Objective To investigate the potential mechanism of POD in the elder rat model in different depths of anesthesia. Method 120 elderly rats were randomly divided into the A1,A2,A3,B1,B2 and B3 groups. The incidence of POD in the elderly rats was assessed in different depths of anesthesia ,and then the death of neurons,and the expressions of Bid,Bim,Puma and Caspase?3 were detected by Annexin/PI ,real?time PCR and Western blot assay ,respectively. Results Compared with the A1 and A3 group ,the incidence of POD in the elderly rats was decreased and the death of neurons ,and the expressions of Bid ,Bim ,Puma and Caspase?3 were decreased in Group A2(P<0.05). Compared with the preoperative condition,the incidence of POD in the elder?ly rats was increased and the death of neurons,and the expressions of Bid,Bim,Puma and Caspase?3 were in?creased in all groups (P < 0.05). Additionally,similar results were found in the group of inhalational anesthesia. Conclusion The depth of BIS 60 ~ 75/BIS 30 ~ 45 in the elderly rats lead to the increase in the incidence of POD,and that might result from the apoptosis of neurons and the increases of Bid,Bim,Puma and Caspase?3.

Routine vaccination is a most important way to prevent and control various kinds of infection disease,however,concerns about epileptic diseases after vaccination worries patients and health care providers.Many studies have shown that the risk of febrile seizure(FS)increases after measles-mumps-rubella(MMR)and iphtheria-tetanus-pertussis(DTP)vaccine,but this increase is associated with the fever after vaccine.The prognosis of vaccine related FS is similar to non-vaccine FS.Moreover,no evidence has shown that vaccine is related with non-febrile seizure and epileptic encephalopathy.

Wnt/β-catenin signaling pathway is highly conserved in evolution,which involves in the regulation of a variety of biological processes such as embryonic growth,development,energy metabolism and stem cells maintenance.Aberrant activation of Wnt/β-catenin signaling pathway has a closely relationship with tumorigenesis.Investigating the role of Wnt/β-catenin signaling in glioma cell proliferation,invasion,apoptosis and tumor angiogenesis will provide novel therapeutic targets and intervening measures for glioma treatment.

Objective: To explore and discuss the clinical curative effect on intermittent positive pressure breathing therapy of non - invasive ventilator in the treatment for chronic obstructive pulmonary disease (COPD) of elderly patients with complication of acute respiratory failure. Methods: 112 elderly patients who were COPD (all of patients were acute exacerbation period) with complication of acute respiratory failure were divided into control group (60 cases) and observation group (52 cases) as the random number table. A series of basic therapy including routine anti-inflammatory, relieving asthma and expectorant therapy were implemented for all of patient. And the non-invasive ventilator was used to implement non-invasive mechanical breathing therapy. In this therapy, patients of control group were implemented sustaining positive pressure breathing therapy, while patients of observation group were implement intermittent non-invasive positive pressure breathing therapy (1:1). The curative effect, pH value (at 6,24 and 72h), PaO2 (at 6,24 and 72h), PaCO2 (at 6,24 and 72h) and complications between the two methods were compared. Results: There was no significant difference in the general demographic characteristics between the two groups. For patients at 6, 24 and 72 h, the differences of the pH value, PaO2and PaCO2 between pre and post-treatment were significant in observation group (F=5.669, F=6.985, F=7.628, P<0.05) and control group (F=5.311, F=6.892, F=7.958, P<0.05) , respectively. The differences of the pH value, PaO2 and PaCO2 at 6h, 24h and 72h were significant (at 24h, F=6.776, F=7.098, F=7.673. at 72 h, F=7.883, F=6.983, F=7.335, P<0.05),respectively. For two groups, the differences of pH value, PaO2 and PaCO2 at pre-weaning, post-weaning 6h and post-weaning 12h were not significant. While the mechanical ventilation time and mechanical ventilation rate of observation group were significant lower than that of control group (t=3.591, x2=3.052, P<0.05). Besides, the incidences of complications including flatulence, trachea intubation, respiratory and relative pneumonia of observation group were significant lower than that of control group (x2=4.997, P<0.05). Conclusion: The new method can significantly shorten duration of breathing and duration of hospital stays. And its incidence of complication is lower while safety of treatment is relatively higher than that of traditional method.

