Objective To evaluate the accuracy of BIS value for monitoring the depth of sevoflurane-nitrous oxide in children. Methods Seventy-two ASA Ⅰ or Ⅱ children aged 1-14 yr undergoing abdominal surgery were randomly assigned into 3 groups ( n = 24 each) :sevoflurane group (group S), sevoflurane + 30% N2O group (group SN1 )and sevoflurane + 60% N2O (group SN2 ). Anesthesia was induced with atropine, lidocaine, propofol, rocuronium and remifentanil. After tracheal intubation, the patients were mechanically ventilated. PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with 2.5% sevoflurane combined with 0, 30% and 60% nitrous oxide in group S, SN1 and SN2 respectively. The end-tidal sevoflurane concentration (CETSev) was maintained at 2.5%, 2.0% and 1.5%. Each CETSev was maintained for at least 10 min after the begining of the surgery. Then the CETSev was modified to maintain BIS value at 40-60. BIS value was recorded before anesthesia induction and each stable CETSev. CETSev was recorded at maintaining BIS value of 40-60 for at least 20 min ( C50 ).Results BIS value and C50 were significantly lower in group SN2 than in group S and SN1 ( P ＜ 0.05), while no significant difference was found between group S and SN1 ( P ＞ 0.05). BIS value was negatively correlated with CETSev in all 3 groups (r = -0.736, -0.817, -0.729, P ＜ 0.01).There was no significant difference in the correlation coefficients among the 3 groups ( P ＞ 0.05 ). Conclusion BIS value can accurately reflect the depth of sevoflurane-nitrous oxide anesthesia in children.

Objective To investigate the effect of surround needling at articular six meridians plus finger (toe) tip bloodletting therapy on sciatic nerve conduction velocity and lower limb microcirculatory flow in diabetic rats. Method The model was made with streptozotocin. The rats were allocated to model, methycobal, acupuncture and normal groups. The methycobal group received a muscular injection of 50 ?g/kg in the left and right lower limbs alternately, every other day. The acupuncture group received acupuncture at points Taixi(KI3), Kunlun(BL60) and Jiexi(ST41), once daily plus toe tip bloodletting. The normal and model groups were bound 30 min once every other day. Every group was treated for eight weeks. General condition was observed, and sciatic nerve conduction velocity and lower limb microcirculatory flow were measured in the rats before and after treatment. Result Compared with the normal group, sciatic nerve conduction velocity decreased in the other groups of rats (P<0.01). Compared with the model group, sciatic nerve conduction velocity was higher in every treatment group of rats (P<0.05). Conclusion Surround needling at articular six meridians plus finger (toe) tip bloodletting therapy can increase sciatic nerve conduction velocity and improve lower limb microcirculation.

Objective To investigate impact of admission renal dysfunction on in-hospital and longterm outcome of patients with ST-elevation myocardial infarction (STEMI).Methods This was a multicentre,observational,prospective-cohort study.Totally 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI.Estimation of glomerular filtration rate (eGFR) was calculated according to the abbreviated MDRD equation.The patients were categorized into two groups as renal preservation group(eGFR ≥60 ml · min-1 · 1.73 m-2) and renal dysfunction group(eGFR ＜ 60 ml ·min-1 · 1.73 m-2).The association between admission renal dysfunction and in-hospital and six-year outcome was evaluated.Results A total of 718 patients with STEMI were evaluated.There were 551 men and 167 women with age of (61.0 ± 13.0) years.One hundred and thirty-three patients(18.5％) had renal dysfunction.Patients with renal dysfunction were more often female and older,more patients had hypertension,diabetes and heart failure,and more patients had ≥ Killip Ⅱ classes on admission.These patients were less likely to present with chest pain.The in-hospital mortality(16.5％ vs 2.6％,P＜0.001),major adverse cardiac events(MACE) (60.9％ vs 24.4％,P ＜0.001),six-year all-cause mortality(35.3％vs 11.4％,P ＜ 0.001),six-year cardiac mortality (15.9％ vs 5.7％,P =0.001) and six-year MACE (52.4％ vs 28.0％,P ＜ 0.001)were markedly increased in renal dysfunction group than in renal preservation group.After adjusting for other confounding factors,renal dysfunction was an independent predictor of in-hospital MACE (OR 2.120,95％ CI 1.563-2.878,P =0.003),six-year all-cause mortality (RR 2.122,95％ CI 1.127-3.996,P =0.020) and six-year MACE(RR 1.586,95％ CI 1.003-2.530,P =0.047).Conclusions The mortality and MACE in STEMI patients with renal dysfunction were higher than in those with preserved renal function.Renal dysfunction evaluated by eGFR on admission is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

