Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.

Objective:To construct and evaluate T7 phage display cDNA library from synovium of rheumatoid arthritis patients.Methods:Total RNA was extracted from pooled RA synovium by Trizol reagents.Messenger RNA was isolated from total RNA by oligo (dT)-conjugated Oligotex particles,and then,the agarose gel electrophoresis showed the range of mRNA size.After mRNA was reverse-transcribed into double-stranded cDNA,end modification,adaptors ligation and EcoR Ⅰ and Hind Ⅲ digestion were performed.After eliminating excess adaptors and small fragments(less than 300 bp),the cDNA was ligated into T7Select 10-3 vector.The RA synovium phage display cDNA library was constructed by package reaction in vitro and plate proliferation.Plaque assay and PCR were used to evaluate the library.Results:We showed that complexity of the library was about 2?107,and the phage titer of the amplified library was 8.9?10 10 pfu/ml.Insert ratio was proved to be 90% with the range of 300-2 000 bp inserts.Meanwhile,a target cDNA gene of BiPwas probed with PCR amplification.Conclusion:The phage display cDNA library from synovium was construted with high quality and can be used as a valuable source in screening of RA self-antigens.

Objective To investigate the sensitivity and specificity of anti ? fodrin polypeptide antibody in Sjgren′s syndrome (SS) patients.Methods Synthesized ? fodrin polypeptide was used as substrate in enzyme linked immunosorbent assay (ELISA) to detect the specific antibody in sera of SS and other rheumatic diseases.Results Antibody against ? fodrin polypeptide were detected in 73% of patients with primary SS,40% of patients with secondary SS,19 5% of patients with SLE,29 5% of patients with RA,and 3 8% of normal blood donors.The positive rates of ? fodrin polypeptide antibody in primary and secondary SS (73% and 40%,respectively) were significantly higer than those in SLE,RA and normal controls ( P

Objective To observe the influence of different tumor resection extent on facial nerve function and tumor recurrence in acoustic neuroma surgery.Methods A total of 118 patients with acoustic neuroma operated by the same surgeon from January 2009 to December 2015 were enrolled retrospectively.All patients were treated via suboccipital retrosigmoid transmeatal approach.The neartotal resection strategy was used during operation.Part of the tumors closely adhered to the facial nerveswere not removed forcibly.If there was tumor residue partly,the internal auditory canal was not drilled open.The relationship between facial nerve function or tumor recurrence and tumor resection degree was analyzed.The patients with recurrent tumor were treated with Gamma knife.Results In 118 patients,1 patient (0.8％) died during the operation.The follow-up time ranged from 8-90 months.The total resection rate of acoustic neuroma was 19.5％ (23/118),the near-total resection rate was 74.6％(88/118),and subtotal resection rate was 5.9 ％ (7/118).The recurrence rate was 16.1％ (19/118),in total resection group was 0,in near-total resection group was 15.9％ (14/88),in subtotal resection group was 5/7,there was significant difference (x2 =21.980,P ＜ 0.01).The good rate of facial nerve function after procedure was 90.7％ (107/118),in total resection group was 73.9％ (17/23),in near-total resection group was 95.5 ％ (84/88),in subtotal resection group was 6/7,and there was significant difference between total resection group and near-total resection group (x2 =14.168,P ＜ 0.05).After Gamma knife treatmentthe tumor volume increased again in 3 patients (2.5 ％) during the follow up period,and they were reoperated.Conclusions After near-total resection of acoustic neuroma,the assisted Gamma knife therapy may effectively control the growth of acoustic neuroma,and significantly improve the retention rate of facial nerve function.For the improvement of the quality of life,it is a feasible treatment scheme in the patients with tumors closely adhered to the facial nerves.

Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.

Objective: To compare moxibustion sensation and infrared thermography by the assessment of heat-sensitization on Guanyuan (CV 4) in patients with primary dysmenorrhea, and to prove the possibility of adopting infrared thermography as an objective demonstration of acupoints heat-sensitization. Methods: Seventy-one patients with primary dysmenorrhea were enrolled to receive moxibustion and infrared to detect the heat-sensitization of Guanyuan (CV 4). The results were then analyzed and compared. Results: The infrared radiation showed a lower temperature when the acupoint Guanyuan (CV 4) was sensitized in patients with primary dysmenorrhea. Compared with moxibustion sensation, its sensitivity rate (real positive rate) was 76.6%, divergence rate (real negative rate) was 70.1%, and the accuracy rate was 74.6%. After giving moxibustion to Guanyuan (CV 4), the infrared radiation area was significantly expanded longitudinally and transversely. Compared with moxibustion test, the sensitivity rate (real positive rate) of infrared test was 78.7%, divergence rate (real negative rate) was 83.3%, and the accuracy rate was 80.3%. Conclusion: To a certain extent, the heat-sensitization of the acupoint Guanyuan (CV 4) in patients with primary dysmenorrhea can be revealed by infrared thermography. The acupoint heat-sensitization phenomena (heat extension or transmission) after giving moxibustion to the heat-sensitized acupoints can also be demonstratedobjectively by infrared thermography, besides experienced subjectively by the receivers.

