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Objective: To compare the effects of general anesthesia between remimazolam and propofol in pediatric patients undergoing binocular strabismus day surgery. Methods: Prospectively, 60 pediatric patients, American Society of Anesthesiologists (ASA) grade â -â ¡, scheduled to undergo binocular strabismus daytime surgery in Beijing Tongren Hospital under general anesthesia with laryngeal mask airway from December 2021 to May 2022 were selected. They were randomly divided into Remimazolam group and Propofol group with 30 cases in each group, according to the ratio of 1â¶1 by SPSS program. Patients in Remimazolam group were induced by remimazolam, remifentanil and micuronium chloride, and maintained by remimazolam and remifentanil. Patients in Propofol group were induced by propofol, remifentanil and micuronium chloride, and maintained by propofol and remifentanil. Patients in Remimazolam group were given 0.1 mg of flumazenil for antagonism 3 minutes after operation, while children in Propofol group waited for natural awakening. The primary outcome was the time from drug withdrawal to laryngeal mask removal after operation. The secondary outcomes included the time for consciousness loss during induction, intraoperative hemodynamic data [mean arterial pressure (MAP) and heart rate], the success rate of sedation, the awareness rate during operation, and the incidence of adverse events after admission to postanesthesia care unit(PACU). Results: The Remimazolam group included 12 males and 18 females, aged (5.0±1.4) years. There were 14 males and 16 females in the Propofol group, aged (5.3±1.3) years. The time from drug withdrawal to laryngeal mask removal in Remimazolam group was (6.5±1.2) min, which was shorter than that in Propofol group of (10.7±1.9) min (P<0.001). The time for consciousness loss during induction was (38.1±4.8) s in Remimazolam group, which was longer than that in Propofol group of (31.6±4.9) s (P<0.001). The variability of MAP and heart rate of patients during operation in Remimazolam group was lower than that in Propofol group (all P<0.05). There was no significant difference in sedation success rate, intraoperative awareness and adverse reactions in PACU between the two groups (all P>0.05). Conclusion: In pediatric patients with binocular strabismus during daytime surgery, general anesthesia with remimazolam can shorten the time from drug withdrawal to laryngeal mask removal after operation without increasing the incidence of postoperative adverse reactions and can provide more stable hemodynamics.
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Anestesia General , Propofol , Estrabismo , Humanos , Propofol/administración & dosificación , Estrabismo/cirugía , Niño , Estudios Prospectivos , Masculino , Femenino , Preescolar , Benzodiazepinas/uso terapéutico , Periodo de Recuperación de la Anestesia , Anestésicos Intravenosos/administración & dosificaciónRESUMEN
Objective: To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. Methods: This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. Results: The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all P<0.001); The NRS score [M (Q1, Q3)] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (P<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all P<0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all P<0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (P<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (P=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Conclusion: Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.
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Analgesia , Gastrostomía , Neoplasias de Cabeza y Cuello , Bloqueo Nervioso , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Analgesia/métodos , Bloqueo Nervioso/métodos , Gastrostomía/métodos , Masculino , Anestesia Local , Dolor Postoperatorio , Femenino , Manejo del Dolor/métodos , Estudios Prospectivos , Anestésicos Locales/administración & dosificación , Persona de Mediana Edad , Dimensión del DolorRESUMEN
Objective: To investigate the effect and safety of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) technique in hysteroscopic diagnostic and therapeutic surgery. Methods: This study was a randomized controlled trial. A total of 100 female patients undergoing hysteroscopy surgery at Beijing Tongren Hospital from September to December 2023 were selected and randomly divided into two groups by the random number table method: the THRIVE group and the mask oxygen group, with 50 patients in each group. Patients in both groups were given total intravenous anesthesia with propofol combined with remifentanil and preserved spontaneous respiration. The THRIVE group was given oxygen by the THRIVE device with an oxygen flow rate of 50 L/min, while the mask oxygen group was given oxygen by the mask with an oxygen flow rate of 5 L/min; the oxygen concentration of both groups was set at 100%. The general condition of the patients, vital signs during the operation, the amount of anesthesia drugs used and the operation time were recorded. The primary observation index was the incidence of hypoxic events in the two groups; the secondary observation indexes were the incidence and time of intraoperative apnea as well as the corresponding oxygenation interventions and the incidence of non-hypoxic adverse events. Results: The age of the THRIVE group was (42±14) years, and the age of the mask oxygen group was (43±15) years. The duration of surgery in the THRIVE group was (15.9±3.4) min, which was statistically lower than that of the mask oxygen group (16.3±4.5) min (P=0.041), and there were no differences observed in the duration of awakening time and anesthesia time (both P>0.05). There was no significant difference in the dosage of propofol, remifentanil, and intraoperative vasoactive drugs between the two groups (all P>0.05). The SpO2 of the patients in the THRIVE group at the end of the operation was (99.7±1.1) %, which was higher than that of the mask-oxygen group (99.1±1.1) % (P<0.05). There was no difference in SpO2 of the two groups at the other time points (all P>0.05). There were no differences in HR and MAP of two group patients at each time point (all P>0.05). The incidence of hypoxic events in the THRIVE group was 12.0% (6/50), which was lower than that of 28.0% (14/50) in the mask oxygen group (P=0.045). The difference in the incidence and duration of apnea between the two groups was not statistically significant (all P>0.05). There were no cases of temporary need for laryngeal mask or tracheal intubation during surgery in both groups. There was no statistically significant difference in the incidence of intraoperative body movement, dizziness, nausea and vomiting between the two groups (all P>0.05), and no cardiac, cerebral, renal or other important organ insufficiency occurred in the two weeks after surgery. Conclusion: THRIVE technology can provide effective oxygenation for patients undergoing hysteroscopic diagnosis and treatment, maintain patients' circulatory stability, and improve the safety and efficiency of surgery.
