Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ ~Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group:group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C(3.65 ±0.88)min vs.group A(5.60 ±0.88)min,group B(5.35 ±0.81)min,t =7.303, 6.367,all P =0.000;group D(3.30 ±0.80)min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45 ±1.19)min vs. group A(12.75 ±2.05)min,group B(12.65 ±1.90)min,t =8.583,8.383,all P =0.000;group D(7.80 ±0.89)min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B(430.50 ±30.86)min,group C(435.00 ±38.46)min,group D(534.50 ±46.73)min vs. group A(314.50 ±33.32)min,t =9.696,10.072,18.388,all P =0.000],group D was the best(group D vs.group B,group C,t =8.693,8.317,all P =0.000),there were no significant differences between group B and group C (group C vs.group B,t =0.376,P =0.708).In the 80 patients,only one case of group C had postoperative nausea and vomiting symptoms,there were no significant differences between the groups(all P >0.05).Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.

Objective To compare the efficacy of ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia and single general anesthesia in patients undergoing thyroidectomy.Methods 60 patients with ASAI ~II undergoing thyroidectomy,in accordance with the random number table,were divided into bilateral superficial cervical plexus block combined with general anesthesia group (group A)and single general anesthesia group(group B),30 cases in each group.In group A,the patients were provided ultrasound -guided bilateral superficial cervical plexus block with 0.4% ropivacaine 40 ml(20 mL for each side)before general anesthesia induction.In group B,the patients were directly induced for general anesthesia.The patients of the two groups had the same general anesthesia induction drugs.SBP,DBP and HR were monitored and recorded at the time of pre -anesthesia,skin incision, postoperation and extubation.The cumulative amount of propofol and remifentanil during the operation were recorded. The extubation time was recorded and each patient was assessed 1,2,3,4h after surgery for resting VAS score. Results Blood pressure and heart rate at the different time points during operation were higher than pre -anesthesia significantly in group B[skin incision SBP (134.8 ±8.5)mmHg,the end of operation SBP (123.4 ±5.1)mmHg, tracheal extubation SBP (138.7 ±8.5)mmHg vs preanesthesia SBP (117.3 ±9.8)mmHg,t =7.39,3.02,9.04,all P =0.00;skin incision DBP (86.7 ±7.6)mmHg,the end of operation DBP (80.6 ±7.8)mmHg,tracheal extubation DBP (87.4 ±5.8)mmHg vs preanesthesia DBP (75.6 ±6.6)mmHg,t =6.04,2.68,7.35,all P =0.00;skin incision HR (92.4 ±6.5)times/min,the end of operation HR (86.8 ±6.3)times/min,tracheal extubation HR (96.9 ± 7.2)times/min vs preanesthesia HR (78.9 ±6.8)times/min,t =7.86,4.67,9.96,all P =0.00].The cumulative amount of general anesthesia during operation in group A was less than that in group B,the extubation time in group A was shorter than that in group B[propofol doses of group A (650.6 ±50.3)mg vs group B (762.3 ±43.5)mg,t =9.2,P =0.00;remifentanil doses of group A (0.61 ±0.08)mg vs group B (0.95 ±0.06)mg,t =18.62,P =0.00;extubation time of group A (10.6 ±5.1)min vs group B (15.5 ±5.2)min,t =3.68,P =0.00].The resting VAS score at the different time points after surgery in group A was less than that in group B[the resting VAS score at 1,2, 3,4h after surgery in group A vs group B,(0.99 ±0.81)vs (1.75 ±1.23),t =2.83,P =0.00;(1.23 ±1.02)vs (3.45 ±0.84),t =9.2,P =0.00;(2.80 ±0.85)vs (3.71 ±1.19),t =3.41,P =0.00;(3.11 ±1.02)vs (5.19 ± 1.36),t =6.7,P =0.00],there were statistically significant differences.Conclusion Ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia used in patients undergoing thyroidectomy can maintain the intraoperative hemodynamic stability effectively,reduce the amount of general anesthetics,shorten the extubation time,and ease the early postoperative pain,the efficacy is significantly better than single general anesthesia.

