Objective To evaluate the efficacy of remifentanil combined with propofol in children of different age undergoing short-term ophthalmologic operation.Methods Forty-eight children aged 4-12 yr undergoing elective short-term ophthalmologic operation were divided into 4 groups(n=12 each)according to age and anesthetics:group ⅠPK aged 4-7 yr and group ⅡPK aged 8-12 yr received ketamine and propofol combined anesthesia;group ⅠPR aged 4-7 yr and group ⅡPR aged 8-12 yr received remifentanil and propefol combined anesthesia.In group ⅠPK and ⅡPK the anesthesia was induced with intravenous bolus of ketamine 2 ms/kg and ketamine 1-2 ms/kg.In group ⅠPR and ⅡPR the anesthesia was induced with intravenous remifentanil 1 μg/kg and respiratory rate(RR),cerebral state index(CSI)and SpO2 were recorded before anesthesia induction(baseline),2 min after induction,at the initiation of the operation,15 min after the initiation of operation and at emergence from anesthesia.Adverse effects during and after the operation,induction time,analepsia time,conscious recovery time and total sedation time were recorded.The mean infusion rate of remifentanil was calculated.Results Compared with the baesline,SP,DP,HR,RR and CSI were significantly decreased in 4 groups(P＜0.05).RR,CSI and incidence rates of adverse effects were significantly lower,and the emergence time and the recovery time of consciousness were significantly shorter in group ⅠPR and ⅡPR than in group ⅠPK and ⅡPK(P＜0.05).The average infusion rate of remifentanil was lower in group ⅡPR than in group ⅠPR(P＜0.05).Conclusion Remifentanil combined with propofol can produce good anesthetic effect in children undergoing short-term ophthalmologic operation,with less adverse effects,stable hemodynamics and rapid emergence from anesthesia.The dosage of remifentanil is difierent in children at different ages.

ObjectiveTo investigate the effect of controlled low perfusion pressure on expression of phosphor-Akt (p-Akt) and phosphor-ERK1/2 (p-ERK1/2) following spinal ischemia-reperfusion (1/R) in rabbits.MethodsThirty-six Japanese long-ear white rabbits aged 3 months weighing 2.0-2.5 kg were randomly divided into 3 groups ( n ＝ 12 each):group sham operation (group S) ; group spinal I/R (group I/R) and group controlled low perfusion pressure (group LP).Auricular artery and femoral artery were carnulated for proximal and distal BP monitoring.A 4F catheter with a balloon at the tip was inserted into abdominal aorta.The tip was positioned 1 cm below left renal artery.Spinal ischemia was induced by inflating the balloon until the distal MAP < 20 mm Hg,and maintained for 25 min.During the first 10 min of reperfusion the distal MAP was increased to 45-55 mm Hg by partially deflating the balloon.Then the balloon was fully deflated to allow complete reperfusion.The function of lower limbs was assessed with Tarlov score (0 ＝ no detectable movement,4 ＝ normal function) at 1,3,7,28 d of reperfusion.Au the animals were sacrificed at 1 d of reperfusion in each group.The lumbar segment L3-5 of the spinal cord was removed for microscopic examination and determination of expression of p-Akt and p-ERK1/2 by immuno-histochemistry) and detection of neuronal apoptosis in dorsal horn (by TUNEL).ResultsSpinal I/R significantly decreased Tarlov scores,and increased the number of apoptotic cells and expression of p-Akt and pERK1/2 in group I/R as compared with group S.Low perfusion pressure during the 10 min at the beginning of reperfusion significantly increased Tarlov scores,decreased apoptotic index and further increased p-Akt and pERK1/2 expression in group LP compared with group I/R.The histopathological damage in the spinal cord was attenuated in group LP.ConclusionControlled low pcrfusion pressure can reduce the spinal cord I/R injury by activating Akt and ERK1/2 and decreasing neuronal apoptosis.

