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Objective:To investigate the effect of etomidate combined with transversus abdominis plane block (TAPB) on serum inflammatory factors and immune function indexes in patients after total hysterectomy.Methods:The study included 86 patients who underwent transabdominal total hysterectomy from Jan. 2020 to Jan. 2023. They were divided into group A (44 cases) and group B (42 cases) according to the random number table method. Group A received general anesthesia (propofol for anesthesia maintenance) + TAPB anesthesia, and group B received general anesthesia (propofol combined with etomidate for anesthesia maintenance) + TAPB anesthesia. The changes of heart rate (HR) and mean arterial pressure (MAP) at different time points were observed in the two groups. The serum related factors [interleukin-6 (IL-6) , tumor necrosis factor-α (TNF-α) ] and immune function indexes (T lymphocyte subsets CD3 +, CD4 +, CD4 +/CD8 +) were compared between the two groups before anesthesia and 24 h after operation. The complications of the two groups after anesthesia were counted. Results:HR and MAP of the two groups were gradually increased at T1 and T2 compared with those at T0, and gradually decreased at T3 and T4 compared with those at T2. The serum levels of IL-6 and TNF-α in the two groups at 24 h after operation were higher than those before anesthesia. The levels of IL-6 and TNF-α in group B were (261.17±33.67) ng/L and (12.37±2.57) ng/L, lower than those in group A (287.89±45.71) ng/L and (16.46±3.78) ng/L ( P<0.05) . The levels of CD3 +, CD4 + and CD4 +/CD8 + in the two groups were lower than those before anesthesia. The levels of CD3 +, CD4 + and CD4 +/CD8 + in group B were (65.26±4.67) %, (27.83±2.59) % and (1.48±0.35) , higher than those in group A (62.17±3.85) %, (26.25±2.16) % and (1.32±0.21) ( P<0.05) . There was no significant difference in the total incidence of complications after anesthesia between the two groups (13.64% in group A and 7.21% in group B) ( P>0.05) . Conclusions:The application of etomidate combined with TAPB anesthesia in total abdominal hysterectomy can inhibit the inflammatory response caused by surgical trauma, maintain the stability of postoperative immune function,without increasing the impact on hemodynamics of patients, or the incidence of complications.
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As an important protein structure on the surface of bacteria, type Ⅳ pili (TFP) is the sensing and moving organ of bacteria. It plays a variety of roles in bacterial physiology, cell adhesion, host cell invasion, DNA uptake, protein secretion, biofilm formation, cell movement and electron transmission. With the rapid development of research methods, technical equipment and pili visualization tools, increasing number of studies have revealed various functions of pili in cellular activities, which greatly facilitated the microbial single cell research. This review focuses on the pili visualization method and its application in the functional research of TFP, providing ideas for the research and application of TFP in biology, medicine and ecology.
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Fimbrias Bacterianas/metabolismo , Proteínas Bacterianas/genética , Fenómenos Fisiológicos Bacterianos , Adhesión Bacteriana/fisiologíaRESUMEN
Objective:To predict the dose of lumbosacral spine (LS) and pelvic bone marrow (PBM) based on kernel density estimation (KDE) in patients with gynecological tumors.Methods:Fifteen patients with gynecological tumors receiving radiotherapy plans with dose limitation for LS and PBM in our hospital were selected as training data for machine learning. Another 10 cases were selected as the data for model validation. The minimum directional distance between the dose point in the organs and the edge of the planned target volume for the LS and PBM was calculated. Model training was performed by KDE. The accuracy of the model prediction was evaluated by the root mean square error. The model was utilized to predict the actual planned doses of the LS and PBM, and a linear fitting was performed on the predicted dose volume histogram (DVH) and actual results. The prediction effect was assessed by the goodness of fit R 2. Results:In terms of the DVH parameters required by the planner, the prediction doses from the model were similar to those of the verification plans: the difference of PBM V 40Gy was 2.0%, the difference of the mean dose was 1.6 Gy, and the difference of LS V 10Gy was -0.4%. In the unrequired DVH parameters, except for the PBM V 10Gy, the predicted values of the model were significantly high. The difference between the DVH predicted by the model and the actual plan was small, and the R 2 of the LS and PBM were 0.988 and 0.995, respectively. Conclusions:The model based on KDE method can accurately predict the doses of the LS and PBM. This model can also be used as a method to ensure the quality of the plan, and improve the consistency and quality of the plan.
