Objective To discuss the influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery.Methods A total of 96 patients with gynecologic laparoscopic surgery were selected from January 2012 to October 2013.All patients were in propofol target controlled infusion anesthesia induction downward internal jugular vein retrograde through jugular vein ball tube,radial artery catheter.According to propofol target controlled infusion target concentrations,96 patients were divided into A group (32 cases,3 μ g/ml),B group (33 cases,5 μμg/ml) and C group (31 cases,7 μg/ml).Hemodynamic and Nacotrend index (NI) change were monitored in the process of surgery patients,with internal jugular vein and radial artery blood at pre-induction (To),intubation (T1),30 min after intubation (T2) and the end of the operation (T3) were detected and arterial blood oxygen saturation (PaO2),arterial oxygen content (CaO2),internal jugular vein ball blood oxygen saturation (SjvO2),internal jugular vein ball blood oxygen partial pressure (PjvO2) at different time points were compared among three groups.Artery-internal jugular vein ball low blood oxygen of components (Da-jvO2),brain oxygen uptake rate (CEO2),poor lactic acid content (Da-jvL) were calculated.Results The systolic blood pressure,heart rate and NI at T1,T2 was lower than that at To in three groups,and there was significant difference (P ＜ 0.05),but there was significant difference in NI at T1,T2 among three groups (P ＜ 0.05).Compared with T0,PaO2,PjvO2,SjvO2 and CaO2 at T1-T3 in three groups were increased significantly (P ＜ 0.05),and the highest was C group,and then B group and A group.In the process of propofol target controlled infusion,Da-jvO2,CEO2 and Da-jvL showed a trend of gradual decline,Da-jvL decline highest significantly (P ＜ 0.05).Conclusions Propofol target controlled infusion induced endotracheal intubation can decrease the laparoscopic surgery in patients with cerebral oxygen metabolism and the brain tissue of ischemia hypoxia tolerance,but will not lead to cerebral oxygen supply and demand imbalance,and 7 μ g/ml concentration of propofol anesthesia effect is the best.

Objective To explore the impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy.Methods 90 patients with uterine fibroids with ASA class Ⅰ or Ⅱ who were going to undergoing general intravenous anesthesia laparoscopic hysterectomy were selected and they were divided into group A (dexmedetomidine 0.4μg·kg-1·h-1,n=30) and group B (dexmedetomidine 0.2μg·kg-1·h-1,n=30) and group C (no dexmedetomidine,n=30) by digital random method.The analgesia effect (VAS score) of group A,group B and group C preoperation and postoperative 1h,12h and 24h,and the sedation (Ramsay sedation score) were compared.General information,postoperative blood pressure,heart rate,pulse oxygen saturation,postoperative patients'' satisfaction on analgesic effect and the sedation effect and adverse reactions of the three groups were also compared.Results Age,body mass index and other basic information of three groups had no statistically significant differences (all P＞0.05).The preoperative VAS score of the three groups also had no statistically significant difference (F=0.625,P＞0.05).Postoperative 12h,24h,the VAS scores of group A and group B were lower than those of C group,which of group A were lower than group B (F=11.250,P＜0.05,F=21.181,P＜0.05).The Ramsay sedation score was higher than that of C group[(3.67±0.18) vs.(2.13±0.11)].The satisfaction of group A was significantly higher than group B and group C (96.67％ vs.73.33％,46.67％,χ2=25.953).The Ramsay sedation score and satisfaction were higher than those of group B (all P＜0.05).There were no significant differences in blood pressure (F=0.362,P＞0.05),pulse oxygen saturation (F=0.978,P＞0.05) and heart rate among the three groups before and after operation (F=1.268,P＞0.05).There was no obvious adverse reaction in the three groups.Conclusion Dexmedetomidine can promote anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy,and the dose 0.4μg·kg-1·h-1 of dexmedetomidine has better effect,feasibility and safety,it is worthy of clinical promotion.

Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post-operative.The fusion rate at the end of post-operative follow-up:44 excellent cases,2 good cases.Conclusion When the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position in vertebral tuberculosis was higherthan 10mm,reliable stability and treatment efficiency were achieved with anteriorinternal fixation.

Psychogenic non-epilepsy seizures (PNES) are defined as paroxysms with clinical symptoms similar to epilepsy without epileptiform discharges. It is often misdiagnosed as epilepsy. Misdiagnosis not only delays the time for patients with PNES to get correct diagnoses and treatments, but also may increase the risk of adverse effects from improper use of antiseizure medications. The diagnostic method of PNES is video electroencephalogram monitoring, but there is no consensus on the optimal duration of monitoring. At the same time, the use of diverse physiological signals, brain imaging, laboratory examination, and the application of machine learning provide new perceptions for the precise identification of PNES and epilepsy. This article reviewed the progress of precise differential diagnosis between PNES and epilepsy.

OBJECTIVETo study the identification characters of Abutilon indicum and its confused herb A. theophrasti and establish an identification method.

METHODLMVP (leaf morphological-venation pattern for identification Chinese herbs), and QAERM (quantitatively analyze and evaluate reliability for the method of identification Chinese herbs) were applied for the study.

