Objective To compare the influence of cardiopulmonary bypass(CPB) on brain injury in the infants with compli‐cated congenital heart disease(CHD) and simple CHD by analyzing and monitoring the perioperative cerebral electric impedance co‐efficient ,serum S‐100βprotein and neuron specific enolase (NSE) .Methods Forty infants with CHD were randomly selected and divided into two groups:the complicated group(n=20 ,13 cases of tertralogy of fallot ,7 cases of transposition of great arteries) and the simple group(n=20 ,8 cases of atrial septal defect ,12 cases of ventricular septal defect) .Blood samples were taken and the cere‐bral electric impedance coefficients before operation(T1 ) ,at 10 min after CPB(T2 ) ,immediately after aortic clamping(T3 ) ,aortic o‐pening(T4 ) ,end of CPB(T5 ) ,at 5 h(T6 ) and 24 h (T7 ) after CPB were measured by the BORN‐BE noninvasive brain edema moni‐tor .Serum levels of S‐100βprotein and NSE were detected by ELISA .Results There was no statistically significant difference in the cerebral electric impedance coefficient ,S‐100βprotein and NSE before surgery(P>0 .05) .The cerebral electric impedance coef‐ficient ,S‐100βprotein and NSE were significantly increased from the beginning to the end of CPB(P< 0 .05) ,and gradually de‐creased after CPB(P<0 .05) .The cerebral electric impedance coefficient ,S‐100βprotein and NSE were obviously higher in the com‐plicated group than those in the simple group at the same time points(P<0 .05) .The cerebral electric impedance coefficient was re‐spectively correlated with S‐100βprotein and NSE .Conclusion The influence of CPB on brain injury in complicating CHD infants is more serious than that in simple CHD infants .The BORN‐BE noninvasive brain edema monitor can be used during CPB periopera‐tive period in complicating CHD infants for conducting the real time monitoring in order to reduce brain damage .

Objective To explore the effect of the unilateral lumbar anesthesia by hypobaric bupivacaine and general anesthe‐sia in elderly hip replacement and their influence on the stress response .Methods Forty elderly patients undergoing hip replace‐ment in our hospital from December 2013 to November 2014 were selected and randomly divided into the unilateral lumbar anesthe‐sia group and general anesthesia group according to the random number table ,20 cases in each group .Venous blood was collected to determine the levels of blood sugar ,serum catecholamine(CA) and cortisol(CORT ) at 10 min before anesthesia(T0 ) ,end of surgery (T1 ) and at postoperative 24 h(T2 ) .MAP ,HR ,SpO2 ,intraoperative adverse reactions and postoperative related complications were recorded at each time point ,and the comparative analysis was performed .Results All patients successfully completed surgery and the anesthetic effect was satisfied .The occurrence rates of intraoperative hypotension ,hypertension and bradycardia in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences had statistical significances (P>0 .05) .HR and MAP at T1 in the two groups were reduced ,but the differences between the two groups were no statistical signifi‐cance(P>0 .05);the levels of GLU ,CORT and CA were increased ,moreover the differences between the two groups were statisti‐cally significant(P<0 .05) .SpO2 at T2 in the general anesthesia group was obviously lower than that in the unilateral lumbar anes‐thesia group ,while CORT was higher than that in the unilateral lumbar anesthesia group ,the differences were statistically signifi‐cant(P<0 .05) .The occurrence rates of postoperative nausea and vomiting ,sore throat ,dizziness ,drowsiness and pulmonary infec‐tion in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences were statistical‐ly significant(P<0 .05) .Conclusion The unilateral lumbar anesthesia by using hypobaric bupivacaine and general anesthesia all could offer better anesthetic effect .The unilateral lumbar anesthesia by using hypobaric bupivacaine can effectively regulate the stress response in elderly patients with hip replacement .