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Histeroscopía , Humanos , Femenino , Adulto , Histeroscopía/métodos , Insuflación/métodos , Persona de Mediana Edad , Oxígeno , Remifentanilo/administración & dosificación , Hipoxia , Propofol/administración & dosificación , ApneaRESUMEN
Objective: To investigate the impact of intermittent senescent cell clearance on the proliferation and differentiation of dental pulp stem cells (DPSC) in long-term, large-scale expansion, and to explore strategies for maintaining the youthful state of DPSC in vitro. Methods: Human-derived dental pulp stem cells were isolated from healthy permanent teeth extracted for orthodontic or impeding eruption reasons, provided by the Department of Oral and Maxillofacial Surgery at West China Hospital of Stomatology, Sichuan University. Long-term, large-scale in vitro expansion of DPSC was conducted. The study compared young DPSC (passage 5) with aged DPSC (passage 25) using cellular senescence-associated ß-galactosidase staining, colony formation assay, and Alizarin Red S staining for osteogenic differentiation induction. To assess the differences between the two cell populations in terms of senescence and amplification and differentiation ability. Medicine screening for the most effective senolytic was compared among 5 common senolytics [Navitoclax (ABT-263), curcumin, dasatinib, fisetin, and quercetin]. The clearance efficacy was compared using cellular senescence-associated ß-galactosidase staining to reflect the changes in senescent cell ratio. The senolytic with the highest efficacy was chosen for further experiments. The passage at which the proportion of senescent cells significantly increased was identified, and the selected senolytic was administered three times at three-generation intervals from that passage to remove senescent cells. Both the control and senolytic-treated groups were estimated by fluorescence cellular senescence-associated ß-galactosidase staining, real-time fluorescence quantitative PCR (RT-qPCR), colony formation assay, wound healing assay, and Alizarin Red S staining for osteogenic differentiation induction. Subcutaneous heterotopic osteogenesis was performed in nude mice and the grafts were analyzed by HE staining and alkaline phosphatase (ALP) immunohistochemical staining. Results: The proportion of senescent cells increased as the expansion extended, leading to decreased proliferation and osteogenic differentiation ability of senescent DPSC compared to young DPSC (P<0.05). Senescent DPSC exhibited altered mRNA expression levels of senescence-related genes, including p21, p16INK4a, IL-6, and Ki67 (P<0.001). Among the five senolytics, ABT-263 had the biggest decreases in the proportion of senescent cells. After intermittent ABT-263 treatment during expansion, the proportion of senescent cells in the senolytic-treated group [(6.72±2.34)%] was significantly lower than that in the control group [(31.82±0.57)%] (P<0.001). RT-qPCR confirmed that compared with the control group, mRNA expressions of p21, p16INK4a, and IL-6 in the senolytic-treated group were significantly decreased (P<0.05), while mRNA expressions of Ki67 were significantly increased (P<0.01). Furthermore, the cell healing ability and osteogenic differentiation ability of the senolytic-treated group were higher than those of the control group (P<0.05). In vivo experimental results indicated that the relative new bone area [(2.36±0.48)%] after DPSC transplantation in the senolytic-treated group was greater than that in the control group [(1.00±0.46)%] (P<0.05), and the expression of ALP was higher than that in the control group (P<0.01). Conclusions: ABT-263 can effectively eliminate senescent cells in long-term large-scale DPSC expansion. Continuous treatment with ABT-263 during cultivation can maintain the proliferation and differentiation ability of DPSC both in vivo and in vitro.
