Objective Evaluate the performance of the encephalon state index(ESI)in depth of anesthesia monitoring during clinical surgery,compared with the bispectral index(BIS).Methods ESI and BIS data were collected from 60 patients in a single-center clinical trial to compare their efficacy in measuring the depth of anesthesia.Results Consistency analysis revealed mean differences and standard deviations of-0.18±5.42 and-0.11±6.51 between ESI and BIS for awake and anesthetized states,respectively.Correlation analysis showed a correlation coefficient of 0.92 throughout the operative period.Prediction probability analysis indicated that both ESI and BIS had prediction probabilities of 0.97,effectively predicting anesthesia status.Conclusion ESI and BIS show good equivalence in monitoring depth of anesthesia during clinical surgery,which meet the requirements of clinical anesthesia.

Objective:To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-" 8" suture.Methods:From January 2018 to December 2020, 24 children (14 males and 10 females, aged 6-15 years) with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction, non-absorbable Krackow-" 8" suture for the base of the anterior cruciate ligament, and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks, followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results:All the 24 cases were successfully operated, with the operation time of (63.1±20.2) (40-115) min.All children were followed up for 24-36 months[(28.7±3.4) months]. All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement, suture rupture, or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up, the Lysholm score and IKDC 2000 subjective score were (94.4±4.8) points and (93.8±5.6) points, respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions:Arthroscopic reduction with non-absorbable Krackow-" 8" suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures, minimal invasiveness, which is an effective treatment method.

OBJECTIVE: Reduce the number of false alarms and measurement time caused by movement interference by the sync waveform of the movement. METHODS: Vital signal monitoring system based on motion sensor was developed, which collected and processed the vital signals continuously, optimized the features and results of vital signals and transmitted the vital signal results and alarms to the interface. RESULTS: The system was tested in many departments, such as digestive department, cardiology department, internal medicine department, hepatobiliary surgery department and emergency department, and the total collection time was 1 940 h. The number of false electrocardiograph (ECG) alarms decreased by 82.8%, and the proportion of correct alarms increased by 28%. The average measurement time of non-invasive blood pressure (NIBP) decreased by 16.1 s. The total number of false respiratory rate measurement decreased by 71.9%. CONCLUSIONS False alarms and measurement failures can be avoided by the vital signal monitoring system based on accelerometer to reduce the alarm fatigue in clinic.
Humans ; Monitoring, Physiologic ; Electrocardiography ; Arrhythmias, Cardiac ; Blood Pressure ; Accelerometry ; Clinical Alarms

Objective To explore the effect of 5M1E quality analysis tool-based hand hygiene(HH) comprehensive intervention measures on pediatric healthcare-associated infection(HAI).Methods HH status of 29 health care workers(HCWs) in the pediatric department of a hospital was monitored, April-June 2015 was baseline survey stage, 5M1E quality analysis tool was adopted to analyze various factors affecting the compliance rate of pediatric HH, intervention measures began to be taken in June 2015, and compared with HH in July 2015-March 2016.The occurrence of HAI between July 2014-March 2015 and July 2015-March 2016 was compared.Results HH compliance rate of HCWs increased from 30.86% in April-June 2015 to 81.94% in January-March 2016;HH correct rate increased from 68.14% to 93.75%;HH compliance rate and correct rate of HCWs gradually increased(X2=2 608.626, 630.798,respectively, both P<0.001).Qualified rate of detection of HCWs' HH sampling increased from 20.69% in April-June 2015 to 89.66% in January-March 2016(X2=31.957,P<0.001).Incidence of HAI decreased from 7.74% in July 2014-March 2015 to 3.62% in July 2015-March 2016(X2=46.717,P<0.001).Conclusion Application of 5M1E quality analysis tool in the investigation, analysis, and comprehensive intervention in HCWs' HH in pediatric department has greatly enhanced HCWs' HH compliance rate, and reduced the incidence of HAI in pediatric patients.

