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Objective:To compare the effects of five different types of videolaryngoscopes in patients with a simulated difficult airway.Methods:575 patients who needed endotracheal intubation in Nanjing Hospital Affiliated to Nanjing Medical University from May 2021 to September 2021 were randomly divided into 5 groups [UE videolaryngoscope group (U group), GlideScope videolaryngoscope group (G group), C-MAC videolaryngoscope group (C group), Airtraq videolaryngoscope group (A group) and A. P.advance videolaryngoscope group (AP group)], with 115 patients in each group. They all wore cervical collar to simulate difficult airway. The main observation index was the success rate of first endotracheal intubation. Secondary observation indicators included overall success rate, laryngoscope exposure field, intubation time, operator′s subjective score, cause of failure, adverse events, and complications of intubation.Results:The patients′ mouth opening degree was reduced from (46±6)mm to (24±4)mm ( P<0.05) after wearing the cervical collar; The success rate of the first endotracheal intubation were 96%(UE), 92%(C-MAC), 86%(GlideScope), 85%(Airtraq), and 60%(AP.Advance) respectively, with statistically significant difference ( P<0.05); Compared with AP group and G group, the incidence of soft tissue injury or bleeding in U group and C group were lower ( P<0.05); There were significant difference in the overall success rate of videolaryngoscopes, laryngoscope visual field exposure, intubation time, the subjective score of the operator and adverse events ( P<0.05); There was no significant difference in the complications of intubation among the groups ( P>0.05). Conclusions:Among 575 patients with a simulated difficult airway with limited neck mobility and limited mouth opening, there were significant differences in the use of five videolaryngoscopes. Among them, UE video laryngoscope had the highest first intubation success rate and lowest tissue trauma rate, C-MAC video laryngoscope, GlideScope video laryngoscope and Airtraq video laryngoscope followed in performance, while A. P.Advance video laryngoscope performed the worst.
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Objective:To explore the clinical effect of different flow rates of transnasal humidified rapid-insufflation ventilatory exchange (Thrive) on hypoxic events during painless gastroscopy.Methods:Patients who underwent painless gastroscopy in Nanjing First Hospital from April to July 2020 were randomly selected by random number table method and assigned to Thrive groups of 30 L/min ( n=52), 50 L/min ( n=55) and 70 L/min ( n=54). The incidences of different degree of hypoxic events (including subclinical respiratory depression, hypoxia and severe hypoxia) and adverse events related to Thrive were recorded. Results:The total incidence of hypoxic events in the 70 L/min group was 0 (0/54), which was significantly lower than that in the 30 L/min group (21.3%, 11/52, χ2=12.75, P<0.001) and 50 L/min group (12.7%, 7/55, P=0.007). There were no significant differences in subclinical respiratory depression [13.5% (7/52) VS 5.5% (3/55), χ2=1.19, P=0.194] or hypoxia [7.7% (4/52) VS 7.3% (4/55), P=0.610] between 30 L/min group and 50 L/min group. No severe hypoxia occurred in any group. The oxygenation of patients with hypoxemia in 30 L/min and 50 L/min groups was improved (SpO 2>95%) after opening the airway by mandibular support. In addition, there were no significant differences in the incidence of adverse events except hypoxemia among the three groups ( P>0.05). Conclusion:The flow rates of Thrive of 30 L/min, 50 L/min, and 70 L/min can prevent the occurrence of severe hypoxia during painless gastroscopy, and the flow rate of 70 L/min can further reduce the incidence of subclinical respiratory depression.
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Seven indole alkaloid glycosides containing a 1'-(4″-hydroxy-3″,5″-dimethoxyphenyl)ethyl unit (-) were isolated from an aqueous extract of leaves (da qing ye). Their structures were determined by spectroscopic data analysis combined with enzymatic hydrolysis as well as comparison of their experimental CD (circular dichroism) and calculated ECD (electrostatic circular dichroism) spectra. Based on analysis of and/or Cotton effect (CE) data of -, two simple roles to assign location and/or configuration of -glycopyranosyloxy and 1'-(phenyl)ethyl units in the indole alkaloid glycosides are proposed. Stereoselectivity in plausible biosynthetic pathways of - is discussed. Compounds and and their mixture in a 3:2 ratio showed activity against KCNQ2 in CHO cells. The mixture of and (3:2) exhibited antiviral activity against influenza virus H1N1 PR8 with IC 64.7 μmol/L (ribavirin, IC 54.3 μmol/L), however, the individual or was inactive. Preliminary structure-activity relationships were observed.
