The effects of halogen elements on the opening of an icosahedral B12 framework.

The fully halogenated or hydrogenated B12X122- (X = H, F, Cl, Br and I) clusters are confirmed to be icosahedral. On the other hand, the bare B12 cluster is shown to have a planar structure. A previous study showed that a transformation from an icosahedron to a plane happens when 5 to 7 iodine atoms are remained [P. Farràs et al., Chem. - Eur. J. 18, 13208-13212 (2012)]. Later, the transition was confirmed to be seven iodine atoms based on an infrared spectroscopy study [M. R. Fagiania et al., Chem. Phys. Lett. 625, 48-52 (2015)]. In this study, we investigated the effects of different halogen atoms on the opening of the B12 icosahedral cage by means of density functional theory calculations. We found that the halogen elements do not have significant effects on the geometries of the clusters. The computed infrared (IR) spectra show similar representative peaks for all halogen doped clusters. Interestingly, we found a blue-shift in the IR spectra with the increase in the mass of the halogen atoms. Further, we compared the Gibbs free energies at different temperatures for different halogen atoms. The results show that the Gibbs free energy differences between open and close structures of B12X7- become larger when heavier halogen atoms are presented. This interesting finding was subsequently investigated by the energy decomposition analysis.

Serum Gamma-glutamyl Transferase Levels Predict Functional Outcomes after Aneurysmal Subarachnoid Hemorrhage.

OBJECTIVE: We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. METHODS: A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ⋝ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. RESULTS: The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of < 30 U/L, 30-50 U/L and ⋝ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively (P < 0.01). The age-sex and multivariable adjusted odds ratios (95% confidence intervals) of poor prognosis comparing the top group (⋝ 50 U/L) with the lowest group (< 30 U/L) were 5.76 (2.74-12.13), 6.64 (2.05-21.52), and 6.36 (1.92-21.02). A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. CONCLUSION: Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.

Perioperative acute myocardial infarction increases mortality following noncardiac surgery.

OBJECTIVE: To provide insight into diagnosis, treatment, and prevention of perioperative myocardial infarction (PMI). DESIGN: The authors retrospectively analyzed PMI characteristics in patients undergoing noncardiac surgery and identified risk factors for death. SETTING: An affiliated teaching hospital with about 1500 beds. PARTICIPANTS: The authors screened electronic medical records and retrospectively analyzed clinical data from 117,856 patients who underwent noncardiac surgery during the period from August 2003 through June 2011. INTERVENTIONS: Patients were divided into two groups based on survival at 30 days after PMI. MEASUREMENTS AND MAIN RESULTS: PMI was reported in 61 patients, for an overall incidence rate of 5.2 per 10,000. PMI incidence increased significantly with age, with a rate of 0.97 per 10,000 for the 45- to 60-year-old group, and increasing to a rate of 40.4 per 10,000 for the>75-year-old group (p<0.001). The mortality rate of non-PMI patients (n = 117,795) was 0.32%, whereas the mortality rate for the 61 PMI patients was 36.1% (p<0.001). PMI occurred acutely (within 48 to 72 hours of surgery) in the majority of patients (78.7%), and only 18% of these patients complained of chest pain. The majority of patients who suffered PMI had non-ST segment elevation acute myocardial infarction (78.7%). By multiple logistic regression analysis, lack of anticoagulation/antiplatelet therapy and cardiogenic shock were independent risk factors for death in PMI patients (p = 0.001 for both). CONCLUSIONS: PMI incidence increased significantly with advanced age. PMI increased mortality following non-cardiac surgery. The independent risk factors for death in PMI patients following noncardiac surgery were lack of anticoagulation/antiplatelet therapy and cardiogenic shock.

[Study of blood oxygen saturation, heart rate changes and plateau reaction of the Antarctic Kunlun station investigation team in different plateau environments].

