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Objective:To evaluate the effect of esketamine combined with ultrasound-guided dorsal penile nerve block (DPNB) on negative postoperative behavioral changes (NPOBCs) in pediatric patients undergoing circumcision under general anesthesia.Methods:One-hundred and ninety-five pediatric patients, aged 4-8 yr, with body mass index of 10-35 kg, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective circumcision under general anesthesia, were selected and divided into 3 groups ( n=65 each) using a random number table method: esketamine group (group E), DPNB group (group D) and esketamine combined with DPNB group (group ED). Propofol 1.5 mg/kg was intravenously injected, and the patients were admitted to the operating room after consciousness disappeared in the 3 groups. Esketamine 0.5 mg/kg was intravenously injected in E and ED groups, and the equal volume of normal saline was given in group D. D and ED groups underwent bilateral DPNB with 0.25 % ropivacaine 0.15 ml/kg under ultrasound guidance, with the maximum total amount of the drug not exceeding 10 ml. Fentanyl 1.0 μg/kg and propofol 2.0 mg/kg were intravenously injected prior to the skin incision in the three groups. If intraoperative body movement occurred, propofol 10 mg was added, which could be repeated. The occurrence of intraoperative body movement, respiratory depression and amount of propofol added was recorded. When postoperative pain (FLACC score >4) occurred, flurbiprofen 1 mg/kg was intravenously injected for analgesia, and the usage of flurbiprofen was recorded. When emergence agitation(PEAD score>10) occurred, propofol 1 mg/kg was intravenously injected for sedation, and the occurrence of emergence agitation was recorded. Parents were followed up by telephone at 1, 7 and 30 days postoperatively to assess the occurrence of NPOBCs using the PHBQ scale. Results:Fifty-six patients in group E and 59 patients in D and ED groups finally completed the study.Compared with group E, the incidence of intraoperative body movement was significantly decreased, the amount of additional propofol was reduced, the emergence agitation score, incidence of emergence agitation and severe agitation and usage rate of postoperative flurbiprofen were decreased, and the incidence of separation anxiety at 7 and 30 days postoperatively was decreased in D and ED groups, and the incidence of intraoperative respiratory depression was significantly decreased, and the incidence of NPOBCs at 7 and 30 days postoperatively was decreased in group ED ( P<0.05). Compared with group D, the incidence of intraoperative respiratory depression was significantly decreased, the amount of additional propofol was decreased, the usage rate of postoperative flurbiprofen and incidence of sleep anxiety at 1 day postoperatively were decreased ( P<0.05), and no significant change was found in the incidence of NPOBCs at each time point after operation in group ED ( P>0.05). Conclusions:Esketamine combined with ultrasound-guided DPNB can reduce the occurrence of NPOBCs in pediatric patients undergoing circumcision under general anesthesia.
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The gut microbiota plays a key role in host health and disease, particularly through their interactions with the immune system. Intestinal homeostasis is dependent on the symbiotic relationships between the host and the diverse gut microbiota, which is influenced by the highly co-evolved immune-microbiota interactions. The first step of the interaction between the host and the gut microbiota is the sensing of the gut microbes by the host immune system. In this review, we describe the cells of the host immune system and the proteins that sense the components and metabolites of the gut microbes. We further highlight the essential roles of pattern recognition receptors (PRRs), the G protein-coupled receptors (GPCRs), aryl hydrocarbon receptor (AHR) and the nuclear receptors expressed in the intestinal epithelial cells (IECs) and the intestine-resident immune cells. We also discuss the mechanisms by which the disruption of microbial sensing because of genetic or environmental factors causes human diseases such as the inflammatory bowel disease (IBD).
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Humanos , Doenças Inflamatórias Intestinais , Microbioma Gastrointestinal , Microbiota , Sistema Imunitário , IntestinosRESUMO
Objective To compare the treatment effect of intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens and simple intraocular lens ciliary sulcus implantation.Methods We retrospectively analyzed 60 eyes of 60 children with traumatic cataract from June 2012 to June 2015 in the Second People's Hospital of Yunnan Province,including 44 males and 16 females and the average age ranged from 1 to 14 years.The patients were divided into two groups according to the situation of posterior capsular,30 eyes of 30 children for each group.The patients in combined surgery group were performed intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens,and the patients in simple surgery group were performed simple intraocular lens ciliary sulcus implantation.The follow-up time ranged from 1 month to 6 months.The best corrected visual acuity(BCVA),grade of optic axis turbid,dislocation of intraocular lens,postoperative complications and surgical duration were compared between the two groups.Results The BCVA after surgery was significantly different from that before surgery in both groups (combined surgery group:x2 =7.548,P＜ 0.05;simple surgery group:x2 =5.579,P＜0.05).The postoperative turbidity of central axis area and BCVA were not significantly different between the 2 groups (x2 =0.362,P＞0.05).The dislocation degree of intraocular lens and proportion of postoperative complications were lower in the combined surgery group than those in the simple surgery group (x2 =9.858,P＜0.05;x2 =7.200,P＜0.05).The duration of surgery was not significantly different between the 2 groups (x2 =0.658,P ＞ 0.05).Conclusions Posterior capsular incarceration of intraocular lens has fewer complications,lower dislocation degree of intraocular lens and more effective for children with traumatic cataract than intraocular lens ciliary sulcus implantation.