Objective:To investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.Methods:A retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip, who had undergone Bernese periacetabular osteotomy. Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%, 20%, 50%, and 100% of the patient's weight. The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions, including whether the acetabular bone block and the ilium were in contact, whether 3 or 4 screws were used, and whether a graft (including fibular cortical bone and PEEK grafts) was used.Results:The structural stiffness of the pelvis fixed with four screws increased by 67%-94% compared to that with three screws. After using a graft, the structural stiffness of the pelvis increased by 50%-83%. As the load increased, the maximum equivalent stress on the screws also increased. When the acetabular bone block and the ilium had no contact, no graft was used, and only three screws were used for fixation, the maximum equivalent stress could reach 518.9 MPa, while this value dropped to 61% when four screws were used (318.7 MPa). When the acetabular bone block and the ilium were in contact, the maximum equivalent stress was about 12% of that when there was no contact, regardless of the number of screws used. When a cortical bone graft or a PEEK graft was used, the maximum equivalent stress could drop to 21%-26% of that without a graft. When the screw strength was 130 MPa, a load of 20% of body weight was applied, and only three screws were used without a graft, the equivalent stress could exceed the strength of the screw; if four screws were used, the equivalent stress was slightly higher than the strength of the screw when a load of 50% of body weight was applied. However, when a graft was used (either cortical bone or PEEK), even when a load of 100% of body weight was applied, the equivalent stress was slightly lower than the strength of the screw.Conclusion:Absorbable screws can provide sufficient stability for Bernese periacetabular osteotomy. The contact between the acetabular bone block and the ilium, an increase in the number of screws, and the use of grafts (cortical bone and PEEK grafts) can further improve stability. Therefore, absorbable screws have broad application prospects in Bernese periacetabular osteotomy.

Objective:To identify the risk factors for supine hypotension syndrome (SHS) after spinal anesthesia and establish a predictive model in parturients.Methods:The medical records from pregnant women undergoing elective cesarean section were retrospectively analyzed. According to the standard that SBP dropped by 30 mmHg or below 80 mmHg after spinal anesthesia, the parturients were divided into non-SHS group and SHS group. The general data from patients and difference of external iliac vein flow (ΔIVF) during postural changes before anesthesia were collected. The factors with statistically significant differences between groups were included in the logistic regression model, the risk factors were identified and the weighted score regression prediction model was established, and the receiver operating characteristic curve was drawn to evaluate the model.Results:There were 64 parturients developed SHS after spinal anesthesia, with an incidence of 54.7%. Logistic regression analysis showed that fetal abdominal circumference, amniotic fluid index, ΔIVF and consumption of norepinephrine were independent risk factors for SHS after spinal anesthesia. The area under the receiver operating characteristic curve was 0.983, 95% confidence interval was 0.968-0.999, the sensitivity was 90.6%, the specificity was 96.2%, and the Youden index was 0.868. The prediction model of the line chart was tested by Hosmer-Lemshow, P=0.984, and the C index visualized the line chart model was 0.983. Conclusions:Fetal abdominal circumference, amniotic fluid index, ΔIVF and consumption of norepinephrine are independent risk factors for SHS after spinal anesthesia in parturients, and the risk prediction model can effectively predict the occurrence of SHS after spinal anesthesia.

Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.

