Objective To explore the anesthesia management experience in the interventional treatment of pediatric congenital heart diseases (CHD) percutaneously guided by transthoracic echocardiography (TTE) on a mobile operating platform. Methods From March to July 2023, a total of 13 patients from remote areas underwent interventional treatment for CHD on the mobile operating platform of Fuwai Yunnan Cardiovascular Hospital. Patients who received non-tracheal intubation general anesthesia were retrospectively included. Results Eight children who had difficulty cooperating with the surgery (due to young age, emotional tension, crying) received monitored anesthesia care with local anesthesia supplemented by sedative and analgesic drugs while maintaining spontaneous breathing under the monitoring and management of an anesthesiologist (i.e., non-tracheal intubation general anesthesia). Among them, there were 5 males and 3 females, with an age of (6.95±3.29) years and a body weight of (19.50±6.04) kg. Through transthoracic echocardiography, they were diagnosed with atrial septal defect (6 patients), residual shunt after patent ductus arteriosus ligation (1 patient), and severe pulmonary valve stenosis (1 patient). The surgery proceeded smoothly, with satisfactory anesthesia and surgical effects, complete analgesia, and satisfactory postoperative recovery. There was 1 patient of body movement and 1 patient of respiratory depression during the operation, and both patients completed the surgery successfully after treatment. All children had no serious surgery- and anesthesia-related complications. The anesthesia time was 40.5 (34.5, 47.5) min, the surgery time was 39.0 (33.0, 45.5) min, and the recovery time was 43.0 (28.0, 52.5) min Conclusion Interventional surgery for CHD guided by TTE at a mobile platform is a minimally invasive approach without radiation damage. Non-tracheal intubation general anesthesia with spontaneous breathing can be safely and effectively implemented in children who cannot cooperate.

Objective To explore the correlation between serum vitamin D levels,vitamin D receptor gene polymorphism,and the incidence of chronic urticaria in children,and to provide clinical evidence for screening the genetic susceptibility of chronic urticaria in children.Methods Clinical data and peripheral blood samples were collected from 100 children with chronic urticaria in the test group and 100 healthy children in the control group who were admitted to the Dermatological Department of Pingshan Distinct Maternal and Child Health Hospital from December 2021 to January 2023.Chemiluminescent assays were used to measure the levels of 25(OH)D,IgE and IgG.PCR amplification was performed to amplify the VDR gene polymorphic sites ApaI,BsmI,TaqI,FokI,and Tru9I,followed by sequencing to assess the VDR gene polymorphism and the expression levels of the associated genetic polymorphic sites rs7975232,rs1544410,rs731236,rs2228570,and rs757343.Results The levels of 25(OH)D in the test group were lower than that in the control group,while IgE and IgG levels were higher than those in the control group,and the differences were statistically sig-nificant.Multivariate logistic regression analysis showed that the T allele of rs757343 was a risk factor for the incidence of chronic urticaria in children(OR=1.45 8,95％CI:1.015-2.153,P=0.047),while the CC geno-type of rs757343 and 25(OH)D were protective factors(OR=0.250,95％CI:0.056-0.786,P=0.031;OR=0.553,95％CI:0.373-0.713,P＜0.001).ROC curve analysis showed that the area under the curve for 25(OH)D,white blood cell count,neutrophil percentage,lymphocyte percentage,and basophil percentage were 0.928,0.701,0.808,0.797 and 0.753,all＞0.7.Conclusion Vitamin D can assist in the diagnosis of uricaria in children and evaluate the progression of the disease.25(OH)D is a protective factor for the onset of chronic urticaria in children,the T allele of the VDR gene polymorphism rs757343 is a risk factor for chronic urticaria in children,while the CC genotype is a protective factor.

【Objective】 To explore the factors influencing the survival and prognosis of patients with bladder urothelial carcinoma (BUC) after surgical treatment, and to establish an artificial intelligence algorithm to predict the effects of different surgical regimens. 【Methods】 BUC patients treated with surgery during Jan.2007 and Jan.2019 in The Second Hospital of Dalian Medical University and Nanfang Hospital of Southern Medical University were enrolled. The complete clinical and follow-up data were collected. Deep neural network (DNN) was used to establish an artificial intelligence algorithm model. A prediction model of survival and prognosis was established, and the influencing factors of survival were explored and ranked by the artificial intelligence algorithm. 【Results】 A total of 832 patients were involved, including 438 (52.64%) treated in The Second Hospital of Dalian Medical University, and 394 (47.36%) treated in Nanfang Hospital of Southern Medical University. Of all cases, 579 (69.6%) were non-muscle invasive bladder cancer, and 253 (30.4%) were muscle invasive bladder cancer. Transurethral resection of bladder tumor was conducted in 539 (64.8%) cases, partial cystectomy in 66 (7.9%) cases, and total cystectomy in 227 (27.3%) cases. The data of patients treated in Second Hospital of Dalian Medical University were used for DNN modeling, and the data of patients treated in Nanfang Hospital of Southern Medical University were used for external verification after modeling. Finally, it was concluded that the factors affecting survival and prognosis were T stage, pathological grade, hypertension or cardiovascular and cerebrovascular disease, hemoglobin, blood calcium, smoking, albumin, lymphocytes, age, ratio of albumin/globulin, operation method, N stage, and creatinine clearance rate in descending order. The model could be used for preoperative prediction. 【Conclusion】 Through DNN modeling and external verification, the influencing factors of postoperative survival can be predicted for patients with bladder cancer, and the surgical effects can also be predicted before operation. The model can provide artificial intelligence algorithm support for the selection of surgical methods and postoperative follow-up plans.