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Diferenciación Celular , Proliferación Celular , Senescencia Celular , Pulpa Dental , Osteogénesis , Células Madre , Pulpa Dental/citología , Humanos , Células Madre/citología , Osteogénesis/efectos de los fármacos , Animales , Ratones , Dasatinib/farmacología , Ratones Desnudos , Quercetina/farmacología , beta-Galactosidasa/metabolismoRESUMEN
The treatment of patients with acute pulmonary embolism (APE) is extremely challenging due to the complex clinical presentation and prognosis of APE related to the patient's hemodynamic status and insufficient arterial blood flow and right ventricular overload. Protective efficacy against cardiovascular diseases of curcumin, a common natural polyphenolic compound, which has antithrombotic properties and reduces platelet accumulation in the circulation by inhibiting thromboxane synthesis has been demonstrated. However, the direct effect of curcumin on APE has rarely been studied. Therefore, the present study aimed to investigate the therapeutic potential of curcumin in APE and associated myocardial injury to provide new insights into curcumin as a promising competitive new target for the treatment of APE. A suspension of 12 mg/kg microspheres was injected intravenously into rats. An APE rat model was built. Before modeling, intragastric 100 mg/kg curcumin was given, and/or lentiviral plasmid vector targeting microRNA-145-5p or insulin receptor substrate 1 (IRS1) was injected. Pulmonary artery pressure was measured to assess right ventricular systolic pressure (RVSP). Hematoxylin and eosin (H&E) staining was performed on liver tissues and myocardial tissues of APE rats. TUNEL (terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling) staining and immunohistochemical (IHC) staining were conducted to measure apoptosis and CyPA-CD147 expression in the myocardium, respectively. Inflammatory indices interleukin-1beta (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were measured by ELISA in cardiac tissues. RT-qPCR and Western blot were performed to determine the expression levels of related genes. In addition, by dual luciferase reporter assay and RIP assay, the relationship between microRNA-145-5p and insulin receptor substrate 1 (IRS1) was confirmed. In results: curcumin improved APE-induced myocardial injury, reduced myocardial tissue edema, and thrombus volume. It attenuated APE-induced myocardial inflammation and apoptosis, as well as reduced lung injury and pulmonary artery pressure. Curcumin promoted microRNA-145-5p expression in APE rat myocardium. MicroRNA-145-5p overexpression protected against APE-induced myocardial injury, and microRNA-145-5p silencing abolished the beneficial effects of curcumin in APE-induced myocardial injury. IRS1 was targeted by microRNA-145-5p. IRS1 silencing attenuated APE-induced myocardial injury, and enhanced therapeutic effect of curcumin on myocardial injury in APE rats. In conclusion, curcumin alleviates myocardial inflammation, apoptosis, and oxidative stress induced by APE by regulating microRNA-145-5p/IRS1 axis.
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Curcumina , Hominidae , MicroARNs , Miocarditis , Embolia Pulmonar , Humanos , Ratas , Animales , MicroARNs/genética , MicroARNs/metabolismo , Curcumina/farmacología , Curcumina/uso terapéutico , Proteínas Sustrato del Receptor de Insulina/metabolismo , Interleucina-6/metabolismo , Apoptosis , Inflamación/tratamiento farmacológico , Estrés Oxidativo , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/genética , Hominidae/genética , Hominidae/metabolismoRESUMEN
Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
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Fístula , Uréter , Femenino , Humanos , Vejiga Urinaria/cirugía , Uréter/cirugía , Recto del Abdomen , DrenajeRESUMEN
OBJECTIVE: To explore the lumbar spine biomechanics of graded ventral facetectomy and determine the appropriate extent of resection for foraminoplasty. PATIENTS AND METHODS: We retrospectively measured several radiological parameters of superior articular process (SAP) and bony intervertebral foramen in computed tomography scans of 170 lumbar vertebral discs. The intact finite element (FE) spine of L2-sacrum was modified to simulate foraminoplasty with two typical graded ventral facetectomy methods (Method â : basal part resection of SAP; Method â ¡: apical part resection of SAP) to explore the biomechanical effects under different physiological motions. RESULTS: Examination of the radiological parameters of the bony intervertebral foramen indicated that they were generally narrower than the diameters of commercially available working cannulas. Some of these parameters showed gender differences. The biomechanical evaluation indicated that the range of motion increased gradually with the expansion of the resection extent, and the differences compared to the intact spine at the same level were greater in Method I than in Method â ¡. CONCLUSIONS: The appropriate ventral resection extent of the basal part of the SAP (Method I) was 4 mm, 3 mm, and 3 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. The appropriate ventral resection extent of the apical part of the SAP (Method II) were 10 mm, 6 mm and 6 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. Extensive resection of foraminoplasty may destabilize lumbar motion segments.
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Discectomía Percutánea , Desplazamiento del Disco Intervertebral , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Estudios Retrospectivos , Discectomía , Fenómenos Biomecánicos , Rango del Movimiento Articular/fisiologíaRESUMEN
Objective: To explore the influencing factors of AIDS-related deaths among HIV-infected patients in Shandong Province, to help reduce the risk of death and prolong survival time. Methods: The study population was HIV-infected patients in Shandong Province from 2017-2021, and Cox proportional hazards regression model was used to analyze the influencing factors of AIDS-related deaths and deaths within one year of confirmation. Results: Among 14 700 HIV- infected patients reported in Shandong Province in 2017-2021, 351 AIDS-related deaths occurred, accounting for 2.4% (351/14 700). The results of multifactorial Cox proportional hazards regression model analysis showed that the risk factors for AIDS-related deaths among HIV-infected patients included education level of junior high school, high school, and secondary school (aHR=1.37, 95%CI:1.01-1.84), sample source from healthcare institutions (aHR=1.61, 95%CI:1.22-2.12), duration of disease in AIDS stage (aHR=9.86,95%CI:6.86-14.19), baseline CD4+T lymphocytes (CD4) undetected (aHR=3.93, 95%CI:2.69-5.75), duration of antiviral treatment (ART) <6 months (aHR=3.46, 95%CI:2.42-4.93) and no ART (aHR=1.45, 95%CI:1.02-2.07), final CD4 <200 cells/µl (aHR=3.51, 95%CI:2.18-5.65) and final CD4 undetected (aHR=10.58, 95%CI:6.15-18.19), and final viral load (VL) values of 50-999 copies/ml,≥1 000 copies/ml and undetected (aHR=2.59, 95%CI:1.07-6.26; aHR=9.50, 95%CI:5.60-16.12; aHR=15.33, 95%CI:8.91-26.36). Factors with higher risk of AIDS-related deaths within one year of confirmation of HIV-infected patients included samples originating from healthcare facilities (aHR=1.68, 95%CI: 1.19-2.36), AIDS stage of disease (aHR=10.60, 95%CI:7.13-15.75), baseline CD4 undetected (aHR=3.71, 95%CI:2.34-5.90), duration of ART <6 months (aHR=4.30, 95%CI:2.85-6.49) and no ART (aHR=2.05, 95%CI:1.35-3.13), final CD4 <200 cells/µl (aHR=5.45,95%CI:2.04-14.60) and final CD4 undetected (aHR=20.95, 95%CI: 7.69- 57.04), and final VL values of 50-999 copies/ml, ≥1 000 copies/ml and undetected (aHR=15.21, 95%CI: 2.54-91.21; aHR=42.93, 95%CI:9.64-191.20; aHR=61.35, 95%CI:13.85-271.77). Conclusions: Expanding the coverage of testing, promoting early detection and treatment, strengthening regular follow-up and the test of HIV-infected patients, grasping the progress of the disease to provide accurate management and treatment are important for reducing the disease mortality rate and prolonging the survival time of HIV-infected patients.