Objective To explore the effect of preoperative evaluation checklist in the preoperative preparation of laparoscop‐ic cholecystectomy .Methods Based on whether the preoperative evaluation checklist was used or not ,664 cases of patients were di‐vided into control group (n=350) and experimental group (n=314) .Routine preparation was used in the control group ,while the preoperative evaluation checklist made by department of hepatobiliary surgery in the second affiliated hospital of Chongqing medical university was added to the experimental group .The case histories of patients in both groups were retrospectively reviewed ,so as to make comparisons of the defect of preoperative preparation ,influence to operation (delay or cancel) ,comprehension of preoperative knowledge ,and score of degree of satisfaction .Results The incidence rate of the defect of preoperative preparation in the experi‐mental group (1 .59% ) was lower than that in the control group (6 .86% ) with a statistical difference (P<0 .05) .The influence to operation (delay or cancel) in the experimental group was lower than that in the control group with a statistical difference (P<0 .05) .The comprehension of preoperative knowledge and score of degree of satisfaction in the experimental groups were obviously superior to those in the control groups ,which both had a statistical difference (P<0 .05) .Conclusion The application of preopera‐tive evaluation checklist in laparoscopic cholecystectomy could benefit for sufficient preoperative preparation ,conducting surgery as scheduled ,patients′comprehension of preoperative knowledge and patients′satisfaction of medical treatment ,which deserved widely clinical generalization .

Objective To investigate the expression of microRNA-29b (miR-29b) in gastric cancer cell line GC9811 and high peritoneal metastatic gastric cancer cell line GC9811-P and its effect on invasion,proliferation and apoptosis.Methods The relative quantitative expression of miR-29b was detected by quantitative realtime polymerase chain reaction(qRT PCR).GC9811 cells were divided into three groups,miRNA down-regulated and transfected with lentiviruses LV-miR-29b inhibitor group,negative control group with negative transfection,and untransfected blank control group.GC9811-P cells were divided into three groups,miR-29b up regulated and transfected with lentiviruses LV miR 29b group,negative control with negative transfection group,and untransfected blank control group.The cell invasion ability was detected with Transwell assay,the cell proliferation ability was measured by methyl-thiazolyl tetrazolium (MTT) test,the colony forming ability was determined by plate colony formation assay,and the apoptosis was tested by flow cytometry.The expressions of miR 29b and secreted protein,acidic and rich in cystenie (SPARC) in gastric cell line GC9811-P,GC9811,MKN28M,MKN28NM and normal gastric cell line GES were determined by qRT-PCR,and the correlation was analyzed.Two independent samples t test or SNK-q test was performed for mean comparison between two groups,and one way analysis of variance was used for mean comparison among three groups.Results The relative quantitative expression of miR-29b inGC9811-P (0.21±-0.04) was significantly lower than that of GC9811 (1.00±0.03,t 28.140,P＜ 0.01).After GC9811 cells transfected with lentiviruses LV-miR-29b inhibitor,the expression of miR-29b (0.21±0.04) was significantly lower than that of control group (0.89±0.07) and blank control group (1.00±0.04,q 12.76,14.73,both P＜0.01).Compared with negative group,the transmembrane cell number and the clonality of miRNA up-regulated group raised(274.33± 9.03 vs 110.67 ± 13.69,t=9.981,P＜0.01;131.33±4.91 vs69.67±2.33,t 11.340,P＜0.01),and the results of MTT test also shows the proliferation was increased.After GC9811-P cells transfected with LV-miR-29b,the expression of miR 29b (4.08±0.20) was significantly higher than that of negative control group (1.15±0.05) and blank control group (1.00±0.10,q=21.73,22.81,both P＜0.01).Compared with negative group,the transmembrane cell number and the clonality of miRNA up regulated group reduced (51.33±5.55 vs 104.00±6.24,t 6.305,P＜0.01; 48.00±5.51 vs 113.33±5.17,t 11.340,P＜0.01),and the results of MTT test also shows the proliferation was weakened.Apoptosis assays demonstrated miR-29b promoted apoptosis; however,the difference was not statistically significant.The expression of miR-29b was negatively correlated with SPARC mRNA in gastric cancer cells (r=-0.97,P=0.03).Conclusions The low expression of miR-29b in high peritoneal metastatic gastric cancer cell inhibited the ability of invasion and proliferation.MiR-29b might be a new target of inhibiting peritoneal metastasis in gastric cancer.

