Neuromuscular blocking agents have been used for a variety of clinical conditions such as emergency intubation,acute respiratory distress syndrome,status asthmaticus,elevated intracranial pressure,etc.Neuromuscular blocking agents should be used and monitored appropriately according to evidence-based guidelines to reduce the adverse events associated with the use of neuromuscular blocking agents.

Objective:Based on the technology-organization-environment model and the theory of planned behavior, to construct a theoretical model for exploring the influencing factors of the adoption intention of hepatic contrast-enhanced ultrasound by clinicians in a medical alliance.Methods:By agency of self-administered scales, a questionnaire survey was conducted among the clinicians in liver disease-related departments of four medical alliances from Fujian and Jiangxi provinces between February and August, 2019.Results:Behavioral attitudes, subjective norms, perceived behavioral control, organizational atmosphere, and industry technical environment all had positive impacts on the clinicians′ intention to adopt hepatic contrast-enhanced ultrasound technology in medical alliances. The total influence of the five types of factors on the adoption intention of hepatic contrast-enhanced ultrasound was as follows: perceived behavioral control(0.779), subjective norms(0.635), industry technical environment(0.578), behavioral attitudes(0.359), and organizational atmosphere(0.218).Conclusions:It is recommended to strengthen the intention to adopt corresponding health technologies by providing adequate technical education and training, giving play to the leading role of core members, and building an organizational atmosphere of advocating technological innovation and communication.

Objective To explore the mechanism of immunologic injury in patients with Tourette's syndrome(TS). Methods The serum level of anti-brain antibody ( ABAb) , antinuclear antibody ( ANAb) , soluble IL-6 receptor (sIL-6R) and soluble gpl30(sgp130) in patients with TS were analyzed by commercially available ELISA kits,and the titer of anti-streptolysin O ( ASO) in TS and in control was examined with latex enhanced immunoturbidimetry. Results The level of sIL-6R and sgpl30 was significantly elevated in TS compared with control group [(44. 1 ± 15.8)ng/mL vs (30. 3 ± 9. 0) ng/mL and (69. 0 ±24. 6)ng/mL vs (47. 3 ±14. l)ng/mL,P <0. 01 respectively]. ASO titer(250 U/mL) was found higher in TS than that in control(P <0. 01). The positive rates of anti-brain an-tibody and antinuclear antibody in TS were higher than that in control group (66% vs 4% and 53% vs 25% , P <0. 01 respectively). The level of ABAb negatively correlated with sgpl30 concentration( r = 0. 375, P <0. 05 ). Conclusion IL-6 signal transduction might be involved in Tourette's syndrome to lead the function enhancementand start cascade of feedback inhibition, because of elevated levels of slL-6R, sgp130, ANAb and ABAb in serum.Autoimmune-related injuries may potentially explain the pathogenesis of the disease.

Rat models of diabetes were established by injecting streptozocin intraperitoneally.According to random number table,three groups were divided:normal group,diabetic group,and fisetin-treated group.After 24 weeks,all rats were sacrificed.Biochemical parameters of blood and urine samples were tested.The pathological changes were observed by paraffin sections staining with HE.The expression of extracellular matrix proteins was analyzed via PAS and Masson staining.Location of p300 protein expression was analyzed by immunohistochemistry.The protein expressions of p300 and MMP-2 were determined by Western blotting.The mRNA expressions of MMP-2 were analyzed via real-time PCR.The biochemical parameters and kidney pathological images in fisetin-treated group were better than those in diabetic group.The expression of extraeellular matrix proteins was lower than that in diabetic group.Immunohistochemistry analysis showed that among three groups the expression of p300 was mainly in glomeruli,and was also expressed in cell nucleus and cytoplasm and the coloration of fisetin-treated group was weakened as compared with diabetic group.Western blotting analysis showed that the expression of p300 protein in fisetin-treated group was lower than that in diabetic group(P＜O.05).The expressions of MMP-2 mRNA and MMP-2 protein were higher than those in diabetic group (P ＜ 0.05).It is suggested that fisetin may attenuate diabetes associated abnormalities in the kidney of rats,owing probably to inhibiting the expressions of p300 and enhancing the expressions of MMP-2.

