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OBJECTIVE@#To use the low-cost anesthesia monitor for realizing anesthesia depth monitoring, effectively assist anesthesiologists in diagnosis and reduce the cost of anesthesia operation.@*METHODS@#Propose a monitoring method of anesthesia depth based on artificial intelligence. The monitoring method is designed based on convolutional neural network (CNN) and long and short-term memory (LSTM) network. The input data of the model include electrocardiogram (ECG) and pulse wave photoplethysmography (PPG) recorded in the anesthesia monitor, as well as heart rate variability (HRV) calculated from ECG, The output of the model is in three states of anesthesia induction, anesthesia maintenance and anesthesia awakening.@*RESULTS@#The accuracy of anesthesia depth monitoring model under transfer learning is 94.1%, which is better than all comparison methods.@*CONCLUSIONS@#The accuracy of this study meets the needs of perioperative anesthesia depth monitoring and the study reduces the operation cost.
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Inteligência Artificial , Redes Neurais de Computação , Frequência Cardíaca , Eletrocardiografia , Fotopletismografia/métodos , AnestesiaRESUMO
Objective:To investigate the effect of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy.Methods:90 elderly patients undergoing pancreaticoduodenectomy were randomly divided into methoxyamine group and control group, with 45 cases in each group. The patients in both groups were treated with intravenous inhalation combined anesthesia. The stroke volume variation (SVV) was maintained at 7%-10% and the central venous pressure (CVP) was 4-8 cmH 2O. In methoxyamine group, 3 μg/(kg·min) methoxyamine was continuously pumped, while the control group was pumped with the same amount of normal saline at the same speed. The intraoperative infusion volume, urine volume, bleeding volume, blood transfusion cases, intraoperative mean arterial pressure, heart rate, blood gas analysis results, B-type natriuretic peptide (BNP), creatinine, urea nitrogen level and postoperative exhaust time were compared between the two groups. Results:Compared with the control group, the patients in methoxyamine group had less infusion volume, urine volume, lower postoperative BNP level and heart rate, shorter postoperative exhaust time (all P<0.05), and higher mean arterial pressure ( P<0.05). There was no significant difference in blood loss, blood transfusion cases, PaO 2, PaCO 2, pH, creatinine and urea nitrogen between the two groups (all P>0.05). In addition, the number of patients in the methoxyamine group who used pressor drugs was less than that in the control group ( P<0.05), and the frequency of bradycardia was more than that in the control group ( P<0.05). The proportion of tachycardia and urapidil was similar in the two groups (all P>0.05). Conclusions:Methoxyamine combined with target guided fluid therapy can reduce the intraoperative infusion volume of pancreaticoduodenectomy in elderly patients, stabilize circulation, shorten postoperative exhaust time, and contribute to the recovery of gastrointestinal function.
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Objective:To explore the influence of online and offline family therapy based on the Satir model on emotions of adolescents with depressive disorder and their parents in remote areas.Methods:A total of 98 cases adolescents with depressive disorder treated in the psychosomatic medicine of the Second Affiliated Hospital of Nanchang University from January 2021 to June 2021 and their parents were selected as the objects. The adolescents with depressive disorder and their parents were randomly divided into the control group (49 parents and 49 adolescents) and the observation group (49 parents and 49 adolescents). The control group received the medical treatment (sertraline 100 mg/d) and the routine health education, while the observation group received the online and offline Satir family therapy on the basis of the intervention of the control group. Generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) were used to investigate the negative emotions of the parents of the two groups before and 12 weeks after the intervention. The screen for child anxiety related emotional disorders (SCARED) and depression self-rating scale for childhood (DSRS) were used to investigate the negative emotions of the adolescents before and 12 weeks after the intervention.The SPSS 20.0 software was used for statistical analysis. t test was used to compare the SCARED scale score and DSRS score changes of the adolescents in the two groups, and χ 2 test was used to compare the proportional changes of parents' anxiety and depression. Results:The scores of SCARED (51.55±12.69 vs 36.82±7.69, t=15.839) and DSRS (25.08±4.81 vs 16.88±2.16, t=13.047) of adolescents in the control group were significantly different before and after the intervention (both P<0.05). The scores of SCARED (51.16±15.84 vs 31.31±7.72, t=14.385) and DSRS (24.12±4.81 vs 14.08±2.03, t=14.723) of adolescents in the observation group were significantly different before and after the intervention (both P<0.05). After the intervention, the scores of SCARED and DSRS in the observation group were lower than those in the control group ( t=3.540, 6.609, both P<0.05). Before intervention, there was no significant difference in the proportion of anxiety and depression between the parents of the two groups (χ 2=1.837, 3.547, both P>0.05). After 12 weeks of intervention, there was a statistically significant difference in the proportion of anxiety and depression between the two groups, which were lower in the observation group than those in the control group (χ 2=5.995, 4.009, both P<0.05). Conclusion:Online + offline family therapy based on the Satir model can not only effectively reduce anxiety and depression of adolescents, but also effectively reduce anxiety and depression of their parents.It is especially suitable for outpatient management of children with depressive disorder in remote areas.
