Objective To explore the method of anesthesia and intra-operative management for robotic thoracic surgery. Methods Twelve patients who underwent robotic thoracic surgery using the Da Vinci surgical system were anesthetized with general anesthesia combined with T4-8 paravertebral block. After induction of anesthesia, a double-lumen endotracheal tube was positioned by bronchofibroscope to allow onelung ventilation during intra-operative procedure. Hemodynamics and respiratory function were routinely monitored and arterial blood gas (ABG) were tested during operation. Results All patients could tolerate the anesthesia for robotic thoracic surgery and there was no hospital mortality. The arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after induction were (35.2 ± 3.6) mm Hg( 1 mm Hg =0.133 kPa) and (213.3 ± 57.5) mm Hg respectively; PaCO2 and PaO2 30 min after one -lung ventilation were (37.9 ± 4.8) mm Hg and ( 125.3 ± 36.5) mm Hg respectively. When the one-lung ventilation started about 58% (7/12) of the patient developed temporarily low SpO2 (over 0.90) and recovered to 0.95 soon when using 3 - 5 cm H2O( 1 cm H2O = 0.098 kPa) positive end expiratory pressure (PEEP). The anesthesia time was ( 291.5 ± 99.4) min, the time for one-lung ventilation was (206.3 ± 93.4) min, the volume of blood loses in operation was ( 171.7 ± 110.3 ) ml and the tracheal catheter extration time was ( 16.3 ± 4.5 ) min, all the patients left ICU on the second day after surgery. Conclusions The anesthesia for robotic thoracic surgery with Da Vinci surgical system is multiplicity, the hemodynamics and respiratory function can be instable, it is a new challenge for the technology and management of anesthesia. Good one-lung ventilation is important for this surgery, ventilation parameter need to be adjusted when hypoxia occurred and PEEP could be used to the ventilated lung. General anesthesia combined with paravertebral block will be a good option for postoperative pain control and minimal hemodynamics disturb ance.

Objective To observe the effect of fluvastatin on urinary albumin excretion rate(UAER)of microalbuminuria in type 2 diabetes patients.Methods Type 2 diabetes patients with mieroalbuminuria were randomly divided into fluvastatin goup(n=126)and control group(n=129).Fluvastatin group was given fluvastatin 40 mg each night.Follow up was conducted for 1.5 years.The UAER and glomerular filtration rate(GFR)as well as blood lipid level before and after therapy were compared.Results UAER in fluvastatin group was significantly lower than that in control group[(59.6±10.5)vs(87.5±12.3)mg/min,P＜0.05]before therapy[(104.4±25.2)vs(110.6±19.7)mg/min,P＜0.05],which was independent of its lowering-lipid effect.But GFR had no signifimicroalbuminuria which is independent of lowering-lipid effect in type 2 diabetic nephropathy patients and delay the progress of diabetic nephropathy.

Objective To investigate the reliable parameters of the efficacy of CRT on patients with CHF evaluated by 3D-STI. Methods Thirty-six patients with CHF were performed by three-dimensional speckle tracking imaging (3D-STI) before and at one week, one month and three months after CRT, respectively. The left ventricular end systolic volume (3D-LVESV), the left ventricular ejection fraction (3D-LVEF) and the left ventricular dys-synchrony parameters which include the standard deviation of time to peak (AT-SD) and the maximum difference of time to peak (AT-Dif) of radial strain, circumferential strain and area tracking in the 16 left ventricular segments and the changes of 3D-LVESV, 3D-LVEF (ΔLVEF), AT-SD (ΔAT-SD) and AT-Dif (ΔAT-Dif) at 3 months after CRT were determined. Forty normal volunteers as the controls were performed 3D-STI only once. Results AT-SD, AT-Dif of three kinds of strain, LVESV of the patients in both effective and non-effective groups were significantly higher than those in the control group before CRT (P < 0.05). AT-SD, AT-Dif of three kinds of strain in the CRT effective group were significantly higher than those in the CRT non-effective group , whereas 3D-LVESV and 3D-LVEF were not significantly different between these two groups before CRT. For the CRT effective group, one week after CRT, all of the left ventricular dyssynchrony parameters were decreased (P < 0.05, respectively). For the CRT non-effective group, the changes of total assessment parameters after CRT were not significant (P > 0.05). ΔAT-SD and ΔAT-Dif were negatively correlated with ΔLVEF. Conclusion 3D-STI can efficiently evaluate the short-term efficacy of CRT , and the area tracking is a reliable parameter to predict and assess CRT efficacy.