Objective: To explore the effect of valproic acid with different loading doses in treatment of children with status epilepticus. Methods: The data of children who were hospitalized in the intensive care unit of the Children′s Hospital Affiliated to Zhejiang University because of status epilepticus from January 1, 2013 to December 31, 2017 were collected.All the patients were divided into different groups according to loading dose of valproic acid.The effect were analyzed in different groups. Results: (1)There were 66 children with status epilepticus were admitted, including 35 males and 31 females.Among all children with status epilepticus, the etiology included epilepsy(n=36, 54.5%), intracranial infection(n=16, 24.2%), hypoxic asphyxia (n=3, 4.5%), intracranial tumor(n=2, 3.0%), abnormal brain development(n=2, 3.0%), intracranial hemorrhage(n=2, 3.0%), and etiology was not clear(n=5, 7.6%). (2)All children with status epilepticus were divided into four groups according to different valproic acid loading dose(0 mg/kg, 10-15 mg/kg, 16-39 mg/kg, 40 mg/kg). There are no significant differences in gender and age among groups.There were no significant differences in duration of status epilepticus and epileptic treatment efficiency(P=0.402, 0.034). (3)All children were monitored for liver function after the treatment of sodium valproate, and no patient had been found increased alanine aminotransferase. Conclusion There are no significant differences in the effect of different valproic acid loading doses in children with status epilepticus, and no adverse side effects are observed in children with status epilepticus who received a dose of 40 mg/kg.

Objective:To evaluate the real-world short-term effectiveness of ixekizumab in the treatment of psoriasis, and to investigate factors influencing the effectiveness.Methods:Baseline data and short-term effectiveness evaluation results were retrospectively collected from patients with psoriasis, who received ixekizumab treatment in Department of Dermatology, Xiangya Hospital from November 2019 to September 2021. A descriptive analysis was performed on the baseline characteristics of patients, continuous data were described as median (lower quartile, upper quartile), and categorical data were described as percentages. Comparisons of disease severity scores before and after the treatment with ixekizumab were performed using Wilcoxon signed-rank test or paired McNemar test. Multivariable logistic regression analysis was conducted to explore factors influencing the effectiveness of 4-week ixekizumab treatment.Results:A total of 118 patients with psoriasis were included, including 94 males and 24 females, and their age [ M ( Q1, Q3) ] was 43.4 (32.5, 53.0) years; plaque psoriasis (99 cases, 83.9%) and severe psoriasis (72 cases, 68.6%) predominated among the 118 patients, and skin lesions were mainly located on the scalp (59/116, 50.9%). Among the 49 patients who had received 2-week ixekizumab treatment, 27 (55.1%) achieved a 50% improvement in the psoriasis area and severity index (PASI) score (PASI50) ; after 4-week treatment, 44 (89.8%), 30 (61.2%), 13 (26.5%) and 10 (20.4%) patients achieved PASI50/75/90/100 respectively, and their PASI scores (2.1 [1.1, 7.1]), involved body surface area (3.9% [0.5%, 14.5%]), dermatology life quality index scores (1.0 [0.0, 2.0]) and physician global assessment (PGA) scores (1.0 [1.0, 3.0]) were significantly lower than the corresponding scores at baseline (12.4 [8.8, 23.2], 22.0% [11.3%, 43.4%], 6.0 [3.0, 11.0], 4.0 [3.0, 5.0], respectively; all P < 0.001]. Multivariable logistic regression analysis showed that the baseline body mass index was significantly associated with the PASI75 response rate ( OR = 0.814, 95% CI: 0.659 - 0.958, P = 0.029) and the proportion of patients with PGA0/1 ( OR = 0.743, 95% CI: 0.562 - 0.917, P = 0.017) after 4-week ixekizumab treatment, and the baseline BSA score was significantly associated with the proportion of patients with PGA0/1 after 4-week ixekizumab treatment ( OR = 0.924, 95% CI: 0.870 - 0.968, P = 0.003) . Conclusion:The 4-week ixekizumab treatment significantly decreased the severity of psoriasis, and may be more effective in patients with lower disease severity and lower body mass index at baseline.