Objective To observe the application effects of postoperative analgesia of ultrasound guided transverses abdominis plane (TAP) block in patients undergoing hysterectomy.Methods 50 patients with hysterectomy under general anesthesia were selected,and they were randomly divided into two groups according to the digital table,25 cases in each group.The patients of group A were injected with 0.45% ropivacaine mesylate 20mL in ultrasound guided bilateral TAP after the end of surgery before extubation,the patients of group B were injected with the same amount of normal saline in ultrasound guided bilateral TAP block.Postoperative patient-controlled intravenous analgesia with sufentanil was provided to all patients.The VAS score of the two groups after operation,the postoperative dosage of sufentanil in 24h and pressing times of analgesia pump,and the satisfaction of patients with postoperative analgesia,and adverse reactions were observed.Results The VAS scores of 2h of group A (0.96±0.74)points vs.group B (1.88±0.73)points (t=4.45);The VAS scores of 4h of group A (1.52±0.65)points vs.group B (2.24±0.72)points (t=3.69);The VAS scores of 8h of group A (1.88±0.44)points vs.group B (2.68±0.56)points (t=5.64);The VAS scores of 12h of group A (2.24±0.52)points vs.group B (2.96±0.54)points (t=4.80);The VAS scores of 24h of group A (2.44±0.51)points vs.group B (3.24±0.44)points (t=5.99);there were statistically significant differences(all P=0.00).The postoperative dosage of sufentanil in 24h[group A (51.60±1.02)μg vs.group B (55.46±1.37)μg,t=11.30,P=0.00],the pressing times of analgesia pump[group A (7.20±2.04)times vs.group B (14.92±2.74)times,t=11.30,P=0.00],the satisfaction of patients with postoperative analgesia[group A (9.20±0.71)points vs.group B (7.52±0.77)points],t=8.03,P=0.00].There were 2 cases of postoperative nausea and vomiting in group B,and 8 cases in group A,the difference was statistically significant(x2=4.50,P=0.03).Conclusion The application of postoperative analgesia of ultrasound guided TAP block in patients undergoing hysterectomy can reduce postoperative intravenous analgesic drug usage,reduce the incidence of adverse reactions induced by drugs,improve patients' comfort and satisfaction,it is suitable for clinical application.

Objective To observe the application effects of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients .Methods Fifty patients undergoing radical resection of colorectal cancer in our hospital within nearly two years were divided into two groups,according to number table mehtod ,25 cases in each group.Patients of group A were injected with 0.45%ropivacaine mesylate 20 mL in ultrasound-guided bilateral TAP after the end of surgery before extuba-tion;the patients of group B were injected with the same amount of normal saline in ultrasound -guided bilateral TAP block,Postoperative patient -controlled intravenous analgesia with sufentanil was provided to all patients . The VAS score of two groups after operation record the postoperative dosage of sufentanil in 24h,pressing times of analgesia pump ,the satisfaction of patients with postoperative analgesia and adverse reactions .Results The VAS score of group A(1.08 ±0.86),(1.60 ±0.71),(1.92 ±0.49),(2.28 ±0.61),(2.44 ±0.51)were lower than that of group B(1.88 ±0.73),(2.24 ±0.72),(2.68 ±0.56),(2.96 ±0.54),(3.24 ±0.44).The dos-age of sufentanil in group A(53.20 ±1.39)μg vs.group B(59.18 ±2.82)μg,pressing times of analgesia pump,group A(10.40 ±2.78)vs.group B(22.36 ±5.63),the satisfaction of patients with postoperative analge-sia,group A(9.12 ±0.78)vs.group B(7.52 ±0.77).There were 2 cases of postoperative nausea and vomiting in group B vs 8 cases in group A,The above -mentioned indexes difference had statistical significance except postoperative 4h score.The indicators of respiratory depression in the two groups did not occur .Conclusion The application of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients ,can reduce postoperative intravenous analgesic drug usage ,decrease the in-cidence of adverse reactions induced by opioid drugs ,and the analgesic effect is more effective with the positioning accuracy ,convenient operation ,less injury ,high safety and suitable for clinical application .

Objective To observe the analgesic effect of ultrasound guided fascia iliaca compartment block on postural changes in patients with the femoral neck fracture.Methods From January 2017 to November 2017, 60 patients with femoral neck fracture of American Society of Anesthesiologists ( ASA) anesthesia grade Ⅱ -Ⅲundergoing elective surgery in the Hospital of Yanqing District were selected , and they were divided into the ultrasound guided fascia iliaca compartment block group ( F group) and the intravenous dezocine analgesia group ( D group) according to the random number table ,with 30 cases in each group.The F group received ultrasound guided fascia iliaca compartment block with 30 mL 0.45%ropivacaine mesylate,30 min before entering the operating room. The D group received intravenous injection of dezocine 0.1 mg/kg,10 min before entering the operating room.The VAS scores were recorded at entered the operating room ( T1),overing the bed ( T2), the position for intraspinal anesthesia(T3),and the occurrence of adverse reactions were observed.Results The VAS scores of the F group at T1,T2,T3 were lower than those of the D group[(2.07 ±0.52)points vs.(2.90 ±0.80)points,t＝4.77,(2.80 ± 0.61)points vs.(3.83 ±0.59)points,t＝6.66,(3.83 ±0.65)points vs.(5.27 ±0.58)points,t＝9.01],the differ-ences were statistically significant (all P＝0.00).There were no complications such as puncture site hematoma and local anesthetic toxicity in the F group.There were 8 dizziness patients (26.67%) and 4 nausea patients (13.33%) in the D group.Conclusion The analgesic effect of ultrasound guided fascia iliaca compartment block relative to intravenous drug on postural changes in patients with the femoral neck fracture is more obvious and has less adverse reactions,and it is suitable for clinical use.