Objective To preliminarily explore the effects of human microRNA-181a on migration of gastric cancer cells and its mechanism.Methods The expression of miRNA-181a-5p in gastric cancer cell line GC9811 and peritoneal high metastasis gastric cancer cell line GC9811-P were tested by quantitative real-time polymerase chain reaction (qRT-PCR ). GC9811 cell line was transfected byendogenous synthetic analog mimic and its homologous negative control of miRNA-181a-5p,which were considered as up-regulated group and its control group respectively;GC9811-P were transfected by miRNA inhibitor and its homologous negative control of miRNA-181a-5p,which were considered as down-regulated group and its control group respectively.After miRNA-181a-5p was up or down-regulated,cell proliferation,migration and apoptosis capabilities of gastric cells were detected by matrix thiazolyl tetrazollium (MTT)assay,cloning-forming assay,Transwell migration test,wound healing assays and apoptosis test.After miRNA-181a-5p was up or down regulated,the changes of matrix metalloproteinase (MMP)14 expression were determined by Western blot.Independent sample t test was performed for mean comparison between samples and chi square test was used for rate comparison.Results The results of qRT-PCR showed the relative expression quantity of miRNA-181a-5p in GC9811 was 1 .000 00 ± 0.021 26 and in GC9811-P was 3.175 61 ±0.106 76,and the difference was statistically significant (t =34.620,P <0.01 ).The results of MTT assay indicated that the cell proliferation rate of up-regulated group was higher than that of up-regulated control group,and that of down-regulated group was lower than down-regulated control group.The cloning-forming assay demonstrated that the number of clone forming and clone forming rate of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were 234.00±10.12 and 46.8%,93.00±9.61 and 18.6%,51 .00 ±7.96 and 10.2%,99.00±8.05 and 19.8%,respectively.The differences between up-regulated group,down-regulated group and their control group were statistically significant (t = 17.500,7.344,χ2 = 12.27, 9.51 ,all P <0.01).The results of Transwell migration experiment showed the number of cells migrated through membrane hole of up-regulated group was 164.00±19.31 ,and which was higher than that of up-regulated control group (87.00±23.04,t=4.436,P <0.05);that of down-regulated group was 157.00± 11 .50,and which was lower than that of down-regulated control group (234.00 ±12.12,t =7.982,P <0.05).The result of wound healing assays indicated that the rate of migration distance of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were 2.09 ± 0.18,1 .27 ±0.23,1 .15 ±0.15 and 1 .67 ±0.12,respectively.The differences between up-regulated group,down-regulated group and their control group were statistically significant (t =4.863 and 4.689, both P <0.05).The results of apoptosis experiments demonstrated that the apoptosis rate of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were (6.10± 1 .02 )%,(9.10 ± 2.13 )%,(12.70 ± 1 .23 )%,(8.70 ± 2.54 )%,respectively,and there was no statistically significant difference between up-regulated group,down-regulated group and their control group (both P *0.05).The results of Western blot showed that the grey value of up-regulated group was 561 .881 ±35 .740,which was higher than that of up-regulated control group (275 .784±23.520);that of down-regulated group was 579.565 ±37.950,which was lower than that of down-regulated control group (1 312.760±51 .270),and the differnces were statistically significant (t =11 .580 and 19.910,both P <0.01).Conclusion miRNA-181a-5p highly expresses in peritoneal high metastasis gastric cancer cell line GC9811-P and promoted the proliferation and migration of gastric cancer cell line GC9811 and GC9811-P with a tendency to suppress apoptosis.

