Objective To compare the effects of sevoflurane-and propofol-based anesthesia on kid-ney injury in pediatric patients undergoing living donor liver transplantation. Methods Eighty pediatric pa-tients of both sexes, aged 5-15 months, weighing 5. 5-10. 0 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective living donor liver transplantation, were divided into 2 groups ( n=40 each) using a random number table method: sevoflurane-based anesthesia group ( group S) and propofol-based anesthesia ( group P ) . Sevoflurane was inhaled, and the end-tidal concentration was maintained at 1. 0％-3. 0％ in group S. Propofol 9-15 mg·kg-1 ·h-1 was intravenously infused in group P. Fentanyl 1-3 μg∕kg was intermittently injected, and cisatracurium 1-2 μg·kg-1·min-1 was intrave-nously infused in two groups. Bispectral index value was maintained at 40-60. Immediately before skin in-cision ( T1 ) , at 30 min of anhepatic phase ( T2 ) , at 3 h of neohepatic phase ( T3 ) , at 24 h after operation ( T4 ) and at day 3 after surgery ( T5 ) , blood samples from the central vein and urine specimens were col-lected for determination of the levels of neutrophil gelatinase-associated lipocalin and cystatin C in serum and urine by enzyme-linked immunosorbent assay. The urine volume, requirement for dopamine and occurrence of hypotension and myocardial ischemia were recorded during surgery. Results Compared with group P, the levels of neutrophil gelatinase-associated lipocalin and cystatin in serum and urine were significantly de-creased at T3-5 ( P<0. 05) , and no significant change was found in the intraoperative urine volume, inci-dence of hypotension and myocardial ischemia, or requirement for dopamine in group S ( P>0. 05) . Con-clusion Compared with propofol-based anesthesia, kidney injury is attenuated in pediatric patients under-going living donor liver transplantation under sevoflurane-based anesthesia.

Objective To evaluate the effect of propofol and sevoflurane on acute kidney function in infants undergoing pediatric parent liver transplantation.Methods 80 pediatric patients scheduled for pediatric liver transplantation were randomly assigned to receive either continuous infusion of propofol or inhalation of sevoflurane.Serum creatinine (Scr),inflammatory medium and renal biomarkers were measured before surgery (T1),30min after anhepatic phase (T2),3h after ischemia reperfusion (T3),36 h after surgery (T4) to evaluate the effect of anesthetics on the development of postoperative kidney injury.Results Overall,compared Propofol group,the mean arterial pressure changed slightly in sevoflurane group.The inflammatory factors of Scr,IL-18,TNF-α,and levels of NGAL were lower in sevoflurane group while no differences of IL-10 were found between both groups.Conclusions Compared with propofol anesthesia,the degree of renal injury in pediatric living donor liver transplantion under sevoflurane anesthesia is reduced,which may be related to hemodynamic stability and decreased release of inflammatory factors.

Objective To explore the effects of dexmedetomidine on myocardial injury during liver cold ischemia reperfusion in rats .Methods A total of 40 healthy male Sprague-Dawley (SD)rats with a weight of 220～250 gram and an age of 8～10 weeks were randomly divided into 5 groups of sham ,model ,Dex ,Atip and AG490 by a random number table (n= 8 each) .At 8h post-reperfusion , blood samples were harvested from infra-hepatic vena cava and serum levels of tumor necrosis factor-alpha (TNF-α) ,interleukin-6 (IL-6) ,creatine kinase-muscle/brain (CK-MB) ,troponin I (cTnI)and heart-type fatty acid binding protein (H-FABP )determined by enzyme-linked immunosorbent assay (ELISA ) .After blood sampling ,the rats were sacrificed ,the expression of activated caspase-3 was detected by immunohistochemistry and apoptotic cells by TUNEL .Apoptotic rate was calculated .And the phosphorylations of JAK2 ,STAT1 and STAT3 were assessed by Western blot .Results As compared with sham group ,the levels of TNF-α,IL-6 ,CK-MB ,cTnI and H-FABP significantly increased ,apoptotic rate spiked ,pathological damage worsened and the expressions of activated caspase-3 ,p-JAK2 ,p-STAT1 and p-STAT3 were up-regulated in other groups ( P< 0 .05 );As compared with model group ,the levels of TNF-α,IL-6 ,CK-MB ,cTnI and H-FABP significantly decreased ,apoptotic rate declined ,pathological damage became alleviated and the expressions of activated caspase-3 ,p-JAK2 ,p-STAT1 and p-STAT3 became down-regulated in groups Dex and AG490 (P<0 .05);as compared with group Dex ,the levels of TNF-α,IL-6 ,CK-MB ,cTnI and H-FABP significantly increased ,apoptotic rate rose ,pathological damage worsened and the expressions of activated caspase-3 ,p-JAK2 ,p-STAT1 and p-STAT3 became up-regulated in group Atip (P<0 .05) . Conclusions Dexmedetomidine can ameliorate myocardial injury induced by liver cold ischemia-reperfusion in rats .

