Objective To compare the dexmedetomidine and midazolam administered intranasally for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.Methods Forty pediatric patients of both sexes, aged 2-7 yr, weighing 1 1-26 kg, of American Society of Anesthesiology Anesthesiologists physical status Ⅱ, were equally and randomly assigned into either midazolam group (group M) and dexmedetomidine group (group D).Group M received midazolam 0.2 mg/kg administered intranasally, and group D received dexmedetomidine 2 μg/kg administered intranasally in the room for preoperative preparation.The pediatric patients were separated from their patients at 30 min after administration.Oxygen was inhaled by mask after admission to the operating room, and venipuncture was performed.The responses to nasal mucous membrane irritation and separation from their parents were recorded.Ramsay sedation scores were recorded when the patients were separated from their parents.The occurrence of bradycardia, hypotension, hypertension and hyoxemia was recorded from the end of administration until venipuncture.Results The pediatric patients were successfully separated from their patients in the two groups.Compared with group M, the incidence of responses to nasal mucous membrane irritation was significantly decreased, and Ramsay sedation scores were increased in group D (P＜0.05).No pediatric patients developed adverse reactions such as bradycardia, hypotension, hypertension and hyoxemia in the two groups.Conclusion Dexmedetomidine administered intranasally provides better efficacy than midazolam when used for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.

Background and purpose:Breast invasive ductal carcinoma (IDC) is the most common breast carci-noma, and the ultrasonographic features of its molecular subtypes has great clinical value. The purpose of this study was to discuss the correlation between ultrasonographic features of IDC and its molecular subtypes.Methods:Ultrasonographic features of 112 patients with preoperative integrated ultrasonographic information and pathologically confirmed IDC from Sep. 2012 to Feb. 2015 were retrospectively analyzed. Based on the immunohistochemistry results of ER (estrogen receptor), PR (progesterone receptor), HER-2 (human epidermal growth factor receptor-2) and Ki-67, these cases were categorized into 4 molecular subtypes: Luminal A group, Luminal B group, ERBB2 positive group and Basal-like group. Results:There were 14 cases (12.5%) in Luminal A group, 62 cases (55.4%) in Luminal B group, 21 cases (18.7%) in ERBB2 positive group and 15 cases (13.4%) in Basal-like group. The 4 molecular subtypes differed in tumor length, lymph node involvement, tumor boundary, tumor shape and internal blood flow on ultrasonography (P<0.05). There were no sig-nificant differences in tumor internal echo, posterior echo, micro-calcification and elastrography between subtypes (P>0.05).Luminal A group and Luminal B group had less lymph node involvement, more obscure boundary and irregular shape. More internal blood flow, bigger tumor size and lymph node involvement were observed in ERBB2 positive group of this study. Patients in Basal-like group were more likely to have clear tumor boundary, regular tumor shape, bigger tumor size and lymph node involvement on ultrasonogram.Conclusion:Correlation exists between ultrasonographic features and molec-ular subtypes of IDC. This has tremendous clinical significance in the early diagnosis of IDC, preoperative, intraoperative and prognosis evaluation of IDC patients.

Objective To compare the effects of labor epidural analgesia initiated in latent phase and active phase on parturients and neonates. Methods One hundred twenty nulliparous women at full term (single, head presentation, ASA Ⅰ or Ⅱ ) were randomly divided into 3 groups (n=40 each):control group(group C) ; PCEA initiated in latent phase group (cervical dilatation 0.5-3.0 cm) (group L) and PCEA initiated in active phase group (cervical dilatation＞3.0 cm) (group A). Epidural catheter was placed through L2,3 interspace. 0.1% ropivacaine with fentanyl 2 μg/ml was used for PCEA. A test dose of 5 ml was followed by a loading dose of 10 ml. PCEA device was programmed to allow a bolus of 6 ml with a 30 min lockout interval. The intensity of pain was measured with VAS (0=no pain, 10=worst pain) before analgesia, at 5, 10, 15 and 30 min after beginning of PCEA and cervical dilatation of 7-8 cm and 10 cm. Degree of motor block was assessed by lower extremity muscle strength (modified Bromage scale,0=no motor block, 3=inability to flex ankle joints).Plasma cortisol in maternal venous blood obtained before analgesia and at delivery of fetus and in umbilical cord blood and plasma ropivacaine concentrations in umbilical core blood were determined.The length of every stage, duration of analgesia,delivery mode, the amount of oxytocin used, maternal satisfaction, Apgar scores of the neonates and adverse effects were recorded. Results PCEA initiated in latent phase or active phase significantly reduced VAS score, the plasma cortisol level at delivery, the duration of 1st stage of labor, and the rate of cesarean section and increased the use of oxytocin in L and A groups as compared with group C, but there was no significant difference in the above variables between L and A groups. The duration of analgesia was shorter in group A than in group L. Conclusions Labor epidural analgesia initiated in latent phase or active phase can decrease the rate of cesarean section but does not prolong the duration of labor and is safe for the newborn.