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Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Humanos , Infecciones por VIH/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Modelos de Riesgos Proporcionales , Recuento de Linfocito CD4RESUMEN
Objectives: To understand the use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) and related factors in men who have sex with men (MSM) in Shandong Province, and provide reference for the promotion of PrEP and PEP in MSM. Methods: From April to July in 2022, MSM were recruited from 7 sentinel surveillance sites in Shandong Province for a questionnaire survey, and the sample size of each city site was 400. The information about sociodemographic characteristics, sexual behaviors, the uses of PrEP and PEP and others were collected from the MSM, and blood samples were collected from them for HIV and syphilis testing. Results: A total of 2 815 MSM were investigated, the majority of them were aged less than 30 years (55.7%, 1 569/2 815), unmarried (68.6%, 1 931/2 815) and had education background of college and above (56.5%, 1 590/2 815). Only 9.2% (258/2 815) had used PrEP and 10.8% (305/2 815) had used PEP. Multivariate logistic regression showed that factors associated with high likelihood of PrEP use in MSM included age ≤30 years (aOR=4.04, 95%CI:1.25-13.01), self-perceived lower risk of HIV infection (aOR=1.76, 95%CI:1.16-2.68), group sex and commercial sex in the past six months (aOR=1.51, 95%CI: 1.10-2.09; aOR=1.69, 95%CI: 1.16-2.47), new-type drug use (aOR=1.53, 95%CI: 1.11-2.11), receiving peer education (aOR=1.56, 95%CI: 1.03-2.37), other people using PrEP (aOR=3.29, 95%CI: 2.48-4.36), and being HIV negative (aOR=8.40, 95%CI:1.12-63.12). Factor associated with low likelihood of PrEP use in MSM was anal sex with casual partner (aOR=0.67, 95%CI:0.49-0.90). Factors associated with high likelihood of PEP use in MSM included age under 50 years (≤30 years old: aOR=2.41, 95%CI:1.02-5.69; 31-49 years old: aOR=3.33, 95%CI:1.42-7.85), no self-perceived risk for HIV infection (aOR=1.87, 95%CI:1.12-3.11), group sex in the past six months (aOR=1.68, 95%CI:1.23-2.29), new-type drug use (aOR=3.86, 95%CI:2.94-5.07) and receiving no peer education (aOR=1.54, 95%CI:1.12-2.12). Conclusions: In Shandong, a higher proportion of MSM used PrEP and PEP. Peer education and self-perceived HIV infection risk education should be strengthened to increase the rates of PrEP and PEP use in MSM.
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Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Adulto , Persona de Mediana Edad , Trabajo Sexual , Profilaxis Posexposición , Homosexualidad Masculina , Infecciones por VIH/prevención & control , Conducta SexualRESUMEN
Objective: To compare the characteristics of MSM with different types of primary sexual partners and to analyze the factors associated with MSM not being tested for HIV in the last six months. Methods: MSM were recruited in nine cities of Shandong Province from April to July 2021, and face-to-face questionnaires were conducted to collect information on sociodemographic characteristics, high-risk behaviors, and HIV testing of MSM. Blood samples were taken for serological tests of HIV and syphilis antibodies. Results: A total of 3 008 men who had anal sex with men in the last six months were divided into three groups according to the type of primary sexual partner in the last six months: the fixed sexual partner group (36.83%, 1 108/3 008), the commercial sexual partner group (3.06%, 92/3 008), and casual sexual partner group (60.11%, 1 808/3 008). There were statistically significant differences in the distribution of age, local residence time, education level, the primary place to find male sexual partners, use of new-type drugs in the last six months, consistent condom use every time during same-sex anal sex in the last six months, group sex in the last six months, no HIV testing in the last six months, having had a sexually transmitted disease in the last year, receiving peer education in the last year, and frequency of syphilis testing in the last year among different groups (P<0.05). Multivariable logistic regression analysis showed that related factors of not being tested for HIV in the last six months in MSM were those aged less than 30 years old (aOR=1.39, 95%CI: 1.06-1.83), married/cohabiting (aOR=1.74, 95%CI: 1.39-2.16), high school education or less (aOR=1.39, 95%CI: 1.15-1.67), had not used new-type drugs in the last six months (aOR=2.27, 95%CI: 1.89-2.71), had not received peer education in the last year (aOR=1.59, 95%CI: 1.28-1.98), had never been tested for syphilis (aOR=11.30, 95%CI: 8.15-15.66), had not been tested in the last year but had been previously tested for syphilis (aOR=5.65, 95%CI: 4.19-7.62), the type of primary sexual partner in the last six months being a commercial sexual partner (aOR=1.80, 95%CI: 1.01-3.20), and the type of primary sexual partner in the last six months being a casual sexual partner (aOR=1.50, 95%CI: 1.26-1.80). Conclusions: The characteristics of MSM with different types of primary sexual partners are different, and the proportion of HIV testing still needs to be improved. In the future, we should make full use of the Internet and peer education to expand the coverage of HIV testing for MSM, targeting the characteristics of MSM with different types of primary sexual partners.