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Clinical data of patients underwent pancreaticoduodenectomy due to malignant ampullary tumors from January 2013 and December 2016 in our hospital with full access to medical records were collected,and 144 patients were enrolled in total.Surgical Apgar Score (SAS) was calculated based on the intraoperative lowest mean arterial pressure,lowest heart rate and blood loss.The patients were divided into 2 groups depending on whether postoperative delirium developed or not within 7 days after surgery.The receiver operating characteristic curve of SAS in predicting postoperative delirium was drawn.The area under the curve,optimal cut-off value and sensitivity and specificity were calculated.Thirty-six patients developed postoperative delirium,and the incidence was 25.0％.The area under the curve of SAS in predicting postoperative delirium was 0.86 (95％ confidence interval 0.79-0.91).The optimal cut-off value was 6 with a sensitivity of 86％ and a specificity of 83％.In conclusion,intraoperative SAS can predict the development of postoperative delirium in patients undergoing pancreaticoduodenectomy.
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Objective To analyze the clinical data of 20 young and middle-aged patients with bronchial foreign bodies who were hospitalized because of unknown lung shadow. Methods The clinical data of 20 confirmed cases, including history of aspiration, imaging examination results, bronchoscopy findings and therapeutic process were retrospectively analyzed. The outcome of bronchial foreign body granuloma in the airway was observed. Results ⑴100%of the 20 patients with an average age of (46.39±3.26) years were misdiagnosed before bronchoscope examination. (2) The results of chest CT showed that the 20 patients had bronchial stenosis or obstruction with pulmonary consolidation or atelectasis, of which 18 cases were on the right side and 2 on the left side. (3) According to the shape and size of the foreign bodies as well as the length of time of aspiration, the bronchial openings were blocked by foreign bodies in 10 patients, and the foreign bodies were taken out by foreign body forceps. The diagnosis was confirmed in 3-6 (average 4.40±0.92) months in 10 patients. Four patients were obstructed by foreign bodies and granulation tissue, which took 5-12 (average 8.25±2.86) months to diagnose, while in 6 cases, masses were found in tracheal cavity, which took 6-15 (average 10.17±2.85) months to diagnose. The latter 10 (4+6) patients were treated with endotracheal intubation to remove foreign bodies and granulation tissue. (4) After 24-72 hours of treatment, the symptoms of cough, expectoration and blood in the sputum were relieved, and no severe complications occurred in 20 patients. (5) About two weeks after bronchial foreign bodies were removed, the granulation tissue disappeared. Conclusion Foreign body aspiration on the right side is more common in the 20 young and middle-aged patients, and bronchoscope is the best means of diagnosis and treatment.
