Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane required to inhibit the body movement evoked by skin incision.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 21-27 kg/m2,undegoing elective lower abdominal surgery under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (groups D1,D2 and D3 ).Dexmedetomidine 0.2,0.4 and 0.6 μg/kg in 15 ml of normal saline was infused over 30 min before induction of anesthesia in groups D1,D2 and D3 respectively.While 15 ml of normal saline was given instead in group C.Anesthesia was induced with inhalation of 8％ sevoflurane.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane.The initial end-tidal concentration of sevoflurane was set at 3.0％,3.0％,2.5％,2.0％ in groups C,D1,D2 and D3 respectively.The ratio between the two successive concentrations was 0.9.Skin incision was made after 15 min of equilibratiton.At least 7 independent crossover pairs were observed in each group.The MAC of sevoflurane was the mean of the end-tidal concentration of sevoflurane of each crossover pair,and 95 ％ confidence interval (CI) was calculated.Results In groups C,D1,D2 and D3,18,20,20 and 22 patients were enrolled respectively.The MAC (95 ％ CI) of sevoflurane was 2.5 ％ (2.3 ％-2.8 ％ ),1.5 ％ ( 1.3 ％-1.7％),1.3％ (1.0％-1.6％) and 1.1％ (0.7％-1.5％) in groupsC,D1,D2 and D3 respectively.The MAC of sevoflurane was significantly lower in groups D1,D2,D3 than in group C,and in groups D2 and D3 than in group D1 ( P ＜ 0.05).There was no significant difference in the MAC of sevoflurane between groups D2 and D3 ( P ＞0.05).Conclusion Dexmedetomidine 0.2,0.4,0.6 μg/kg can significantly decrease the MAC of sevoflurane required to inhibit the body movement evoked by skin incision in a dose-dependent manner.

It is well known that Tn5B1-4(commercially known as the High Five)cell line is highly susceptible to baculovirus and provides superior production of recombinant proteins when compared to other insect cell lines.But the characteristics of the cell line do not always remain stable and may change upon continuous passage.Recently an alphanodavirus,named Tn5 Cell Line Virus(or TNCL Virus),was identified in High Five cells in particular. Therefore,we established a new cell line,QB-Tn9-4s,from Trichoplusia ni,which was determined to be free of TNCL virus by RT-PCR analysis. In this paper,we describe the development of a novel cell clone,QB-CL-B,from a low passage QB-Tn9-4s cell line and report its susceptibility to ACMNPV,and the level of recombinant protein production. This cell clone was similar to its parental cells QB-Tn9-4s and Tn5B 1-4 cells in morphology and growth rate;although it also showed approximately the same responses to AcMNPV infection and production of occlusion bodies,there were higher levels of recombinant protein production in comparison to QB-Tn9-4s(parental cells)and High5 cells.

Objective To investigate the outcome of damage control sugery in patients with acute superior mesenteric occlusion (ASMO).Methods Seventeen patients with acute superior mesenteric occlusion from June 2008 to May 2012 were reviewed retrospectively.Diagnosis was confirmed by CT and/or DSA.Patients were divided into two groups:seven patients in damage control group (shortening surgical time,bowel exteriorization,temporary abdominal closure) ; ten patients in conventional surgical treatment group.The treatment outcomes of the two groups were compared.The survival of all patients was followed up for 6 months to 5 years at outpatient clinic.Results The overall mortality rate was (5/17) and surgical complications rate was (8/17).Operation time was (97 ±42) min and (236 ± 137) min(t =-4.72,P ＜0.01,P ＜ 0.05) respectively in damage control group and conventional surgical treatment group.Intestine resection length was (114 ± 94) cm and (229 ± 93) cm (t =-2.49,P =0.03,P ＜ 0.05) respectively.Complications rate was (1/7) and (7/10) (Fisher's dxact test P =0.05,P ≤0.05) respectively; mortality was (1/7) and (4/10) (Fisher's dxact test P =0.34,P ＞ 0.05) respectively.Conclusions Although damage control does not significantly reduce mortality,but the rational use of damage control can effectively reduce operation time,shorten intestine resection length and decrease surgical complications.

Objective To investigate the relationship of external hydrocephl(EH) with brain-injure in the neonate.Methods By performing on the patients with brain-injure with CT and making the clinical study,the change of brain following injure and its relationship with EH were analyzed.Results Hypoxic-ischemic encephalopathy(HIE) were 36 cases,EH were 19 in the cases,6 get the cerebrospinal symptom;SAH were 22 cases,EH were 15 in the cases,3 get the cerebrospinal symptom;Intracranial hemorrhage were 8 cases,EH were 3 in the cases,3 got the cerebrospinal symptom.Conclusion All the kinds of brain-injure can get EH and the rate of EH with any brain-injure is no different.But the outcome is significantly different.

