Objective To investigate the effect of preoperative anxiety on postoperative recovery and short-term prognosis in patients with liver cancer resection.Methods A total of 96 patients underwent elective open hepatocellular carcinoma resection,with American Society of Anesthesiologists(ASA)grade Ⅰ-Ⅱ were included in this study.Patients were divided into the control group(41 cases,HAMA<7 points)and the anxiety group(55 cases,HAMA≥7 points)according to Hamilton Anxiety Scale(HAMA).Heart rate(HR),mean arterial pressure(MAP)after entering the operating room,operative time,intraoperative bleeding,intraoperative fluid infusion and intraoperative remifentanil consumption were monitored in patients.Recovery time,extubation time,Emergence Agitation(EA)score,the resting and dynamic visual analogue scale(VAS)at 5 min after extubation(T1),6 h(T2),12 h(T3),24h(T4)and 48 h(T5)after surgery,the cumulative effective pressing times of patient controlled analgesia(PCA),the remedy times of analgesic drugs,the postoperative gastrointestinal reaction,exhaust time,hospital stay,the serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels at the 5th day after operation were recorded.Results Compared with the control group,the heart rate and MAP in the anxious group were significantly increased after entering operating room,and the recovery time and extubation time were significantly prolonged(P＜0.05).The incidence of intraoperative remifentanil consumption,EA score,T1,T2,T3 resting and dynamic VAS score,T4 dynamic VAS score,PCA pressing times,analgesic drug remedy times and postoperative gastrointestinal reactions were significantly higher in the anxious group than those in the control group(P＜0.05),and incidence of gastrointestinal reactions,postoperative out of bed time,exhaust time,feeding time and hospital stay were significantly prolonged(P＜0.05).Conclusion Preoperative anxiety is not conducive to anesthesia recovery and short-term prognosis in patients with liver tumor resection.

Objective    To investigate the operation of transcatheter aortic valve replacement (TAVR), the use of TAVR instruments and the current situation of TAVR-related nursing in our country, to reveal the characteristics of TAVR in various hospitals in our country, and to provide reference data for improving perioperative nursing and industry development of TAVR. Methods    A questionnaire survey was conducted among the head nurses of the cardiac catheterization laboratories of 51 hospitals in China that carried out TAVR operations, with a total of 5 items and 23 questions. The current situation of TAVR operation methods, intraoperative instruments and nursing care in China were analyzed. Results    The number of hospitals in China which started conducting TAVR and the beginning year were: 2 in 2010, 1 in 2012, 1 in 2013, 1 in 2015, 11 in 2016, 13 in 2017, 15 in 2018 and 7 in 2019; the number of transfemoral TAVR in 2019: 32 (62.75%) hospitals conducted on less than 20 patients, 7 (13.73%) hospitals 20-<50 patients, 6 (11.76%) hospitals 50-100 patients and 6 (11.76%) hospitals more than 100 patients; TAVR strategies adopted by most hospitals were: general anesthesia (90.20%), the use of vascular sealers (80.39%), backing by cardiac surgeon (74.51%) and using homemade prosthetic valves. Conclusion     At present, the number of TAVR carried out in Chinese hospitals is still far behind that of developed countries in Europe and the United States. Our country has adopted the form of multi-disciplinary cardiac team cooperation and formed a TAVR nursing model with Chinese characteristics.

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825–0.910) in the training cohort and 0.890 (0.844–0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