OBJECTIVE: To explore the blood oxygen saturation and heart rate changes of the Antarctic explorers. METHODS: During August 2010 to April 2011, the changes in blood oxygen saturation, heart rate and plateau reaction of 16 Antarctic expedition team in different plateau environments (Tibetan plateau versus Antarctic plateau) were monitored with the noninvasive pulse oximeter MD300-C. The extent of acute mountain sickness was determined according to the Lake Louise Consensus acute mountain reaction symptom scores and judgment method. RESULTS: The changes of blood oxygen saturation, heart rate at different altitudes of 110, 3650, 4300 m (96.8% ± 1.2%,89.1% ± 1.2%, 86.1% ± 2.0%, (75.0 ± 5.4) times/min, (104.0 ± 4.3) times/min, (113.0 ± 5.2) times/min,F = 214.155, 240.088,both P < 0.05). With rising latitude and elevation gradient in Antarctic plateau, the changes of blood oxygen saturation, heart rate at different altitudes of 2000, 2500, 3000, 3500 and 4087 m(91.9% ± 1.3%,90.5% ± 1.3%,87.6% ± 1.4%,85.0% ± 1.8%,81.5% ± 2.2%, (85.9 ± 3.2) times/min, (90.6 ± 2.8) times/min, (97.8 ± 4.1) times/min, (102.0 ± 3.4) times/min, (106.3 ± 3.9) times/min, F = 105.418, 90.174, both P < 0.05). Levels of blood oxygen saturation and heart rate were both correlated with the risk of altitude sickness (r = -0.446 and 0.565, both P < 0.05). CONCLUSIONS: As the increases of altitude, there are significant changes in oxygen saturation, heart rate of the Antarctic explorers. And with the increases of altitude, the risk of altitude sickness gradually increases.

Primary intracranial extraskeletal myxoid chondrosarcoma: A case report and review of literature.

BACKGROUND: Primary intracranial extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare low- to intermediate-grade malignant soft tissue sarcoma, and only 15 cases have been reported in the literature. Due to its rarity, clinical data and research on this tumor type are extremely limited, the pathogenesis and histological origin are still unclear, and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined. CASE SUMMARY: We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo, and his health status deteriorated during the last week. CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus. Brain magnetic resonance imaging (MRI) showed a 3.4 cm × 3.0 cm sized, well-defined, round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus. The entire lesion was removed via supratentorial craniotomy and microsurgery. Postoperative pathological diagnosis indicated primary intracranial EMC. Subsequently, the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge. At present, it is 12 mo after surgery, with regular postoperative follow-up and regular MRI examinations, that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor, and the patient has returned to normal life. CONCLUSION: Currently, the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy. Long-term follow-up is also necessary for patients.

[A comparison of remifentanil versus sufentanil with target-controlled infusion in combined inhalation anesthesia for surgical patients: effects on hemodynamics and postoperative recovery].

OBJECTIVE: To compare the effect of remifentanil versus sufentanil with target-controlled infusion in combination with inhalation anesthesia for surgical patients on the parameters of hemodynamics and postoperative recovery. METHODS: Forty ASA I-II patients aged 18 - 65 years old with BMI (body mass index) < 30, undergoing colectomy or pedical screw interfix were enrolled. Upon the approval of institutional Ethics Committee, they were randomized to receive remifentanil or sufentanil at a target plasma concentration of 3 ng/ml and 0.3 ng/ml respectively in combination of inhalated anesthesia at 0.9 MAC (minimal alveolar concentration). The infusion of remifentanil was discontinued at the end of surgery while the infusion of sufentanil at 40 - 60 minutes before the end of surgery. The arterial blood pressure (ABP), heart rate (HR), electrocardiogram (ECG) and pulse blood oxygen saturation during anesthesia were monitored. The time between the termination of anesthetic use and recovery of spontaneous breathing and extubation were observed. And the incidence of postoperative pain and respiratory depression were recorded. RESULTS: As compared with the baseline values, BP and HR decreased significantly in both groups. BP was similar in both groups whereas HR was lower in Group R than that in Group S at post-induction, post-intubation, incision, the end of surgery and extubation (P < 0.05). The time from termination of anesthesia to recovery of spontaneous breathing was 1.8 ± 1.4 min in Group R. And it was significantly shorter than that in Group S (2.9 ± 1.5 min) (P < 0.05). The time from termination of anesthetic use to extubation was 6.8 ± 3.9 min in Group R. And it was also significantly shorter than that in Group S (9.1 ± 2.8 min) (P < 0.05). Seven patients experienced postoperative pain with visual analogue scale (VAS) > 4. And morphine was used for rescue analgesia in recovery room. CONCLUSION: When combined with inhalation anesthesia, the effects on hemodynamics are similar between the patients receiving the target-controlled infusions of remifentanil and sufentanil. Remifentanil offers a shorter time to recovery of spontaneous breathing and tracheal extubation.

