Objective To investigate the effect of sodium citrate on the efficacy of oral midazolam premedication in children with congenital heart disease. Methods Forty ASA Ⅱ or Ⅲ children, aged 2-6 yr, weighing 12-20 kg, undergoing cardiac surgery, were randomly divided into 2 groups (n = 20 each): control group (gronp C) and sodium citrate group (group S). Group S received oral mixture of midazolam 0.12 ml/kg (0.6 my/kg), ketamine 0.12 ml/kg (6 my/kg), glucose 0.12 ml/kg (60 mg/kg) and sodium citrate 0.12 ml/kg (3 mg/kg), total volume 0.48 ml/kg. Group C received oral mixture of midazolam 0.12 ml/kg, ketamine 0.12 ml/kg and glucose 0.24 ml/kg, total volume 0.48 ml/kg. Hydrochloric acid (pH value 1.75) was mixed with the mixtures in the two groups and pH values were measured. Preoperative anxiety scale and the onset time,sedation score and parental separation score after receiving oral drugs were recorded in preparation room for anesthesia. After entering the operating room, HR, MAP and SpO2 were monitored, and the response to venepuncture in children and the adverse effects associated with oral drugs were also observed and recorded. Results The pH value was 1.97 in group C and 4.52 in group S. The parental separation score, sedation score and response score were significantly lower and the onset time was significantly shorter in group S than in group C. HR, MAP and SpO2 were in the normal range after entering the operating room. There was no obvious adverse effect after administration of oral drugs in the two groups. Conclusion Application of sodium citrate in the oral premedication in children with congenital heart disease can raise the pH value, shorten the onset time of midazolam, and enhance the sedative efficacy.

Objective To evaluate the effect of dexmedetomidine on the expression of antisense hypoxia-inducible factor-1α (aHIF-1α) during brain injury after asphyxial cardiac arrest and resuscitation in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),cardiac arrest and resuscitation group (group R) and dexmedetomidine group (group D).Asphyxial cardiac arrest and resuscitation were performed in R and D groups.The rats were tracheally intubated without clipping the trachea in group S.Dexmedetomidine 4 μg/kg was injected via the tail vein at 5 min before clipping the trachea in group D,while the equal volume of normal saline was given instead in S and R groups.Neurological deficit was assessed and scored (NDS) at 12,24,48 and 72 h after recovery of spontaneous circulation (T1 4).The rats were sacrificed after assessing neurological deficit at T4,brains were removed and hippocampi were isolated for determination of cell apoptosis (by TUNEL),HIF-1α expression (by Western blot) and expression of HIF-1α and aHIF-1α mRNA in hippocampal tissues (using polymerase chain reaction).Apoptosis rate was calculated.Results Compared with group S,the NDS at each time point and apoptosis rate of hippocampal neurons at T4 were significantly increased,and the expression of HIF-1α protein and mRNA and 5'aHIF-1α mRNA was up-regulated in R and D groups (P＜O.05).Compared with group R,the NDS at T2.4 and apoptosis rate of hippocampal neurons at T4 were significantly decreased,the expression of 5'aHIF-1α mRNA was down-regulated,and the expression of HIF-1α protein and mRNA was up-regulated in group D (P ＜ 0.05).Conclusion The mechanism by which dexmedetomidine reduces brain injury after asphyxial cardiac arrest and resuscitation is related to down-regulation of 5'aHIF-1α expression in rats.

Objective To analyze the differentially expressed genes between the NCAM + c-Kit +RBE and NCAM-c-Kit-RBE of intrahepatic cholangiocarcinoma (ICC) cell lines,and to screen out the differentially expressed genes that are related to the stem cell signaling pathways.Methods Magnetic activated cell sorting was used to isolate the NCAM + c-Kit +/NCAM-c-Kit-subset cells,and then Agilent Whole Human Genome Microarray Kit was used to test the difference in gene expressions between the NCAM + cKit + and NCAM-c-Kit-subset cells.The difference in gene expressions related to the stem cell signaling pathways was analyzed by the SAS system.The result of the microarray was further confirmed by RT-PCR.Results The total differentially expressed genes which could be found through gene microarray were 7270 [foldchange(fc) ≥2 or fc ≤0.5].Compared with the NCAM-c-Kit-RBE,3572 genes were upregulated while 3698 genes were downregulated.The differences in gene expressions related to the stem cell signaling pathways were 421 (fc ≥2 or fc ≤ 0.5),among which 231 genes were upregulated while 190 genes were downregulated.Conclusions High-flux microarray could be used to screen out lots of differentially expressed genes between the NCAM + c-Kit + and NCAM-c-Kit-RBE cells.The differences in gene expression in the stem cell signaling pathways could also be further analyzed using the SAS system.

