Objective To compare the dexmedetomidine and midazolam administered intranasally for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.Methods Forty pediatric patients of both sexes, aged 2-7 yr, weighing 1 1-26 kg, of American Society of Anesthesiology Anesthesiologists physical status Ⅱ, were equally and randomly assigned into either midazolam group (group M) and dexmedetomidine group (group D).Group M received midazolam 0.2 mg/kg administered intranasally, and group D received dexmedetomidine 2 μg/kg administered intranasally in the room for preoperative preparation.The pediatric patients were separated from their patients at 30 min after administration.Oxygen was inhaled by mask after admission to the operating room, and venipuncture was performed.The responses to nasal mucous membrane irritation and separation from their parents were recorded.Ramsay sedation scores were recorded when the patients were separated from their parents.The occurrence of bradycardia, hypotension, hypertension and hyoxemia was recorded from the end of administration until venipuncture.Results The pediatric patients were successfully separated from their patients in the two groups.Compared with group M, the incidence of responses to nasal mucous membrane irritation was significantly decreased, and Ramsay sedation scores were increased in group D (P＜0.05).No pediatric patients developed adverse reactions such as bradycardia, hypotension, hypertension and hyoxemia in the two groups.Conclusion Dexmedetomidine administered intranasally provides better efficacy than midazolam when used for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.

Objective To compare the clinical effect of video-assisted thoracoscopic surgery (VATS) and chest tube drainage combined with urokinase for the treatment of empyema after fibropurulent pneumonia, and to determine the best therapy for patients. Methods Patients were randomly divided into two groups according to inclusion and exclusion crite?ria:55 patients were selected as group VATS performed VATS;46 patients were selected as drainage group performed 12F catheter chest closed drainage by Seldinger technique under B ultrasound guidance. The 100 000 unit urokinase was inject?ed into chest, and open after 4-hour closed, once a day for three days. Values of white blood cell (WBC), pH, glucose, lactate dehydrogenase (LDH) and C reactive protein (CRP) of pleural effusion before treatment were recorded, and the duration of fe?ver after treatment, duration of chest-tube placement, antibiotic use, hospital stay, cure rate, complication and hospitaliza?tion expenses were also recorded. Results The duration of fever after treatment,, duration of chest-tube placement, antibiot?ic use and hospital stay were significantly lower in VATS group than those in drainage group. The cure rate was significantly higher in VATS group than that of drainage group (P<0.05). There were no significant differences in complication rates and hospitalization expenses between two groups. There was no death in both two groups. Conclusion VATS is more suitable for the treatment of empyema after fibropurulent pneumonia than chest tube drainage combined with urokinase, and which is worthy of clinical promotion for not adding complication rates and hospitalization expenses.

Objective To investigate the relationship between the numbers of deep medullary veins (DMV) beside the ipsilateral lateral ventricle and the stenotic degree of large artery of ipsilateral internal carotid artery (ICA) system and cerebrovascular reactivity (CVR) in patients with acute cerebral infarction showed on susceptibility-weighted imaging (SWI) in middle cerebral artery (MCA) territory.Methods The patients with acute cerebral infarction in MCA territory who underwent SWI,cerebral angiography and the transcranlal Doppler carbon dioxide challenge test during the hospital stay were enrolled retrospectively.According to the numbers of DMV beside the lateral ventricle on SWI,they were classified into 3 grades:Grade 1:DMV ＜5; Grade 2:DMV 5-10; Grade 3:DMV ＞ 10.The correlations of the DMV grades and the degree of ipsilateral ICA/MCA and CVR were analyzed.Results A total of 44 patients with acute cerebral infarction in MCA territory were enrolled.Twenty-four patients were DMV 1,15 were DMV2,and 5 were DMV 3.The mean stenosis degree of the main arteries of the ipsilateral ICA system was 40.52％ ±30.62％.The mean CVR of MCA was 0.41 ± 0.16.The stenosis degrees in the DMA grade 1,2,and 3groups were 31.31％ ± 26.02％,44.93％ ± 31.03％,and 71.76％ ± 26.68％,respectively.There were significant differences among the 3 groups (F=4.589,P =0.018),and the stenosis degree in the DMV grade 3 group was significantly higher than that in the DMV grade 1 group (P=0.014).The CVRs in the grade 1,2,and 3 groups were 0.45 ± 0.12,0.41 ± 0.18,and 0.22 ± 0.12,respectively.There were significant differences among the 3 groups (F=6.179,P=0.005),and the CVR in the DMV grade 3 group was significantly lower than that in the DMV grade 1 group (P =0.006) and in the DMV grade 2 group (P =0.038).Spearman correlation analysis showed that DMV grade was significantly positively correlated with the stenosis degree (rs =0.381,P =0.013),and was significantly negatively correlated with CVR (rs =-0.375,P=0.012).Conclusions The DMV grade in patients with cerebral infarction was positively correlated with the stenosis degree of responsible large artery and was negatively correlated with the MCA CVR in the responsible side.