[Application of sedation with a low dose of dexmedetomidine during intrathecal anesthesia in elderly patients].

OBJECTIVE: To explore the feasibility and safety of sedation with a low dose of dexmedetomidine (DEX) during intrathecal anesthesia in the elderly patients. METHODS: Thirty elderly patients were randomly divided into the DEX group (n = 15) and the control group (n = 15). There were 13 males and 17 females with a mean age of 77 years old (range: 65 - 89 years old). After an induction of intrathecal anesthesia, the patients in the DEX group received an infusion of 0.4 µg×kg(-1)×h(-1) for 10 min. Then the infusion speed was adjusted between 0.2 and 0.4 µg×kg(-1)×h(-1) to maintain the values of bispectral index (BIS) at around 80. An equivalent volume of normal saline was administered in the control group. Blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (P(ET)CO(2)) and BIS were recorded at the beginning of DEX infusion, 10, 20, 30 and 60 min after DEX infusion beginning and at the end of surgery. The observer's assessment of alertness/sedation (OAA/S) scores and the clinical responses were also recorded. A statistical analysis was performed. RESULTS: All intraoperative hemodynamic and respiratory parameters were within the normal range in both groups. Compared with the beginning after infusion, blood pressure at the point of 10 min after infusion decreased about 10% - 15% (P < 0.05) in the DEX group. But there was no such change in the control group. The values of BIS also decreased significantly at each time point after 10 min infusion versus the beginning of administration (P < 0.05); as compared with the control group, the values of BIS also decreased significantly at 30, 60 min and the end of infusion (P < 0.05). The 95%confidence interval (CI) of BIS values were 70 - 95 in the DEX group and 80 - 100 in the control group (P < 0.05). In the DEX group, the OAA/S scores were significantly lower at the points of 20, 30, 60 min and the end of infusion versus the beginning after infusion. And it was also lower in the DEX group than that in the control group (95%CI: 3 - 4 vs 4 - 5, P < 0.05). No bradycardia occurred in the DEX group. Two of three patients with concurrent atrial fibrillation were converted to sinus rhythm after the administration of DEX. Patients with severe lung diseases (pulmonary fibrosis, asthma or chronic obstructive pulmonary disease) maintained normal cardiopulmonary functions in the DEX group. DEX showed a good sedation effect in 1 patient with mental diseases. CONCLUSION: Sedation with a small dose of DEX during intrathecal anesthesia in elderly patients is both feasible and efficacious. But studies of larger sample sizes are warranted to confirm its safety.

[The application of remifentanil-propofol and remifentanil-midazolam analgesia for choledochofiberscopic dilatation of bile duct].