Objective To observe the effects and mechanism of lung inflation with carbon monoxide (CO) during the cold ischemia phase on lung ischemia-reperfusion injury (IRI) after rat lung transplantation.Method Twenty-four pairs of SD rats were selected to establish the model of lung transplantation,and random number method was used to divide 24 donors into 3 groups with 8 rats in each group.(1) CO inflation group (CO group):During the cold ischemia phase,500 ppm CO +volume fraction 40％ O2 + N2 was used for lung inflation,and the volume was 5 mL/kg;(2) O2 inflation group (O2 group):During the cold ischemia phase,volume fraction 40％ O2 + volume fraction 60％ N2 was used for lung inflation;(3) Control group:The lung was deflated during the cold ischemia phase.The gas was replaced every 30 min in the CO and O2 groups,and the lung transplantations were performed after 180 min of cold ischemia.The arterial blood gas analysis was performed at baseline,3 min after reperfusion,and 60,120,and 180 min after reperfusion.The recipient serum levels of relative inflammatory factors,lung tissue cell apoptosis and nuclear factor kappa B (NF-κB) protein expression were detected after 180 min of reperfusion.Result As compared with the control group (238 ± 61 mm Hg),the oxygenation index in the O2 group (293 ± 78 mm Hg) and CO group (361 ± 48 mm Hg) was increased (P＜0.05),and as compared with the O2 group,that in the CO group was increased (P＜0.05).Furthermore,as compared with the control group,the interleukin (IL)-8,tumor necrosis factor (TNF)-α,and cell apoptosis in the O2 group and CO group were decreased significantly,and as compared with the O2 group,those in the CO group and NF-κB protein expression were significantly decreased (P＜0.05).Conclusion Lung inflation with CO during the cold ischemia phase ameliorated the rat lung IRI via reducing the inflammatory response and cell apoptosis mediated by the NF-κB pathway.

Objective To evaluate the clinical outcomes of lumbar spinal stenosis treated with three different surgical modalities.Methods One hundred and forty patients were treated with posterior lumbar interbody fusion (PLIF,n =50),transforaminal lumbar interbody fusion (TLIF,n =40) or modified method (n =50).The operation time and intraoperative blood loss were compared.The outcones were evaluated with Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS),and the radiographic findings were also reviewed.Results The operation time was shorter and the intraoperative blood loss was less in modified group than those in other two groups (F =10.02,P ＜0.05).The excellent and good rate was 90％ (45/50) in PLIF group,92％ (37/40) in TLIF group and 90％ (45/50) in modified group.No complication happened in both TLIF group and modified group.Two patients had cerebrospinal fluid leakage in PLIF group.The JOA scores and VAS scores were significantly improved 3 and 6 months after surgery in three groups (F =10.66,9.68,11.03,all P ＜ 0.05).There were no significant differences in JOA scores and VAS scores among three groups before operation (P ＞ 0.05),also in JOA scores after operation among three groups.The VAS scores in TLIF group and modified group 3 and 6 months after operation were significantly lower than those in PLIF group (F =9.46,10.02,all P ＜ 0.05),but there was no significant difference between TLIF group and modified group.Interbody fusion was good in all three groups.Conclusions Three surgical methods have good clinical outcomes for lumbar spinal stenosis.But compared with PLIF and TLIF,the modified method has less blood loss,shorter operation time and less pain after operation.

Objective To evaluate the relationship between the concentration of pentane in the exhaled air and degree of the lung injury in non-heart-beating (NHB) rabbits.Methods Twenty-four healthy male Japanese white rabbits weighing 2.4-3.0 kg were randomly divided into 4 groups ( n =6 each):A,B,C and D groups.The NHB model was established by exsanguination through the femoral artery.The exhaled gases were collected and lung tissues were removed at 0,30,60 and 120 min after cardiac arrest in A,B,C and D groups respectively.The concentration of pentane in the exhaled gases was detected immediately using the gas chromatography-mass spectrography.The wet to dry (W/D) lung weight ratio and content of malondialdehyde (MDA) in lung tissues were measured.The lung injury score (LIS) was recorded.The maximal volume ( Vmax ) of the lung was recorded when the airway pressure reached 30 cm H2O.Results Compared with groups A and B,the exhaled pentane concentration was significantly increased in group C,and the W/D ratio,content of MDA and LIS were significantly increased,while Vmax was significantly decreased in group D ( P ＜ 0.05).Compared with group C,W/D ratio and LIS were significantly increased in group D ( P ＜ 0.05 ).Conclusion The concentration of exhaled pentane can not reflect the degree of the lung injury in NHB rabbits.

