patients received thoracic surgery. Methods Fifty patients underwent radical resection of pulmonary carcinoma were divided into DP group ( dexmedetomidine infusion by micro pumo and parecoxib 40 mg through intravenous injection) and DN group ( dexmedetomidine infusion by micro pumo and nomal saline 5mL through intravenous injection). The time for spontaneous breath,eye opening and extubation after the oper-ation were recorded. The mimi-mental state examination ( MMSE) was used to assess the cognitive function. The concentration of protein S100β and IL-6,TNF-α were determined at 1 d before operation and 1 h,24 h after the operation. Results The difference of time for spon-taneous breath,eye opening,extubation and preoperative values of MMSE between two groups were not statistically significant(P>0. 05). MMSE scores at 1 d,3 d and 5 d after operation in group DN were lower than those in group DP (P<0. 05). The values of S100β、IL-6、TNF-α at 1 h and 24 h after operation in group DN were higher than that in group DP (P< 0. 05). Conclusion Dexmedetomidine com-bined with parecoxib can decrease the incidence of postoperative cognitive dysfunction in elderly patients underwent thoracic surgery,and the mechanism of which may be related to the downregulation of serum inflammatory factors.

Objective To prepare the multi-functional ultrasound contrast agents,which were investigated for ultrasound(US)/MR dual-mode imaging and high-intensity focused ultrasound(HIFU)synergism in vitro.Methods Double emulsion method was used to prepare the superparamagnetic iron oxide(SPIO)-loaded PLGA microcapsules(s-PLGA),and its morphology,size,Fe3O4 loading capacity were assessed.Then,the prepared s-PLGA microcapsules with different concentrations were applied to perform ultrasound and MR imaging in vitro.In addition,the degassed bovine liver in vitro was directly injected into 200 μl s-PLGA in saline(0.5 mg Fe/ml)just before HIFU ablation,the saline(200 μl)and pure PLGA (200 μl)were employed for control.After HIFU ablation,the volume of coagulated tissue irradiated by HIFU was calculated.Results The s-PLGA microcapsules were observed with regular spherical morphology and its average size was(885.6 ± 133.2)nm.In vitro,the s-PLGA showed hyperechogenicity in US imaging and MR negatively enhanced effeet in T2WI,the volume of coagulated tissue irradiated by HIFU after local injection of s-PLGA was larger than that of saline and pure PLGA(P＜0.05).Conclusions The prepared s-PLGA microcapsules are successfully acted as dual-mode biological imaging contrast agents for ultrasound and MR imaging and HIFU synergism in vitro.

Objective To investigate the correlation between serum amyloid A (SAA) and disease activity (DAS28) in patients with rheumatoid arthritis (RA). Methods Forty-four patients with RA, 35 patients with systemic lupus erythe-matosus (SLE), 18 patients with osteoarthritis (OA) and 30 healthy controls (HC) were enrolled in this study. The levels of SAA were measured by ELISA. Erythrocyte sedimentation rate (ESR) was measured by the Westergren method. The value of serum C reactive protein (CRP) was examined by immunonephelometry assay. The correlation between SAA and DAS 28, ESR and CRP was assessed, respectively. Results The SAA levels were significantly higher in RA group than those of SLE, OA, and HC groups (P<0.05). The serum ESR and CRP levels were both higher in RA group than those of OA and HC groups (P>0.05), but there was no significant difference between RA group and SLE group. There was positive correlation between SAA and DAS28, ESR, and CRP levels (rs=0.790, P<0.001;rs=0.674, P<0.001;rs=0.679, P=0.004), respective-ly. Conclusion SAA may be a new serological marker to assess disease activity in RA.