ObjectiveTo compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children.MethodsNinety-two ASA Ⅰ or Ⅱ children (46 cases aged 1-3 yr and 46 cases aged 4-6 yr) scheduled for elective general or urologic surgeries,were enrolled in this study.The children were randomly divided into 2 groups (n =46 each):midazolam group (group M) and dexmedetomidine group (group D).The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 min before induction of anesthesia,and midazolam 0.1 mg/kg òr dexmedetomidine 1 μg/kg was infused intravenously over 10 min.Anesthesia was induced with proporol-rocuroniume-remifentanil,and maintained with sevoflurane-remifentanil-rocuroniume.Modified Yale Preoperative Anxiety Scale (mYPAS) score,sedation score,HR,mean arterial pressure (MAP),respiratory rate (RR) and SpO2 were recorded before premedication (T1),before separation from their parents (T2) and when entering the operating room (T3).The incidence of sleep (a sedation score of 4) was recorded at T2,3.The end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also retorded.ResultsCompared to that at T1,the mYPAS score was significantly decreased at T2,3,and the sedation score was significantly increased at T2,3 in both groups ( P ＜ 0.05),HR at T2 and MAP at T2,3 were significantly decreased in group D,and HR at T3 was significantly increased in group M ( P ＜ 0.05 ).Compared to group M,the sedation scores and the incidence of sleep were significantly increased at T2,3,and the HR was significantly decreased at T2 in group D ( P ＜ 0.05).There was no significant difference in the mYPAS score,RR,MAP,SpO2,end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiting rescue analgesic,and incidence of adverse effects between D and M groups ( P ＞ 0.05).ConclusionThe sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children,but it exerts much influence on hemodynamics,and the changes in hemodynamics should be noted.

Objective To compare the efficacy of closed-loop infusion of propofol for surgery in pe-diatric patients of different ages. Methods Forty-five pediatric patients of both sexes, weighing 10-63 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective urologic sur-gery under general anesthesia, were divided into 3 groups(n=15 each)according to the age: infant group (1-3 yr), pre-school group(4-6 yr)and school-age group(7-12 yr). The bispectral index(BIS)moni-tor was connected to the closed-loop anesthesia delivery system, and the system automatically regulated the target plasma concentration of propofol to achieve a target BIS value of 45-55 during maintenance of anes-thesia. Remifentanil was given by target-controlled infusion at a target plasma concentration and rocuronium was intravenously injected when necessary during surgery. BIS40-60time percentage(percentage of time of BIS value maintaining at 40-60 in time of closed-loop infusion), median performance error(MDPE), me-dian absolute performance error(MDAPE), wobble and global score were recorded. The consumption of propofol, mean target plasma concentration and regulating frequency and consumption of remifentanil and rocuronium were recorded during surgery. Extubation time or laryngeal mask airway removal time, time to eye-opening and time of regaining consciousness were recorded. Results The BIS40-60time percentage was significantly higher, MDPE, MDAPE, wobble and global score were lower in pre-school and school-age groups than in infant group(P<005). Compared with pre-school group, the consumption of remifentanil was significantly decreased(P<005), and no significant change was found in BIS40-60time percentage, MDPE, MDAPE, wobble or global score in school-age group(P>005). There was no significant differ-ence in the consumption of propofol, mean target plasma concentration, regulating frequency, consumption of rocuronium, extubation time or laryngeal mask airway removal time, time to eye-opening or time of regai-ning consciousness among the 3 groups(P>005). Conclusion Closed-loop infusion of propofol produces better stability for surgery in pre-school and school-age children than in infants.

BACKGROUNDNumerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes. These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China. The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.

METHODSThis was a multicenter, observational, prospective-cohort study. 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI, between January 1,2006 and December 31,2006. Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients. The patients were categorized according to eGFR, as normal renal dysfunction (eGFR ≥ 90 ml·min -1·1.73 m -2 ), mild RI (60 ml·min -1·1.73 m -2 ≤ eGFR < 90 ml·min -1·1.73 m -2 ) and moderate or severe RI (eGFR < 60 ml·min -1·1.73 m -2 ). The association between RI and inhospital and 6-year mortality of was evaluated.

RESULTSSeven hundred and eighteen patients with STEMI were evaluated. There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years. Two hundred and eighty patients (39.0%) had RI, in which 61 patients (8.5%) reached the level of moderate or severe RI. Patients with RI were more often female, elderly, hypertensive, and more patients had heart failure and stroke with higher killip class. Patients with RI were less likely to present with chest pain. The inhospital mortality (1.4% vs. 5.9% vs. 22.9%, P < 0.001), 6-year all-cause mortality (9.5% vs. 19.8 vs. 45.2%, P < 0.001) and 6-year cardiac mortality (2.9% vs. 12.2% vs. 23.8%, P < 0.001) were markedly increased in patients with RI. After adjusting for other confounding factors, classification of admission renal function was an independent predictor of inhospital mortality (Odd ratio, 1.966; 95% confidence interval [CI], 1.002-3.070, P = 0.019), 6-year all-cause mortality (relative risk [RR] = 1.501, 95% CI: 1.018-4.373, P = 0.039) and 6-year cardiac mortality (RR = 1.663, 95% CI: 1.122-4.617, P = 0.042).