OBJECTIVE: To evaluate the safety and efficacy of remifentanil-propofol and remifentanil-midazolam analgesia for choledochofiberscopic dilatation of bile duct. METHODS: 95 patients undergoing choledochofiberscopic dilatation of bile duct were reviewed, 43 of which were dealt with remifentanil-propofol (PR) and 52 with remifentanil-midazolam (MR). After medication, changes of HR, MAP, RR and SPO(2) were observed. The effects of sedation and analgesia, the instance of amnesia, and side effects were recorded. RESULTS: HR in group PR and MR were increase at 10 to 20 min and 20 min respectively after medication. MAP in group PR was increased at 20 min, which were decreased in group MR (P < 0.05). Compared with group PR, group MR achieved similar analgesia (P > 0.05), more moderate sedation with modified OAA/S score of 3 - 4 (67% vs 28%, P < 0.01), less memory, less injection pain, and higher satisfaction (P < 0.05). CONCLUSION: Both remifentanil-propofol and remifentanil-midazolam can provide safe and effective sedation and analgesia for choledochofiberscopic dilatation of bile duct. Remifentanil-midazolam provides more stable hemodynamics, more amnesia, moderate sedation duration and less side effects.

[Effect of remifentanil on propofol pharmacokinetics with target controlled infusion in elderly patients].

OBJECTIVE: To investigate the effects of remifentanil administered by target-controlled infusion (TCI) with different plasma concentration and time on pharmacokinetics of propofol in elderly patients. METHODS: Thirty-two ASA I-II patients (65-82 years old) undergoing elective lower abdominal operations were divided into 4 groups randomly: TCI propofol combined with epidural block (group A, n=8); TCI remifentanil with plasma concentration 4 µg/L and propofol (group B, n=8); TCI remifentanil with plasma concentration 7 µg/L and propofol (group C, n=8); and TCI propofol and remifentanil (plasma concentration 4 µg/L) with infusion time longer than 4 hours (group D, n=8). Propofol was infused by target-controlled infusion with plasma concentration 3 mg/L in the 4 groups. bispetral index (BIS), heart rate (HR), blood pressure (BP) were recorded during operation. Blood samples were collection from radial arterial catheter. Samples of 2 mL of arterial blood were taken at 0, 1, 3, 5, 10, 15, 30 min and then every 30 min after the start of the infusion of propofol, and at 0, 2, 4, 6, 8, 10, 15, 30, 45, 60, 120, 240, 360, 480, 720, 1440 min after the termination of the infusion of propofol. Propofol concentrations in blood were measured by reversed-phase high-performance liquid chromatography (HPLC). The pharmacokinetics analyses were performed using the nonlinear mixed-effects model approach implemented in NONMEM computer program. After obtaining the best NONMEM model with covariates, the influence of coadministered remifentanil on the model was examined. RESULTS: In all the patients, the depth of anesthesia was enough (BIS value=40-60), and the circulatory system function was stable during operation. The final model of propofol pharmacokinetics in the three groups (A+B, A+C, and A+D groups) was best described by a three-compartment mammillary model. The values of objective function (OFV) were -810.1, -714.4, and -896.4. Addition of remifentanil covariate effects to the final model resulted in no improvement in the objective function. CONCLUSION: target-controlled infusion of propofol combined with different plasma concentration of remifentanil or remifentanil infusing more than 4 hours had no effect on pharmacokinetics of propofol in elderly patients.

[Investigation and analysis of status in simulation education of anesthesiology of China].

OBJECTIVE: To investigate the status of simulation education of anesthesiology in China. METHODS: Five hundreds questionnaires were mailed to chairmen of department of anesthesiology in teaching hospitals in 29 provinces and autonomous regions in China. The retrieved questionnaires and data were processed and analyzed with statistics. RESULTS: Sixty one questionnaires were retrieved, and retrieved rate is 12.2%. The result indicated that the theory and knowledge of anesthesiology was adopted for the training of medical students and residents in 2% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion in 52% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion and simulation training in 46% teaching hospitals. The order of simulation devices possessed was as follows: Basic Life Support (BLS) (79.6%), training model for clinical anesthesia techniques (53.1%) and Advances Life Support (ALS) (51.0%). There were only six teaching hospitals utilized Human Patient Simulator for anesthesia training. The result of evaluation of simulation education showed that 91.2% anesthesiologists recognized it as applicable, 90.1% anesthesiologists recognized it as medical ethic requirement and 86.0% anesthesiologists recognized it as partly close to clinical situation. The degree of cognition of anesthesiologists to simulation education was ordered as follows: manipulation correcting ability (92.6%), procedure controllability (87.0%), training adjustability (76.0%) and patients safety (68.5%). CONCLUSION: The simulation education of anesthesiology in China is still in the preliminary period. The executive departments of education should enhance supports to the simulation education in both hard ware and in soft ware.

