Core Techniques of Anesthesia for Elderly Patients：a Review / 中山大学学报(医学科学版)

@#China has entered an aging society in which the problem about the aged becomes a public concern. The incidence and risk of surgery are much higher in the elderly. Before the surgery，anesthesiologists can identify high-risk surgical patients and deal with them to prepare the patients in a relatively good physical condition. During and after the surgery，anesthesiologists choose the specific treatment for the elderly patients to achieve the best prognosis，by using core anesthesia techniques，including anesthetic drugs，pain management，respiratory- circulation management，and organ protection. This review summarized the core techniques of anesthesiology in elderly patients from the assessment and management perspectives.

DNA barcoding and its utility in commonly-used medicinal snakes / 中国中药杂志

Identification accuracy of traditional Chinese medicine is crucial for the traditional Chinese medicine research, production and application. DNA barcoding based on the mitochondrial gene coding for cytochrome c oxidase subunit I (COI), are more and more used for identification of traditional Chinese medicine. Using universal barcoding primers to sequence, we discussed the feasibility of DNA barcoding method for identification commonly-used medicinal snakes (a total of 109 samples belonging to 19 species 15 genera 6 families). The phylogenetic trees using Neighbor-joining were constructed. The results indicated that the mean content of G + C(46.5%) was lower than that of A + T (53.5%). As calculated by Kimera-2-parameter model, the mean intraspecies genetic distance of Trimeresurus albolabris, Ptyas dhumnades and Lycodon rufozonatus was greater than 2%. Further phylogenetic relationship results suggested that identification of one sample of T. albolabris was erroneous. The identification of some samples of P. dhumnades was also not correct, namely originally P. korros was identified as P. dhumnades. Factors influence on intraspecific genetic distance difference of L. rufozonatus need to be studied further. Therefore, DNA barcoding for identification of medicinal snakes is feasible, and greatly complements the morphological classification method. It is necessary to further study in identification of traditional Chinese medicine.

Fast track surgery accelerates the postoperative rehabilitation and recovery of insulin sensitivity in elective operation for colorectal carcinoma: a randomized controlled clinical trial / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of fast track surgery on postoperative insulin sensitivity on the basis of clinical benefits in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>During May 2008 to December 2008, Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters, stress markers and insulin sensitivity were evaluated in both groups.</p><p><b>RESULTS</b>The 62 patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. The speed of recovery of postoperative insulin sensitivity on 7 days postoperative in the fast-track group (97% ± 9%) was significantly faster than the conventional care group (88.5% ± 9.0%, t = 2.552, P = 0.016). The hospitalization days in the fast-track group was 6 days (M(50)), and it was significantly shorter than the conventional care group ((11.7 ± 3.8) days, Z = 4.360, P = 0.000). The time of recovery of bowel function were faster in the fast-track group (time to pass flatus was 2 days (M(50))) than the conventional care group (4 days, Z = 3.976, P = 0.000). The Infectious complication rate in the fast-track group (2/32) is lower than the other group (8/30, P = 0.040).</p><p><b>CONCLUSION</b>Fast track surgery accelerates recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a lower rate of postoperative infectious complications and a shorter length of postoperative hospital stay.</p>

Predictors and scoring system for sustained complete response to conventional interferon-alpha therapy on chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To establish a predictive scoring system which may serve for the prediction of sustained response to conventional interferon-alpha (IFN-alpha) treatment on chronic hepatitis B.</p><p><b>METHODS</b>A total of 474 IFN-alpha treated hepatitis B virus e antigen (HBeAg)-positive patients were enrolled in the present study. The patients' baseline characteristics, such as age, gender, aminotransferases, activity grading (G) of intrahepatic inflammation, score (S) of liver fibrosis, hepatitis B virus (HBV) DNA and genotype were evaluated; therapy duration and response of each patient at the 24th wk after cessation of IFN-alpha treatment were also recorded. A predictive scoring system for a sustained complete response (CR) to IFN-alpha therapy was established based on genetic algorithm. About 10% of the patients were randomly drawn out as the test set. Responses to IFN-alpha therapy were divided into CR, partial response (PR) and non-response (NR). The mixed set of PR and NR was recorded as PR + NR.</p><p><b>RESULTS</b>For the scoring system, the sensitivity and specificity were 78.8% and 80.6%, respectively.</p><p><b>CONCLUSION</b>This SCR scoring system has satisfying prediction efficiency and is easily employed in clinical practice. With this scoring system, practitioners can propose individualized decisions that have an integrated foundation on both evidence-based medicine and personal characteristics.</p>