Objective To evaluate the changes in the expression of artemin in skin around the inci-sion during remifentanil-induced hyperalgesia in the rats with incisional pain. Methods Thirty-two healthy male Sprague-Dawley rats, aged 10-12 weeks, weighing 250-280 g, were divided into 4 groups (n = 8 each) using a random number table: control group (group C), incisional pain group (group I), remifen-tanil group (group R) and incisional pain plus remifentanil group (group I+R). Remifentanil was intrave-nously infused for 60 min at a rate of 1 μg·kg-1 ·min-1 in group R. In group I, the model of incisional pain was established, and the equal volume of normal saline was infused for 60 min via the tail vein at the same time. In group I+R, the model of incisional pain was established, and remifentanil was infused for 60 min via the tail vein at a rate of 1 μg·kg-1 ·min-1 at the same time. The equal volume of normal saline was infused for 60 min via the tail vein in group C. Mechanical paw withdrawal threshold (MWT) and ther-mal paw withdrawal latency (TWL) were measured at 24 h before infusion of remifentanil or normal saline and 2, 6, 24 and 48 h after the end of infusion (T0-4 ). Rats were sacrificed following the last measurement of pain threshold, and ipsilateral plantar skin was removed for detection of the expression of artemin protein and mRNA (by fluorescent quantitative real-time polymerase chain reaction or Western blot). Results Compared with group C, MWT was significantly decreased and TWL was shorten at T1-4 , and the expression of artemin protein and mRNA in plantar skin was up-regulated in R, I and I+R groups (P<0. 01). Compared with R and I groups, MWT was significantly decreased and TWL was shorten at T1-4 , and the ex-pression of artemin protein and mRNA in plantar skin was up-regulated in group I+R (P<0. 01). Conclu-sion The peripheral mechanism by which remifentanil induces hyperalgesia may be related to up-regulated expression of artemin in skin around the incision in the rats with incisional pain.

Objective:To conduct a survey on major surgeon′s mental trauma caused by iatrogenic biliary injury (IBI) during laparoscopic cholecystectomy (LC), and explore its influencing factors.Methods:The retrospective cross-sectional survey was conducted. Surgeons who have registered in Chinese College of Surgeons of Chinese Medical Doctor Association and Chinese Surgical Society of Chinese Medical Association were recruited to participate as respondents between December 1, 2018 and January 1, 2019. The survey was conducted by the questionnaires of influencing factors for surgeon′s mental trauma caused by IBI during LC. The questionnaires were distributed to participants via WeChat on the Wenjuanxin platform. Observation indicators: (1) results of questionnaire survey; (2) analysis of influencing factors for severe mental trauma of major surgeons caused by IBI during LC. Measurement data with normal distribution were expressed as Mean± SD, and count data were expressed as absolute numbers or percentages. The chi-square test was used for univariate analysis. Factors with P<0.10 in the univariate analysis were included in multivariate analysis, and Logistic regression model was used for multivariate analysis. Results:(1) Results of questionnaire survey. A total of 606 questionnaires were retrieved. ① Basic information of major surgeons: of the 606 major surgeons, there were 596 males and 10 females, aged (41±7)years, with a range from 18 to 62 years. Of the 606 major surgeons, 59.24%(359/606) came from non-teaching hospitals, and 64.03%(388/606) encounted the most impressive case of IBI during LC when they were in the primary or intermediate professional title. For 76.24%(462/606) of the major surgeons, the first case of IBI during LC was the most impressive case, and 69.80%(423/606) believed that careful operation during LC could avoid IBI. ② Patient information: of the patients with the most impressive IBI during LC in each major surgeon′s memory, there were 400 females and 206 males. The proportion of patients younger than 35 years old, in 35-65 years old and older than 65 years old was 9.57%(58/606), 65.51%(397/606), and 24.92%(151/606), respectively. ③ IBI related information: 57.43%(348/606) of the major surgeons indicated that they could receive help from senior surgeons in time for the occurrence of IBI during LC, and 78.88%(478/606) of the major surgeons invited senior surgeons to participate in the initial repair. For the most impressive case of IBI during LC, 66.83%(405/606) of the primary repair surgeries were performed during LC, 11.06%(67/606) were performed within postoperative 3 days and 22.11%(134/606) were performed after 3 days. The main repair methods included local repair, bile duct to end anastomosis, and bilioenteric anastomosis, accounting for 24.92%(151/606), 30.20%(183/606), 33.17%(201/606), respectively. The proportion of patients requiring partial hepatectomy, with perioperative death, and requiring multiple repair was 2.48%(15/606), 2.15%(13/606), and 9.24%(56/606), respectively. ④ Subsequent processing on major surgeons: after the occurrence of IBI during LC, 64.85%(393/606) of the major surgeons gained the understanding of patients and their families, 35.15%(213/606) of the major surgeons were involved in medical disputes, 15.68%(95/606) of the major surgeons received administrative punishment from the hospital. About the compensation, 14.36%(87/606) of the major surgeons had to pay for the compensation by themselves, and only 6.77%(41/606) of the major surgeons had medical liability insurance. There were 9.24%(56/606) of the major surgeons invloved in violent conflicts during the medical disputes. ⑤ Psychology-related information of major surgeons: of the 606 major surgeons, 544 had mental trauma including 279 with severe mental trauma. After the occurrence of IBI during LC, 82.01%(497/606) of the major surgeons experienced anxiety and/or depression for more than one month; 63.37%(384/606) of the major surgeons expected to avoid LC or showed tension during LC; 44.72%(271/606) of the major surgeons had a physiological response when recalling the case; 36.14%(219/606) of the major surgeons initiated the idea of not being a surgeon; 6.44%(39/606) of the major surgeons asked psychologists for help; and 5.61%(34/606) of the major surgeons had taken psychiatric drugs such as antianxiety and anti-depression drugs for more than one month. (2) Analysis of influencing factors for severe mental trauma of major surgeons caused by IBI during LC. Results of univariate analysis showed that the hospital type of the major surgeons, participation of senior surgeons in the repair, surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administrative punishment from the hospital, compensation paid by the major surgeon, having medical liability insurance, violent conflicts in medical disputes were related factors for severe mental trauma of the major surgeons caused by IBI during LC ( χ2=7.688, 3.932, 19.764, 13.837, 61.488, 24.904, 30.976, 5.344, 26.285, P<0.05) . Results of multivariate analysis showed that the surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administrative punishment from the hospital, compensation paid by the major surgeon, violent conflicts in medical disputes were independent risk factors for severe mental trauma caused by IBI during LC of the major surgeons ( odds ratios=1.203, 2.198, 2.922, 1.830, 2.405, 2.171, 95% confidence interval: 1.033-1.402, 1.143-4.226, 1.944-4.391, 1.083-3.093, 1.076-5.375, 1.002-4.702, P<0.05). Having medical liability insurance was an independent protective factor for severe mental trauma of the major surgeons caused by IBI during LC ( odds ratios=0.336, 95% confidence interval: 0.126-0.896, P<0.05). Conclusions:Most surgeons in China are troubled by IBI during LC, and nearly half of them suffer from severe mental trauma. Surgical method of the primary repair, IBI requiring repeated repair, medical disputes, administartive punishment from the hospital, compensation paid by the major surgeon, and violent conflicts in medical disputes are independent risk factors for severe mental trauma of major surgeons caused by IBI during LC. Having medical liability insurance is an independent protective factor for severe mental trauma of major surgeons caused by IBI during LC.