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Objective:To investigate the accuracy and postoperative efficacy of fluoroscopy and CT in measuring the mounting parameters of Taylor Spatial Frame.Methods:Data of patients with peripheral knee deformities who were treated by Taylor Spatial Frame from June 2006 to December 2017 were retrospectively analyzed. According to different measurement methods of mounting parameters, they were divided into fluoroscopy group (mounting parameters were obtained by intraoperative fluoroscopy) and CT group (mounting parameters were obtained by postoperative CT). There were 33 patients (35 segments) in the fluoroscopy group, 23 males (23 segments) and 10 females (12 segments), with an average age of 36.4±11.6 years old. In CT group, there were 30 patients, 19 males and 11 females, with an average age of 36.9±13.8 years. There were 22 cases (24 segments) of high tibial osteotomy, 5 cases (5 segments) of distal femur osteotomy, and 6 cases (6 segments) of both distal femur and high tibial osteotomy. Operation time, external fixation time, the number of electronic prescription and deformity correction time, mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), mechanical lateral distal femoral angle (mLDFA), range of motion (ROM) andhospital for special surgery (HSS) knee functional scores were compared between the two groups.Results:All the 63 patients were followed up for 21.9 months (range, 12-60 months). In fluoroscopy group, operating time was 100.9±9.1 min, electronic prescription number 1.4±0.6, and deformity correction time was 19.4±3.6 days. In CT group, operating time was 79.2±10.8 min, electronic prescription number 1.2±0.4, and deformity correction time was 16.0±4.4 days. The difference of the above indexes between the two groups was statistically significant ( t=8.803, 2.042, 3.440, all P < 0.05). In the fluoroscopy group, the external fixation time was 4.8±0.9 months; MAD was 4.3±2.1 mm; MPTA was 88.5°±1.9°; mLDFA was knee 89.2°; ROM was 122.4°±3.9° and HSS score was 90.0±3.6. In CT group, the external fixation time was 4.6±0.9 months; MAD was 4.0±1.9 mm; MPTA was 87.8°±1.7°; mLDFA was knee 88.6°; ROM was 122.7°±3.4° and HSS score was 91.1±2.9. There was no statistically significant difference in the above indexes between the two groups (all P >0.05). In the fluoroscopy group, 22 segmental deformities were corrected by one electronic prescription, and 13 segmental deformities were corrected by two or more electronic prescriptions. In CT group, 25 segmental deformities were corrected by one electronic prescription, and 5 segmental deformities were corrected by two electronic prescriptions. There was no incision infection and no neurovascular injury in the two groups. Conclusion:Both fluoroscopy and CT scan can obtain the mounting parameters of the Taylor Spatial Frame, and the results of correction of the peripheral deformities of the knee joint are satisfactory. However, CT measurement of the mounting parameters is more accurate which could achieve shorter operation time, and less times of electronic prescriptions.
