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.

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.

To study the effects of connective tissue mast cells ( CTMCs ) on T cell activation in an antigen-dependent manner.Methods: Connective tissue mast cells were differentiated from mouse bone marrow cells.Alexa Fluor 488-conjugated ovalbumin (OVA)/IgG immune complexes were generated and incubated with CTMCs ,and analyzed by flow cytometry to detect the antigen uptake by CTMCs via Fcγreceptors ( FcγRs ).The relevant effects on antigen-specific T cell activation and proliferation were further determined by CD 69 and Ki67 expression.Results: A magnificent increase in OVA uptake was seen in CTMCs treated with OVA/IgG immunocomplex after 24-hour incubation ,compared with that treated with fluorescent OVA alone.OVA-incorporated mast cells induced OVA-specific CD4+T-cell activation and proliferation.Conclusion:It was suggested that the binding of IgG receptor FcγRs could elicit CTMCs reaction and ,as a result,to mediate crosstalk between professional APCs and T cells.

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 understand drug use in children with common cold through comments on prescription and drug analysis,and to provide theoretical basis for standardizing medical treatment and promoting rational drug use.Methods A retrospective survey method was applied.Prescriptions of common cold in the department of pediatrics from Oct.to Dec.2015 were reviewed,and Excel 2013 was used for statistical analysis.Rationality of drug use was evaluated based onhospital prescription review management specification (try out),instructions and consensus of related experts at home and abroad.Results The utilization rate of antibacterial drugs was 93.4％in children with common cold of our hospital,utilization rate of antiviral drugs was 59.7％,utilization rate of compound cold medicine was 96.4％,and the rate of combined utilization of more than two kinds of compound medicine was 65.7％.Excessive medicine for common cold existed and abuse of cold medicine,antimicrobial and antiviral drug,irational drug combination in this hospital.Conclusion Clinical doctors lack cognition to common cold and cold medicines.Hospital pharmacy department should take effective pharmaceutical interventions to improve the level of rational drug use.

CD72 is a B cell specific receptor that exists in multiple alternative splicing forms. Eight novel alternative splicing forms of CD72 were identified from the spleenocytes of BALB/C mice. Two very unique intron sequences were found in those alternative splicing forms. One kind of splicing variants retained the intron1 in the mRNA. This intron can be translated into 32 amino acid residues without changing the reading frame of the whole proteins. Another kind of splicing variants used an alternative 3' splice site in intron 3(3'AS) which led to premature termination of its encoded protein. The differential expression of the CD72 splicing variants were compared in BALB/C and NZB/W mice that were at different stage of systematic lupus erythematosis(SLE) disease development. It was found that 1) splicing forms containing 3'AS was rare in all samples examinated; 2) splicing forms containing two ITIM domains and transmembrane domains were more abundant in BALB/C mice than in NZB/W mice, even in some cases the two ITIM domains were separated by the intron 1; 3) a shorter splicing form with both exon2 and exon3 missing was expressed highly in terminally diseased NZB/W mice.These results suggested an important role of CD72 alternative splicing forms in B cell receptor signaling and in SLE.

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 To investigate different scoring systems in predicting the severity of acute pancreatitis(AP).Methods The clinical data of 1 56 patients with AP were retrospectively reviewed.Ser-um c-reactive protein(CRP)levels were measuredat admission.According to the Chinese guidelines for the management of acute pancreatitis(2007),all the patients were categorizedas either mild acute pancre-atitis(MAP)or severe acute pancreatitis(SAP).Ranson,acute physiology and chronic health evaluation (APACHE)-Ⅱ,bedside index for severity in acute pancreatitis(BISAP),and computed tomography se-verity index(CTSI)scoring systemswere calculated according to the corresponding grading standardsin all patients.Patients were divided into MAP group(APACHEⅡ <8,Ranson <3,BISAP <2,CTSI <3 and CRP <21 .4)and SAP group (APACHEⅡ≥8,Ranson≥3,BISAP≥2,CTSI≥3 and CRP≥21 .4)ac-cording to the scoring results.ROC curve was used to compare the difference among the systems.Results Among the 1 56 patients,21 (1 3.5%)were classified as SAP and 1 35 as (86.5%)MAP.AUCs for Ranson,BISAP,APACHEⅡ,CTSI,and CRP in predicting SAP were 0.69 (95%CI:0.62-0.76),0.74 (95%CI:0.66-0.80),0.78 (95%CI:0.70-0.84),0.69 (95%CI:0.61 -0.76),and 0.68 (95%CI:0.57-0.78),respectively.There were no significant differences among these scoring systems.Conclusion There were no significant differencesin predicting the severity of AP among these scoring systems. Therefore,the early prediction of SAP should consider multiple scoring systems,and the referential signifi-cance of accessing and applying a simpler laboratory indicator deserves further studies.

Objective To explore the influencing factors of hypotension in hemodialysis patients with end stage of diabetic nephropathy.Methods 106 patients of advanced diabetic nephropathy who received maintenance hemodialysis were selected in the present study.According to the patients'condition needs, chose different dialysis modes,dialyzers, dialysis blood flow and ultrafiltration rate, compared the frequency of occurrence of hypotension during treatment.Results By multivariate regression analysis,gender,dialysis mode,dialysis and blood flow had no correlation with hypotension during dialysis.The age, hemoglobin, serum albumin, cardiac function and individual ultrafiltration rate were correlated with the incidence of hypotension in patients with diabetic nephropathy.Individual-ized ultrafiltration rate was less than or equal to 10 mL · kg-1 · min-1 and individual ultrafiltration rate was up to 10 mL· kg-1 · min-1 ,the incidence rates of hypotension were 18.9% and 25.9%,the difference was statistically significant (χ2 =7.102,P<0.05).Conclusion Diabetic nephropathy patients during dialysis,ultrafiltration rate control individuals can effectively reduce the frequency of occurrence of hypotension during dialysis, hemodialysis patients may improve tolerability.