[The feasibility of Supreme laryngeal mask airway in gynecological laparoscopy surgery].

OBJECTIVE: To explore the safety, efficacy and side effect of Supreme laryngeal mask airway (LMA) used in gynecological laparoscopy. METHODS: From Oct. 2009 to Apr. 2010 in First Hospital of Peking University, 125 patients undergoing general anesthesia for elective gynecological laparoscopy were reviewed, 69 of which were dealt with Supreme LMA (S) and 56 with endotracheal tube (T). After anesthesia induction, changes of HR and MAP were observed during intubation and extubation. The peak inspiratory airway pressure (P(peak)) and P(ET)CO(2) were monitored. Relevant perioperative side effects were recorded. RESULTS: HR and MAP in group T were increased right after intubation and during extubation (P < 0.05), which were significantly decreased in group S (P < 0.01). P(peak) and P(ET)CO(2) were comparable in the two groups at all the time points (P > 0.05). There was no body movement or coughing at the time of intubation. Group S had less incidence of body movement, coughing and sore throat than group T during extubation (P < 0.05). CONCLUSION: Supreme LMA can provide the same safe and effective ventilation as intubation and less stress response and side effects in gynecological laparoscopy.

[The effects of hydroxyethyl starch on lipopolysaccharide-induced endothelial injury in rat mesenteric venules].

OBJECTIVE: To investigate the effect of hydroxyethyl starch (HES, 130/0.4) on lipopolysaccharide (LPS)-induced endothelial injury in rat mesenteric venules. METHODS: Thirty-six Wistar rats weighing 200 - 250 g were randomly divided into 3 groups, n = 12 for each group. Rats were given LPS (2 mg/kg) and followed by normal saline 16 ml x kg(-1) x h(-1) in LPS group or HES 16 ml x kg(-1) x h(-1) in HES group for 60 min. Rats in control group received equal volume of saline. The dynamic changes in diameters of postcapillary venules, red blood cell velocities in venules, and hydrogen peroxide released from venules were evaluated. The ultrastructure of postcapillary venule was observed by electron microscopy. RESULTS: Mesenteric venular RBC velocities, vascular diameters and shear rates on the venular wall remained constant in any of the groups during the observation (P > 0.05). The hydrogen peroxide generation from venules increased in both HES and LPS groups (P < 0.05). In HES group, the hydrogen peroxide generation and cytoplasmic caveolae in postcapillary venule induced by LPS were significantly inhibited compared with LPS group (P < 0.05). CONCLUSIONS: Hydroxyethyl starch (130/0.4) could reduce the LPS-induced endothelial injury in rat mesentery. The effect was related to the inhibition of hydrogen peroxide generation on venular wall.

[The changes and significance of multiple organ functions in acute pancreatitis patients under hypoxic condition on plateau].

