Objective:To investigate key differential expressed genes(DEGs),enriched biological functions and signaling pathways in exosomes derived from angiosarcoma cells ISOHAS and angiosarcoma stem-like cells Sphere by bioinformatics analysis,to provide new therapeutic targets for angiosarcoma.Methods:Transcriptome sequencing of exosomes derived from ISOHAS and Sphere were performed to screen for DEGs by|log2FC|>2 and FDR<0.05 as criteria.Bioinformatics analysis was used to enrich GO and KEGG pathways of DEGs to identify biological functions and signaling pathways of enriched DEGs.STRING database was used to screen key DEGs,and iPath was used to visualize to identify metabolic pathways enriched by DEGs.Results:Transcriptome sequencing results showed that 91 DEGs were identified in exosomes derived from ISOHAS and Sphere.GO and KEGG pathway enrichment analysis demonstrated that main biological functions and signaling pathways enriched by DEGs were response to glucocorticoid and TNF signaling pathway,respectively.STRING database demonstrated that TNF and IL-6 were key DEGs.iPath metabolic network analysis demonstrated that DEGs were mainly identified in lipid metabolism and nucleotide metabolism.Conclusion:Sphere-derived exosomes may influence occurrence and development of angiosarcoma by carrying key genes TNF and IL-6 to interfere with glucocorticoid response,TNF signaling pathway,lipid metabolism,nucleotide metabolism and other biological functions and signaling pathways,providing new ideas for therapeutic targets for angiosarcoma.

OBJECTIVES: Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery. METHODS: From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group ( RESULTS: In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both CONCLUSIONS Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.
Abdomen/surgery* ; Aged ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Intravenous ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Propofol ; Remifentanil ; Surgical Procedures, Operative

Objective: To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis. Methods: The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results: Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×10⁴ yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×10⁴ yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ²=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×10⁹/L to (6.8±1.9)×10⁹/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×10⁹/L to (7.5±1.9)×10⁹/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05). Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.

Objective: To observe whether the active forced-air warming has the same efficacy on the prevention of perioperative hypothermia in the elderly as compared with young patients. Methods: This was a prospective, randomized, controlled clinical trial.Forty patients scheduled for abdominal surgery under general anesthesia were allocated to two groups: the elderly group and the young group(n=20, each). All patients received active forced-air warming at 20-30 min before induction of anaesthesia till leaving the operation room.Blood products and peritoneal lavage fluids were warmed to 37℃, and other intravenous fluids were at room-temperature.The core temperatures were recorded after entering the operation room(baseline), before induction of anaesthesia, at 15 min intervals after induction of anaesthesia, at the end of surgery and before leaving the operation room.The postoperative shivering and adverse reactions were also recorded. Results: The core temperature was lower in elderly patients than in young patients at baseline and at each time points after 30 min of induction of anaesthesia(P<0.05). In elderly patients, the core temperature was significantly lower before leaving operation room than at the baseline(t=2.353, P=0.03), but in young patients, no significant difference was found in the core temperature between at the baseline and before leaving operation room(t=0.233, P=0.818). The incidence of intra-operative hypothermia was higher in elderly patients than in young patients(40.0% or 8/20 vs.5.0% or 1/20, c²=7.025, P=0.008). Conclusions During abdominal surgery under general anesthesia, active forced-air warming cannot effectively prevent perioperative hypothermia in elderly patients as compared with young patients.

Objective: To comb the thread and trend of critical care fields in China for nearly 15 years, analyze research frontiers, demonstrate research evolution paths, provide reference for researchers and clinicians to carry out related work. Methods: Using CiteSpace software and CNKI database to retrieve research literature about critical care from 2004 to 2018 in China for visual analysis. Results: A total of 3 049 valid articles were retrieved. The research frontiers were mainly about emergency and critical nursing, nursing quality management, intensive care, clinical teaching quality and ICU nurses. Research trends from critical care, critically ill patients, disease condition change, to quality control, family members, nursing skills, basic nursing, now gradually turned to humanized care, nursing strategies, sustainable human care concepts, evolution map showed that emerging trend was more active. Conclusions In last 15 years, research fields of critical care in China have evolved actively, exploring research frontiers, focus on important topics such as evidence-based nursing,humanistic care nursing concept, intensive care information system, and cluster management strategy, extending and deepening professional development of critical care.

Objective: To analyze and summarize the ultrasonographic features of fibrolamellar hepatocellular carcinoma (FLHCC). Methods: The ultrasound images were retrospectively analyzed in 23 FLHCC cases which were confirmed by pathology, including the size, echogenicity, boundary and other features on gray scale ultrasound, color Doppler flow imaging and enhancement patterns on contrast-enhanced ultrasound (CEUS). Results: Twenty-three patients had 23 lesions of FLHCC. The average age was (40.0±17.1) (15-77) years old and among them 3 cases had liver cirrhosis(13.0%). The maximum diameter of FLHCC lesions was 2.5-16.7 cm and the average was (7.2±4.3)cm. On gray scale ultrasound, 82.6% (19/23) lesions were hypoechoic, 78.3% (18/23) lesions showed cord-like or sheet-like hyperechoic area and 47.8% (11/23) lesions displayed strip-like echogenic attenuation in the center, with calcification in 17.4% (4/23) lesions. There were 91.3% (21/23) lesions showed peripheral and internal rich color flow signals on color Doppler flow imaging and 60.9% (14/23) with subcapsular thick blood vessels. All 8 FLHCC lesions displayed early and hyper-enhancement in the arterial phase and wash-out in the portal and delayed phases on CEUS. Internal nonenhanced scar-like area was appeared in all lesions on CEUS. Conclusions Patients with FLHCC are mostly young and few with liver cirrhosis. Ultrasonographic features are characterized by relatively large-sized mass with internal acoustic attenuation or calcification on gray scale ultrasound and hypervascularity with central scar on CEUS.