目的探讨选择性脊神经后根切断术(SPR)治疗小儿脑性瘫痪(CP)的疗效。方法对我院获取1年完整随访资料的62例SPR患儿进行回顾性分析。结果按AshWorth 5级肌力标准判断,术后下肢肌张力平均下降2.4级,上肢肌张力平均下降0.4级。术后1年患肢肌张力缓解62例(缓解率100%),行走功能和步态改善48例(77.4%)。伴随症状部分改善。结论SPR能有效缓解CP患儿肢体肌张力,改善康复条件。

Objective To investigate the effects of conductive education with routine rehabilitation on cerebral palsy. Methods 59 caseswere divided into the conductive group (n=38) and the control group (n=21). The conductive group received conductive education with routinerehabilitation and the control group received routine rehabilitation only. They were assessed with the gross motor function, intelligentand activity of daily living (ADL) before and after treatment. Results The improvement of gross motor was not significantly different betweenthese groups (P>0.05), while the intelligence, ADL improved more in the conductive group than in the control group (P=0.001). ConclusionConductive education can promote the development of the children in ADL and intelligent.

Objective To determine the optimum dose of dexmedetomidine administered locally through evaluating the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for brachial plexus block.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 19-50 yr, weighing 50-80 kg, scheduled for elective ulna and radius fracture open reduction and internal fixation, requiring ultrasound-guided axillary brachial plexus block, were randomly assigned into 4 groups using a random number table: control group (group C) and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg groups (D1 , D2 and D3 groups).Axillary brachial plexus block was performed only with ropivacaine in group C.In D1-3 groups, axillary brachial plexus block was performed with the mixture of ropivacaine and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg, respectively.The effective block was defined as complete loss of pain sensation in the areas innervated by the brachial plexus.The volume of local anesthetics was 40 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.4％ and the ratio between the two successive concentrations was 1.0.If the block was effective, the next patient received a lower dose of ropivacaine;or conversely if ineffective, a higher dose was given in the next patient.At least 7 independent crossover pairs were observed in each group.The EC50 of ropivacaine was the mean of the concentration of ropivacaine of each crossover pair.The occurrence of brachial plexus block-related adverse events, adverse cardiovascular events and over-sedation was recorded.Results In C, D1, D2 and D3 groups, 20, 22, 24 and 19 patientswere enrolled, respectively.Compared with group C, the EC50 of ropivacaine was significantly decreased in D2 and D3 groups, and no significant change in the EC50 of ropivacaine was found in group D1.No patients developed adverse events in group D1.The incidence of bradycardia was 17％, but it was transient in group D2.In group D3, the incidence of bradycardia and hypotension was 58％ and 32％, respectively, and they required special treatment, and the incidence of over-sedation was 10％.Conclusion The optimum dose of dexmedetomidine is 0.6 μg/kg when mixed with ropivacaine for brachial plexus block.

Objective To analyze the implementation of day surgery in a public hospital in Tianjin,and to provide refer-ence for the quantity and quality of day surgery.Methods The implementation of day surgery in a public hospital in Tianjin from 2020 to 2022 was analyzed.Results From 2020-2022,the main types of daytime operations were secondary(43 kinds)and ter-tiary operations(28 kinds).In terms of the implementation of professional disciplines,anorectal surgery,urology surgery and orthopedics carried out the largest number of operations,among which anorectal surgery accounted for 70.76％(2 285/3 229).Conclusion It is necessary to further improve the development of professional disciplines,the management system of day surger-y,and the guarantee of medical services,strengthen the construction of weak links in the management path of day surgery and im-prove the coverage and accessibility of day service.