Objective To construct nursing service quality evaluation index system for abdominal operation patients. Methods Based on the service quality(SERVQUAL)model, a total of 33 nursing experts were selected by Delphi method for two turns of consultation. All the consultation experts have got senior professional title and 90.9%(30/33) have been working for more than 20 years. Finally, we calculated the questionnaire response rates, the authority coefficient, the mean and standard deviation, the coefficient of variation and the harmony coefficient. Results The response rates of questionnaires was 91.89% and 100% respectively, while the authority coefficient of experts was 0.91. The harmony coefficient of first and second and third indictors was 0.43, 0.47 and 0.53 respectively in the second consultation. Combined with selection of indicators and expert opinion, the final evaluation index system includes 6 first grade indexes, 14 second grade indexes and 49 third grade indexes. Conclusions There is a high level of authority and team coordination in experts. The results of the study can provide a reference for evaluating the nursing service quality of abdominal operation patients.

The implant-supported prosthesis has gradually become the preferred treatment for patients with partial edentulous or complete edentulous. Causes for the implant failure have been discussed in the majority of studies conducted in recent years, while their risk factors are still controversial. Patient factors (gender, age, smoking, osteoporosis, diabetes, medication, periodontitis and bruxism), clinical parameters (implant area, bone quality, implant size) and doctor factors (surgical-related factors, prosthesis-related factors) will all affect implant failure. This article presents typical clinical cases and reviews the potential risk factors for dental implant failure, in order to provide guidance for clinical practice.

Objective:To explore the feasibility of fetal intelligent navigation echocardiography (FINE) in automatic quantitation of cardiac axis (CA).Methods:A total of 62 pregnant women of which 2 with twins′ pregnancy in the second and third trimesters from May to June 2020 in Sir Run Run Shaw Hospital Zhejiang University College of Medicine were enrolled in this non-selective and prospective study. After excluding those who could not be analyzed, they were assigned into four groups according to their CA measuring methods: ①Group with manual measuring CA in systole (CAS); ②Group with manual measuring CA in diastole(CAD); ③Group with CA measured by FINE in three-steps; ④Group with CA measured by FINE in seven-steps. The CAS among groups were compared in order to analyze the consistency and correlation of CAS achieved by different methods, meanwhile, the intra-observer and inter-observer consistency and repeatability were also evaluated.Results:A total of 64 fetuses with 187 volume data were collected, of which 60 cases of fetal data can be included in the study, 57 cases of normal CA, 3 cases of abnormal CA, a total of 158 volume data can be used for data analysis, the success rate was about 84.5%. Because of the small number of abnormal CA cases (3 cases), only 57 cases of normal CA were statistically analyzed in this study. Three-step and seven-step FINE automatic quantitative CA showed significantly different from those obtained with manual measurements of CAD ( P=0.005, P<0.001). There were no significant differences in quantitative analysis of CA between three-step or seven-step FINE and manual measurements of CAS ( P=0.458, 0.883), however, there was no correlation between CA using three-step FINE and manual measurement of CAS ( rs=0.056, P=0.679), but there was a positive correlation between CA using seven-step FINE and manual measurement of CAS ( rs=0.599, P<0.001). The linear regression equation was constructed as follows: Y=10.96+ 0.73 X ( R2=0.431, P<0.001). There was no correlation between three-step method and seven-step method for automatic quantitative CA ( rs=0.158, P=0.241). There was significant difference( P<0.001), but strong correlation between manual measurement of CAS and manual measurement of CAD ( rs=0.973, P<0.001), the average difference was ΔCA=(4.5± 3.8)°. The linear regression equation was constructed as follows: Y=-2.94+ 0.96 X ( R2=0.950, P<0.001). Intra-observer and inter-observer measurements had shown no significant difference in consistency and repeatability (all P>0.05). Conclusions:The measurement of fetal CA by seven-step FINE is superior to the three-step FINE when the fetal CA is in normal range. This may be considered a promising aspect that seven-step FINE automatic quantitation of fetal CA can replace the manual measurement of CAS. Future research is needed to deliminate the reliability of automatic quantification of fetal CA by seven-step FINE with the CA in abnormal range.