Objective Intranasal drops of dexmedetomidine can induce conscious sedation in children .This study was to com-pare the sedative effects of different doses of intranasal dexmedetomidine in different age groups of children patients . Methods We e-qually randomized 90 hernia children waiting for elective unilateral inguinal surgery ( ASAⅠ-Ⅱ) to groupsⅠ,ⅡandⅢ.At 35 minutes be-fore surgery, we obtained the heart rate (HR), mean artery pressure (MAP) of all the patients.The children in groupsⅠandⅡreceived nasal instillation of dexmedetomidine at 1 and 2μg/kg respectively, while those in groupⅢ0.4 mL of normal saline, followed by sevoflu-rane induction, intravenous injection of sufentanil (0.2μg/kg), and laryngeal mask airway anesthesia with sevoflurane .We recorded HR, MAP before medication, at 10 min, 20 min and 30 min before mediation, right after surgery, and at the recovery to consciousness . We also recorded the sedation onset time and post-surgery recovery time and assessed sedation satisfaction using the Ramsay score . Results The rates of satisfactory preoperative sedation were 50 and 63% in groupsⅠandⅡ, significantly higher than 10%in groupⅢ(P<0.05). In the 1-4-year group, the sedation satisfaction rate , sedation onset
time and post-surgery recovery time showed no significant differences between groupsⅠandⅡ(P>0.05).In the 5-8-year group, seda-tion satisfaction rate was markedly higher in groupⅡthan in groupsⅢ(77%vs 22%, P<0.05) andⅠ(77%vs 45%) . Conclusion At 1 and 2μg/kg, intranasal drops of dexmedetomidine produces similar rates of satisfactory sedation in children aged 1-4 years, and at 2μg/kg can achieve an even higher rate of satisfactory sedation without adverse hemodynamic effects in those aged 5-8 years.

Objective To observe the effect of application of dexmedetomidine on cerebral injury in infants after cardiopulmonary bypass.Methods 60 cases of congenital heart disease were divided into 3 groups,each group 20 infants,namely D1,D2 and N group.Group D1 dexmedetomidine 1.0μg/kg,in 0.2μg · kg-1 · h-1 intravenous infusion,until the end of operation; group D2 with dexmedetomidine 0.5 μg/kg,in 0.1 μg · kg-1 · h-1,drug concentration and injection speed was the same as the group D1.Group N intravenous normal saline in the whole operation process,infusion speed was the same as the experimental group,anesthesia and experimental group agreement.Take blood samples sent to laboratory before the operation (T1),at the end of CPB (T2),after CPB 2 h (T3),6 h (T4),24 h (T5) respectively,colleced records of perioperative data.Results There were no significant in 3 groups,for infant's age,weight,operation time,CPB time difference (P ＞0.05).In T1,there was no statistical difference between the 3 groups in S-100β protein and NSE (P ＞ 0.05).In group N,S-100β protein and NSE in T2,T3,T4,T5 were increased significantly than the level in T1 (P ＜ 0.05).In T2,compared with group D2,S-100β and NSE increased significantly in group N and D1 (P ＜ 0.01),and there were more in D2 than D1 group.Differences in heart rate,blood pressure and hemodynamics were observed in infant during perioperative period was not significant (P ＞ 0.05).Conclusion Dexmedetomidine can reduce the ascensional range of S-100β and NSE in infant after cardiopulmonary bypass,and relieve the cerebral injury.

The metastases status of internal mammary lymph node(IMLN) is an independent prognostic factor for breast cancer and it also is an important reference for neoplasm staging.The patients with IMLN metastases consistently have worse outcomes.The overall risk of IMLN metastases is 18 ％-33 ％.Metastases exclusively situated in the IMLN,without concurrent axillary metastases,occur in 2 ％-11％ of patients.Factors related to IMLN metastases include the status of axillary node,the age of patients,the localization and characteristics of primary tumor.Recently,with the development of sentinel lymph node biopsy(SLNB), internal mammary-SLNB may access the status of IMLN with a minimal risk. Internal mammary-SLNB procedure can improve the system for nodal staging of breast cancer,and it will contribute to the individualized treatment for breast cancer patients.

