Objective To observe the analgesic effects of dexmedetomidine combined with dif-ferent-doses of sufentanil in patients undergoing spine surgery.Methods Sixty patients(ASA grade Ⅰor Ⅱ degree,age 18-70 years)undergoing spine surgery were randomly assigned into three groups ac-cording to PCA formulation(n =20):3 μg/kg sufentanil group (group S1),1.5 μg/kg dexmedetomi-dine+ 2 μg/kg sufentanil group (group S2 )and 1.5 μg/kg dexmedetomidine + 1 μg/kg sufentanil group (group S3).The same anesthesia method was applied among three groups.Patient-controlled intravenous analgesia pump was applied before 30 minutes prior to the end of surgery.The drugs in each group were diluted to 1 50 ml and infused by a pump at a rate of 3 ml/h with a patient-controlled analgesia (PCA)bolus of 0.5 ml and lock time of 30 minutes.VAS and Ramsay scores at 2 h(T0 ),4 h (T1 ),8 h(T2 ),12 h(T3 ),24 h(T4 )and 48 h(T5 )after surgery were estimated.Postoperative nausea and vomiting,bradyrhythmia and hypersomnia were also recorded.Results Compared with group S1, VAS of groups S2 and S3 was significantly decreased at T1-T5 (P <0.05).There were also no signifi-cant difference in the incidence of postoperative nausea and vomiting,bradyrhythmia and hypersomnia among three groups.Conclusion Dexmedetomidine of 1.5 μg/kg can significantly reduce the dosage of sufentanil on postoperative analgesia in patients undergoing spine surgery,and decrease the rate of postoperative nausea and vomiting without any bradyrhythmia and hypersomnia.

Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71%(18/21).Seventeen cases were followed up for 12-26 (12.83 ± 4.23) months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Atlanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axialfusion is higher.

Objective The aim of the study was to investigate the related factor of postoperative provisional paraly?sis of parasagittal meningioma in the eloquent area. Methods A retrospective review was conducted on ninety-six pa?tients with parasagittal meningioma in the eloquent area treated by surgery from May 2005 to December 2015. Accord?ing to the diagnostic criteria for postoperative provisional paralysis, patients were divided into postoperative provisional paralysis group(n=31)and non- postoperative provisional paralysis group(n=65). Univariate and multivariate logistic regression methods were used to analyze the data including age, size of tumor,preoperative epilepsy, preoperative periph?eral edema, complete the occlusion of superior sagittal sinus(SSS) by tumor, incision of SSS during surgery, drainage vein damage during surgery. Results Univariate analysis showed that there were significant differences(P<0.05)between these two groups in age(χ2=14.943,P=0.000), preoperative peripheral edema(χ2=4.435,P=0.049), the complete occlu?sion of SSS by tumor(χ2=5.248,P=0.028), incision of SSS during surgery(χ2=5.773,P=0.026), drainage vein damage during surgery(χ2=11.441,P=0.002). Multivariate analysis showed that the factors related to postoperative provisional paralysis were age(OR=8.709,P=0.028), drainage vein damage during surgery(OR=16.242,P=0.012)and complete oc?clusion of SSS by tumor(OR=0.053,P=0.025). Conclusion Age and the drainage vein damage during surgery are the risk factors of postoperative provisional paralysis and complete occlusion of SSS by tumor is the protective factor for the oc? currence of postoperative provisional paralysis.

Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P<0.01).The risk of regimen modification in AZT group were significantly higher than that in TDF group (aHR=2.89, 95%CI: 2.57-3.24).The risk of toxicity-related regimen modification in AZT group was also significantly higher than that in TDF group (aHR=3.85, 95%CI: 3.34-4.45).Conclusions Patients initiated antiretroviral treatment with AZT+3TC+EFV are more likely to change their initial regimen than those who initiated treatment with TDF+3TC+EFV.Female, age >45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.

