ERAS,namely enhanced recovery after surgery,refers to the implementation of optimized EBM (evidence-based medicine) measures comprised of preoperative preparation,anesthesia and postoperative management,in order to reduce psychological stress and physiological trauma,thus contributing to rapid recovery.Recently,researches focus mainly on adult ERAS and are rarely seen in pediatric surgeries.Considering the more sophisticated process children faced,it is urgent and strongly-needed to enforce optimization of perioperative management in pediatric surgeries.Difficulties and challenges exist in the process of ERAS in pediatric surgery,such as the break-through of traditional concepts,cooperation between departments of the anesthesiology and surgery,the fasting time issue,implementation of goal-di-rected fluid therapy,anesthesia method selection,analgesia mode and drug options.Prospective,multicenter clinical trials are needed to explore and solve the problems.In this paper,we review the present situation,difficulties,and prospects in ERAS of pediatric surgery.

10.3969/j.issn.1000-3606.2013.06.012

Cerebral small vessel diseases refer to small intracranial vascular lesions caused ischemic or hemorrhagic disease.Although researches have performed a large number of studies for its pathogenesis,it remains unclear now.This article reviews the pathogenesis of cerebral small vessel diseases from endothelial dysfunction,blood-brain barrier damage,ischemic and hypoperfusion,amyloid deposition,and genetic factor.

Objective　To evaluate the safety of biopsy of the prostate guided by transrectal ultrasound.Methods　Three hundred and seventeen patients suspected to have prostate cancer were examined and 208 patients were followed up.Results　One hundred and eighty-one patients followed up did not feel severe pain during the biopsy of the prostate. Clinical manifestations induded 12 cases of hematuria,4 dases of hematospermia,1 case of fever, 2 cases of pollakisuria and urodymia,2 cases of uroschesis,which disappeared after corresponding treatment.Conclusions　Biopsies of the prostate guided by transrectal ultrasound is advantageous in diagnosis of prostatic carcinoma.

Upper extremities dysfunction seriously impacted quality of life and independent self-care ability in patients after stroke. Transcutaneous electrical nerve stimulation has been proved to be an effective method for upper extremities dysfunction rehabilitation. Clini-cians focused to select the proper therapeutic method according to the patient's specific condition to accelerate the upper limb rehabilitation. This article summarized the clinical application researches of transcutaneous electrical nerve stimulation in stroke patients with upper ex-tremities dysfunction.

Objective:To explore the strain experiences by suicides and to test the strain theory of suicide.Methods：A consecutive sample of 155 suicides(91 males and 64 females)aged from 15 to 34 years was studied with the psychological autopsy method.Informants consisted of family members and close friends of the suicides.Suicide stories were composed based on the background information of the suicides and what happened at the suicide site and then content-analyzed and rated by independent judges.Results:All of the victims had experienced at least one type of strain before suicide took place.The sequence of the 4 types of strains beginning with the most frequent one was coping strain,100%;aspiration strain,81%,deprivation strain,72% and value strain,45%.Generally,males experienced more coping strains,especially loss of money or investment than females [(8.85±3.64)vs.(7.72±3.77),(0.35±0.92)vs.(0.09±0.52);Ps<0.05],except for the traditionalism and modernity for status of women,religion and atheism [(0.08±0.37)vs.(0.53±0.97),(0.00±0.00)vs.(0.06±0.30);Ps<0.05].As age increased,value strain tended to increase(r= 0.16,P=0.048),whereas aspiration strain tended to decrease(r= -0.30,P<0.001).Conclusion：With the prevalence of dissonant stresses among suicide victims,it is suggested that crisis intervention and suicide prevention should begin with strain reduction through psychological counseling and therapy.

Objective To construct and identify the shRNA plasmid vector targeting nuclear factor erythroid-2-related factor 2 (Nrf2),and to collect the strongest RNAi effect of Nrf2 shRNA sequence.Methods Nrf2 gene was targeted gene.Three shRNA sequences were designed by software and synthesized by chemical method: shRNA-1,shRNA-2 and shRNA-3.The double strand shRNA oligo was ligated to the vector.The construct was verified by sequencing analysis.BV2 cells were transfected with expressing shRNA plasmid vectors using Lipofectamine 2000.The expression of Nrf2 in the levels of mRNA was detected by real-time PCR,and Western Blot was adopted to abserve the expression of Nrf2 protein.Results Sequencing analysis suggested that the shRNA vectors targeting Nrf2 possessed correct nucleotide sequence and read frame.The result of Real-time PCR and Western Blot showed that the sequence of shRNAi-3 could more effectively knockdown the expression level of Nrf2 than the others.Conclusions The shRNA vectors targeting Nrf2 are successfully constructed and the shRNA can signidicantly inhibit the expression of Nrf2.These findings could provide an experimental basis for further study on Nrf2 signaling pathway in stroke field.

OBJECTIVE: We used electrophysiological methods to study that whether GABA could elicit OHCs outward currents provide evidence for exsitence of GABA-A receptor and investige the relationship between the effect of GABA and the development of OHCs. METHOD: We used whole-cell recording OHCs at current-clamp or voltage-clamp to verify the function of GABA receptor on OHCs. Then we counteds the responsive cells vs. total number cells, and according to results to study the relationships between the GABA receptor and development of OHCs. RESULT: OHC was elicited outward current or hyperpolarized by GABA and the responsive cells were decreased with development. CONCLUSION The result of GABA receptor decreasing with development suggested that the receptor may draw efferents to OHCs or facilitate the MOC-OHC synapse formation.
Animals ; Electrophysiological Phenomena ; Hair Cells, Auditory, Outer ; physiology ; Patch-Clamp Techniques ; Rats ; Receptors, GABA-A ; physiology ; gamma-Aminobutyric Acid ; physiology

With the development of genetics, more and more research has been focused on modal organisms because of the conservative nature of biological species. Saccharomyces cerevisiae is one of the most important model organisms widely used all over the world. Recently, works published in this journal from Tsinghua University revealed a role of YMR166C in mitochondrial magnesium homeostasis in Saccharomyces cerevisiae with transposon-based genetic screen. A genome-wide screening in Saccharomyces cerevisiae for suppressor genes of MTM1 also yielded some very interesting results. Those wonderful works indicated a new era in genetic studies in China.

Objective The study discussed the underlying mechanism of the impact of perceived social support on individual learning behavior from the perspective of the psychosocial impact theory .Methods 224 students majored in public management were involved ,and the dada was collected by questionnaires ,then the conceptual model was tested by moderate effect sequence of statistical analysis .Results The findings were as follows :Firstly ,perceived social support had a significant effect on individual learning behavior (β=0 .332 ,P<0 .01) .Secondly ,the relationship between perceived social support and individual learning behavior was moderated by self efficacy (β= -0 .216 ,P<0 .01) .Conclusion Perceived social support and self efficacy have moderate effect on individual learning behavior .