Objective To compare the effect and safety of propofol with intranasal dexmedetomidine in analgesic enteroscopy for children.Methods Ninety children undergoing analgesic enteroscopy were ran-domly assigned to 3 groups.Intranasal dexmedetomidine followed by propofol was administered in the observ-ing group;sufentanil and followed by propofol was intravenously given to the control group A;propofol was given to the control group B.The scale of anesthetic effect,HR,RR,MAP and SpO2 30 min after intranasal administration were monitored.The intranasal sedation satisfaction rate,the dose of propofol,wake-up time, hospitalization,hemodynamics,adverse reaction and complication after anesthesia were recorded.Results Intranasal sedation satisfaction rate of the observing group was 83.3%(25 /30).The anesthetic effect in ob-serving group(excellent/good /bad:24 /6 /0)showed no significant difference from that in the control group A (excellent/good /bad:25 /5 /0),but better than that in the control group B(excellent/good /bad:12 /14 /4) (P <0.05).The amount of propofol in the observing group(96.2 ±5.3)mg showed no significant difference from that of group A(93.7 ±4.6)mg,but less than group B[(121.1 ±4.9)mg,P <0.05].The time of re-covery of infants in the control group A[(14.2 ±5.5)min]and the control group B[(13.7 ±3.9)min] were longer than that in observing group[(7.9 ±4.1)min,P <0.05].The hospitalization time of observing group[(14.3 ±5.4)min]was shorter than those of group A[(27.5 ±3.7)min,P <0.05]and group B [(26.3 ±6.6)min,P <0.05].The incidences of breath suppression,glossoptosis,nausea and dizziness were the lowest in the observing group,compared with the two others (all P <0.05).Conclusion In-tranasal dexmedetomidine combined with propofol,increasing children compliance,decreasing the adverse reaction,is satisfactory and safe for children anesthesia.

BACKGROUND:Due to special physiological and anatomical location, stability of the spine is very complicated during thoracolumbar fractures. It is difficult to identify the stability of the spine. It should be based on their individual circumstances, to explore more effective internal fixation repair method.
OBJECTIVE:To explore the Cobb’s angle and vertebral height of patients with thoracolumbar fracture and spinal cord compression treated with posterior laminectomy and screw fixation, and compared with anterior laminectomy.
METHODS:One hundred patients with thoracolumbar fracture and spinal cord compression, who were treated in the Panyu District Central Hospital from January 2013 to November 2014, were enroled in this study. The patients were equaly and randomly divided into posterior laminectomy fixation group and anterior laminectomy fixation group. Tactile and sports of American Spinal Injury Association scores, Cobb’s angle and vertebral height were assessed before treatment and 1 month after treatment, and fixation effects were compared between the twogroups.
RESULTS AND CONCLUSION:(1) No significant difference in each index was detected between the two groups preoperatively (P> 0.05). (2) Tactile and sports of American Spinal Injury Association scores, Cobb’s angle and vertebral height were better in the posterior laminectomy fixation group than in the anterior laminectomy fixation group at 1 month postoperatively (P< 0.05). (3) These findings indicated that compared with the anterior laminectomy fixation, posterior laminectomy fixation for thoracolumbar fracture combined with spinal cord compression obtained better outcomes, and could obviously relieve spinal cord compression. Posterior laminectomy fixation isasafe and effective treatment method for thoracolumbar fracture and spinal cord compression.

