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Objective To evaluate the efficacy of patient-controlled brachial plexus block with different concentrations of dexmedetomidine mixed with ropivacaine for analgesia after elbow joint surgery.Methods One hundred patients of both sexes,aged 18-64 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elbow joint surgedyy,were divided into 4 groups (n =25 each) using a random number table method:different concentrations of dexmedetomidine mixed with ropivacaine groups (DR1-3 groups) and ropivacaine group (group R).An analgesia pump was connected at the end of surgery and patient-controlled brachial plexus block was performed.The patient-controlled analgesia (PCA) solution contained 0.5 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR1,0.75 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR2,1 μg/ml dexmedetomidine and 0.2％ ropivacaine in group DR3 and 0.3％ ropivacaine in group R.All the drugs were diluted to 400 ml in normal saline in each group.The PCA pump was set up to deliver 3 ml bolus dose with a 20-min lockout interval and background infusion at 5 ml/h.Parecoxib 0.6 mg/kg was intravenously injected as a rescue analgesic.The visual analogue scale (VAS) scores at rest and during movement (voluntary and continuous passive movement) were recorded at the end of surgery and 12,24,36,48 and 72 h after surgery.The number of successfully delivered doses,the number of attempt and postoperative consumption of parecoxib were recorded.The elbow flexion angle during voluntary and continuous passive movement was recorded.The development of motor block and drug-related adverse reactions was also recorded.Results There was no significant difference in VAS scores at rest at each time point among the four groups (P＞0.05).Compared with group R,the VAS scores during movement,the number of attempts,the number of successfully delivered doses and parecoxib consumption were significantly increased in DR1 and DR2 groups,the elbow flexion angle during voluntary and continuous passive mnovement was significantly decreased in group DR1,the elbow flexion angle during continuous passive movement was significantly decreased in group DR2,and the elbow flexion angle during voluntary movement was significantly increased (P＜0.05),and no significant change was found in the other parameters in group DR3 (P＞0.05).Compared with group DR1,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in DR2 and DR3 groups (P＜0.05).Compared with group DR2,the VAS scores during movement were significantly decreased,the number of attempts,the number of successfully delivered doses and parecoxib consumption were decreased,and the elbow flexion angle during voluntary and continuous passive movement was increased in group DR3 (P＜0.05).No motor block was found in DR1,DR2,and DR3 groups,and the incidence of motor block was significantly higher in group R than in the other three groups (P＜0.05).The hemodynamics was stable and no drug-related adverse reactions were found in the perioperative period in the four groups.Conclusion Patient-controlled brachial plexus block with dexmedetomidine 1 μg/ml mixed with 0.2％ ropivacaine can provide satisfactory analgesia and is helpful in improving prognosis for the patients undergoing elbow joint surgery.
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Objective To compare the effects of general anesthesia and epidural block anesthesia on postoperative short-term cognitive function of elderly orthopedic patients.Methods From January 2015 to March 2013,80 elderly patients with orthopedic surgery in the Sixth Hospital of Ningbo were selected in the research ,According to the anes-thesia method,40 patients received general anesthesia were enrolled into general anesthesia group ,40 patients received epidural anesthesia were enrolled into epidural group.The cognitive function of different time were compared between the two groups.Results There were no statistically significant differences in blood pressure and heart rate between the two groups (all P＞0.05).The simple mental health scale (MMSE) scores at 6h,12h,24h after anesthesia in the general anesthesia group were (26.4 ±0.7)points,(25.9 ±0.5)points,(29.2 ±0.8)points,respectively,compared with that before anesthesia[(29.1 ±1.1)points],the difference was statistically significant (t＝6.235,P＜0.05). The MMSE scores at 6h,12h after anesthesia in the epidural group were (26.5 ±0.4) points,(25.8 ±0.7) points, compared with that before anesthesia[(29.2 ±0.8)points],the difference was statistically significant (t＝5.123, P＜0.05).The MMSE score at 24 h after anesthesia in the epidural group was (29.5 ±0.7)points,which was obvi-ously higher than (27.2 ±0.8)points in the general anesthesia group (t＝13.684,P＜0.05).The incidence rates of postoperative cognitive dysfunction (POCD) at 6h,12h after anesthesia in the general anesthesia group (17.50%, 20.00%) were significantly higher than those in the epidural group (7.50,5.00%) ( χ2＝4.571,10.285,all P＜0.05).Conclusion The effect of general anesthesia on postoperative cognitive function is significantly greater than that of epidural anesthesia.
