ERAS,namely enhanced recovery after surgery,refers to the implementation of optimized EBM (evidence-based medicine) measures comprised of preoperative preparation,anesthesia and postoperative management,in order to reduce psychological stress and physiological trauma,thus contributing to rapid recovery.Recently,researches focus mainly on adult ERAS and are rarely seen in pediatric surgeries.Considering the more sophisticated process children faced,it is urgent and strongly-needed to enforce optimization of perioperative management in pediatric surgeries.Difficulties and challenges exist in the process of ERAS in pediatric surgery,such as the break-through of traditional concepts,cooperation between departments of the anesthesiology and surgery,the fasting time issue,implementation of goal-di-rected fluid therapy,anesthesia method selection,analgesia mode and drug options.Prospective,multicenter clinical trials are needed to explore and solve the problems.In this paper,we review the present situation,difficulties,and prospects in ERAS of pediatric surgery.

Objective To construct and identify the shRNA plasmid vector targeting nuclear factor erythroid-2-related factor 2 (Nrf2),and to collect the strongest RNAi effect of Nrf2 shRNA sequence.Methods Nrf2 gene was targeted gene.Three shRNA sequences were designed by software and synthesized by chemical method: shRNA-1,shRNA-2 and shRNA-3.The double strand shRNA oligo was ligated to the vector.The construct was verified by sequencing analysis.BV2 cells were transfected with expressing shRNA plasmid vectors using Lipofectamine 2000.The expression of Nrf2 in the levels of mRNA was detected by real-time PCR,and Western Blot was adopted to abserve the expression of Nrf2 protein.Results Sequencing analysis suggested that the shRNA vectors targeting Nrf2 possessed correct nucleotide sequence and read frame.The result of Real-time PCR and Western Blot showed that the sequence of shRNAi-3 could more effectively knockdown the expression level of Nrf2 than the others.Conclusions The shRNA vectors targeting Nrf2 are successfully constructed and the shRNA can signidicantly inhibit the expression of Nrf2.These findings could provide an experimental basis for further study on Nrf2 signaling pathway in stroke field.

ObjectiveTo observe the effects of Yishen-Huoxue-Huatan capsule on carotid artery intima-media thickness (IMT),carotid atherosclerosis plaque area and the level of serum lipids,plasma endothelin (ET) and nitric oxide (NO) in patients with carotid atherosclerosis.Methods126 patients with carotid atherosclerotic were randomly assigned to treatment group and control group.Patients in treatment group was treated by yishen huoxue huatan capsule,and patients in control group was treated by zocor.Each patient was treated for 24 weeks.ResultsAfter the treatment,carotid IMT [respectively (0.81±0.11)mm,(1.10± 0.27)mm],atherosclerotic plaque area [respectively (11.21 ± 9.3)mm2,(16.53± 6.9)mm2] in both the treatment group and the control group were significantly lower compared with the same group before treatment (P＜0.05),and the treatment group was better than the control group (P＜0.05); serum cholesterol (TC),respectively [ (4.51 ± 0.37) mmol/L,(5.15 ± 0.20) mmol/L],triglyceride (TG) [respectively ( 1.77± 0.09) mmol/L,(1.79 ± 0.36) mmol/L],high-density lipoprotein cholesterol (HDL-C) [respectively (1.28 ± 0.26) mmol/L,(1.27 ±0.36) mmol/L],low-density lipoprotein cholesterol (LDL-C) [ (2.50± 0.30) mmol/L,(3.10± 0.39) mmol/L] in the treatment group and the control group were improved significantly (P＜0.05) compared with the same group before treatment,and the TC and LDL-C levels in the treatment group were significantly lower than the control group (P＜0.05); plasma ET [respectively (67.26± 14.13) ng/L,(79.38± 11.54)ng/L] NO [respectively (71.65± 111.64)μmol / L,(60.64±14.02)μmol/L] in the treatment group and the control group were higher than those in the same group before treatment (P＜0.05),and the plasma ET levels in the treatment group was significantly lower than the control group (P＜0.05),while the plasma NO level was significantly higher(P＜ 0.05).ConclusionYishen-Huoxue-Huatan capsule is effective in the treatment of carotid atheroselerosis.