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Cellulosic ethanol, with the advantages of renewable resource, cleanliness and safety, is the mainstream of new energy development and has obtained extensive attention worldwide. In this review, the biological characteristics of beets were introduced, and then the superiority and application progress of beets and its by-product sugar beet pulp in the bioethanol production were stated. At last, cellulosic ethanol production coupled with the component separation and comprehensive utilization of beet pulp was proposed.
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Beta vulgaris , Química , Biocombustíveis , Celulose , Química , Etanol , QuímicaRESUMO
Objective To investigate the effect of preoperative prophylactic parenteral nutrition on prognosis of advanced gastric cancer.Methods A total of 159 patients with advanced gastric cancer in our hospital were collected,and randomly divided into experimental group and control group.80 cases in experimental group were treated with prophylactic parenteral nutrition,and 79 cases in control group were treated with traditional nutrition.The partial indexes of liver function,complications and mortality rate were compared between the two groups before and after surgery.Results The levels of aspartate aminotransferase (AST),alanine aminotransferase (ALT),total bilirubin (TBIL) and direct bilirubin (DBIL) were much lower in experimental group than in control group at 8 days after surgery (t=6.542,6.460,5.634,5.275,all P＜0.001).The levels of ALB and PAB were much higher in experimental group than in control group at 2 and 8 days after surgery (t=12.580,12.471,6.757,12.821,all P＜0.001).The incidence of complications and mortality rate were much lower in experimental group than in control group (x2 =23.409,4.818,P＜0.001 or 0.05).Conclusions Preoperative prophylactic parenteral nutrition can speed up the recovery of liver function and reduce the complications and mortality rate after surgery in patients with advanced gastric cancer.
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Objective To evaluate the effect of remifentanil pretreatment on myoclonus after etomidate injection.Methods Sixty patients undergoing scheduled for intestinal endoscopy under general anesthesia were divided into remifentanil group and control group by random digits table method with 30 cases each.Before 0.3 mg/kg etomidate was given,the patients in remifentanil group and control group were pretreated with remifentanil 0.5 μ g/kg or amount of 0.9％ sodium chloride.Myoclonus was observed and recorded.Nausea,pruritis and apnea were observed after procedures.Results The incidence of myoclonus was 73.3％(22/30) in control group,mild in 11 cases,moderate in 10 cases and severe in 1 case.The incidence of myoclonus was 6.7％(2/30) in remifentanil group and mild in 2 cases.There was significant difference in the incidence of myoclonus between two groups (P ＜ 0.01).In control group,the ratio of myoclonus was 14/16 in males and 8/14 in females.In remifentanil group,male and female each had 1 case of myoclonus.There was no nausea,pruritis and apnea in remifentanil group.Conclusion Pretreatment with 0.5 μ g/kg remifentanil reduces myoclonus after etomidate injection,male patients are more associated with the incidence of myoclonus than female patients.
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Components separation is the key technology in biorefinery. Combination of steam explosion and laccase was used, and synergistic effect of the combined pretreatment was evaluated in terms of physical structure, chemical components and extraction of lignin. The results showed that steam explosion can destroy the rigid structure and increase the specific surface area of straw, which facilitated the laccase pretreatment. The laccase pretreatment can modify the lignin structure based on the Fourier transform infrared test, as a result the delignification of straw was enhanced. Nuclei Growth model with a time dependent rate constant can describe the delignification, and the kinetics parameters indicated that the combined pretreatment improved the reaction sites and made the delignification reaction more sensitive to temperature. The combined pretreatment enhanced delignification, and can be a promising technology as an alternative to the existing pretreatment.
