Objective To investigate the diagnosis judgment values of trimester ultrasound screening for simple single umbilical artery fetal malformation.Methods From January 2011 to January 2015,selected the 15-28 weeks pregnant singleton pregnancies in Shunyi Hospital of Beijing Chinese Medicine Hospital for system fetal ultrasound,in which the single umbilical artery group of 50 patients,50 cases of healthy pregnant women (control group),the two groups were carried ultrasound screening with single umbilical artery flow spectrum analysis,and observed the prognosis.Results The single umbilical artery fetal bladder after abdominal oblique horizontal cross-section of the umbilical artery bypass saw one side of the bladder,and there were 24 patients the malformations with the incidence rate was 48.0％.In the two groups can be clearly demonstrated umbilical artery condition,but the umbilical artery pulsation index(PI),arterial resistance index (RI) and peak valley ratio of umbilical artery blood flow velocity (S/D) value in the single umbilical artery group were 1.02±0.17,0.66±0.06 and 3.08 ±0.57,significantly higher than those of the control group (0.75 ± 0.21,0.53 ± 0.08,2.11±0.27;t=7.298,11.874,15.983,P＜ 0.05).In the single umbilical artery group,there were 32 patients of abortion,10 patients of birth were,8 patients ogpregnancy.Perinatal death in 8 cases,the mortality rate was 16.0％,the single umbilical artery fetal malformations of perinatal mortality was significantly higher than that of children with simple single fetal umbilical artery (x2 =9.333,P ＜ 0.05).Conclusion Trimester ultrasound screening for single umbilical artery combined with simple two-dimensional ultrasound and umbilical arteryblood flow velocity conditions can improve fetal malformations value judgment,provide a reliable detection method to reduce oerinatal mortality.

Objective To evaluate the effect of hydrogen on the postoperative cognitive function in aged mice.Methods Sixty aged male Kunming mice,aged 12-14 months,weighing 35-45 g,were assigned into 3 groups (n=20 each) using a random number table:sham operation group (group Sham),partial hepatectomy group (group PH) and partial hepatectomy plus hydrogen-enriched saline group (group PH-H).On preoperative day 3,during operation and on postoperative day 3,hydrogen-enriched saline 10 ml/kg was intraperitoneally injected once a day in group PH-H,and the equal volume of normal saline was intraperitoneally injected once a day in S and PH groups.The spatial probe test was performed on postoperative day 7 to evaluate the cognitive function.Ten mice were selected on postoperative days 3 and 7 (after the end of the spatial probe test),and blood samples were collected for determination of serum tumor necrosis factor-alpha (TNF-α),interleukin-lbeta (IL-1β) and high-mobility group box 1 protein (HMGB1) concentrations by enzyme-linked immunosorbent assay.The animals were sacrificed after blood sampling,brains were removed and hippocampi were isolated for detection of the expression of TNF-α,IL-1β and HMGB1 by Western blot.Results Compared with group S,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly decreased,the serum concentrations of TNF-α,IL-1β and HMGB1 were increased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was up-regulated in group PH (P＜0.05),and no significant change was found in the variables mentioned above in group PH-H (P＞0.05).Compared with group PH,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly increased,the serum concentrations of TNF-α,IL-1β and HMGB1 were decreased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was down-regulated in group PH-H (P＜0.05).Conclusion Hydrogen can improve the postoperative cognitive function in aged inice.

Objective To evaluate the relationship between the anesthesia factor and myocardial injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eightyeight patients of both sexes,aged 42-71 yr,weighing 59-83 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective coronary artery bypass grafting with CPB,were divided into 4 groups (n =22 each) using a random number table:routine anesthesia control group (group C),dexmedetomidine-based anesthesia group (group D),sevofluranebased anesthesia group (group S) and dexmedetomidine combined with sevoflurane anesthesia group (group DS).After tracheal intubation,0.2％-2.1％ sevoflurane was inhaled until the beginning of CPB in S and DS groups.In D and DS groups,dexmedetomidine was intravenously infused as a loading dose of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of surgery.Before induction of anesthesia,before CPB,after the end of CPB,immediately after the end of surgery and at 24 h after surgery,venous blood samples were collected for determination of plasma creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) concentrations by immunofluorescence.The restoration of spontaneous heart beat and adverse events such as hypotension,malignant arrhythmia,cardiac arrest and respiratory depression during surgery and within 24 h after surgery were recorded.Results Compared with group C,the plasma concentrations of CK-MB and cTnI were significantly decreased in the other three groups (P＜0.05).The plasma eoncentrations of CK-MB and eTnl were significantly lower in group DS than in S and D groups (P＜0.05).There were no significant differences in the rate of restoration of spontaneous heart beat among the four groups (P＞ 0.05).No adverse events were found during surgery and within 24 h after surgery in the four groups.Conclusion Dexmedetomidine combined with sevoflurane anesthesia is helpful in reducing myocardial injury and provides better efficacy than either alone in the patients undergoing cardiac surgery with CPB and is more suitable for cardiac surgery with CPB.