Objective:To summarize and analyze the efficacy, experience and follow-up results of 300 cases of transposition of the great arteries (TGA) intervened by arterial switch operation.Methods:It was a retrospective, single-center study involving 300 TGA patients intervened by arterial switch operation between January 2010 and December 2017 in Guangdong Provincial People′s Hospital.Their clinical data were retrospectively analyzed.There were 236 male patients and 64 females.Among them, 128 cases (42.7%) were TGA with ventricular septal defect (TGA/VSD), and 172 cases (57.3%) were TGA with intact ventricular septal defect (TGA/IVS). The mean age and weight at operation were (23.8±39.2) cases days, and (3.5±0.8) kg, respectively.There were 193 cases (64.3%) with usual coronary artery patterns, and 107 cases (35.7%) with unusual coronary artery patterns.Among the 107 cases with unusual coronary artery patterns, 21 cases (7.0%) were involved with the intramural coronary artery, and 17 (5.7%) presented the single-ostium coronary pattern.Non normal distribution data were used the Mann- Whitney U test.Categorical measures were compared by Chi- square test or Fisher′ s exact test.Survival probability and freedom from events were calculated by the Kaplan-Meier method, and difference in survival probability by the Log Rank test. Results:All patients were successfully intervened by arterial switch operation, 73.3% of patients with TGA/IVS underwent the surgery within 3 weeks after birth, and 85.9% of patients with TGA/VSD underwent surgery within 3 months.The mean cardiopulmonary bypass time and aortic occlusion time were (193±68) min, and (122±39) min, respectively.Twenty-five patients (8.3%) died in hospital.Thirty cases had low cardiac output syndrome, 1 implanted with a permanent pacemaker due to complete atrioventricular block.A total of 254 patients were followed up for 1 month to 10 years.Three patients with single-ostium coronary pattern died at the follow-up period.The 5-year and 10-year survival rates were both 90.7%.During the follow-up, 49 cases (49/254 cases, 19.3%) had pulmonary artery stenosis, 66 cases (66/254 cases, 26.0%) had aortic valve regurgitation, 47 cases (47/254 cases, 18.5%) had pulmonary valve regurgitation, and 4 (4/254 cases, 1.6%) had aortic anastomotic stenosis.Among the 21 patients (21/254 cases, 8.3%) requiring reintervention, 17 patients (17/254 cases, 6.7%) underwent a total of 18 reinterventions, including 12 interventions of pulmonary artery plasty, 4 of percutaneous balloon pulmonary valvuloplasty, 1 of aortic reconstruction at anastomosis and 1 of pacemaker exchange due to battery exhaustion.Conclusions:Arterial switch operation is the optimal treatment for TGA.The long-term follow-up results of arterial switch operation are satisfactory in TGA children, with a low risk of long-term reoperation.