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Minorías Sexuales y de Género , Sífilis , Humanos , Masculino , Lactante , Adulto , Parejas Sexuales , Homosexualidad Masculina , Sífilis/diagnóstico , Sífilis/epidemiología , CiudadesRESUMEN
Objective: To evaluate the effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation. Methods: A total of 64 patients undergoing elective surgery under general anesthesia using laryngeal mask airway (LMA) with positive pressure ventilation in Beijing Tongren Hospital Affiliated to Capital Medical University From January to March 2023 were prospectively selected and divided into two groups by the random number table method: normal saline group (n=32), with 18 males and 14 females, aged 28-64 (48.4±10.6) years, and the compound chamomile and lidocaine hydrochloride gel group (chamomile gel group, n=32), with 18 males and 14 females, aged 24-64 (46.3±10.8) years. Patients in both groups received total intravenous anesthesia. Before LMA placement, the front, shoulder and back of LMA were lubricated with normal saline and compound chamomile and lidocaine hydrochloride gel in the normal saline group and the chamomile gel group, respectively. The main outcome measure was the incidence of postoperative oropharyngeal mucosal inflammation at different time points after the removal of the laryngeal mask. Secondary outcome measures included oropharyngeal mucositis score, sore throat score, hoarse voice score, cough score and throat dryness score at different time points after LMA removal, the number of LMA insertion times, time of successful insertion and leakage pressure, as well as stress reactions such as cough and agitation before and after LMA removal, and adverse reactions such as tongue numbness and protective pharyngeal reflex limitation during recovery. Results: The incidence of oropharyngeal mucositis in the chamomile gel group was 25.0% (8/32), 31.3% (10/32), 28.1% (9/32) and 3.1% (1/32) at 0.5, 3, 6 and 24 h after LMA removal, respectively, which were lower than those of normal saline group [53.1% (17/32), 59.4% (19/32), 59.4% (19/32) and 21.9% (7/32)] (all P<0.05). The oropharyngeal mucositis scores of patients in the chamomile gel group were 0 (0, 0.8), 0 (0, 1.0), 0 (0, 1.0) and 0 (0, 0) respectively at 0.5, 3, 6 and 24 h after LMA removal, which were lower than those in the saline group [1.0 (1.0, 1.8), 1.0 (0, 2.0), 1.0 (0, 2.0) and 0 (0, 0)] (all P<0.05). The cough score of the patients in the chamomile gel group was 0 (0, 0) and 0 (0, 0) at 3, 6 h after LMA removal, which were lower than those of the normal saline group [(0, 0) and 0 (0, 0)] (both P<0.05). The throat dryness score of the patients in the chamomile gel group was 0 (0, 1.0) at 3 h after LMA removal, which was lower than that of the normal saline group [1.0 (0.3, 1.0)] (P=0.019). The time of successful LMA insertion in the chamomile gel group was 25.0 (20.3, 29.8) s, which was shorter than that in the saline group [29.0 (25.0, 32.0) s] (P=0.016). There were no significant differences in the number of LMA insertion, leakage pressure, postoperative sore throat and hoarse voice scores between the two groups (all P>0.05). Likewise, there were no stress reactions such as cough and agitation before and after LMA removal, and no adverse reactions such as tongue numbness and limited protective pharyngeal reflex during recovery. Conclusion: Compound chamomile and hydrochloride lidocaine gel can reduce the incidence of postoperative oropharyngeal mucositis, relieve the symptoms of postoperative oropharyngeal mucositis, pharyngeal dryness and cough, and improve the postoperative comfort of patients using the laryngeal mask airway with positive pressure ventilation.