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Objective To explore the safety and efficacy of dezocine combined with flurbiprofen axetil in postoperative analgesia in elderly patients undergoing upper abdominal surgery.Methods 80 patients underwent abdominalsurgery were selected.They were divided into study group(T group) and control group(C group) according to the random number table,40 cases in each group.The visual analogue scale(VAS) and Ramsay sedation score were recorded at 2h,6h,12h,24h,48h after operation,respectively.The anesthesia-related complications such as sleepiness,chills,postoperative nausea and vomiting (PONV),and pulmonary infection in 48 hours were also recorded.Results There were no statistically significant differences in the VAS score between the two groups in the resting state and the active state(t =0.287,0.436,all P ＞ 0.05).The VAS scores of T group were significantly lower than those of C group at 2h,6h,12h,24h and 48h after operation (t =4.096,4.241,5.510,6.121,5.752,3.542,3.866,4.948,5.542,4.030,all P ＜ 0.05).There were no statistically significant differences in Ramsay sedation scores between the two groups at postoperative 2h,6h,12h,24h and 48h (t =0.323,0.226,0.541,0.297,0.771,0.795,all P ＞ 0.05).There were no statistically significant differences in the incidence of drowsiness,chills,PONV,skin itching and pulmonary infection in the two groups (4 cases vs.6 cases,6 cases vs.5 cases,5 cases vs.3 cases,1 case vs.3 cases,5 cases vs.1 case,P =0.499,0.712,0.745,0.615,0.201).Conclusion The postoperative analgesic compatibility of dezocine combined with flurbiprofen axetil can effectively relieve the postoperative pain in elderly patients with upper abdominal surgery and provide good postoperative analgesic effect and does not increase the incidence of drug related complications.It is worth to promote in clinical.
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Objective To compare the analgesic effect and motor function of epidural analgesia and continuous adductor canal block in the elderly patients with internal malleolus fracture,in order to provide a reference for the choice of postoperative analgesia.Methods A total of 80 patients aged 65-74 years were enrolled in this study.They were randomly divided into adductor canal block group (T group,n =40) and epidural block group (C group,n =40) by computer random software.The T group underwent laryngeal mask intubation with general anesthesia + ultrasound guided transnasal saphenous nerve block.The C group underwent epidural anesthesia.The systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were measured before anesthesia (T0),10 minutes after anesthesia (T1),30 minutes after operation (T2),before leaving OR (T3).Visual analogue (VAS) was recorded immediately before leaving OR,2h,6h,12h,24h and 48h after operation.The incidence of complications such as hypotension,ephedrine use,postoperative urinary retention and other anesthesia-related complications were also recorded.Results The SBP and DBP were significantly higher in the T group at T1,T2 and T3 than those in group C (t =5.069,3.087,3.019,5.659,2.744,2.254,all P ＜ O.05).The HR was lower in the T group at T1 and T2 than those in the C group (t =4.138,3.797,all P ＜ 0.05).There were no statistically significant differences in VAS between the two groups at 2h,6h,12h,24h and 48h postoperatively (all P ＞ 0.05).The incidence of intraoperative hypotension (7 cases),ephedrine use (6 cases) and postoperative urina-ry retention (12 cases) were significantly higher in the C group than those in the T group (0 cases,O cases,1 cases,x2 =11.11,P ＜0.05).Conclusion Compared with epidural anesthesia,ultrasound-guided adductor canal block anesthesia can maintain hemodynamics stability in elderly patients with internal malleolus fracture,it can provide the same analgesic effect as epidural analgesia,and has no effect on the motor function of the contra lateral limbs and can reduce the risk of postoperative complications.
