反应.结果 盐酸羟考酮组和舒芬太尼组患者4h、8h、12 h、24 h及48 h时VAS评分比较差异均无统计学意义(P均＞0.05).盐酸羟考酮组镇痛满意度高于舒芬太尼组,差异有统计学意义(P＜0.05).盐酸羟考酮组不良反应总发生率低于舒芬太尼组,差异有统计学意义(P＜0.05).结论 盐酸羟考酮用于经腹胰腺癌根治术后镇痛效果与舒芬太尼相当,不良反应较舒芬太尼少,患者满意度高.

目的 评价盐酸羟考酮注射液与舒芬太尼复合丙泊酚用于肝硬化食管胃底静脉曲张患者内镜下套扎治疗的效果及安全性.方法 48例肝硬化食管胃底静脉曲张拟行内镜下套扎治疗的患者,分为羟考酮注射液复合丙白酚组(A组)和舒芬太尼复合丙泊酚组(B组),每组24例.A组静脉注射羟考酮注射液0.1 mg/kg,丙泊酚2 mg/kg诱导,后以丙泊酚4～7 mg· kg-1·h-1维持;B组注射舒芬太尼1 μg/kg,丙泊酚2 mg/kg诱导,后以丙泊酚4～7 mg· kg-1· h-1维持.观察两组患者不同时间点的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)和麻醉深度(BIS);记录呛咳、体动次数、丙泊酚总用量、呼吸抑制及术后30 min疼痛评分.结果 两组各时间段MAP、HR、RR及SpO2差异无统计学意义(P＞0.05),A组发生呛咳、体动、呼吸抑制发生的总例数少于B组(P＜0.05),同时,A组中丙泊酚用量及术后30 min疼痛评分的概率明显低于B组.结论 盐酸羟考酮注射液复合丙泊酚麻醉下行内镜食管胃底曲张静脉套扎,对循环和呼吸系统影响小,不良反应较少,镇痛作用持久,麻醉效果好.

ObjectiveTo investigate the correlation between serum interleukin-1 receptor antagonist (IL-1Ra) level and disease severity in patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). MethodsA total of 31 patients with HBV-ACLF who visited Fuzhou Infectious Disease Hospital from October 2013 to January 2015 were enrolled as study subjects. Another 28 patients with acute hepatitis B (AHB) and 30 patients with chronic hepatitis B (CHB) were enrolled as controls. The Q-Plex was used to measure the peripheral blood concentrations of cytokines including IL-1Ra, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-4, interleukin-10, tumor necrosis factorα (TNFα), and interferonγ. Liver function and coagulation function were examined for each group, and the correlations of concentrations of serum cytokines including IL-1Ra with Model for End-Stage Liver Disease (MELD) score and HBV DNA were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the Mann-Whitney U test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation was used for correlation analysis. ResultsThe IL-1Ra level and IL-1Ra/IL-1β ratio showed significant differences between the three groups (all P＜0.05), and the HBV-ACLF group had a significantly higher IL-1Ra level than the CHB group and the AHB group ［186.46(162.68-512.90) pg/ml vs 70.47 (47.07-92.47) pg/ml, Z=6.300, P＜0.001; 18646 (162.68-512.90) pg/ml vs 143.69 (117.75-208.54) pg/ml, Z=2.505, P=0.012］. The HBV-ACLF group had a significantly lower IL-1Ra/IL-1β ratio than the AHB group ［2.92 (2.20-4.74) vs 4.54 (2.75-6.05), Z=1.966, P=0.048］, but a significantly higher IL-1Ra/IL-1β ratio than the CHB group ［2.92 (2.20-4.74) vs 2.49 (1.50-2.50), Z=2.682, P＜0.001］. The HBV-ACLF group had significantly higher IL-1β, IL-6, and TNFα levels than the other two groups (all P＜0.01). Serum IL-1Ra level was negatively correlated with total bilirubin (TBil) and MELD score (r=-0.506 and -0.818, both P＜0.01) but was positively correlated with prothrombin activity (PTA) (r=0475, P=0.007). ConclusionIL-1Ra is negatively correlated with TBil and MELD score and positively correlated with PTA, which are the indicators for the severity of HBV-ACLF. IL-1Ra may play an important role in the pathogenesis of HBV-ACLF.

目的 白细胞介素-1受体拮抗剂(IL-1ra)是炎症细胞因子IL-1的天然拮抗剂,在许多炎症性疾病中发挥关键作用.本研究探讨IL-1ra在乙型肝炎相关肝衰竭(HB-ACLF)中的作用.方法 采集31例HB-ACLF、28例急性乙型肝炎(AHB)、31例慢性乙型肝炎(CHB)患者及15例健康对照者(healthy controls,HC)外周静脉血,用QPlex法检测外周血IL-1ra、IL-1β、IL-6、IL-4、IL-10、TNF-α及IFN-γ浓度,并分析肝衰竭患者存活组与死亡组各细胞因子的差异.结果 HB-ACLF患者血清IL-1ra平均浓度为(338.9±268.8) pg/ml,与AHB[(182.7±l23.1)pg/ml,P=0.012]、CHB[(77.07 ±40.5) pg/ml,P＜0.001]及HC[(37.9±15.6) pg/rnl,P＜0.001]比较,浓度最高.但HB-ACLF患者IL-1 ra/IL-1β比例(2.96±1.54)较AHB患者(4.54 ±2.29)低(P =0.048).AHB患者血清IL-1ra浓度亦较CHB患者(P ＜0.001)及HC(P ＜0.001)高.在HB-ACLF患者中,最终死亡患者外周血IL-1ra浓度(P=0.02)及IL-1ra/IL-1β比值(P =0.007)均比存活者低.结论 IL-1ra在HB-ACLF发展过程中起重要作用,与HB-ACLF患者预后相关.

目的：探讨分析IL-1ra对乙型肝炎病毒（hepatits B virus，HBV)相关慢加亚急性肝衰竭(acute-on-chronic liver failure , ACLF)患者外周血单核细胞（peripheral blood mononuclear cell，PBMC）分泌细胞因子的影响。方法：选取2013年10月～2014年10月间福州市传染病医院收治的HB-ACLF患者20例作为研究对象，对其PBMC进行分离，并将分离出的PBMC平均分为五份，分别加入BPS、LPS、LPS+IL-1ra（125ng/ml）、LPS+IL-1ra（250ng/ml）及LPS+ IL-1ra（500ng/ml），刺激培养24h后，收集细胞上清液，然后用Q-Plex multiplex array检测Th1类及Th2类细胞因子的水平，并将检测结果及所有患者的临床资料进行回顾性的分析。结果：BPS组4种细胞因子的水平最低。经LPS刺激后，PBMC分泌的4种细胞因子的水平均显著升高。当加入125ng/ml的IL-1ra后，PBMC分泌的4种细胞因子的水平均开始降低，且随着IL-1ra剂量的增加，这4种细胞因子的水平呈逐渐降低的趋势，具有统计学意义（P＜0.05）。结论：IL-1ra可抑制HB- ACLF患者PBMC分泌Th1类细胞因子及Th2类细胞因子，并且呈剂量依赖关系。由此可见，IL-1ra可能是一种肝损伤保护因子。

羟考酮注射液是羟考酮的一种新剂型，能有效缓解术后疼痛和癌症疼痛，并且能避免口服制剂的不良反应，本文概述羟考酮注射液的药理作用和临床应用。