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Objective:To evaluate the changes in topological properties of brain functional network after induction of general anesthesia in the patients with glioma.Methods:Twenty-two patients scheduled for elective intracranial glioma resection were selected.Resting-state functional magnetic resonance imaging was performed during wakefulness and general anesthesia with endotracheal intubation in patients with glioma. Large-scale functional brain networks of each patient were constructed based on 123 regions of interest in non-surgical hemisphere. Global properties (local efficiency, clustering parameter, shortest path length, global efficiency, small world) and nodal properties (nodal degree, nodal efficiency, and between centrality) in brain functional networks were then compared between wakefulness and general anesthesia.Results:Eighteen patients were finally enrolled. Compared with the status during wakefulness, the local efficiency and clustering parameter on non-surgical side significantly decreased ( P<0.05), no significant change was found in the shortest path length and global efficiency ( P>0.05), and small world was greater than 1 throughout the entire density range; the nodal degree, nodal efficiency and between centrality of nodes located in the medial/mesal regions, such as the medial prefrontal cortex, posterior cingulate gyrus/precuneus, medial temporal lobe, anterior cingulate gyrus, thalamus, amygdala, were significantly reduced ( P<0.05); however, these node parameters increased significantly in the lateral brain regions ( P<0.05) except for the primary auditory and somatosensory cortex, which also decreased significantly after induction of general anesthesia( P<0.05). Conclusions:The functional segregation of brain functional network is widely inhibited after induction of general anesthesia, but the functional integration is still retained. The lateral brain regions show no anticorrelation with the medial brain region during general anesthesia.
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Objective:To investigate the perioperative alterations and management of coagulation function in patients of massive blood transfusion during retroperitoneal tumor (RT)resection.Methods:Fourty-seven RT patients at Peking University International Hospital from Jan 2016 to Dec 2021 undergoing resection with massive blood transfusion more than 20 U within 24 h were reviewed for coagulation function before and after surgery.Results:Intraoperative bleeding was 3 000-25 800 ml, 10 patients had blood loss ≥10 000 ml. During the operation, (25.3±9.9) U of red blood cells were transfused, (2 720±1 369) ml plasma transfused, and (2.4±3.3) U platelets were transfused in 6 patients. Fourty-five patients received intraoperative albumin of (79.5±46.5) g; All 47 patients received fibrinogen of (2.3±1.3) g; Prothrombin complex was given in 45 patients (1 205±807) U. Preoperative hemoglobin was statistically different compared to postoperatively and days 1, 3 and 5 ( W=1 790, P<0.001; W=1 672, P<0.001; W=1 704, P<0.001; W=1 486, P=0.004);As with platelets, the difference was also statistically significant compared to postoperative days 1, 3, and 5 ( W=2 153, P<0.001; W=2 092, P<0.001; W=1 732, P<0.001); Preoperative albumin was different compared to postoperative days 1 and 3 ( W=1 568, P<0.001; W=1 578, P<0.001,); Preoperative fibrinogen was different compared to postoperative day 1 ( W=1 964, P<0.001). PT and APTT were prolonged on postoperative days 1 and 3 ( W=628, P<0.001, W=804, P=0.023) ( W=661, P<0.001, W=796, P=0.02). Patient's preoperative fibrin degradation products and D-dimer were above the normal value and were higher on postoperative days 3 and 5 ( W=498, P<0.001, W=345, P<0.001). Conclusions:Coagulation disorders occur perioperatively in patients with massive transfusion while undergoing surgery for RT.The implementation of ratiional transfusion strategy and close postoperative survey and management of coagulation dysfunction help avoid the coagulation related morbidities.
