Objective To investigate the expression changes of victims suffering from sudden cardiac death(SCD), eurological calcium adhesion proteins (N-Cadherin) and Bax and explore their significance in forensic medicine. Methods Separately select 33 samples of myocardial tissue suffering from sudden cardiac death and 29 samples of myocardial tissue from the cases which were diagnosed not dying of heart disease as SCD and controls. Histological methods were used to examine the morphologic changes in myocardial tissue, examining the expression changes of N-Cadherin and Bax and analyzing them in a statistic way. Results N-Cadherin was weakly positively expressed in myocardial tissue of group SCD and the cells shew disordered arrangement, which is obviously lower than the controls. The cells exhibited obvious features ordered arrangement in control group. The positive expression of Bax was detected in myocardial tissue of group SCD, which is obviously higher than the controls. Conclusion The expression changes observation of N-Cadherin and Bax will make a difference to the sudden cardiac death.

Objective To determine the purity of sodium nitrite(NaNO2) using in stray light standard substance which was applied to check semiautomatic clinical chemistry analyzer.Methods Titration was used to determine the purity of NaNO2,the uncertainty of the purity was assessed,and a parallel test was used to validate the uncertainty.Results The purity of NaNO2 was 99.81%,and its uncertainty was 0.86%.Conclusion The uncertainty of the purity passes the validation,it shows that the purity test is credible,and its uncertainty assessment is logical.

Objective: To investigate influence of isometric exercise (IE) training on number of endothelial progenitor cells (EPCs) and level of vascular endothelial growth factor (VEGF) of circulating blood in patients with coronary chronic total occlusion (CTO). Methods: A total of 20 CTO patients were divided into training group (n=10) and control group (n=10). Both groups received routine medication for three months, training group also received three-month IE training (maximal handgrip was used to induce maximum IE of upper limb muscles, leading to temporary physiological ischemia of skeletal muscle),while control group remained sedentary without exercise training. Flow cytometry was used to measure number of blood EPCs, and enzyme linked immunosorbent assay (ELISA) was used to measure serum concentration of VEGF. Results: Before treatment, the differences of levels of blood EPCs and VEGF between two groups were no significant（P>0.05）. Compared with before treatment, there were significant increase in blood number of EPCs [(0.028±0.009)% vs. (0.044±0.016)%] and VEGF concentration [(65.3±15.1) pg/ml vs. (98.5±17.4)pg/ml] after three-month treatment in training group (P=0.015, P<0.01), and they were significantly higher than those of control group after treatment. Compared with before treatment, there were no significant difference in blood number of EPCs and concentration of VEGF after treatment in control group, P>0.05. The blood numbers of EPCs were positively correlated with VEGF concentration in training group and control group (r=0.727, r=0.785, P<0.05 both). Conclusions: Isometric exercise training can increase blood number of EPCs and VEGF concentration in coronary CTO patients, which may contribute to collateral angiogenesis in remote ischemic myocardium.

