Objective To explore the effect of lidocaine combined with ropivacaine in penile dorsal nerve block for pediatric circumcision.Methods 130 children with pediatric circumcision surgery were divided into observation group and control group by the digital meter method,65 cases in each group.The control group was taken inhaled sevoflurane composite static note ketamine surgery,the observation group was given ropivacaine combined with intravenous infusion of ketamine for penile dorsal nerve block anesthesia.The anesthesia effects of the two groups were recorded.Results In the observation group,10 min after surgery,the rhythm of the heart was (98.47±10.88)times/min,central arterial pressure was (65.13±7.78)mmHg.In the control group,10min after surgery,the rhythm of the heart was (121.78±15.23)times/min,central arterial pressure was (85.27±12.31)mmHg,the differences between the two groups were statistically significant(t=10.040,11.150,all P＜0.05).In the observation group,the used ketamine,waking up time,pain score,incidence rate of pain and irritability were (41.38±11.28)mg,(5.54 ±1.03)min,(2.11±1.13)points,7.69％,respectively,which in the control group were (71.47±16.82)mg,(13.67±2.57)min,(3.89±1.79)points,26.15％,respectively,the differences between the two groups were statistically significant(t=11.978,23.673,6.779,χ2=7.878,all P＜0.05).Conclusion The anesthesia effect of lidocaine combined with ropivacaine in penile dorsal nerve block for pediatric circumcision is stable,safe and reliable,it is worthy of popularization and application in clinic.

Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.

Objective To analyze the GDM of 336 cases with chronic HBV in pregnancy. Methods According to HBV DNA≥1.0 × 103 IU/mL, participants were divided into HBV DNA (+) or (-) group. 409 cases without HBV were selected as control group. Differences on GMD incidence between groups and virus load and OGTT blood sugar correlation were compared. Results The incidence of GDM of HBV DNA (+) or (-) group was 16.77% and 17.71%, which is higher than that in HBV group (10.27%). The difference is significant (P < 0.05). The correlation index between HBV DNA and fasting blood-glucose is r = 0.005, P = 0.610, the result of which is not statistically significant. But correlation index between HBV DNA and blood sugar at 1 h , 2 h are r = 0.082, 0.086; P = 0.000, 0.000, the result of which is statistically significant. Conclusion The oc-currence of GDM were higher in HBV DNA (+) or (-) group. The viral load is positively related with blood sugar of glucose tolerance at 1 h or 2 h.

Objective To investigate the effect and safety of dexmedetomidine combined with dorsal penile nerve block for circumcision in children .Methods 130 children with circumcision were divided into the observation group and the control group according to the digital table ,65 cases in each group .The control group received total inhalation of seven halothane anesthesia ,and the observation group received dexmedetomidine combined with dorsal penile nerve block anesthesia .The efficacy and safety of the two groups were compared .Results In the observation group after induction,the mean arterial pressure[(69.89 ±5.24)mmHg],awake and mean arterial pressure[(70.14 ± 5.30)mmHg],rhythm of the heart after induction [(100.36 ±10.67)times/min],the rhythm of the heart when they woke up[(102.64 ±10.58) times/min],blood oxygen saturation after induction [(98.25 ±0.63)％],awake and blood oxygen saturation[(98.64 ±0.66)％]and other signs of vital signs had no statistically significant differences compared with the control group (F=0.130,0.215,0.548,0.613,0.106,0.257,all P>0.05).In the observation group,the eyelash reflex disappearing time , operation time, awakening time were ( 23.16 ±2.13 ) s, ( 9.70 ± 1.24)min,(10.03 ±1.27)min,respectively,which in the control group were(27.98 ±3.87)s,(11.88 ±2.87)min, (11.89 ±3.87) min,respectively,there were statistically significant differences between the two groups ( t=8.797, 5.621,6.633,all P<0.05).In the observation group,the postoperative agitation score ,sedation score,pain score were(2.75 ±1.25)points,(1.11 ±0.13)points,(5.26 ±1.44)points,respectively,which in the control group were (6.78 ±2.89) points,(1.11 ±0.13) points,(8.97 ±3.64) points,respectively,there were statistically significant differences between the two groups (t =10.318,17.236,10.318,all P <0.05).Conclusion Application of dexmedetomidine combined with penile dorsal nerve block anesthesia in pediatric circumcision takes effect quickly , children with stable vital signs ,less postoperative agitation ,it is worthy of popularization and application in clinic .