Objective: To investigate the effect of enolase 1 (ENO1) expression on proliferation, apoptosis and migration of lung cancer PC14 cells. Methods: ENO1 over-expression vector-pcDNA3.1/ENO1 was constructed and transfected into PC14 cells at logarithmic growth phase with liposome LipofectamineTM 2000. G418 was used to screen PC14 cells that stably expressing ENO1. The effects of ENO1 over-expression on proliferation, migration and apoptosis of PC14 cells were detected by CCK-8 method, scratch-healing assay and flow cytometry, respectively. Results: The ENO1 over-expression cell model was successfully constructed. Compared with PC14-vehicle and wild-type PC14 cells, the mRNA and protein expression levels of ENO1 in PC14-ENO1 cells were significantly elevated (all P<0.05), and the proliferation of PC14-ENO1 cells was significantly increased (all P<0.05). The relative mobility of PC14ENO1 cells was significantly higher than that of pcDNA3.1-vehicle cells and wild-type PC14 cells ([13.26±1.13]% vs [8.46±1.11]%, [7.86±1.00]%, both P<0.05). There was no significant difference in apoptotic rate among PC14-ENO1, PC14-vehicle and PC14 cells (all P> 0.05) Conclusion: Over-expression of ENO1 promotes proliferation and migration of lung cancer PC14 cells.

Objective:To confirm items included in a tool for assessing clinical outcomes based on International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set.Methods:The item pool was established based on the ICF Rehabilitation Set. Then 15 experts were invited to participate in three rounds of expert Delphi consensus-building to choose items with high importance in assessing clinical outcomes. The reliability of the tool was examined by analyzing the experts′ positive coefficients, authority coefficients and degree of agreement.Results:The assessment tool which emerged from the three rounds comprised 17 items, including 8 Body Functions items (b130 Energy and drive functions, b134 Sleep functions, b152 Emotional functions, b280 Sensation of pain, b455 Exercise tolerance functions, b620 Urination functions, b710 Mobility of joint functions and b730 Muscle power functions), d230 Carrying out daily routine from General Tasks and Demands, 3 Mobility items (d410 Changing basic body position, d450 Walking and d465 Moving around using equipment), 4 Self-care items (d510 Washing oneself, d530 Toileting, d540 Dressing and d550 Eating) and 1 item of Interpersonal Interactions and Relationships (d710 Basic interpersonal interactions). All had 100% positive coefficients after the three rounds, with an authority coefficient of 0.81 and coefficients of variation between 0.054 and 0.412.Conclusion:The assessment tool constructed in this study provides a new direction for quality control in clinical practice and medical insurance assessments.

Improper control of depth of anesthesia is not only detrimental to the rapid and stable recovery of anesthesia, but also affects the postoperative outcome of patients. Therefore, accurate control of anesthesia depth is an urgent clinical and scientific problem in the field of anesthesiology. At present, different algorithm models derived from electroencephalogram (EEG) signals are used to monitor the depth of anesthesia, but they cannot meet the requirements of anesthesiologists to accurately evaluate the depth of anesthesia. In recent years, the research on the mechanism and modulation of anesthesia-related neural network suggests that it has potential value as a method to monitor depth of anesthesia. Anesthesia-related neural networks mainly include sleep-wake circuit, thalamic-cortical circuit and corticocortical network. A thorough understanding of the neural network involved in the loss of consciousness caused by anesthesia will guide the depth of anesthesia monitoring more accurately and provide possibility for improving the quality of clinical anesthesia resuscitation.

Purpose: This retrospective study aimed to evaluate the distribution pattern and prognostic value of 21-gene recurrence score (RS) in Chinese patients with mucinous breast cancer (MC) and compared with infiltrating ductal carcinoma (IDC). Materials and Methods: Patients diagnosed with MC or IDC from January 2010 to January 2017 were retrospectively recruited. Reverse transcriptase–polymerase chain reaction assay of 21 genes was conducted to calculate the RS. Univariate and multivariate analyses were performed to assess the association between RS and clinicopathological factors. Survival outcomes including disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared by log-rank test. Results: The MC cohort included 128 patients and the IDC cohort included 707 patients. The proportions of patients with a low (RS < 18), intermediate (18-30), or high risk (RS > 30) were 32.0%, 48.4%, and 19.5% in MC cohort, and 26.9%, 46.8% and 26.3% in IDC cohort. The distribution of RS varied significantly according to different Ki-67 index and molecular subtype in both cohorts. Moreover, the receipt of chemotherapy was associated with RS in both cohorts. Among patients with MC, tumor stage was related to the DFS (p=0.040). No significant differences in DFS and OS were found among MC patients in different RS risk groups (OS, p=0.695; DFS, p=0.926). Conclusion RS was significantly related to Ki-67 index and molecular subtypes in MC patients, which is similar in IDC patients. However, RS was not able to predict DFS and OS in patients with MC.