One hundred and fifty ASA Ⅰ-Ⅱ infants scheduled to undergo surgery on unilateral inguinal region,were randomly assigned to 3 groups with 50 in each group.In groups Ⅰ and Ⅱ puncture was performed at traversus abdominis plane under ultrasound-guidance,0.4 or 0.5/kg of 0.25％ ropivacaine was injected respectively.In group Ⅲ the triangle of Petit was positioned through palpating and then 0.5 ml/kg of 0.25％ ropivacaine was injected.HR,RR,SpO2,PETCO2,expired sevoflurane concentration and BIS value at the time of entering the operation room (T1),incision of skin (T2),pulling hernia sac (T3),ending the surgery (T4),waking (T5),the number of pressing the analgesia pump after operation were recorded.The results showed that HR at T2 and T3 of groups Ⅰ and Ⅱ was lower than group Ⅲ (P ＜ 0.05).The were significant differences in case numbers of insufficient intraoperative analgesia among 3 groups(x2 =10.500,P =0.005).The CHEOPS scores and the number of pressing analgesia pump after operation in groups Ⅰ and Ⅱ were lower than those in group Ⅲ (x2 =7.230,P =0.027).Results indicate that ultrasound-guided transversus abdominis plane block is safer and more effective than conventional method for operations of inguinal region in infants; it may reduce dose of local anesthetics and postoperative use of analgesics.

Low back pain is an important cause of disability worldwide. It has a high incidence rate and brings a huge burden to families and society. Intervertebral disc degeneration (IDD) is one of the leading factors causing low back pain and the pathological basis of degenerative disc diseases, such as intervertebral disc herniation and spinal stenosis. However, the etiology of IDD is complex, and the risk factors and specific mechanisms behind remain unclear. Some controversial views have also been observed. Surgery is often considered for patients with severe intervertebral disc diseases, but there is no effective treatment for IDD at the early and middle stages. It will be of great significance to in-depth explore the molecular biological mechanisms and related risk factors, which can bring benefits to the prevention, accurate diagnosis, early treatment, and rehabilitation of degenerative disc diseases. Refer to the literatures published in the past ten years, this paper describes the latest research progress on risk factors related to IDD in terms of aging, genetics, mechanical loading, low-grade infection, biological rhythms, smoking, metabolic disease, estrogen, and nutrition. The results show that IDD is affected by multiple risk factors. These factors can interact with each other, and lead to death, phenotypic transformation, and metabolic disorder of disc cells, leading to a reduction of extracellular matrix and an unbalanced microenvironment and eventually loss of structural integrity of intervertebral disc tissue and IDD. A good body clock, a controlled weight, an appropriate blood glucose level, adequate nutrition, no smoking, a good hormone level, moderate exercise, avoiding injury, and strict aseptic techniques in the clinic will bring benefits to the progress of IDD.

Objective To explore the effect of thyroxine (TH) on the migration of hippocampal neurons in newborn rat exposed to tritiated water (HTO).Methods The hippocampal neurons from neonatal rats were primarily cultured,7 days later,randomly divided into control group,HTO group,TH group and HTO + TH group(3.7 × 105 Bq/ml HTO and 0.3 μg/ml TH were simultaneously added).After 24 h,the distance of neuronal migration was measured with Leica AF 6000,the expressions of BDNF and Reelin mRNA in neurons were analyzed with reverse transcription polymerase chain reaction (RT-PCR),the expression of β-tubulin protein in neurons was assayed with Western blot and immunocytochemical staining.Results Compared with control group,the expression of Reelin mRNA,BDNF mRNA and β-tubulin in HTO group were significantly reduced(t =5.80,5.48,5.47,P ＜ 0.01),but those in HTO + TH group and TH group were obviously increased (t =7.75,12.06,13.65,P ＜ 0.01 ;t =4.34,5.47,5.65,P ＜0.01)and higher than that in HTO group (t =2.92,10.32,8.76,P ＜ 0.01 ;t =18.07,20.55,40.13,P ＜0.01).Accordingly,the neuronal migration distance in HTO group was much shorter than that in control (t =8.62,P ＜ 0.01),and in HTO + TH group and TH group was far longer than that in control(t =7.64,4.93,P＜0.01).Moreover,the neuronal migration distance in HTO + TH group was notably elongated in comparison with that in HTO group(t =11.32,12.31,P ＜ 0.01).Conclusions Thyroxine may promote the migration of hippocampal neurons in newborn rat exposed to HTO.