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The cyclodialysis cleft is a rare disease characterized by ocular hypotony and vision loss.Gonioscopy,ultrasound biomicroscopy and anterior segment optical coherence tomography are used to evaluate the cleft before treatment.The evaluation of cyclodialysis clefts provide a basis for the selection of treatment and the evaluation of effect.Current popular therapeutic approaches for cyclodialysis clefts include medical management,laser photocoagulation,transscleral diathermy,cryotherapy,cyclopexy and so on.Medical treatment is effective in small-size cyclodialysis cleft.But the indications and course of medical treatment remains controversial.Although laser photocoagulation,transscleral diathermy and cryotherapy are effective to treat cyclodialysis clefts in some cases,there are some risks,such as ocular damage,uncertainty about the effect and so on.Cyclopexy is the principal method for cyclodialysis clefts that failed to respond to conservative management,including extraocular cyclopexy,intraocular cyclopexy and cyclopexy under endoscopic.The modified cyclopexy is effective which reduces the surgical risk.For keeping the lens,intraocular cyclopexy and cyclopexy under endoscopic are not suitable.Vitrectomy combined with other method for cyclodialysis is effective for cyclodialysis clefts which combined with serious posterior segment damage.
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Lysozyme generally exists in animals,plants and microorganisms,and it is used as a natural anti?infection materi?al and one of the important non?specific immune factors in organisms. This paper reviews the progress of researches on its classifi?cation,gene structure and function,and expression regulation in Oncomelania hupensis,and on the factors affecting its activi?ties in recent years,in order to further discuss its distribution in O. hupensis.
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Objective To explore the relationship between the Yangtze River floodplain ecological environment(vegetation, soil,water and light intensity)and the distribution of Oncomelania hupensis snails,so as to provide the evidence for ecological snail control. Methods Three regions(the Lu-Gang Bridge,Dragon Nest Lake in the bund,and Dragon Nest lake beach)were selected to investigate the plant characteristics(species,height,coverage,frequency and strain of clusters),soil characteristics (temperature,humidity,light intensity)and pH value. All the results were analyzed statistically with SPSS 18 software. Results A total of 920 boxes were investigated. The vegetation coverage was 3.7%-63.5%,and the dominant population was Cyperusrotun-dus L. cluster on the marshland. The soil temperature was 19.0℃-24.0℃,pH 5.0-5.7,and humidity 53%-75%. There were statis-tical significants in average number of living snails and dead snails among 3 groups( P<0.05). As the light intensity was strong in summer and weak in winter,the snails were in the back surface in summer and front surface in winter respectively. The average number of living snails was the most near the water. The difference was statistical significant(P<0.01)among three ranges(0-1 m,1-3 m and 3-5 m). Conclusion The snail survival and distribution have close relations with micro ecological environment factors,such as vegetation,soil,water and light intensity.
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Objective To detect the microvessel density(MVD) marked by MIF protein in esophagus squamous cell carcinoma(ESCC), and to see if a relationship exists between microvessel density(MVD) and clinicopathologic features. Methods The expression of MIF in vascular endothelial cell in forty ESCC specimens was examined by immunohistocbemistry staining, calculated the mean of MVD and analysed the relationship with clinicopathologic features. Results The positive rate of MIF protein was 95.00 %(38/40) in ESCC vascular endothelial cell. Compared with the normal esophageal squamous tissue[32.50 %(13/40)], there was significant difference in statistics, the mean of MVD was 26.5±8.5. MVD was positively correlated with the tumor TNM stages and lymph node motastasis. Conclusion MIF can be used in tagging vascular endothelial cell, MVD of ESCC was positively correlated with the tumor TNM stages and lymph node metastasis. It might be an major prognostic factor in ESCC.
