Objective To investigate the impact of PET-CT on the target volume delineation and precise radiothera?py planning for patients with advanced non-small cell lung cancer (NSCLC). Methods PET-CT scanning was performed in 30 histologically proved NSCLC patients. The gross tumor volume (GTV) was delineated, and radiotherapy planning was es?tablished with identical parameters based on the CT image and PET-CT fused image, respectively. The differences of doses between GTV, planning target volume (PTV) and organsat rise (OAR) were compared. Results PET-CT image results changed the target volume delineation in 30 patients with 8 increased and 22 decreased. There were no differences in GTV and PTV between the VGTV and VPTV statistically, although PET-CT image changed conventional CT image size sketch of GTV and PTV. The V20 of total lung decreased in the PlanPET-CT compared with that of PlanCT (P<0.05), but no differences were found in the V30 of total lung, mean lung dose (MLD), the data of spinal cord, esophagus and heart. Conclusion PET-CT may reduce the radiation injuries in the lung and improve the target dose.

Objective:To investigate the changes and their clinical values of renal oxygen saturation(RrSO 2) and abdominal local oxygen saturation(A-rSO 2) in infants who underwent cardiac surgery. Methods:Thirty children with atrial septal defect or ventricular septal defect underwent cardiopulmonary bypass (CPB) in Henan People′s Hospital from April to August 2019 were randomly selected.There were 15 males and 15 females, aged 2-13 months, weighted 4.5-10.0 kg and American Society of Anesthesiologists(ASA) grade Ⅰ-Ⅲ.The probe of near-infrared spectroscopy(NIRS)was fixed at the body surface of the right kidney and 1 cm below the umbilicus.RrSO 2 and A-rSO 2 were continuously monitored during operation.The changes of parameters, including RrSO 2, A-rSO 2, mean arte-rial pressure(MAP), and nose temperature were recorded after anesthesia induction (T 0), cardiopulmonary bypass (T 1), 5 minutes after aortic blockade (T 2), the lowest temperature (T 3), 5 minutes after aortic opening (T 4), and 5 minutes after stopping cardiopulmonary bypass (T 5). CPB time, ascending aorta occlusion time and operation time were recorded as well.Meanwhile, perioperative complications such as acute renal injury (AKI) and gastrointestinal dysfunction were recorded.Relevant information, including the time of first eating after operation was recorded. Results:Totally, 30 children were enrolled in this study.The basic values of RrSO 2 and A-rSO 2 were (70.00±7.50)% and (70.70±11.29)%, respectively.Compared with T 0, the RrSO 2 and A-rSO 2 of patients decreased at T 1, gradually increased at T 2, T 3 and T 4, and returned to T 0 at T 5.There was no significant difference in RrSO 2 and A-rSO 2 at each observation point. Pearson correlation analysis displayed that there was a positive correlation between A-rSO 2 and RrSO 2 ( r=0.806, P<0.01). RrSO 2 and A-rSO 2 were positively correlated with MAP ( r=0.565, 0.605, all P<0.05), and negatively correlated with the nasopharynx temperature ( r=-0.365, -0.331; all P<0.05). Among them, 3 children(10%) suffered from AKI after operation.Compared with T 0, RrSO 2 values at T 1, T 2, T 3 and T 4 decreased significantly ( P<0.05). Postoperative gastrointestinal hysteresis occurred in 6 children(20%). The A-rSO 2 value in T 0-T 5 of children with gastrointestinal hysteresis was significantly lower than that of children without gastrointestinal hysteresis ( P<0.05). Conclusions:As a new noninvasive monitoring method of renal and intestinal function, NIRS has certain clinical guiding value in perioperative period of infantile congenital heart disease.

Objective To evaluate the effect of penehyclidine hydrochloride on Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway in the myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass (CPB).Methods One hundred pediatric patients of both sexes,aged 5 months-3 yr,with body mass index of 13.9-16.0 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association classification Ⅱ or Ⅲ),with the left ventricular ejection fraction＞50％,scheduled for elective radical correction of tetralogy of Fallot with CPB,were divided into 2 groups (n =50 each) using a random number table:penehyclidine hydrochloride group (group P) and control group (group C).Penehyclidine hydrochloride was intravenously injected at a dose of O.04 mg/kg immediately after successful internal jugular vein puncture in group P,and the equal volume of normal saline was given instead at the same time in group C.Before anesthesia induction,at 10 min after induction,after re warming to 36 ℃,at 1 h after termination of CPB,at the end of surgery and at 24 h after surgery,venous blood samples were collected to detect the concentrations of tumor necrosis factor-alpha,interleukin-6 (IL-6),IL-8 and cardiac troponin T in plasma (by enzyme-linked immunosorbent assay).Myocardial specimens were obtained from the right auricular appendage after opening of pericardium and at 1 h after aortic unclamping for microscopic examination and for determination of activated NF-κB and TLR4 protein and mRNA expression (by Western blot and real-time polymerase chain reaction,respectively).Results Compared to group C,the concentrations of plasma tumor necrosis factor-alpha,IL-6,IL-8 and cardiac tropnin T were significantly decreased after re-warming to 36 ℃C,at 1 h after termination of CPB,at the end of surgery and at 24 h after surgery,the expression of activated NF-κB and TLR4 protein and mRNA was down-regulated at 1 h after aortic unclamping (P＜0.05),and the pathological changes of myocardium were significantly attenuated in group P.Conclusion The mechanism by which penehyclidine hydrochloride reduces inflammatory responses is related to inhibition of the activation of NF-κB/TLR4 signaling pathway in the myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with CPB.