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Biotecnologia , Métodos , Lacase , Química , Lignina , Química , Caules de Planta , Química , VaporRESUMO
Objective To investigate the effect of ropivacaine combined with dexanmethasone sprayed intratracheally in patients with resistant tubes and postoperative sore throat.Methods Eighty patients ASA Ⅰ-Ⅱ grade undergoing laparoscopic cholecystectomy were randomly divided into four groups by random digits tabel method,20 patients in each.2 ml of 0.75％ ropivacaine combined with 1 ml dexamethasone (group A) ; 2 ml of 0.75％ ropivacaine combined with 1 ml 0.9％ sodium (group B) ; 3 ml of 1％ tetracaine (group C); 3 ml of 0.9％ sodium (group D) were immediately intratracheal sprayed before intubation.The resistant tubes and degree of postoperative 24 h sore throat [by visual analog scale (VAS) scores],comfort [by Bruggrmann comfort scale (BCS) scores] and the incidence of sore throat were recorded.Results The resistant tubes appraised rate in group A,B and C was higher than that in group D [65.0％ (13/20),60.0％ (12/20),70.0％ (14/20) vs.5.0％ (1/20)] (P ＜ 0.05),but there was no significant difference among group A,B and C (P＞ 0.05).The incidence of sore throat at 24 h after surgery in group A,B and C was lower than that in group D [20.0％(4/20),25.0％ (5/20),25.0％ (5/20) vs.90.0％ (18/20)] (P ＜ 0.05),but there was no significant difference among group A,B and C (P＞ 0.05).The VAS and BCS scores in group A were better than those in group B,C and D [(0.52 ± 1.14) scores vs.(1.68 ± 1.42),(1.59 ± 1.33),(4.22 ± 1.95) scores,(2.80 ± 1.54) scores vs.(1.60 ± 1.19),(1.80 ± 1.20) and (0.45 ± 0.81) scores] (P ＜ 0.05),but there were no significant differences between group B and group C (P ＞ 0.05).Conclusion Ropivacaine combined with dexamethasone sprayedintratracheally can significantly increase the degree of postoperative resistant tubes,decrease the rate of sore throat after general anesthesia,and increase patient' s comfort.
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Objective To investigate the effect of dexmedetomidine on patients with pancreatic cancer treated by high intensity focused ultrasound (HIFU) under general anesthesia.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients with pancreatic cancer undergoing HIFU treatment,were divided into control group (group C) and dexmedetomidine group (group D) by random digits table method,each group with 60 cases.Dexmedetomidine was intravenously infused at 0.2 μ g/(kg· h) until the end of operation after a loading dose of 0.7 μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with intravenous injection of fentanyl 2-3 μg/kg and propofol 1.5-2.0 mg/kg and cisatracurium 0.2 mg/kg at 5 min after administration of the loading dose.Anesthesia was maintained with sevoflurane,remifentanil,propofol,cisatracurium.The propofol,remifentanil and sevoflurane consumption,the incidence of postoperative agitation,delirium,delayed recovery were recorded.Results The intraoperative heart rate in group D was significantly lower than that in group C (P ＜ 0.05).The propofol,remifentanil and sevoflurane consumption in group D were significantly shorter than those in group C [(341.4 ± 45.7) mg vs.(520.5 ± 50.8) mg,(1.7 ± 0.5) mg vs.(2.3 ± 0.8) mg,(11.6 ± 4.1) ml vs.(16.7 ± 3.8) ml,P ＜ 0.05].The incidence of postoperative agitation and delirium in group D were significantly lower than those in group C [6.7％(4/60) vs.21.7％(13/60),8.3％ (5/60) vs.26.7％ (16/60),P ＜ 0.05].There was no statistically significant difference in the incidence of delayed recovery between group D and group C [3.3％ (2/60) vs.1.7％ (1/60),P ＞ 0.05].Conclusions Dexmedetomidine given HIFU treatment of pancreatic cancer patients can reduce the amount of general anesthetic,reduce the incidence of postoperative agitation and delirium,intraoperative heart rate.