Effects of preoperative oral glucose on perioperative insulin resistance and plasma proteins of intestinal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of oral intake of glucose solution before surgery on the pH at the lower esophagus, perioperative blood glucose level, and plasmic protein in patients undergoing radical resection for colorectal cancer.</p><p><b>METHODS</b>Between January 2008 and December 2008, 60 patients undergoing radical surgery for colorectal cancer were enrolled and randomized into three groups using the table of random digits. Four patients were withdrawn from the study. Patients in group A (n=19) were given 800 ml of 12.5% glucose solution for oral intake the night before surgery, and 200 ml two hours before surgery. Patients in group B (n=19) were given distilled water instead of glucose. Patients in group C (n=18) were asked to fast for 8-12 hours before operation. Combined general and epidural anesthesia was used. pH at the lower esophagus was monitored during intubation and extubation. Albumin, transferrin, prealbumin, insulin, and fasting blood glucose were measured before surgery and at postoperative day 1, 3, and 7.</p><p><b>RESULTS</b>pH at the lower esophagus was 8.05±0.43 in group A, 7.98±0.41 in group B, and 7.94±0.41 in group C. There were no perioperative acid regurgitations (P>0.05). Serum insulin in group A at postoperative day 1 was (16.32±16.11) μU/L, which was significantly lower than that in group B (30.65±41.74) μU/L and group C (34.01±52.91) μU/L. Log HOMA-IR in group A at postoperative day 1 was significantly lower than that in group B and group C (0.49±0.35 vs. 0.59±0.56 and 0.60±0.63, P<0.05). Transferrin in group C at postoperative day 3 and 7 was significantly lower than that in the other two groups, as was albumin at postoperative day 3 (P<0.05).</p><p><b>CONCLUSION</b>Oral liquid intake 2 hours before surgery is not associated with increased risk of regurgitation or aspiration during intubation and extubation, and may glucose solution intake reduce insulin resistance and protein degradation after colorectal surgery.</p>

Proteomics study of intestinal mucosa after ischemic preconditioning against intestinal ischemic reperfusion injury in rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify associated proteins involved in the molecular response of ischemic preconditioning (IPC) against intestinal ischemia/reperfusion (II/R) in the intestinal mucosa of rats.</p><p><b>METHODS</b>Sixteen SD rats were randomly divided into II/R and IPC groups. II/R injury in rats was produced by clamping superior mesenteric artery for 60 min followed by 60 min reperfusion. IPC was elicited by 20 min ischemia and 5 min reperfusion before index ischemia. The intestinal mucosa was scratched immediately after 60 min of reperfusion and total proteins were separated by immobilized pH gradient (IPG) based on two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins were analyzed using Image Master 2D Elite 5.0 image analysis software and identified by MALDI-TOF-MS. The biological information of these proteins was searched in the database of these peptide mass finger-printing (PMF). Western blotting and RT-PCR were used to validate the differentially expressed proteins.</p><p><b>RESULTS</b>Image analysis revealed that averages of 1404+/-20 and 1338+/-20 were detected in II/R and IPC groups. A total of 10 spots yielded good spectra, and 8 spots matched with known proteins after database searching. These proteins were mainly involved in anti-oxidation, inhibiting apoptosis and energy metabolism. Western blot confirmed up-regulation of aldehyde dehydrogenase and RT-PCR confirmed up-regulation of aldose reductase in IPC group.</p><p><b>CONCLUSION</b>The clues provided by comparative proteome strategy will shed light on molecular mechanisms of IPC against II/R injury.</p>

A comparison of the metabolic effect of postoperative analgesia with lornoxicam and morphine or morphine on patients undergoing gastrointestinal carcinoma operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the metabolic effect of postoperative analgesia with lornoxicam/morphine or morphine on patients undergoing gastrointestinal carcinoma operation.</p><p><b>METHODS</b>One hundred patients, undergone gastrointestinal carcinoma operations, were randomly assigned into two groups: group A received postoperative analgesia with lornoxicam/morphine and Group B with morphine alone. Parenteral nutrition with limited nitrogen resource was given to both groups. Visual analog scale (VAS), temperature and postoperative nitrogen balance were monitored postoperatively. The concentration of plasma cortisol , epinephrine, tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured preoperatively and day 1, 3 postoperatively.</p><p><b>RESULTS</b>VAS of two groups at 24 th, 48 th, 72 th after operation were similar (P>0.05). The temperature of two groups on the third postoperative day increased as compared to that before operation, and the temperature of group B on 1st and 3rd postoperative day [(37.8+/-0.6),(37.5+/-0.8)degrees C] were significantly higher than those of group A[(37.3+/-0.5)degrees C,(37.0+/-0.8)degrees C](P<0.05). Nitrogen balance within 3 days after operation were -7.5+/-3.2, -5.2+/-4.2, -3.1+/-1.2 in group A and -16.7+/-7.3, -10.5+/-6.1, -9.1+/-2.1 in group B (P<0.05). The post-operative plasma concentrations of cortisol and epinephrine increased significantly in both groups as compared to those examined preoperatively(P<0.05), but there was no significant difference between the two groups. However, the plasma concentrations of TNF-alpha and IL-6 in group B were significantly higher than those in group A(P<0.05).</p><p><b>CONCLUSIONS</b>Postoperative analgesia with lornoxicam/morphine or morphine is able to produce an adequate postoperative analgesia to patients undergoing gastrointestinal carcinoma operation. Lornoxicam and morphine analgesia possesses a better metabolic intervention in decreasing the protein metabolism and improving the nitrogen balance.</p>