Objective To evaluate the optimized efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia via the research on the postoperative cellular immune function in the patients undergoing radical resection for esophageal cancer.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 45-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical resection for esophageal cancer,were divided into 2 groups (n =20 each) using a random number table:general anesthesia group (G group) and TPVB combined with general anesthesia group (TPVB+G group).In group TPVB+G,TPVB was performed at T4 and T6 on the operated side under ultrasound guidance with 0.5％ ropivacaine 15 ml before anesthesia induction.Anesthesia induction was started after the level of block was confirmed.Anesthesia was maintained with propofol given by target-controlled infusion at the target plasma concentration of 1-4 μg/ml,and bispectral index value was maintained at 40-50.Patient-controlled intravenous analgesia was performed after operation,and visual analog scale score was maintained ≤ 3.Before anesthesia induction,at the end of operation and at 24 and 48 h after operation,blood samples were collected from the central vein for determination of the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ and CD4+/CD8+ ratio.Ricker Sedation-Agitation Scale scores were recorded at 10 min,20 min,30 min and 1 h after extubation and 6,24 and 48 h after operation.The consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia,the number of unsuccessfully delivered doses and the total number of attempts were also recorded.Results Compared with group G,Ricker Sedation-Agitation Scale scores were significantly decreased at 10 min after extubation,the consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia and the number of unsuccessfully delivered doses were decreased,and the postoperative CD4+ level and CD4 +/CD8 + ratio were increased in group TPVB+G (P＜0.05).Conclusion TPVB combined with general anesthesia can improve the postoperative cellular immune function and is an optimal anesthesia regimen in the patients undergoing radical resection for esophageal cancer.

Objective To evaluate the effect of dexmedetomidine on high-mobility group box 1 protein (HMGB1)/Toll-like receptors (TLRs) signaling pathway during lung injury in septic rats.Methods Twenty-four SPF healthy adult male Wistar rats,aged 15-18 weeks,weighing 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),sepsis group (group Sep) and dexmedetomidine group (group D).Dexmedetomidine 25 μg/kg was intraperitoneally injected in D group,while the equal volume of normal saline was given instead in S and Sep groups.Sepsis was produced by cecal ligation and puncture in Sep and D groups.The rats were sacrificed at 24 h after operation,and the right lung was removed for examination of the pathological changes which were scored and for determination of myeloperoxidase (MPO) activity,content of interleukin-1β (IL-1β),IL-6 and tumor necrosis factor-α (TNF-α) in lung tissues (by enzyme-linked immunosorbent assay),wet to dry weight ratio (W/D ratio) and expression of HMGB1,TLR2 and TLR4 in lung tissues (by Western blot).Results Compared with group S,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly increased in Sep and D groups (P＜0.05).Compared with group Sep,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly decreased in group D (P＜0.05).Conclusion Dexmedetomidine reduces lung injury through inhibiting HMGB1/TLRs signaling pathway in septic rats.

BACKGROUNDAcute lymphoblastic leukemia (ALL) and chemotherapy can cause immune imbalance, and gaseous molecule hydrogen sulfide (H2S) can participate in the process of immune response. This study aimed to investigate the immune regulation of H2S in pediatric ALL.