In mammals, the piezoelectric protein, Prestin, endows the outer hair cells (OHCs) with electromotility (eM), which confers the capacity to change cellular length in response to alterations in membrane potential. Together with basilar membrane resonance and possible stereociliary motility, Prestin-based OHC eM lays the foundation for enhancing cochlear sensitivity and frequency selectivity. However, it remains debatable whether Prestin contributes to ultrahigh-frequency hearing due to the intrinsic nature of the cell's low-pass features. The low-pass property of mouse OHC eM is based on the finding that eM magnitude dissipates within the frequency bandwidth of human speech. In this study, we examined the role of Prestin in sensing broad-range frequencies (4-80 kHz) in mice that use ultrasonic hearing and vocalization (to >100 kHz) for social communication. The audiometric measurements in mice showed that ablation of Prestin did not abolish hearing at frequencies >40 kHz. Acoustic associative behavior tests confirmed that Prestin-knockout mice can learn ultrahigh-frequency sound-coupled tasks, similar to control mice. Ex vivo cochlear Ca²⁺ imaging experiments demonstrated that without Prestin, the OHCs still exhibit ultrahigh-frequency transduction, which in contrast, can be abolished by a universal cation channel blocker, Gadolinium. In vivo salicylate treatment disrupts hearing at frequencies <40 kHz but not ultrahigh-frequency hearing. By pharmacogenetic manipulation, we showed that specific ablation of the OHCs largely abolished hearing at frequencies >40 kHz. These findings demonstrate that cochlear OHCs are the target cells that support ultrahigh-frequency transduction, which does not require Prestin.
Animals ; Cochlea/metabolism* ; Hair Cells, Auditory, Outer/metabolism* ; Hearing ; Humans ; Mammals/metabolism* ; Mice ; Mice, Knockout ; Molecular Motor Proteins/metabolism*

Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities.Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May,2014 to May,2018.A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle,of which there were 19 cases of upper limbs and 18 of lower limbs.There were 27 cases of defects caused by trauma,and 10 by soft tissue tumor resection.The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line.The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm,and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm.The length of vascular pedicle ranged of 7.0-13.0 cm,with an average of 11.5 cm.The donor sites were directly sutured.All of the patients were followed-up regularly in the outpatient department.Results All the flaps survived and the donor sites were primarily healed.Of these 37 cases,2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing,but still healed after multiple dressing changes.All the patients were followed-up for 3-26 months,with an average of 13 months.The texture,color and elasticity of the flap were similar to the surrounding tissue of the recipient sites,while only a linear scar remained at the donor sites.Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation;there was no tumor recurrence during the follow-up period.Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliacpatellar line,which locates in the upper lateral side,travels parallel to the vastus lateralis,and give off the skin and muscular perforators.The lateral branch can be used as pedicle to make into perforator flap or chimeric flap,which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap.When the descending branch does not provide a thick and large perforator,the LBLCFA has important practical value and is worth utilizing in the clinic.

Objective To evaluate the safety of morphine hydrochloride injection. Methods Ear verin injection was used to evaluate the vascular irritation using the comparison of left side with right side in rabbits. Quadriceps femoris injection was used to evaluate the muscle irritation using the comparison of left side with right side in rabbits. Guinea pigs were intravenously injected with morphine hydrochloride injection at a dose of 2.8 mg·kg-1 once daily 3 times, stimulation was performed on 14 d after the last sensitization and the booster dose was 2 times the sensitization dose. The allergic reactions were observed. The different concentrations of morphine hydrochloride injection were placed in 2％ rabbit erythrocyte suspension, and then the hemolyzation and agglutination were observed. Results There were no significant vascular or muscular irritation and injury effects of morphine hydrochloride injection in rabbits. There were no evidenceof hemolyzation and agglutination in rabbit erythrocytes in vitro. No allergic reactions on guinea pigs in vivo were observed. Conclusion After treatment of morphine hydrochloride injection, neither obvious vascular /muscle stimulation or sensitization, nor hemolyzation or agglutination appeared in rabbits. The research results provide basic reference for the clinical rational and safe application of morphine hydrochloride injection.