Objective To investigate the expressions and clinical significances of breast cancer stem cell markers such as aldehyde dehydrogenase 1 (ALDH1) and transforming growth factor-β2 (TGF-β2) in patients with triple negative breast cancer.Methods Samples of 60 triple negative breast cancer tissues were investigated for the expressions of ALDH1 and TGF-β2 proteins by immunohistochemical staining.The correlation analysis,disease-free survival analysis and overall survival analysis were performed.Results The positive expressions of ALDH1 protein and TGF-β2 protein in the 60 breast cancer primary lesions were 23 cases (38.33％) and 38 cases (63.33％) respectively.The expression of ALDH1 protein was not correlated with tumor size (x2 =0.307,P =0.580),histological grade (x2 =4.244,P =0.120),clinical stage (x2 =0.982,P =0.612) or lymph node metastasis (x2 =1.111,P =0.292).The expression of TGF-β2 protein was not correlated with histological grade (x2 =4.651,P =0.098),lymph node metastasis (x2 =3.513,P =0.061),clinical stage (x2 =1.310,P =0.519) or tumor size (x2 =0.629,P =0.428).The disease-free survival time [(38.43±3.86) months vs.(53.38 ±2.58) months] and the overall survival time [(42.00±3.11) months vs.(53.84 ± 2.19) months] of ALDH1-positive patients were significantly shorter than those of ALDH1-negative patients,and the differences were statistically significant (x2 =8.490,P =0.004;x2 =11.270,P =0.001).The disease-free survival time [(42.81 ±3.32) months vs.(54.72 ±2.50) months] and the overall survival time [(44.74 ± 2.68) months vs.(57.18 ± 1.55) months] of TGF-β2 positive patients were significantly shorter than those of TGF-β2-negative patients,and the differences were statistically significant (x2 =4.300,P =0.038;x2 =8.900,P =0.003).The expression of ALDH1 protein was positively correlated with the expression of TGF-32 protein (r =0.360,P =0.005).Conclusion The ALDH1 phenotype is an independent predictor of poor prognosis.The activation of TGF-32 signaling pathway may be involved in the regulation of triple-negative breast cancer stem cells.

Objective:To explore the key genes and its biological functions of aldosterone producing adenoma (APA) using bioinformatics analysis.Methods:Differentially expressed genes of APA were identified from two training datasets GSE60042 and GSE64957 in GEO database. Function and pathway enrichment analyses for differentially expressed genes were performed and transcriptional regulation network among these genes were determined. Hub genes were extracted by node analysis from the protein-protein interaction (PPI) network. The expression of key genes was verified by a testing dataset GSE8514. Receiver operating characteristic(ROC) curve analysis was applied to assess the diagnostic efficiency of key genes in APA. The biofunction of each key gene were determined by gene set enrichment analysis (GSEA).Results:A total of 68 differentially expressed genes, including 33 up-regulated genes and 35 down-regulated genes, were detected from the training datasets. These genes were mainly enriched in aldosterone biosynthetic process, calcium signaling pathway, serotonin receptor signaling pathway, transcriptional activator activity, and regulation of transcription. JUN and VDR were at the center of the transcriptional factor-gene network. Furthermore, we identified nine Hub genes from the PPI network. In testing dataset, CYP11B2 and VDR showed the higher expression, while JUN, NFKBIZ, EGR3, and KLF6 showed lower expression in APA (all P<0.05), and the value of area under ROC curve analysis was 0.936, 0.833, 0.953, 0.854, 0.868, and 0.929, respectively. GSEA indicated the alter of key genes in APA led to up-regulation of the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway, and complement and coagulation cascades [all normalized enrichment score (NES)>1.5, P<0.05], but down-regulation of the DNA replication, ribosome, and autophagy (all NES<-1.5, P<0.05). Conclusion:Results of bioinformatics indicate that JUN and VDR are key transcriptional factors, and CYP11B2, NFKBIZ, EGR3, and KLF6 are the key genes for APA, which are involved in the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway in APA.