Objective To investigate the variation of chemical characteristics with environmental factors and establish a relationship betweem morphological characters and chemical composition of Prunella vulgaris collected in different areas of China.Methods Twelve phenotypic traits and three chemical compositions were assessed in 28 populations of P.vulgaris collected from different locations in China.Results The variability ranges observed at phenotypic and chemical levels were polymorphic.According to the morphological traits,28 populations of P.vulgaris could be grouped into six clusters,and two morpho-types could be clearly distinguished.Perceptible differences could be discerned in the plant height,leaf length,corolla length,calyx length,fruiting spikes length,and maturity period.Based on three kinds of components including ursolic acid,total flavonoids,and total polysaccharides,all populations could be identified as four types.Cluster Ⅳ showing high content of ursolic acid,total flavonoids,and total polysaccharides could be utilized to develop superior derivatives.Conclusion The variation of chemical characteristics is influenced by the genetic and environmental factors,such as soil,climate,longitude,and altitude.It provides a solid basis for efficiently evaluating qualities and establishing good agricultural practices for P.vulgaris.

Objective:To summarize the experience in diagnosis and treatment of primary cardiac tumors in pediatric patients.Methods:Retrospectively analyzing 7 pediatric patients who were suspected as primary cardiac tumors and diagnosed and treated in Department of Heart Center, Children′s Hospital of Dalian Medical University from August 2013 to February 2019.All patients underwent echocardiography and other examinations, so as to confirm the diagnosis and the treatment plan was chosen based on the size and location of the tumor.All patients were followed up after discharge.Results:A total of 7 patients were diagnosed as primary cardiac tumors by echocardiography, among which 5 cases underwent surgical treatment, and 2 cases were diagnosed with tuberous sclerosis without surgery.In children undergoing surgery, 1 patient underwent autologous heart transplantation to remove the tumor, 1 patient had arrhythmia, 1 patient had mitral regurgitation after surgery, and the mitral regurgitation was corrected again.The remaining children had no adverse complications and were discharged successfully.Histologic examination revealed rhabdomyoma in 4 patients, and fibroma in 1 patient.The patients were followed up for 2-66 months after discharge, and no tumor recurrence was observed in the children who performed surgery.There was a trend of spontaneously regress of cardiac tumor in 2 patients without surgery.Conclusions:Echocardiography is the first choice for the diagnosis of primary cardiac tumors in Pediatric patients.Rhabdomyoma is the most prevalent histologic type of primary cardiac tumors, and tuberous sclerosis should be excluded during the diagnosis process.Patients with tuberous sclerosis selected conservative treatment, and surgical treatment was selected for children with obvious symptoms.According to the location and size of lesion, therapy strategies should be chosen and autologous heart transplantation can be adopted to remove the tumor for children with large tumors.Autologous heart transplantation to remove the tumor is a good surgical treatment.

Objective To investigate the efficacy and safety of percutaneous patent ductus arteriosus (PDA) closure via femoral vein solely under transesophageal echocardiography guidance.Methods From May 2014 to May 2015,28 patients(13 boys,15 girls) were selected in Dalian Children's Hospital Affiliated to Dalian Medical University with PDA closure via the femoral vein under transesophageal echocardiography guidance,with mean age (3.5 ± 2.6)years and mean body weight (16.0 ± 6.5) kg.The mean diameter of PDA was (7.1 ± 3.9) mm.Patients were all treated by percutaneous PDA closure solely by transesophageal echocardiography via the femoral vein.The effect of the procedures was evaluated by echocardiography.The transthoracic echocardiography,chest X-ray film,cardiogram at 1 month,3 months and 6 months after procedure were followed up.Results Twenty-seven cases were successfully treated with percutaneous PDA closure via the femoral vein solely under transesophageal echocardiography guidance,while 1 patient was closed by surgical closure with on-pump beating-heart because PDA occluder strayed into the left pulmonary artery on 1-month follow-up.The procedural time was (48.5 ±8.7) min.The mean diameter of PDA occluder was (8.2 ± 4.1) mm.Twenty-seven patients survived without peripheral vascular injury or complications such as residual shunt,arrhythmia and cardiac perforation.One patient was transformed to surgical closure.Hospitalization time was (2.5 ± 0.5) days.At one month follow-up,no complications such as residual shunt or pericardial effusion occurred.Conclusion Transesophageal echocardiography guided percutaneous PDA closure via the femoral vein approach is safe and effective without the damage from radiation and contrast agents,and aviods the use of femoral artery puncture.