ObjectiveTo establish a enzyme-linked immunosorbent assay (ELISA) method for detecting the β-amyloid peptide 42 ( Aβ42 ) and explore its clinical meaning for diagnosis and treatment in the early stages of the alzheimer disease ( AD).Methods Using the Aβ42 single chain variable fragment constructed by phage antibody library display system as coat antibody,associated with the Aβ42 polyclonal antibody acquired by Aβ42 immunized rabbit and HRP labeled goat anti rabbit IgG to establish ELISA method for detecting the Aβ42 in peripheral blood.The method was used it to test the Aβ42 in 120 vascular dementia VD) or cerebral vessel infarction patients and 120 AD patients and 120 controls.The methodology performance were evaluated.ResultsThe inter and intra coefficient of variable (CV) of this self-established ELISA method was 3.6％ and 3.5％,6.8％ and 7.1％ respectively.The recovery rate was 97.2％ -103.1％.The linear range was 0.050 - 2 μg,/L.Its reactivity decreased ＜ 12％ when it was put in both 37 ℃ for 6 days and 4 ℃ for 6 months.Compared with the Belgium INNOTEST reagent by testing 90 samples simultaneously,the results of self-established method was (0.207 ± 0.039 ) μg/L,the results of INNOTEST was (0.206± 0.038 ) μg/L; the regression equation was Y =1.011X - 0.003,R2 =0.979,P ＜0.01.The Aβ42 in blood of AD group was (0.247 ± 0.032 ) μg/L,VD or cerebral vessel infarction group was (0.173 ±0.028) μg/L,control group was (0.172 ±0.032) μg/L.The Aβ42 in AD group was higher than that in the VD or cerebral vessel infarction group and control group (q =18.867,18.907respectively,P ＜ 0.01 ).The cut off value was 0.212 μg/L decided by the receiver operating characteristic (ROC) curve.The reference interval was 0 -0.212 μg/L.The sensitivity of this ELISA method was 86.7％(104/120) and specificity was 90.8％ (218/240).ConclusionsThe ELISA method for detecting Aβ42 in peripheral blood established by the study is sensitive and specific and has good precision and stability.It could provide a new effective criterion and support for the early diagnosis and treatment of the AD patients.

Objective To investigate the effects of inhalation of different concentrations of carbon monoxide (CO) on brain death (BD)-induced lung injury in rats. Methods Thirty-two pathogen free adult male Wistar rats weighing 250-300 g were randomly divided into 4 groups ( n= 8 each): group Ⅰ sham operation (group S);group Ⅱ brain death (group BD) and group Ⅲ and Ⅳ BD + CO 0.025% and 0.050% (group C1, C2 ). The animals were anesthetized and tracheally intubated. Fogarty catheter was inserted into the skull. BD was induced by inflating the balloon slowly at 20 μl/min until apnea developed. The animals were then mechanically ventilated (VT 10 ml/kg, RR 50 bpm, PEEP 2 cm H2O) with 40% O2 in N2 . In group Ⅲ and Ⅳ CO 0.025% and 0.050%were added to the air mixture respectively. In group S the balloon was not inflated. BD was confirmed by apnea,dilated pupils and flat EEG. In group BD,C1 and C2, MAP was maintained at 80-120 mm Hg by norepinephrine infusion. The arterial blood gas analysis was performed before (baseline) and immediately after BD was confirmed (T1) and at 30, 60, 90 and 120 min (T2-5) of CO inhalation. The animals were then sacrificed. The plasma concentrations of IL-6 and TNF-α and the activity of myeloperoxidase (MPO) in the lungs were measured. The W/D lung weight ratio and lung injury score (LIS) were recorded. Results BD significantly decreased PaO2/FiO2, BE and pH while increased plasma IL-6 and TNF-α concentrations, MPO activity in the lungs, the W/D ratio and lung injury score as compared with group S. CO inhalation ameliorated the deleterious effects induced by BD. The antiinfiammatory effect of 0.050% CO was better than that of 0.025 % CO. Conclusion Inhalation of 0.025 % or 0.050% CO can ameliorate BD-induced lung injury in rats, but there is no significant difference in the efficacy.

Objective To test the antiproliferative and proapoptotic effect of Survivin small interfering RNA(siRNA) expression vector on lung adenocarcinoma cell A549 in vitro.Methods The Survivin-siRNA expression vector was constructed and conformed by sequencing.The inhibitory effect of Survivin-siRNA was tested by fluorescent quantitative reverse transcription polymerase chain reaction(FQ RT-PCR),Western blot and immunohistochemistry.The cell proliferation and apoptotic rate were assayed by tetrazolium bromide(MTT)colorimetry and flow cytometry.Results Survivin-siRNA expression vector was constructed and transfected into A549 cell.It effectively reduced mRNA and protein level of Survivin.Immunohistochemistry also showed lower expression of Survivin.The A549 cells transfected with Survivin-siRNA had a lower cellular growth rate than that of control group(P