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OBJECTIVE@#To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.@*METHODS@#Ninety obese patients (BMI 30-39.9 kg/m@*RESULTS@#The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (@*CONCLUSIONS@#Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
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Humans , Anesthesia, General , Insufflation , Intubation, Intratracheal , Masks , ObesityABSTRACT
Objective@#To investigate the effects of Shuxuening injection combined with edaravone on neurological function, serum vascular endothelial growth factor (VEGF) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with cerebral infarction.@*Methods@#A total of 112 patients with cerebral infarction admitted to Zhejiang Provincial Armed Police Hospital from August 2016 to August 2018 were enrolled in the study.They were divided into observation group and control group according to the digital table, with 56 patients in each group.The two groups were given routine symptomatic treatment.On the basis of this, the control group was given edaravone treatment, and the observation group was given Shuxuening injection combined with edaravone.The changes of NIHSS, GCS score, serum NSE, NGF, NTF, VEGF and sVCAM-1 levels before and after treatment were compared between the two groups, and the clinical efficacy was compared.@*Results@#After treatment, the effective rate of the observation group was 92.86%(52/56), which was higher than that of the control group 73.21%(41/56), the difference was statistically significant (χ2=7.669, P<0.05). After treatment, the NIHSS score, NSE, sVCAM-1 of the two groups were decreased, which of the observation group were lower than those of the control group[(3.27±1.16)points vs.(6.32±2.12)points, (13.15±1.14)μg/L vs.(17.64±1.89)μg/L, (648.56±134.67)ng/mL vs.(1 078.36±131.23)ng/mL], while the GCS score, NGF, NTF, VEGF levels of the two groups were elevated, which of the observation group were higher than those of the control group[(13.64±3.86)points vs.(11.89±3.41)points, (76.13±8.72)μg/L vs.(68.24±7.25)μg/L, (5.14±0.36)μg/L vs.(3.74±0.29)μg/L, (831.51±91.67)ng/L vs.(752.83±91.24)ng/L], the differences were statistically significant (t=9.414, 2.543, 15.223, 5.205, 22.663, 4.552, 15.672, all P<0.05).@*Conclusion@#Shuxuening injection combined with edaravone can improve the curative effect of patients with cerebral infarction, improve neurological function, effectively improve serum VEGF level and decrease sVCAM-1 level.It is worthy of clinical application.
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Objective@#To investigate the efficacy and safety of rosuvastatin combined with memantine hydrochloride in the treatment of vascular dementia.@*Methods@#Sixty-six patients with vascular dementia admitted to the Hospital of Zhejiang Provincial Armed Police Force and Haining Kanghua Hospital from January 2016 to January 2018 were enrolled.According to the digital table, the patients were divided into the observation group and the control group, with 33 cases in each group.Both two groups were given routine treatment.The control group was treated with rosuvastatin, and the observation group was given rosuvastatin combined with memantine hydrochloride.Both two groups were treated for 12 weeks.The ADL score and MoCA score, oxidative stress index, inflammatory factor, cerebral kinetic index changes, clinical efficacy and adverse reactions after treatment were compared between the two groups.@*Results@#The therapeutic effect of the observation group was 87.88%(29/33), which was significantly higher than 63.64%(21/33) of the control group (χ2=5.280, P=0.022). After treatment, the ADL, MoCA, SOD levels, Vmax and BHI of the observation group were (41.26±5.37)points , (24.23±1.71)points, (112.27±15.35)μU/L, (65.15±11.75)cm/s, (0.79±0.36), respectively, which were higher than those of the control group [(36.19±4.07)points, (20.25±1.46)points, (93.84±12.76)μU/L, (59.15±11.74)cm/s, (0.58±0.26)], the differences were statistically significant (t=4.322, 10.168, 5.304, 2.075, 2.846, all P<0.05). The levels of MDA, HCy, TNF-α, IL-6 and IL-1β in the observation group were (6.37±1.05)μmol/L, (31.36±9.59)μmol/L, (184.15±15.12)ng/L, (229.85±27.69)ng/L, (127.64±17.86)ng/L, respectively, which were lower than those in the control group [(7.32±1.07)μmol/L, (42.27±11.34)μmol/L, (208.72±15.26)ng/L, (262.75±25.64)ng/L, (148.75±18.64)ng/L], the differences were statistically significant (t=3.640, 4.220, 6.570, 5.008, 4.698, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).@*Conclusion@#The clinical efficacy of rosuvastatin combined with memantine hydrochloride in the treatment of patients with vascular dementia can significantly reduce oxidative stress and inflammatory response, improve cerebral hemodynamics and cognitive function, and improve patients’ quality of life.
