Objective To investigate the effect of full-dose and half-dose aprotinin on perioperative inflammatory response in patients undergoing off-pump coronary artery bypass grafting (CABG) .Methods Thirty-nine patients aged 50-65 yrs undergoing off-pump CABG were randomly divided into 3 groups (n = 13 each):Ⅰcontrol group (C);Ⅱfull-dose aprotinin group (A-full) andⅢhalf-dose aprotinin group (A-half) . In groupⅡ( A-full) aprotinin 2?106 KIU in 100 ml normal saline (NS) was infused over 30 min after induction of anesthesia followed by aprotinin infusion at 0.5?106 KIU?h-1 until the end of surgery. In group A-half, half the amount of aprotinin administered in group A-full was given. In control group only NS was administered. Blood samples were taken before operation (T1,baseline) , 0.5 h after completion of vascular anastomosis (T2) and 2, 6, 18 h after operation (T3-5), for determination of plasma concentrations of IL-10, IL-6 and troponin (TnI) .Results The 3 groups were comparable with respect to age, M/F ratio, duration of operation and the number of bypass grafts. Plasma concentrations of IL-10, IL-6 and TnI were significantly increased after operation as compared to the baseline values (T0) in all 3 groups. The plasma concentrations of IL-10, IL-6 and TnI were significantly lower and postoperative blood loss smaller in the 2 aprotinin groups than in the control group; but they were not significantly different between the two aprotinin groups. Conclusion Both full-dose and half-dose aprotinin can inhibit the inflammatory response to CABG, reduce myocardial injury and postoperative blood loss. Half-dose aprotinin is recommended in patients undergoing off-pump CABG.

Objective To investigate the effects of propofol on the survival rate of and the expression ofinducible nitric oxide synthase (iNOS) in the cultured hippocampal neurons.Methods Hippocampal neuronsisolated from new-born SD rats were dispersed and cultured in B27 culture medium for 9-10days.The culturedhippocampal neurons were randomized to one of 4 groups: (1)control group; (2) anoxia group; (3)propofol 4?g?ml~(1) + anoxia group; (4) propofol 12 ?g?ml~(-1)+ anoxia group. For anoxia the cultured hippocampal neurons wereplaced in a tightly closed vessel filled with 95 % N_2～5% CO_2 at 37℃ for 4h,followed by 24 h reoxygenation. Inthe propofol groups (group 3 and 4) propofol was added before anoxia. Survival rates were measured by MTTassay The levels of iNOS expression were determined by immunocytochemistry method.Results In the twopropofol groups (group 3 and 4) propofol attenuated the levels of iNOS expression in the cultured hippocampalneurons and increased the survival rates as compared with anoxia group (group 2). Depofol reduced the levels ofiNOS expression in a concentration-dependent manner.Conclusion Propofol can decrease the level of iNOSexpression in cultured hippocampal neurons induced by anoxia-reoxygenation and increase the survival rate ofhippocampal neuron after anoxia-reoxygenation. Inhibition of iNOS expression may explain partly the mechanism ofcerebral protective effects of propofol.

Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.

Objective:To search, evaluate and summarize the evidence related to the maintenance of peripheral arterial duct flushing systems in children for clinical reference.Methods:Up To Date, BMJ, Nathional Institute for Health and Care Excellence(NICE), Chinese Medlive, Cochrane Library, Joanna Briggs Institute(JBI), CINAHL, METSTR, PubMed, Wanfang, CNKI, VIP were used to collect secondary evidence resources about management and maintenance of peripheral arterial duct flushing systems in children. After the quality evaluation of each type of literature, the evidence was extracted and summarized.Results:A total of 9 articles were included in the research. The 22 pieces of best evidence were obtained from 7 aspects, including basic requirements of children′s peripheral arterial duct flushing systems, arterial flushing method, flushing rate of injection pump system, flushing pressure of pressurized bag pump system, arterial flushing fluid, replacement and maintenance of children′s arterial catheter flushing system, and continuous improvement of arterial catheter maintenance.Conclusions:The best evidence for the establishment and maintenance of pediatric peripheral arterial duct flushing systems provides a basis for clinical decision, but practice testing is still needed.

