Objective To investigate the effect of dexmedetomidine on minimum alveolar concentration (MAC) of isoflurane required to inhibit the body movement during skin incision. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 40-60 yr with body mass index of 22-27 kg/m2 undergoing elective upper abdominal surgery under general anesthesia were randomly divided into 3 groups: control group (group C, n = 15);low dose dexmedetomidine group (group D1, n = 17) and high dose dexmedetomidine group (group D2, n = 16). The patients were unpremedicated. Dexmedetomidine 0.4 and 0.8 μg/kg in normal saline (NS) 15 ml was infused over 15 min before induction of anesthesia in D1 and D2 groups respectively. Anesthesia was induced with fentanyl-propofol-succinylcholine. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoflurane. MAC of isoflurane was determined by up-and-down technique. The initial end-tidal isofiurane concentration was set at 1.0%, 0.8% and 0.6% in C, D1 and D2 groups respectively. Each time the end-tidal isoflurane concentration was increased/decreased by 0.2%. Skin incision was made after 15 min of equilibration, when the twitch height returned to more than 90% of its control value. Movement of body and limbs including swallowing and coughing were carefully looked for when skin incision was made. MAC of isoflurane was the mean of end-tidal concentration of isoflurane of each crossover pair, and 95 % CI was calculated. Results MAC of isoflurane was significantly decreased in D1 and D2 groups as compared with group C and in group D2 as compared with group D1( P ＜ 0.05 or 0.01 ). Conclusion Dexmedetomidine can significantly decrease MAC of isoflurane required to inhibit the body movement during skin incision in a dose-dependent manner.

Objective To evaluate the effects of posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle in the treatment of severe throracolumar fractures.Methods A retrospective study was conducted to evaluate the outcomes of 11 patients with severe thmracolumar fracture who had been treated with posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle at our department from March 2009 to March 2012.They were 10 males and one female,aged from 20 to 42 years (mean,31.1 years).According to AO classification,there were 2 cases of type B1,3 cases of type B2 and 6 cases of type C2.The Gaines scores for anterior column stability were more than 6 in all.All the patients had neurological disorders.The fracture reduction,fusion of bone grafting and recovery of neurological function were followed up.Results Their operation time ranged from 200 to 300 minutes,averaging 243.2 minutes;the amount of bleeding ranged from 800 to 1,600 mL,averaging 1,023.3 mL.No deterioration of neurological symptoms or no new neurological symptoms were observed postoperatively.Cerebrospinal fluid leakage was found in 3 patients who healed spontaneously following extubation,compressive dressing and elevation of the bed end.All the patients were followed up for 12 to 30 months (average,18.3 months).A loosened screw cap was found in one patient after 6 months who had no discomfort and received no treatment.X-ray films showed satisfactory fracture reduction and fine bone grafting locations.No spinal canal stenosis was found by CT scans.It took 3 to 6 months (mean,4.3 months) for the bone grafts to get fused.No height loss of the injured vertebrae was no found at the last follow-ups.No functional recovery was found in the patients with complete spinal cord injury whose Frankle grade remained A.The spinal function recovered from Frankel grade B to grade D in one patient with incomplete spinal injury.Of the 8 patients with medullary cone injury,7 recovered Frankle grade E and one Frankle grade D.The symptoms were relieved in one patient with simple cauda equine injury.Conclusion Posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle is an effective alternative for treatment of severe throracolumar fractures,because it can lead to satisfactory fracture reduction,thorough decompression of the spinal canal and good reconstruction of spinal stability.