Preventing and mitigating major risk exposure is an important task for modern countries to maintain sustained and healthy economic development and overall social stability. In this manuscript, the authors introduced Israel′s current medical and health care risk prevention system, including the regional health emergency response coordination mechanism, hospital′s external emergency rescue capacity building and hospital′s internal security system. Israel′s risk prevention system has been tested by wars and terrorist attacks, as well as many infectious diseases outbreaks. Thus the authors expected that its successful experiences can be introduced as a reference for improving China′s medical and health care risk prevention system.

ObjectiveTo clarify the evolutionary laws of syndromes and syndrome elements at different stages during the malignant transformation of chronic hepatitis B （CHB）. MethodsA total of 671 patients with hepatitis B virus infection， who were admitted to the outpatient and inpatient departments of Dongzhimen Hospital of Beijing University of Chinese Medicine and The Fifth Medical Center of Chinese PLA General Hospital from July 1st， 2020 to June 30th， 2021， were included， involving 120 cases of CHB， 340 cases of hepatitis B liver cirrhosis （HBLC）， 64 cases of precancerous lesions with hepatitis B liver cirrhosis （PLHC）， and 147 cases of hepatitis B liver cirrhosis with hepatocellular carcinoma （HCC）. A Survey form of traditional Chinese medicine syndrome during malignant transformation of chronic hepatitis B was designed， and the general information， auxiliary examination and the four examinations results were collected. Factor analysis and K-means clustering were used to determine and statistically analyze the syndrome and syndrome elements. ResultsFive traditional Chinese medicine （TCM） syndrome types were identified in CHB patients， while there were six TCM syndrome types in HBLC， PLHC and HCC stages. Among CHB patients， the main syndromes were liver constraint and spleen deficiency （53.33%） and liver-gallbladder damp-heat （21.67%）， and the dominant syndrome elements were qi stagnation （27.60%）， heat （17.71%） and qi deficiency （17.71%）. In the HBLC stage， the syndromes were mainly blood stasis obstructing the collaterals （23.83%） and liver constraint and spleen deficiency （22.35%）， with dominant syndrome elements being blood stasis （19.25%）， dampness （17.46%）， and qi deficiency （15.01%）. For the PLHC stage， the primary syndrome types were blood stasis obstructing the collaterals （29.68%） and liver-kidney yin deficiency （20.31%）， and the leading syndrome elements were blood stasis （22.12%）， yin deficiency （15.93%）， and qi deficiency （15.04%）. In the HCC stage， the syndrome was dominated by blood stasis obstructing the collaterals （33.34%） and liver-kidney yin deficiency （19.73%）， with the main syndrome elements being blood stasis （24.52%）， yin deficiency （16.09%）， and qi deficiency （15.33%）. During the progression of CHB to malignancy， there was a gradual decrease in excess syndromes including liver-gallbladder damp-heat and water-dampness internal obstruction from 21.67% to 19.04%. In contrast， deficiency syndromes including liver-kidney yin deficiency and spleen-kidney yang deficiency increased from 15.83% to 31.97%. Additionally， excess syndrome elements including qi stagnation， heat and dampness decreased from 59.89% to 34.48%， while deficiency syndrome elements including qi deficiency， yin deficiency and yang deficiency increased from 32.30% to 41.00%. ConclusionDuring the malignant transformation of CHB， there exists a progression of syndrome and syndrome elements， shifting from qi stagnation， heat and qi deficiency to blood stasis （predominantly excess）， dampness and qi deficiency， and then to blood stasis （predominantly deficiency）， yin deficiency and qi deficiency， characterized by “deficiency-excess complex， and shift from excess to deficiency”.