Objective:To investigate the association between serum thyroid level and prognosis of critically ill children with euthyroid sick syndrome(ESS).Methods:The clinical data and serum thyroid hormone levels of 176 children with ESS who were admitted to the Department of Pediatric Intensive Care Medicine at West China Second Hospital of Sichuan University from January 2015 to April 2021 were retrospectively collected.According to the prognosis, the children were divided into improved group and invalid group, as well as basic disease group and non basic disease group, and the differences of thyroid hormone between two groups were compared.The pediatric risk of mortality Ⅲ(PRISMⅢ) scores within 24 hours of admission were assessed, and the correlation between thyroid hormone level and PRISMⅢ score was analyzed.Results:Among 176 critically ill children with ESS, the most common diseases were sepsis(31.8%), severe pneumonia (23.8%) and heart failure(10.7%), respectively.The levels of free T3(FT3), T3, free T4(FT4) and T4 in invalid group were significantly lower than those in improved group ( P<0.05), but there was no statistical difference in thyroid-stimulating hormone(TSH) level between two groups( P>0.05). The levels of FT3, T3, FT4 and T4 were negatively correlated with PRISMⅢ score( r=-0.419, -0.459, -0.341, -0.383, respectively, P<0.05), and there was no correlation between TSH level and PRISMⅢ score ( P>0.05). The common underlying diseases of severe children with ESS were malnutrition(31/98), heart disease(30/98), hematologic neoplasms(15/98), and bronchopulmonary dysplasia(10/98). The median age of children in basic disease group was younger than that in non-basic disease group(0.7 years old vs. 2.0 years old, P<0.05); The proportion of children with underlying diseases in invalid group was 24.5%, which was significantly higher than that of children without underlying diseases (6.4%), and the difference was statistically significant ( P<0.05); There were no significant differences in the levels of FT3, T3, FT4, T4 and TSH between two groups ( P>0.05). Conclusion:In critically ill children, a variety of diseases can lead to ESS, and sepsis is the most common disease.Young children with underlying diseases should be more alert to ESS.The more severe the disease, the greater the decline of FT3, T3, FT4 and T4 levels.When low T3, T4 and TSH occur simultaneously, the prognosis of the children may be worse.Thyroid hormone level could be used as an indicator to evaluate the prognosis of critically ill children, which is needed further studies to explore.

AIM: To study the bioequivalence of two metformin hydrochloride sustained-release tablets in Chinese healthy subjects. METHODS: A randomized, open-label, two-period, crossover study design was adopted in the study. In fasting test 36 and in fed test 23 healthy subjects were given a single oral dose of metformin hydrochloride sustained-release tablet (0.5 g). The concentration of metformin in plasma was measured by HPLC-MS/MS. The pharmacokinetic parameters were calculated by WinNonlin 7.0 program, and statistical analysis were performed by using SAS9.4 statistics software. RESULTS: In the fasting test, the pharmacokinetic parameters of metformin of the test (T) and reference(R) preparation were as follow: C

Sepsis associated encephalopathy (SAE) features are the diffuse cerebral dysfunction induced by the systemic response to the infection,without clinical or laboratory evidence of direct brain infection or other types of encephalopathy.The core feature of SAE is a diffuse disturbance in cerebral function free of any lateralizing signs.The primary clinical feature of SAE is a change in mental status,especially that of consciousness and cognition.The key prerequisite for the diagnosis of SAE is presence of extracranial infection.There is no precise criteria for the diagnosis of SAE or exclusion of it,and no well-established clinical or biological markers are available.But,neural electrophysiological examination,cranial imaging and biomarkers have been found with implications for the diagnosis of SAE.At present,treatment options for SAE are limited.Things of significant importance are early identification of change in mental status,searching for pathogens and lesions,as well as prompt anti-infectious treatment,maintaining hemodynamic stability and supporting therapy.

The pathogenesis of diabetes is complicated by several factors including autoimmunity, environment, heredi?ty, and etc. Autophagy is a kind of intracellular biodegradation processes, which plays an important role in intracellular ho?meostasis of islet cells. In diabetes, autophagy is involved in the endoplasmic reticulum stress, mitochondrial dysfunction and inflammatory, and it affects the development of the disease. In this paper, we reviewed the interactions of autophagy with endoplasmic reticulum stress and mitochondrial dysfunction with inflammation in diabetes in order to investigate the patho?genesis of diabetes, to find new strategies for prevention or treatment of diabetes.