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To investigate the effects of Shuxuening injection combined with edaravone on neuro -logical function,serum vascular endothelial growth factor ( VEGF) and soluble vascular cell adhesion molecule -1 (sVCAM-1) in patients with cerebral infarction.Methods A total of 112 patients with cerebral infarction admitted to Zhejiang Provincial Armed Police Hospital from August 2016 to August 2018 were enrolled in the study.They were divided into observation group and control group according to the digital table ,with 56 patients in each group.The two groups were given routine symptomatic treatment.On the basis of this, the control group was given edaravone treatment,and the observation group was given Shuxuening injection combined with edaravone .The changes of NIHSS, GCS score,serum NSE,NGF,NTF,VEGF and sVCAM -1 levels before and after treatment were compared between the two groups,and the clinical efficacy was compared.Results After treatment,the effective rate of the observation group was 92.86%(52／56),which was higher than that of the control group 73.21%(41／56),the difference was statistically significant (χ2 ＝7.669,P＜0.05).After treatment,the NIHSS score,NSE,sVCAM-1 of the two groups were decreased,which of the observation group were lower than those of the control group [(3.27 ±1.16)points vs. (6.32 ±2.12)points,(13.15 ±1.14)μg／L vs.(17.64 ±1.89)μg／L,(648.56 ±134.67)ng／mL vs.(1 078.36 ± 131.23 ) ng／mL], while the GCS score, NGF, NTF, VEGF levels of the two groups were elevated , which of the observation group were higher than those of the control group [(13.64 ±3.86) points vs.(11.89 ±3.41) points, (76.13 ±8.72) μg／L vs.( 68.24 ±7.25 ) μg／L, ( 5.14 ±0.36 ) μg／L vs.(3.74 ±0.29) μg／L, (831.51 ± 91.67)ng／L vs.(752.83 ±91.24) ng／L],the differences were statistically significant (t＝9.414,2.543,15.223, 5.205,22.663,4.552,15.672,all P ＜0.05).Conclusion Shuxuening injection combined with edaravone can improve the curative effect of patients with cerebral infarction ,improve neurological function,effectively improve serum VEGF level and decrease sVCAM -1 level.It is worthy of clinical application.
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Objective To investigate the efficacy and safety of rosuvastatin combined with memantine hydrochloride in the treatment of vascular dementia.Methods Sixty-six patients with vascular dementia admitted to the Hospital of Zhejiang Provincial Armed Police Force and Haining Kanghua Hospital from January 2016 to January 2018 were enrolled.According to the digital table,the patients were divided into the observation group and the control group,with 33 cases in each group.Both two groups were given routine treatment.The control group was treated with rosuvastatin,and the observation group was given rosuvastatin combined with memantine hydrochloride.Both two groups were treated for 12 weeks.The ADL score and MoCA score,oxidative stress index,inflammatory factor,cerebral kinetic index changes,clinical efficacy and adverse reactions after treatment were compared between the two groups.Results The therapeutic effect of the observation group was 87.88％ (29/33),which was significantly higher than 63.64％ (21/33) of the control group (x2 =5.280,P =0.022).After treatment,the ADL,MoCA,SOD levels,Vmax and BHI of the observation group were (41.26 ± 5.37) points,(24.23 ± 1.71) points,(112.27 ± 15.35) μU/L,(65.15 ± 11.75) cm/s,(0.79 ± 0.36),respectively,which were higher than those of the control group [(36.19 ± 4.07) points,(20.25 ± 1.46) points,(93.84 ± 12.76) μU/L,(59.15 ± 11.74) cm/s,(0.58 ± 0.26)],the differences were statistically significant (t =4.322,10.168,5.304,2.075,2.846,all P ＜ 0.05).The levels of MDA,HCy,TNF-α,IL-6 and IL-1β in the observation group were (6.37 ± 1.05) μmol/L,(31.36 ± 9.59) μmol/L,(184.15 ± 15.12) ng/L,(229.85 ± 27.69) ng/L,(127.64 ± 17.86) ng/L,respectively,which were lower than those in the control group [(7.32 ± 1.07) μmol/L,(42.27 ± 11.34) μmol/L,(208.72 ± 15.26) ng/L,(262.75 ± 25.64) ng/L,(148.75 ± 18.64) ng/L],the differences were statistically significant (t =3.640,4.220,6.570,5.008,4.698,all P ＜ 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion The clinical efficacy of rosuvastatin combined with memantine hydrochloride in the treatment of patients with vascular dementia can significantly reduce oxidative stress and inflammatory response,improve cerebral hemodynamics and cognitive function,and improve patients' quality of life.