Objective To investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. Methods A case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active ( ≥ 3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. ResuLts The median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1% (OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026; primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). ConcLusions Insufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae.

Objective To investigate the effect of dexmedetomidine pretreatment on Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway during myocardial injury induced by liver ischemia-reperfusion (I/R) in rats.Methods Twenty-four healthy adult male SpragueDawley rats,aged 8-10 weeks,weighing 220-250 g,were divided into 3 groups (n=8 each) using a random number table method:sham operation group (group S),liver I/R group (group I/R),and dexmedetomidine pretreatment group (group D).The portal vein,superior and inferior vena cava,subhepatic inferior vena cava and hepatic artery were clamped,and the liver was perfused with 4 ℃ lactated Ringer's solution for 60 min through the portal vein to establish the model of liver cold I/R in anesthetized rats.Dexmedetomidine 100 μg/kg was intraperitoneally injected at 30 min before ischemia in group D.Blood samples were collected at 8 h of reperfusion from the inferior vena cava for determination of serum cardiac troponin Ⅰ (cTnⅠ) and heart-type fatty acid binding protein (H-FABP) concentrations (using the automatic biochemistry analyzer),tumor necrosis factor-alpha (TNF-α) and high-mobility group box 1 protein (HMGB1) concentrations (by enzyme-linked immunosorbent assay).The rats were then sacrificed,andhearts were harvested for examination of histopathological changes (with a light microscope) and for determination of the malondialdehyde (MDA) content (using thiobarbituric acid method) and superoxide dismutase (SOD) activity (by xanthine oxidase method),and expression of phosphorylated STAT1 and STAT3 (p-STAT1,p-STAT3) and phosphorylated JAK2 (p-JAK2) in myocardial tissues (by Western blot).Results Compared with group S,the serum concentrations of cTnI,H-FABP,TNF-α and HMGB1 were significantly increased,the MDA content was increased,the SOD activity was decreased,and the expression of p-JAK2,p-STAT1 and p-STAT3 was up-regulated in I/R and D groups (P＜0.05).Compared with group I/R,the serum concentrations of cTnI,H-FABP,TNF-α and HMGB1 were significantly decreased,the MDA content was decreased,the SOD activity was increased,the expression of pJAK2,p-STAT1 and p-STAT3 was down-regulated (P＜0.05),and pathological changes of myocardium were significantly attenuated in group D.Conclusion The mechanism by which dexmedetomidine pretreatment mitigates myocardial injury induced by liver cold I/R may be related to inhibiting activation of JAK/STAT signaling pathway in rats.

Objective To investigate the early predictive value of several commonly used biochemical markers for predicting persistent organ failure ( POF ) in patients with hyperlipidemic acute pancreatitis ( HLAP) . Methods Clinical data of 157 patients with HLAP within 72 hours after the onset of first attack who were admitted to the Dept. of Gastroenterology in Changhai Hospital from January 2015 to December 2017 were retrospectively analyzed, including 106 cases without POF ( non POF group ) and 51 cases with POF ( POF group) . Hct, BUN, Cr, APACHEⅡand BISAP were recorded within 24 hours after admission. Receiver-operating characteristic ( ROC) curve was drawn to calculate area under the ROC curve ( AUC) and evaluate the performance of Hct, BUN, Cr, APACHEⅡand BISAP scores in predicting HLAP complicated with POF, which was compared by DeLong test. Results Values of BUN, Cr, APACHEⅡand BISAP were significantly higher in HLAP patients with POF than those without POF [(10. 30 ± 7. 43) vs (5. 34 ± 2. 26) mmol/L, (165. 31 ± 123. 93) vs (65. 61 ± 20. 82)μmol/L, (10. 22 ± 6. 22) vs (4. 61 ± 2. 99) points, (2. 61 ± 0. 87) vs (1. 42 ± 1.07) points], and the differences were all statistically significant (all P<0.05), whereas Hct was not significantly different between the two groups. The AUC of Cr and BUN for predicting POF was 0. 77(95％ CI, 0. 69-0. 86) and 0. 71 (95％ CI, 0. 61-0. 81), respectively, and the optimum predictive Cut-off values were 130 μmol/L and 8. 95 mmol/L, respectively. The sensitivity was 53％, and the specificity was 99％ and 94％;the accuracy was 84％ and 81％;negative predictive value was 81％, and positive predictive value was 96％ and 82％. DeLong test showed that predictive performance of BUN and Cr was not statistically different from that of APACHEⅡand BISAP. Conclusions Cr≥130 μmol/L and BUN≥8. 95 mmol/L can be used clinically to predict the presence of POF in HLAP, and the predictive efficacy were comparable to APACHEⅡand BISAP.