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Objective To study the effect of different mechanical ventilation modes and parameters on intragastric pressure and digestive function. Methods Forty patients suffered respiratory failure were selected in the study. In different modes and parameters of mechanical ventilation, a multi-channel physiological signal recording device was used to monitor the intra-trachea pressure (ITP), intra-gastric pressure (IGP) synchronously, and the emptying time of stomach, pH value and total bile acid (TBA) concentration in gastric fluid of patients. Results (1) For three types of ventilation mode(PSV,SIMV and CMV), ITP was the lowest in group PSV, the highest was in group CMV and the middle was in group SIMV. With the in-crease in ITP, IGP was also increased. CMV was the most influencing factor for the IGP (P＜0.01). In different PEEP values, the greater the PEEP, the higher the ITP. (2) Under mechanical ventilation support, when ITP increased, the emptying time of stomach decreased (P＜0.01), the concentration of TBA increased (P＜0.05). However, there was no significant change in pH value of gastric fluid (P>0.05). Conclusion Various mechanical ventilation modes and parameter settings induced differ-ent ITP, thereby affecting the IGP and gastric emptying. The digestive function can be promoted by choosing the appropriate mechanical ventilation mode and parameters.
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Objective To study the effect of long-time carbon dioxide (CO2) pneumoperitoneum on QT dispersion (QTd) in elderly patients during Davinci robotassisted surgery.Methods Thirty elderly patients undergoing elective Davinci robot-assisted hepato-pancreato-biliary surgery with general anesthesia were enrolled in this study.Pneumoperitoneum was established at 12 mm Hg ( 1 mm Hg =0.13 3 k Pa).QTd was recorded before the induction of anesthesia; at 5,15,30,60,120,180 and 240 min after pneumoperitoneum.Results Compared with before anesthesia,mean arterial blood pressure (MAP) increased significantly at 15,30 min after pneumoperitoneum ( P＜0.05 ),and had no significant difference at 5,60,120,180,240min (P＞0.05 ).Heart rate (HR) increased significantly at 15,30 min after pneumoperitoneum (P＜0.05 ).End-tidal pressure of carbon dioxide (PETCO2) increased after pneumoperi-toneum,and had significant difference at 30,60,120,180,240 min after pneumoperitoneum (P＜0.05).In 30 patients,11 patients occurred arrhythmia including atrial extrasystole,premature ventricular beats,tachycardia.Compared with before anesthesia,QTd,corrected QTd (QTcd),QT interval,corrected QT interval (QTe) were significantly increased at 15,30,60 min after pneumoperitoneum (P＜0.05),but had on significant difference at 5,120,180,240 min after pneumoperitoneum (P＞0.05).Conclusion The effect of CO2 pneumoperitoneum on the autonomic nervous system for elderly patients might be important,as an imbalance in autonomic cardiac control might lead to serious consequences.
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Objective To study the characteristics of craniocerebral injury caused by the handgun bullet impacting on the bulletproof helmet.Methods Fourteen healthy landrace pigs were involved and randomly divided into injury group(n =9)and control group(n =5).The landrace pigs of the injury group were shot vertically on the head under the protection of helmet plate with 9 mm handgun bullet at velocity of 360 m/s.While the landrace pigs of the control group were dealt with the same process as the injury group except for use of unarmed handgun bullet of the same ammunition dose.The changes of vital sign in the early period and the retina injury at two hours after injury were observed.Porcine cerebrospinal fluid (CSF)at pre-injury and at three hours post-injury were obtained for investigating the levels of neuron specific enolase(NSE)andαⅡ-spectrin protein.Then,the landrace pigs were sacrificed and dissected to examine the general morphological changes of the brain.The brain cortex was taken,fixed and stained with hematoxylin-eosin for microscopic observation.Results The landrace pigs in the injury group manifested decrease of the blood pressure and increase of the heart rate and respiratory rate in the early stage after injury.General morphological observation found retinal hemorrhage(3/9),skull fracture(3/9)and brain surface damage including local impact lesion(9/9)and contrecoup lesion(9/9),with severe impact lesion than contrecoup lesion.Optical microscopic observation revealed acute injury of the cerebral cortex neuron both on the impact and contrecoup locations.The concentrations of NSE and αⅡ-spectrinwere significantly increased in CSF three hours after injury(P ＜ 0.05).Conclusions The handgun bullet impacts on the pig head protected by the bulletproof helmet may induce blunt craniocerebral injury in the early period,with severe impact lesion than contrecoup lesion.Therefore,traumatic brain injury of the soldiers armed with the helmets should be stressed and managed early.