Objective To investigate the risk of postpartum haemorrhage in HBV-infected pregnant women. Methods Cohort or case-control studies that discussed the relationship between hepatitis b virus infection and pregnancy outcome were searched in PubMed , EMBASE , Wiley Online Library , Cochrane Library , Google Scholar, CBM, WanFang database and CNKI etc. (till August 2015). The quality of included Cohort or case-control studies was evaluated , and Meta-analysis was performed with Rev Man5.2 software. Results Four observational case-control studies and 17 cohort studies , involving 19 549 women in observation , were identifled. Meta-Analysis results displayed that the incidence of postpartum haemorrhage in HBV-infected women was 9.3%, while 2.8% in women without HBV [RR = 2.97, 95% CI (2.25 ~ 3.92),P < 0.01]. Compared with normal-risk women , the incidence of postpartum haemorrhage of HBV-infected women with normal hepatic function was also higher [RR = 2.56, 95% CI (2.01 ~ 3.25),P < 0.01]. HBV-infected women with hepatic dysfunction had higher incidence of postpartum haemorrhage than those with normal hepatic function [RR = 2.67, 95% CI (2.17~ 3.28),P < 0.01]. Conclusions HBV-infected women are at higher risk of postpartum haemorrhage than normal pregnancy women and further hepatic dysfunction would lead to a continuing increase of the risk.

Objective:To investigate the effects of B ultrasound-guided lumbar plexus combined with sciatic nerve block on immune function, stress response, and postoperative analgesia in older adult patients undergoing hip surgery, providing theoretical evidence for clinical diagnosis and treatment.Methods:We included 300 older adult patients undergoing hip surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from August 2018 to August 2019 in this study. We randomly allocated them into the observation and control groups ( n = 150/group). The control group was subject to general anesthesia and the observation group was subject to B ultrasound-guided lumbar plexus combined with sciatic nerve block. Hemodynamic changes and plasma cortisol levels were recorded in each group immediately after endotracheal intubation (T1), at 2 hours of surgery (T2), at the end of surgery (T3), and 24 hours after surgery (T4). Each patient's immune function was assessed 3 months after surgery. The Visual Analog Scale score at each time point was compared between the two groups. Results:The systolic blood pressure, diastolic blood pressure, and heart rate in the observation group at T1-T4 were (122.14 ± 8.68) mmHg, (117.41 ± 8.72) mmHg, (109.62 ± 8.43) mmHg, (127.82 ± 7.83) mmHg, (83.47 ± 6.32) mmHg, (72.34 ± 7.02) mmHg, (67.13 ± 6.72) mmHg, (74.15 ± 7.12) mmHg, (71.94 ± 7.64) beats/minute, (71.84 ± 7.11) beats/minute, (63.52 ± 6.16) beats/minute, (73.43 ± 7.29) beats/minute , respectively, which were significantly lower than those in the control group [(131.22 ± 8.69) mmHg, (125.81 ± 8.76) mmHg, (115.11 ± 8.44) mmHg, (133.26 ± 7.85) mmHg, (89.28 ± 6.12) mmHg, (77.64 ± 7.13) mmHg, (75.51 ± 8.02) mmHg, (81.13 ± 7.14) mmHg, (79.24 ± 7.65) beats/minute, (75.27 ± 7.13) beats/minute, (70.54 ± 6.22) beats/minute, (80.11 ± 7.32) beats/minute, t = 9.05, 8.32, 5.63, 6.00, t = 8.08, 6.48, 9.80, 8.47, t = 8.26, 4.17, 9.82, 7.91, all P < 0.001]. Plasma cortisol levels in the observation group at T2-T4 were (332.28 ± 15.64) ng/L, (334.67 ± 15.77) ng/L, (331.40 ± 15.68) ng/L, respectively, which were significantly lower than those in the control group [(344.75 ± 15.63) ng/L, (346.02 ± 15.76) ng/L, (345.83 ± 15.66) ng/L, t = 6.90, 6.23, 7.97, all P < 0.001]. At 3 months after surgery, the proportion of CD 4+ helper T cells, the proportion of CD 8+ cytotoxic T cells, and the ratio of proportion of CD 4+ Helper T cells to the proportion of cytotoxic CD 8+ T cells in the observation group were (31.39 ± 6.72)%, (25.73 ± 6.24)%, 1.31 ± 0.38, respectively, which were significantly lower than those in the control group [(38.61 ± 6.73)%, (32.79 ± 6.25)%, 1.52 ± 0.39, t = 9.29, 9.79, 4.72, all P < 0.001]. At 12-48 hours after surgery, The Visual Analog Scale scores in the observation group were (1.59 ± 0.54) points, (1.47 ± 0.33) points, (1.55 ± 0.41) points, respectively, which were significantly lower than those in the control group [(2.72 ± 0.55) points, (2.29 ± 0.36) points, (2.39 ± 0.43) points, t = 17.95, 20.56, 17.31, all P < 0.001]. Conclusion:B ultrasound-guided lumbar plexus combined with sciatic nerve block can effectively stabilize the hemodynamics in older adult patients undergoing hip surgery, reduce the occurrence of the stress response, promote the recovery of immune function, and alleviate pain.