Objective To investigate the prevalence of malnutrition in human immunodeficiency virus ( HIV )‐infected children in China , and to explore and analyze the factors associated with malnutrition .Methods A cross‐sectional study was conducted by the antiretroviral treatment database of children .HIV‐infected children aged between 0 - 15 years old who initiated antiretroviral treatment were collected between January 1st , 2010 and December 31st , 2014 . Z‐score of height and weight were calculated by WHO Anthro (plus) software .Univariate and multivariate Logistic model analyses were performed to determine the factors associated with acute /chronic/mixed malnutrition .Results Baseline data of the 3 138 HIV‐infected children showed that 1 645 patients (52 .42% ) had malnutrition before antiretroviral treatment ,with acute ,chronic and mixed malnutrition of 8 .76% (275) ,39 .77% (1 248) and 3 .89% (122) ,respectively according to the type of malnutrition .Multivariate analysis showed that baseline CD4 + cell count < 200 cells/μL was the risk factor associated with acute malnutrition (aOR =2 .27 ,95% CI :1 .68 - 3 .06) ;rural settings (aOR = 1 .30 ,95% CI :1 .11 - 1 .53) ,baseline CD4 + cell count < 200 cells/μL (aOR = 1 .98 ,95% CI :1 .65 - 2 .38) ,baseline CD4 + cell count between 200 to 350 cells/μL (aOR = 1 .38 ,95% CI :1 .13 - 1 .69) and having AIDS‐related diseases (aOR = 1 .34 ,95%CI :1 .13 - 1 .59) were risk factors associated with chronic malnutrition ;and age of 11 - 15 years (aOR =2 .38 ,95% CI :1 .46 - 3 .88) ,baseline CD4 + cell count < 200 cells/μL (aOR = 4 .99 ,95% CI :3 .04 -8 .21) and having AIDS‐related diseases (aOR = 2 .45 ,95% CI :1 .65 - 3 .66) were risk factors associated with mixed malnutrition .Conclusions The prevalence of malnutrition in untreated HIV‐infected children remains high .All three types of malnutrition are associated with immunodeficiency .Early diagnosis and early treatment should be improved in HIV‐infected children through antiviral therapy to reduce the destruction of HIV to immune system .At the same time ,intensified monitoring of the nutritional status and nourishing undernourished children should be strengthened to reduce the prevalence of malnutrition .

Objective To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago.Methods Retrospective cohort study and cross-sectional analysis had been conducted in this study.368 449 cases that had received the ‘free antiviral therapy’ from 2002 to 2014 were selected from the National Treatment Database.Data from the baseline (initial time of ART,CD4 cell count,and antiretroviral regimen) and from the follow-up program (dates and status of follow-up,CD4 cell counts) were gathered and analysed by SAS 9.3.Results The number of cases that having received new treatment was increasing year by year,accounting for 75.4％ of all the cases identified from 2010 to 2014.Constituent ratios of patients with baseline CD4 cell count ＜200 cells/μl and clinical diagnosis of AIDS were decreasing from 81.0％ in 2006 to 39.7 ％ in 2014.Status on drug optimization showed that:3TC replaced DDI,EFV replaced NVP and TDF replaced D4T,making the utilization rates as 99.5％,75.7％,and 60.6％,respectively,by 2014.Regions that were covered by the treatment accounted for 75.4％ of all the counties/districts involved.The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model.Proportion on the twice-CD4-testing model had been 75.2％ since 2010,with the rate of virological detection increased from 70.8％ in 2010 to 87.4％ in 2014 and the virological unsuccessful testing rate decreased from 17.6％ in 2010 to 11.8％ in 2014.Among all the patients,the 1,5 and 10 year survival rates appeared as 92.2％,80.5％ and 69.6％,respectively.For patients with baseline CD4 cell counts as ＜50 cells/μl or ＞350 cells/μl,the corresponding survival rates showed as 81.6％,69.9％,60.9％ and 97.9％,89.8％,81.0％,respectively.Conclusion China's HIV/AIDS free anti-retroviral therapy program appeared as a national treatment cohort which involved large number of participants,with new patients joining in,annually.Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO.Management program on treatment had gradually turned to hospital-based,with follow-up and laboratory testing programs guaranteed,ended up with satisfactory treatment effects.

Objective:To explore the application of weighted adjustments of dropout rates in sensitivity analysis of medically repeated measurements data and the implementation with SAS 9.4 software.Methods:By compiling SAS codes, mixed-effects models for repeated measures were used to conduct the covariance analysis of multivariable repeated measurements data. Meanwhile, the overall dropout rate and the dropout rates of each group were used to make weighted adjustments by applying pattern-mixture models, which was considered to be a sensitivity analysis to validate the stability of results.Results:The dropout rates of placebo group, low-dose and high-dose groups were 8.77%, 11.79% and 16.15%, respectively, the differences were significant ( P=0.025). The results of mixed-effects models for repeated measures showed the differences of curative effect indicators changes from baselines of between high-dose, low-dose groups and placebo group were significant ( P=0.008 and P=0.002). The results of pattern-mixture models considering weighted adjustments of the respective groups' dropout rates were consistent with those of mixed-effects models for repeated measures. Conclusions:The pattern-mixture models considering weighted adjustments of dropout rates can be used in the sensitivity analysis of repeated measurements data. The SAS codes can provide a practical basis for the popularization and application of weighted adjustments of dropout rates in the sensitivity analysis of repeated measurements data.