Objective To evaluate the feasibility and curative effect of extracorporeal liver perfusion (ECLP) in treatment of acute liver failure (ALF) in pigs. Methods The experiments were carried out in healthy pigs (weight 20-30 kg) under general anesthesia. All of the pigs were randomly divided into 3 groups. ALF model was established by liver blood supply obstructing and portal-systemic shunting. ALF group (n=5): ALF pigs were killed 8 h after establishing. ALF+ECLP group (n=5): ALF pigs were perfused with ECLP for 4 h and killed 8 h after establishing. Normal liver+ECLP group (n=4): normal pigs were dealt with just as ALF+ECLP group. The data of PT, AST, TNF, blood ammonia were collected in all groups. Pathologic changes in liver and brain were detected. Results The levels of PT, AST, TNF, blood ammonia, RBC and HCT in the ALF+ECLP group were lower than those in the ALF group (P

Objective:To investigate the role and mechanism of human umbilical cord mesenchymal stem cell exosomes (hUCMSC-ex) in wounds with escharectomy and skin grafting in scalded rats.Methods:The study was an experimental study. Twelve male Sprague-Dawley (SD) rats aged 6-8 weeks were divided into combined treatment group, fixed+allogeneic skin group, autologous skin+allogeneic skin group, and allogeneic skin group by random number table method (the same grouping method hereinafter), with 3 rats in each group. The four groups of rats were inflicted with scalded wounds on the back and performed with escharectomy, and then the wounds of rats in combined treatment group were fixed with a metal ring (the same fixing method hereinafter) and transplanted with autologous skin grafts and allogeneic skin grafts, and the other three groups of rats were fixed and/or transplanted with skin grafts corresponding to the group name. At 14, 21, and 28 d after surgery, the wound healing area in the four groups of rats was measured. Another 15 male SD rats aged 6-8 weeks were divided into normal group with no treatment, high exosome group, low exosome group, supernatant group, and phosphate buffer solution (PBS) group, with 3 rats in each group. The last 4 groups of rats were treated as that in the above-mentioned combined treatment group, and then were injected around the wounds with 200 μL of PBS containing 100 μg of hUCMSC-ex, 200 μL of PBS containing 50 μg of hUCMSC-ex, 200 μL of supernatant with no hUCMSC-ex, and 200 μL of PBS at 0 (immediately), 7, 14, and 21 d after surgery, respectively. At 14, 21, and 28 d after surgery, the wound healing area in the four groups of rats was measured. The wound neo-epithelial tissue of rats in high exosome group and PBS group at 28 d after surgery and the normal skin tissue of rats in normal group at the same time point were taken, and the differentially expressed proteins were screened by label-free quantitative proteomics method; the two up-regulated and differentially expressed proteins, the immunoglobulin G1 heavy chain constant region (IGHG1) and cystatin A (CSTA) with the largest and second largest fold changes in comparison between high exosome group and PBS group were selected, and their protein expressions were detected by Western blotting. The number of samples in all experiments was 3.Results:At 14, 21, and 28 d after surgery, the wound healing area in combined treatment group, autologous skin+allogeneic skin group, and allogeneic skin group of rats was significantly larger than that in fixed+allogeneic skin group ( P<0.05), the wound healing area in autologous skin+allogeneic skin group of rats at 21 d after surgery and that in allogeneic skin group of rats at 14 and 21 d after surgery was significantly larger than that in combined treatment group ( P<0.05), and the wound healing area in allogeneic skin group of rats at 14 d after surgery was significantly larger than that in autologous skin+allogeneic skin group ( P<0.05). The wound healing area of rats in high exosome group and low exosome group at 14, 21, and 28 d after surgery and in supernatant group at 14 and 28 d after surgery was significantly larger than that in PBS group ( P<0.05); the wound healing area in high exosome group of rats at 14 and 21 d after surgery was significantly larger than that in supernatant group ( P<0.05), and the wound healing area at 14 d after surgery was significantly larger than that in low exosome group ( P<0.05); the wound healing area in low exosome group of rats at 14 d after surgery was significantly larger than that in supernatant group ( P<0.05). Compared with that in PBS group, 332 proteins were differentially expressed in the neo-epithelial tissue of the wounds in high exosome group of rats at 28 d after surgery ( P<0.05), among which the protein expressions of IGHG1 and CSTA were significantly up-regulated (with fold change of 12.60 and 2.27, respectively, P<0.05). Compared with those of normal skin tissue in normal group, 1 400 and 1 057 proteins were differentially expressed in the neo-epithelial tissue of the wounds in high exosome group and PBS group of rats at 28 d after surgery, respectively. The protein expressions of IGHG1 and CSTA in the wound neo-epithelial tissue in high exosome group of rats at 28 d after surgery were significantly larger than those in normal skin tissue of rats in normal group ( P<0.05) and those in PBS group ( P<0.05). Conclusions:hUCMSC-ex may accelerate the repair process of wounds with escharectomy and skin grafting and improve the quality of wound healing in scalded rats by regulating the protein expressions of IGHG1 and CSTA.