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Objective To evaluate the efficacy of injecting drugs through fiberoptic bronchoscope (FOB) and epidural catheter in improving topical anesthesia for awake tracheal intubation in patients undergoing cervical surgery.Methods Fifty patients with cervical spine injury that requiring surgical treatment,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 2 groups (n=25 each) using a random number table method:FOB injection hole group (group Ⅰ) and FOB combined with epidural catheter group (group Ⅱ).In group Ⅰ,2％ lidocaine was sprayed through the FOB injection hole on the oropharynx posterior (2 ml),glottis above vocal cords (3 ml) and the site 5 cm below the glottis (2 ml).In group Ⅱ,2％ lidocaine was sprayed via the epidural catheter implanted through FOB injection hole on the oropharynx posterior (1 ml),the site above vocal cords (3 ml),the site immediately after crossing the glottis (1 ml),the site 5 cm below the glottis (1 ml),and 2％ lidocaine 1 ml was slowly injected into the site 5 cm below the glottis to protuberance via the epidural catheter.Awake nasotracheal intubation was then performed under FOB guidance at 5 min after administration in both groups.When patients presented with severe bucking during operation and did not tolerate severe bucking,the previous procedure was repeated for rescue.When severe bucking was not significantly improved after carrying out rescue measures,thyrocricoceniesis was performed and the patients were tracheally intubated.The development of hypertension,tachycardia and hyoxemia was recorded during anesthesia and intubation.The operation time,intubation time,success of intubation at first attempt,requirement for rescue measures and thyrocricocentesis were recorded.The development of bucking,body movement and laryngeal spasm were record during anesthesia and tracheal intubation.JOA score was used to evaluate the occurrence of accentuated spinal cord injury after intubation.Parents' satisfaction with intubation was recorded and scored on 2nd day after operation.Results Compared with group Ⅰ,the incidence of hypertension and tachycardia was significantly decreased,the operation time was prolonged,the requirement for rescue measures and incidence of thyrocricocentesis were decreased,the incidence of body movement and bucking was decreased,and the parents' satisfaction scores were increased (P＜0.05),and no significant change was found in intubation time,success rate of intubation at first attempt or incidence of hyoxemia in group Ⅱ (P＞0.05).Accentuated spinal cord injury or laryngeal spasm was not found in either group.Conclusion Injecting drugs through FOB and epidural catheter can achieve better efficacy of topical anesthesia for awake tracheal intubation with reduced adverse reactions than injecting drugs through FOB injection hole in patients undergoing cervical surgery.
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Potassium 2-(1-hydroxypentyl)-benzoate (PHPB) is a novel drug candidate for acute ischemic stroke. PHPB has been also shown to be beneficial for some neurodegenerative diseases. In this study, we demonstrated that PHPB improved depressive-like behaviors induced by chronic unpredictable mild stress (CUMS) in rats. Male SD rats were subjected to the stress for five weeks. PHPB (30 and 100 mg/kg) or fluoxetine (FLX 10 mg/kg, as positive control) was administered orally from the third week in CUMS procedure. The behavioral tests were applied and then the biochemical studies were carried out. PHPB or FLX treatment rescued the behavioral deficiency in CUMS-exposed rats. Meanwhile, PHPB normalized the enhanced level of serum corticosterone, improved hippocampal and serum BDNF levels, as well as p-CREB level in hippocampus. In addition, PHPB could reverse the reduced level of extracellular 5-HT and its metabolite 5-HIAA in prefrontal cortex (PFC) of depressed rats. In summary, our results showed that PHPB improved depression-like behaviors in CUMS-exposed rats. The mechanisms might relate to the reverse of neurotrophic disturbance in the brain, reducing excessive HPA axis response and facilitating the release of 5-HT.