Objective: To evaluate the effects of milrinone on serum myocardial enzymes and malondialdehyed (MDA), a lipid peroxidation product, in the perioperative patients undergoing valve replacement. Methods: Twenty patients, scheduled for valve replacement were randomly divided into 2 groups: group A and group B. Before induction of general anesthesia , milrinone was administrated at a 30 ?g/kg bolus dose progressively in 10 min, followed by a continuous infusion of 0.5 ?g/(kg?min) in group A and the same volume of saline was administrated in group B. The mixed venous blood samples were obtained from pulmonary artery at the following time points: before induction of anesthesia (T 1), 30 min after anesthesia (T 2), 30 min after the cross clamping of aorta (T 3 ), 10 and 30 min after the removal of the aorta clamping (T 4,5 ), 30 min and 8 h after CPB(T 6,7 ), 24 and 72 h after operation (T 8,9 ). Creatine phosphokinase (CK) and creatine phosphokinase isoenzyme (CK MB) were measured with the auto biochemical analytical machine. MDA level in serum was estimated by the method of thiobarbituric acid. Results: The values of CK and CK MB were increased significantly in 2 groups from the point T 4 to T 9 ( P

Objective To investigate the effect of glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide on hypoxia/reoxygenation (H/R)-induced cardiomyocytes death under high glucose condition and the potential mechanisms.Methods H9C2 cardiomyocytes were divided into 4 groups:normal glucose (N,5 mmol/L),high glucose (G,20 mmol/L),high glucose in combination with liraglutide (L,100 nmol/L),high glucose in combination with liraglutide and wortmannin (W,25 nmol/L).The apoptosis of H9C2 was detected by TUNEL assay.Nitric oxide synthetase(eNOS),nitric oxide (NO) and reactive oxygen(ROS) in supernatants were measured by enzymatic analysis,p-PI3K,PI3K,p-Akt,Akt,Bcl-2,caspase-3 were examined by western blotting.Results Compared with cells in N group,the apoptosis of H9C2 cells induced by H/R was markedly increased [(15.79 ± 3.92) ％ vs (9.74 ± 1.14) ％,P =0.028] in G group.The same was true for ROS [(489.63 ±21.01) U/ml vs (338.50 ±43.60) U/ml,P ＜0.001] and caspase-3 levels (1.87 ±0.03 vs 1.15 ±0.04,P ＜0.001),but not for Bcl-2 protein expression (1.79 ± 0.06 vs 1.89 ±0.03,P =0.047).Pretreatment of cells with liraglutide (100 nmol/L) prevented the cell death induced by high glucose and H/R together with decrease of ROS and caspase-3 levels and increase of Bcl-1 expression.Moreover,treatment of cells with liraglutide also significantly increased phosphorylation of PI3K and Akt (p-PI3K/PI3K:0.87 ± 0.07 vs 0.59 ± 0.09,P =0.002;p-Akt/Akt:0.34 ± 0.01 vs 0.08 ± 0.01,P＜0.001),eNOS[(41.29 ±0.56) μmpl/L vs (37.20 ±0.52)μxmpl/L,P ＜0.001]and NO [(31.24 ±0.40) μmpl/L vs (26.66 ±0.53) μmpl/L,P ＜0.001] levels.Furthermore,addition of PI3K/Akt inhibitor wortmanin markedly inhibited the expression of p-PI3K/PI3K,p-Akt/Akt,reversed the changes of eNOS,NO,caspase-3 and Bcl-2 by liraglutide,and abolished the protective effect of liraglutide on cell apoptosis.Conclusions GLP-1 receptor agonist liraglutide treatment could alleviate cardiomyoeytes apoptosis induced by high glucose and H/R through the activation of PI3K-Akt-eNOS-NO signaling pathway and inhibition of oxidative stress.

Long non-coding RNAs(LncRNAs),a class of RNAs,are more than 200 nucleotides in length and do not encode protein.The abnormal expression of LncRNAs is closely associated with the occurrence and development of various human diseases.In recent studies,LncRNAs regulate the tumor immune response by regulating the differentiation and function of tumor-related immune cells.In addition,LncRNAs affect the microenvironment by regulating the expression of multiple inflammatory factors.This review will summarize that LncRNAs regulate the tumor microenvironment.

Anaphylaxis is increasingly in children, which is currently undernotified, underdiagnosed, and undertreated in China.In order to further improved the understanding and management of anaphylaxis, this issue reviews the pathogenesis, triggers and risk factors, clinical diagnosis and management of anaphylaxis, thus offers the recommedations of anaphylaxis in Chinese children based on previous published evidence-based guidelines and practice parameters.Recommendation aims to develop guiding principles for the diagnosis and management of anaphylaxis in children, and provide a framework for the development of new guidelines.