Objective:To analyze the influencing factors of anesthesia recovery time after gastric cancer surgery in patients with type 2 diabetes mellitus (T2DM), and establish a nomogram model.Methods:The clinical data of 120 T2DM patients underwent open surgery for gastric cancer from February 2020 to January 2021 in Handan Central Hospital were retrospectively analyzed. Among them, 50 patients had an anesthesia recovery time>30 min (observation group), and 70 patients had an anesthesia recovery time≤30 min (control group). Multivariate Logistic regression was used to analyze the independent risk factors of anesthesia recovery time after gastric cancer surgery in patients with T2DM. Receiver operating characteristic (ROC) curve was drawn to analyze the optimal cut-off value of each influencing factor for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM. A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM was established with R language software 4.0 "rms" package.Results:The proportion of men, age, decrease amplitude of postoperative temperature, operation time intraoperative blood transfusion rate in observation group were significantly higher than those in control group: 84.00% (42/50) vs. 20.00% (14/70), (60.31 ± 14.23) years vs. (47.58 ± 8.96) years, (0.33 ± 0.09) ℃ vs. (0.28 ± 0.08) ℃, (92.32 ± 8.58) min vs. (84.54 ± 6.24) min and 38.00% (19/50) vs. 10.00% (7/70), the body mass index (BMI), heart rate and operating room temperature were significantly lower than those in control group: (20.11 ± 3.96) kg/m 2 vs. (24.69 ± 4.58) kg/m 2, (103.73 ± 9.57) beats/min vs. (118.32 ± 18.15) beats/min and (28.66 ± 1.58) ℃ vs. (30.25 ± 1.98) ℃, and there were statistical differences ( P<0.01); there were no statistical differences in smoking, drinking, hypertension, hyperlipidemia, coronary heart disease, anesthetic drug types, anesthesiologist job title, muscle relaxant drug types and body temperature between 2 groups ( P>0.05). ROC curve analysis results showed that the optimal cut-off values of age, BMI, heart rate, decrease amplitude of postoperative temperature, operating room temperature and operation time for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM were 46 years old, 21.8 kg/m 2, 113 beats/min, 0.3 ℃, 30.6 ℃ and 91 min, respectively. Multivariate Logistic regression analysis results showed that gender (male), age (>46 years old), BMI (≤21.8 kg/m 2), decrease amplitude of postoperative temperature (>0.3 ℃), operating room temperature (≤30.6 ℃) and operation time (>91 min) were independent risk factors for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM ( OR = 1.909, 1.815, 1.606, 1.458, 1.521 and 1.539; 95% CI 1.215 to 3.000, 1.014 to 3.249, 1.252 to 1.941, 1.251 to 1.628, 1.068 to 2.167 and 1.119 to 1.828; P<0.01 or<0.05). When gender, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time were included as predictors for constructing the nomogram model, the internal validation results showed that the c-index of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was 0.701 (95% CI 0.672 to 0.724); calibration curve showed good agreement between observed value and predicted value; the threshold value of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was>0.20, and the nomogram model provided a net clinical benefit; the clinical net benefit of the nomogram model was greater than that of sex, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time. Conclusions:A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM is constructed based on gender, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time, and this model is significant for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM.

Objective To observe the effect of different doses of mivacurium chloride on muscle relaxation time-course and hemodynamics in children with different ages. Methods One hundred children of selective inguinal hernia repair under general anesthesia with endotracheal intubation from January 2016 to January 2017 were enrolled, and the age was 0.5 to 6.0 years. The children were divided into low age group (0.5 to 3.0 years) and high age group (3.1 to 6.0 years) according to the age, then the children were divided into low dose group (mivacurium chloride 0.20 mg/kg) and high dose group (mivacurium chloride 0.25 mg/kg) according to the doses of mivacurium chloride. Therefore, the children were divided into low age low dose group, low age high dose group, high age low dose group and high age high dose group with 25 cases each. The mean arterial pressure (MAP) and heart rates before anesthesia (T0) and 1 min (T1), 3 min (T2), 5 min (T3), 10 min (T4) after intravenous injection of mivacurium chloride were recorded. The times of first intravenous injection of mivacurium chloride to neuromuscular block 75% (ThD75), 90% (ThD90) and maximum (ThDmax) were recorded. The recovery index (RI) was recorded. The times of last intravenous injection of mivacurium chloride to onset of muscle convulsions (Th) and muscle convulsions recovery 10% (ThR10), 25% (ThR25), 75% (ThR75), 90% (ThR90) were recorded. The times of ratio of the fourth muscle twitch to the first muscle twitch (TOFR) recovery 75% (TOFR75) and 90% (TOFR90) were recorded. Results There were no statistical difference in MAP and heart rate among 4 groups (P＞0.05). The ThD75, ThD90 and ThDmax in low age low dose group were (126 ± 40), (163 ± 59) and (192 ± 49) s, those in low age high dose group were (73 ± 15), (115 ± 41) and (142 ± 37) s, those in high age low dose group were (149 ± 38), (193 ± 44) and (221 ± 47)s, and those in high age high dose group were (105 ± 32), (138 ± 35) and (167 ± 44)s. The ThD75, ThD90 and ThDmax in low age high dose group were significantly shorter than those in low age low dose group, those in high age high dose group were significantly shorter than those in high age low dose group, those in high age low dose group were significantly longer than those in low age low dose group, those in high age high dose group were significantly longer than those in low age high dose group, and there were statistical differences (P＜0.05). There were no statistical differences in Th, ThR10, ThR25, ThD75, ThD90, RI, TOFR75 and TOFR90 among low age low dose group and low age high dose group, high age low dose group and high age high dose group (P＞0.05). Conclusions In the children of 0.5 to 3.0 years, the effect of mivacurium chloride is significantly faster than that in the children of aged 3.1 to 6.0 years. Compared with 0.20 mg/kg of mivacurium chloride, 0.25 mg/kg of mivacurium chloride has less time to display muscle relaxation effect. The recovery time is not affected by age and induction dose. Mivacurium chloride has no significant effect on hemodynamics.