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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on inflammatory responses during intestinal mucosal barrier damage caused by gastrointestinal surgery in the rats.Methods:Forty-five healthy male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were divided into 3 groups ( n=15 each) by a random number table method: control group (C group), gastrointestinal surgery group (S group), and TEAS group (T group). Rats underwent pylorectomy and Roux-en-Y gastrojejunal anastomosis to establish gastrointestinal surgery models in S and T groups, while group C received no treatment.In group T, bilateral Zusanli and Hegu acupoints were stimulated with disperse-dense waves, current intensity 5 mA, frequency 2 Hz, from 30 min before surgery until the end of operation.Only electrode patches were applied, but no stimulation was applied in group S. Five rats were randomly selected from each group and sacrificed at 12, 24 and 48 h after surgery (T 1-3), and ileal tissues were taken after anesthesia.The pathological changes of ileal tissues were observed with a light microscope and scored according to Chiu.Enzyme-linked immunosorbent assay was used to determine contents of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP). Western blot was used to detect the expression of occludin, claudin-3 and ZO-1.The immunohistochemical method was used to determine the percentage of occludin, claudin and zonula occludens-1 (ZO-1) positive cells. Results:Compared with group C, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly increased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was decreased, and the expression of occludin, claudin-3 and ZO-1 was down-regulated at T 1-3 in group S and group T ( P<0.05). Compared with group S, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly decreased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was increased, and the expression of occludin, claudin-3 and ZO-1 was up-regulated at T 1-3 in group T ( P<0.05). Conclusion:TEAS can reduce the intestinal mucosal barrier damage caused by gastrointestinal surgery by inhibiting the inflammatory response in rats.
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Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.Methods Forty patients of both sexes,aged 18-67 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Mallampati physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic lobectomy,were divided into 2 groups (n =20 each) using a random number table method:general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+GS).Anesthesia was routinely induced and maintained,a laryngeal mask was placed,and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation,and visual analogue scale score was maintained＜4 points.In group TE+GS,Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave,frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP),heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia,immediately after start of operation,during thoracic exploration,immediate after lobectomy,and at 30 min and 1 h after lobectomy.The intraoperative MAP,HR,and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol,norepinephrine,epinephrine,and blood glucose in serum (by enzyme-linked immunosorbent assay).The highest value of PETCO2,the lowest value of SpO2,and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay,time to first flatus,ambulation time,occurrence of nausea and vomiting,chest tube drainage time,development of surgical complications,length of postoperative hospital stay and hospitalization expenses were recorded.Results MAP,HR and RR all fluctuated within the normal range,and no clinically significant events occurred in two groups.Compared with group GS,the highest value of PETCO2 was significantly decreased,the lowest value of SpO2 was increased,the MAP and HR were decreased,the consumption of propofol and remifentanil was decreased,the cortisol,norepinephrine,epinephrine,and blood glucose concentrations in serum were decreased,the time to first flatus,ambulation time,chest tube drainage time and length of postoperative hospital stay were shortened,and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE +GS (P＜0.05).Conclusion TEAS can reduce the amount of opioids consumed in the perioperative period,effectively inhibits intraoperative stress responses,and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective@#To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.@*Methods@#Forty patients of both sexes, aged 18-67 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Mallampati physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy, were divided into 2 groups (n=20 each) using a random number table method: general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+ GS). Anesthesia was routinely induced and maintained, a laryngeal mask was placed, and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation, and visual analogue scale score was maintained<4 points.In group TE+ GS, Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave, frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia, immediately after start of operation, during thoracic exploration, immediate after lobectomy , and at 30 min and 1 h after lobectomy.The intraoperative MAP, HR, and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol, norepinephrine, epinephrine, and blood glucose in serum (by enzyme-linked immunosorbent assay). The highest value of PETCO2, the lowest value of SpO2, and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay, time to first flatus, ambulation time, occurrence of nausea and vomiting, chest tube drainage time, development of surgical complications, length of postoperative hospital stay and hospitalization expenses were recorded.