Objective To compare the effects of propofol versus sevoflurane combined with remifentanil anesthesia on the activity of nuclear factor-kappa B (NF-κB) in neutrophil granulocyte during one-lung ventilation (OLV) in patients undergoing radical resection of esophagus cancer.Methods Forty ASA physical status Ⅰ or Ⅱpatients of both sexes,aged 40-64 yr,with body mass index 18-25 kg/m2,undergoing radical resection of esophagus cancer,were randomized into 2 groups (n =20 each):propofol-remifentanil group (group P) and sevofluraneremifentanil group (group S).Anesthesia was induced with midazolam,sufentanil,etomidate and cisatracurium besylate in both groups.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · min-1 in group P,or with inhalation of 1%-3% sevoflurane in group S,and with iv infusion of remifentanil 0.2μg· kg-1 · min-1 and intermittent iv boluses of cisatracurium besylate 7 mg in both groups.The Narcotrend index value was maintained between 40 and 50.Blood samples were taken from the radial artery at 5 min after intubation,the beginning of OLV,30,60 and 90 min of OLV,0 and 10 min after re-expansion of the collapsed lung,and the end of surgery for blood gas analysis and for determination of plasma concentrations of IL-1.The oxygenation index and respiratory index were calculated.The nuclear protein of neutrophil granulocytes was extracted for detection of NF-κB-DNA binding activity.Results Compared with group P,the respiratory index,plasma concentrations of IL-1 and NF-κB-DNA binding activity were significantly increased (P ＜ 0.05),and no significant change was found in the oxygenation index in group S (P ＞ 0.05).Conclusion Compared with sevoflurane-remifentanil anesthesia,propofol-remifentanil anesthesia can inhibit activation of NF-κB in neutrophil granulocyte and is helpful in attenuating the inflammatory response in lung tissues during OLV in patients undergoing radical resection of esophagus cancer.

Objective To explore the relationship and clinical significance between the serum levels of oxidized low density lipoprotein (Ox-LDL) and soluble P-selectin (SP-S),and carotid atherosclerosis (CA) in metabolic syndrome (MS) patients.Methods In 103 cases of MS patients and 44 healthy subjects (control group),in MS patients with 3 MS diagnostic criteria for the low risk group (51 cases),with ≥ 4 MS diagnostic criteria for high risk group (52 cases).Carotid artery intima-media thickness (IMT) and plaque was measured by color Doppler ultrasound,serum Ox-LDL,SP-S was determined by enzyme linked immunosorbent assay,and pearson regression analysis of linear correlation and classification of two non condition Logistic was performed.Results The serum levels of Ox-LDL,SP-S,carotid artery IMT in low risk group and high risk group were higher than those in control group [(36.42 ±7.17) μg/L and (54.44± 8.10) μg/Lvs.(30.08±7.15) μg/L,(71.46± 12.52) μ g/Land (89.33±20.28) μg/Lvs.(49.95 ± 12.49) μ g/L,(0.86 ± 0.11) mm and (1.00 ± 0.10) mm vs.(0.69 ± 0.11) mm],the difference was statistically significant (P ＜ 0.01).The incidence of plaque in high-risk group and low-risk group was significantly higher than that in control group [55.8％ (29/52) and 45.1％ (23/51) vs.15.9％ (7/44)],the difference was statistically significant (P ＜ 0.01).Linear correlation analysis results of Pearson display,Ox-LDL was positively correlated with SP-S (P ＜0.01).Conclusion Serum Ox-LDL and SP-S are independent risk factor for carotid atherosclerosis in MS patients,they can evaluate progression of carotid atherosclerosis in patients with MS.

