Objective To compare the effects of phenylephrine and norepinephrine in patients with restrictive transfusion.Methods 65 patients undergoing laparoscopic resection of rectal cancer were selected.According to the random number table method,the patients were randomly divided into 32 cases of observation group (phenylephrine composite restriction infusion) and 33 cases of control group(norepinephrine combined restrictive transfusion).The operation and hemodynamics of the two groups at different time points were compared.At T0,T1,T2,the central venous blood and arterial blood were collected,the central venous blood saturation (ScvO2),arterial blood lactate (Lac),central venous oxygen partial pressure (PcvO2),PaO2,Hb concentrations,venous oxygen content (CcvO2),arterial oxygen content(CaO2),arteriovenous oxygen content difference (Ca-cvO2) and oxygen uptake rate (ERO2) were compared between the two groups.Results The ASA levels (Ⅰ / Ⅱ grade) of the observation group and the control group were 11 cases/21 cases and 13 cases/20 cases,respectively,the difference was not statistically significant(x2 =5.298,P =0.052).The BMI of the observation group and the control group were (20.61 ± 1.65) kg/m2,(21.57 ± 1.42) kg/m2,respectively,the difference was not statistically significant (t =0.652,P =1.980).The fluid replacement of the observation group and the control group were (1 162 ± 113) mL,(1171 ± 104) mL,respectively,the difference was not statistically significant (t =1.734,P =0.065).The blood loss of the observation group and the control group were (276 ± 41) mL,(294 ± 42) mL,respectively,the difference was not statistically significant (t =0.083,P =1.023).The urine volume of the observation group and the control group were (524 ± 113) mL,(532 ± 109) mL,respectively,the difference was not statistically significant(t =1.834,P =0.053).The operation time of the observation group and the control group were (192 ± 24) min,(197 ± 21) min,respectively,the difference was not statistically significant(t =1.367,P =0.073).The MAP at T1-T2 of the two groups increased,the CVP of the two groups was significantly higher at T1,the HR of the two groups was significantly higher at T2.The MAP,CVP,HR between the two groups had no significant differences (all P ＞ 0.05).The levels of ScvO2,PcvO2 and PaO2 at T1 were significantly higher than those at T0,on the contrary,the levels of ScvO2,PcvO2 and PaO2 at T2 were significantly lower than those at T0,and the Hb in the observation group was significantly lower at T1-T2,the Hb in the control group was significantly lower at T,-T2,which in the observation group was lower than the control group,the differences were statistically significant(all P ＜ 0.05).There was no statistically significant difference in Lac between the two groups (P ＞ 0.05).There were statistically significant differences in CcvO2,CaO2,Ca-cvO2 and ERO2 between the two groups at different time points (all P ＜ 0.05).Conclusion Phenylephrine is more effective than norepinephrine in limiting infusion in elderly patients,and it has more obvious effects on tissue oxygen metabolism.

Objective To study the clinical and genetic features of familial paroxysmal kinesigenic dyskinesia (PKD). Methods The clinical information of 14 family members in one pedigree, including 2 patients (one treated in hos?pital, the other not treated) were analyzed and the response to treatment and prediction were followed up. DNA was ex?tracted from peripheral blood samples, and then screened for PRRT2 mutations. Results There were two male patients in the pure PKD pedigree, Prevalence rate was 14.3%,One of the PKD patients showed good response to carbamazepine as well as lamotrigine whereas other patients recovered without treatment. We detected a nonsense mutation c.797G>A (p.266R>Q) in PRRT2 gene in three family members. One affected member harboring PRRT2 mutation resulted from the incomplete penetrance of the disease,PKD and polycystic kidney disease coexist in the pedigree which showed autoso?mal dominant inheritance with incomplete penetrance and anticipation. Conclusions The curative effect of antiepileptic drugs to purely familial PKD is related to mutations and clinical features;Treatments should be decided based upon clini?cal features and mutations.