Objective To compare the effects,stress reaction and concentration of ropivacaine in umbilical cord blood of patients who accepted combined spinal epidural analgesia or patient controlled epidural labor analgesia in latent and active phase.Methods After approved by the ethics committee and informed consents from 80 nulliparous parturients who were admitted to Beijing Friendship Hospital,Capital University of Medical Sciences between January to June 2009,and who were term,single,cephalic presentation delivery and ASA Ⅰ-Ⅱ,were divided into two groups randomly:latent phase group (Group L,cervical dilation 0.5-2.5 cm,n=40) and active phase group (Group A,cervical dilation ≥3.0 cm,n =40).Ropivacaine 2 mg and fentanyl 10 μg was administered in subarachnoid space of all patients.Then,patient controlled epidural infusion of 0.1 ％ ropivacaine plus fentanyl 2 μg/ml were administered.Pain scores (visual analogue score,VAS),lower extremity muscle strength,duration of labor,delivery mode,total dosage used,maternal satisfaction,Apgar score (1 min and 5 min) were evaluated; concentration of ropivacaine (high performance liquid chromategraphy) in cord blood,and concentration of cortisol (radioimmunoassay) in maternal venous blood and cord blood were detected.Forty nulliparous parturients without labor analgesia were taken as control group (Group C).Chi-square test and one way analysis of variance was applied for statistical analysis.Results (1) VAS in Group L and Group A were lower than that of Group C when cervix dilated at 7.0-8.0 cm (2.9± 1.4,2.6± 1.5 vs 9.2±0.7,F=201.50,P＜0.01) and fully dilated (4.7±2.2,3.6±2.0 vs 9.1±0.7,F =-62.07,P＜0.01,respectively).(2) Tbe concentration of cortisol in maternal venous blood right after delivery was higher than that before analgesia in all groups,and the change in group C was significantly greater than that in group L and group A [(902±172) μg/L vs (761±125) μg/L and (731±184) μg/L,t =-3.491 and-3.483,all P＜0.01],moreover there was no significant difference between group L and group A (P＞0.05).There were no difference in cortisol concentration of umbilical blood among the three groups [(168±46) μg/L,(159±49) μg/L and (170±86) μg/L,F=0.23,P＞0.05].(3) There was no difference between ropivacaine concentration in umbilical blood of group L and group A [(0.21±0.10) mg/L vs (0.20±0.03) mg/L,t=0.557,P＞0.05].(4) No significant differences was shown among the three groups in the duration of first and second stage of labor,rate of augmentation,neonatal birth weight,Apgar score at 1 min and 5 min (all P＞0.05).Compared with group C,group L and group A had higher rate of vaginal delivery (52.5％ vs 75.0％ and 85.0％,P＜0.05) and lower rate of cesarean section (45.0％ vs 20.0％ and 15.0％,P＜0.05).The duration of analgesia in group L was longer than that in group A [(215±143) min vs (118±50) min,t =3.722,P＜0.01] and the dosage of fentanyl was also higher [(28± 11) μg vs (17±6) μg,t =5.084,P＜0.01].Conclusions Labor analgesia with combined spinal epidural could decrease cesarean section rate and maternal stress reaction without prolonging the duration of labor and inhibiting neonatal stress reaction.Labor analgesia start from latent phase would not increase the concentration of ropivacaine in cord blood.

Objective To investigate the clinical effect of magnesium sulfate combined with nifedipine in the treatment of patients with pregnancy induced hypertension( HDCP) .Methods Retrospective study was used in this study and 116 patients with HDCP from January 2013 to July 2015 in department of obstetrics and gynecology from our hospital were divided into two groups, including routine group of 62 patients who received routine treatment +magnesium sulfate) and combination group of 54 patients who received routine treatment +magnesium sulphate +nifedipine.The clinical effect was analyzed after five days’ continuous treatment.Results The systolic blood pressure, diastolic blood pressure,24h urinary protein, random urine protein /creatinine,serum homocysteine (Hcy) and CRP values in combination group were lower than routine group (P<0.05).There were no statistical difference in maternal uterine inertia, neonatal asphyxia, fetal distress, postpartum hemorrhage rate between the two groups after the treatment.But the rate of cesarean section in the combination group(50.00%)was significantly lower than that in the routine group(68.25%)(P <0.05).Conclusion Magnesium sulfate combined with nifedipine in the treatment of patients with HDCP had better antihypertensive effect, and would not increase fetal adverse birth outcomes incidence and significantly reduce the rate of cesarean section.

Following the blood pressure, pulse, breathing and body temperature, pain was identified as the fifth vital signs.Postoperative pain of the spine and spinal cord surgery was a neuropathic pain, it was severe and may affect multiple systems of the patients.Therefore, postoperative analgesia of spine and spinal cord surgery is very important.

