Objective To observe the contrast sevoflurane anesthesia and propofol intravenous anesthesia in children hernia surgery anesthesia on blood flow dynamics in children to assess the quality of anesthesia, anesthesia program aims for the future choose to provide important reference for basis . Methods The surgical treatment of pediatric hernia patients from January 2012 to June 2016 was prospectively selected as the study group, and the rats were divided into two groups by random drawing method. Results There were other children point and T1 relatively SBP, DBP were significantly lower (P<0.05), the observation group were significantly lower than the control group (P<0.05), the control group of children with T2, T3 compared with T1 point HR significantly increased (P<0.05). Conclusion Pediatric hernia surgery using laryngeal mask sevoflurane anesthesia exact effect, maintaining hemodynamic stability, safety, and can be widely used in clinical.

Objective To evaluate the effects of reminfentanil combined with propofl on patients received video assisted thoracoscopic surgery. Methods 40 ASA Ⅰ～Ⅱ patients underwent video assisted thoracoscopic surgery were randomly divided into two groups. BP、HR before anesthesia induction(T0) ,tracheal induction(T1) ,tracheal induction instantly (T2), after five minutes of tracheal induction(T3) were observed; The time of breathing recovery withdrawl,and open eye,extubation and instantly of extubation,VAS;to record in the operation and adverse effect of postoperative nausea were analyzed. Results During tracheal induction, hemodynamic and respiratory variables of groupR less then group F(P ＜ 0. 05), after operation group R time of breathing recovery withdrawl, and open eye, extubation is short of group F(P ＜ 0. 05). Two groups was not appear to know in operation, postoperative nausea is not satistically significant. Conclusion General anesthesia by reminfentanil combined with Propofol on video assisted thoracscopic surgery was safe and feasible.

Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to thelethal triadprecursor,and terminate the operation quickly when it happens.

Objective To investigate the efficiency and safety of endoscopic large balloon dilation following small sphincterotomy (ESBD) for treatment of common bile duct (CBD) stones, and to prospectively compare it with traditional sphincterotomy (ES). Methods Patients with single or multiple calculi in extra-hepatic bile ducts and with the diameter of CBD larger than 13 mm, were randomized into 2 groups to receive maximal sphincterotomy (ES group), or partial sphincterotomy plus sphincteroplasty with 15mm-balloon (ESBD group), respectively, followed by conventional stones removal and/or lithotripsy. The success rate of stone clearance, operation time and related complications were observed. Results A total of 86 patients were enrolled in 2 endoscopy centers, with 2 excluded because of papillary pre-cut in 1 and non-compliance with the protocol in the other, and were randomly divided into groups ES and ESBD, with 42 patients in each. The clinical characteristics, including average diameter of CBD, size and quantity of calculi, and incidences of peri-ampullary diverticulum, of patients in both groups were all similar. Stones clearance with single session in 2 groups were 88% and 93%, respectively (P =0. 531 ). The operation time were (25.76 ± 12. 74) min and (26. 38 ± 12. 86) min ( P = 0. 825 ). The rate of mechanical lithotripsy was 36% and 25%, respectively (P=0. 363). Complications occurred in 5 cases in ES group (3 mild, 2 medium), and 2 mild complications occurred in ESBD group (no statistical difference). No death happened in any group.Conclusion ESBD is an effective method for clearance of extra-hepatic bile duct stones with the similar safety, compared with traditional sphincterotomy. It could be an optimal alternative for those with large stones or difficult sphincterotomy.

