Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.

Objective To explore application of pulse indicator continuous cardiac output(PICCO)in the treatment of septic shock during continuous renal replacement therapy (CRRT).Methods 34 patients with septic shock who underwent CRRT were randomly divided into the control group and the experimental group.Heart rate(HR),mean arterial pressure(MAP)and central venous pressure (CVP) were monitored in the control group.The experimental group were monitored by PICCO technology in addition to conventional monitoring,the hemodynamics parameters were collected such as end-diastolic volume index (GEDI),extravascular lung water index(EVLWI),and systemic vascular resistance index(SVRI),etc.Dehydration volume and supplementary volume were controlled by means of two group's hemodynamics parameters.The change of Acute Physiology And Chronic Health Evaluation-Ⅱ (APACHE Ⅱ),lactate (Lac),saturation of central venous oxygen(SevO2) and oxygenation index (PaO2/FiO2) were observed.Results After treatment of 72h,the decrease of APACHE Ⅱ and lactate in the experimental group was higher than those in the control group,the increase of ScvO2 in the experimental group was higher than those in the control group,the increase of PaO2/FiO2 in the experimental group was evidently higher than those in the control group.Conclusions During PICCO monitoring technique to guide CRRT therapy in patients with septic shock,the volume status of patients can be accurately controlled,organizational cycle can be improved,oxygenation of lung can be obviously improved,which contributes to treatment of septic shock.

Objective To compare the difference in radiotherapy dose caused by different ways of adding bolus.Methods A total of 20 patients who needed to receive postmastectomy chest wall irradiation from October to December on 2014 were selected.Each patient underwent two CT scans;CT-1 was to perform CT scan directly without bolus, and CT-2 was to perform CT scan after adding bolus to the body surface.An equivalent bolus was added for CT-1 in the radiotherapy planning system, and Plan-1, which met the clinical requirements, was performed.Then Plan-1 was put on CT-2 through image fusion and plan verification to develop Plan-2, which was to develop plans with equivalent boluses at other times and perform radiotherapy with a bolus added to the surface of the body.At last, CT-2 was used to perform radiotherapy Plan-3, which met the clinical requirements.The paired t-test was used for comparison of clinical data between any two plans with SPSS 19.0.Results The V20 of the whole lung, V20 of the diseased lung, V30 of the heart, and Dmax of the healthy breast showed no significant differences across the three plans (P=0.074-0.871).The V50 , V55 , conformity index, and homogeneity index of the planning target showed significant differences across the three plans, and the total number of monitor units showed a significant difference between Plan-1 and Plan-2(P=0.002-0.049).The dose distribution in the target volume and the number of monitor units in each radiation field also showed significant differences.Conclusions When the equivalent bolus is added to the body surface before CT scan, such a plan can accurately reflect the dose distribution of the planning target and the dose to organs at risk.

OBJECTIVETo analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province.

METHODSIn 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ² test was used to compare the differences of above indicators among different groups. The structural equation model were used to statistical analyze.

RESULTSIn the 284 subject women, 51.7% (147/284) women owned more than 2 children, 41.6% (118/284) women were more than 30 years old, 87.3% (248/284) women were illiteracy. The prenatal care rate was 69.7% (197/284), the hospital delivery rate was 26.8% (76/284), and the postnatal check rate was 22.9% (65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ² were 10.92, 13.24, 9.58; P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (β = 0.236, P < 0.001), women's cognition (β = 0.226, P = 0.020) and women's attitudes on maternal health behavior (β = 0.157, P = 0.001). Among subjective norms, women have high compliance to their husbands (β = 0.850, P < 0.001), their peers (β = 0.708, P < 0.001), and their mothers-in-law (β = 0.636, P < 0.001).

CONCLUSIONThere were still serious problems in maternal health behaviors for Yi-nationality women in poor rural areas. The main factors included not only the women's cognition and attitudes for maternal health, but also the attitudes of important social relationships.

