Objective To determine the optimum dose of dexmedetomidine through evaluating the effects of different doses of dexmedetomidine combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.Methods Sixty ASA physical status Ⅱ patients of both sexes,aged 18-60 yr,with body mass index 20-26kg/m2,Child-Pugh grade A,undergoing radical resection for stomach or colon cancer,were randomly assigned into 3 groups (n=20 each):propofol and remifentanil group (group Ⅰ),low-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅱ) and high-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅲ).In Ⅱ and Ⅲ groups,dexmedetomidine was infused at a rate of 0.2 μg·kg-1 · h-1 and 0.4 μg·kg 1 · h-1,respectively,until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.4 μg/kg and 0.8 μg/kg,respectively,was infused at 10 min before induction of anesthesia.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentration 2-4 μg/ml),iv infusion of remifentanil 0.2 μμg·kg-1 · h-1 and intermittent iv boluses of rocuronium 0.15 mg/kg.BIS value was maintained at 40-60.Before dexmedetomidine infusion (T0),at 2 min before intubation (T1),at 1 min after intubation (T2),immediatay after zskin incision (T3),and at 30 min of surgery (T4),arterial blood samples were taken for measurement of concentrations of plasma norepinephrine (NE) and epinephrine (E).The emergence time,adverse cardiovascular events,and the development of nausea and vomiting and restlessness during recovery from anesthesia were recorded.Results Compared with group Ⅰ,the plasma concentration of propofol was significantly decreased,and the incidence of tachycardia and restlessness during recovery from anesthesia were significantly decreased in Ⅱ and Ⅲ groups,and the incidence of bradycardia during operation was significantly increased,and the incidence of hypertension during recovery from anesthesia was significantly decreased,and the emergence time was prolonged in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,the plasma concentration of propofol was significantly decreased,the incidence of bradycardia during operation was increased,and the emergence time was prolonged in group Ⅲ (P ＜0.05).The plasma NE and E concentrations were significantly higher at T2.3 in group Ⅰ,and were lower at T1-4 in Ⅰ and Ⅲ groups than those at T0 (P ＜ 0.05).Conclusion 0.4 μg/kg injected before induction of anesthesia followed by infusion at 0.2 μg·kg-1 · h-1 is the recommended optimum method for application of dexmedetomidine when combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.

Objective To explore the application of CARE kV technique in the adult chest CT and the value of reducing radiation dose.Methods Sixty-nine patients were divided into two groups by random number generators:group A(39 cases) and group B(30 cases).Group A was examined by using CARE kV technique and group B was examined at routine 120 kV.CT dose index(CTDIvol),dose length product (DLP) and effective dose (E) were compared between the two groups,and analyzed the correlation between tube voltage selection and patient body mass index (BMI) of group A was analyzed.Results The average CTDIvol [(11.00 ± 3.89) mGy],DLP[(294.05 ± 91.17) mGy·cm] and E[(4.12 ± 1.28) mSv] of group A were lower than those of group B (16.64 ± 1.20) mGy,[(475.99 ± 41.16) mGy · cm],[(6.66 ±0.58) mSv].With statistically significant difference (t =-7.653,-10.151,-10.150,P ＜ 0.05).Compared with routine 120 kV technique (group B),the CARE kV technique (group A) could reduce the total radiation dose about 38.14％.Compared obese patients(BMI≥28 kg/m2) with non-obese patients in group A and B,the mean E of non-obese patients was lower than that of obese patients in group A,which reduced the total E about 31.74％ (t =4.322,P ＜0.05),while E in group B was no significant different between non-obese patients and obese patients.Conclusions In adult chest CT,CARE kV technique can select optimum scanning voltage automatically according to the patients with different BMI and anatomical regions,which can reduce the overall radiation dose while maintaining image quality.

Objective To explore the effects of mental practice on upper extremity function after stroke. Methods Thirty sub-acute stroke patients were randomly divided into a treatment group ( n=15 ) and a control group (n=15). The patients in the control group were treated with conventional therapy. The patients in the treat-ment group were treated with motor imagery therapy in addition. All patients were assessed using the Fugl-Meyer mo-tor assessment (FMA) and the motor assessment scale (bIAS) before treatment and after 2, 4 and 8 weeks of treat-ment. Results After 2 weeks of treatment, average MAS scores in the treatment group improved significantly com-pared with before treatment, but there was no significant difference between the two groups. After 4 weeks, FMA and MAS scores in the two groups had improved, and the FMA scores in the treatment group were significantly higher than those of the control group. After 8 weeks, the FMA and MAS scores of both groups had further improved significant-ly, but the average FMA and MAS scores in the treatment group were now significantly higher than those in the control group. Conclusions Mental practice can improve the functional performance of the upper extremities of stroke pa-tients.