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Máscaras Laríngeas , Mucositis , Femenino , Masculino , Humanos , Lidocaína/uso terapéutico , Atragantamiento , Manzanilla , Tos , Hipoestesia , Solución Salina , Respiración con Presión Positiva , DolorRESUMEN
Objective: To explore the impact of a new type of modified nasopharynx airway preserving spontaneous breathing under general anesthesia on the postoperative recovery quality of patients undergoing hysteroscopic daytime surgery. Methods: A total of 80 patients undergoing hysteroscopic daytime surgery at Beijing Tongren Hospital from August to December 2022 was prospectively selected. The patients were randomly divided into two groups using a random number table method: patients in the laryngeal mask mechanical ventilation general anesthesia group (laryngeal mask group, n=40) aged (46.8±10.1) years (20-65 years), while patients in the modified nasopharyngeal airway preserving spontaneous breathing general anesthesia group (nasopharyngeal airway group, n=40) aged (45.5±12.1) years (26-65 years). The main outcome measures were the clinical recovery score (CRS) and modified alertness and sedation score (MOAA/S) of patients at different postoperative time points. Secondary observation indicators included anesthesia induction time, awakening time, and extubation time, changes of hemodynamic indicators between preoperative and intraoperative period, and incidence of adverse reactions during and after surgery. Results: The CRS scores [M (Q1, Q3)] of patients in the nasopharyngeal airway group were 8 (8, 9), 8 (8, 9), 8 (8, 9), 9 (9, 9) and 10 (10, 11) at postoperative awakening, immediately after extubation, 5 minutes after extubation, 15 minutes after extubation, and 30 minutes after extubation, respectively, which were higher than those in the laryngeal mask group [7 (6, 8), 7 (7, 8), 7 (7, 8), 8 (8, 8) and 9 (8, 9)] (all P<0.001). The MOAA/S scores of the nasopharyngeal airway group were 5 (5, 5), 5 (5, 5), 5 (5, 5) and 5 (5, 5) at postoperative awakening, immediately after extubation, 5 minutes after extubation, and 15 minutes after extubation, respectively, which were higher than those in the laryngeal mask group [4 (3, 5), 4 (4, 5), 5 (5, 5) and 5 (5, 5)] (all P<0.05). The anesthesia induction time, awakening time, and extubation time of the nasopharyngeal airway group were (47.8±4.3) s, (4.1±1.7) min and (4.5±1.7) min, respectively, which were shorter than those of laryngeal mask group [(138.8±4.2) s, (7.2±2.9) min and (8.1±2.7) min] (all P<0.05). The mean arterial pressure (MAP) of patients in the nasopharynx airway group during extubation was (84.9±10.2) mmHg (1 mmHg=0.133 kPa), which was lower than that of the laryngeal mask group [(93.2±7.5) mmHg] (P<0.05). The partial pressure of end-tidal carbon dioxide (PetCO2) during cervical dilation was (22.0±5.9) mmHg, which was lower than those of the laryngeal mask group [(37.2±2.2) mmHg] (P<0.05). The PetCO2 during intrauterine operation and extubation were (45.5±6.7) and (41.6±4.5) mmHg, which were higher than those of the laryngeal mask group [(39.2±4.1) mmHg and (38.6±3.6) mmHg] (both P<0.05). The incidence of respiratory depression and body movement during surgery in the nasopharyngeal airway group were 27.5% (11/40) and 17.5% (7/40), respectively, which were higher than those in the laryngeal mask group [0 and 0] (both P<0.05). The incidence of postoperative drowsiness was 2.5% (1/40), which was lower than that of the laryngeal mask group [17.5% (7/40)] (P<0.05). There was no severe physical activity or intraoperative awareness in the two groups. Conclusion: The new modified general anesthesia method of preserving spontaneous breathing through the nasopharynx airway can improve the postoperative recovery quality of patients, and reduce the occurrence of adverse reactions, which facilitates rapid recovery after hysteroscopic daytime surgery.
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Máscaras Laríngeas , Humanos , Anestesia General , Hemodinámica , Nasofaringe , Respiración Artificial , Adulto Joven , Adulto , Persona de Mediana Edad , AncianoRESUMEN
Objective: To evaluate the preventive effect of atropine premedication during anesthesia induction on vagal reflex in patients undergoing suspension laryngoscopy. Methods: A total of 342 patients (202 males and 140 females) scheduled for suspension laryngoscopy under general anesthesia in Beijing Tongren Hospital from October 2021 to March 2022 were prospectively enrolled, with a mean age of (48.1±11.9) years. The patients were randomly divided into two groups using the random number table method: the treatment group (n=171) and the control group (n=171). Patients in the treatment group were administrated with 0.5 mg atropine intravenously guttae (ivgtt) while patients in the control group were given equivalent volume of normal saline. For all patients, if heart rate (HR)<50 beats/min happened during the insertion of the suspension laryngoscope, the operation should be stopped and the laryngoscope should be removed. Patients without HR recovery after the removal of the laryngoscope should be given 0.5 mg atropine, and the operation should be continued after the HR recovered. The primary outcome was the incidence of HR fluctuation over 20% (ΔHR>20%) before and immediately after suspension laryngoscope fixation, and the secondary outcomes included HR, mean arterial pressure (MAP) of the two groups recorded before and after anesthesia induction, before and immediately after suspension laryngoscope fixation, and the incidences of sinus bradycardia, laryngoscope removal and atropine treatment during operation. Results: The incidences of ΔHR>20% and bradycardia immediately after the suspension laryngoscope fixation were 14.6% (25/171) and 12.9% (22/171) in the treatment group, which were significantly lower than those in the control group [28.1% (48/171) and 29.8% (51/171)] (both P<0.05). The HR immediately after the suspension laryngoscope fixation in the treatment group [(66.4±13.5) beats/min] and in the control group [(60.8±15.7) beats/min] was significantly lower than those before the suspension laryngoscope fixation [(74.7±11.1) beats/min and (67.6±12.8) beats/min, respectively] (both P<0.05). There were no significant differences in MAP between the two groups at each time point (all P>0.05). The incidence of laryngoscope removal once plus 0.5 mg atropine administration, laryngoscope removal twice plus 0.5 mg atropine administration and laryngoscope removal twice plus 1.0 mg atropine administration was 9.9% (17/171), 1.8% (3/171) and 0 (0) in the treatment group, respectively, which was significantly lower than those in the control group [24.0% (41/171), 5.8% (10/171) and 2.3% (4/171), respectively] (all P<0.05). Conclusion: Atropine premedication during anesthesia induction can effectively reduce the occurrence of vagal reflex in patients undergoing suspension laryngoscopy.