OBJECTIVE:To observe the effects of dexmedetomidine combined with ulinastatin on stress reaction indexes,ex-travascular lung water value(EVLW)and pulmonary vascular permeability indexes(PVPI)and other parameters in one-lung venti-lation(OLV)lobectomy patients. METHODS:A total of 80 patients underwent OLV lobectomy selected from the Affiliated Hospi-tal of Southwest Medical University during Nov. 2015-Nov. 2016 were divided into control group (group N),ulinastatin pretreat-ment group(group U),dexmedetomidine continuous pump group(group D),ulinastatin pretreatment+dexmedetomidine continu-ous pump group(group U+D),with 20 cases in each group. Thirty min before anesthesia induction,all patients were given atro-pine sulfate 0.5 mg intramuscularly and received catheterization of right internal jugular vein and ipsilateral femoral artery under lo-cal anesthesia. Based on that,group N was given 0.9％ Sodium chloride injection 100 mL intravenously;group U was given sodi-um chloride mixed solution 100 mL containing Ulinastatin for injection 200000 U intravenously;group D was given continuous in-travenous pump of Dexmedetomidine hydrochloride injection 2 μg/mL mixed with sodium chloride mixed solution at 1 μg/(kg·h), and after induction intravenous pump at 0.5 μg/(kg·h)until the end of surgery;group U+D was given Sodium chloride mixed so-lution containing 200000 U ulinastatin 50 mL and 4 μg/mL dexmedetomidine sodium chloride mixed solution 50 mL intravenously (same dose as above during induction period and maintenance period). The levels of blood glucose,partial pressure of oxy-gen [p(O2)],adrenocorticotropic hormone (ACTH),norepi-nephrine (NE),heart rate (HR),cardiac output (CO),sys-temic vascular resistance(SVR),EVLW and PVPI were com-pared among 4 groups 30 min before anesthesia induction(T1),2 h after the beginning of surgery(T2),immediately after extuba-tion(T3)and 12 h after surgery(T4). Liquid intake and output volume were recorded during T2-T4. The occurrence of ADR among 4 groups was observed. RESULTS:There was no statistical significance in each index among 4 groups at T1 (P>0.05). During T2-T4,the levels of blood glucose,ACTH,NE,SVR,EVLW and PVPI in group N were significantly higher than other 3 groups, and group U and D were significantly higher than group U+D,with statistical significance(P<0.05);there was no statistical sig-nificance between U and D(P>0.05). The levels of p(O2)and CO in groups U+D were significantly higher than other 3 groups, with statistical significance (P<0.05);there was no statistical significance among other 3 groups (P>0.05). HR of group N and U were significantly higher than other 2 groups,with statistical significance (P<0.05). There was no statistical significance be-tween group N and U,between group D and U+D(P>0.05). There was no statistical significance in liquid intake or output vol-ume among 4 groups (P>0.05). No obvious ADR was found in 4 groups. CONCLUSIONS:Dexmedetomidine combined with ulinastatin can significantly relieve stress reaction,and reduce the levels of part blood flow and respiratory dynamics indexes as EV-LW,PVPI in patients with OLV lobectomy so as to play lung protective effect.

Objective To evaluate the predictive value of tumor metabolic indexes measured by 18F-FDG PET/CT in recurrence of stage Ⅰ NSCLC after surgery.Methods A total of 85 patients (44 males,41 females,age (62.46± 10.38) years) in Shanghai Renji Hospital with stage Ⅰ NSCLC,who underwent 18F-FDG PET/CT and subsequent surgical resection,were retrospectively enrolled from April 2006 to December 2011.Gender,age,tumor size,pathology,SUVmax,MTV and TLG of the primary tumor were selected as variables.ROC curve analysis was used to analyze the cut off value.The prognostic significance of parameters for recurrence-free survival (RFS) was evaluated by univariate and multivariate analyses.Survival analysis was analyzed by Kaplan-Meier method.Results During follow-up period,tumor recurrence occurred in 21 patients (24.7％,21/85) and 11 patients (12.9％,11/85) died.The median follow-up period was 44 months.The median values of SUVmax,MTV and TLG were 4.100,3.048 cm3 and 7.970,respectively.Cut off values of SUVmax,MTV and TLG were 7.115,4.701 cm3 and 12.015 according to ROC curve analysis.Univariate Cox analysis showed that SUVmax(x2 =22.091),MTV (x2 =4.941) and TLG(x2 =10.488) were associated with RFS(all P＜0.05).But gender,age,tumor size,and pathology were not independent risk factors of recurrence (x2=0.248-3.888,all P＞0.05).Multivariate Cox analysis revealed that SUVmax(=16.902,HR=15.426,P＜0.05) and TLG (x2=6.029,HR=4.054,P＜0.05) were independent prognostic factors for recurrence.Kaplan-Meier survival analysis showed that the period of RFS in high SUVmax (＞ 7.115) group (x2=32.545,P＜0.05) and in high TLG (＞12.015) group (x2=12.665,P＜0.05) were lower than those in low SUVmax group and low TLG group.Conclusion The SUVmax and TLG measured by 18F-FDG PET/CT have significant value for predicting the recurrence of stage Ⅰ NSCLC.