Objective:To investigate the effect of sevoflurane anesthesia on electroencephalographic (EEG) seizures and long-term behavior and possible mechanism in neonatal rats.Methods:A total of 141 postnatal days 4-6 Sprague-Dawley rats (66 male, 75 female) were divided into 3 groups ( n=47 in each group) according to random number table method: control group, sevoflurane group, and NKCC1 inhibitor group, with 22 males and 25 females in each group. Rats in the control group were fed in normal cage without anesthesia; rats in the sevoflurane group were anesthetized with 2.1% sevoflurane for 6 hours; rats in the NKCC1 blocker group received intraperitoneal injection of 1.82 mg / kg bumetanide 30 minutes before anesthesia with 2.1% sevoflurane. The rats in the control group and sevoflurane group were injected subcutaneously with the same dose of DMSO at the same time when the NKCC1 blocker group received the drug intervention, so as to eliminate the influence caused by the solvent. The rats were observed for 30 minutes after recovery from anesthesia and then continued to breastfeed normally. Some of the new born rats received EEG monitoring from 9 to 11 days after being raised; the other rats received EPM and PPI respectively at 60 and 70 days after being raised. Results:The results of EEG showed that, compared with the control group, the number of epileptic waves((0.429±0.787), (1.571±0.787), t=2.753, P<0.01), the average duration of single epileptic wave ((1.575±2.349), (6.392±3.374), t=3.880, P< 0.01), the total duration increased significantly ((1.800±3.617), (10.957±6.028), t= 3.929, P<0.01) were all increased, the differences were statistically significant. Compared with sevoflurane group, the number of epileptic waves in EEG of male rats in NKCC1 blocker group decreased, the average duration of single epileptic wave decreased, and the total duration of epileptic wave shortened significantly, with statistical significance ((0.286±0.756), (0.925±1.733), (1.043±2.759), t=3.097, 4.404, 4.254, all P<0.01). There were no significant differences in female rat among the three groups (all P>0.05). Compared with male rats, the average duration of female rats in sevoflurane group decreased ((6.392±3.374), (2.515±2.992), t=3.044, P<0.01), the total duration shortened ((10.957±6.028), (3.270±5.883), t=2.626, P<0.01), the difference was statistically significant.The behavioral results showed that, compared with the control group, the open arm dwell time of male rats in sevoflurane group was significantly shorter ( P<0.05), and the panic response in PPI group was significantly lower ( P<0.05), the difference was statistically significant.Compared with the sevoflurane group, the open arm dwell time in NKCC1 blocker group was significantly longer ( P<0.05), and the panic response in PPI group was significantly increased.The difference was statistically significant ( P<0.05). The change trend in female rats of each group was similar to that of male rats, but there was no significant difference (all P>0.05). Comparison between male and female rats: compared with male rats in sevoflurane group, the female rats in sevoflurane group had a longer open arm stay time in EPM experiment ( P<0.05), the difference was statistically significant. Conclusion:Sevoflurane anesthesia for 6 hours can significantly increase the generation of epileptic waves in EEG of male newborn rats, and cause behavioral abnormalities in adult male rats, which may be related to NKCC1.And male rats are more vulnerable to the negative effects of sevoflurane anesthesia on brain nerve development.

Objective:To evaluate the role of hypothalamic aromatase in sevoflurane anesthesia-induced epileptic waves in neonatal rats.Methods:Thirty clean-grade healthy neonatal Sprague-Dawley rats of both sexes, aged 5 days, weighing 10-15 g, were divided into 3 groups ( n=10 each) according to a random number table method: control group (group C), sevoflurane group (group S), and aromatase inhibitor formestane plus sevoflurane group (group F). The electroencephalogram (EEG) in the neonatal rat cortex was monitored, 30 min later formestane 2 mg/kg was subcutaneously injected in F group, while the equal volume of normal saline was given instead in C and S groups.At 30 min after subcutaneous administration, 6% sevoflurane was inhaled to induce anesthesia for 3 min, and then the concentration was adjusted to 2.1% to maintain anesthesia for 57 min in S and F groups.The total duration and single duration of epileptic waves and the number of seizure during sevoflurane anesthesia were recorded.After the end of EEG recording, the laparotomy was performed, the left ventricular puncture was performed, and blood samples were collected for blood gas analysis and for determination of corticosterone levels (by enzyme-linked immunosorbent assay). Brain tissues were obtained, and then the hypothalamus was rapidly isolated for determination of the expression of aromatase mRNA, Na + -K + -2Cl - cotransporter-1 (NKCC1) mRNA and K + -Cl - cotransporter-2 (KCC2) mRNA (by polymerase chain reaction). Results:No epileptic waves were found in group C. Compared with group C, the total duration and single duration of cortical epileptic waves were significantly prolonged, and the number of seizures was increased, the serum corticosterone concentration was increased, the expression of aromatase mRNA was up-regulated, and NKCC1/KCC2 mRNA ratios were increased in S and F groups ( P<0.05). Compared with group S, the total duration and single duration of cortical epileptic waves were significantly shortened, and the number of seizures was decreased, the serum corticosterone concentration was decreased, the expression of aromatase mRNA was down-regulated, and NKCC1/KCC2 mRNA ratios were decreased in group F ( P<0.05). Conclusion:Up-regulation of hypothalamic aromatase expression is involved in the development of sevoflurane anesthesia-induced epileptic waves in newborn rats.