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Atropina , Laringoscopía , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Atropina/farmacología , Bradicardia , Frecuencia Cardíaca/fisiología , Premedicación , Anestesia General , ReflejoRESUMEN
Objective: To understand the related factors of new-type drug use and recent HIV infection among men who have sex with men (MSM), and provide a reference for formulating targeted strategies for HIV/AIDS prevention and control. Methods: MSM were recruited in sentinel surveillance sites of nine cities in Shandong province from April to July 2021, with a sample size of 400 in each city. A face-to-face questionnaire was conducted to collect demographic characteristics, high-risk behaviors, acceptance of HIV intervention services, etc. Blood samples were collected for HIV and syphilis antibodies detection. Limiting-antigen avidity enzyme immunoassay (LAg-Avidity EIA) was used to detect recent HIV infection, and the rate of recent HIV infection was calculated. Results: 3 624 MSM were under study with the following characteristics as: aged (32.70±9.33) years old, the aged 30 and above (59.52%, 2 157/3 624), with high school education or below (55.99%, 2 029/3 624), being unmarried/divorced/widowed (57.70%, 2 091/3 624) and as having homosexual orientation (86.26%, 3 126/3 624) accounted for the more mainly. Of 32.95% (1 194/3 624) had same-sex unprotected anal sex in recent six months; 27.48% (993/3 613) ever used new-type drugs, and the HIV antibody positive rate was 3.12% (113/3 624). The recent HIV infection rate appeared as 2.61% (95%CI: 1.73%-3.49%). The multivariable logistic regression analysis indicated that the related factors of new-type drug use were unmarried/divorced/widowed (compared with being married/cohabitating, aOR=1.43, 95%CI: 1.22-1.69), educational level of college or above (compared with educational level of high school or below, aOR=1.47, 95%CI: 1.25-1.72), mainly through the Internet/dating software to find male sex partners (compared with mainly through bars/baths/parks and other places to find male sex partners, aOR=1.76, 95%CI: 1.41-2.19). Those who had unprotected anal sex in the last six months (compared with no unprotected anal sex, aOR=1.33, 95%CI: 1.13-1.57), had sexually transmitted diseases in the past year (compared with no sexually transmitted disease, aOR=2.77, 95%CI: 2.04-3.76) were more likely to use new-type drugs. The multinominal logistic regression showed that MSM who had unprotected anal sex in the last six months (compared with no unprotected anal sex, aOR=2.51, 95%CI: 1.25-5.01) or did not receive HIV intervention services in the past year (compared with those who received HIV intervention services, aOR=3.89, 95%CI: 1.30-11.60), were syphilis positive (compared with syphilis negative, aOR=8.18, 95%CI: 2.98-22.48), used new-type drugs (compared with those who did not use new-type drugs, aOR=4.75, 95%CI: 2.32-9.70) had a higher risk of recent HIV infection. Conclusions: New-type drugs have been widely used in MSM in Shandong province. The abuse of new-type drugs increases the risk of recent HIV infection.
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Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Minorías Sexuales y de Género , Trastornos Relacionados con Sustancias , Sífilis , Masculino , Humanos , Adulto Joven , Adulto , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
Objective: To understand the characteristics and depressive status of men who have sex with men (MSM) who self-reported HIV infection through heterosexual transmission and to provide evidence for personalized management of HIV infected people. Methods: A cross-sectional survey was carried out in Shandong province from September to December in 2019. Male HIV patients aged ≥15 years who self-reported HIV infection through heterosexual transmission were selected to verify the route of infection by one-to-one interview in Ji'nan, Qingdao, Weifang and Linyi cities of Shangdong province. According to the 1â¶1 ratio, local HIV patients with age difference ≤3 years who self-reported MSM were selected as controls. A questionnaire survey was conducted, including data on demographic characteristics, behavior status, CES-D and PSSS. The related factors of the depressive symptoms and characteristics were analyzed. Results: A total of 373 male HIV patients were interviewed, and 39.7%(148/373) were confirmed as MSM after reexamination. The interviewers were: aged (40.3±12.0) years old, 41.9% (62/148) married/cohabiting. 27.0% (40/148) had been tested before HIV diagnosis, 71.6% (106/148) had homosexual partners ≥2 and 55.4% (82/148) had depressive symptom. Multivariate analysis showed that the MSM without HIV testings before diagnosis, had homosexual partners ≥2 before diagnosis, had first homosexual behavior at the age >30 years old and with depressive symptoms were more likely to conceal the true infection route. The incidence of depression among MSM who self-reported HIV infection through heterosexual transmission was related to physical health status social support and occupational stability. Conclusions: Some male HIV persons self-reported as being heterosexually transmitted were really transmitted through homosexual behavior. There were high-risk behaviors such as multiple partners and intersex among this group, and with high incidence of depression. It is necessary to encourage the reexamination program during follow-up and target on psychological and behavioral interventions, continuously.