Objective To study the pharmacological function of the aconitine in treating adjuvant arthritis(AA).Methods Fifty rats were randomly divided into the control group, AA model group, methotrexate group(0.5 mg/kg), and aconitine groups of different dosages (25, 100μg/kg). Except the control group, each group was injection of intradermal Freund's complete adjuvant (0.1 ml) into right hindpaw of rats to establish adjuvant arthritis model. On the 10th day after model onset, the aconitine were administered by gavage with 25, 100μg/kg once daily, and the methotrexate group was administered with 0.5 mg/kg methotrexate twice per week, and all groups were treated for 19 days. After the last administration, the foot swelling was measured by toe volume meter, arthritis index was calculated by 5-grade scoring method, spleen and thymus index were calculated, and the pathological changes of right ankle joint were observed by HE staining.Results After the model establishment, compared with the model group, the degree of swelling of the ankle at 20 days (668.7 ± 144.5μl, 566.9 ± 179.3μl vs. 912.1 ± 200.5μl), 24 days (833.1 ± 144.0μl, 803.9 ± 213.4μlvs.1069.5 ± 164.6μl) and 28 days (736.4 ± 115.0μl, 835.7 ± 170.1μlvs. 1107.2 ± 215.8μl) in the aconitine groups significantly decreased (P<0.05 orP<0.01). After the model establishment, compared with the model group, arthritic index scores at 18 days (3.1 ± 0.7, 3.2 ± 0.4vs. 3.8 ± 0.6), 24 days (3.1 ± 0.5, 3.4 ± 0.5vs.3.9 ± 0.3), 28 days (2.7 ± 0.6, 3.2 ± 0.9 vs. 4.0 ± 0.0) in the aconitine groups significantly decreased (P<0.05). Compared with the model group, the spleen index (3.5 ± 0.4, 3.3 ± 0.4, 4.0 ± 0.6vs.4.9 ± 0.5) respectively in the low and high dose group of aconitine and methotrexate group (P<0.01).Conclusion Aconitine has a certain degree therapeutic effect on AA rats.

Objective:To explore accurate prenatal diagnosis, full-coverage graded counseling and follow-up for the fetus with cardiac birth defects (CBD).Methods:CBD fetus diagnosed prenatal by echocardiography from January 2018 to December 2020 in Guangdong Provincial People's Hospital were enrolled. Fetal CBD was graded (Ⅰ-Ⅵ) according to prognosis and possible operation time after birth, and the classification criteria and common diseases included were proposed. After the prenatal grading counseling, the outcome of the fetus was followed-up. The induced labor rate, live birth rate, prenatal and postnatal ultrasound diagnosis coincidence rate and other indicators were calculated. The disease composition ratio, prognosis of fetus with different grades and the outcome of integrated treatment were analyzed.Results:The detection rate of fetal CBD was up to 16.2% (1 971/12 188), 30 cases of which were excluded. A total of 1 941 cases were included in this study, including 196 cases (10.1%) of gradeⅠ, 433 cases (22.3%) of gradeⅡ, 615 cases (31.7%) of grade Ⅲ, 261 cases (13.4%) of grade Ⅳ, 388 cases (20.0%) of gradeⅤ, 48 cases (2.5%) of grade Ⅵ. Grade Ⅱ and gradeⅢ (the operation time was within 1 year after birth) accounted for 54.0% (1 048/1 941). The distribution of some diseases in different grades had obvious proportion advantage, which was representative. Among 1 747 CBD fetus, 736 cases (induced labor rate 42.1%) chose to terminate pregnancy due to CBD. Of the 1 010 live births, 975 cases (96.5%) had the same prenatal and postnatal diagnosis, 3 cases were missed diagnosis and 32 cases were misdiagnosed. The diagnostic accuracy of live births with severe and complex congenital heart disease was 383 out of 389 (98.5%). A total of 258 cases have received surgery or intervention. The age at the time of surgery or intervention was different among grades（ χ2 =47.3， P<0.001）. With the improvement of prognosis from gradeⅠ to Ⅴ, the live birth rate increased and the induced labor rate decreased accordingly; the difference between grades was significant（ χ2 =623.6， P<0.001）. Conclusions:Prenatal diagnosis and graded counseling is important in the integrated model. Fetal CBD grading could refine post-natal treatment strategies, guide delivery decisions and become an evaluation standard.