Objective To investigate the role of chemokine ligand 2 (CCL2) in the spinal cord expression in a rat model of tibia bone cancer pain.Methods Eighty-four female SD rats weighing 160-180 g were randomly divided into 3 groups ( n =28):control group (group C),sham operation group (group S) and tibia bone cancer pain group (group P).Tibia bone cancer pain was induced by intra-tibial inoculation of Walker-256 breast cancer cells.Paw withdral threshold to mechanical stimulation (MWT) was measured with von Frey filaments at 1 d before and at 1,3,7,10,14 and 21 d after inoculation.Six rats in each group were sacrificed after the measurement of MWT at 1 d before inoculation and at 7,14 and 21 d after inoculation.Lumbar 4-6 segments of the spinal cord were removed for determination of the expression of CCL2 by ELISA.The coexpression of CCL2 with Iba-1 (a specific marker of microglia),GFAP(a specific marker of astrocyte) and NeuN (a specific marker of neuron) was determined by double immunofluorescence assay after the measurement of MWT at 14 d after inoculation in group P.Results Compared with groups C and S,MWT was significantly decreased from 7 d to 21 d after inoculation,the expressive of CCI-2 in the spinal cord up-regulated at 7,14 and 21 d after inoculation in group P ( P ＜ 0.05).CCL2 was expressed in the microglia and astrocyte but not in neuron in the spinal cord dorsal horn in a rat model of tibia bone cancer pain.Conclusion Release of CCL2 from microglia and astrocytes in the spinal cord was involved in mechanical hyperalgesia in a rat model of tibia bone cancer pain.

Objective To study the effect of Xin Kang Injection on cardiac function of rats with adriamycin-induced myocarditis and to explore its pharmacological mechanism.Methods Seventy Wistar rats were randomly divided into seven groups:normal control group,model group,three-dosage Xin Kang Injection groups(high-,moderate-and low-dosage respectively),deslanoside group,and Huangqi group.The myocarditis rat model was established by intraperitoneal injection of adriamycin.Left ventricular end-diastolic pressure(LVEDP),left ventricular systolic pressure(LVSP),heart rate(HR),T value,and ? DP/DTmax were observed.Results LVSP,+ DP/DTmax in the treatment groups were higher and-DP/DTmax lower than those in the model group(P

Objective To explore effects of heroin and ephedrine on the histological structure and ChAT activity of hypothalamus and hippocampus of filial mice. Expression of Bcl-2 associated X protein(Bax protein) and keratinocyte growth factor(KGF) of hypothalamus and hippocampus were measured. Methods One hundred and eight filial mice were given intraperitoneal injection of heroin and ephedrine by gradually increase of doses, apoptosis and expression of Bax protein and KGF of hypothalamus and hippocampus were observed by Giemsa staining and immunohistochemistry, and the ChAT activity was detected by colorimetry. Results After administration of heroin and ephedrine at 5,10,15,20 days, the number of apoptotic cells and expression of Bax protein and KGF of hypothalamus and hippocampus were significantly increased and ChAT activity was lower than those of the control group(P<0.05 or P<0.01). There were differences between heroin group and the ephedrine group in the above-mentioned four indexes (P<0.05 or P<0.01). The number of apoptotic cells and Bax protein and KGF immunopositive neurons of hypothalamus and hippocampus increased by the increase in dose of heroin and ephedrine. Conclusions Heroin and ephedrine had great effect on the histological structure and ChAT activity of hypothalamus and hippocampus of filial mice, and this effects would be related to the cell apoptosis of hypothalamus and hippocampus.

[Objective] The objective of this study was to evaluate the diagnostic accuracy of the 2013 edition of Breast Imaging Reporting and Data System (BI-RADS) ultrasound lexicon in diagnosing breast categories 3-5 lesions.[Methods] Using our breast ultrasound database from June 2014 to June 2016,we identified 4428 BI-RADS category 3 to 5 lesions with a known pathological diagnosis in 4 428 adult women.The positive predictive value (PPV) of each BI-RADS category was calculated based on the pathological diagnoses and compared with the reference range provided by the American College of Radiology (ACR).[Results] 4 428 lesions from 4428 patients were included in this study.The PPV of each BI-RADS category waswithin the reference range provided by the ACR in 2013.1198 (27.1％) pathological malignant/borderline results were found in the 4 428 lesions,the other 3 230 (72.9％)lesions were diagnosed with benign results.Among the malignant/borderline lesions,the rate of lymph node metastasis gradually increased as the BI-RADS categories were upgraded.Malignant lesions with a diagnosis ofinvasive ductal carcinoma or invasive lobular carcinoma showed an increasing distribution trend from category 3 to 5.[Conclusion] The 2013 editionof BI-RADS ultrasound lexiconhas good diagnostic accuracy and efficiencyin clinical practice.