Objective To evaluate the effects of autologous blood withdrawal-reinfusion on inflam-matory responses of patients undergoing cardiac surgery with different time courses of cardiopulmonary by-pass(CPB). Methods A total of 120 patients, aged 18-70 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, were divided into 2 groups(n=60 each)using a random number table: autologous blood withdrawal-reinfusion group(ABWR group)and non-autologous blood withdrawal-reinfusion group (NABWR group). Each group was further divided into 3 subgroups(n=20 each)according to the expected time of CPB: long time course(>120 min)subgroup(L subgroup), medium time course(>60 min-≤120 min)subgroup(M subgroup)and short time course(≤60 min)subgroup(S subgroup). In group ABWR, after the end of CPB and after heparin was reversed with protamine, blood shed from the surgical field and left in the autologous blood recycling machine pipeline after the end of CPB was collected, filtra-ted, washed, concentrated and reinfused. After the end of CPB, blood left in the autologous blood recy-cling machine pipeline was directly kept in the storage bag and partially or totally reinfused in group NAB-WR. Before operation and at 1, 6, 24 and 48 h after the end of CPB, blood samples were collected for de-termination of serum tumor necrosis factor-alpha(TNF-α), interleukin-6(IL-6)and IL-10 concentrations by enzyme-linked immunosorbent assay. Results Compared with ABWR-S subgroup, the serum TNF-α and IL-6 concentrations were significantly increased at each time point after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L and ABWR-M subgroups (P>005). There were no significant differences in serum TNF-α, IL-6 and IL-10 concentrations between ABWR-L subgroup and ABWR-M subgroup(P>005). Compared with NABWR subgroup of the same time course, the serum TNF-α concentration was significantly decreased at each time point after the end of CPB, the serum IL-6 concentration was decreased at 6-48 h after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L subgroup(P>005); the serum TNF-α con-centration was significantly decreased at 1 h after the end of CPB, and the serum IL-6 concentration was de-creased at 6 and 24 h after the end of CPB in ABWR-M subgroup(P<005); no significant difference was found in the serum concentrations of TNF-α, IL-6 or IL-10 at each time point after the end of CDB in AB-WR-S subgroup(P<005). Conclusion With prolongation of the time courses of CPB, the efficacy of autologous blood withdrawal-reinfusion in inhibiting inflammatory responses of patients undergoing cardiac surgery is more significant.

Objective To investigate the correlation of DCEGMRI findings with pathologic tumor response to neoadjuvant chemotherapy for patients with tripleGnegative breast cancer (TNBC).Methods SixtyGnine patients with TNBC were enrolled,who underwent DCEG MRI before neoadj uvant chemotherapy,then completed neoadjuvant chemotherapy and surgery.Patterns of tumor volume reduction were divided into two types.Univariate and multivariate Logistic regression analyses were performed to detect the independent predictors of pathological tumor response.Results 30.4% (21/69)patients achieved a pathologic complete response.Multivariate Logistic regression analysis showed that homogenous enhancement on preGneoadj uvant chemotherapy MRI (OR＝1 0.87 ,9 5%CI＝2.94－48.3 1 ,P＜0.00 1 )and concentric shrinkage pattern on postGneoadj uvant chemotherapy (OR＝1 3.04,9 5%CI＝2.0 1－54.1 1 ,P＜0.00 1 )were the independent predictors of pathologic complete response.Conclusion Homogeneous enhancement on preGneoadj uvant chemotherapy MRI and the presence of concentric shrinkage pattern are correlated with pathologically complete response in patients with TNBC.

Objective:To construct a set of quality evaluation index system of "Internet + nursing" with clear evaluation criteria with the service objects as the evaluation subject and Service Quality model as the theoretical framework, and to provide an objective basis for the quality evaluation of "Internet + nursing".Methods:CNKI, Wanfang databases, VIP, PubMed, and Web of Science were searched from establishment to November 2021. The article determined the quality evaluation items of "Internet + nursing" based on the perspective of service objects by means of literature analysis, field research and Delphi expert inquiries. Analytic hierarchy process was used to confirm the weight of each indicator.Results:In this study, 22 experts were consulted for 2 rounds.The effective recovery rate of the two rounds of questionnaires were 100%. The judgment basis coefficient was 0.936, familiarity coefficient was 0.945 and authority coefficient was 0.941; in the first round, the Kendall harmony coefficients assigned to the importance of the first and second level indicators were 0.187 and 0.122, and the Kendall harmony coefficients assigned to the feasibility were 0.183 and 0.125; in the second round, the Kendall harmony coefficients assigned to the importance of the first and second level indicators were 0.241 and 0.190, and the Kendall harmony coefficients assigned to the feasibility were 0.218 and 0.166 (both P<0.01). The final evaluation index system for the "Internet + nursing" based on the perspective of service objects included 7 first-class indicators and 33 second-class indicators. Conclusions:The "Internet + nursing" quality evaluation index system constructed in this study based on the perspective of service objects is scientific, reliable and practical, which can be used as an evaluation tool for the current "Internet + nursing" quality evaluation and strategy optimization.