Objective To evaluate the effect of ulinastatin pretreatment on endoplasmic reticulum stress during myocardial injury in the patients undergoing mitral valve replacement (MVR) with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes,aged 35-64 yr,weighing 40-80 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective MVR with CPB,were divided into ulinastatin pretreatment group (UP group,n=50) and normal saline control group (NS group,n =50) using a random number table.Ulinastatin 0.5× 104 U/kg was intravenously infused over 1 h before skin incision,and administration was repeated every 4 h until the end of operation in group UP,while the equal volume of normal saline was given instead in group NS.Immediately after opening the right atrium (T0),at 30 min after aortic clamping (T1) and while suturing the right atrium (T2),blood samples were collected from the radial artery for measurement of the concentrations of plasma creatine kinase-MB and cardiac troponin T by enzyme-linked immunosorbent assay.Right auricle specimens were obtained after blood sampling at each time point for determination of the expression of glucose-regulated protein 78,CCAAT/enhancer-binding protein homologous protein and c-Jun N-terminal kinase protein and mRNA (by real-time polymerase chain reaction and Western blot,respectively) and apoptosis in cardiomyocytes (by TUNEL).The apoptosis rate was calculated.Results Compared with group NS,the plasma concentrations of creatine kinase-MB and cardiac troponin T at T1 and T2 and apoptosis rate at T2 were significantly decreased,and the expression of glucose-regulated protein 78,CCAAT/enhancer-binding protein homologous protein and c-Jun N-terminal kinase protein and mRNA was down-regulated at T1 and T2 in group UP (P＜0.05).Conclusion The mechanism by which ulinastatin pretreatment inhibits apoptosis in cardiomyocytes and attenuates myocardial injury is related to decrease in endoplasmic reticulum stress in the patients undergoing MVR with CPB.

Objective:To evaluate the relationship between postoperative delirium (POD) and pyroptosis of peripheral blood mononuclear cells (PBMCs) in the patients undergoing heart valve replacement with cardiopulmonary bypass (CPB).Methods:Sixty patients of either sex, aged 45-64 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, undergoing elective heart valve replacement with CPB, were enrolled in this study.POD was assessed by the Consciousness Assessment Method for the intensive care unit (CAM-ICU) within 3 days after operation.All the patients were divided into 2 groups according to whether POD occurred within 3 days after operation: POD group ( n=45) and non-POD group (NPOD group, n=15). After induction of anesthesia and before skin incision (T 1), at 30 min after start of CPB (T 2), immediately after termination of CPB (T 3) and at 24 h after termination of CPB (T 4), blood samples from the internal jugular vein were collected to determine the concentrations of plasma S100β, neuron-specific enolase (NSE), interleukin (IL)-18 and IL-1β (by enzyme-linked immunosorbent assay) and expression of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), caspase-1 and gasdermin D (GSDMD) in PBMCs (by Western blot). The postoperative mechanical ventilation time and length of stay in ICU were recorded. Results:Compared with NPOD group, the concentrations of plasma S100β, NSE, IL-18 and IL-1β were significantly increased, the expression of NLRP3, caspase-1 and GSDMD in PBMCs was up-regulated at T 2-4, and the postoperative mechanical ventilation time and length of stay in ICU were prolonged in POD group ( P<0.05). Compared with those at T 1, the concentrations of plasma S100β, NSE, IL-18 and IL-1β were significantly increased, and the expression of NLRP3, caspase-1 and GSDMD in PBMCs was up-regulated at T 2-4 in POD and NPOD groups ( P<0.05). Conclusion:The occurrence of POD may be associated with the pyroptosis of PBMCs in patients undergoing heart valve replacement with CPB.