Objective To evaluate the effects of dexmedetomidine with different-dose on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting. Methods Sixty patients undergoing off-pump coronary artery bypass grafting were selected, with ASA grade Ⅱ - Ⅲ, NYHA cardiac functional grading Ⅱ - Ⅲ, and left ventricles ejection fraction >45%. The patients were divided into D1 group, D2 group and control group by table of random digit method with 20 cases each. In D1 group, intravenous infusion dexmedetomidine 0.3μg/kg was given for 20 min before anesthesia induction;in D2 group, intravenous infusion dexmedetomidine 0.6μg/kg was given for 20 min before anesthesia induction;in control group, intravenous infusion the same volume of 0.9% sodium chloride was given before anesthesia induction. The mean arterial pressure (MAP), heart rate, cardiac output and stroke volume variation (SVV) were recorded before infusion dexmedetomidine (T0), before anesthesia induction (T1), 3 min after anesthesia induction (T2), trachea cannula (T3) and 5 min after trachea cannula (T4). The adverse cardiovascular events and drug intervention were recorded during anesthesia induction. Results There were no statistical differences in MAP, heart rate, cardiac output and SVV at T0 among 3 groups (P>0.05). Compared with that in control group, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3 and T4 in D2 group were decreased, and there were statistical differences (P<0.05). Compared with that at T0, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T3 in control group were increased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3, T4 in D2 group were decreased, and there were statistical differences (P<0.05). Compared with that in D1 group, the MAP, heart rate, cardiac output and SVV at T2, T3 and T4 in D2 group were decreased, and there were statistical differences (P<0.05). The rates of adverse cardiovascular events in D1 group and D2 group were significantly lower than those in control group:35%(7/20) and 40%(8/20) vs. 95%(19/20), the rate of drug intervention in D1 group was significantly lower than that in control group and D2 group:10% (2/20) vs. 45% (9/20) and 35% (7/20), and there were statistical differences (P<0.05). Conclusions Dexmedetomidine (0.3 μg/kg) is beneficial for the stability of hemodynamics before anesthesia induction in patient undergoing off-pump coronary artery bypass grafting.

Objective To investigate the distribution of breast invasive ductal carcinoma with different molecular subtypes ,and to study the relationship between molecular subtypes and clinical pathological features in Xinjiang area .Methods A total of 621 patients with IDC from January 2013 to January 2014 was classified into Luminal A type,Luminal B type,HER-2 overexpression type and Basal -like type,different molecular subtypes according to the estrogen receptor(ER),progesterone receptor(PR),epidermal growth factor receptor -2(HER-2) and Ki-67,and compared the statistics combining with the clinical pathological characteristics of IDC .Re-sults The result showed that Luminal B type accounted for 53.1%,Luminal A type,HER-2 overexpression type and Basal-like type accounted for 14.5%,15.9%,16.4%,respectively.There were significant differences between the molecular subtypes and tumor size ,histological grade ,tumor pathological stage ,the expression of ER , PR and HER-2(P<0.05 for all).There were no correlations between the molecular subtypes and age ,as well as lymph node metastasis(P>0.05).Conclusion There is a close relationship between invasive ductal carcino-ma of different molecular subtypes and clinical pathological characteristics .The molecular subtypes are beneficial to treatment guidelines for clinical individual .

Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD)induced by patient-controlled intravenous analgesia(PCIA)in elderly patients. Methods 95 patients with POCD and 97 cognitive normal controls were included in the study. The cases and controls were matched for gender, type of operation and PCIA volume dose. Cognitive function was assessed by Mini-Mental-State test and the relationship between POCD and various factors was analyzed by univariate and multivariate analysis. Results Univariate analysis revealed that the education level and visual analog scale (VAS) score had significant differences between the two groups. Multivariate analysis showed that the VAS score and education level were significantly related to POCD induced by PCIA, with the odds ratios of 2. 379 (95%CI:1.205～4.698) and 0. 292 (95%CI:0.157～0.543), respectively. Conclusions Lower VAS score is an independent risk factor and higher education level seems to be a protective factor for POCD induced by PCIA.