Analysis of factors leading to prescheduled analgesic withdrawal in patients with postoperative epidural analgesia / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the factors leading to prescheduled analgesic withdrawal in patients with postoperative epidural analgesia.</p><p><b>METHODS</b>A retrospective study of 4876 patients with postoperative epidural analgesia was conducted and the effect of analgesia and incidence of prescheduled analgesic withdrawal were recorded. The factors precipitating the occurrences of analgesic withdrawal and complications were analyzed.</p><p><b>RESULTS</b>Early analgesic withdrawal occurred in 113 cases (2.3%), among which 74 (0.5%) were due to factors irrelevant to analgesic complications. Analgesia-related complications occurred in 578 patients, but only 39 (0.7%) of them needed discontinuation of the analgesics.</p><p><b>CONCLUSION</b>Prescheduled analgesic withdrawal is predominantly due to technical inadequacies rather than complications arising from the analgesics, and improvement of the operation skills for postoperative analgesia may reduce early analgesia discontinuation and enhance the patients' satisfaction.</p>

Heuristic algorithm for off-lattice protein folding problem / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Enlightened by the law of interactions among objects in the physical world, we propose a heuristic algorithm for solving the three-dimensional (3D) off-lattice protein folding problem. Based on a physical model, the problem is converted from a nonlinear constraint-satisfied problem to an unconstrained optimization problem which can be solved by the well-known gradient method. To improve the efficiency of our algorithm, a strategy was introduced to generate initial configuration. Computational results showed that this algorithm could find states with lower energy than previously proposed ground states obtained by nPERM algorithm for all chains with length ranging from 13 to 55.

Application of lornoxicam to patient-controlled analgesia in patients undergoing abdominal surgeries / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries.</p><p><b>METHODS</b>Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.</p><p><b>RESULTS</b>The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).</p><p><b>CONCLUSION</b>In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.</p>

The influence of body temperature on the recovery from vecuronium-induced neuromus cular block / 中华麻醉学杂志

Objective To investigate the influence of body temperature on the recovery from vecuronium-induced neuromuscular block.Methods Sixty-eight ASA I - II patients (39 male, 29 female) aged 19-69 yr undergoing elective surgery under general anesthesia were randomly divided into 2 groups: group I in which patients' body temperature was maintained at 37 ℃ using warming blanket; group II in which no measures were taken to maintain the patients' body temperature. The patients were premedicated with phenobarbital 2 mg?kg-1 and atropine 0.01 mg? kg-1 intramuscularly. Anesthesia was induced with fentanyl 5 ?g? kg -1, propofol 2 mg? kg-1 and vecuronium 0. 1 mg?kg-1 . After tracheal intubation anesthesia was maintained with inhalation of 0.8%-2.5% isoflurane and propofol infusion at a rate of 2-4 mg ? kg-1? h-1 .Neuromuscular block was monitored using accelograph (Biometer, Denmark) .The changes in TOF and T1 were monitored. T1was maintained at 10% by vecuronium infusion during operation. At the end of operation a bolus of vecuronium 80?g ? kg-1 was given intravenously and T1 was completely depressed. The time for T1 to returned to 5% ,25% and 90% and the time required for T1 to return from 25 % to 75 % were recorded. The total amount of vecuronium given was recorded. Temperature probe was placed in the esophagus ( core temperature) . The room temperature was also recorded. Results The body temperature was lower, the total dose of vecuronium was smaller and the vecuronium-induced neuromuscular block lasted longer in group II as compared with group I . There was close correlation between body temperature and vecuronium-induced neuromuscular block. Conclusions Lower core body temperature could prolong the vecuronium-induced neuromuscular block.