We report the management of a fetus diagnosed with critical pulmonary stenosis, right ventricular hypoplasia, severe tricuspid regurgitation and severe hydronephrosis. After echocardiography and multidisciplinary team consultation, fetal pulmonary valvuloplasty was performed at 30 +3 weeks of gestation, to facilitate the development of the right ventricle and tricuspid valve. Fetal transdermal renal puncture performed at 31 weeks of gestation showed that the hydronephrotic fluid was urine. The mother gave birth vaginally at 37 +3 weeks. Prostacyclin was given to the baby to keep the ductus arteriosus open and maintain oxygen saturation above 80%. Nephrostomy was performed on the 6th day after birth for improvement of the hydronephrosis and renal function. Biventricular correction (percutaneous balloon pulmonary valvuloplasty) and left dismembered pyeloureteroplasty were successfully performed on 16 and 37 d after birth, respectively. Ultrasound follow-ups showed the structure and function of both heart and kidney recovered. We summarized the characteristics and management of fetal critical pulmonary stenosis complicated by severe hydronephrosis in this case, aiming to enhance experiences for appropriate treatment of similar cases in the future.

To improve the accuracy of prenatal diagnosis for coarctation of the aorta ( CoA ) by comparatively analyzing the relevant factors and their application value . Methods Cases of disproportion of ventricles and great vessels were selected between January 2011 and July 2018 . Only liveborn fetuses with complete postnatal follow‐up were included in the study . One hundred and twelve cases were retrieved and analyzed . According to the postnatal ultrasound and CT results ,the patients were divided into gruop A and goup B . Different fetal echocardiography parameters and features were selected to evaluate the diagnostic value . Logistic regression analysis was used to select the best predictors of CoA and optimal cut‐offs for these parameters were identified by ROC analysis . Results One hundred and thirty eight fetuses were suspected to be CoA ,and 112 of them were born . T hey included 59 cases ( 52 .9% ) with CoA ( Group A ) and 53 cases ( 47 .3% ) without CoA ( Group B ) . T here were statistically significant differences between the two groups in gestational age ,Z‐score of diameter of left ventricle ,ascending aorta ( AAO ) and aortic arch isthmus ,main pulmonary artery ( M PA )/AAO diameters ratio ,and arterial duct/isthmus diameters ratio . T he parameters most predictive of postnatal CoA selected by logistic regression and the cut‐off values identified by ROC analysis were :gestational age at first diagnosis ≤34 .5 weeks ,Z‐score of diameter of left ventricle ＜ －1 .8 ,Z‐score of diameter of isthmus ＜ －2 .7 ,M PA/AAO diameters ratio＞1 .6 . AUC yielded by these parameters in combination was 0 .94 ( 95% CI :0 .89 －0 .99) . T he study group were divided into two subgroups by gestational age at first diagnosis .T he parameters and cut‐off values in subgroups were selected by the same analysis as above :Group Ⅰ ( ≤ 34 .5 weeks ) ,Z‐score of diameter of right ventricle ＞2 .1 ,M PA/AAO diameters ratio＞1 .6 ; Group Ⅱ( ＞34 .5 weeks) ,M PA/AAO diameters ratio ＞ 1 .7 ,arterial duct/isthmus diameters ratio ＞ 2 .3 . Meanw hile ,some ultrasound features ( including aortic arch hypoplasia ,retrograde blood flow of aortic isthmus ) should also be considered to improve diagnostic accuracy . Conclusions Combined with the use of different ultrasound parameters and features at different gestational weeks can improve the accuracy of the prenatal diagnosis of CoA in the right heart dominant fetus .