Objective To investigate the prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities.Methods Total 3316 subjects with type 2 diabetes (age 20-80 years) were recruited from 15 urban community health centers in Beijing using a multi-stage random sampling approach.Dyslipidemia was diagnosed according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults:2007 version.Results Among 3316 diabetic subjects (1329 malesand 1987 females),75.6％ (2506/3316) had dyslipidemia,the prevalence was 72.5％ (964/1329)in men and 77.6％ (1542/1987) in women.The prevalence of hypertriglyceridemia and hypercholesterolemia was 41.9％ (1388/3316) and 48.1％ (1595/3316),respectively.31.5％ (1043/3316) subjects had high levels of low-density lipoprotein cholesterol (LDL-C) and 21.2％ (703/3316) had low high-density lipoprotein cholesterol (HDL-C).Among all subjects with dyslipidemia only 22.9％ (575/2506) took hypolipid agents.The overall blood lipid control rates of triglyceride (TG),total cholesterol (TC),LDL-C and HDL-C in 1393 subjects with dyslipidemia history were 48.0％ (669/1393),17.4％ (242/1393),30.9％ (430/1393) and 75.8％ (1056/1393),respectively.Diabetics with dyslipidemia had higher body mass index,waist circumference,blood pressure,plasma glucose and hemoglobin A1c.The prevalence of dyslipidemia in the overweight and uncontrolled-glucose group were 79.0％ (1678/2125),78.9％ (1756/2227),respectively.Logistic regression analysis showed that gender,age,body mass index and hemoglobin A1c were associated with dyslipidemia.Conclusions The prevalence of dyslipidemia in diabetic subjects in Beijing urban communities is high and less than one quarter patients take hypolipid agents.Age,body mass index and hemoglobin A1c are the risk factors of dyslipidemia in type 2 diabetic patients.

Objective To study clinical characteristics of type 2 diabetic(T2D)patients with metabolic syndrome(MS)and its components in Beijing urban communities.Methods Totally,3295 T2D patients involved in a combined prospective diabetic management study from 15 urban communities in Beijing were classified as four groups, according to 2004 Chinese Diabetes Society's definition of MS, i. e, isolated T2D, T2D with one component of MS, T2D with two components of MS and T2D with three components of MS. Their clinical characteristics were analyzed. Results ( 1 ) Among 3295 T2D patients, 155 (4. 7% )were isolated T2D, 107 (32.6%) T2D with one component of MS, 1386 (42.1%) T2D with two components of MS and 679 (20.6%) T2D with three components of MS, with an overall 62.7% (2065/3295) of T2D patients complicated with MS. (2) In these T2D patients, the more components of MS they had, the higher body mass index (BMI), waist circumference, waist to hip circumference ratio (WHR),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum levels of insulin and triglyceride (TG) and the lower level of high-density lipoprotein-cholesterol (HDL) were presented (P <0. 01 ). (3) Percentage of isolated T2D in women increased from 49. 0% (76/155) to 61.9% (420/679)of those with three components of MS ( P < 0 01 ), with increasing of components of MS. (4) Multiple logistic regression analysis showed that BMI, history of hypertension, decreased HDL, increased TG,increased blood pressure, all were risk factors for T2D patients complicated with MS. Conclusions Among T2D patients in urban communities of Beijing, 95.3% (3140/3295) of them complicated with one or more components of MS, and 61.9% (420/679) of them complicated with MS. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids,body weight and so on, in addition to control of blood sugar.

Objective The purpose of this paper was to use a new biphasic poroelastic tibia model to develop a two-dimensional numerical method for simulating impact responses of human tibia in car-pedestrian accidents. Methods The geometry of tibia model was reconstructed from CT scans of the left tibia of a living human volunteer. A poroelastic approach was utilized to establish the governing equations of the model and the finite element method was applied to solve these governing equations. Both cortical and cancellous components of tibia were represented using a poroelastic material model consisting of solid phase (matrix) and fluid phase (marrow). A lateral-medial impact direction was selected in the simulation analysis and the impact responses of the pedestrian tibia during 0-200 ms were analyzed. Results The bending deformation of the tibia predicted by the computer simulation was primarily concentrated on the impact zones. The displacement response of Node 107 in the impact zone indicated a peak displacement of -6 mm at around 75 ms, and the significant time delay between the impact force and the displacement response of the skeleton. The axial stress response at the center of element E77 in the impact zone indicated a peak stress of 140 MPa at around 30 ms,and the significant time delay was observed between the impact force and the axial stress response of the skeleton, too. Conclusion This research developed a two-dimensional numerical method for simulating impact responses of human tibia in car-pedestrian accidents. It was able to approximately simulate the bending deformation, lateral displacement response and axial stress response of pedestrian tibia in the impact zones,and the effects of the fluid phase on the solid phase. More in-depth investigation is helpful to further the biofidelity of tibia dynamics model.