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Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.
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Objective To investigate the effect of ultrasonograpy (US )-guided bilateral superior laryngeal nerve (SLN)block by different concentrations of lidocaine combined with intrave-nous anesthesia for polypectomy of vocal cord by laryngoscope.Methods Sixty patients,aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective polypectomy of vocal cord by laryngoscope were divided into 3 groups (n=20 each)using a random number table:US-guided bilat-eral SLN block by 2% lidocaine (group A),S-guided bilateral SLN block by 1% lidocaine (group B), and traditional SLN block by 2% lidocaine (group C).HR,MAP,SpO2and plasma concentration of NE were detected at the time of patients entering the operating room (T0),immediately after intuba-tion(T1),suspensing laryngoscopy (T2),5 min after suspensing laryngoscopy (T3),immediately af-ter extubation(T4),5 min after extubation(T5).Extubation time and side effects such as dysphagia and dyspnea in two hours after extubation were recorded as well.Results HR and MAP in the three groups at T1-T5were increased compared to T0(P<0.05).Compared with group C,HR and MAP in groups A and B were decreased at T1-T5(P<0.05).Plasma concentration of NE of groups A and B was more significantly decreased than group C (P<0.05),and extubation time of groups A and B was less than that of group C (P <0.05 ).Conclusion US-guided bilateral SLN block by 1% lidocaine has definite effect and better comfort level,with stable haemodynamics and less extubation time.
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Objective To investigate the changes of serum C-X-C motif ligand 13 (CXCL13) concentration in senior patients undergoing total hip replacement and its role in post-operative dys-function(POCD).Methods Eighty consecutive senior patients aged 65-80 years with BMI 18.4-27.3 kg/m2,ASA physical status Ⅱ or Ⅲ,were recruited and scheduled to undergo hip joint replacement operation.Neuropsychological test was performed 1-5 d after operation and patients were divided into POCD group and non-POCD group.Serum C reactive protein (CPR),procalcitonin (PCT),IL-6, TNF-α,CXCL13 concentration were detected 1 d before and 1,2,3,4,5 d after operation. Results A total of 21 (26%)patients developed POCD 1-5 d after operation (recruited in POCD group),and the other 59 patients were recruited in non-POCD group.Compared with the time point of 1 d before operation,serum CRP,PCT,IL-6,TNF-αand CXCL13 concentration were higher 1-5 d after operation in all patients (P<0.05).The concentrationsof these factors were higher in patients from POCD group than in those from non-POCD group 1-5 d after operation (P < 0.05). Conclusion The CXCL13 concentration insenior patients undergoing total hip replacement who devel-oped POCD were higher than in those who did not developed POCD.Whether it is correlated with POCD remains further study.
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Objective To observe the efficacy of the ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intubation.Methods Forty patients with limited cervical activity scheduled for elective surgery under general anesthesia,23 males and 17 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were chosen.According to random number table method,they were randomly divided into two groups (n =20).Group N received superior laryngeal nerve block u-sing the acupoint-located method by anatomical landmark,and group D was under ultrasound-guided, combined with airway anesthesia.Awake orotracheal fiberoptic intubation was then performed.Intu-bation time and the changes of MAP,HR,Ramsay sedation score were recorded at the time of bur-glary (T0 ),before the endotracheal tube into the mouth (T1 ),endotracheal tube into the glottis im-mediately (T2 ),5 min after intubation (T3 ).Ramsay score was rated to assess the patients'comfort and tolerance,complications during intubation process were documented,the patient's satisfaction was received.Results Compared with the group N,the intubation time of group D was significantly shorter [(0.5±0.1)min vs (1.0±0.2)min,P <0.05].In group N,MAP and HR were obviously higher during intubation with lower Ramsay sedation score at T2 compared with group D (P <0.05). Patients in group D had lower comfort score and tolerance grade during intubation (P <0.05).The incidence of nausea,vomiting,restlessness and pharyngalgia were significantly lower in group D (P< 0.05 ).Besides, patients during intubation in group D were more satisfactory (P < 0.05 ). Conclusion Ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intuba-tion could provide an ideal sedative effect,maintain stable circulation and keep patients tolerable.
