Objective To evaluate the effects of hyperbaric oxygen post-conditioning on the expression of P2X4 receptors in the spinal dorsal horn and hippocampus of rats with neuropathic pain (NP).Methods Seventytwo male Sprague-Dawley rats,aged 8-10 weeks,weighing 300-350 g,were randomly divided into 3 groups (n =24 each) using a random number table:sham operation group (group S),NP group and hyperbaric oxygen postconditioning group (group H).NP was induced by chronic constrictive injury.The rats in group H underwent hyperbaric oxygen treatment once a day for 7 consecutive days starting from 1 day after NP was successfully induced.After the rats were placed in the hyperbaric oxygen chamber,the pressure was increased at a rate of 10 kPa/min until the hyperbaric oxygen was at 2.0 atmosphere absolute,and maintained at this level for 60 min,and then the pressure was decreased at a rate of 10 kPa/min until the normal pressure was reached.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before NP was induced and 1,3,7 and 14 days after NP was induced.After the end of measurement,6 rats were randomly chosen from each group and then sacrificed and the L4-6 segments of the spinal cord and hippocampal tissues were removed for determination of the expression of P2X4 receptors (by immunohistochemistry).Results Compared with group S,the MWT was significantly decreased,TWL was shortened,and P2X4 receptor expression in the spinal dorsal horn and hippocampus was up-regulated in NP and H groups.Compared with group NP,the MWT was significantly increased and TWL was prolonged,and P2X4 receptor expression in the spinal dorsal horn and hippocampus was down-regulated in group H.Conclusion Hyperbaric oxygen post-conditioning mitigates NP by down-regulating the expression of P2X4 receptors in the spinal dorsal horn and hippocampus of rats.

AIM: To decide the effect that selected siRNA degrades mRNA of IL-1? specifically and suppression of its expression after connected with target site with homology complementary sequence. METHODS: Synthesized DNA expression box aimed directly at target site through PCR reaction in vivo was purified, and transfected into lymphocytes stimulated by LPS. siRNA was transcribed by cellular endogenous RNA polymerase Ⅲ and then evoke the degradation of target mRNA. After 48 hours of transfection, the cell culture supernatant was collected and the concentration of IL-1? was assayed using ELISA. RESULTS: Compared with blank-control and negative-control, selected sequence decreased the expression of IL-1?. Rate of the suppression was about 15%. CONCLUSION: RNAi technology produces specific interference effect in mouse spleen lymphocytes in original culture and inhibits the excretion of IL-1?.

Objective To study the angle and articular facet curvature of lumbar zygapophyseal joints in adults.Methods The lumbar zygapophyseal joints in 120 healthy subjects without lumbar diseases were detected using spiral CT and mutiple planner re-construction.The angle and articular facet curvature of zygapophyseal joints were measured.The differences in the measured param-eters between male and female or different age groups were compared.Results ①There were no significant differences in the angle of the same lumbar zygapophyseal joints between males and females or different age groups (P >0.05);however,the significant differences in the angle between different lumbar segments were found (P <0.05).②There were no significant differences in articu-lar facet curvature of the same lumbar zygapophyseal joints between males and females or different age groups (P >0.05);however, there were significant differences in the curvature between different lumbar segments (P <0.05).The maximum articular facet cur-vature of L3-L4 was 22.1°±6.0°.Conclusion The angle and articular facet curvature of lumbar zygapophyseal joints varies from different lumbar segments with different contributions for the lumbar stability.