Objective To investigate the effect of estradiol on sevoflurane-induced epileptiform cor-tical EEG waves in neonatal rats. Methods Forty neonatal rats,aged 4-6 days,weighting 8-15 g,were di-vided into 5 groups according to random number table:normal saline control group (group C),estradiol group (group E),ICI182780 (group I),Formestane group (group O) and estradiol +ICI182780 (group EI). Af-ter establishing the monitoring model of cortical electroencephalogram in neonatal rats, EEG was recorded continuously for 30 minutes, then different treatment drugs were given according to different groups. After 30 minutes of continuous recording of EEG, anesthesia induction was started with inhalation of 6% sevoflurane for 3 minutes, followed by inhalation of 2. 1% sevoflurane to maintain anesthesia. Sevoflurane anesthesia las-ted for 1 hour. The righting reflex disappearance time was recorded after sevoflurane anesthesia. The total du-ration,single duration and frequency of EEG convulsion waves were recorded. Spike frequencies were recor-ded at different periods. Animal respiratory rate was recorded after sevoflurane induction. Results One rat in group I and one rat in group EI showed convulsion wave before treatment,which were excluded from the study. The righting reflex disappearance time of group S,group E,group I,group O and group EI were (24. 4 ±2. 5)s,(16. 4±4. 2)s,(31. 8±5. 2) s,(29. 8±1. 8) s,(24. 8±2. 7) s respectively,and there were statisti-cally significant differences among the 5 groups (F=16. 693,P<0. 01). There were no significant difference in respiratory frequency among the 5 groups (F=0. 276,P>0. 05). Compared with group S,the total dura-tion,single duration and frequency of convulsion wave were significantly increased in group E during anesthe-sia,and the differences were statistically significant (P<0. 05). Compared with group E and group S,the total duration,single duration and frequency of convulsion wave during anesthesia were significantly reduced in group I,group O and group EI,and the differences were statistically significant (P<0. 05). Compared with group S,the spike frequency of group E increased significantly in each period,and the differences were statis-tically significant (P<0. 05). The frequency of spike wave in group I,group O and group EI at 65-70 min and 90-95 min were lower than that in group S,and the differences were statistically significant (P<0. 05). The frequency of spike wave between group O and group EI during 115-120 min was statistically different with group S and group E(P<0. 05). Conclusion The mechanism of epileptiform EEG wave induced by sevoflu-rane anesthesia may be related with neuroactive steroidal estradiol.

Objective To analyze copy number variance (CNV) in whole genome by using gene chip technology, and to screen the radiosensitivity associated genes on esophageal squamous cell carcinoma (ESCC). Methods The patients with ESCC who received radiotherapy alone in Anyang Tumor Hospital from December 2013 to August 2016 were selected, and biopsy paraffin samples were preserved in the center of pathology. The patients were divided into radiosensitivity group (group S) and radio-resistance group (group R). DNA was extracted from these paraffin samples in both groups. Whole human genome CNV was detected by using genechip from OncoScan Array platform designed by Affymetrix company, and the differences of gene segments were screened in the two groups. Results Nineteen samples of ESCC patients were collected to extract DNA in this study. To balance pair analysis in the two groups, 10 samples were selected from the qualified patients, including 5 cases in group S and 5 cases in group R respectively. There were no statistical differences in gender, age, lesion site, lesion length, radiation dose of the two groups (all P> 0.05). Loss of heterozygosity (LOH) was the main type of CNV. The analysis results showed that LOH in q24.32-q24.33 of chromosome 10 and LOH in q21.2-q21.31 of chromosome 18 had high frequencies (100 ％) in group R, however, none were detected in group S. LOH in q27-q28.1 of chromosome 4 had a high frequency (80％) in group S , however, none were detected in group R. Conclusion LOH in 10q/18q is related to radio-resistance in ESCC, and LOH in 4p is associated with radiosensitivity in ESCC.

Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.