Objective:To explore the effects of phased goal directed fluid therapy (GDFT) during anesthesia surgery on tissue perfusion and cognitive function in patients undergoing radical lung cancer surgery.Methods:A total of 108 lung cancer patients were prospectively selected and randomly divided into a control group and a study group using a random number table method. The control group received classical restrictive liquid therapy, while the study group received staged GDFT. We compared the surgical time, intraoperative blood loss, colloid fluid dosage, crystalloid fluid dosage, total output, and urine volume between two groups of patients; Two groups of patients were compared in terms of oxygenation index (OI), respiratory index (RI), central venous oxygen saturation (ScvO 2), lactate (Lac), central venous arterial carbon dioxide partial pressure difference (Pcv-aCO 2), oxygen supply index (DO 2I), and oxygen uptake rate (O 2ERe) before anesthesia induction (T 0), before single lung ventilation (T 1), 1 hour of single lung ventilation (T 2), immediate resumption of dual lung ventilation (T 3), 30 minutes of dual lung ventilation (T 4), and after surgery (T 5); The Mini Mental State Examination (MMSE) was used to evaluate the cognitive function scores of two groups of patients 1 day before surgery and 1 and 3 days after surgery, while recording the incidence of cognitive dysfunction (POCD) and pulmonary complications (including pulmonary infection, acute lung injury, pulmonary embolism, pulmonary edema, atelectasis, etc.) within 3 days after surgery. Results:The amount of crystal fluid and urine output in the research group was significantly lower than that in the control group, while the amount of colloidal fluid was significantly higher than that in the control group (all P<0.05). The OI of the study group T 1-T 5 was significantly higher than that of the control group, while the RI of T 2-T 5 was significantly lower than that of the control group (all P<0.05). The ScvO 2 of the study group T 1 to T 5 was significantly higher than that of the control group, and the Lac was significantly lower than that of the control group (all P<0.05); The MMSE scores of both groups of patients were significantly lower than those before surgery on day 1 and 3 after surgery, and the MMSE scores of the study group were significantly higher than those of the control group on day 1 and 3 after surgery (all P<0.05). The incidence of POCD within 3 days after surgery in the study group was 16.67%(9/54), lower than 37.04%(20/54) in the control group (χ 2=5.704, P=0.017); The incidence of pulmonary complications in the study group was lower than that in the control group (5.56% vs 22.22%, χ 2=4.955, P=0.026). Conclusions:The application of staged GDFT during anesthesia in patients undergoing radical lung cancer surgery can further improve tissue perfusion, improve microcirculation and oxygen supply-demand balance of systemic organs and tissues, including the brain, alleviate perioperative brain function damage, and reduce the occurrence of postoperative POCD compared to conventional liquid therapy.