Objective To investigate the expression of connexin CX43 using hybridization techniques after GABA restraining receptor gene was transferred into the supramammillary of hypothalamus in Kainic acid(KA) induced epileptic rats.Methods Twenty-four male Wistar rats were divided into four groups: control group(n=2),surgery group(n=2),KA group(n=10) and GABA restraining receptor gene transferred group(GABA group)(n=10).No treatment was given to the control group.Physiological saline(1 ?L) was injected into right amygdala of rat in surgery group.In KA group,KA(1 ?L,1 ?g) was injected into the amygdala of rat to build epileptic model.In GABA group,the GABA restraining receptor gene(400 nL,40 ng) was transferred into the supramammillary of hypothalamus by HVJ-liposome 48 h before KA was injected into amygdala.The expressions of CX43 mRNA and morphological changes different time(3 h,6 h,24 h,3d,7d) were observed by in situ hybridization in each group.Results In control group and surgery group,the morphological manifestations were normal,and the hippocampus structures were complete.In KA group,swell and degenerative hippocampus neurons were showed and deteriorated with time.In GABA group,the degeneration and necroses of hippocampus neurons were relatively alleviated.The positive expression of CX43 mRNA was few in control group and surgery group.And in KA group it increased with time.In GABA group,the positive expression of CX43 mRNA was fewer than that of KA group at every period.Conclusion The expression of CX43 mRNA in hippocampus can be decreased by transferring GABA receptor gene into hypothalamus.

] AIM: To investigate the expression of the urotensin Ⅱ (UⅡ) receptor GPR14 in the aorta of apoE knockout mouse. METHODS: The expression of GPR14 in the aorta of apoE knockout C57BL/6J mice at various ages (18 weeks, 28 weeks, and 38 weeks old, respectively) was determined with competitive RT-PCR. A binding assay of [ 125 I]-UⅡ on the aortic tissue was also performed in 28 weeks group. RESULTS: We found significant upregulation of GPR14 mRNA at all three ages. Compared with wild type group at the same age, the GPR14 mRNA level in apoE knockout mice increased 54.2% in 18 week group (P

Objective:To investigate the effect of early enteral nutrition combined with Bacillus in the treatment of patients with digestive tract perforation.Methods:59 patients with emergency digestive tract perforation were randomly divided into experimental group (EN plus Bacillus,n =31) and control group (TPN,n =28).The patients in the experimental group were given enteral nutrition plus Bacillus after first days (＜ 24 h),and the control group was treated with parenteral nutrition support on the first day after surgery.The average hospitalization time,length of ICU stay,incidence of complications,and serum C-reactive protein in the two groups were analyzed.Results:The average length of hospitalization time,ICU stay,recovery of bowel function and eating time were significantly shorter in the experimental group than in the control group(P ＜ 0.05).There was no significant difference in nutrition index between the two groups during the perioperative period (P ＞ 0.05).The C-reactive protein in the experimental group was significantly lower than that in the control group fourth days after operation (P ＜ 0.05).The incidence of postoperative wound infection in the experimental group was significantly lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of other complications.Conclusion:Early administration of enteral nutrition combined with Bacillus can significantly shorten the intestinal function recovery time,decreasethe average hospitalization days,reduce the postoperative wound infection rate and thus improve the outcome of patients with digestive tract perforation.

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury.Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked.The animal model of iatrogenic splenic injury was established by general anesthesia.Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding.The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 rmin if still bleeding.Then hemostatic effect after removing blocking and oppression was observed.Control group was only treated with gelatin sponge compression to stop bleeding.Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group,and before compression and relieving the compression for 2 hours in control group.IL-1 (interleukin),SOD (superoxide disproportionation enzyme),MPO (myeloperoxidase),MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected.Results The control group still had bleeding,while the experimental group had successfully stopped bleeding.Serum markers before and after occlusion in the experinental group were IL-1 (124.4 ± 106.8 vs.121.2 ± 105.1),SOD (4.7 ± 2.7 vs.5.2 ± 1.8) and MDA (8.8 ±6.5 vs10.8 ±7.5).There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2 ± 105.1 vs.162.8 ± 73.8),SOD (5.2 ± 1.8 vs.4.7 ± 2.8) and MDA (10.8 ±7.5 vs.9.6 ±6.6) (P＞0.05).Histological indicators before and after occlusion in the experimental group included MPO (0.62 ±0.23 vs.0.68 ±0.21) and Caspase-3 (0.90 ±0.29 vs.0.86 ± 0.26),and there was no statistical difference on MPO (0.68 ±0.21 vs.0.86 ±0.23 after two sets of experiments) and Caspase-3 level (0.86 ± 0.26 vs.1.21 ± 0.18) (P ＞ 0.05) in two groups after occlusion/ oppression.Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury.