Objective To study the clinical features, diagnosis and treatment of torsion of testes in newborn. Method Neonates who were diagnosed with neonatal testicular torsion and admitted to Shenzhen Children's Hospital from March 2008 to July 2018 were studied. The clinical data such as days in age, time of onset, clinical manifestations, time of ultrasound examination, characteristics of ultrasound examination, surgery time, surgical types, postoperative conditions, pathological findings, and follow-up results were retrospectively analyzed. Result A total of 12 infants with torsion of testes were enrolled. The average onset time was 2.9 d, ranged from 1～10 d. The time of onset was within 24 h after birth in six infants. The median duration from onset to seeing a doctor was 3.5 d, ranged from 2 h to 28 d. First manifestations being reported grammer were scrotal swelling or mass, including 7 cases on the left side and 5 cases on the right side. Among them, 9 cases were associated with redness or cyanosis of the scrotum. Ultrasound was characterized by the disappearance or significant reduction of testicular parenchymal blood flow signal, and the sensitivity of ultrasound was 100％. The average time from admission to operation was (2.1±1.1) h. All the 12 infants had orchiectomy,after necrosis of unilateral testicle was confirmed. Eight of them underwent contralateral test icular fixation. The average operation time was 46 min. There was no wound bleeding or infection postoperatively, and the average hospital stay was 6.4 d. The pathological features were blurred residual contour of the seminiferous tubule (9 cases) or the disappearance of the seminiferous tubule structure (3 cases). After 3 to 24 months of follow-up, no contralateral testicular torsion or atrophy was found. Conclusion The rate of testicular necrosis in children with torsion of testes is high. The newborn with scrotal swelling should be diagnosed promptly with color Doppler ultrasound. If necessary, surgical exploration should be performed in time.

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.