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Objective To explore the predictive capability of different methods for difficult la-ryngoscopy and analyze its optimal cutoff value.Methods Three hundred consecutive patients (aged 18-65 years,weighing 42-88 kg,ASA physical status Ⅰ or Ⅱ)scheduled to undergo general anesthe-sia and surgery were invited to participate.Difficult airway assessments were performed by thyromen-tal height (TMH),thyromental distance (TMD),sternomental distance (SMD),modified Mallam-pati test (MMT)and ratio of height and TMD (RHTMD)before anesthetic induction.Cormack-Le-hane (C-L)grade of laryngoscopy view was assessed after induction.Sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and accuracy of these tests were calculated. Receiver operator characteristic (ROC)curve of TMH was performed to determine the optimal cutoff value of TMH.Results There were 22 patients diagnosed as difficult airway.Sensitivity,specificity, PPV,NPV and accuracy of TMH were higher than those of TMD,SMD and MMT tests.Sensitivity of RHTMD was lower than that of TMH test,and specificity,PPV,NPV and accuracy of RHTMD were similar to that of TMH.The optimal cutoff value of TMH was 4.9 cm through ROC curve. Conclusion The optimal cutoff value of TMH detecting difficult laryngoscopy was 4.9 cm.Similar to RHTMD,TMH appears to be more effective for prediction of difficult laryngoscopy than TMD, SMD and MMT.
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Objective To explore the influence of dexmedetomidine for nasal administration by three different concentrations on the stress response in patients with general anaesthesia during the peri-extubation period of gynecological surgery and to explore the optimized dosage.Methods Eighty patients undergoing general anaesthesia were randomly divided into four groups:control group (group C),and three different doses of intranasal dexmedetomidine,groups D1,D2,D3 receiving intranasal dexmedetomidine 0.6,1.2 and 1.8 μg/kg 30 min before the end of the operation,respectively.Group C was given the same volume of saline.Heart rate (HR),mean arterial pressure (MAP) and ratepressure-product (RPP) were recorded immediately after intranasal administration (T1),the end of the surgery (T2),recovery time (T3),extubation time (T4),1 min after extubation (T5),5 min after extubation (T6) and 10 min after extubation (T7).Blood samples were taken at T1,T2,T4 and T6 to detect the serum concentrations of norepinephrine (NE) and cortisol (Cor).Postoperative recovery outcomes were recorded.Results Compared with group C,MAP,HR and RPP at T3-T5 in group D1 were reduced significantly (P＜0.05).In addition,those were all decreased in groups D2 and D3 at T2-T7 (P＜0.05).Compared with group C,the serum concentrations of NE and Cor at T4 and T6 in group D1,at T2,T4 and T6 in groups D2,D3 were decreased obviously (P＜0.05).Awaken time,extubation time and PACU stay time were shortened significantly in groups C,D1 and D2 compared with group D3 (P＜0.05).Conclusion Intranasal administration of dexmedetomidine 30 min before the end of the operation could attenuate the extubation reaction and the adverse reaction of cardiovascular system during the peri-extubation period.