Objective:To analyze the survival time and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in LiangShan Prefecture, Sichuan Province for reduction of AIDS death rate.Methods:The retrospective research method was used to collect relevant information from the Management Database of Antiviral Treatment from the National AIDS Comprehensive Prevention Information System. The Kaplan-Meier method was used to describe the survival distribution and to analyze the survival time by single factor and the model of Cox proportional riskanalysis was performed to analyze the survival time of HARRT by multi-factors analysis.Results:Total 14 219 adults and young persons aged ≥15 HIV/AIDS patients received antiviral treatment from 2005 to 2015. The average age of all cases was (36.10±9.41) years old and 10 021 were males (70.5%). The main route of infection was intravenous drug use (61.0%, 8 678 cases). At the end of the observation, 10001 cases (70.3%) were still treated, and 1 425 cases (10.0%) died; Cox Regression analysis showed that female (0.67 (0.55-0.81)), route of sexual infection (0.67 (0.56-0.79)), baseline CD4 +T lymphocyte count 200-350 (0.41 (0.35-0.47)) and ≥350 (0.28 (0.24-0.34)), was a protective factor in death. At the beginning of treatment, the patient is clinically staging stage Ⅱ (0.70 (0.58-0.84)) and abnormal BMI (1.75 (1.50-2.03)), is a risk factor for death ( P<0.05). Conclusion:Early antiviral treatment is of great significance in improving the anti-viral treatment effect of AIDS. Compliance education should be further strengthened so as to enhance their knowledge. And it is feasible to enhance the effect of treatment through nutritional support for prolonging patients survival time and improving the quality of life.

Objective:To analyze the survival time and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in LiangShan Prefecture, Sichuan Province for reduction of AIDS death rate.Methods:The retrospective research method was used to collect relevant information from the Management Database of Antiviral Treatment from the National AIDS Comprehensive Prevention Information System. The Kaplan-Meier method was used to describe the survival distribution and to analyze the survival time by single factor and the model of Cox proportional riskanalysis was performed to analyze the survival time of HARRT by multi-factors analysis.Results:Total 14 219 adults and young persons aged ≥15 HIV/AIDS patients received antiviral treatment from 2005 to 2015. The average age of all cases was (36.10±9.41) years old and 10 021 were males (70.5%). The main route of infection was intravenous drug use (61.0%, 8 678 cases). At the end of the observation, 10001 cases (70.3%) were still treated, and 1 425 cases (10.0%) died; Cox Regression analysis showed that female (0.67 (0.55-0.81)), route of sexual infection (0.67 (0.56-0.79)), baseline CD4 +T lymphocyte count 200-350 (0.41 (0.35-0.47)) and ≥350 (0.28 (0.24-0.34)), was a protective factor in death. At the beginning of treatment, the patient is clinically staging stage Ⅱ (0.70 (0.58-0.84)) and abnormal BMI (1.75 (1.50-2.03)), is a risk factor for death ( P<0.05). Conclusion:Early antiviral treatment is of great significance in improving the anti-viral treatment effect of AIDS. Compliance education should be further strengthened so as to enhance their knowledge. And it is feasible to enhance the effect of treatment through nutritional support for prolonging patients survival time and improving the quality of life.

Objective To investigate the characteristic of lipoprotein(a)[Lp(a)]in different phases of chronic kidney disease (CKD ),to provide the basis for clinical prevention and treatment of CKD.Methods 200 patients with CKD in the Republic Hospital of Shifang were collected as study group,including 5 phases (every phase had 40 cases),and 100 healthy people were selected as control group.Measured the serum Lp(a)of both study and control group,analyzed the correlations between Lp(a)and different phase of CKD.All data were analyzed by SPSS version 17.0.The significant level was established at 0.05.Results CKD1 [(146.0 ±95.5)mg/L]and all CKD group [(231.5 ±133.2)mg/L]had higher level of serum Lp(a)than the control group [(115.5 ±70.2)mg/L] (Z=-2.800,P<0.05 and Z=-7.922,P<0.05).CKD3 had higher Lp(a)level than CKD2(Z=-2.069,P<0.05 ),while there were no significant differences between each of the other two groups.CKD4 -5 [(325 .0 ± 194.7)mg/L]also had higher Lp(a)level than CKD1 -3 [(182.0 ±110.5)mg/L](Z=-4.439,P<0.05). Conclusion Patients with CKD always have high level of serum Lp(a),which have been slowly increased since CKD1 ,meanwhile the level of Lp(a)may have a certain correlation with the stage of CKD development,since Lp(a) is an important promoting factor in the progress of CKD.