Objective To evaluate the efficacy of different doses of dexmedetomidine mixed with ropivacaine used for thoracic paravertebral nerve block (TPVB) combined with general anesthesia in the pa-tients undergoing radical resection of lung cancer. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective radical resection of lung cancer, were divided into 5 groups (n＝20 each) using a random number table method: general anesthesia group ( group G), TPVB with ropivacaine com-bined with general anesthesia group (group R), TPVB with 0. 5 μg∕kg dexmedetomidine mixed with ropiva- caine combined with general anesthesia group (group RD0. 5), TPVB with 1. 0 μg∕kg dexmedetomidine mixed with ropivacaine combined with general anesthesia group (group RD1. 0), and TPVB with 2. 0 μg∕kg dexmedetomidine mixed with ropivacaine combined with general anesthesia group ( group RD2. 0). Two-point TPVB was performed, and anesthetic 10 ml was injected into each puncture site. Zero point five per-cent ropivacaine was administered in group R. Dexmedetomidine 0. 5, 1. 0 and 2. 0 μg∕kg mixed with ropi-vacaine at the final concentration of 0. 5% were injected in group RD0. 5, group RD1. 0 and group RD2. 0, respectively. Anesthesia was maintained by intravenously infusing propofol and remifentanil and cisatracuri-um was intermittently injected to maintain muscle relaxation. The occurrence of intraoperative hypotension and bradycardia was recorded. The emergence time, extubation time, duration of postanesthesia care unit (PACU) stay and requirement for rescue analgesia during emergence from anesthesia were also recorded. Small marginal lung samples next to the tumor were harvested immediately after removing the tumor tissues. The expression of caspase-3 and Bcl-2 was determined by Western blot, the content of IL-1β in lung tissues was determined by enzyme-linked immunosorbent assay, the cell apoptosis was evaluated by TUNEL, and apoptosis index ( AI) was calculated. The injury to lung tissues was observed with a light microscope and scored. Results Compared with G and R groups, AI, IL-1β content and lung injury score were signifi-cantly decreased, the expression of caspase-3 was down-regulated, and the expression of Bcl-2 was up-regulated in the other three groups, the incidence of hypotension and bradycardia was significantly in-creased in group RD1. 0, the incidence of bradycardia was significantly decreased in group RD0. 5, and the incidence of hypotension and bradycardia was significantly increased, and the emergence time, extu-bation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). Compared with group RD0. 5, IL-1β content was significantly decreased, and the incidence of hypotension and bradycardia was increased in group RD1. 0, and IL-1β content was significantly decreased, the incidence of hypoten-sion and bradycardia was increased, and the emergence time, extubation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). Compared with group RD1. 0, the incidence of hypotension and bradycardia was significantly increased, and the emergence time, extubation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). There was no significant difference in the AI, expression of caspase-3 and Bcl-2, lung injury score, or requirement for rescue analgesia among RD0. 5, RD1. 0 and RD2. 0 groups ( P＞0. 05). Conclusion Dexmedetomidine 0. 5 μg∕kg mixed with ropiva-caine for TPVB combined with general anesthesia provides better efficacy in the patients undergoing radical resection of lung cancer.

Objective To evaluate the effect of dexmedetomidine on the cell apoptosis during the acute lung injury induced by blunt chest trauma in rats.Methods Thirty pathogen-free male SpragueDawley rats,weighing 240-270 g,aged 8 weeks,were divided into 3 groups (n=10 each) using a random number table:shan operation group (group Sham),blunt chest trauma group (group T) and blunt chest trauma plus dexmedetomidine group (group TD).The model of acute lung injury was induced by dropping a 300 g weight onto a precordium in anesthetized rats.After the model was established,dexmedetomidine was intravenously infused at a rate of 5 μg · kg 1 · h-1 for 6 h in group TD.At 6 h after the model was established,blood samples were collected from the femoral artery for determination of concentrations of serum tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6).The rats were sacrificed after blood sampling,and lungs were removed for examination of the pathological changes (with light microscope) and for determination of Bax and Bcl-2 expression in lung tissues (by immuno-histochemistry) and cell apoptosis (by TUNEL).Bcl-2/Bax ratio and apoptosis index (AI) were calculated.Results Compared with group C,the serum TNF-α and IL-6 concentrations and AI were significantly increased,the expression of Bax and Bcl-2 was up-regulated,and Bcl-2/Bax ratio was decreased in T and TD groups (P＜ 0.01).Compared with group T,the serum TNF-α and IL-6 concentrations and AI were significantly decreased,the expression of Bax in lung tissues was down-regulated,the expression of Bcl-2 in lung tissues was up-regulated,Bcl-2/Bax ratio was increased (P＜0.05),and the pathological changes of lung tissues were significantly attenuated in group TD.Conclusion The mechanism by which dexmedetomidine mitigates the acute lung injury induced by blunt chest trauma is related to inhibition of cell apoptosis in rats.