Child ; China ; Ethnic Groups ; Family ; Female ; Health Behavior ; ethnology ; Humans ; Infant ; Maternal Health ; ethnology ; Maternal Health Services ; Postpartum Period ; Pregnancy ; Prenatal Care ; Risk Factors ; Rural Population

Objective To investigate the efficacy and safety of three?dimensional radiotherapy (3DRT) with concurrent chemotherapy for stage IV non?small?cell lung cancer ( NSCLC). Methods A total of 198 eligible patients from 2008 to 2012 were enrolled as subjects. With an age ranging between 18 and 80 years and a Karnofsky Performance Status ( KPS) score of 70 or more, those patients had no contraindication for radiotherapy and chemotherapy, and were newly diagnosed with stage IV NSCLC confirmed by histology or cytology, as well as limited metastatic disease (≤3 organs). Survival rates and acute toxicities in those patients were evaluated. Results The 3?year follow?up rate was 98?? 5% and the 3?year sample size was 165. The median overall survival (OS) and progression?free survival (PFS) were 13?? 0 months (95% CI,11?? 7 ?14?? 3 months) and 9?? 0 months (95% CI,7?? 7 ?10?? 3 months), respectively, while the 1?, 2?, and 3?year OS rates were 53?? 5%, 15?? 8%, and 9?? 2%, respectively. Multivariate analysis showed that a primary tumor volume smaller than 134 cm3 , a stable or increased KPS score after treatment, and a radiation dose of 63 Gy or more were independent prognostic factors for longer survival time ( P=0?? 008;P= 0?? 010;P= 0?? 014). The incidence rates of grade 3?4 neutropenia, thrombocytopenia, anemia, grade 3 radiation esophagitis, and grade 3 radiation pneumonitis were 37?? 9%, 10?? 1%, 6?? 9%, 2?? 5%, and 6?? 6%, respectively. The main cause of death was distant metastasis, and only 10% of the patients died of recurrence alone. Conclusions 3DRT with concurrent chemotherapy achieves satisfactory treatment outcomes with tolerable toxicities for stage IV NSCLC. Primary tumor volume, change in the KPS score after treatment, and radiation dose are independent prognostic factors for OS.Clinical Trial Registry Chinese Clinical Reistry,registration number:ChiCTRC10001026.

Objective: To analyze the extubation indications of tracheotomy patients with severe neuropathy by Meta-analysis in order to determine the effective indication parameters for successful extubation. Methods: The literatures in databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed and Cochrane Library were retrieved from their establishment to April 2019. The literatures were case-control studies, cohort studies, randomized controlled trials (RCTs) or surveys related to indication parameters for successful extubation in patients with severe neuropathy. Two researchers identified and extracted literatures and data independently. The quality of literatures was assessed by the Newcastle-Ottawa scale (NOS). Meta-analysis was performed by RevMan 5.3 software. The stability of the results were evaluated by assessing the statistical models (the fixed effects model or the random effects model) and literatures quality (inferior or superior), and by sensitivity analysis. The publication bias of literatures was assessed by funnel plot. Results: Eleven studies involving 1 357 participants were enrolled, and the rate of successful extubation was 46.7%-97.5%. Nine studies defined successful extubation as no need of re-intubation, and other two did not explain. All studies were high quality research, with NOS score of 6-8. Meta-analysis showed that the correlation between the level of consciousness [Glasgow coma score (GCS) ≥ 8 vs. < 8: odds ratio (OR) = 3.34, 95% confidence interval (95%CI) was 2.22-5.03, P < 0.001], the amount of tracheal secretions (less vs. more: OR = 13.07, 95%CI was 5.64-30.32, P < 0.001), cough reflex (with vs. without: OR = 14.33, 95%CI was 6.36-32.28, P < 0.001), swallowing function (good vs. bad: adjusted OR = 18.56, 95%CI was 8.16-42.21, P < 0.001) and successful extubation was statistically significant, and the correlation between the pulmonary infection (with vs. without: adjusted OR = 1.94, 95%CI was 0.87-4.35, P = 0.11), oxygen saturation (≥ 0.95 vs. < 0.95: OR = 2.34, 95%CI was 1.11-4.91, P = 0.12), tolerance of tube plugging (good vs. bad: OR = 2.12, 95%CI was 0.67-6.71, P = 0.20), method of tube drawing (gradually vs. abruptly: OR = 0.99, 95%CI was 0.95-1.04, P = 0.93) and successful extubation was not statistically significant. Sensitivity analysis showed that the results were stable. Funnel plot showed that the studies distributed in both sides of the funnel symmetrically, indicating the publication bias of literatures was small. Conclusion The effective indication of extubation is consciousness level (GCS score ≥ 8), less secretion, cough reflex and good swallowing function.