@*Results@#MAP, HR and RR all fluctuated within the normal range, and no clinically significant events occurred in two groups.Compared with group GS, the highest value of PETCO2 was significantly decreased, the lowest value of SpO2 was increased, the MAP and HR were decreased, the consumption of propofol and remifentanil was decreased, the cortisol, norepinephrine, epinephrine, and blood glucose concentrations in serum were decreased, the time to first flatus, ambulation time, chest tube drainage time and length of postoperative hospital stay were shortened, and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE+ GS (P<0.05).@*Conclusion@#TEAS can reduce the amount of opioids consumed in the perioperative period, effectively inhibits intraoperative stress responses, and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective To observe and analyze the morbidity and risk factors of postoperative delirium in the patients un-dergoing cardiac surgery.Methods From March 2017 to March 2018, 478 patients who need cardiac surgery were selected from our hospital.According to the postoperative results evaluated with Confusion Assessment Method(CAM), they were divid-ed into delirium group(54 patients)and control group(424 patients).Morbidity and risk factors of postoperative delirium were analyzed.Results Delirium occurred in 54 patients of 478 patients and morbidity of postoperative delirium was 11.3％.Psy-chomotor excitement is the most common clinical presentations , followed by attention impairment and a reduced level of con-sciousnes.Single factor analysis result showed that delirium was associated with advanced age (≥65 years) , hypertension, pre-vious cerebral vascular event(previous cerebral infarction, previous brain heamorhage), intraoperative blood loss, mechanical ventilation time, intensive care unit duration time.The multiple-logistic regression analysis indicated that the perioperative risk factors of delirium included advanced age, cerebrovascular accident history and ICU duration time.Conclusion The patients with advanced age, hypertension, previous cerebral vascular event(previous cerebral infarction, previous brain heamorhage) are the high risk groups for delirium after cardiac surgery.Advanced age, hypertension, previous cerebral vascular event(previ-ous cerebral infarction, previous brain heamorhage) are risk factors for delirium in patients undergoing cardiac surgery.
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Objective To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.Methods Fifty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 35-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic radical resection of colorectal cancer,were selected and divided into 2 groups (n =28 each) using a random number table method:general anesthesia group (group G) and TEAS combined with general anesthesia group (group TG).In group TG,patients received continuous TEAS at bilateral Neiguan,Hegu,Zusanli,Shangjuxu and Xiajuxu acupoints from 30 min before anesthesia induction until the end of surgery,with a frequency 2/100HZ,disperse dense waves,intensity the maximum current that could be tolerated (3-8 mA).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia in both groups.Peripheral venous blood samples were collected when entering the operating room (T1),at the end of operation (T2),and at 24 and 72 h after operation (T3,4) for determination of intestinal fatty acid binding protein (I-FABP) and diamine oxidase (DAO) in palsma using enzyme-linked immunosorbent assay.Quality of Recovery-9 (QoR9) was used to assess the postoperative quality of recovery at 24 h before surgery (T0),T3 and T4.Results The concentrations of plasma I-FABP and DAO were significantly higher at T2 and T3 than at T1 in G and TG groups (P＜0.05).Compared with the baseline at T0,QoR-9 scores were significantly decreased at T3 and T4 in G and TG groups (P＜0.05).Compared with group G,the concentrations of plasma I-FABP at T2-T4 and DAO at T2 and T3 were significantly decreased,and QoR-9 scores were increased at T3 and T4 in group TG (P＜0.05).Conclusion TEAS can attenuate intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.
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Radiofrequency ablation concomitant with open-heart procedures is one of the most common surgical methods to treat organic heart disease complicated with atrial fibrillation .However, the recurrence of atrial fibrillation still bothers both doctors and patients.There are different views on the main factors influencing the long-term effects of sinus rhythm maintenance after ablation.We reviewed past related clinical observations and researches to summarize the factors influencing recurrence of long-term atrial fibrillation after radiofrequency ablation concomitant with open-heart procedures.