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Infecciones por VIH , Minorías Sexuales y de Género , Masculino , Humanos , Adulto , Persona de Mediana Edad , Heterosexualidad , Depresión/epidemiología , Infecciones por VIH/epidemiología , Autoinforme , Homosexualidad Masculina , Estudios TransversalesRESUMEN
OBJECTIVE: The goal of this paper is to investigate the use of Potentilla bifurca in the treatment of type 2 diabetes. MATERIALS AND METHODS: We analyzed the improvement effect of 3T3-L1 adipocytes under insulin resistance (IR) with the compounds of Potentilla bifurca. RESULTS: The Potentilla bifurca can significantly improve the glycolipid metabolism disorder in 3T3-L1 adipocytes (the effect of MC compounds is very significant). It can improve insulin resistance by enhancing the glucose uptake of 3T3-L1 adipocytes, decreasing IL-6 content, and regulating the content of p-Akt/Akt, IKKß, and p-NF-κBp65/NF-κBp65 in the IRS/PI3K/Akt signaling pathway. CONCLUSIONS: Studies have shown that Potentilla bifurca has the ability to regulate glucolipid metabolism and can be used in the treatment of type 2 diabetes.
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Diabetes Mellitus Tipo 2 , Resistencia a la Insulina , Potentilla , Flavonoides/farmacología , Flavonoides/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Fosfatidilinositol 3-Quinasas , Proteínas Proto-Oncogénicas c-aktRESUMEN
A survey was conduct to analyze the usage situation of post-exposure prophylaxis(PEP) and related factors among men who have sex with men(MSM) in 6 cities of Shandong Province. Total of 2 620 subjects, the use ratio was 2.98% (78/2 620). Compared with age≤24 years,monthly income<5 000 yuan,non-commercial sex, non-DU,non-STD,role for being insert in the anal intercourse,MSM was more likely to use PEP with age≥45 years(OR=3.87, 95%CI:1.12-13.36),monthly income≥5 000 yuan(OR=1.87, 95%CI:1.07-3.28),commercial sex (OR=3.13, 95%CI:1.56-6.28), drug users (DUs) (OR=4.63, 95%CI:2.51-8.52),STD patient (OR=2.35,95%CI:1.05-5.27),the mixed sex role group(OR=2.25,95%CI:1.10-4.62).
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Infecciones por VIH , Minorías Sexuales y de Género , Masculino , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Homosexualidad Masculina , Infecciones por VIH/prevención & control , Profilaxis Posexposición , Conducta SexualRESUMEN
The incidence of anastomotic leakage, a common and serious postoperative complication of low rectal cancer, remains high. Clarifying the risk factors for anastomotic leakage in patients with low rectal cancer after surgery can help guide clinical treatment and help patients improve their prognosis. The current literature suggests that the risk factors affecting the occurrence of anastomotic leakage after low rectal cancer include three aspects: (1) individual factors: male gender, high body mass index, malnutrition, smoking, alcoholism, and metabolic diseases; (2) tumor factors: the lower margin of tumor <5 cm from the anal verge, tumor diameter >2.5 cm, late tumor stage, high level of tumor markers and preoperative intestinal obstruction; (3) surgical factors: long operative time (>180 min), intraoperative bleeding (≥70 ml), more than 2 cartridges of stapling for anastomosis, contamination of the operative field, epidural analgesia and intraoperative hypothermia. Notably, the surgical approach (laparoscopic, open and hand-assisted laparoscopic surgery) was not a factor influencing the occurrence of postoperative anastomotic leakage in low rectal cancer. The findings on the effects of receiving neoadjuvant therapy, gut microbiota,intestinal bowel preparation, insufficient time for preoperative antibiotic prophylaxis, left colonic artery dissection, intraoperative blood transfusion, pelvic drainage, transanal drainage and combined organ resection, and postoperative diarrhea on postoperative anastomotic leakage in low rectal cancer are controversial. However, clinical workers can still take measures to reduce the risk of anastomotic leakage according to the above risk factors by making a good assessment before surgery, actively avoiding them during and after surgery, and taking measures for each step, so as to bring maximum benefits to patients.
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Laparoscopía , Neoplasias del Recto , Humanos , Masculino , Fuga Anastomótica/prevención & control , Recto/cirugía , Neoplasias del Recto/cirugía , Neoplasias del Recto/complicaciones , Anastomosis Quirúrgica/efectos adversos , Laparoscopía/efectos adversosAsunto(s)
Endometriosis , Preservación de la Fertilidad , Femenino , Humanos , Consenso , Fertilidad , ChinaRESUMEN
Objective: To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods: A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results: In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S2 in 5 patients and S0 in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions: The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.