OBJECTIVE: To explore characteristics of the pathogenesis and progression of the acute pancreatitis (AP) in high altitude and the relationship between AP and plateau erythrocythemia. METHODS: Retrospective analysis of the clinical data of AP was conducted for 103 inpatients who were admitted during 2003 and 2005 to the People's Hospital of Qinghai Province, including 12 cases of AP complicated with plateau erythrocythemia and 91 cases of AP no complicating plateau erythrocythemia. The patients were divided into a group of 57 cases living in high altitude (>3 000 m) and 46 patients in lower altitude group (<2 200 m). Clinical data of the patients were collected at admission, and liver, kidney and lung functions were determined for all patients. RESULTS: Alanine aminotransferase (ALT) and creatinine (Cr) were significantly higher in AP complicating plateau erythrocythemia compared with AP patients without complicating plateau erythrocythemia [ALT: (160.70 + or - 19.14) U/L vs. (78.00 + or - 14.96) U/L, Cr: (135.45 + or - 11.99) micromol/L vs. (91.42 + or - 17.08) micromol/L, both P<0.05]. Arterial partial pressure of oxygen (PaO(2)) and arterial oxygen saturation (SaO(2)) were significantly lower in AP with complication of plateau erythrocythemia than in AP without complicating plateau erythrocythemia [PaO(2): (45.10 + or - 0.40) mm Hg vs. (65.48 + or - 1.36) mm Hg, 1 mm Hg=0.133 kPa, SaO(2): 0.851 + or - 0.004 vs. 0.940 + or - 0.009, both P<0.05]. There was no difference in aspartate aminotransferase (AST), blood urea nitrogen (BUN) and arterial partial pressure of carbon dioxide (PaCO(2)), however, their levels were higher in plateau erythrocythemia cases than those without plateau erythrocythemia [AST: (87.35 + or - 8.10) U/L vs. (83.00 + or - 18.61) U/L, BUN:(10.90 + or - 0.97) mmol/L vs. (7.37 + or - 0.98) mmol/L, PaCO(2): (33.20 + or - 0.31) mm Hg vs. (25.32 + or - 1.14) mm Hg , all P>0.05]. ALT and Cr were significantly higher in high altitude cases than those in lower altitude cases [ALT: (126.92 + or - 15.46) U/L vs. (86.00 + or - 10.23) U/L, Cr:(126.10 + or - 10.01)micromol/L vs. (101.84 + or - 5.46) micromol/L, both P<0.05]. There was no difference in AST, BUN and PaCO(2), however, the values were slightly higher in high altitude cases compared with lower altitude cases [AST: (98.70 + or - 8.10) U/L vs. (93.14 + or - 21.46) U/L, BUN: (8.15 + or - 1.00) mmol/L vs. (5.86 + or - 0.40) mmol/L, PaCO(2): (32.32 + or - 1.01) mm Hg vs. (30.12 + or - 2.76) mm Hg, all P>0.05]. There was no difference in PaO(2) and SaO(2), however, it was slightly lower in high altitude cases than lower altitude cases [PaO(2): (58.80 + or - 1.20) mm Hg vs. (66.86 + or - 3.20) mm Hg, SaO(2): 0.910 + or - 0.011 vs. 0.930 + or - 0.008, both P>0.05]. CONCLUSION: The results showed that the deterioration of hepatic, kidney and lung function in AP patients living in the plateau was related to high altitude and erythrocythemia.

[The relationship between systemic inflammatory response syndrome and severity of acute pancreatitis combined with plateau erythrocythemia].

OBJECTIVE: To explore the relationship between systemic inflammatory response syndrome(SIRS) and severity of acute pancreatitis combined with plateau erythrocythemia in the high altitude. METHODS: A retrospective analysis on the clinical data which involved acute pancreatitis combined with plateau erythrocythemia (n = 40) and without plateau erythrocythemia (n = 40) admitted from September 2006 to September 2009 was conducted. According to the unified standards, these cases were divided into plateau erythrocythemia group and no plateau erythrocythemia group. The patients in plateau erythrocythemia group were further divided into severe group and mild group according to scores of APACHEII. The data was analyzed according to the patient with (or without) SIRS, SIRS's standard indicators, diagnostic parameter and relation of severity and duration of SIRS in acute pancreatitis combined with plateau erythrocythemia. RESULTS: There was significantly discrepancy between plateau erythrocythemia group and no plateau erythrocythemia group not only in the incidence of patients who developed SIRS, but also in two items of patients fulfilling or not fulfilling diagnostic criteria of SIRS (P < 0.05). There was significant statistical difference in three items of diagnostic parameter of SIRS between plateau erythrocythemia group and no plateau erythrocythemia group (P < 0.05). Significant difference in two and three diagnostic parameter was found on severity of SIRS in acute pancreatitis combined with plateau erythrocythemia (P < 0.05). The more severity acute pancreatitis combined with plateau erythrocythemia was, the longer duration of SIRS was. CONCLUSION: SIRS is highly correlated with the severity of SIRS in acute pancreatitis combined with plateau erythrocythemia in the high altitude.