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Objective: To compare the efficacy of Tuina (Chinese therapeutic massage) plus physical agents and physical agents alone for lateral collateral ligament injury of ankle in gymnasts, and to explore the feasibility of Tuina for injury intervention in competitive athletes.Methods: A total of 64 gymnasts with types Ⅰ-Ⅱ lateral collateral ligament injury of ankle were selected and divided into a control group and an observation group according to a full analysis set based on the intention-to-treat principle, with 32 cases in each group. Patients in the control group received ultrasound and microwave treatment, while those in the observation group received additional Tuina manipulations. The efficacy was evaluated by total effective rate, visual analog scale (VAS) score, and American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AHS) score. Results: The total effective rate was 96.9％ in the observation group and 90.6％ in the control group. There was no statistical difference in the total effective rate between the two groups (P>0.05). The markedly effective rate was 75.0％ in the observation group and 46.9％ in the control group. The markedly effective rate in the observation group was higher than that in the control group (P<0.05). After treatment, the VAS scores of both groups showed a downward trend, and there were statistical differences between different treatment time points in the same group (P<0.05). After one and three months of treatment, the VAS scores of the observation group were lower than those of the control group (P<0.05). There were statistical differences in the AOFAS-AHS score before and after treatment within the same group (P<0.05). After one month of treatment, there was no statistical difference in the AOFAS-AHS score between the two groups (P>0.05). After three months of treatment, the AOFAS-AHS score in the observation group was higher than that in the control group, indicating statistical significance (P<0.05). There was an interaction between time and group (P<0.05). Conclusion: Tuina plus physical agents can improve the symptoms of lateral collateral ligament injury of ankle in gymnasts. This combined treatment is superior to physical agents alone in relieving pain and improving joint functions. Therefore, Tuina plus physical agents can be used as a treatment for lateral collateral ligament injury of ankle in gymnasts.
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Objective:To investigate the status of viral reservoirs in prostate tissue of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and to investigate the effect of highly active anti-retroviral therapy (HAART) on HIV-1 DNA in prostate tissue of HIV/AIDS patients.Methods:Twelve patients with HIV infection and hyperplasia of prostate who required surgical treatment and admitted to Guangzhou Eighth People′s Hospital from July 2017 to October 2019 were included. Blood and prostate specimens of these patients were collected, and HIV-1 RNA in plasma, CD4 + T lymphocyte count in peripheral blood and HIV-1 DNA level in prostate tissue were tested respectively. The independent sample t test or Mann-Whitney U test was used for statistical analysis. Results:Among the 12 patients, the CD4 + T lymphocytes was (519.8±121.5)/μL and HIV-1 DNA in the prostate tissue was 2 602 (365, 10 700) copies/10 6cells in six patients who had not started HAART. The CD4 + T lymphocytes was (182.8±69.7)/μL and the HIV-1 DNA in the prostate tissue was 144 (36, 563) copies/10 6cells in the six patients who underwent HAART for over six months. There were statistically significant differences in CD4 + T lymphocytes and HIV-1 DNA in the prostate tissue between the two groups ( t=-5.889 and Z=-2.082, respectively, both P<0.05). Conclusion:Prostate tissue can be used as an HIV-1 virus repository with or without HAART, and the size of the prostate tissue virus repository can be reduced by HAART after immune reconstitution.
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@#Objective To study the association between neutrophil to lymphocyte ratio (NLR) or platelet to lymphocyte ratio (PLR) in patients with vestibular neuritis (VN).Methods A total of 137 patients who were finally diagnosed as VN were selected as the study group and 192 healthy volunteers without a history of dizziness or vertigo were selected as the control group in Hwa Mei Hospital and Ningbo Women and Children’s Hospital from January 2016 to December 2020.The general information,complete blood counts,NLR and PLR were obtained and analyzed.Results There were no significant differences in the age distribution,sex ratio,body mass index,comorbidities,hemoglobin,lymphocyte and platelet values between the study group and control group.White blood cell and neutrophil count were significantly higher in the study group and control group (P<0.001).NLR and PLR were significantly higher in the study group as well (2.5 vs 1.9,Z=-5.74,P<0.001;124.2 vs 109.5,Z=-2.727,P=0.003).Conclusion The elevations of NLR and PLR in patients with VN indicate that inflammation is involved in the pathogenesis of VN.
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At present,thyroid surgery is widely carried out during clinical practice.Because of preoperative or intraoperative misdiagnosis,nonstandard scope of operation,tumor recurrence and other factors,resulting in some cases needed to treat again.Due to the previous surgical scar adhesion and disordering of anatomical structure,the risk of injury of recurrent laryngeal nerve(RLN)increased manyfold.Intraoperative neuromointoring(IONM)is a technology for monitoring the functional integrity of the nervous system in state of dangerous by neural electrophysiological means.Better than the naked eye to identify and prompt the recurrent laryngeal nerve injury,to find the site of injury,IONM can significantly reduce the chance of transient RLN injury during thyroid reoperation as a sharp weapon to protect RLN.
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To study the changes in median frequency (MF) from a surface electromyogram of skeletal muscles and functional assessment of chronic illness therapy (FACIT) figure scale scores for patients with chronic fatigue syndrome (CFS) before and after Tuina treatment.