CONCLUSIONSRI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

Aged ; Female ; Glomerular Filtration Rate ; physiology ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; physiopathology ; Renal Insufficiency ; mortality ; physiopathology

Objective:To explore one-stage total knee arthroplasty (TKA) combined with open reduction and internal fixation (ORIF) for knee osteoarthritis complicated with tibial stress fracture.Methods:The 3 patients were retrospectively analyzed who had been treated for knee osteoarthritis complicated with tibial stress fracture at Department of Orthopedics, Ganzhou District People＇s Hospital from March 2018 to March 2020. They were all female, aged from 54 to 76 years (average, 66 years). There were 2 transverse fractures and one short oblique fracture; all of them had knee varus deformity. The Hospital for Special Surgery (HSS) scores averaged 37.6 (from 28 to 50) for the left knee and 28.3 (from 22 to 39) for the right knee. One-stage TKA was performed for the articular surface while ORIF for the right tibial stress fracture for all patients. Recorded were fracture union time, HSS knee score and range of articular motion.Results:The 3 patients were followed up for 25 to 44 months (average, 32 months).The fracture union time ranged from 4 to 7 months (average, 5 months). The last follow-ups revealed no such complications as prosthesis loosening, peri-prosthesis osteolysis or joint instability. Knee varus deformity was corrected in all patients. The HSS knee scores at the last follow-up averaged 89.6 (from 88 to 91) for the left knee and 88.3 (from 85 to 90) for the right knee.Conclusion:In the treatment of knee osteoarthritis complicated with tibial stress fracture, one-stage TKA combined with ORIF can restore the function of knee joint, leading to fine curative effects.

Objective Using Z-score to assess the prevalence of proximal aorta dilatation in middle-aged and aged individuals during routine transthoracic echocardiogram examinations and to identify its risk factors. Methods A total of 823 middle-aged or elderly patients on routine transthoracic echocardiogram examinations were consecutively enrolled. The internal diameters of the sinus of Valsalva (SoV ) and the ascending aorta (AA ) were measured. Z-scores were calculated according to the proposed equation for SoV and AA. A dilated aortic root was defined as a Z-score ≥1.96 or the diameter of SoV or AA ≥ 40 mm. The prevalence of proximal aorta dilatation and associated factors were analyzed. Results The prevalences of proximal aorta dilatation ,SoV dilatation ,and AA dilatation were 26.1%(25/823 ) ,6.0%(49/823 ) ,and 23.7%(195/823 ) , respectively.In the aortic root dilatation group ,age and the proportion of obesity were higher (both P＜0.05) ,and there were more female subjects (30.5% or 117/384 vs.22.3% or 98/439 ,P＜0.01) . The incidences of left atrial dilation ,left ventricular dilation ,left ventricular hypertrophy ,and aortic regurgitation in the aortic root dilatation group were higher than those in the non-aortic root dilatation group(P＜0.05 ) .Logistic regression analysis demonstrated that sex (OR＝ 1.827 ,95% CI :1.248-2.673 ,P＝0.002) ,hypertension (OR＝1.441 ,95% CI :1.000-2.075 ,P＝0.050)and left ventricular hypertrophy (OR＝1.827 ,95% CI :1.248-2.673 ,P＝0.002)were independently correlated with aortic root dilatation. Conclusions The prevalence of proximal aorta dilatation is high in middle-aged and aged individuals. Proximal aorta dilatation is related to sex ,age ,and body size ,and it is often accompanied by structural abnormalities of the heart.

Proteomic characterization of plasma is critical for the development of novel pharmacodynamic bio-markers.However,the vast dynamic range renders the profiling of proteomes extremely challenging.Here,we synthesized zeolite NaY and developed a simple and rapid method to achieve comprehensive and deep profiling of the plasma proteome using the plasma protein corona formed on zeolite NaY.Specifically,zeolite NaY and plasma were co-incubated to form plasma protein corona on zeolite NaY(NaY-PPC),followed by conventional protein identification using liquid chromatography-tandem mass spectrometry.NaY was able to significantly enhance the detection of low-abundance plasma proteins,minimizing the"masking"effect caused by high-abundance proteins.The relative abundance of middle-and low-abundance proteins increased substantially from 2.54％to 54.41％,and the top 20 high-abundance proteins decreased from 83.63％to 25.77％.Notably,our method can quantify approxi-mately 4000 plasma proteins with sensitivity up to pg/mL,compared to only about 600 proteins iden-tified from untreated plasma samples.A pilot study based on plasma samples from 30 lung adenocarcinoma patients and 15 healthy subjects demonstrated that our method could successfully distinguish between healthy and disease states.In summary,this work provides an advantageous tool for the exploration of plasma proteomics and its translational applications.