Objective:To evaluate the efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart disease.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ pediatric patients, aged 1-3 yr, undergoing elective cardiac surgery for left-to-right shunt type congenital heart diseases, were divided into dexmedetomidine group (group D, n=25) or dexmedetomidine combined with esketamine group (group DK, n=25) using a random number table method.Dexmedetomidine 3.9 μg/kg was intranasally delivered in group D. Dexmedetomidine 3.3 μg/kg combined with esketamine 2 mg/kg was intranasally administered in group DK.The Children′s Hospital of Wisconsin Sedation Scale score, SpO 2, HR, and pulmonary artery systolic pressure (PAP) were recorded before and at 30 min after administration, and the rate of decrease in SpO 2, HR and PAP after administration was calculated.The onset time of sedation and occurrence of adverse effects such as nausea and vomiting, bradycardia and respiratory depression during sedation were recorded. Results:Inadequate sedation and over-sedation were not observed in either group.Compared with group D, Children′s Hospital of Wisconsin Sedation Scale scores were significantly decreased at 30 min after administration, the onset time of sedation was shortened, and the decrease rate of HR was decreased in group DK ( P<0.05), and there were no significant changes in HR, SpO 2 and PAP before and after administration ( P>0.05). In group DK, nausea and vomiting occurred in 2 cases, but the symptoms were mild and no medication intervention was needed.No other adverse effects such as bradycardia and respiratory depression were found in either group. Conclusion:Combination of intranasal dexmedetomidine and esketamine can optimize the efficacy of preoperative sedation in pediatric patients with congenital heart disease, esketamine may induce nausea and vomiting, and the fasting time should be strictly controlled during sedation.

Objective To evaluate the effect of ulinastatin on endoplasmic reticulum stress in car-diomyocytes of patients undergoing beating heart mitral valve replacement(MVR). Methods A total of 80 patients of both sexes with rheumatic heart disease complicated with mitral valve stenosis, aged 38-59 yr, weighing 43-73 kg, with American Society of Anesthesiology physical statusⅡorⅢ, scheduled for elective MVR, were divided into ulinastatin group(UTI group, n=40)and normal saline group(NS group, n=40) using a random number table. Immediately after opening the right atrium(T0), at 30 min of cardiopulmonary bypass(T1)and while suturing the right atrium(T2), blood samples from the radial artery were collected to determine the concentrations of plasma creatine kinase-MB and cardiac troponin T by enzyme-linked immu-nosorbent assay, and the right auricle specimens were collected for determination of the expression of glucose-regulated protein 78, CCAAT∕enhancer-binding protein homologous protein, c-Jun amino-terminal kinase (JNK)protein and mRNA(by real-time polymerase chain reaction or Western blot)and phosphorylated JNK (p-JNK)expression(by Western blot). The apoptosis in cardiomyocytes was detected by TUNEL at T0,2, and the apoptosis rate was calculated. Results Compared with group NS, the concentrations of plasma crea-tine kinase-MB and cardiac troponin T at T1,2and the apoptosis rate of cardiomyocytes were significantly de-creased at T2, and the expression of glucose-regulated protein 78, CCAAT∕enhancer-binding protein homolo-gous protein and JNK protein and mRNA and p-JNK was down-regulated at T1,2in group UTI(P<0.05). Conclusion The mechanism by which ulinastatin reduces myocardial damage is related to inhibiting endo-plasmic reticulum stress in cardiomyocytes of patients undergoing beating heart MVR.

Objective:To evaluate the effects of thoracic paravertebral block (TPVB) on graft patency in off-pump coronary artery bypass grafting.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-75 yr, weighing 50-80 kg, undergoing elective off-pump coronary artery bypass grafting under combined intravenous-inhalational anesthesia, were divided into 2 groups using a random number table method: control group (group C, n=30) and TPVB group (group T, n=20). In group T, TPVB was performed at T 4, 5 interspace under the guidance of ultrasound, a test dose of 1% lidocaine 5 ml was injected on both sides, and 2 min later 0.375% ropivacaine 15 ml was injected.According to the anatomy of coronary artery, the graft was divided into 4 parts: left internal thoracic artery-anterior descending branch (arterial graft), the middle branch or the first diagonal branch, blunt marginal branche, and right posterior descending branch or left ventricular posterior branch.The blood flow was measured and pulsatility index was calculated after graft transplantation.Central venous pressure, mean pulmonary artery pressure, cardiac output, systemic resistance index and pulmonary resistance index were recorded immediately after placement of floating catheter (T 1), immediately after sawing sternum (T 2), immediately after anastomosis of all grafts (T 3) and 5 min before leaving the room (T 4). The intraoperative cardiovascular adverse events and consumption of sufentanil were recorded. Results:Compared with group G, central venous pressure, systemic resistance index and pulmonary resistance index were significantly decreased, cardiac output were increased, the incidence of intraoperative tachycardia was decreased, the incidence of hypotension was increased, the consumption of sufentanil was reduced, the flow of left internal thoracic artery-anterior descending branch was increased, and the pulsatility index was decreased at T 3 and T 4 in group T ( P<0.05). Conclusion:TPVB can improve the patency of left internal thoracic artery-anterior descending branch in off-pump coronary artery bypass grafting.