Objective:To evaluate the efficacy of esketamine combined with different doses of remimazolam for induction of general anesthesia in pediatric patients.Methods:One hundred and sixty pediatric patients of either sex, aged 3-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with body mass index of 13-20 kg/m 2, undergoing elective general anesthesia under a laryngeal mask, were divided into 4 groups ( n=40 each) by the random number table method: esketamine combined with propofol group (KP group) and esketamine combined with different doses of remimazolam group (0.2, 0.3, 0.4 mg/kg) groups (KR1 group, KR2 group, KR3 group). Esketamine 0.8 mg/kg was intravenously injected in the preanesthesia room. After entering the operating room, propofol 2.5 mg/kg was intravenously injected in KP group, and remimazolam 0.2, 0.3 and 0.4 mg/kg were intravenously injected in KR1, KR2 and KR3 groups, respectively. When the child lost consciousness and the Modified Observer′s Assessment of Alertness/Sedation Scale score<1, sufentanil and mevacurium were intravenously injected. When the Modified Observer′s Assessment of Alertness/Sedation Scale score≥1, rescue sedation was performed, and 3 min later the laryngeal mask airway was inserted. The onset time of sedation, response to laryngeal mask airway placement, rescue sedation, hypotension, tachycardia, bradycardia, bucking, hiccup, injection pain and apnea were recorded, and the increase rate of perfusion index (PI) was calculated. Results:No response to laryngeal mask implantation occurred in the four groups. Compared with KP group, the onset time of sedation was significantly prolonged, the incidence of hypotension, bradycardia, injection pain and apnea was decreased, the incidence of tachycardia was increased, and the increase rate of PI was decreased in KR1, KR2 and KR3 groups, and the rate of rescue sedation and incidence of bucking were increased in KR1 and KR2 groups ( P<0.05). Compared with KR1 group, the onset time of sedation was significantly shortened in KR2 group and KR3 group, and the rate of rescue sedation and incidence of bucking were decreased in KR3 group ( P<0.05). Compared with KR2 group, the onset time of sedation was significantly shortened, and the rate of rescue sedation was decreased in KR3 group ( P<0.05). There was no significant difference in the increase rate of PI, hypotension, bradycardia, tachycardia, injection pain and apnea among KR1, KR2 and KR3 groups ( P>0.05). There was no significant difference in the incidence of hiccup among the four groups ( P>0.05). Conclusions:Esketamine 0.8 mg/kg combined with remimazolam 0.4 mg/kg can be safely and effectively used for anesthesia induction and has milder inhibition of respiration and circulation as compared with esketamine combined with propofol in pediatric patients.

Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.

Objective:To study the clinicopathological features, diagnosis, treatment and prognosis of patients with solid pseudopapillary neoplasm of the pancreas (SPN).Methods:From Jan 2008 to Dec 2017, 112 pathology confirmed SPN patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University were followed up. The clinicopathological characteristics and diagnosis were analyzed.Results:Most SPN patients were young women, the ratio of male to female is 1∶7. SPN patients have no typical clinical symptoms. The preoperative diagnostic accuracy of SPN was 57.14% with imaging examination. Pathological diagnosis depends mainly on immunohistochemical staining. All patients underwent surgical resection. Follow-up ranged from 4 to 123 months. The mean follow-up time was 49 months. All patients were doing well and no recurrence or metastasis was found.Conclusions:SPN is a rare tumor with low malignant potential. Surgical resection is effective.

Objective To analyze the consistency between computer tomography angiography(CTA)and digital subtraction angiography(DSA)in evaluating the global limb anatomic staging system(GLASS)stage of patients with chronic limb-threatening ischemia(CLTI).Methods The clinical data of patients with CLTI,who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University of China to receive treatment between January 2017 and December 2020,were retrospectively analyzed.Taking the DSA assessment as the gold standard,the consistency of CTA and DSA in evaluating the GLASS stage of patients with CLTI was analyzed.Results In the assessment of GLASS stage of CLTI,CTA showed strong agreement with DSA.The weighted Kappa coefficient of CTA and DSA for the staging of femoropopliteal segment was 0.798(95％CI=0.722-0.873,P＜0.01),and the weighted Kappa coefficient of CTA and DSA for the staging of infrapopliteal artery segment was 0.785(95％ CI=0.725-0.845,P＜0.0l).For the overall staging of GLASS,the weighted Kappa coefficient of CTA and DSA was 0.832(95％ CI=0.752-0.91 1,P＜0.01).All the above results indicated that a very strong consistency existed between CTA and DSA in evaluating the GLASS stage of patients with CLTI.Conclusion CTA examination of lower limb can accurately evaluate GLASS score and stage of CLTI patient's target lesions,which is helpful in diagnosing lower extremity arteriosclerosis occlusion disease as well as in assessing the technical difficulty degree of its revascularization operation.(J Intervent Radiol,2024,33:300-303)

