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Objective:To evaluate the effect of remimazolam combined with propofol for sedation in the pediatric patients undergoing outpatient root canal treatment.Methods:Seventy pediatric patients of either sex, aged 2-6 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with an expected treatment time<1 h, scheduled for elective outpatient root canal treatment, were divided into 2 groups ( n=35 each) using a random number table method: propofol group (P group) and remimazolam plus propofol group (RP group). Induction of anesthesia was as follows: propofol 1-3 mg/kg was intravenously injected until BIS value was less than 60 in group P, and remimazolam 0.2 mg/kg and propofol 1-3 mg/kg were intravenously injected until BIS value was less than 60 in group RP.Anesthesia maintenance was as follows: propofol 6-12 mg·kg -1·h -1 was intravenously infused in group P, and remimazolam 0.3 mg·kg -1·h -1 and propofol 6-12 mg·kg -1·h -1 were intravenously infused in group RP.The BIS value was maintained at 50-70 during operation.Spontaneous breathing was kept, and oxygen was inhaled through a nasal catheter with oxygen flow rate of 2-3 L/min in both groups.The amount of propofol consumed during induction and maintenance periods and the total consumption were recorded.The onset time of sedation, duration of operation, emergence time and duration of post-anesthesia care unit stay were recorded.The adverse reactions such as intraoperative respiratory depression, hypotension, bradycardia, coughing and body movement, emergence agitation and postoperative nausea and vomiting were recorded. Results:Compared with group P, the amount of propofol consumed during induction and maintenance periods and the total consumption were significantly reduced, the onset time of sedation was prolonged, the emergence time and duration of post-anesthesia care unit stay were shorted, the incidence of respiratory depression was decreased ( P<0.05), and no significant change was found in the incidence of duration of operation, hypotension, bradycardia, body movement or emergence agitation in group RP ( P>0.05). No intraoperative coughing or postoperative nausea and vomiting was found in two groups. Conclusions:The combination of remimazolam and propofol provides better efficacy than propofol alone when used for sedation in the pediatric patients undergoing outpatient dental root canal treatment.
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Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.
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Objective:To evaluate the sedative efficacy of S-ketamine combined with propofol for MRI examination in pediatric patients.Methods:One hundred children of both sexes, aged 1-6 yr, weighing 10-30 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent MRI from February to June 2021, were selected and divided into 2 groups ( n=50 each) by a random number table method: propofol group (P group) and S-ketamine plus propofol group (K+ P group). Anesthesia induction: propofol 2.5 mg/kg was intravenously injected in group P, and S-ketamine 0.5 mg/kg and propofol 1.5 mg/kg were intravenously injected in group K+ P.Anesthesia maintenance: propofol 100 μg·kg -1·min -1 was intravenously infused, and the infusion rate of propofol was adjusted to maintain Ramsay sedation score ≥5.Propofol 0.5-1.0 mg/kg was intravenously injected and/or increasing the infusion rate of propofol when moderate and severe movement occurred.The quality of MRI images was evaluated during the examination, and the occurrence and degree of movement, airway-related adverse events (hypoxemia, apnea, upper airway obstruction, hypersalivation), hypotension and bradycardia were recorded.The average infusion rate, consumption of additional propofol for intravenous administration and total consumption of propofol were recorded.The emergence time and time of anesthesia recovery room stay were recorded.The occurrence of adverse events (vomiting, diplopia and agitation) and the parents′ satisfaction with sedative efficacy and recovery were recorded during observation in the recovery room. Results:Compared with group P, the average infusion rate of propofol, total consumption of propofol, airway-related adverse events and incidence of hypotension and bradycardia were significantly decreased ( P<0.05), and no significant change was found in the incidence and degree of body movement, quality of MRI images, emergence time and time of anesthesia recovery room stay and incidence of adverse events during recovery from anesthesia in group K+ P ( P>0.05). Conclusion:S-ketamine combined with propofol can be safely and effectively used in MRI examination in pediatric patients.
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Objective To explore a time series based meta-analysis of randomized clinical trials (RCTs) and observational studies which examined differences in mortality in acute-on-chronic liver failure (ACLF) patients treated with artificial liver support system(ALSS) or not.Methods Medline,Embase,Ovid,and Cochrane library database was systemically searched up to December 2014.The outcome measure was mortality at different follow-up endpoints.Relative risks (RRs) were pooled for analysis.Results Ten studies,involving a total of 1682 ACLF patients,among whom 842 were treated with ALSS.ALSS was found to reduce the risk of 1-month and 3-month mortality for patients with ACLF by nearly 16.4％ and 13.2％,respectively.Randomized trials and observational studies provided good internal and external validity,respectively.Conclusions ALSS therapy could reduce short-term mortality in patients with ACLF.Clinical utility of this system for survival benefit may be implied.