Objective:To assess whether Veronicastrum axillare (V. axillare) can ameliorate ethanol-induced gastric mucosal lesions in rats, reduce the production of pro-inflammatory cytokines, suppress apoptosis and improve local microcirculation disturbances.
Methods:Totally 48 male Sprague-Dawley rats were randomly divided into six groups, eight rats in each group. Rats in the normal group and the model group were administered with 0.9%normal saline respectively. Rats in the positive group and ranitidine group were administered with 0.18% ranitidine suspension by intragastric administration respectively. Those in the high dose V. axillare group, the medium dose V. axillare group and the low dose V. axillare group were administrated with V. axillare at the daily dose of 2.8 g/kg, 1.4 g/kg and 0.7 g/kg by intragastric administration. Gastric mucosal lesions were produced by intragastric administration of absolute ethanol. Water extract of V. axillare was successively injected for 14 d and last day was injected 1 h before ethanol administration. Gastric mucosal ulcer index and ulcer inhibitory rate were counted by improved Guth methods. The tissue sections were made for pathological histology analysis. Also, we measured the concentrations of tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1) in gastric mucosal, as an index of the pro-inflammatory cytokines, apoptosis and local microcirculation. Besides, the mRNA contents of TNF-αand ET-1 were measured to verify effects on gene expression by real-time fluorescent quantitative PCR.
Results: Water extract of V. axillare significantly ameliorated the gastric mucosal lesions induced by ethanol administration (P<0.01). Pro-inflammatory cytokines, TNF-αand ET-1 were increased after ethanol administration and significantly reduced by water extract of V. axillare. The expressions of TNF-αand ET-1 mRNA were also be inhibited by water extract of V. axillare.
Conclusion: Current evidences show water extract of V. axillare is effective for defending against ethanol-induced gastric mucosal lesions, significantly inhibiting the production of pro-inflammatory cytokines and the expressions of TNF-αand ET-1 mRNA, which may be useful for inhibiting apoptosis and improving local microcirculation.

Objective To summarize the pathogenesis,diagnosis and treatment of aplasia cutis congenita (ACC) in China.Methods We reviewed and summarized all published ACC cases in China in the past four decades from China National Knowledge Internet(CNKI),Wan-Fang Medical Database and VIP database.Results Totally,258 cases were included,consisting of 144 males,95 females and 19 of unknown gender.Fifteen cases reported family history,16 had maternal morbidity during pregnancy,17 exposed to maternal medication or toxic material.Skin lesions of ACC occurred on the scalp (39 cases,15.1％),trunk (8 cases,3.1％) or limbs (107 cases,41.5％) and sometimes were manifested as multiples skin defects (104 cases,40.3％).Eighty-nine cases (38.4％) were presented with isolated skin defect,and 169 (61.6％) were complicated by other abnormalities or congenital defects.Totally,235(91.1％) cases were treated conservatively,15 cases with dural defect,skull defect or defect area ＞ 10％ underwent dermatoplasty,and the other eight cases refused any treatment.Among the 248 cases being followed up,233 (93.95％) healed after treatment for one week to four months,three had scar contracture,four developed joint contracture,and eight (3.2％) died of hemorrhage or infection.Conclusions ACC is a congenital skin defect which might involve skin,bone and multiple parts of the body,often complicated with other abnormalities.Superficial and small skin defect maybe managed conservatively,while for patients with bone exposure or defect,large area skin defect,surgical management is recommended.Appropriate management can ensure good outcomes in most cases.

Ribonucleic acid (RNA) deserves not only a dedicated field of biological research -- a discipline or branch of knowledge -- but also explicit definitions of its roles in cellular processes and molecular mechanisms. Ribogenomics is to study the biology of cellular RNAs, including their origin, biogenesis, structure and function. On the informational track, messenger RNAs (mRNAs) are the major component of ribogenomes, which encode proteins and serve as one of the four major components of the translation machinery and whose expression is regulated at multiple levels by other operational RNAs. On the operational track, there are several diverse types of RNAs--their length distribution is perhaps the most simplistic stratification--involving in major cellular activ-ities, such as chromosomal structure and organization, DNA replication and repair, transcriptional/post-transcriptional regulation, RNA processing and routing, translation and cellular energy/metabolism regulation. An all-out effort exceeding the magnitude of the Human Genome Project is of essence to construct just mammalian transcriptomes in multiple contexts including embryonic development, circadian and seasonal rhythms, defined life-span stages, pathological conditions and anatomy-driven tissue/organ/cell types.