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Objective:To investigate the main clinical features of critically ill patients with influenza A (H1N1) influenza virus pneumonia, and the relationship between airway secretions and cardiopulmonary pathology change with continuous hypoxemia. Methods: The retrospective analysis was made in critically ill patients with H1N1 influenza virus pneumonia admitted to a respiratory intensive care unit(RICU). Twenty-four patients were all administrated antiviral drugs (oseltamivir 75/150 mg Bid). Twenty of them were subjected to application of hormonal therapy, and 6 of them with mechanical ventilation. Results: The average age of 24 patients was (48.25±19.73) years old. Fifteen of them were pregnant women, obesity and who suffered from chronic underlying diseases. The main symptoms of them were progressive shortness of breath, cough and myalgia. It was found by X-ray that 22 patients(91.67%) had multiple lung consolidation shadow. After admission, airway secretions were collected, and the protein concentration of which was 34.1-37.7 g/L in 5 cases. The concentration of l-lactate dehydrogenase(LDH) was 792-1 890 U/L. White blood cell count was (0.722-1.470)×10~9/L, included 0.21-0.44 neutrophils, 0.111-0.560 mononuclear cells, 0.027-0.110 eosinophils, 0.018-0.054 basophils. Pathological changes of these patients were hyaline membrane formation, alveolar cavity collapse, myocardial cell degeneration and focal myocardial necrosis. Intubation and mechanical ventilation were performed in 6 cases, 5 of them dead and the mortality rate was 20.83%. Conclusion: The lung pathological damages were increased LDH and protein in airway secretions, and increased count of inflammatory cells. Effect of mechanical ventilation was not satisfied in part of patients who had diffuse lung consolidation in X-ray, and the related complications leaded to exacerbation or death in part of them.
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Objective To investigate the role of miR-125b-1 gene in oncogenesis and progression of human lung cancer. Methods PCR-SSCP was used to detect miR-125b-1 gene mutation in 121 specimens from primary site of lung cancer tissues and 22 samples of nor- real adjacent lung tissues. Results There were 40 cases of miR-125b-1 gene mutation, and gene mutation was positively correlated to the status of lymph node metastasis ( r,=0.285, P＜0.01 ) and clinical stage metastasis( r, =0. 241, P ＜0. 01 ), but no relationship between miR-125b-1 mutation and other clinical features was found. The postoperative survival time in patients with miR-125b-1 gene mutation was significantly longer than those with low expression ( P＜0.05). Conclusion There exist miR-125b-1 gene mutation in lung cancer, miR- 125b-1 gene mutation probably plays a crucial role in lung carcinogenesis.
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Objective To compare the analgesic effect of morphine combined with lornoxicam in different proportions in rats. Methods 63 male adult SD rats were assigned randomly into nine groups (7 each). Under the 1.4% isoflurane anesthesia, an incision of 1cm in length was made in the plantar region of the left hind paw parallel to the muscle according to the method of Brennan. The rats in sham operation group (A) inhaled 1.4% isoflurane for 5 min but no incision was made, the rats in operation control group (B) received hypodermic injection of 1ml 0.9% NaCl 1h after incision, the rats in groups C to H and group L received hypodermic injection of morphine combined with lornoxicam in different proportions (6mg/kg∶0mg/kg; 1mg/kg∶5mg/kg; 2mg/kg∶4mg/kg; 3mg/kg∶3mg/kg; 4mg/kg∶2mg/kg; 5mg/kg∶1mg/kg and 0mg/kg∶6mg/kg, respectively) 1h after incision. Analgesic effect was assessed by cumulative pain score within 1 hour after administration. Results The cumulative pain scores of rats in group A was 0.375?0.518, which was significantly lower than that of the other groups (P0.05). The scores in groups F and G were 3.625?1.061 and 3.750?1.165 respectively, which were significantly lower than those in groups C, D, E and L (P