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Eosinophilic esophagitis(EoE)is a chronic autoimmune inflammatory disease characterized by accumulation of eosinophils in all layers of esophagus and lacking typical clinical manifestations. The pathogenesis has not yet been clarified. Diagnosis is mainly by combined judgment,including clinical manifestation,endoscopy and histopathology. Treatment includes food,drug and surgical therapy. This article reviewed the advances in study on EoE.
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Objective To investigate the effects of dexmedctomidine pretreatment and postconditioning on renal ischemia-reperfusion (I/R) injury in rats.Methods Thirty-two male Wistar rats,aged 3-4 months,weighing 220-300 g,were randomly divided into 4 groups ( n =8 each):sham operation group ( group S),I/R group,dexmedetomidine pretreatment group (group Pre) and dexmedetomidine postconditioning group (group Post).The rats were anesthetized with phenobarbital sodium 65 mg/kg.Renal I/R was produced by occlusion of both renal pedicles for 60 min followed by 48 h reperfusion.Dexmedetomidine 50 μg/kg was given intraperitoneally at 30 min before ischemia and at the beginning of reperfusion in Pre and Post groups respectively.The concentrations of serum creatinine and blood urea were determined at 0,24 and 48 h of reperfusion (T1-3).The renal tissues were obtained at the end of reperfusion for microscopic examination and detection of apoptosis by TUNEL assay.Acute kidney tubular necrosis was scored and apoptosis index (AI) was calculated.Results Compared with group S,the concentration of serum creatinine and blood urea at T2.3,and acute kidney tubular necrosis score and AI were significantly increased in I/R,Pre and Post groups ( P ＜ 0.05).Compared with I/R group,the concentration of serum creatinine and blood urea at T2.3,acute kidney tubular necrosis score and AI were significantly decreased in Pre and Post groups ( P ＜ 0.05).Conclusion Both dexmedetomidine pretreatment and postconditioning can attenuate renal I/R injury through inhibition of cell apoptosis in rats.
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Objective:Eph receptors constitute the largest sub-family of receptor tyrosine kinases(RTKs) and have an important role in oncogenic transformation and tumor progression.This study aimed to analyze the aberrant expression of EphA1 gene in gastric cancer and its correlation with clinical parameters,so as to explore the significance of EphA1 in the etiology and progression in gastric cancer.Methods: Expression of EphA1 protein was determined using immunohistochemical staining in 60 gastric cancer patients.Correlation between EphA1 protein expression and clinical parameters was evaluated by statistics.Results: Over-expression was more commonly observed in more advanced patients(P=0.015) and in those with lymph nodes metastases(P=0.032).There was no correlation between EphA1 expression and other clinical parameters.Conclusion: EphA1 gene could promote the progression of gastric cancer.
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Objective:Eph is the largest member of the family of receptor tyrosine kinases (RTK). Hypermethylation of CpG island is an important mechanism leading to down-regulation of EphA7 in gastric cancer. The objective of this study is to investigate the expression level of EphA7 in gastric carcinoma and its roles in the development,progression and prognosis of gastric carcinoma. Methods:The expression level of EphA7 transcript in gastric carcinoma specimens and normal mucosa tissues was detected using real-time RT-PCR. Results:The expression level of EphA7 in gastric carcinoma was divided into three groups according to the expression rate in gastric cancer tissue and matched normal mucosa. Statistics analysis showed that the expression of EphA7 is significantly related to age and stage. Overexpression of EphA7 has a tendency to relate to metastasis. Conclusion:EphA7 is differentially expressed in gastric carcinoma specimens. Overexpression of EphA7 may play a role in the development and progress of gastric carcinoma.
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Objective: To investigate EphA7 protein expression of gastric carcinoma cells and its clinicopathological parameters.Methods: The expression level of EphA7 protein in gastric carcinoma and normal mucosa was detected using immunohistochemical staining.Results: The overexpression of EphA7 protein in gastric carcinoma was significantly related to age(P=0.016) and stage(P =0.033).Conclusion: EphA7 was differentially expressed in gastric carcinoma cells.
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Increased catabolism, including reduced protein synthesis rates and increased protein degration rates, is common in patient with trauma and sepsis. There has been a long time search in how to reverse the increased catabolism. Besides nutritional support, people hope manipulation of anti catabolism hormone might reverse or at least ameliorate catabolism. Recent researches indicate that the GH IGF IGFBP axis plays a crucial part in regulating the metabolism of muscle protein on both basal and stress condition. This article aims to review the changes in GH IGF IGFBP axis and its clinical significance associated with trauma and sepsis.