Objective To investigate the effect of different volume of fresh gas on postoperative analepsia period of general anesthesia with sevoflurane in patients undergoing abdominal surgery. Methods 181 ASAⅠ-Ⅱpatients aged 20 - 70 undergoing elective abdominal surgery were divided into group A (112 patients) and group B (69 patients). Both groups received sevoflurane general anesthesia during surgery. At the end of surgery , group A received fresh gas for no more than 2L/min , and group B received the gas for more than 2L/min. The recovery time of spontaneous breathing, eye-opening time (from the end of surger to eye opening), and time of endotracheal extubation (from the end of surgery to endotracheal extubation ) were recorded. Results There were no significant differences in the recovery time of spontaneous breathing ,eye-opening time and time of endotracheal extubation between group A and group B (P > 0.05); Gender and time of intraoperative continuous uses of sevoflurane had effects on the recovery time of spontaneous breathing , which showed statistical significances (P < 0.05). Conclusions Uses of fresh gas for no more than 2L/min or more than 2L/min after surgery have no marked effects on the recovery time. However , gender and time of intraoperative continuous uses of sevoflurane may have effects on the recovery time of spontaneous breathing.

Objective To establish sepsis-associated encephalopathy (SAE) animal models by using neurobiology score,electroencephalography (EEG),somatosensory evoked potentials in order to provide evidence for early clinical diagnosis of SAE.Methods A total of 30 rats were weighted,numbered,and monitored with EEG electrodes 10 days before modeling.Ten days later,rats were weighted,numbered,and divided randomly (random number) into groups.Rat models of sepsis were made by cecal ligation and puncture (CLP).The changes of their neurological behaviors were observed and EEG was used to monitor at 4,6,8,12 and 24 hours after CLP.The changes of EEG waveform and somatosensory evoked potentials were analyzed and recorded.Rat models of sepsis were divided into sepsis + non-SAE group and SAE group based on the presence or absence of EEG or somatosensory evoked potentials changes ~thin 24 hours.Rats were sacrificed 24 hours later,and histopathological changes of brain tissue were observed under electronic microscopy.Thus,the feasibility of establishing early SAE animal model by monitoring the changes of neurological behaviors,EEG and somatosensory evoked potentials was evaluated.Results SAE could be early diagnosed by using neurobiology score,reduced α wave and markedly increased δ wave on EEG,reduced amplitudes of evoked potentials P1,and significantly prolonged latency of S-P1 and NI-P1.In survived septic rats,6 had changes on neurological behaviors,EEG and somatosensory evoked potentials,and thus were diagnosed as SAE.The incidence of SAE was 46％.Conclusions SAE can be diagnosed in early stage by using neurobiology score,EEG and somatosensory evoked potentials,confirming the SAE rat models to be successfully established.

Objective To investigate the clinical manifestations ofi nfantile and late-onset glycogen sot rage diseaes type Ⅱ.Mte hods We analyzed the cliin calm anifestations and prognosiso f infantile and late-onset glcy ogen storage disease type Ⅱ with a retrospective analysis of five cases admitted in PICU of Shengjing Hospital of China Medical University from 2013 to 2014.Resulst Firsts ymptoms of three infan-tile cases were dyspnea,cardiac hypertrophy,hepatomegaly,skeletal muscle weakness and low concentration of α-glucosidase A.Two cases completed gene detection.One case had frameshift mutation and missense mu-tation,and the other had two missense mutatoi n.Three infantile csa es all showed arrhythmia performance. Two cases died of fat l arrhythmia.One caes received ne zyme replacement therapy and survived.The main symptoms of two al te-onset cases who had not get gene detection were dyspnea,low muscle strength,muscle hypotonia and low concentration of ca idα-gluco sidase.One case receivedm echanicla ventilation,complicated with multiple infections,severe pneumonia andv entilator dependence,finally gave up the treatment.The other died of cardiac arrhythmia.Concluis on Infantile cases have the major symptoms of myocardial hypert o-phy,hepatomegaly,low muscular tension with rapid progression,high mortality and fatal arrhythmia.Late-on-set cases have the clinical features of respiratory failure,proximal limb muscle weakness and be susceptible to ventilator dependence and multiple infections.Enzyme replacement therapy can improve the clinical symp-toms of infantile cases.