Objective:To explore the expression of fructose bisphosphate aldolase A (ALDOA) in the bone marrow of patients with acute myeloid leukemia (AML) and the correlation with clinical features and prognosis.Methods:The bone marrow samples of 90 newly diagnosed AML (non-acute promyelocytic leukemia) patients and 18 allogeneic hematopoietic stem cell transplantation donors who were treated from January 2013 to December 2015 in the First Affiliated Hospital of Zhengzhou University and the Children's Hospital Affiliated to Zhengzhou University were collected. The relative expression level of ALDOA mRNA in bone marrow samples was detected by using real-time quantitative polymerase chain reaction (qRT-PCR). Clinical data of these patients were retrospectively analyzed, and the patients were divided into continuous complete remission (CR) group and refractory recurrent (RR) group according to the clinical response and follow-up results. The differences of the relative expression level of ALDOA mRNA between AML group and the normal control group, CR group and RR group were analyzed. Univariate and multivariate Cox regression risk model were used for analysis of factors influencing prognosis of AML patients.Results:The relative expression level of ALDOA mRNA in AML group was higher than that in normal control group [(5.71±0.44) vs. (1.10±0.08), t = 4.74, P<0.001]. The relative expression level of ALDOA mRNA in the RR group was higher than that in the CR group [(6.69±0.67) vs. (4.30±0.36) , t = 2.79, P < 0.001]. In addition, there were statistically significant differences in the proportion of patients with ALDOA mRNA high expression and those with ALDOA mRNA low expression stratified by the number of white blood cell, the proportion of bone marrow blasts and whether complete remission could be achieved or not after 1 course of induction therapy (all P < 0.05). Overall survival in patients with ALDOA high expression was worse than that in patients with ALDOA low expression ( χ2 = 5.59, P = 0.018). Multivariate analysis showed that white blood cell count, prognosis stratification, whether complete remission could be achieved or not after 1 course of induction therapy and ALDOA expression were the independent prognostic factors for the death of AML patients (all P < 0.05). Conclusions:ALDOA may play an important role in the development and progression of AML, and the expression level of ALDOA in the bone marrow can be used as an index for the prognosis assessment of AML patients and may be a potential therapeutic target for AML.

ObjectiveTo investigate the bactericidal effect of loaded multifunctional povidoneiodine-nanometer selenium （PVP-I@Se） disinfectant on Staphylococcus aureus （SA） and methicillin-resistant Staphylococcus aureus （MRSA）， and to provide an experimental basis for the reduction of surgical site infection （SSI）. MethodsThe control group was the povidone iodine （PVP-I） group with different concentrations of iodine （50， 75， 100， 200 and 400 μg/mL）. The PVP-I@Se group （experimental group） was the PVP-I group further supplemented with 2 μg/mL Selenium nanoparticles （SeNPs）. Then we compared the bactericidal effect of the two groups of disinfectant solutions on SA and MRSA by examining the minimum inhibitory concentration （MIC）， minimum bactericidal concentration （MBC）， the shortest sterilization time at a concentration of 50 μg/mL iodine and the inhibition zone diameters at concentrations of 200 μg/mL and 400 μg/mL iodine. ResultsMIC values of PVP-I against SA and MRSA were both 79.17 μg/mL， and those of PVP-I@Se were 54.17 and 70.83 μg/mL， respectively. MBC values of PVP-I against SA and MRSA were 129.17 and 150.00 μg/mL， respectively， and those of PVP-I@Se were 70.83 and 87.50 μg/mL， respectively. At a concentration of 50 μg/mL iodine， the shortest sterilization time of PVP-I for SA and MRSA was 130 s and 140 s， respectively， and that of PVP-I@Se was 65 s and 75 s， respectively. At a concentration of 200 μg/ml iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 7.67 mm and 8.33 mm， and those of PVP-I@Se were both 9.50 mm. At a concentration of 400 μg/mL iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 9.00 mm and 9.33 mm， and those of PVP-I@Se were 11.67 mm and 12.00 mm， respectively. ConclusionsPVP-I with different concentrations of 50， 75， 100， 200 and 400 μg/mL iodine supplemented with 2 μg/mL SeNPs have better and faster bactericidal effect on SA and MRSA. When combined with SeNPs， PVP-I can enhance the bactericidal activity against SA and MRSA， but with better sensitizing effect on SA than MRSA and higher demand of iodine concentration （400 μg/mL） for sensitizing effect on MRSA. This study provides a theoretical basis for selecting optimal concentration and action time of the disinfectant， thus reducing SSI.