METHODSChildren (n = 78) with ALL admitted during 2010-2013 were included in this study. Two blood samples were collected in period of before chemotherapy, bone marrow remission and two days after chemotherapy, respectively. Serum contents of H2S and cytokines, including interleukin-1β (IL-1β), interleukin-2 (IL-2), interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10) and macrophage inflammatory protein-1α (MIP-1α), were detected using ELISA method. Stepwise regression was used to analyze the correlation between H2S and cytokines. Furthermore, human Jurkat cells were cultured in vitro, and nucleoprotein of Jurkat cells and peripheral blood mononuclear cells (PBMCs) were collected, contents of cystathionine γ-lyase (CSE) and certain cytokines were measured by Western blotting.

RESULTSSerum concentrations of H2S, IL-1β, IL-6, IL-10 and MIP-1a in children with ALL were increased significantly (P < 0.01), while concentrations of IL-2, TNF-α, IFN-γ and IL-4 decreased obviously (P < 0.01). In patients after chemotherapy, concentrations of H2S and IL-10 were decreased significantly (P < 0.05), but IL-4 and IFN-γ concentrations increased markedly (P < 0.05). At remission stage, H2S, IL-1β, IL-4, IL-6, IL-10 and MIP-1α concentrations were further decreased markedly (P < 0.05), but concentrations of IL-2, TNF-α and IFN-γ increased again (P < 0.05). Protein contents of CSE, IL-10, IL-4 and IL-2 of PBMCs also increased markedly in children with ALL. Moreover, changes of CSE protein contents of PBMCs were consistent with serum H2S contents, and there were significant correlation between H2S and certain cytokines based on stepwise regression analysis. Furthermore, compared with those of PBMCs group, in vitro study indicated that Jurkat cells of H2S group expressed IFN-γ, IL-10, IL-4 and IL-2 protein increased obviously (P < 0.05), while IL-4, IL-2 and CSE expression of PPG group decreased markedly (P < 0.05).

CONCLUSIONGaseous molecule H2S might participate in the process of immune regulation in pediatric ALL through modulating transcription and expression of cytokines.

Child ; Child, Preschool ; Cystathionine gamma-Lyase ; blood ; Female ; Humans ; Hydrogen Sulfide ; blood ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-1beta ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Interleukin-6 ; blood ; Leukocytes, Mononuclear ; metabolism ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; blood ; Tumor Necrosis Factor-alpha ; blood

Objective To construct a Type 1 diabetes model in miniature pigs and explore postoperative care strategies for effectively prolonging the survival time of the model pigs. Methods Seven Banna miniature pigs were selected for pancreatectomy. Glucose, vitamins, and antibiotics were administered for 3-5 days after surgery to aid recovery. Blood glucose and urine glucose levels were measured twice a day in the morning and evening to adjust insulin supplementation accordingly. The model pigs were observed daily and records were kept, including orexis, psychosis, weakness, skin ulcer, and feces and urine. Body weight was measured weekly until the death of the model animals. Based on the model pigs' condition, glucose injection and Ringer's lactate solution were administered to supplement nutrition and correct electrolyte imbalances. Results All seven Banna miniature pigs showed typical symptoms of diabetes: random blood glucose levels higher than 11.1 mmol/L after pancreatectomy, far exceeding the average blood glucose level of 6.0 mmol/L in normal pigs; positive urine glucose; and progressive weight loss. These features indicated the successful construction of Type 1 diabetes model. Additionally, Type 1 diabetic pigs that survived more than 8 weeks showed progressive hair loss and skin ulceration. Euthanasia was performed on model pigs when they were unable to stand or even eat independently, and pathological examination and HE staining were conducted on tissues collected from affected organs such as the liver, kidneys, and skin. Pathological sections revealed liver congestion, massive glycogen accumulation, ballooning degeneration of hepatocytes, and progressive liver fibrosis, along with glomerular congestion, vacuolar degeneration in renal tubular epithelial cells, proteinuria, dermal congestion, thinning of vascular walls, and varying degrees of parakeratosis and dyskeratosis in the liver, kidneys, and skin tissues due to prolonged hyperglycemia. The average survival time of the constructed Banna miniature pig diabetes model was 44 d, with a maximum survival time of 121 d. Conclusion Type 1 diabetes model can be constructed successfully in Banna miniature pigs through pancreatectomy. With meticulous postoperative care, a long-term Type 1 diabetes model with significant complications can be achieved, providing a stable large-animal model for Type 1 diabetes treatment strategies.