Objective To investigate the effectiveness and safety of intranasal different dose of dexmedetomidine for pediatric echocardiography sedation and to discuss the factors concerning recovery.Methods In a single-blinded randomized clinical trial,183 children were studied with a range of 2months and 33 months of age,and American Society of Anesthesiologists(ASA) physical status Ⅰ to Ⅱ.Those children were divided randomly into one of three groups.Groups D1,D2,and D3,which were received intranasal dexmedetomidine 1.0,1.5,and 2.0 μg/kg,respectively.The induction time,recovery time,examination time,and total sedation time were compared.The success rate of sedation and the occurrence of any side-effects with the drug were compared.Sex,age,weight,dose,induction time,and examination time were used as independent valuations,the recovery time was used as dependent valuation,and then the multiple linear regression analysis was performed to filtrate and formulate the valuable factors influencing recovery time.Results The induction time had no significantly difference among groups (P ＞ 0.05).The recovery time of group D3 was longer than group D1 and group D2 (P ＜ 0.05).The total sedation time of group D3 was longer than group D1 (P ＜ 0.05).The success rate of sedation and the incidence of sideeffects had no significantly difference among groups (P ＞0.05).Children's weight and medicine dose were found to affect recovery time.Conclusions Intranasal dexmedetomidine 1 ～ 2 μg/kg could be used effectively and safely in children undergoing echocardiography examination.Weight and dose were considered as key indexes to predict recovery time.

Objective To investigate the diagnostic value of ADC in the evaluation of small round cell malignant tumors(SRCMT) of nasal and paranasal sinus.Methods This study included 143 patients with surgically confirmed SRCMT and Non-SRCMT of nasal and paranasal sinus between 2008 and 2015, all patients underwent diffusion weighted MRI at 3.0 T with a b factor of 0 and 1 000 s/mm2.Quantitative analysis of ADC values was performed.Difference in ADC values between SRCMT and Non-SRCMT was evaluated using the independent samples t test.One-way analysis of variance(ANOVA) test was performed to compare the ADC values of SRCMT.Receiver operating curves (ROC) were developed to determine the cutoff points to differentiate SRCMT from Non-SRCMT.Results There were 98 SRCMT, of which 20 lesions were rhabdomyosarcoma(RMS), 19 lesions were non-Hodgkin's lymphoma(NHL), 4 lesions were malignant melanoma(MM), 14 lesions were neuroendocrine carcinoma(NEC), 12 lesions were Ewing sarcoma or primitive neuroectodermal tumor(EWS or PNET), 11 lesions were extramedullary plasmacytoma(EMP), and 8 lesions were olfactory neuroblastoma(ON).There were 45 Non-SRCMT, of which 28 lesions were squamous cell carcinoma(SCC) and 17 lesions were adenoid cystic carcinoma(ACC).The mean ADC value of SRCMT[(0.66 ± 0.12) × 10-3mm2/s] was significantly different (t=14.97, P＜0.01) from Non-SRCMT [(1.02± 0.16)× 10-3mm2/s].All of 7 kinds of SRCMT were divided into 3 groups according to ADC values: NHL,MM, NEC,EMP;RMS,EWS,PNET;ON.There was statistically significant difference among all 3 groups(F=39.743, P＜0.01), and the differences between any 2 groups were still statistically significant.The area under the ROC of ADC values diagnosing SRCMT was 0.975.Compared with pathological results, an ADC value of 0.82 × 10-3mm2/s was used as the threshold for diagnosing SRCMT with a sensitivity of 97.8％ (44/45),specificity of 89.8％(88/98), and accuracy of 92.3％ (132/143).ADC value had high correlations compared with pathological results (Kappa value was 0.831).Conclusion The ADC value is a non-invasive imaging parameter that can be used to effectively assess SRCMT of nasal and paranasal sinus.

Objective To study the effect of Pingchuan Formula(PCF)on Rho/Rock signaling pathway in the mice of asthmatic model, explore the mechanism of PCF on asthma. Methods Forty BALB/C mice were randomly divided into four groups:a control group, a model group,a dexamethasone group and a PCF group. After treated with medicine for 4 weeks, albumen expression of RhoA and RockI in lung tissues were detected by using Western blot, mRNA expressions of RhoA and RockI were detected by using Real-time PCR. Results The albumen and the mRNA expression of RhoA and RockI in the model group were(1.05± 0.20),(1.06±0.08),(6.60±1.09), (6.53±1.84), the control group were(0.76±0.08), (0.84±0.14), (3.82± 1.77), (3.65±1.46),there was a significant difference between two groups(P<0.01). The albumen and the mRNA expression of RhoA and RockI in the dexamethasone group were(0.78±0.11), (0.87±0.32), (4.19± 2.33), (4.09±1.08), there was a significant difference compared with the model group(P<0.01). The PCF group were(0.86±0.12), (0.93±0.14), (4.38±2.01), (4.50±1.13), there was a difference compared with the model group(P<0.05). These was no difference between the dexamethasone group and the PCF group(P>0.05). Conclusion The expressions of Rho/Rock signaling pathway were controlled significantly by PCF, and the curative effect was similar to dexamethasone.