Objective To build a multi‐level hierarchical structure model of the influencing factors for hierarchical medical system ,to identify the role relationship between all the factors and transmission pathways ,and to recommend on developing China′s hierarchical medical system . Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system .On such basis ,16 influencing factors were identified by three health policy experts ,which affect operations of the current system .Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops .Results There exist among the 16 factors a 3‐level hierarchical structureand two conduction loops .The factor directly limiting the hierarchical medical system is two‐way referral,and most internal core drivers arehuman resources development and governance mechanism.By means of self‐growth and external constraints ,they exert their influence on the operation of hierarchical medical system .Conclusions There are interactive hierarchical effects among the factors ,merging into three node elements of functional role,inter‐entity relationshipand patient participation.

Objective:To assess the usage of the robot-assisted core-needle biopsy for the bone tumors, moreover to compare its outcomes with the manual technique.Methods:A retrospective study was conducted from February 2019 to February 2021, the medical records of the patients with bone lesions that had received core-needle biopsy were collected. There were 57 males and 45 females, the age was 45.9 (10~79) years. Eight patients received robot-assisted biopsy, whereas 94 patients underwent C-arm/ CT guided biopsy, the recorded data included operational duration, aspirational direction adjustment, etc. The pathological diagnosis reports of the biopsy specimens and the operational specimens were compared.Results:The diagnosis outcomes included metastases (33 cases), osteosarcoma (12 cases), chondrosarcoma (12 cases), giant cell tumor of bone (12 cases), fibrous dysplasia (7 cases), chronic osteomyelitis (7 cases), lymphoma (4 cases), multiple myeloma (4 cases), chronic fracture (3 cases), chondroblastoma (2 cases), pleomorphic undifferentiated sarcoma (2 cases), leiomyosarcoma (1 case), and Langerhans cell histiocytosis (1 case). Eighty-seven cases (85.29 %) lesions were found in the limbs, whereas 15 cases (14.71%) were in the axial locations. Compared with the manual group, the robot-assisted group had more axial locations: 7/8 vs. 11.70%(11/94), P<0.01; fewer aspirational direction adjustment: (0.4 ± 0.1) times vs. (3.1 ± 1.5) times, P<0.01 ; longer operational duration: (48.8 ± 8.8) min vs. (29.6 ± 6.0) min, P<0.01. There were no statistical differences between the two groups regarding the sex, age, pathological fracture, diagnostic accuracy, open biopsy rate and complications ( P>0.05). Conclusions:The robot-assisted core-needle biopsy is a reliable technique, it helps decrease the operational difficulty. The usage of this technique is recommendable for the bone lesions with great difficulty for biopsy, such as the minimal bone tumors and the lesions in the spine and the pelvis.

Objective To investigate the current status of job burnout among anesthetists in Ningxia and to analyze its related risk factors.Methods A total of 310 anesthetists from 30 public hospitals in Ningxia were conducted to collect data on the job burnout by Maslach Burnout InventoryHuman Services Survey (MBI-HSS).The factors associated with severe job burnout and its three domains (high emotional exhaustion,high depersonalization and low personal accomplishment) were included in the multinomial logistic regression analysis.Results The incidence of job burnout and its three domains (high emotional exhaustion,depersonalization and low personal accomplishment) were 18 (5.81％) cases,134 (43.22％) cases,35 (11.29％) cases and 128 (41.29％) cases,respectively.Multinomial logistic regression analysis results indicated that the risk degree associated with job burnout was master and higher degree (OR=4.695,95％CI 1.556-4.172).The risk facts associated with three components of job burnout were work time per week [40-60 h (OR=4.420,CI 2.504-7.802);≥60 h (OR =7.469,95％CI 1.758-31.733)] and tertiary hospital (OR =1.847,95％oCI 1.112-3.069);master and higher degree (OR=2.306,95％CI 1.032-5.155),working years [6-15 years (OR=0.358,95％CI 0.135-0.949)] and cases of anesthesia per year [≥390 cases (OR =3.352,95％CI 1.301-8.639)];secondary hospital (OR =1.717,95％CI 1.045-2.823).Conclusion This survey indicates that job burnout exists among anesthetists in Ningxia and is mainly displayed in emotional exhaustion and low personal accomplishment domains.Master and higher degree tend to occur serve job burnout.

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit (P＜0.05). The influencing factors of medical staff's satisfaction included the type of payment, work unit, and working years among others(P＜0.05). The influencing factors of farmers'satisfaction included the type of payment and the average annual income, etc(P＜0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients'understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.