Objective To explore the clinical efficacy of 3D printing technique in assisting sacroiliac screwing in combination with front ring nail-rod system for treatment of unstable pelvic fractures.Methods From July 2015 to June 2017,3D printing technique was used to assist the sacroiliac screwing in combination with front ring nail-rod system for 16 patients with unstable pelvic fracture at Orthopaedic Center,The Fourth People's Hospital of Zigong.They were 9 males and 7 females,aged from 19 to 60 years (average,39.8 years).By the Tile classification,5 cases were type B1,6 type B2,3 type B3 and 2 type C.Their operation duration,bleeding,fluoroscopy frequency,incision length,postoperative fracture reduction,success rate of sacroiliac screwing,accuracy of sacroiliac screwing,perioperative complications,weight-bearing exercise time,fracture healing time and the Majeed scores at the last follow-up were documented.Results All the 3D models and navigation templates were successfully designed and printed.Surgery succeeded in all the patients.Follow-ups ranged from 6 to 18 months,averaging 13.3 months.The bleeding ranged from 100 to 250 mL,averaging 162.4 mL;the operation duration ranged from 60 to 120 min,averaging 73.2 min;the intra-operative fluoroscopy frequency ranged from 13 to 31 times,averaging 17.4 times;the incision length ranged from 16 to 32 cm,averaging 21.1 cm.All the incisions healed by the first intention and all the fractures obtained osseous union after 90 to 120 d (average,102.3 d).No significant complications like neurovascular injury or pulmonary embolism happened.The weight-bearing exercise time ranged from 25 to 40 d,averaging 31.5 d.According to the Matta imaging scores,the reduction was rated as excellent in 12 cases and good in 4.Altogether 28 screws were inserted with a success rate of 100％.Compared with the preoperative simulated screwing,the actual screwing angle deviated postoperatively by 0.12° ± 0.32°,the X axis by 0.36 ± 1.24 mm,the Y axis by 0.36 ± 1.24 mm and the Z axis by 0.22 ± 1.26 mm,showing no statistically significant difference between the actual 3D deviations and the test value of 0 (P ＞ 0.05).Conclusion In the treatment of unstable pelvic fractures,3D printing technique can be used in preoperative preparation of the connecting rod in the front ring nail-rod system to assist the sacroiliac screwing,significantly shortening the operation duration,reducing bleeding,ensuring safe and accurate screwing,and facilitating functional recovery.

The human gastrointestinal tract is the largest reservoir of bacteria in the body,inhabiting a very complex and active microbial community.Under normal circumstances,the interaction between the intestinal flora and the host maintains a dynamic balance.Spleen deficiency syndrome is a common classic syndrome type in TCM clinical practice.A large number of studies have shown that spleen deficiency syndrome is closely related to intestinal microorganisms,and the balance of intestinal flora is the basis for the normal functioning of the spleen's main transportation and transformation functions.Intestinal flora imbalance can lead to a series of manifestations of spleen deficiency.In addition,intestinal flora is an important medium for the metabolism of polysaccharide components and the effectiveness of traditional Chinese medicine for invigorating the spleen,and traditional Chinese medicine for invigorating the spleen can also play a therapeutic role by regulating the structure and quantity of intestinal flora.This article summarizes the relationship between intestinal flora and spleen deficiency syndrome in physiology,pathology,and the efficacy of traditional Chinese medicine for invigorating the spleen.Based on intestinal flora,the study of spleen deficiency syndrome aims to provide some thoughts and suggestions for revealing the connotation of spleen deficiency syndrome in traditional Chinese medicine.

Objective:The aim of noise quality management for ICU patients was to explore the clinical feasibility of noise quality management.Methods:A randomized controlled trial method and convenient sampling method were used to select 240 patients treated in the ICU of Shanghai Fengxian District Central Hospital from April 2021 to March 2023 as the study objects. According to the time of admission, 120 patients admitted from April 2021 to March 2022 were divided into the control group. A total of 120 patients admitted to hospital from April 2022 to March 2023 were included in the intervention group. The control group was given routine care, and noise quality management was implemented in the intervention group on the basis of routine care. The noise decibel value, sleep quality, incidence of delirium and patient satisfaction of the two groups were compared.Results:In the intervention group, there were 69 males and 51 females, aged (56.08 ± 5.74) years old. The control group included 68 males and 52 females, aged (56.11 ± 5.72) years old. The decibels of day and night in ICU of the intervention group were (42.62 ± 1.33) and (38.72 ± 1.28) dB, which were lower than those of the control group (67.49 ± 2.36) and (59.65 ± 2.37) dB, with statistically significant differences ( t=100.57, 85.12, both P<0.05). Total score of sleep quality of patients in the intervention group (78.40 ± 5.86) was higher than that of the control group (60.49 ± 6.25), with statistically significant differences ( t=24.32, P<0.05). The incidence of delirium in the intervention group 12.50%(15/120), was lower than that in the control group 26.67%(32/120) with a statistically significant difference ( χ2=7.65, P<0.05). Satisfaction of patients in the intervention group 97.50%(117/120) was higher than that in the control group 90.00%(108/120), with a statistically significant difference ( χ2=5.76, P<0.05). Conclusions:The application of noise quality management for ICU patients is conducive to improving the overall environment of the ward, improving the sleep quality of patients, reducing the occurrence of patients′ delirium and improving patient satisfaction.