Objective:To explore the correlation between the indexes of tongue coating exfoliated cells and the Traditional Chinese Medicine (TCM) syndromes of patients with chronic gastritis.Methods:One hundred and forty-eight patients with chronic gastritis in our hospital from March 2017 to May 2018 were selected and divided into 4 groups, including 36 patients with spleen and stomach weakness syndrome, 39 patients with liver-stomach discordance syndrome, 32 patients with stomach yin deficiency syndrome, and spleen and 41patients with stomach damp-heat syndrome according to the TCM classification. In addition, another 50 healthy people without cold and heat deficiency syndrome were selected as healthy control group. The maturity index (MI) and mature value (MV) of tongue coating exfoliated cells, chemical indicators and cell cycle of tongue coating exfoliated cells were detected. The spearman rank correlation method was used to analyze the indicators of tongue coating exfoliated cells and TCM syndromes.Results:Compared with the healthy control group, the subjects with spleen and stomach weakness syndrome, liver-stomach discord syndrome, stomach-yin deficiency syndrome, spleen-stomach damp-heat syndrome showed significantly higher percentage of intermediate cells [(14.85 ± 4.03) % vs. (26.47 ± 3.94) %, (22.32 ± 5.41) %, (31.47 ± 3.28) %, (35.62 ± 3.96) %, P<0.05], significantly lower percentage of surface cells [(85.15 ± 5.33) % vs. (73.53 ± 6.47) %, (77.68 ± 5.38) %, (68.53 ± 4.20) %, (64.38 ± 4.39) %, P<0.05], and significantly lower percentage of MV value [(92.61 ± 3.74) % vs. (83.52 ± 3.10) %, (87.64 ± 2.95) %, (79.38 ± 3.21) %, (75.63 ± 2.83) %, P<0.05]. Compared with the healthy control group, the ACP, LDH, SDH, and -SH in tongue coating exfoliated cells of subjects with spleen and stomach weakness syndrome, liver and stomach discordance syndrome, and stomach yin deficiency syndrome were all significantly decreased ( P<0.05), while ACP, LDH, SDH, and -SH in subjects with spleen and stomach damp-heat syndrome were all significantly increased ( P<0.05). the percentage of cells in G1 phase of subjects with gastric yin deficiency and spleen and stomach damp-heat syndrome were significantly decreased ( P<0.05), while the percentage of S phase cells were significantly increased ( P<0.05). Spearman rank correlation analysis showed that each syndrome type was correlated with ACP, LDH, SDH, -SH ( r values were 0.608, 0.712, 0.704, 0.631, respectively, all Ps<0.05). Conclusion:Patients with different TCM syndromes of chronic gastritis may have different morphological changes of tongue coating exfoliated cells, large differences in cell cycle, and different levels of cell biochemical indicators.

Objective: To establish a fluorescence method based on turncated aptamer for the determination of bisphenol A in water. Methods: The bisphenol A truncated aptamer containing 38 bases was selected as a recognition module, and was modified with the fluorophore 6-FAM at the 5'end. The 3'end of the complementary sequence cDNA was modified with the quencher DABCYL. The standard solutions of bisphenol A and interfering compounds were configured. The detection system was established after optimizing the number of bases in cDNA, the concentration ratio of truncated aptamer to cDNA, the incubation temperature and time, and the pH of the buffer. The specificity and recovery experiments were carried out. Results: When the complementary sequence cDNA included 9 bases, the concentration ratio of the truncated aptamer to cDNA was 1:1.5, the pH value of the buffer solution was 7.5, the cDNA was incubated at 55 ℃ for 60 minutes, in the concentration range of 10-75 pmol/L, the linear regression equation was y=2 230.7x+110 825, the correlation coefficient was 0.926. The limits of detection was 3.3 pmol/L. The difference values of fluorescence intensity between tetrabromobisphenol A, estradiol, estriol, bisphenol S and bisphenol A were obviously different, so there was no significant interference to the test result. The recovery rates were 97.8%, 98.8% and 102.3% with the spiked concentrations of 20.0, 40.0 and 60.0 pmol/L. The relative standard deviations were 4.4%, 2.1% and 2.6% (n=5), respectively. Conclusion The fluorescence method based on turncated aptamer has the advantages of easy operation, high sensitivity and specificity, which can be used for the determination of bisphenol A in water.