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Objective To investigate the clinical and neuroimaging features of Vogt-KoyanagiHarada syndrome ( VKH ).Methods Cerebrospinal fluid ( CSF ), neuroimaging examination, clinical manifestation and pharmacotherapy features were investigated in 5 patients diagnosed as VKH. ResultsAll 5 patients were diagnosed as uveitis in the early stage of disease.All patients suffered “ headache”.Meningeal irritation sign was appeared in 3 cases. The MRI enhanced scan of all 5 cases showed abnormal enhancement of meninges. CSF examination showed increased leukocyte number ((4--196) × 106/L). All patients were alleviatedwith combination therapyof high dose of steroid with cyclophosphamide.ConclusionsVKH is a systemic disease that usually involving the uvea, central nervous system, internal ear and the skin. MRI and CSF examination are valuable for diagnosis. High dose of steroid combined with cyclophosphamide is an effective therapeutic strategy.

Objective To investigate the effects of different dialysates on expression of protein kinase C-δ (PKCδ) and apoptosis of U937 cell line. Methods Different dialysates were added into culture fluid with U937 cell line at exponential phase of growth, and groups were divided: fluid A+fluid B group (dialysate A+dialysate B), fluid A+fluid B+rottlerin (PKCδ specific inhibitor)group, fluid A+powder B group (dialysate A+powder B) and fluid A+powder B + rottlerin group. Besides, blank control group and normal control group were established. Cells were harvested 24 h and 48 h after treatment, morphological changes were observed by Hoechst33258 fluorescence staining, cell apoptosis was measured by Annexin-V-FITC/PI double staining, and expression of PKCδ mRNA and protein was detected by RT-PCR and Western blotting, respectively. Results Cell apoptosis significantly increased in fluid A+powder B group, with typical morphology of apoptosis. After treatment for 24 h and 48 h, cell apoptosis rates in fluid A+powder B group were significantly higher than those at corresponding time points in blank control group , normal control group and fluid A+powder B+rottlerin group (P<0.05). Compared with normal control group, blank control group and fluid A+powder B+rottlerin group, the expression of PKCδ mRNA and protein of U937 cells in fluid A+powder B group were significantly increased (P<0.05). There was no significant difference in cell apoptosis rates and expression of PKCδ mRNA and protein between fluid A+fluid B group and blank control group, normal control group and fluid A+fluid B+rottlerin group (P＞0.05). Conclusion Fluid A+powder B can significantly increase apoptosis of U937 cell line, the mechanism of which may be associated with the up-regulation of expression of PKCδ. Compared with fluid A+powder B, fluid A+fluid B is superior in reducing apoptosis of peripheral blood monouclear cells.

Objective To evaluate the effect of dexmedetomidine on nerve regeneration following cerebral ischemia-reperfusion (Ⅰ/R) in mice and the role of transforming growth factor-beta 1 (TGF-β1) in brain tissues.Methods Sixty healthy SPF male C57BL/6J mice,weighing 23-25 g,aged 8-10 weeks,were divided into 5 groups (n =12 each) using a random number table method:sham operation group (group Sham),Ⅰ/R group,dexmedetomidine group (group D),dexmedetomidine plus IgG1 isotype control monoclonal antibody group (group DI) and dexmedetomidine plus TGF-β1 neutralizing monoclonal antibody group (group DA).Cerebral Ⅰ/R was induced by occlusion of the middle cerebral artery followed by reperfusion.Dexmedetomidine 50 μg/kg was intraperitoneally injected every 24 h for 14 days starting from 14 days of reperfusion in group D.TGF-β1 neutralizing monoclonal antibody 20 μg and IgG1 isotype control monoclonal antibody 20 μg were intraperitoneally injected at 30 min prior to dexmedetomidine injection in group DA and group DI,respectively.5-bromodeoxyuridine (BrdU) 100 mg/kg was intraperitoneally injected and injected again at an 8-h interval on 27 days of reperfusion.Forced swimming test (FST),sucrose consumption test (SCT) and open field test (OFT) were performed at 16 h after the second administration of BrdU.After the end of behavior testing,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone on ischemic side was measured by immunohistochemistry,and the expression of TGF-β1 protein and mRNA in brain tissues in ischemic area was detected using Western blot and real-time polymerase chain reaction,respectively.Results Compared with group Sham,the time spent floating in FST was significantly prolonged,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were decreased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was increased,and the expression of TGF-β1 protein and mRNA was up-regulated in group Ⅰ/R (P＜0.05 or 0.01).Compared with group Ⅰ/R,the time spent floating in FST was significantly shortened,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were increased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was increased,and the expression of TGF-β1 protein and mRNA was up-regulated in group D (P＜0.05 or 0.01).Compared with group D,the time spent floating in FST was significantly prolonged,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were decreased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was decreased in group DA (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group DI (P＞0.05).Conclusion Dexmedetomidine can relieve depression and anxiety following cerebral Ⅰ/R,thus promotes nerve regeneration and the mechanism is related to up-regulating the expression of TGF-β1 in brain tissues of mice.