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Objective To evaluate the cardioprotection of electroacupuncture (EA) in the patients undergoing heart surgery with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅲ patients,aged 18-55 yr,of New York Heart Association Ⅱ-Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table:control group (group C) and group EA.In group EA,bilateral Neiguan,Ximen,Shenmen and Baihui acupoints were stimulated with an electrie stimulator with the frequency of 2 Hz from 20 min before anesthesia induction until the end of operation,and the optimal intensity was selected according to the patient's tolerance when awake.Before EA and at 30 min of CPB,30 min,1 h and 2 h after termination of CPB and 6 and 24 h after operation,blood samples were taken from the central vein for determination of concentrations of heart-type fatty acid binding protein and cardiac troponin Ⅰ in plasma (by enzymelinked immunosorbent assay) and concentrations of malondialdehyde (using hydroxylamine method).Cardiac contractility was scored at 1,6 and 24 h after operation,and arrhythmia was scored at 24 h after operation.Results Compared with group C,the plasma concentrations of malondialdehyde at 30 min and 1 and 2 h after termination of CPB and 6 h after operation,plasma concentrations of cardiac troponin Ⅰ at 24 h after operation,and plasma concentrations of heart-type fatty acid binding protein at 30 min of CPB and 24 h after operation were significantly decreased,and the arrhythmia score and cardiac contractility score at 6 and 24 h after operation were decreased in group EA (P＜0.05).Conclusion EA can inhibit lipid peroxidation and exerts cardioprotection in the patients undergoing heart surgery with CPB.
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Biofilms are surface-attached complex aggregates consisting of bacteria cells and extracellular polymeric substances. Cells in biofilms show strong resistance to antibiotics and immune-escape capabilities. Their motility and metabolic activities are quite different from those when they are in planktonic style. In recent years, applications of new image-capturing techniques together with new image-processing methods, have greatly advanced the development of bacterial studies. This review focuses on bacterial tracking techniques. We first present an overview of recent progress in applications of those techniques in biofilm research, especially in the areas of bacterial motility and biofilm regulation, including swimming, twitching, swarming and typical regulatory signaling pathways for biofilms. Then we give a prospect for future applications of bacterial tracking in other related microbial fields.
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Objective To observe the effects of compound Danshen dropping pill combined with low frequency pulsed electrical stimulation in rehabilitation period after stroke.Methods 90 stroke patients in recovery period were randomly divided into control group and observation group with 45 cases in each group.The control group was treated with low frequency pulsed electrical stimulation while the observation group was additionally given oral compound Danshen dripping pill.The levels of erythrocyte sedimentation rate(ESR), extracranial internal carotid artery blood flow velocity(ICAex), microcirculation blood flow perfusion(PU), and the scores of neurological deficit, Fugl-Meyer upper limb fraction(FMA-UE), the motion function status Scale(MSS) and the improved Barther Index(MBI) were measured before and after treatment.Results After treatment, the ESR of the observation group was significantly lower than that of the control group(P<0.05), and ICAex and PU were significantly increased(P<0.05).The score of neurological deficit in the observation group was significantly lower than that in the control group(P<0.05), and the scores of FMA-MS, MSS and MBI were significantly increased(P<0.05).Conclusion Compound Danshen Dripping Pill combined with low frequency pulse electrical stimulation is an effective treatment after stroke, and can effectively improve intracranial blood perfusion, reduce neurological damage and promote limb function recovery.