Objective To explore the clinical effect and safety of oxycodone hydrochloride in the induction of genenral anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 35-75 years,sched-uled for colorectal surgery,undergoing general aneasthesia were randomly divided into two groups with 30 cases in each group:fentanyl group (group F)and oxycodone hydrochloride group (group O).Fentanyl 2 μg/kg+propofol 2 mg/kg+cisatracurium 0.1 5 mg/kg (group F)or oxycodone 0.2 mg/kg+propofol 2 mg/kg + cisatracurium 0.1 5 mg/kg (group O)was administered intravenously for general anesthesia induction.MAP and HR were monitored and recorded before the induction (T0 ),1 min before intubation (T1 ),at the time of intubation (T2 ),1 min after intubation (T3 )and 5 min after intubation (T4 ).Side-effect incidence of each group,operation time,wakening time,extuba-tion time and visual analogue scale (VAS)were recorded.Results Compared with group F,MAP in group O were lower than that of group F at T1 (P <0.05),while HR between two groups at T0-T4 showed no significant difference.In group F,there were statistical significances in MAP and HR be-tween T1-T3 and T0 ;in group O,there were statistical significances in MAP between T1-T2 and T0 , and HR at T2-T3 was significantly higher than that at T0 (P <0.05).No statistical significance were obtained between two groups in the operation time,wakening time and extubation time.The incidence of cough and the VAS of group O was less than that of group F with statistical significance (P <0.05).Conclusion Oxycodone hydrochloride used for the intubation of general anesthesia is practica-ble.

OBJECTIVETo explore the clinical and laboratory characteristics in favor of the diagnosis of Ph/BCR-ABL positive acute myeloid leukemia (Ph/BCR-ABL⁺ AML).

METHODSRetrospectively analyzed the clinical and laboratory characteristics of 12 Ph/BCR-ABL⁺ AML cases from Feb, 2006 to Dec, 2013, with classic myeloid blast crisis of chronic myeloid leukemia (CML-MBC) as control, and followed-up the survival in these two cohorts of patients.

RESULTSThe median age of 12 Ph/BCR-ABL⁺ AML was 27.5 years, 10 cases (83.3%) showed non/mild splenomegaly, and mainly comprised of M₂ and M₄ subtypes according to FAB classification. The median number of basophils and megakaryocytes in peripheral blood and bone marrow was lower than that of CML-CBC patients. All the cases expressed myeloid antigens, 8 cases (66.7%) expressed CD34, 11 cases were detected with t(9;22), 5 cases (45.5%) with additional chromosomal abnormalities, including 1 case of inv(16). All the cases had BCR-ABL transcripts at diagnosis:3(25.0%) cases were e1a2 type and the remaining was b2a2/b3a2type, among which 1 case coexpressed CBFβ-MYH11. Two out of 6 cases existed AML-like mutations:1 case of CEBPA and the other of FLT3-TKD. For all the patients, 7 cases achieved complete remission (CR), including 6 out of 7 cases receiving induction chemotherapy combined with tyrosine kinase inhibitor (TKI) achieved CR, and 1 out of 3 cases receiving chemotherapy alone achieved CR. The median overall survival was 16.5 months, that of allo-HSCT group was 33.5 months, which was higher than that of non-HSCT group (5.5 months).

CONCLUSIONThe expression of e1a2 type BCR-ABL, the coexpression of fusion genes which were more common in AML, the existence of AML-like mutations were all indications of a de novo Ph/BCR-ABL⁺ AML. Low induction CR rate and short survival of Ph/BCR-ABL⁺ AML implied that chemotherapy combined with TKI and followed by allo-HSCT in CR was the only effective way to improve their survival.