Objective To develop an accurate deep learning prediction model of YOLO-V5 capable of accurately iden-tifying medication packaging boxes in outpatient and emergency pharmacies,aiming to assist pharmacists in achieving"zero dis-pensing error".Methods A total of 2 560 images of packaging boxes from 136 different drugs were collected and labeled to form the deep learning dataset.The dataset was split into training and validation sets at a ratio of 4∶1.YOLO-V5 deep-learning algorithm was employed for training the data using images from our dataset(train epochs:500,batch size:4,learning rate:0.01).The values of the precision(Pr)and mean average precision(mAP)were used as measures for model performance evaluation.Results The Pr of the four sub-models of YOLO-V5 in the training set all reached 1.00.The mAP_0.5 of YOLO-V5x was 0.95,which was higher than those of YOLO-V5s(0.94),YOLO-V5l(0.94),and YOLO-V5m(0.94).The mAP_0.5:0.95 of YOLO-V5l and YOLO-V5x were 0.85 which were higher than those of YOLO-V5s(0.84)and YOLO-V5m(0.84).Training time and model size were 82.56 hours and 166.00MB for YOLO-V5x which were the highest among the four models.The speed of detection in one im-age was 11ms for YOLO-V5s which was the fastest among the four models.Conclusion YOLO-V5 can accurately identify the packaging of drugs in outpatient and emergency pharmacies.Implementing an artificial-intelligence-assisted drug dispensation sys-tem is feasible for pharmacists to achieve"zero dispensing error".

Objective:To investigate the value of a deep learning method based on MobileNet in classification of bedside chest radiograph and improvement of the work efficiency.Methods:A total of 6, 320 bedside chest radiographs from January 2017 to December 2022 in the Second Peoples′ Hospital of Changzhou were retrospectively collected. The included cases were divided into normal group (885 images), pneumonia group (1 927 images), pleural effusion group (373 images), and pneumonia with pleural effusion group (3 135 images). Three hundred and fifty images were selected as a validation set, while the remaining images were divided into a train set (4 775 images) and a test set (1 195 images) using simple randomization, by 8∶2 ratio. Two lightweight convolutional neural network models (MobileNetV1 and MobileNetV2) were used to construct a bedside chest radiograph classification model, based on which two fine-tuning strategies were designed. Four models were generated namely MobileNetV1_False (V1_False), MobileNetV1_True (V1_True), MobileNetV2_False (V2_False) and MobileNetV2_True (V2_True). In the first stage, a binary classification model was established to divide the images into normal and lesion groups; then a four-class classification model was established in the second stage, with which the images were divided into four groups: normal, pneumonia, pleural effusion and pneumonia with pleural effusion. Metrics for model performance evaluation including accuracy (Ac), precision (Pr), recall rate (Rc), F1 score (F1) and area under the receiver operating characteristic curve (AUC) were calculated.Results:In both the first and second stages, V1_True and V2_True had higher Ac, Pr, Rc, and F1 than V1_False and V2_False in both the training set and validation set; and the V1_True model outperformed the other three models in classification. The classification Ac of the V1_True model in the validation set was higher than that of radiologists in the first stage [95.71% (335/350) vs. 90.29% (316/350)] and in the second stage [93.43% (327/350) vs. 87.14% (305/350)]. The recognition time of V1_True model′s in the validation set of 350 bedside chest radiographs was significantly less than that of the radiologists (mean: 17 s vs. 300 min).Conclusions:V1_True is an optimal MobileNet model for classifying bedside chest radiographs. The application of this model in clinical practice may help to accurately identify the information of lung lesions from bedside chest radiographs in time, and may improve the work efficiency in the radiology department.