Objective To analyze the key factors influencing the number of diseases or conditions in which clinical pathways ( CPs) were implemented at public hospitals of China. Methods Based on the questionnaire survey of 51 public hospitals that had implemented CPs in Shanghai, Hubei province, and Gansu province, a multivariate logistic model was used to analyze the factors that influenced the number of CPs implemented in hospitals. Results In terms of the 14 issues and difficulties found in CPs′implementation, the overall acceptance rate was 38. 8% on average among surveyed hospitals, yet with a great variation(from 7. 1% to 100. 0%). A multivariate logistic model showed that the recognition of public hospitals on the issues and difficulties in CPs′implementation did not affect the number of implemented CPs, and tertiary public hospitals had significantly higher number of CPs implemented than secondary hospitals. Conclusions The resources and management capabilities of public hospitals in China are the determinants of CPs′promotion.

Objective To investigate the value of ADC and T2WI in differentiating of skull base chordoma and invasive pituitary adenomas(IPA).Methods 15 patients with skull base chordoma and 19 patients with IPA which involve paranasal sinus were reviewed retrospectively.All diagnosis were demonstrated by pathology.Quantitative analysis of minimum ADC, normal ADC and rT2WI values were performed.Differences in minimum ADC, normal ADC and rT2WI values between skull base chordoma and IPA were evaluated using the independent samples t test and receiver operating curves(ROC).Results Statistical analysis revealed a significant difference among normal ADC, minimum ADC and rT2WI values (P<0.01),and the area under the ROC curves decreased in turn.Conclusion Both ADC values and rT2WI SI are effective parameter for differentiating diagnosis of skull base chordoma and IPA.

Objective To assess the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) in differential diagnosis of neuroendocrine carcinoma of the uterine cervix (NECUC) from other tumors.Methods A total of 12 NECUCs,39 cervical squamous cell carcinomas (SCC) and 21 cervical adenocarcinomas (CA) confirmed by pathology were analyzed retrospectively.All the patients underwent conventional MRI and DWI.The ADC values were measured and compared among NECUC,SCC and CA.Diagnostic performance of ADC was compared using receiver operating characteristic curves (ROC).Results The mean ADC values of NECUC,SCC and CA were (0.66 ± 0.11) ×10-3 mm2/s,(0.86 ± 0.11) × 10-3 mm2/s and (1.04 ± 0.17) × 10-3 mm2 / s,with statistical differences between any two groups (P ＜0.001).The optimal cutoff values of ADC for differentiating NECUC and SCC was 0.681 ×10-3mm2/s with a sensitivity of 94.9％,specificity of 75.0％ and accuracy of 90.2％.The optimal cutoff values of ADC for differentiating NECUC and CA was 0.824× 10-3mm2/s with a sensitivity of 95.2％,specificity of 91.7％ and accuracy of 98.9％.Conclusion The differences of the mean ADC value are helpful for the differential diagnosis of NECUC,SCC and CA.

Objective To analyze the management of clinical pathways ( CP) in China. Methods Cross-sectional questionnaire surveys of 51 public hospitals with CPs in place in Shanghai, Hubei province and Gansu province were conducted from March to May of 2015. Results Among the 51 public hospitals with CPs, 48 ( 94. 1%) of them organized training on CPs, 48 ( 94. 1%) of them monitored CPs′implementation, and 40 (78. 4%) applied incentives for CPs′ implementation. But there were some issues and difficulties encountered in CPs′ implementation. Conclusions Comprehensive measures are necessary to improve the management of CPs at public hospitals of China.

Objective To analyze the implementation of clinical pathways ( CP) at public hospitals at different levels and in different regions in China. Methods The status of CPs′ implementation at 54 public hospitals in Shanghai, Hubei province and Gansu province was surveyed by questionnaires from March to May of 2015. Results 51 (94. 4%) of the surveyed public hospitals put in place clinical pathway(s), where the average CPs implemented were 45 and the average percentage of the cases using CPs was 52. 7%. There were great variations among these hospitals. In addition, the common diseases with definite diagnostic and treatment options were found with the highest implementation rates of CPs at such hospitals. Conclusions CPs are implemented widely at public hospitals of China, yet enhanced implementation strategies are expected to further CPs′adoption.