The CD19-targeted chimeric antigen receptor (CAR) T-cell treatment has achieved clinical success in treating B-cell lineage hematopoietic malignancies. This accomplishment involved the precise and efficient elimination of tumor cells by tumor-associated an-tigen-redirected immune cells. As a result, the reinitiation of several CAR T-cell (CART) based clinical trials in solid tumors was promot-ed. However, developing a feasible and efficient CAR T based therapeutic modality for solid tumors is urgently needed given the differ-ential properties between liquid and solid tumors. In this review, we discuss the advances in the management of cytotherapeutic mo-dality for solid tumors. The aspects considered include toxicity management, target selection, and primer or conditioning treatment.

Objective To compare the effects of labor epidural analgesia initiated in latent phase and active phase on parturients and neonates. Methods One hundred twenty nulliparous women at full term (single, head presentation, ASA Ⅰ or Ⅱ ) were randomly divided into 3 groups (n=40 each):control group(group C) ; PCEA initiated in latent phase group (cervical dilatation 0.5-3.0 cm) (group L) and PCEA initiated in active phase group (cervical dilatation＞3.0 cm) (group A). Epidural catheter was placed through L2,3 interspace. 0.1% ropivacaine with fentanyl 2 μg/ml was used for PCEA. A test dose of 5 ml was followed by a loading dose of 10 ml. PCEA device was programmed to allow a bolus of 6 ml with a 30 min lockout interval. The intensity of pain was measured with VAS (0=no pain, 10=worst pain) before analgesia, at 5, 10, 15 and 30 min after beginning of PCEA and cervical dilatation of 7-8 cm and 10 cm. Degree of motor block was assessed by lower extremity muscle strength (modified Bromage scale,0=no motor block, 3=inability to flex ankle joints).Plasma cortisol in maternal venous blood obtained before analgesia and at delivery of fetus and in umbilical cord blood and plasma ropivacaine concentrations in umbilical core blood were determined.The length of every stage, duration of analgesia,delivery mode, the amount of oxytocin used, maternal satisfaction, Apgar scores of the neonates and adverse effects were recorded. Results PCEA initiated in latent phase or active phase significantly reduced VAS score, the plasma cortisol level at delivery, the duration of 1st stage of labor, and the rate of cesarean section and increased the use of oxytocin in L and A groups as compared with group C, but there was no significant difference in the above variables between L and A groups. The duration of analgesia was shorter in group A than in group L. Conclusions Labor epidural analgesia initiated in latent phase or active phase can decrease the rate of cesarean section but does not prolong the duration of labor and is safe for the newborn.

Objective To investigate the expression of membrane CD14 (mCD14), Toll-like receptor (TLR4) and nuclear factor-kappa B (NF-kB) in peripheral blood ieukocytes from patients with psoriasis vulgaris (PV). Methods Blood samples were obtained from 29 normal controls and 32 patients with PV. Patient cohort consisted of 19 males and 13 females, with an average age of 30.28 ±13.11 years, disease duration of 8.21±10.21 years, and PASI score of 21.19±5.85. Flow cytometry was used to measure the expression of mCD14, TLR4 and activated NF-kB in peripheral blood leukocytes in these subjects. Results The expressions of mCD14 and TLR4 in peripheral blood leukocytes were significantly higher in patients than in the normal controls (5.454±2.78 vs 3.937±1.964, P < 0.05; 17.641±18.120 vs 7.527±8.574, P <0.01 ). Although the expression of activated NF-kB in total blood leukocytes in patients was higher than that in normal controls, no statistical difference was noticed (63.538±8.650 vs 62.236±6.72, P > 0.05). Conclusion There is an abnormal expression of mCD14 and TLR4 in patients with PV, suggesting that the abnormal activation of endotoxin signal transduction pathway may exert a role in the induction of psoriasis.