Effect of flumazenil on bispectral index monitoring in unpremedicated patients.

BACKGROUND: Flumazenil is an imidazobenzodiazepine that promptly reverses via competitive inhibition the hypnotic/sedative effects of benzodiazepines on gamma-aminobutyric acid receptors. Endogenous benzodiazepine ligands (endozepines) were isolated in urine, cerebrospinal fluid, and breast milk of women who had not received benzodiazepines. The bispectral index (BIS), an electroencephalographically derived parameter widely used for monitoring the effects of anesthetic/hypnotic drugs, was shown to correlate to various conditions that could influence electroencephalography. The authors examined the hypothesis that 0.5 mg of flumazenil administered to healthy unpremedicated patients during deep surgical remifentanil/propofol anesthesia would increase the BIS value and might expedite recovery from anesthesia. METHODS: Sixty healthy unpremedicated patients were randomly allocated to the flumazenil or control groups. After study drug administration, the authors compared BIS values and various recovery parameters in the flumazenil and control groups. RESULTS: BIS baseline values in the flumazenil group (38.7 +/- 3.8) increased 15 min after flumazenil administration (53.2 +/- 4.7), with a significant difference over time (P < 0.0001) between the two groups. Mean recovery parameters time, comprising time to spontaneous breathing, eye opening/hand squeezing on verbal command, extubation, and date of birth recollection, was significantly shorter (P = 0.0002) in the flumazenil group (6.9 +/- 2.6 min) compared with the control group (9.8 +/- 2.9 min). CONCLUSIONS: This study demonstrates that flumazenil given to healthy unpremedicated patients during propofol/remifentanil anesthesia significantly increased the BIS value and allowed earlier emergence from anesthesia. This may indicate that flumazenil could be used on a case-by-case basis to reverse endogenous or exogenous endozepines that might play a role during anesthesia.

The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery.

BACKGROUND: Postoperative cognitive dysfunction (POCD) can be a debilitating complication after coronary artery bypass graft (CABG) surgery. Cerebral microemboli during cardiopulmonary bypass (CPB) are believed to be an important etiologic factor of POCD. In this study, we examined whether avoidance of CPB with "off-pump" surgery reduces the number of cerebral microemboli and the incidence of POCD after CABG surgery in Chinese population. METHODS: Two hundred twenty-seven patients were enrolled in this prospective cohort study. Fifty-nine patients underwent CABG surgery with CPB and 168 underwent off-pump surgery. Cerebral microemboli were measured continuously with bilateral transcranial Doppler ultrasonography of the middle cerebral arteries. A neuropsychological test battery that included seven tests with nine subscales was administered at baseline, as well as at 1 wk and 3 mo after surgery. POCD was defined using the international study of POCD1 definition. RESULTS: The median total number of cerebral microemboli for the case was 430 (range: 155-2088) in patients undergoing surgery with CPB and 2 (0-66) in the off-pump patients (P < 0.001). There were no differences in the incidence of POCD between the patients having surgery with or without CPB either at 1 wk (55.2% or 32 of 58 patients [95% confidence interval: 41.5%-68.3%] vs 47.0% or 78 of 166 patients [39.2%-54.9%], P = 0.283) or 3 mo (6.4% or 3 of 47 patients [1.3%-17.5%] vs 13.1% or 16 of 122 of patients [7.7%-20.4%], P = 0.214) after surgery. Increasing age and shorter duration of postoperative hospital stay were independently associated with cognitive dysfunction at 1 wk after surgery. Increasing age and a history of diabetes mellitus were independently associated with cognitive dysfunction 3 mo after surgery. CPB or cerebral microemboli were not significantly related to the occurrence of POCD. CONCLUSIONS: In Chinese population, avoidance of CPB during CABG surgery significantly decreased the number of cerebral microemboli, but it did not decrease the incidence of POCD at either 1 wk or 3 mo after CABG. Neither CPB nor cerebral microemboli was independently associated with the risk of POCD.