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Objective To explore the experiment condition and method for the application of in vitro in vasive Transwell chamber and to observe muscarinicreceptor stimulant and muscarinicreceptor antagonist's influence to cholangiocarcinoma's invasiveness.Methods Two hundred microliter cell suspension of various concentrations(0.5×105/mL,1.0×105/mL,1.5×105/mL and 2.0×105/mL)was added into the upper chamber of the Transwell chamber,and the cells were allowed to penetrate the matrigel for 12,18,24and 48 hours respectively.The numbers was gotten as the invasive cells on the under surface of the membrane.After optimal cell concentration and time were gotten,pilocarpine of various concentrations(0 mmol/L,0.1 mmol/L,0.3 mmol/L and 0.5 mmoL/L)was added into the upper chamber of the Transwell chamber,then the cells on the matrigel were stained and counted.So did the cells when atropine of various concentrations(0.01 mmol/L,0.01 mmol/L,0.05 mmoVL and 0.1 mmol/L)were added into the upper chamher of the Transwell chamber in according to pilocarpine of various concentrations(0 mmol/L,0.3 mmol/L,0.3 mmol/L and 0.3mmol/L).Results With the increase of the time and cell concentrations，the cells couts that penetrated the matrigel increased，while the increase tended to he stable when the culture time exceeded 36 hous and the cell concentration Was over 1.0×105/mL.By adding pilocarpine,there were significant differences between the control and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.There were no significant differences in blank group and experimental groups with atropine added(P＞0.05).When added pilocarpine and atropine,there were significant differences between blank and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.Conclusions Thirty-six hours as invasive time,and one cell concentration 1.0 × 105/mL were optimal to test invasion abilities of cholangiocarcingma cells to different medicines or reagents.There is the possibility that museariniereceptor exists in cholangiocarcinoma cells，and may play an important role in cholangiocarcinoma's invasiveness and metastasis.
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Objective To evaluate the influence of head anteflexion on airway sealing pressure during intermittent positive pressure ventilation(IPPV) with ProSeal laryngeal mask airway (PLMA) with an esophageal vent.Methods Fifty ASA Ⅰ or Ⅱ patients (20 males and 30 females), aged 18-51 ye are, weighing 50-70 kg and scheduled for elective plastic surgery under general anesthesia, were enrolled in this study. Anesthesia was induced with fentanyl 2 μg/kg, propofol 2 μg/kg and vecuromium 0.1 mg/kg. PLMA with an esophageal vent was inserted at 2 min after intravenous vecuronium injection.The airway sealing pressure, the anatomic position of the cuff and the efficacy of positive pressure ventilation were checked in the neutral and anteflexed head positions with the cuff deflated and inflated to an intracuff pressure of 60 cm H2 O, respectively.Results The lungs were better ventilated in the head anteflexion position than in the head neutral position whether the cuff was deflated or inflated. There was no significant difference in the volume of air required to achieve an intracuff pressure of 60 cm H2O between the two head positions ( P＞ 0.05). The airway seating pressure increased from (27 ± 6) cm H2O in the head neutral position to (33 ± 6) cm H2O in the head anteflexion position, with no significant difference between them ( P＞ 0.05). The expired tidal volume and the peak inspiratory pressure during IPPV were (496 ± 81 ) ml and (14.3 ± 1.9) cm H2O respectively in the head neutral position and (496 ± 81 ) ml and ( 14.5 ± 2.1 )cm H2O respectively in the head anteflexion position.Conclusion Head anteflexion can significantly improve airway sealing but does not affect the anatomic position of the cuff.Appropriate head anteflexion is a simple and effective way to improve IPPV when the airway sealing pressure is inadequate in the head neutral position.