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Objective To evaluate the effect of isoflurane preconditioning on the expression of hippocampal GluR1 subunits-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate(AMPA)receptors in a rat model of focal cerebral ischemia-reperfusion(I/R).Methods Forty-eight pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups(n=16 each)using a random number table:sham operation group(group S),focal cerebral I/R group(group I/R)and isoflurane preconditioning group(group IPC).Focal cerebral I/R was induced by occlusion of the middle cerebral artery for 2 h followed by reperfusion to induce cognitive decline in I/R and IPC groups. Rats were exposed to 1.5% isoflurane for 1 h every day for 5 consecutive days,and the model was established at 24 h after the last exposure in group IPC. Eight rats in each group were selected to perform Morris water maze test for 6 consecutive days starting from 9 or 23 days after operation. The rats were sacrificed at 14 and 28 days after operation,and the hippocampal tissues were obtained for determination of the expression of GluR1 mRNA(by using real-time polymerase chain reaction)and GluR1 protein(by Western blot).Results Compared with group S,the escape latency was significantly prolonged at each time point after operation,the frequency of crossing the original platform quadrant and percentage of swimming distance at the original platform quadrant were decreased at 14 and 28 days after operation,and the expression of GluR1 protein and mRNA was down-regulated at 14 days after operation in I/R and IPC groups(P<0.05).Compared with group I/R,the escape latency was significantly shortened at 10-13 days after operation,the percentage of swimming distance at the original platform quadrant and frequency of crossing the original platform quadrant were increased at 14 days after the operation,and the expression of GluR1 protein and mRNA was up-regulated at 14 days after operation in group IPC(P<0.05).Conclusion The mechanism by which isoflurane preconditioninig improves the cognitive function is related to up-regulation of the expression of hippocampal GluR1 subunits-containing AMPA receptors in a rat model of focal cerebral I/R.
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Objective To evaluate the effect of isoflurane preconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and isoflurane preconditioning group (group IP).Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion followed by 24 reperfusion.Group IP inhaled 1.5％ isoflurane for 1 h per day for 5 consecutive days,the other two groups only inhaled 30％ oxygen,and focal cerebral I/R was induced at 24 h after the last inhalation.At 24 h of reperfusion,neurologic deficit was assessed and scored,the rats were then sacrificed,and brains were removed for determination of cerebral infarct size (using triphenyl tetrazolium chloride staining) and expression of microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 (by Western blot).Results Compared with group S,the neurologic deficit scores and cerebral infarct size were significantly increased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly up-regulated in I/R and IP groups (P＜0.05).Compared with group I/R,the neurologic deficit scores and cerebral infarct size were significantly decreased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly upregulated in group IP (P ＜ 0.05).Conclusion The mechanism by which isoflurane preconditioning ameliorates focal cerebral I/R injury is related to enhancement of autophagy in the rats.
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Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting (OPCABG) in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group (n =60) received wire to fix the sternum,and the experimental group (n=60) received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7％(7/60) vs.38.3％(23/60),3.3％(7/60) vs.13.3％(8/60),1.7％(1/60) vs.11.7％(7/60),x2 =11.378,3.927,4.821 respectively all P＜0.05].The chest closure time was longer in experimental group than in control group [(39±5)min vs.(30±2) min,x2 =13.386,P＜0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.
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Objective To explore the effect of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting (OPCABG),through comparing the respiratory complication after OPCABG.Methods One hundred and two patients were accepted OPCABG,among whom 49 patients' pleural cavities were opened (open group) and 53 patients' pleural cavities were closed (close group).The ventilation time,intensive care unit time,pleural effusion,the rate of atelectasis and respiratory failure after operation were compared between two groups.Results The ventilation time and intensive care unit time in open group were (40.3 ± 4.8) h and (78.3 ± 10.8) h,in open group were (28.6 ± 6.8) h and (54.8 ± 6.1) h.The ventilation time and intensive care time in open group were significantly longer than those in close group(P ＜ 0.01 or ＜ 0.05).The pleural effusion in open group was (800.0 ± 60.5) ml,in close group was (350.0 ± 28.6) ml.The pleural effusion in open group was significantly higher than that in close group (P ＜ 0.01).The rate of postoperative atelectasis and respiratory failure in open group were 36.7％(18/49) and 38.8％(19/49),in close group were 15.1％(8/53) and 18.9％(10/53).The rate of postoperative atelectasis and respiratory failure in open group were significantly higher than those in close group (P ＜ 0.01).Conclusions OPCABG is the operation in mediastinum.To avoid pleural cavity opened in OPCABG can reduce the incidence of postoperative respiratory complication.