Background and purpose:For patients with human epidermal growth factor receptor 2(HER2)-positive metastatic breast cancer,trastuzumab treatment can prolong the overall survival and significantly improve the prognosis of patients.However,the reference original research trastuzumab(Herceptin?)is more expensive.Biosimilars have comparable efficacy and safety profiles while increasing patient access to treatment.This clinical trial aimed to evaluate the efficacy,pharmacokinetics,safety and immunogenicity of the trastuzumab biosimilar AK-HER2 compared to trastuzumab(Herceptin?)in patients with HER2-positive metastatic breast cancer.Methods:This multi-center,randomised,double-blind phase Ⅲ clinical trial was conducted in 43 subcenters in China.This study complied with the research protocol,the ethical principles stated in the Declaration of Helsinki and the quality management standards for drug clinical trials.It was approved by the hospital's medical ethics committee.The clinical trial registration agency is the State Food and Drug Administration(clinical trial approval number:2015L04224;clinical trial registration number:CTR20170516).Written informed consent was obtained from subjects before enrollment.Enrolled patients were randomly assigned to the AK-HER2 group and the control group,respectively receiving AK-HER2 or trastuzumab(initial loading dose 8 mg/kg,maintenance dose 6 mg/kg,every 3 weeks as a treatment cycle,total treatment time is 16 cycles)in combination with docetaxel(75 mg/m2,treatment duration is at least 9 cycles).The primary endpoint of this clinical trial was the objective response rate(ORR9)between the AK-HER2 group and the control group in the 9th cycle.Secondary efficacy endpoints included ORR16,disease control rate(DCR),clinical benefit rate(CBR),progression-free survival(PFS)and 1-year survival rate.In this study,100 subjects(AK-HER2 group to control group=1:1)were randomly selected for blood sample collection after the 6th cycle of medication,The collection time points were 45 minutes after infusion(the end of administration),4,8,24,72,120,168,336,and 504 hours after the end of administration.After collection,blood samples were analyzed by PK parameter set(PKPS).Other evaluation parameters included safety and immunogenicity assessment.Results:A total of 550 patients with HER2-positive metastatic breast cancer were enrolled in this clinical trial between Sep.2017 and Mar.2021.In the AK-HER2 group(n=237),129 subjects in the experimental group achieved complete response(CR)or partial response(PR),and the ORR9 was 54.4%.There were 134 subjects in the control group(n=241)who achieved CR or PR,and the ORR9 was 55.6%.The ORR9 ratio between the AK-HER2 group and the control group was 97.9%[90%confidence interval(CI):85.4%-112.2%,P=0.784],which was not statistically significant.In all secondary efficacy endpoints,no statistically significant differences were observed between the two groups.We conducted a mean ratio analysis of pharmacokinetics(PK)parameters between the AK-HER2 group and the control group,and the results suggested that the pharmacokinetic characteristics of the two drugs are similar.The incidence of treatment emergent adverse event(TEAE)leading to drug reduction or suspension during trastuzumab treatment was 3.6%(10 cases)in the AK-HER2 group and 8.1%(22 cases)in the control group.There was statistically significant difference between the two groups(P=0.027).The incidence rate was significantly lower in the AK-HER2 group than in the control group,and there was no statistically significant difference among the other groups.The differences in the positive rates of anti-drug antibodies(ADA)and neutralizing antibodies(NAB)between groups were of no statistical significance(P=0.385 and P=0.752).Conclusion:In patients with HER2-positive metastatic breast cancer,AK-HER2 was comparable to the trastuzumab(Herceptin?)in terms of drug efficacy,pharmacokinetics,safety and immunogenicity.