Objective To investigate the senescence of rat mesangial cells induced by Tert-Butyl hydroperoxide (tBHP) and the protective effect of probucol on senesecence. Methods Human glomerular mesangial cells(hGMC) were cultured in vitro and intervened by tBHP. The cell survival rate was observed by methyl thiazolyl tetrazolium( MTT). β-gal staining and cell cycle analysis were used to identify cell senescent status;transmission eletric microscopy was used to evaluate the ultra-microstructure of hGMC. Senescent-related indexes were detected after treatment with probucol. Results The cell survival rate with 30 μmol/L tBHP was (80. 12 ± 3. 25 ) % , the positive rate of β-gal staining was significantly higher in tBHP-induced cells (about 81% )than that of the control cells( P <0. 01). 86% of the cells was arrested at G0-G1 phase. Invagination of nucleus membrane and chromatin condensation at the nuclear margin in tBHP-induced cells was observed through transmission eletric microscopy. In the probucol intervented cells, the cell survival rate was higher than that of tBHP-induced cells (92. 68 ± 5.03) % vs. ( 80. 12 ± 3. 25) % (P < 0. 05 ). The positive rate of β-gal staining decreased to 45. 2%. The proportion of cell cycle stage was similar to the control cells.The change of morphous and ultrastructure was relieved. Conclusions tBHP can induce hGMC senescence in vitro and probucol may play a role in preventing hGMC senescence.

Objective To investigate the association between drainage volume and removal of chest tube after video-as?sisted thoracoscopic surgery(VATS) lobectomy. Methods Patients with VATS were randomly divided into three groups:the drainage volume was less than 100 mL/24 h (group A), the drainage volume was more than 100 mL/24 h but less than 200 mL/24 h(group B) and the drainage volume was more than 200 mL/24 h but less than 300 mL/24 h (group C). According to in?clusion criteria and exclusion criteria, finally there were 90 patients in group A, 87 patients in group B and 83 patients in group C. The duration of chest-tube drainage, the occurrence of pulmonary infection, pulmonary atelectasis, pneumothorax, hydrothorax, seepage or delayed union after removal of chest tube, the dosage of analgesic and the length of hospital stay af?ter surgery were recorded. Data were analyzed statistically. Results The average durations of chest-tube drainage were (91.76±15.59)h, (84.17±18.33)h and (56.14±12.25)h, the average morphine consumptions were (236.82±67.20)mg, (187.36± 76.64)mg and (139.29±52.74)mg, and the average lengths of hospital stay after surgery were (11.47±1.90)d, (10.68±2.50)d and (10.23 ± 2.14)d for three groups of patients, respectively. And the indexes in group C were distinctly lower than those in group A and group B (P<0.05). There were no significant differences in pulmonary atelectasis, the occurrence of postopera?tive pulmonary infection, pneumothorax, hydrothorax, seepage or delayed union after removal of chest tubes between three groups of patients (P > 0.05). Conclusion It is safe and acceptable that the removal of chest tube after VATS when the drainage volume reaches 300 mL within 24 h.

Objective To establish mice model that induces mucosal immunity by orally infected tachyzoites of Toxoplasma gondii. Methods Respectively, 5?103, 5?104, 5?105, 5?106 tachyzoites of RH strain were inoculated to BALB/c mice by stomach delivery. The control group was given PBS solution. Symptoms and pathological changes of mice were observed. Secretory im-munoglobulin A (SIgA) was assayed. The lymphocytes from Peyer's patches (PP) and intraepithe-lial lymphocyte (IEL) were observed and the changes of CD4+ and CD8+ T cells assayed by SABC immunohistochemistry. Results Inoculation of 5?104 tachyzoites of Toxoplasma gondii caused symptoms and pathological changes in mice. The titre of SIgA increased in intestine, and CD4+ T subset of the mucosal inductive sites and CD8+ T subset of the mucosal effectors' sites increased. Conclusion Mucosal immunity may be induced by oral infection of 5?104 tachyzoites of T. gondii RH strain in BALB/c mice.

Following the blood pressure, pulse, breathing and body temperature, pain was identified as the fifth vital signs.Postoperative pain of the spine and spinal cord surgery was a neuropathic pain, it was severe and may affect multiple systems of the patients.Therefore, postoperative analgesia of spine and spinal cord surgery is very important.