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Objective To evaluate the efficacy and safety of peroral direct cholangioscopy (PDCS) in the treatment of refractory common bile duct stones after retrograde cholangiopancreatography (ERCP).Methods Data of 13 patients who underwent peroral direct cholangioscopy for refractory common bile duct stones after retrograde cholangiopancreatography at our institution from April 2012 to August 2014 were retrospectively analyzed.Completion rate,side-effects and complications were summarized.Results Peroral direct cholangioscopy was successfully performed with electrohydraulic lithotripsy and stones were removed in 12 of the 13 patients.Lithotripsy and stone removal failed in one patient,though the ultraslim endoscope accessed distal common bile duct near the stone.Stones were removed directly with extraction basket under PDCS in 7 patients,and duodenoscopy was performed in 5 patients due to too many stone fragments.Stone removal was successfully completed at one time in 9 cases.Stones removal failed in 3 cases at one time because of too many stone fragments,but was successful with duodenoscopy a week later after a temporary biliary tract stenting.Andoxygen saturation decreased in one patient due to vomit during the operation.Sputum in oropharyngeal area was immediately sucked out and the gastric juice at the bottom of the stomach was also sucked by endoscopy.Oxygen saturation returned to normal levels and the subsequent operation was not affected.No aspiration pneumonia occurred after the operation.Hyperamylasemia occurred in two patients,and postoperative biliary tract infection occurred in one,but the situation was controlled after appropriate treatment.Conclusion PDOS using an ultraslim endoscopy is an effective and feasible endoscopic procedure for the refractory common bile duct stones.This study provides a new method for the treatment of refractory common bile duct stones.
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Objective To evaluate the effect of acupuncture on the quality of recovery during the early period after gynecological laparoscopic surgery using the Quality of Recovery?40 questionnaire ( QoR?40). Methods Sixty patients, aged 20-60 yr, with body mass index of 18.5-28.0 kg∕m2, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective gynecological laparoscopic surgery, were equally and randomly divided into either control group ( group C ) or acupuncture group (group Acu) using a random number table. Bilateral Neiguan (PC6) and Hegu (L14) acupoints were stimulated for 30 min starting from the time point before skin incision and immediately after the end of surgery. The quality of recovery was assessed using the QoR?40 on 1 day before surgery, and at 24 and 48 h after surgery. The patient′s cognitive function was assessed using Mini?Mental State Examination. The requirement for rescue analgesics was recorded. The occurrence of nausea and vomiting was also recorded. Results Compared with group C, the global QoR?40 and Mini?Mental State Examination scores were significantly increased, and the incidence of nausea and vomiting and requirement for rescue analgesics were decreased at 24 and 48 h after surgery in group Acu ( P<0. 05 ) . Conclusion Acupuncture can improve the quality of recovery during the early period after gynecological laparoscopic surgery using the QoR?40.
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Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.
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Objective To compare the changes in postoperative pain, complications and clinical effect between gastrodin and remifentanil for controlled hypotension in endoscopic sinus surgery.Methods Eighty patients undergoing endoscopic sinus surgery were enrolled in the study.Patients were randomized into two groups of 40 to receive gastrodin (Group G) or remifentanil (Group R) infusion.Two groups were administered with propofol of 2 mg/kg to induce anaesthesia, which was maintained using sevoflurane.Group R received a continuous infusion of remifentanil titrated between 3 and 4 ng/mL using target-controlled infusion, whereas Group G received an i.v.gastrodin bolus of 2 mg/kg followed by a 20 mg/kg continuous infusion to maintain a mean arterial pressure ( MAP) between 60 and 70 mmHg.Haemodynamic variables, surgical conditions, postoperative pain, and adverse effects, such as postoperative nausea and vomiting ( PONV) and shivering were recorded.Results Controlled hypotension was well maintained in both groups.MAP and heart rate were higher in Group R than Group G after operation(P<0.05).Surgical conditions scores were not different between two groups.Postoperative pain scores were significantly lower in Group G than Group R (P<0.05).Shivering and the use of antiemetic and analgesic drugs were also less frequent in Group G than Group R (P<0.05).Conclusions Both gastrodin and remifentanil when combined with sevoflurane provides adequate controlled hypotension and proper surgical conditions for endoscopic sinus surgery.However, patient administered gastrodin has a more favourable postoperative course with better analgesia and less shivering and PONV.