Objective:To evaluate the interaction between remimazolam and propofol for sedation during hysteroscopy.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 20-45 yr, with body mass index of 18-28 kg/m 2, scheduled for elective hysteroscopy, were included. The test was conducted in two steps. Up-and-down sequential allocation was used to determine the median effective dose (ED 50) of remimazolam (group A) and propofol (group B). The ED 50 obtained in A and B groups were then used as the standard to determine the combination regimen in group C (0.25×ED 50 of remimazolam+ 0.75×ED 50 of propofol as the initial dose), in group D (0.5×ED 50 of remimazolam+ 0.5×ED 50 of propofol as the initial dose), and in group E (0.75×ED 50 of remimazolam+ 0.25×ED 50 of propofol as the initial dose). Up-and-down sequential allocation was used to determine the ED 50 of propofol when propofol and remimazolam were combined in C, D and E groups. The interaction between the sedative effects of two drugs was analyzed using the isobolographic analysis method, and the interaction coefficient and synergistic dose ratio of two drugs were calculated. Results:The ED 50 of remimazolam was 0.180 mg/kg in group A, and the ED 50 of propofol was 1.167 mg/kg in group B. The results of isobolographic analysis showed that remimazolam and propofol had a synergistic effect. When remimazolam 0.045, 0.090 and 0.135 mg/kg were combined with propofol 0.546, 0.288 and 0.160 mg/kg, the interaction coefficients were 1.393, 1.339 and 1.127 respectively. The synergistic dosage ratio of remimazolam and propofol was 1.0∶(3.2 to 12.0). Conclusions:Remimazolam and propofol have a synergistic effect on sedation when used for hysteroscopy, and the dose ratio is 1.0∶(3.2-12.0).

Objective To explore the relationship between accessory renal artery(ARA)and essential hypertension,and the possible mechanism using CT angiography(CTA).Methods The patients who underwent CTA examination on renal artery were reviewed retrospectively in our hospital.A variety of CTA reconstruction techniques were used to observe the type and number of ARA,as well as the diameter of ARA and the main renal artery.Results A total of 126 ARA(66 left ARA and 60 right ARA)were found in 253 patients. 10% of the patients had more than two ARAs.In 164 patients with essential hypertension,ARA detection rate was 40.2%(66/164).In the non-hypertension patients,the proportion of ARA was 31.5%(28/89).There was higher proportion of young(P=0.002)and male (P=0.022)patients in ARA hypertension group compared with ARA non-hypertension group.There were no significant differences on the prevalence of type(P=0.826)and number of ARA(P=0.501)between these two groups.In all of the patients with single ARA,no significant differences were detected on the ratios of diameter of ARA and main renal artery between the two groups(P=0.32). However,in ARA hypertension group,the diameter of main renal artery on the ARA side was significantly smaller than that on the opposite side(P=0.01).In non-hypertension ARA group,no statistical difference was found between the diameter of bilateral main renal arteries(P=0.06).Conclusion ARA is more prevalent in essential hypertensive patients,especially in young male.The decrease of the diameter of main renal artery in the ARA side may be a possible mechanism for essential hypertension.

Objective To investigate the applications of total maturation scores (TMS) in assessment of the hypoxic ischemic encephalopathy (HIE) group and matched group with MRI and to find which patterns of HIE can delay the brain maturation in neonate.Methods MRI were performed on 43 full term neonates (28 HIE newborns and 15 matched controls) who were further divided into three groups,including 37-39 weeks postmenstrualage (PMA) (13 cases),39-41 weeks PMA (16 cases),and 41-44 weeks PMA (14 cases).MRI features and TMS scores were evaluated simulataneously.Results TMS gradually increased with PMA at each stage.While TMS,cortical folding and germinal matrix were all higher in matched group (P＜0.05),myelination and glial cell migration item were lower in HIE group (P＞0.05).Conclusion TMS can reflect brain development in the full term neonates.HIE may delay the brain maturation due to injury of the cortical myelin and neurons.TMS can evaluate the neonatal brain development and injury easily,quantitatively and effectively.