Objective:To compare the perioperative outcomes between robotic pancreaticoduodenectomy(RPD)and laparoscopic pancreaticoduode-nectomy(LPD)in patients aged ≥65 years. Methods:The clinical data of 130 patients aged ≥65 years who received minimally invasive pancreaticoduodenectomy(MIPD)at Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People's Hospital from January 2019 to December 2022 were retrospectively analyzed.The patients were divided into the RPD group(n=66)and the LPD group(n=64)according to the operation method,and the perioperative clinical data were compared between the 2 groups. Results:Compared with the LPD group,the average age of patients in the RPD group was higher than that of the LPD group[(71.95±4.73)years vs(70.39±3.9)years,P＜0.05];the RPD group had more patients with diabetes(39.4％vs 18.8％,P＜0.05)and cardiopulmonary diseases(37.9％vs 17.2％,P＜0.05);the RPD group had shorter operation time[(272.91± 68.38)min vs(362.81±78.24)min,P＜0.05]and less intraoperative blood loss[median(range):1 00 mL(50-200 mL)vs 1 50 mL(1 00-200 mL),P＜0.05)];the RPD group had higher incidence of chylous fistula(1 2.1％vs 1.6％,P＜0.05)but lower incidence of surgical morbidity(37.9％vs 46.9％),serious complications(19.7％vs 34.4％),postoperative pancreatic fistula(12.1％vs 17.2％),biliary fistula(3.0％vs 3.1％),abdominal infection(10.6％vs 14.1％),postoperative bleeding(4.5％vs 4.5％),and postoperative cardiopulmonary complications(1 2.1％vs 20.3％)with no statistically significant difference(P＞0.05);the RPD group waited shorter time before restarting diet[(3.97±1.59)d vs(5.34±2.56)d,P＜0.05]. Conclusion:MIPD is safe and feasible in patients aged ≥65 years.The incidence of perioperative complications is similar between the 2 groups.Compared with LPD,RPD has shorter operation time,less intraoperative blood loss,and shorter duration before restarting diet after operation,which has certain clinical advantages.

BACKGROUNDEndostar™ (rh-endostatin, YH-16) is a new recombinant human endostatin developed by Medgenn Bioengineering Co. Ltd., Yantai, Shandong, P.R.China. Pre-clinical study indicated that YH-16 could inhibit tumor endothelial cell proliferation, angiogenesis and tumor growth. Phase I and phase II studies revealed that YH-16 was effective as single agent with good tolerance in clinical use.The current study was to compare the response rate , median ti me to progression (TTP) ,clinical benefit andsafety in patients with advanced non-small cell lung cancer ( NSCLC) , who were treated with YH-16 plus vi-norelbine and cisplatin (NP) or placebo plus NP.

METHODSFour hundred and ninety-three histologically or cy-tologically confirmed stage IIIB and IV NSCLC patients , withlife expectancy > 3 months and ECOG perform-ance status 0-2 , were enrolledin a randomized ,double-blind ,placebo-controlled , multicenter trial ,either trialgroup : NP plus YH-16 (vinorelbine 25 mg/m² on day 1 and day 5 ,cisplatin 30mg/m² on days 2 to 4 , YH-167.5mg/m² on days 1 to 14) or control group : NP plus placebo (vinorelbine 25 mg/m² on day 1 and day 5 ,cis-platin 30 mg/m² on days 2 to 4 ,0.9% sodium-chloride 3 .75 ml on days 1 to 14) every 3 weeks for 2-6 cycles .The trial endpoints included response rate ,clinical benefit rate ,time to progression,quality of life and safety .

RESULTSOf 486 assessable patients , overall response rate was 35.4% in trial group and 19.5% in controlgroup (P=0 .0003) . The median TTP was 6 .3 months and 3 .6 months for trial group and control group respectively (P < 0 .001) . The clinical benefit rate was 73 .3 %in trial group and 64.0% in control group (P=0 .035) .In untreated patients of trial group and control group ,the response rate was 40 .0% and 23.9%(P=0 .003) ,the clinical benefit rate was 76 .5 % and 65 .0 % (P=0 .023) ,the median TTP was 6 .6 and 3 .7months (P=0 .0000) ,respectively .In pretreated patients of trial group and control group ,the response ratewas 23.9% and 8.5%(P=0 .034) ,the clinical benefit rate was 65.2% and 61.7%(P=0 .68) ,the median TTP was 5 .7 and 3 .2 months (P=0 .0002) ,respectively . The relief rate of clinical symptoms in trial groupwas higher than that of those in control group ,but no significance existed (P > 0 .05) . The score of quality oflife in trial group was significantly higher than that in control group (P=0 .0155) after treatment . There were no significant differences in incidence of hematologic and non-hematologic toxicity , moderate and severe sideeffects betweentrial group and control group .

CONCLUSIONSThe addition of YH-16 to NP regimen results in significantly and clinically meaningful improvement in response rate , median time to tumor progression,and clinical benefit rate compared with NP alone in advanced NSCLC patients . YH-16 in combination with chemotherapy shows a synergic activity and a favorable toxic profile in advanced cancer patients .