[Incidence and influential factors of post-operative nausea and vomiting following gynecological surgery: analysis of 492 cases].

OBJECTIVE: To investigate the incidence and influential factors of post-operative nausea and vomiting (PONV) following gynecologic surgery so as to provide guideline effective for clinical management. METHODS: The clinical data of 492 qualified consecutive female patients who had undergone gynecological surgery were analyzed. Univariate analysis and multivariate logistic regression were applied to examine the relations between the perioperative variables and occurrence of PONV within 6 h or 24 h following gynecologic procedures. RESULTS: PONV developed in 218 patients within 24 h following surgery (44.3%) while in 161 patients within 6 h following surgery (32.7%). Multivariate logistic regression analysis identified PONV history and perioperative opioids administration as significant predictors of PONV within 24 h following gynecologic surgery, while PONV history, general anesthesia, and postoperative shivering predictors of PONV within 6 h after surgery, and found the administration of dexamethasone or droperidol as consistent protective factors of PONV within 6 h or 24 h following surgery. CONCLUSION: For gynecologic surgery, previous PONV history will increase the risk for PONV following current surgery. Perioperative opioids administration will intensify the risk for the development of PONV within 24 h following surgery, while general anesthesia and postoperative shivering for PONV within 6 h after surgery. Perioperative dexamethasone or droperidol will decrease the incidence of PONV within 6 h or 24 h following gynecologic procedures.

[Incidence of peri-operative anxiety and depression in patients and of risk factors].

OBJECTIVE: Our study investigate the peri-operative incidence of depression and anxiety of patients undergoing general anesthesia, and assesses the relationship between peri-operative characteristics with anxiety and depression. METHODS: Demographic, clinical data and HADS score were collected before and after surgery. Analysis all the data with SPSS 10. 3. RESULTS: Anxiety was found pre- and post-operative in 23% and 17% of patients respectively while the rate of depression was 20% and 16% respectively. Middle or high-level (P < 0.05) education was associated with pre-operative anxiety; Pre-operative anxiety and depression are interactional (P < 0.01). Post-operative depression (P < 0.01) predicted post-operative anxiety; female (P < 0.05), pre-operative depression, post-operative anxiety (P < 0.05) and discomfort of pharynx (P < 0.05) predicted post-operative depression. CONCLUSIONS: Patients may experience anxiety or depression during peri-operation. Anxiety and depression are interactional. Level of education, sex and discomfort of pharynx may influence pre- or post-operative anxiety or depression respectively.

[Epidural analgesia in latent phase of labor: effects on length of labor and mode of delivery].

OBJECTIVE: To compare the outcome of ropivacaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor. METHODS: 360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 microg/ml sufentanil and active group (cervix dilation > or = 3 cm) receive 0.15% ropivacaine with 0.5 microg/ml sufentanil, both followed by an infusion of 0.1% ropivacaine with 0.5 microg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed. RESULTS: Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups. CONCLUSIONS: Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.

Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients.

INTRODUCTION: Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population. METHODS: Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis. RESULTS: A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both gram-positive and gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020). CONCLUSION: IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.