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Objective To investigate the role of cyclooxygenase-2(COX-2)and mitochondrial adenosine tuiphosphate sensitive potassium channels (mito-KATP channels) in sufentanil preconditioning-induced delayed cardiopreteetion against myocardial ischemia-reperfnsion (I/R) injury in rats. Methods Seventy-two adult male Wistsr rats weighing 250-300 g were randomly divided into 6 groups ( n =12 each). Group Ⅰ,Ⅱ,Ⅲ were preconditioned with intraperitoneal (IP) normal saline (NS) 1 ml/kg while group Ⅳ,Ⅴ,Ⅵ with IP sufentanil 20 μg/kg at 24 h before myocardial ischemia. Group Ⅱ and Ⅴ were given IP NS-398 ( COX-2 inhibitor) 5 mg/kg at 30 rain before myocardial ischemla while group Ⅲ and Ⅵ were given intravenous 5-HD (mito-KATP channelblocker) 10 mg/kg at 10 min before ischemia or before being killed. Six animals in each group underwent 45 min myocardial ischemia followed by 120 min reperfusion, while the other six animals in each group were killed immediately before ischemia for determination of myocardial COX-2 expression and myocardial PGF2 and PGF1α content. Myocardial ischemia was induced by occlusion of left anterior descending branch (LAD) of coronary artety for 45 rain followed by 120 min reperfusion. MAP and HR were recorded immediately before ischemia (T0), at 15, 30, 45 rain of ischemia (T1-3) and at 30, 60, 90, 120 vain of reperfusion (T4-7). Heart rate-blood pressure product (RPP) was calculated. Arterial blood samples were obtained at T0.3 and T7 for measurement of plasma CK-MB activity. The animals were killed at the end of 120 nan reperfusion. The hearts were removed for determination of myocardial infarct area (IA) and area at risk (AAR). LA/AAR was calculated. Results There was no significant difference in HR, MAP and RPP at all time points among the 6 groups. Preconditioning with sufentanil significantly decreased plasma CK-MB activity at T3 and T7 and IA/AAR in group Ⅳ as compared with group Ⅰ.Myocardial COX-2 expression was up-regulated and PGE2 and PGF1α, contents were elevated by sufentanil preconditioning in group Ⅳ as eomared with control group (Ⅰ). In group Ⅴ and Ⅳ preconditioning with NS-398/5-HD significantly increased plasma CK-MB concentration and IS/AAB as compared with group Ⅳ, indicating involvement of COX-2 and mito-KATP channels in the sufentanil-induced delayed cardioprotection.The myocardial PGE2 and PGF1α contents were significantly reduced in group Ⅴ as compared with group Ⅳ. There was no significant difference in the myocardial COX-2 expression among group Ⅳ, Ⅴ and Ⅵ. Conclusion Both COX-2 and mito-KATP channels are involved in sufentanil preconditioning-induced delayed cardiopmtection.
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Objective:To study the tuina effect on sleep disorder and emotional problems of chronic fatigue syndrome (CFS) cases.Method:Thirty CFS cases were treated in the treatment group,by applying one-thumb pushing,rolling and pressing-kneading manipulations along the Governor Vessel,Bladder and Yangming Meridians.The intended major points include Fengfu (GV 16),Yaoyangguan (GV 3),Xinshu (BL 15),Pishu (BL 20),Ganshu (BL 18),Hegu (LI 4) and Taixi (KI 3).The treatment was done once every other day;10 times constitute a course of treatment.Another 30 healthy cases were selected in the control group,without any intervention.The sleep quality and mental state in the two groups were evaluated by PSQI,HAMA and HAMD.In addition,the pre-treatment and post-treatment score changes were observed.Results:Before treatment,the total score of PSQI,sleep quality,time of falling asleep,sleep efficiency,sleep disorder,daytime functional impairment,and scores of HAMD and HAMA in treatment group were all substantially higher than the control group (P＜0.01).After 10 tuina treatments,the total score of PSQI,time of falling asleep,sleep disorder and daytime functional impairment as well as scores of HAMD and HAMA in treatment group were significantly changed,compared with before treatment,P＜0.05.Conclusion:Those with CFS may present with sleep disorder and mental or psychological abnormality,tuina can improve their sleep quality and adjust their mental conditions.
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Objective To compare the effects of small dose remifentanil and fentanyl on hemodynamic responses to orotracheal intubation in children.Methods Ninety ASAⅠorⅡchildren (57 males, 33 females) aged 3-9 yrs weighing 17-34 kg scheduled for elective plastic surgery under general anesthesia were randomly allocated to one of 3 groups (n = 30 each): groupⅠcontrol (C); groupⅡfentanyl (F) and groupⅢremifentanil (R) . The children were premedicated with intramuscular scopolamine 0.01 mg?kg-1(the maximum dose 0.3 mg) and midazolam 0.1 mg?kg-1.Anesthesia was induced with propofol 2.5 mg?kg-1 and vecuronium 0.1 mg?kg-1. In group F fentanyl 2?g?kg-1 was injectedⅣ5 min before intubation while in group R remifentanil 1?g?kg-1 was injectedⅣover 30 seconds immediately after vecuronium. Tracheal intubation was performed at 2 min after vecuronium injection. Noninvasive BP and HR were recorded and RPP (SBP?HR) was calculated before (baseline) and immediately after induction (T1),during intubation (T2) and at 1,2,3,4, 5 min after intubation.Results BP was significantly decreased after induction of anesthesia (T1) as compared to the baseline values in all 3 groups (P