To study the effects of connective tissue mast cells ( CTMCs ) on T cell activation in an antigen-dependent manner.Methods: Connective tissue mast cells were differentiated from mouse bone marrow cells.Alexa Fluor 488-conjugated ovalbumin (OVA)/IgG immune complexes were generated and incubated with CTMCs ,and analyzed by flow cytometry to detect the antigen uptake by CTMCs via Fcγreceptors ( FcγRs ).The relevant effects on antigen-specific T cell activation and proliferation were further determined by CD 69 and Ki67 expression.Results: A magnificent increase in OVA uptake was seen in CTMCs treated with OVA/IgG immunocomplex after 24-hour incubation ,compared with that treated with fluorescent OVA alone.OVA-incorporated mast cells induced OVA-specific CD4+T-cell activation and proliferation.Conclusion:It was suggested that the binding of IgG receptor FcγRs could elicit CTMCs reaction and ,as a result,to mediate crosstalk between professional APCs and T cells.

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10.3969/j.issn.1000-3606.2013.06.012

Cerebral small vessel diseases refer to small intracranial vascular lesions caused ischemic or hemorrhagic disease.Although researches have performed a large number of studies for its pathogenesis,it remains unclear now.This article reviews the pathogenesis of cerebral small vessel diseases from endothelial dysfunction,blood-brain barrier damage,ischemic and hypoperfusion,amyloid deposition,and genetic factor.

Objective　To evaluate the safety of biopsy of the prostate guided by transrectal ultrasound.Methods　Three hundred and seventeen patients suspected to have prostate cancer were examined and 208 patients were followed up.Results　One hundred and eighty-one patients followed up did not feel severe pain during the biopsy of the prostate. Clinical manifestations induded 12 cases of hematuria,4 dases of hematospermia,1 case of fever, 2 cases of pollakisuria and urodymia,2 cases of uroschesis,which disappeared after corresponding treatment.Conclusions　Biopsies of the prostate guided by transrectal ultrasound is advantageous in diagnosis of prostatic carcinoma.

Objective:To explore the strain experiences by suicides and to test the strain theory of suicide.Methods：A consecutive sample of 155 suicides(91 males and 64 females)aged from 15 to 34 years was studied with the psychological autopsy method.Informants consisted of family members and close friends of the suicides.Suicide stories were composed based on the background information of the suicides and what happened at the suicide site and then content-analyzed and rated by independent judges.Results:All of the victims had experienced at least one type of strain before suicide took place.The sequence of the 4 types of strains beginning with the most frequent one was coping strain,100%;aspiration strain,81%,deprivation strain,72% and value strain,45%.Generally,males experienced more coping strains,especially loss of money or investment than females [(8.85±3.64)vs.(7.72±3.77),(0.35±0.92)vs.(0.09±0.52);Ps<0.05],except for the traditionalism and modernity for status of women,religion and atheism [(0.08±0.37)vs.(0.53±0.97),(0.00±0.00)vs.(0.06±0.30);Ps<0.05].As age increased,value strain tended to increase(r= 0.16,P=0.048),whereas aspiration strain tended to decrease(r= -0.30,P<0.001).Conclusion：With the prevalence of dissonant stresses among suicide victims,it is suggested that crisis intervention and suicide prevention should begin with strain reduction through psychological counseling and therapy.

Objective To observe the efficacy of methylprednisolone stosstherapy of the IgA nephropathy complicated with partial crescenties formation and effects of this therapy on the urine protein output and renal function.Methods 93 patients of IgA nephropathy complicated with partial crescenties formation were identified by renal biopsy and diagnosed according to the WHO diagnostic criteria in 1982 formulation.The patients were randomly divided into two groups:the control and the treating groups.The control group was treated with oral prednisolone (1mg/Kg/day) plus oral cyclophosphamide(2mg?kg -1 ?d -1 ),while the treating group was administered, on the basis of the therapeutic scheme of the control group,with methylprednisolone 0 5～1 0g(20mg?Kg -1 ?d -1 ) in normal saline solution intravenously by drip,for 8 weeks,The degree of puffiness,BP and 24h urine volume were observed in both groups befoue and after the treatment. The 24h urine protein quantitative determination,urine RBC count(uRBC),urine creatinine,blood creatinine(Cr),blood urea nitrogen(BUN),serum albumin (ALB) and the endogenous creatinine clearance rate (Ccr) were also tested.The side effects in two groups were observed at the same time.Results The urine protein output amounts, urine RBC count,blood Cr and BUN were significantly decreased (P