BACKGROUNDRecently, studies have disclosed soluble CD40 ligand (sCD40L) during atherosclerosis development and plaque destabilization. The objective of the present study was to test the hypothesis that sCD40L levels are higher in acute coronary syndrome (ACS) patients with a greater extent of angiographic coronary involvement.

METHODSThis cross-sectional study examined ACS patients who underwent coronary angiography by measuring their sCD40L levels. In order to estimate the serum levels of sCD40L, 10 ml of peripheral venous blood was drawn within 24 hours of admission. sCD40L levels were measured using an enzyme-linked immunosorbent assay (ELISA, RapidBio, West Hills, CA, USA). Demographic data, presence of concomitant diseases, ACS characteristics, and angiographic findings were evaluated. A review of medical records and patient interviews were conducted to assess coronary risk factors. And the severity of coronary artery disease was evaluated using the Gensini score index.

RESULTSTwo hundred and eighty-nine patients were included in the study, of whom 186 were male, with an average age of 64.1 ± 10.0 years. Median sCD40L levels were 1.7 ng/ml (0.3-7.3 ng/ml) and Gensini scores were 50 (0-228). After adjusting for demographic variables and cardiovascular risk factors, the Gensini score was associated with the natural logarithm of the sCD40L level (Coefficient b = 0.002, 95% CI 0.000-0.003, P = 0.029).

CONCLUSIONsCD40L levels were independently associated with angiographic severity of coronary artery disease in patients with ACS.

Acute Coronary Syndrome ; diagnostic imaging ; pathology ; Aged ; CD40 Ligand ; blood ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Severity of Illness Index

OBJECTIVETo explore the effects of group psychological counseling on the self-confidence and social adaptation of burn patients during the course of rehabilitation.

METHODSSixty-four burn patients conforming to the inclusion criteria and hospitalized from January 2012 to January 2014 in Xijing Hospital were divided into trial group and control group according to the method of rehabilitation, with 32 cases in each group. Patients in the two groups were given ordinary rehabilitation training for 8 weeks, and the patients in trial group were given a course of group psychological counseling in addition. The Rosenberg's Self-Esteem Scale was used to evaluate the changes in self-confidence levels, and the number of patients with inferiority complex, normal feeling, self-confidence, and over self-confidence were counted before and after treatment. The Abbreviated Burn-Specific Health Scale was used to evaluate physical function, psychological function, social relationship, health condition, and general condition before and after treatment to evaluate the social adaptation of patients. Data were processed with t test, chi-square test, Mann-Whitney U test, and Wilcoxon test.

RESULTS(1) After treatment, the self-confidence levels of patients in trial group were significantly higher than those in control group (Z = -2.573, P < 0.05). Among trial group, the number of patients with inferiority complex was 17 (53.1%) before treatment, which was decreased to 6 (18.8%) after treatment; the number of patients with normal feeling and that of self-confidence were 8 (25.0%) and 4 (12.5%) before treatment, which were respectively increased to 13 (40.6%) and 10 (31.3%) after treatment. The overall difference in trial group was obvious between before and after treatment (Z = -4.123, P < 0.01) . There was no obvious difference in self-confidence level of patients in control group between before and after treatment (Z = -1.000, P > 0.05). (2) After treatment, the scores of psychological function, social relationship, health condition, and general condition were (87 ± 3), (47.8 ± 3.6), (49 ± 3), and (239 ± 10) points in trial group, which were significantly higher than those in control group [(79 ± 4), (38.3 ± 5.6), (46 ± 4), and (231 ± 9) points, with t values respectively -8.635, -8.125, -3.352, -3.609, P values below 0.01]. After treatment, the scores of physical function, psychological function, social relationship, health condition, and general condition in trial group were significantly higher than those before treatment (with t values from -33.282 to -19.515, P values below 0.05). The scores of physical function, psychological function, health condition, and general condition in control group after treatment were significantly higher than those before treatment (with t values from -27.137 to -17.790, P values below 0.05).

CONCLUSIONSGroup psychological counseling combined with ordinary rehabilitation training give rise to significant effects on self-confidence level and social adaptation for burn patients.

Adaptation, Psychological ; Burns ; psychology ; therapy ; Counseling ; Humans ; Psychotherapy, Group ; methods ; Self Concept ; Social Adjustment ; Treatment Outcome