Objective To test the effect of bone marrow mesenehymal stem cells (MSCs) transplantation on oxidative stress and the development of pulmonary emphysema in rats. Methods SD rats (n=26) were randomly divided into three groups:normal control group (group A, n=8),emphysema group (group B, n=8) and emphysema+MSCs transplantation group (group C, n=10).Rat models of emphysema was established by exposing rats to cigarette smoking for 14 weeks. Then rats of group C received MSCs transplantation. At the 14th and 28th days after 4 course of MSCs transplantations, one rat in group C was sacrificed at each time point and their lungs were preserved in frozen sections. Survival of MSCs in the lung tissues were observed by fluorescence microscopy. Eight weeks after transplantations, lung sections were stained by hematoxylin and eo?sin (HE) to observe the morphological alterations.Mean linear intercept (MLI) and mean alveolar numbers (MAN) were also measured. Serum and lung malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity were also examined. Re?sults At the 14th day and 28th day after transplantations of MSCs, MSCs successfully localized to lung and survived in rat models of emphysema. Emphysematous changes of lung tissues were observed in both group B and group C. MLI was higher while MAN was lower in group B and C than those in group A (P<0.05). MLI and MDA levels in serum and lung were high?er while MAN level and SOD activity were lower in group B than those in group C (P<0.05).MDA levels in serum and lung was higher while SOD activity was lower in group B and C than those in group A (P<0.05). Conclusion MSCs transplanta?tions can effectively alleviates pulmonary emphysema in rat models which might through reducing oxidative stress .

Objective To investigate the effects on the condition of nutrition and immunologic function of gastric cancer treated with the insertion of jejunal nutrient canal after total gastrectomy.Methods In this study 113 gastric cancer patients were randomly divided into enteral nutrition group (the group of the fine-needle/catheter jejunostomy during operation,FCJ group) and parenteral nutrition group (PN group) after total gastrectomy.Evacuating time and postoperative complications were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on days 3 and 7 postoperatively.Results The evacuating time in enteral nutrition group was shorter than that in parenteral nutrition group significantly[(4.1±2.2) d vs.(5.1 ±2.0) d,t =2.156,P =0.037];Serum level of prealbumin[( 18 ± 7 ) mg/dl vs.( 14 ± 7 ) mg/dl,t =2.370,P =0.022]and transferring[(205 ±45 ) mg/dl vs.( 186 ± 39 ) mg/dl,t =3.665,P =0.001]in enteral nutrition group on postoperative day 7 was higher than that in parenteral nutrition group;Serum IgA[( 2.3 ± 1.0 ) g/L vs.( 1.9 + 0.7 ) g/L,t =2.178,P=0.034],lgM[(1.4 ±0.4) g/L vs.(1.0 ±0.4) g/L,t=2.124,P=0.039]and IgG[(9.5 ±1.9) g/L vs.(9.0 ± 2.3 ) g/L,t =2.189,P =0.033]were higher in enteral nutrition group than that in parenteral nutrition group;The incidence of postoperative alimentary dysfunction in enteral nutrition group was lower than that in parenteral nutrition group( 3％ vs.13％,x2 =3.962,P =0.048).Conclusions It is safe and convenient to use early postoperative enteral nutrition support by fine-needle/catheter jejunostomy (FCJ) in gastric cancer patients immediately after total gastrectomy.