Objective To explore the frequencies of MPL exon 10 mutations in JAK2 V617F-negative myeloproliferative neoplasms patients. Methods MPLW515K/L was processed through allele-specific PGR combined with direct sequence analysis. The mutations of others MPL exon 10 were detected by single strand conformation polymorphism PGR (PCR-SSCP) combined with direct sequencing. Results Of the 103 patients with JAK2 V617F-negtive myeloproliferative neoplasms patients, 1 carried MPLW515K mutation (TGG→AAG)in PMF; 1 was found to have new mutation (CTGGTGATCGCT insert) in ET and have homozygous mutation. Conclusion JAK2 V617F-negtive myeloproliferative neoplasms patients carried additional mutations in addition to W515K/L mutations in MPL exon 10, but its frequency of mutation is low.

Objective To investigate the expression of nuclear factor erythroid-2 related factor 2 (Nrf2) gene in chronic myeloid leukemia (CML) and explore its relationship with clinical characteristics and thioredoxin reductase (TrxR).Methods The expressions of Nrf2 and TrxR genes in bone marrow cells and K562 cells were analyzed in 30 bone marrow preparations of CML patients in different phases,including 20 in chronic phase,3 in accelerated phase,7 in blastic phase by real-time quantitative polymerase chain reaction.Ten health subjects were served as normal controls.Results The relative quantitation expression of Nrf2 and TrxR mRNA were 5.601±1.069 and 9.017±2.398 in chronic phase,1.698±0.349 and 5.590±1.015 in accelerated phase,1.252±0.807 and 5.050±1.469 in blastic phase,1.377± 0.344 and 1.867±0.977 in normal controls.The expressions of both Nrf2 and TrxR mRNA in CML had significant differences from those of the normal controls (x2 =14.680,P =0.002,x2 =8.271,P =0.041).The expression of Nrf2 mRNA in accelerated phase,blastic phase group showed no significant difference (Z =0.011,P =0.496),but lower than that in chronic phase group (Z =2.155,P =0.016,Z =2.534,P =0.006).The difference between the first visit and post-treated group was significant (Z =2.015,P =0.022).The expression in K562 cells and normal controls had significant difference (Z =1.898,P =0.029).In CML patients,the expression of Nrf2 was positively correlated with that of TrxR (r =0.738,P =0.037).Conclusion The expression of Nrf2 gene is higher in the first visit group of CML than that in the other groups,and is decreased after therapy,which may be the molecular marker predicting the progress of CML.Nrf2 mRNA expression level is correlated with TrxR.

Objective To identify the features of the NCAM+ c-Kit+ subset of hepatic progenitor cells in the intrahepatic cholangiocarcinoma (ICC) cell line RBE.Method Magnetic activated cell sorting was used to isolate NCAM+ c-Kit+/NCAM-c-Kit-subset cells,which were tested for hepatic progenitor cell properties and proliferation,colony formation,and invasive abilities in nude mice.Resuits The cell proliferation ability of NCAM+c-Kit+ subset cells was stronger than that of NCAMc-Kit-subset cells (P＜0.01).In serum-free condition,the number of colonies formed by NCAM+c-Kit+ subset cells was more than that of NCAM-c-Kit-cells (P＜0.01).1 × 104 NCAM+c-Kit+ cells were enough to form tumors in nude mice after subcutaneous inoculation for two weeks,while 1 × 106 NCAM-c-Kit-cells were necessary to form tumors for three weeks.The tumor formation rate of NCAM+c-Kit+ cells was higher than that of NCAM-c-Kit-cells (P=0.04).Conclusions It is possible that NCAM+c-Kit+ subset cells in RBE have the properties of hepatic progenitor cells,and NCAM combined with c-Kit might be a valuable marker for isolating and purifying ICC stem/progenitor cells.