Objective To evaluate the effect of isoflurane or sevoflurane inhalation before and after gestation on the N-methyl-D-aspartate (NMDA) receptor expression in offspring rat hippocampus.Methods Thirty female adult Sprague-Dawley rats,aged 3 months,weighing 250-300 g,were randomly assigned into 5 groups (n =6 each):control group (group C),exposure to isoflurane before gestation group (group BI),exposure to isoflurane during gestation period group (group PI),exposure to sevoflurane before gestation group (group BS),exposure to sevoflurane during gestation period group (group PS).The rats inhaled 1.6％ isoflurane for 6 h at 1 day before gestation in group BI.The rats inhaled 1.6％ isoflurane for 6 h at 6,10,14 and 18 day gestation in group PI.The rats were exposed to 2.4％ sevoflurane for 6 h before gestation in group BS.The rats were exposed to 2.4％ sevoflurane for 6 h at 6,10,14 and 18 day gestation in group PS.Twelve offspring rats from pregnant rats in each group were chosen on the day of birth (T1),and 7th,14th and 28th days after birth (T2-4) and sacrificed,and the hippocampi were then isolated for determination of the expression NMDA receptor (NR1,NR2A and NR2B).Results Compared with group C,no significant change was found in NMDA receptor expression in off spring rat hippocampus in groups BI and BS (P ＞ 0.05),and the expression of NR1 and NR2A protein and mRNA was significantly up-regulated,and the expression of NR2B protein and mRNA was down-regulated at T1-3 (P ＜0.05),and no significant change was found in NMDA receptor expression at T4 in groups PI and PS (P ＞ 0.05).Compared with group PI,the expression of NRI and NR2A protein and mRNA was significantly up-regulated,and the expression of NR2B protein and mRNA was down-regulated at T1 3 (P ＜ 0.05 or 0.01),and no significant change was found in N MDA receptor expression at T4 in group PS (P ＞ 0.05).Conclusion Isoflurane or sevoflurane inhalation before gestation does not affect the NMDA receptor expression in offspring rat hippocampus,while isoflurane or sevoflurane inhalation after gestation can induce abnormal expression of the NMDA receptor in offspring rat hippocampus,which may result in apoptosis in hippocampal cells and abnormality in the development of nervous system and cognitive function.

Objective To analyze the efficacy and cosmetic results of intensity modulate radiation therapy (IMRT) for breast cancer after breast-conserving surgery.Methods From 2003 to 2006, 117 patients with breast cancer, after breast-conserving surgery followed by 4 - 6 cycles of chemotherapy,received intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT).The radiation dose was 50 Gy in 25 fractions to the whole breast and 10 Gy boost to the tumor bed.Patients with positive hormone receptors then received endocrine treatment.Results The follow-up rate was 94.0% until September 2009.114 and 91 patients were followed up to 3 and 5 years, respectively.The 3-and 5-year overall survival rates were 99.1% and 96%.The 5-year disease free survival and local recurrence rates were 88% and 3.6%.Cosmetic results were satisfied.Severe radiation toxicities, such as radiation pneumonitis, pulmonary fibrosis and heart injury were not found.Conclusions Patients treated with IMRT after breast-conserving surgery have a satisfied prognosis as well as cosmetic results.

Membranous nephropathy(MN)is the predominant cause of primary nephrotic syn-drome(NS)among adults.The identification of PLA2R as target antigen has brought about a pro-found transformation in the management of MN,offering a basis for the utilization of B-cell deplet-ing agents such as rituximab(RTX).The question of whether early intervention targeting antibodies can effectively impede the progression of MN,contrib-uting to enhanced disease control and long-term renal outcomes for patients,remains further explo-ration.We analyzed demographic data,laboratory parameters,and renal involvement in 13 patients with PLA2R antibody-related MN who received at least one RTX treatment at our center from Octo-ber 2019 to March 2023.Early-stage medium-to-high-risk MN was defined as baseline or admission anti-PLA2R antibody levels exceeding 50 RU/mL,ex-cluding patients who already presented with ne-phrotic syndrome at baseline.The median duration of MN at the initiation of the first RTX treatment was 4.1 months(IQR 1-7.7),and the median follow-up time after RTX therapy was 27 months(IQR 23-45).All patients had commenced renin-angiotensin system inhibitors before receiving RTX.Following RTX therapy,none of the 13 patients progressed to NS during the follow-up period,and 12 patients achieved complete or partial remission at the 2-year follow-up or the last visit.No deaths,severe infections,or other serious adverse reactions oc-curred during the follow-up period.In conclusion,RTX demonstrates favorable efficacy and safety in early-stage,medium-to-high-risk MN patients.Initi-ating antibody clearance therapy in these patients may be beneficial for long-term disease control and distant renal outcomes.