Objective:To investigate the value of fibroblast growth factor 2 (FGF-2) and microRNA-206 (miR-206) in predicting postoperative delayed union of closed tibial shaft fractures.Methods:The clinical data of 136 patients who underwent closed tibial shaft fracture surgery in Hospital of the 80 th Group Army of Chinese People's Liberation Army Ground Forces from May 2018 to May 2021 were retrospectively analyzed. Eighty-six patients who had delayed union of closed tibial shaft fractures were included in the observation group, and fifty patients who had normal union of closed tibial shaft fractures were included in the control group. Serum FGF-2 level was measured using the enzyme-linked immunosorbent assay, and serum miR-206 expression was detected using the real-time fluorescence polymerase chain reaction. The relationship between FGF-2 expression and miR-206 expression and closed tibial shaft fractures was analyzed. Results:At 1 day, 1, and 4 weeks after surgery, serum FGF-2 level was significantly lower in the observation group than the control group [(14.24 ± 2.15) ng/L vs. (20.36 ± 3.42) ng/L, (21.38 ± 3.27) ng/L vs. (30.45 ± 4.29) ng/L, (23.59 ± 4.36) ng/L vs. (36.67 ± 4.51) ng/L, t = 7.42, 8.42, 16.66, all P < 0.001]. Serum FGF-2 level gradually increased with time in each group. At 1 day after surgery, serum miR-206 expression was significantly lower in the observation group than the control group ( t = 7.50, P < 0.001). At 4 weeks after surgery, serum miR-206 expression was significantly higher in the observation group than the control group ( t = 17.24, P < 0.001). At 1 week after surgery, there was no significant difference in serum miR-206 expression between the two groups ( P > 0.05). Univariate analysis results showed that postoperative infection, FGF-2, and miR-206 were closely related to the delayed union of closed tibial shaft fractures after surgery (all P < 0.05). Multivariate logistic regression analysis results showed that postoperative infection ( OR = 1.93, 95% CI: 1.20-3.07), FGF-2 ( OR = 2.10, 95% CI: 1.31-3.36), miR-206 ( OR = 2.30, 95% CI: 1.35-3.89) were independent risk factors for delayed union of closed tibial shaft fractures after surgery (all P < 0.05). The receiver operating characteristic (ROC) curves plotting serum FGF-2 level and serum miR-206 expression after closed tibial shaft fractures showed that at 4 weeks after surgery, the optimal cut-off value of FGF-2 for predicting delayed union of closed tibial shaft fractures was 29.83 ng/L, with the area under the curve, sensitivity, and specificity of 0.76 (95% CI: 1.23-3.25), 79.34%, and 68.82%, respectively; at 4 weeks after surgery, the optimal cut-off value of miR-206 for predicting delayed union of closed tibial shaft fractures was 0.63, with the area under the curve, sensitivity and specificity of 0.72 (95% CI: 1.10-2.45), 75.33%, and 67.25%, respectively. The area under the curve, the sensitivity, and specificity of combined use of FGF-2 and miR-206 in predicting delayed union of closed tibial shaft fractures were 0.81 (95% CI: 1.35-3.26), sensitivity and specificity were 83.45% and 67.36% respectively. Conclusion:The decrease in serum FGF-2 level and the increase in serum miR-206 expression at 4 weeks after surgery are independent risk factors for delayed union of closed tibial shaft fractures. Combined use of FGF-2 and miR-206 can better predict the delayed union of closed tibial shaft fractures.

Objective To evaluate the efficacy of patient-controlled brachial plexus block with different concentrations of dexmedetomidine mixed with ropivacaine for analgesia after elbow joint surgery.Methods One hundred patients of both sexes,aged 18-64 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elbow joint surgedyy,were divided into 4 groups (n =25 each) using a random number table method:different concentrations of dexmedetomidine mixed with ropivacaine groups (DR1-3 groups) and ropivacaine group (group R).An analgesia pump was connected at the end of surgery and patient-controlled brachial plexus block was performed.The patient-controlled analgesia (PCA) solution contained 0.5 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR1,0.75 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR2,1 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR3 and 0.3％ ropivacaine in group R.All the drugs were diluted to 400 ml in normal saline in each group.The PCA pump was set up to deliver 3 ml bolus dose with a 20-min lockout interval and background infusion at 5 ml/h.Parecoxib 0.6 mg/kg was intravenously injected as a rescue analgesic.The visual analogue scale (VAS) scores at rest and during movement (voluntary and continuous passive movement) were recorded at the end of surgery and 12,24,36,48 and 72 h after surgery.The number of successfully delivered doses,the number of attempt and postoperative consumption of parecoxib were recorded.The elbow flexion angle during voluntary and continuous passive movement was recorded.The development of motor block and drug-related adverse reactions was also recorded.Results There was no significant difference in VAS scores at rest at each time point among the four groups (P＞0.05).Compared with group R,the VAS scores during movement,the number of attempts,the number of successfully delivered doses and parecoxib consumption were significantly increased in DR1 and DR2 groups,the elbow flexion angle during voluntary and continuous passive mnovement was significantly decreased in group DR1,the elbow flexion angle during continuous passive movement was significantly decreased in group DR2,and the elbow flexion angle during voluntary movement was significantly increased (P＜0.05),and no significant change was found in the other parameters in group DR3 (P＞0.05).Compared with group DR1,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in DR2 and DR3 groups (P＜0.05).Compared with group DR2,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in group DR3 (P＜0.05).No motor block was found in DR1,DR2,and DR3 groups,and the incidence of motor block was significantly higher in group R than in the other three groups (P＜0.05).The hemodynamics was stable and no drug-related adverse reactions were found in the perioperative period in the four groups.Conclusion Patient-controlled brachial plexus block with dexmedetomidine 1 μg/ml mixed with 0.2％ ropivacaine can provide satisfactory analgesia and is helpful in improving prognosis for the patients undergoing elbow joint surgery.