Objective To explore the feasibility of the digital grading scale applied for assessment of anxiety by nurses. Methods Firstly, the digital grading scale was made, and then it was applied for patients guided by nurses to evaluate their anxiety level by themselves within 24 hours and at 3 weeks after admission. Anxiety level of the same crowd guided by doctors was also evaluated independently with Hamilton Anxiety Scale ( HAMA) by blind method. Results The correlation coefficent of the score between the digital grading scale and HAMA was 0. 794 (P<0. 01), and the score between them was positively related. Scores of the digital grading scale were compared with HAMA whose scores were divided into 5 groups according to severity level with significant differences (P <0. 01). Conclusions The digital grading scale has an obvious correlation with HAMA and it can be used to evaluate anxiety level in patients with generalized anxiety disorder.

Objective To construct a motivation goal framework for changes in transcultural self-management health behaviors among senile patients with chronic heart failure (CHF). Methods Totally 15 experts were selected to participate in Delphi consultancy from September 2016 to September 2017. Two rounds of questionnaire consultancy were conducted in terms of the proposed items for the motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients, with an unanimous understanding among the experts attained. Finally, the motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients was preliminarily constructed. Results The preliminarily constructed motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients included 3 primary items, 9 secondary items and 52 tertiary items. The authority coefficient, judgement coefficient and degree of familiarity of these experts were 0.930, 0.950 and 0.910, respectively. The return rate of valid questionnaires in the two rounds of expert consultancy reached 100%. Conclusions The motivation goal framework for changes in transcultural self-management health behaviors among senile CHF patients constructed under the transcultural nursing theory and the cross-theoretical model is scientific and practical, which provides reference for personalized, precise and normalized self-management education.

Objective:To investigate the significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the early assessment of neonatal cardiac dysfunction in sepsis.Methods:The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit (NICU) of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled. Data of clinical sign, laboratory results, bedside echocardiography and survival data were collected, and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection. The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression, and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic (ROC) curve.Results:There were 112 neonates with sepsis (49 with cardiac dysfunction and 63 without cardiac dysfunction) and 67 children with common infection included in the analysis. The onset time of neonates in septic cardiac dysfunction group was significantly earlier than that of septic non-cardiac dysfunction group and common infection group [hours: 52.9 (0, 180.3) vs. 53.9 (0, 183.6), 81.0 (45.6, 202.4), both P < 0.05]. Compared with the general infection group, albumin (ALB), white blood cell count (WBC), left ventricular ejection fraction (LVEF) in septic cardiac dysfunction group significantly decreased, NT-proBNP, hypersensitive C-reactive protein (hs-CRP)/ALB, pulmonary artery systolic pressure (PASP) significantly increased, while right ventricular (RV) and Tei index significantly increased [ALB (g/L): 24.1±3.8 vs. 27.8±3.6, WBC (×10 9/L): 12.7 (3.7, 18.9) vs. 15.4 (9.9, 23.2), LVEF: 0.626±0.123 vs. 0.700±0.021, NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 7 324.5 (2 426.5, 13 890.0), hs-CRP/ALB: 0.33 (0.29, 0.81) vs. 0.06 (0.00, 0.21), PASP (mmHg, 1 mmHg = 0.133 kPa): 52.25±14.12 vs. 41.07±27.73, RV (mm): 10.74±2.42 vs. 8.55±1.41, Tei index: 0.52±0.03 vs. 0.30±0.04, all P < 0.05]. NT-proBNP and Tei index in septic cardiac dysfunction group were significantly higher than those in septic non-cardiac dysfunction group [NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 13 057.6 (8 946.0, 35 000.0), Tei index: 0.52±0.03 vs. 0.39±0.02, both P < 0.05], and LVEF was significantly lower than that in septic non-cardiac dysfunction group (0.626±0.123 vs. 0.671±0.086, P < 0.05). Multivariate Logistic regression analysis showed that NT-proBNP, Tei index and hs-CRP/ALB were independent risk factors for cardiac dysfunction in sepsis neonates [odds ratio ( OR) and 95% confidence interval (95% CI) were 8.73 (1.54-5.67), 1.97 (1.26-2.87), 1.87 (1.03-3.40) respectively, all P < 0.05]. ROC curve analysis showed that NT-proBNP, Tei index and hs-CRP/ALB had good predictive value for the occurrence of cardiac dysfunction in septic neonates, the area under ROC curve (AUC) was 0.81 (95% CI was 0.84-0.91), 0.78 (95% CI was 0.65-0.79) and 0.77 (95% CI was 0.61-0.77), respectively. The sensitivity and specificity of NT-proBNP were 80.0% and 79.0% respectively with 12 291.5 ng/L as the cut-off value, the sensitivity and specificity of Tei index were 74.0% and 77.0% respectively with 0.45 as the cut-off value, and the sensitivity and specificity of hs-CRP/ALB were 76.0% and 76.3% respectively with 0.10 as the cut-off value. Conclusions:NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction, and for rapid diagnosis of neonatal cardiac dysfunction in sepsis. The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.