Objective To analyze the relationship between the level of serum ferritin (SF)and the severity of community acquired pneumonia (CAP)in children,and to explore the timing of glucocorticoid therapy for children with CAP.Methods Retrospective analysis was performed on the clinical data of 738 children with CAP who were hospitalized at the Department of Respiratory,Beijing Children's Hospital,Capital Medical University from January 2014 to December 2015.All patients were divided into a mild group and a severe group based on the severity of CAP,and the levels of SF,C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC) and D-dimer were compared between the 2 groups.In addition,the analysis of receiver operating characteristic (ROC) curve was performed to study the usefulness of SF as severity indicators for CAP,and to learn the relationship between the level of SF and the glucocorticoid therapy in children with CAP.Simultaneous analysis of SF and CRP,WBC,ESR,D-dimer was made at the same time.Results (1) There were all 738 children enrolled into this study.There were 442 children in the mild group and 296 children in the severe group.There was no significant difference in age and sex between the mild group and the severe group(all P ＞ 0.05).(2)Comparisons between the mild group and the severe group were as follows:days of hospitalization [10.0 (9.0,13.0) days],duration of fever [10.0 (7.0,10.0) days] and heat peak [39.9 ℃ (39.1 ℃,40.1 ℃)] in the severe group,which had significant differences than those in the mild group [days of hospitalization 7.0 (6.0,9.0) days,duration of fever 7.0 (5.0,10.0) days and heat peak 39.3 ℃ (39.0 ℃,39.8 ℃)] (all P ＜ 0.05).The levels of SF [229.0 (150.0,436.2) μg/L],CRP [30.00 (9.84,78.20) mg/L],WBC [8.44 (5.91,12.6) × 109/L],ESR [30.5 (16.0,49.0) mm/1 h] and D-dimer [0.871 (0.317,2.532) μg/L] in the severe group were significantly higher than those in the mild group [SF:98.0 (68.2,136.1)μg/L,CRP:11.50 (5.77,11.50) mg/L,WBC:7.59 (5.87,10.1) × 109/L,ESR:23.0 (13.0,36.3) mm/1 h and D-dimer 0.232 (0.159,0.407) μg/L],and the differences were statistically significant (all P ＜ 0.05).(3) The levels of SF [258.5 (177.8,404.9) μg/L] and CRP [8.0 (8.0,16.5) mg/L] in CAP children in the recovery phase were significantly lower than those in the acute phase [SF:912.1 (418.7,1 380.3) μg/L,CRP:47.4 (18.8,105.8)mg/L].(4)The level of SF had significantly positive correlations with CRP,ESR,D-dimer (r =0.485,0.286,0.611,all P ＜ 0.05).(5) The cutoff value for SF,D-dimer for diagnosing severe pneumonia was 168.0 μg/L (sensitivity 70.6％,specificity 86.2％),and 0.616 μg/L (sensitivity 58.1％,specificity 87.1％).(6) There were 17.2％ cases (76/442 cases) in the mild group and 52.7％ cases (159/296 cases) in the severe group who received systemic glucocorticoid therapy.Conclusion The level of SF was correlated with the severity of CAP in children,and the level of SF in patients in recovery phase was significantly lower than that in the acute phase.When SF ≥ 168.0 μg/L,D-dimer ≥0.616 μg/L,attention should be paid to the possibility of severe CAP,regarding the indication for systemic steroid therapy for CAP in children.

【Objective】 To conduct Rh blood group serological testing and third-generation sequencing(TGS) on 22 RhD variant voluntary blood donors in Chongqing and explore the phenotypic distribution and genotyping of RhD variants in Chongqing. 【Methods】 From January to August 2023, individuals who participated in blood donation in our blood center were selected as the study objects. RhD variant phenotype identification was performed using routine serological methods. Once the RhD variants were identified, tests on different antigenic epitopes of RhD were conducted using a D-screen assay kit. Furthermore, after the genomic DNA from 22 RhD variant blood samples was extracted, imbraided primers design and multi-segment amplification and splicing were used to sequence the full-length RHD gene for TGS. The RHD gene sequence was analyzed using SnapGene software. 【Results】 Among the 22 RhD variants, 8 were DVI type 3 (36.36%), with the main mutation of RHD-CE (3-6)-D hybrid allele. Six cases (27.27%) showed partial weak D15 type, with the main mutation of c.845G>A. There were 6 cases of Asia type Del (27.27%), with the main mutation of c.1227G>A. One case was weak D17 type with a mutation of c.340C>T and 1 case speculated to be partial D (c.491A>T, p. Asp164Val, missense mutation). 【Conclusion】 The most common RhD variant phenotype among blood donors in Chongqing is DVI type 3, and the full-length haplotype sequence of RHD variant alleles can be obtained by Pacific Bioscience single-molecule real-time sequencing(SMRT).