Objective To investigate the pshcyological status and influencing factors of patients with acute pancreatitis. Methods Acute pancreatitis patients admitted in Changhai Affiliated Hospital of Navy Medical University from December 2018 to February 2019 were enrolled, and 120 patients were selected using random number table method. Self-made general questionnaire, self-rating depressing scale, self-rating anxiety scale and coping style questionnaire were used for investigation and patients′ psychological status was evaluated. Results In this survey, 109 questionnaires were collected and eligible for final analysis. The incidence of depression in patients with acute pancreatitis was 44. 0％, and the incidence of anxiety was 20. 2％. Male patients had significantly lower anxiety and depression than women. The levels of anxiety and depression in the 31-50 age group were significantly lower than those in other age groups. The level of anxiety in patients with pancreatitis with children was significantly lower than in patients without children. The coping style of "solving problem" was significantly negatively correlated with depression and anxiety level. The"self-blame" coping style was significantly positively correlated with depression and anxiety level. The"rationalized"coping style was positively correlated with the level of depression. Conclusions The mental health status of patients with acute pancreatitis was not optimistic. Different coping styles were important factors affecting the level of anxiety and depression.

Objective: To explore a new platform for pre-hospital and in-hospital emergency medical services based on a new generation of 5G communication technology, providing a basis for further improving the level of emergency medical services. Methods: This study was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2017 to April 2019. Based on the latest requirements of emergency medical services at home and abroad, the cross-enterprise and multi-disciplinary technical forces were organized to build platform. Firstly, to determine the process of pre-hospital and in-hospital emergency medical services, various modules and technical routes were constructed under 5G conditions and individual technologies were tested one by one. Then they were gradually integrated into two platforms of ambulance and hospital emergency. Finally, the simulation test is carried out under the support of the whole 5G network. Results: The pre-hospital and in-hospital emergency medical service platform based on 5G technology comprises of 5G ambulance, 5G panoramic VR real-time display system, 5G remote ultrasonic examination system, medical drone system, and 5G emergency command platform. 5G ambulance contains medical equipments such as multi-function monitor, ventilator, defibrillation monitor, portable B-ultrasound, high-definition remote video interactive system based on 5G network, VR immersive real-time panoramic experience system, and GPS positioning system. 5G panoramic VR real-time display system includes VR panoramic camera and VR glasses. The wearer with VR glasses can view the real-time situation on the ambulance, which makes a preliminary judgment on the patient's condition and provides rescue guidance. 5G remote ultrasonic examination system integrates robot technology, real-time remote control technology, and ultrasonic imaging technology. The specialist can control the movement of the ultrasonic probe set on the 5G ambulance by manipulating the mechanical arm. The patient's image and color super-picture can also be simultaneously returned to the specialist. The medical drone system enables the medical resources to be allocated in the shortest possible time through the 5G networked drones, so as to eliminate the delay caused by traffic congestion. 5G emergency command platform can integrate, transmit, and display data from multiple sources and forms through web pages in assistance of AI and internet of things. Conclusions The new platform for pre-hospital and in-hospital emergency medical services based on 5G technology can realize more fluent information exchange in pre-hospital and in-hospital, and realize the functions that are difficult to achieve under the previous network conditions.

Objective: To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole. Methods: A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed. Results: In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ²=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631). Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.

Objective To evaluate the accuracy of intraocular lens (IOL) power calculation using IOL-Master in patients underwent phacoemulsification and vitrectomy for idiopathic macular epiretinal membrane (IMEM) concurrent with age-related cataract (ARC).Methods A prospective study was designed.A total of 32 patients (32 eyes) with ARC (ARC group) and 30 patients (30 eyes) with ARC and IMEM (ARC+IMEM group) were enrolled from March 2013 to July 2015 in the Hangzhou District of Eye Hospital of Wenzhou Medical University.All the surgeries were performed by the same experienced surgeon and the same IOL (Adapt-AO) was implanted.IOL power was calculated by both SRK-T and Haigis formulas.The central macular thickness was measured by OCT preoperatively and postoperatively.The mean postoperative refractive prediction error (ME),mean absolute postoperative prediction error (MAE) and percentage of eyes achieved target refraction within ± 0.25,± 0.50 and ± 1.00 D were compared between the 2 groups.The correlation between the refractive error and macular thickness change was evaluated.Results The ME and MAE calculated by Haigis were (-0.47±0.66)D and (0.63±0.44)D in ARC+IMEM group,and (-0.18±0.74)D and (0.68±0.65)D in ARC group.The ME and MAE calculated by SRK-T were (-0.60 ±0.59) D and (0.73 ±0.41) D in ARC +IMEM group,and (-0.23 ±0.85)D and (0.75 ±0.69)D in ARC group.No significant differences were found between the two groups in each formula (all at P＞0.05).There was no significant difference of MAE distribution between the two groups in Haigis formula.In SRK-T formula,the percentage of MAE≤0.25 D in the ARC+IMEM group was significantly higher than that in the ARC group (x2 =7.114,P=0.007).In the A RC+IMEM group,the change of the macular thickness was (-97.4± 115.3)μm,which was statistically correlated with the ME of H aigis and SRK-T formulas (r=0.369,P =0.045;r =0.421,P =0.021).Conclusions There is a tendency toward myopia shift in patients underwent phacoemulsification and vitrectomy compared with conventional phacoemulsification.The myopia shift shows a significant correlation with macular thickness changes.Haigis formula performs better than SRK-T formula with the condition of un-optimized parameters.