Objective To obtain the data of injury among children aged 0~6 years in Haidian area and Pinggu area of Beijing.Methods A total of 2970 children aged 0~6 years in Haidian District(city area) and 2558 in Pinggu District (rural area)were investigated by cluster sampling method.Results A total of 5528 children were investigated,the incidence of injury was 8.64%.The incidence rate of aged 0~6 years child injury in Haidian District was10.54%,which was much higher than that in Pinggu District (6.45%).The top five causes of injury were falls,animal bites,burn/scalds,injury by sharp articles and struck/hit by falling object in Pinggu District.The top five causes of injury were falls,animal bites,injury by sharp articles,burn/scalds and blunt in Haidian District.the sequences of injury were similar between the two districts.The incidence rate of burns/scalds was higher in Pinggu District than that in Haidian District.The types of injury were little different between children who lived at home and children who lived in kindergarten.The types of injury were not too different between genders.Falls was the leading cause of injury for all children(in cities or in countries,boys and girls,in different age group).Conclusion The incidence rates of injury and types of injury are different in different areas,genders and age groups.So the intervention of injury should be different.

OBJECTIVETo investigate whether A118G single nucleotide polymorphisms of the µ-opioid receptor (OPRM1) affects epidural patient-controlled analgesia with fentanyl after caesarean section.

METHODSA total of 100 pregnant women (ASA class I or II) scheduled for elective caesarean section were enrolled in this study. All the patients received spinal-epidural anesthesia and were screened for blood A118G polymorphism. Epidural patient-controlled analgesia with fentanyl was provided postoperatively. The pain scores, incidence of nausea and vomiting, and total self-administered epidural fentanyl dose within 48 h postoperatively were recorded.

RESULTSNinety-six patients were finally included in this study. The percentages of the genotypes AA, AG, and GG were 36.5% (35 cases), 46.9% (45 cases), and 16.7% (16 cases), respectively. At 12 and 24 h postoperatively, the pain scores and the total fentanyl dose administered were significantly higher in group GG than in groups AA and AG.

CONCLUSIONA118G single nucleotide polymorphism affects pain relief and total fentanyl dose administered in epidural patient-controlled analgesia after caesarean section. G118 homozygotes have a poorer response to fentanyl than A118 homozygotes or heterozygotes.

Adult ; Analgesia, Epidural ; Cesarean Section ; Female ; Fentanyl ; administration & dosage ; Genotype ; Humans ; Pain Measurement ; Pain, Postoperative ; Polymorphism, Single Nucleotide ; Pregnancy ; Receptors, Opioid, mu ; genetics ; Young Adult

Objective To investigate the current situation of medical students' individual career management and its educational status.Methods Self-made questionnaire was used to investigate the present situation of individual career management and education of medical students in a medical college in November 2016.SPSS 20.0 was used for analyzing descriptive statistical analysis,t test and rank test in questionnaire data.From April to May 2017,30 students were randomly selected for interviews to explore the current situation of medical students' individual career management.Result 900 questionnaires were issued and 816 valid questionnaires were collected,and the recovery rate was 90.67％.Whether medical students accept the relevant education had significant difference in their career management ability (P＜ 0.05),30.15％ of the students who received the relevant education (246) had a higher total score of their own career management than those who had not received,which was reflected in social work environment cognition level,participation in extracurricular activities,consideration of graduation and stage goals setting.It is learned from the interview that most medical students lack clear self-awareness and professional goals are vague,and they fail to form a good personal career management atmosphere.Conclusion Individual career management education promotes the cognitive level of social work environment of medical students and then develops their self-awareness.At the same time,it urges medical students to participate in extracurricular activities,to consider the whereabouts after graduation,to set phased goals,and to carry out targeted self-improvement.The comprehensive development of self-cognition and self-improvement finally make the medical students' individual career management ability continuously improved.

Objective To investigate the effects of different depths of anesthesia on incidence of postopera-tive cognitive dysfunction (POCD). Methods We systematically retrievedPubmed,OVID,CNKI,CBM and Wanfang database and VIP database for randomized controlled trials(RCTs)from inceptionto December 312016, comparing different depths of anesthesia for their impacts on incidence of early POCD. After data extraction and quality evaluation,Revman 5.3 software was used for statistical data analysis. Results A total of 714 patients in 8 eligible RCTs were identified. Results of meta-analysis were as follows.(1)Incidence of POCD of depth anesthesia (NTS=E0-E1)was lower than general anesthesia(NTS=D0-D1)1 d after surgery(OR=0.21,95%CI 0.13~0.35,P < 0.00001).(2)Incidence of POCD of depth anesthesia(NTS = E1)was lower than general anesthesia (NTS=D0)7 d after surgery(OR=0.45,95%CI 0.23~0.91,P=0.03).(3)Incidence of POCD of NTS=E1 was lower than NTS=D07d after surgery(OR=0.42,95%CI 0.24~0.71,P=0.001). Conclusion Comparedwith general anesthesia,depth anesthesia is associated with a lower incidence of early POCD.