Objective To prospectively investigate the optimal setting for sentinel lymph node biopsy (SLNB) in patients with breast cancer by comparing the effects of different preparation methods and injection sites of 99Tcm-SC in sentinel lymph node (SLN) mapping and detection.Methods Two batches of 99Tcm-SC were prepared by boiling for 3 min (radiotracer 1) and 5 min (radiotracer 2),respectively.Radioactive chemical purity (RCP) and size of colloid particles were measured at 10 min,1 h,2 h and 4 h after the preparation.One hundred and forty-seven patients with breast cancer were involved and randomly divided into 3 groups.Group A consisted of 40 patients with periareolar injection of radiotracer 1,group B of 40 patients with periareolar injection of radiotracer 2,and group C of 67 patients with peritumoral injection of radiotracer 2.Lymphatic mapping was performed for all patients using SPECT/CT preoperatively and blue dye was subdermally injected over the tumor.The detection rate of the axillary and internal mammary SLN was recorded.One-way analysis of variance,independent two-sample t and x2 tests were used to analyze the data.Results There was no significant difference of RCP between the two radiotracers at 10 min,1 h,2 h and 4 h after preparation (t =-0.267,-0.794,0.826 and-0.977,all P＞0.05).Compared with radiotracer 1,the percentage of particles smaller than 100 nm in radiotracer 2 reduced significantly ((73.72±2.36) ％ vs (65.25±3.56)％,t=6.436,P＜0.05) and the mean effective particle size was significantly larger ((45.27±6.42) nm vs (75.59t7.04) nm,t=7.315,P＜0.05).In groups A,B and C,the detection rate of the internal mammary SLN was 70.0％ (28/40),47.5％ (19/40) and 17.9％ (12/67),respectively,with significant difference (x2=29.525,P＜0.05).In groups A,B and C,the detection rate of the axillary SLN was 100％ (40/40),95.0％ (38/40) and 97.0％ (65/67),respectively,without significant difference (x2 =2.686,P＞ 0.05).Conclusion For SLNB of patients with breast cancer,the axillary and internal mammary SLN could be better detected by SPECT/CT lymphatic mapping using radiotracer prepared with a shorter boiling time,via periareolar injection,and combined with subdermal injection of blue dye.

Background and purpose: When patients have positive sentinel lymph node (SLN), axillary lymph node dissection (ALND) is usually performed, but most of them have no metastasis in the non-sentinel lymph node (nSLN). It is of great significance to predict metastasis of nSLN precisely. The aim of the study was to establish a nomogram for the intraoperative prediction of nSLN metastasis in breast cancer patients using one-step nucleic acid amplification (OSNA) techniques and to direct the subsequent therapy for breast cancer effectively. Methods: Of 552 breast cancer patients who underwent SLN biopsy in the 2010 OSNA clinical trial, 103 with SLN metastasis treated with ALND were assessed to establish a nomogram for intraoperative prediction of nSLN based on the molecular diagnosis. A validation cohort of 61 patients who met the similar criteria in the 2015 OSNA clinical trial subsequently validated it. Results: Primary tumor size, total tumor load, the number of positive SLNs and negative SLNs were associated with the presence of nSLN metastasis based on the multivariable logistic regression results, and a nomogram was established with these variables. Its area under the ROC curve was 0.814 for the predictive model and it was 0.842 in the re-validation cohort. The tumor size assessed by the postoperative histological examination was replaced by the size evaluated by the imaging examination, and the area under the ROC curve was 0.838. There was no statistically significant difference in the accuracy compared with the former validation data (P=0.7406). Conclusion: The predictive nomogram based on the molecular diagnosis can predict the nSLN metastases intra/post-operatively. It appears to be obviously superior to other predictive models and may help to guide the axillary management and to make decisions about radiation target region.