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Objective To compare and analyze the advantages and disadvantages of the application of self-fixing and plain polypropylene mesh in open inguinal hernia repair.Methods A study of 83 patients who underwent open inguinal hernia repair patients from June 2014 to June 2016 in the Department of General Surgery,AnHui No.2 Provincial People's Hospital Patients were divided into two groups according to the use of different patches,42 cases were applicated self-fixating mesh (observation group) and 41 cases were applicated the ordinary polypropylene patch (control group).The operation time,average postoperative hospitalization time,postoperative complications and Visual Analogue Score of postoperative pain were compared.The measurement data were expressed by mean standard deviation (~ ± s),and using t test,Count data were represented by frequency and percentage,and chi-square test was used for comparison between groups.Results The operation time of the observation group and the control group was (49.9 ± 6.4) minutes and (67.9 ± 6.1) minutes,and there was significant difference(P ＜ 0.05).The postoperative hospitalization time of observation group and control group was (2.5 ± 1.4) days and (2.6 ± 1.8) days,there was no significant difference (P ＞ 0.05).In the complications of the two groups,there were 1 case of scrotal edema in the observation group,and 2 cases of scrotal edema in the control group,the difference was no statistically significance.The Visual Analogue Score in two groups was (4.0 ± 0.8) score and (4.1 ± 0.7) score,there was no significant difference between the two groups (P ＞ 0.05) within 12 hours after operation.The Visual Analogue Score was (2.6 ± 0.7) score,(1.4 ± 0.5) score within 24 hours and 48 hours after operation in the observation group,and was (3.1 ± 0.6) score,(2.7 ± 0.5) score in the control group.There was a significant difference between the two groups (P ＜ 0.05).There was no obvious local pain for the observation group and had a better sense of comfort in one month follow-up after the operation.Conclusions The application of self-fixing suture free patch can reduce the operation time of patients and relieve the discomfort of postoperative pain,and has a high clinical value.
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Objective:To explore the effect of prostaglandin E2 (PGE2) on the expression of high mobility group box-1 protein (HMGB1) in peritoneal macrophages of septic mice and its possible mechanisms.Methods:Ihe mouse peritoneal macrophages were isolated and cultured by conventional methods.The model of inflammation was established by using lipopolysaccharide (LPS) to incubate with mouse peritoneal macrophages.The PGE2,prostaglandin E receptor (EP) 4 agonist,EP4 RNAi,and DN.CREB inhibitory plasmid were used to interfere with the LPS-treated mouse peritoneal macrophage.The levels of HMGB 1 was determined by Western blot.Results:Compared with LPS alone treatment,the expression of HMGB 1 in peritoneal macrophages was increased obviously after 24 h by treatment with PGE2 and LPS,and it was also increased after the combined treatment of EP4 receptor agonist with LPS for 24 h (both P0.05);compared with LPS alone treatment,the combined treatment of EP4 receptor agonist with LPS for 24 h could up-regulate the phosphorylation of epidermal growth factor receptor (EGFR) and protein kinase B (Akt) thr308 (P<0.05),which were blocked by EGFR inhibitor.Once Akt specific inhibitor was used before EP4 and LPS treatment,the expression of HMGB1 was declined (P<0.05).Conclusion:PGE2 can up-regulate the expression of HMGB1 in sepsis of peritoneal macrophages through EP4 receptor,which may be related to the activation of EGFR/PI3K/Akt signaling pathway.
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A neuroinflammatory response is commonly involved in the progression of many neurodegenerative diseases. Potassium 2-(1-hydroxypentyl)-benzoate (PHPB), a novel neuroprotective compound, has shown promising effects in the treatment of ischemic stroke and Alzheimer׳s disease (AD). In the present study, the anti-inflammatory effects of PHPB were investigated in the plasma and brain of C57BL/6 mice administered a single intraperitoneal (i.p.) injection of lipopolysaccharide (LPS). Levels of iNOS and the cytokines TNF, IL-1and IL-10 were elevated in plasma, cerebral cortex and hippocampus after LPS injection and the number of microglia and astrocytes in cortex and hippocampus were increased. LPS also upregulated the expression of heme oxygenase-1 (HO-1) in the cortex and hippocampus. PHPB reduced the levels of iNOS and cytokines in the plasma and brain, decreased the number of microglia and astrocytes and further enhanced the upregulation of HO-1. In addition, PHPB inhibited the LPS-induced phosphorylation of ERK, P38 and JNK. These results suggest that PHPB is a potential candidate in the treatment of neurodegenerative diseases through inhibiting neuroinflammation.