RESULTThe main differences of the leaf of Abutilon indicum: leaf margin cilia short and not clear (75-200 microm), petiole top with long straight hairs (up to 1.0-1.2 cm), when the tertiary veins and intersecondary veins issue from the lower part of midrib, their angles of divergence usually were wide acute (65 degrees-80 degrees) and a few was about right angle (80 degrees-100 degrees). The main differences of the leaf of A. theophrasti: leaf margin cilia long and clear (200-500 microm), petiole top with short straight hairs (most 0.1-0.5 mm), when the tertiary veins and intersecondary veins issue from the lower part of midrib, their angles of divergence usually were about right angle (80 degrees-100 degrees) and a few was wide acute (65 degrees-80 degrees). With the mentioned three groups of key differences, the both plants could be successfully identified from each other. The accuracy of identification results (AC) was from 97.5% to 99.6%, the repeatability of identification results: agreement rate for observation (ARO) was 97.1% and Kappa value was 0.94.

CONCLUSIONThe established method is simple, rapid, economic and reliable.

Objective:To explore the influence of chronic rhinitis on depressive symptoms of college freshmen and the mediating effect of avoidant personality.Methods:A cluster sampling method was used to survey 8 079 college freshmen from April 2018 to October 2018 using the Beck depression inventory and the avoidant personality diagnosis questionnaire based on DSM-Ⅳ.SPSS 25.0 software was used for descriptive statistics and Spearman correlation analysis, and the macro program PROCESS version 3.3 was used for the mediating effect.Results:(1) The detection rates of chronic rhinitis, avoidant personality and depressive symptoms were 22.90% (1 850/8 079), 19.22% (1 553/8 079) and 6.28% (507/8 079). The scores for avoidant personality disorder and depressive symptoms were 1.00 (0, 3.00) and 1.00 (0, 4.00), respectively. (2) The chronic rhinitis, avoidant personality and depressive symptoms were positively correlated ( rchronic rhinitis-avoidant personality=0.094, rchronic rhinitis-depressive symptoms=0.095, ravoidant personality-depressive symptoms=0.416, all P<0.001). (3) Chronic rhinitis could positively predict depressive symptoms ( β=1.113, P<0.001). (4) Avoidant personality played a mediating role between chronic rhinitis and depressive symptoms ( β=1.094, P<0.001), and accounted for 44.92%(0.500/1.113) of the total effect. Conclusion:Chronic rhinitis directly affect the depressive symptoms of college freshmen, and indirectly affect the depressive symptoms of college freshmen through the mediating role of avoidant personality.

Ischemic stroke is one of the leading causes of death and disability worldwide. In Han dynasty， HUA Tuo proposed the original preventive medicine idea that "with good blood circulation， the disease cannot be born"， which opened a broad space for the cross-research of blood-related mechanical factors and pharmacology. In the pathogenesis of ischemic stroke， mechanical factors comprehensively affect the function and crosstalk of platelets and endothelial cells. In recent years， as the well-known effects on thrombosis and stroke， more attention has been paid to hemodynamic factors as the participants involved in pathological mechanisms and potential therapeutic targets of ischemic stroke. The mechanical force ion channel Piezo1 widely exists on the surface of many types of cells. Besides being regulated by chemical and endogenous substances， Piezo1 responds to different mechanical conditions， regulates the opening and closing of channels， and activates different downstream signaling pathways. Piezo1 is now regarded as an important connection between mechanical and biochemical signals. A variety of Chinese medicine can affect the activity of Piezo1 protein， which may prevent and treat thrombotic diseases such as ischemic stroke through Piezo1 protein. In this paper， the effects of Piezo1 protein on the physiological and pathological functions of endothelial cells and platelet under different mechanical conditions and the role of Piezo1 in the process of thrombosis were reviewed， as well as the effects of Chinese medicine， chemical medicine， and endogenous substances targeting Piezo1 channel. These could provide new ideas for further exploring the mechanisms of Chinese medicines in activating blood circulation， developing new drugs， and deepening biomechanical-pharmacology research.

ObjectiveTo investigate the mechanisms of Panax notoginseng saponins （PNS） in inhibiting high shear-induced platelet aggregation and thrombosis via the Piezo1-mediated calcium signaling pathway. MethodBioflux1000z was used for the microfluidic assay， where platelets were stimulated with physiological shear rate （500 s^-1）， pathological shear rate （12 000 s^-1）， or Piezo1 agonist Yoda1 under the physiological shear rate （500 s^-1）. The shear-induced platelet calcium influx and the binding of platelet with von Willebrand factor （vWF） were measured by flow cytometry. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the vWF release from platelets. The microfluidic channels were used to determine the vWF-mediated platelet aggregation and integrin αⅡbβ3 activation. A mouse model of arterial thrombosis induced by high shear stress combined with endothelial injury was established. The ultrasonic Doppler flow meter was used to monitor the cyclic flow reduction （CFR） caused by the repeated formation and shedding of thrombi， and flow cytometry was employed to examine platelet-vWF binding， on the basis of which the effect of PNS on high shear-induced arterial thrombosis was evaluated. ResultThe microfluidic assay showed that PNS decreased the high shear rate （12 000 s^-1） or Yoda1-induced calcium influx， platelet-vWF binding， vWF-mediated platelet-fibrinogen binding， and vWF release from platelet alpha-granules in a dose-dependent manner. In the mouse model of high shear-induced thrombosis， PNS markedly reduced the CFR and occlusion time of the common carotid artery and inhibited platelet-vWF binding. ConclusionPNS can mitigate pathological shear-induced platelet aggregation and arterial thrombosis via influencing Piezo1/GPIbα-vWF signaling.