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OBJECTIVE To investigate the distribution of pathogenic bacteria and the status of drug resistance in intensive care unit(ICU) of Anhui Provinceical Hospital,to provide reference for rational use of the antibiotics in clinical practice and effective control of hospital infection.METHODS From Jan 2007 to Dec 2008,a total of 873 clinical isolates were collected from different samples of infective patients in ICU,drug sensitivity test was conducted based on disk diffusion testing(K-B),to analyze the drug resistance of the pathogenic bacteria.RESULTS The highest isolating rate came from the sample of respiratory tract,which was 68.96%.Among 873 clinical isolates,Gram-negative bacilli and Gram-positive cocci accounted for 65.95% and 19.22%,respectively.Gram positive cocci rised obviously in 2008 compared to 2007.The rate of bacterial drug resistance was relatively high,meticillin-resistant Staphylococcus aureus(MRSA) detection rate was 56.58%;The detection rates Escherichia coli and Klebsiella ESBLs were 75.00% and 57.41%.CONCLUSIONS There is a higher rate of infection for ICU patients,and the condition of drug resistance is serious.To strengthen the pathogen distribution and drug resistance monitoring is of great guiding significance for rational clinical use of drug,reducing multi-drug resistance and nosocomial infection control.
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OBJECTIVE To prevent the nosocomial infection event in the clinical laboratory. METHODS To enhance the conception of self-protection,amplify necessary rules and regulation,fine technique training,establish the health-record of the department staff,purchase the facilities of protection,and disinfect the instrument and environment of laboratory even the test report sheet. RESULTS By means of above mentioned measures and management,it could control in most degree of nosocomial infection in clinical laboratory,and ensure the safety and health of the department staff. CONCLUSIONS The nosocomial infection event of clinical laboratory can be prevented by amplification of necessary rules and regulation as well as enhancement of the management.
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Objective To investigate the expression of macrophage migration inhibitory factor(MIF) in esophageal squamous cell carcinoma(ESCC) and in normal tissues around the esophageal cancer and determine whether there exists a relationship between MIF expression and clinicopathologic features.Methods The expression levels of MMIF in 80 ESCC specimens and 80 normal tissues around esophageal cancer by immunohistochemical staining.Results MIF was overexpressed in ESCC specimens and closely correlated with tumor differentiation and TNM staging.In normal esophageal tissues we found a small amount increment of MIF in the malpighian layer of mucous membrane.Conclusion MIF participates in the accommodation of cell growth cycle,plays an important role in the pathogenesis of ESCC and correlates with TNM staging.
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Objective To study the distribution of metastatic cancer sites in liver of different loctions of colorectal carcinoma as a guide for treatment. Methods According to the blood supply from the superior a and inferior mesenteric arteries we used the splenic flexure as the middle coordinate and divided the large intestine into right and left two halves and then the sites of metastatic cancers were observed carefully. Results When the venous blood streams from the superior and inferior mesenteric veins entered the portal vein they were not well mixed. This phenomina influenced the distribution of the metastatic lesions: primary cancer in right half of large intestine metastasied to right lobe of liver in 87.9%(58/66) of cases, and left half primary cancers metastasised to both right and left lobes of liver without regular rule. Cancers of sigmoid colon had high rate of liver metastases of 69.3% in total number of colorectal carcinoma with liver metastasis (203/293). Conclusion The results of this study suggest that besides chemotherapy given through hepatic artery, the portal vein route of administration of chemotherapeutic drugs may be more reasonable and effective.
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Objective:To explore the mRNA expression of macrophage migration inhibitory factor(MIF)in esophageal squamous cell carcinoma and its relationship with the clinical pathologic characteristics of that carcinoma.Methods:The expressions of MIF mRNA in esophageal carcinoma tissues and normal esophageal tissues were detected by RT-PCR in eighty patients.Results:MIF mRNA expression rate in esophageal carcinoma was 85%(68/80),while in the normal esophageal tissues it was 15%(15/80).the difference was significant(P0.05).Conclusion:Increased MIFmRNA expression contributed to carcinogenesis of esophageal squamous cell carcinoma,which might provide a new way for early diagnosis and therapy of esophageal carcinoma.