ObjectiveTo explore the therapeutic mechanism of Bushen Huoxue prescription from the perspective of bone metabolism by observing the clinical efficacy of this prescription in treating femoral head necrosis （ONFH， syndrome of liver and kidney deficiency） and its influences on bone metabolism indexes： N-terminal propeptide （PINP） and β-collagen degradation product （β-CTX）. MethodSixty-six ONFH patients with the syndrome of liver and kidney deficiency in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics from December 2021 to September 2022 were selected. The patients were randomized into an experimental group and a control group by the parallel control method， with 33 patients in each group. The experimental group received Bushen Huoxue prescription orally， while the control group received Xianlinggubao Capsules orally， with a treatment cycle of 6 months. The visual analogue scale （VAS） score， Harris score， Association Research Circulation Osseous （ARCO） staging， imaging changes， quantitative scores of TCM symptoms， and serum levels of PINP and β-CTX were determined before and after treatment. The occurrence of adverse events and reactions was recorded. ResultThe total response rate in the experimental group was 83.87% （26/31）， which was higher than that （68.75%， 22/32） in the control group （Z=-2.096， P<0.05）. After treatment， the single and total scores of TCM symptoms， VAS score， and β-CTX level decreased in the two groups （P<0.05）. Moreover， the decreases in the scores of hip pain， lower limb mobility， soreness of waist and knees， and lower limb flaccidity， total score of TCM symptoms， VAS score， and β-CTX level in the experimental were larger than those in the control group （P<0.05）. After treatment， the imaging results showed no significant improvement in the two groups. The Harris score and PINP level in both groups increased after treatment （P<0.05）， and the increases were more obvious in the experimental group than in the control group （P<0.05）. No serious adverse event or adverse reaction appeared during the observation period. ConclusionBushen Huoxue prescription can relieve pain and TCM symptoms and improve the hip joint function in treating ONFH patients with the syndrome of liver and kidney deficiency. It can inhibit the development of ONFH， increase PINP， and decrease β-CTX. No obvious side effect appears during the clinical observation period， which shows that Bushen Huoxue prescription has good safety.

Objective To investigate the effects of different concentrations of morphine in combination with ropivacaine on proliferation,migration,invasion and cell cycle in MDA-MB-231 breast cancer cells.Methods MDA-MB-231 breast cancer cells were inoculated on the culture plate for 24h and randomly divided into 8 groups:Control group(C),ropivacaine 400μg/ml group(R),morphine 3μg/ml group(LM),morphine 30μg/ml group(MM),morphine 300μg/ml group(HM),ropivacaine 400μg/ml group+ morphine 3μg/ml group(R+LM),ropivacaine 400μg/ml+ morphine 30μg/ml group(R+MM),and ropivacaine 400μg/ml+ morphine 300μg/ml group(R+HM).After treaments of MDA-MB-231 breast cancer cells for 24h,these proliferation,migration,invasion and cell cycle were evaluated.Results When using morphine alone,the proliferation inhibitive effect was positively correlated with the concentration of morphine.The proliferation was significantly inhibited by morphine of LM,MM,HM group(P<0.05).When using ropivacaine alone,the proliferation was significantly inhibited(P<0.05).When using morphine combined with ropivacaine,the high concentration morphine group has a synergistic effect with ropivacaine group on proliferation inhibition(P<0.05).When using morphine alone,the migration rate decreases sequentially with the increase of morphine concentration.The migration rate was significantly inhibited by morphine of LM,MM,HM group(P<0.05).When using ropivacaine alone,the migration rate was inhibited(P<0.05).When using morphine combined with ropivacaine,the low and medium concentration morphine group have a synergistic effect with ropivacaine group on migration rate(P<0.05).When using morphine alone,the number of cell invasion was decreased with the concentration of morphine increasing(P<0.05).The MM and HM groups inhibited cell invasion ability.When using ropivacaine alone,the invasiveness of cells was also inhibited(P<0.05).When using morphine combined with ropivacaine,the medium and high concentration morphine groups have a synergistic effect with ropivacaine group on inhibiting cell invasion ability(P<0.05).When using morphine alone,the cell cycle progression was inhibited into G2/M Phase(P<0.05).When using ropivacaine alone,the cell cycle progression was inhibited into G2/M phase(P<0.05).The combination of low concentration morphine and ropivacaine has synergistic effect on arresting at G0/G1 and S phase(P<0.05).Conclusion Morphine combined with ropivacaine inhibits the Proliferation,migration and invasion of MDA-MB-231 breast cancer cells in a dose-dependent manner.