Objective:To identify the risk factors for postoperative central nervous system complications (CNSC) developed in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) through determining regional cerebral oxygen saturation (rSO 2C) by near-infrared spectroscopy. Methods:A total of 60 pediatric patients with congenital heart disease undergoing elective orthodontic correction surgery under CPB, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, of both sexes, aged 6-36 months, weighing 5-19 kg, in our hospital from July 2019 to January 2020 were collected.Intraoperative bilateral rSO 2C was monitored continuously by near-infrared spectroscopy.Blood samples were taken from the central vein at 10 min after induction of anesthesia, immediately after CPB, at the end of CPB, on admission to ICU, at 4 and 8 h after entering ICU and at 1, 2 and 3 days after surgery (T 0-8) for determination of the concentrations of serum S100β protein and neuron specific enolase (NSE). At 12 months after surgery, the Pediatric Cerebral Performance Category (PCPC) score was used to evaluate the prognosis of neurological function.The patients were divided into 2 groups according to whether CNSC occurred: CNSC group and non-CNSC group.Multivariate logistic regression analysis was used to identify the risk factors for development of postoperative CNSC in pediatric patients undergoing cardiac surgery under CPB. Results:Two patients were excluded from the study.Eighteen cases developed postoperative CNSC, and the incidence was 31.0%.Compared with group non-CNSC, the minimal rSO 2 was significantly decreased, the maximal difference between pulse oxygen saturation and rSO 2C (da-rSO 2C) was increased, duration of reduction in rSO 2>25% during CPB, duration of rSO 2C<40% during CPB and duration of da-rSO 2C>50% during CPB were prolonged, and concentrations of serum S100β protein and NSE were increased at T 2-T 8 in group CNSC ( P<0.05). The results of logistic regression analysis showed that prolonged duration of reduction in rSO 2C>25% during CPB, prolonged duration of rSO 2C<40% during CPB and prolonged duration of da-rSO 2C>50% during CPB were risk factors for development of postoperative CNSC. Conclusion:Prolonged duration of reduction in rSO 2C>25% during CPB, prolonged duration of rSO 2C<40% during CPB and prolonged duration of da-rSO 2C>50% during CPB are the risk factors for postoperative CNCS developed.

Objective:To summarize the efficacy of general anesthesia for percutaneous pulmonary valve implantation (PPVI).Methods:The clinical data of 6 patients underwent PPVI under general anesthesia in Children′s Heart Center of Henan Provincial People′s Hospital from December 2017 to January 2020 were retrospectively analyzed.Systolic blood pressure, diastolic blood pressure, heart rate, central venous pressure, SpO 2 and regional cerebral oxygen saturation were recorded before anesthesia induction (T 1), after anesthesia induction (T 2), before beginning of surgery (T 3), before pulmonary valve implantation (T 4), during pulmonary valve implantation (T 5), immediately after pulmonary valve implantation (T 6) and when the patients left the operating room (T 7). Right ventricular systolic pressure, diastolic pressure, pulmonary artery systolic pressure and diastolic pressure were recorded at T 4 and T 6.The development of related complications during operation and the cardiac, liver and kidney functions before and after operation were recorded.The postoperative extubation time, intensive care unit stay time and hospital stay time were recorded. Results:Six patients (3 males, 3 females), aged (16±4) yr, weighing (41±12) kg, were analyzed.Compared with the value at T 1-4 and T 6, 7, systolic blood pressure, diastolic blood pressure, heart rate, regional cerebral oxygen saturation and SpO 2 were significantly decreased at T 5 ( P<0.05). Compared with the value at T 1-5, central venous pressure was significantly decreased at T 6, 7 ( P<0.05). Compared with the value at T 4, right ventricular diastolic pressure was significantly decreased, and pulmonary artery diastolic pressure was increased at T 6 ( P<0.05). No anesthesia- and surgery-related serious complications occurred among the patients.One patient was transferred to the ward after extubation in the operating room, and 5 patients were transferred to the intensive care unit after operation.All 6 patients were discharged successfully and entered the follow-up stage. Conclusion:General anesthesia provides better efficacy when used for PPVI, and hemodynamic monitoring of pulmonary circulation and systemic circulation should be strengthened during pulmonary valve implantation to maintain circulation stable.