Objective To establish the pharmacodynamic model of sevoflurane with bispectral index (BIS) as the effective index in pediatric patients.Methods Thirteen ASA physical status Ⅰ or Ⅱ pediatric patients,aged 4-9 yr,weighing 12-39 kg,undergoing non-cardiac surgery,were selected in the study.The pediatric patients sequentially inhaled 1％,5 ％ and 1％ sevoflurane via a face mask and each concentration was inhaled for 15 min.BIS value,HR,BP and SpO2 were automatically recorded every 10 s.Based on nonlinear mixed effect modeling,the population pharmacodynamic model of sevoflurane was established using NONMEM software.The effect of age on the pharmacodynamic parameters was evaluated using a stepwise forward addition then backward elimination modeling approach.The standard for model improvement was defined as a decrease in the value of the objective function by more than 3.84.Results Twelve pediatric patients,aged 4.0-8.5 yr,weighing 12.8-38.0 kg,with body height of 92-135 cm,were enrolled in this study and the data which were enrolled comprised 2964 effective concentration-time-BIS points.The model was not improved significantly with any covariates (age,body height,and body weight) introduced (P ＞ 0.05).The estimated parameters of the final pharmacodynamic model of sevoflurane were as follows:ke0 =O.516/min ; EC50 (BIS50) =2.11％ ; γ =2.46 ; E0 =74.6 ; EMAx =11.2.Conclusion The pharmacodynamic model of sevoflurane is successfully established with BIS as the effective index in pediatric patients,and the analysis for each parameter of the model indicates that the sensitivity to sevoflurane is lower,but the blood-brain equilibration time of the drug is shorter and the onset and recovery are faster in children than in adults.

Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

OBJECTIVETo observe the change of circulating microRNAs(miRNAs), regulatory mechanism in patients with atrial fibrillation (AF) before and after radiofrequency ablation (RFA).

METHODSFrom January 2011 to December 2013, peripheral blood samples were taken from 30 AF patients (10 paroxysmal, 10 persistent and 10 permanent AF) before and 3 months after RFA. The total RNA was extracted and hybridized with the miRNA chips, and the differential expression of miRNA and clustering analysis in whole genome were made with Volcano Plot and tMEV software respectively, and validated by real-time PCR. The target gene analysis of miRNAs was predicted through the Mirbase, Miranda and Targetscan databases. Results were compared with those from 10 healthy subjects (control group).

RESULTSCompared with control group, the expressions of 25 miRNAs were down-regulated before RFA and up-regulated after RFA in AF group, while other 40 miRNAs expression changed in the opposite way; among them, the expressions of 7 miRNAs including miR-199a-3p/miR-199b-3p were down- regulated >1.5-fold before RFA and up-regulated>100-fold after RFA; oppositely, 6 miRNAs including miR-BART8-3p were up-regulated>1.5-fold before RFA and down-regulated>10-fold after RFA. Interestingly, 6 miRNAs including miR-30b-5p, which were involved in AF-related electrical and structural remodeling, were down-regulated>5-fold before RFA, but up-regulated>50-fold after RFA. Four miRNAs including miR-377-5p, which were involved in the regulation of CACNA1C ICaL channel protein, were different before and after RFA.

CONCLUSIONmiRNAs regulate the occurrence and development of AF. RFA can change the expression of miRNAs in AF patients, which may be important for reversing the electrical and structural remodeling and maintaining sinus rhythm after RFA. miRNAs, such as miR-30b-5p, miR-377-5p and miR-199a-3p/miR-199b-3p etc., might become the target markers for early diagnosis and intervention of AF in future.

Atrial Fibrillation ; Catheter Ablation ; Cluster Analysis ; Down-Regulation ; Humans ; MicroRNAs ; Up-Regulation