Objective To investigate the disinfection effect and cytotoxicity of intelligent water treatment system on dental unit waterlines (DUWLs), so as to provide basis for the safe and intelligent treatment of DUWLs.Methods From September to October 2017, 4 dental units with intelligent water treatment system were selected as the experimental group, and 4 dental units with municipal water as the source of water supply were used as the control group. The microbiological quality of water samples collected from DUWLs was assessed before and after installation of the intelligent water disinfection system in terms of the total viable counts of microorganisms. Studentt was used to detect the inhibitory effect of water samples on oral microorganism and its toxicity on human oral normal clone.Results After thoroughly disinfecting the waterlines of the dental unit, the bacteria of dental unit in the control group could rapidly grow up to (3.2±1.02) ×103 CFU/ml within 1 weeks, and the experimental group could be maintained at <100 CFU/ml, the difference was statistically significant (P<0.05); In the control group, Pseudomonas aeruginosa, non tuberculous mycobacteria and Acinetobacter baumannii could be detected in the water samples of the control group, while the above pathogens were not be detected in the experimental group. The water samples in the experimental group had significant inhibitory effects on the common bacteria in the dental unit waterlines and in the human oral cavity (P< 0.05), but only a lower cytotoxicity was shown to the epithelial cells of the human oral cavity.Conclusions The intelligent water treatment system can effectively reduce microbial contamination in dental waterlines and provide safe water for patients.

Objective : To explore an efficient method for the establishment of three-dimensional (3-D) digital models of maxillofacial region including muscle tissue based on CT and MRI images fusion on a personal computer, integration of CT and MRI data, and provide accurate 3D model for biomechanical analysis. Methods : A male volunteer was scanned on maxillofacial region by spiral CT and MRI. Two kinds of data obtained were imported into Mimics 15. In the three sections, namely the transverse, sagittal, coronal sections, two kinds of data were adjusted to the same anatomical layers. The most obvious anatomical points on each layer were selected as registration points. Then, the multi-points registration was implemented for data fusion. Then the bone and facial skin were segmented and 3D reconstructed using CT data, the main facial muscles were segmented and 3D reconstructed using MRI data. Results: The 3D model including 3 pairs of masticatory muscles, 12 pairs of facial expression muscles, facial skin and jaw tissues were established. Conclusion The efficient registration and fusion of CT and MRI datas were accomplished. Moreover, this method can be used for further segmentation and reconstruction of other important structures in craniofacial area, such skin, blood vessel, fat, lymph node and the brain tissues.

Objective To evaluate the effect of wire-reinforced polyurethane epidural catheters on the success rate of epidural catheterization in the patients undergoing caesarean section.Methods A total of 182 pregnant patients,aged 25-43 yr,with body height of 145-178 cm,weighing 51-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were divided into 2 groups using a random number table:polyvinyl chloride epidural catheter group (group Ⅰ,n =94) and wire-reinfnrced polyurethane epidural catheter group (group 11,n=88).Spinal or epidural puncture was performed at L2,3 or L3,4 interspace,and the corresponding epidural catheter was inserted in each group aficr succcssful puncturc.Thc dcvclopment of difficult insertion,intravascular catheter insertion or paresthesia during puncture or insertion was defined as a failure of epidural catheterization.The occurrence of failed epidural catheterization was recorded.Results The failure rate of epidural catheterization was significantly lower in group 1Ⅱ than in gronp Ⅰ (P＜0.05).Conclusion Wire-reinforced polyurethane epidural catheters can raise the success rate of epidural catheterization in the patients undergoing caesarean section.

Objective To determine the effective dose 50 (ED50) of sufentanil blunting the responses to double-lumen endotracheal intubation under propofol in elderly patients.Methods A retrospective analysis was conducted on patients aged 65-78 years with body mass index＜30 kg/m2 , American Society of Anesthesiologists (ASA) I or Ⅱ and Mallampati grade Ⅰ or Ⅱ who underwent onelung ventilation under general anesthesia.Induction of anesthesia was initiated with sufentanil.Then propofol was administered to maintain a bispectral index (BIS) value ranging between 45 and 55.When the patients lost consciousness, cisatracurium 0.30 mg/kg was administrated, followed by double lumen endotracheal intubation.The dose of sufentanil was determined by the up and down sequential test.The initial dose was 0.50 μg/kg and the difference between two successive doses was 0.10 μg/kg.Responses to double-lumen endotracheal intubation were defined as the increase in invasive systolic blood pressure≥20％ of the baseline values and/or heart rate ＞90 bpm within 3 min after tracheal intubation.The ED50 (95％ confidence interval) of sufentanil blunting the responses to double-lumen endotracheal intubation was calculated.Results The ED50 (95％confidence interval) of sufentanil blunting the responses to double-lumen endotracheal intubation in elderly patients was 0.331 μg/kg, and the 95％ confidence interval was 0.246-0.409 μg/kg.Conclusions Under propofol to maintain BIS 45 55, the ED50 of sufentanil blunting the responses to double-lumen endotracheal intubation in elderly patients was 0.331 μg/kg.