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Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.
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Background:With the advancement of endoscopic techniques,the detection rate of duodenal lesions has increased,and the selection and curative effect of endoscopic resection of duodenal lesions need to be further explored.Aims:To evaluate the safety and efficacy of endoscopic treatment of duodenal tumors.Methods:A retrospective analysis was conducted on 32 patients with duodenal tumors treated with endoscopic resection from January 2017 to January 2022 at Taizhou People's Hospital Affiliated to Nanjing Medical University.The location,depth,treatment method,postoperative pathology,and complications of duodenal tumors were summarized.Results:Among the 32 patients,there were 21 males and 11 females.Two patients presented with melena,10 patients had abdominal pain,and 20 patients were asymptomatic.Twenty-eight tumors were located in descending part of duodenum,and 4 were located in duodenal bulb.One patient underwent endoscopic submucosal excavation,2 underwent cold snare polypectomy,12 underwent endoscopic submucosal dissection,and 17 underwent endoscopic mucosal resection.All lesions were completely resected.Among the 32 lesions,there were 21 tubular adenoma or tubulovillous adenoma,7 Brunner's gland adenoma,2 lipoma,1 neuroendocrine tumor,and 1 stromal tumor.One patient with duodenal tubulovillous adenoma had perforation during operation and was transferred to surgery for repair.The other patients did not have complications such as perforation and bleeding during operation.All patients had no recurrence after postoperative endoscopy.Conclusions:Endoscopic treatment for duodenal tumors is safe and effective,and has good clinical value.
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Objective:To analyze the research progress, hot spots and future trends of standardized residency training of Traditional Chinese Medicine from 1998 to now by using CiteSpace knowledge map software.Methods:The related literature on standardized residency training of Traditional Chinese Medicine were retrieved on CNKI. And after Refworks format conversion, using CiteSpace 5.6 R3 software for the construction of knowledge map, the author cooperation, institutional cooperation, keyword co-occurrence, and time-sharing research hot spots views of related literature on standardized residency training of Traditional Chinese Medicine were drawn respectively.Results:A total of 259 papers were obtained, with 253 authors. Ren Xianqing and Cui Jin published the most articles (each with 4 papers), and Beijing University of Chinese Medicine published the most articles (with 23 papers). There were 259 keywords in total, and 16 keywords with frequency greater than 5 and centrality greater than 0.1. There were 14 keyword cluster tags, and 15 burst terms were detected in total, and the trend discussion was carried out accordingly.Conclusion:The research trend of the standardized residency training of Traditional Chinese Medicine mainly follows the relevant policies issued by the functional departments of the government, and the research hot spots depend on the obstacles and difficulties encountered in the practical application of each training base.
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Objective:To evaluate the effect of dexmedetomidine-based anesthesia on cerebral oxygen saturation in the patients undergoing total laparoscopic hysterectomy.Methods:Fifty American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients, aged 20-64 yr, undergoing elective total laparoscopic hysterectomy, were divided into 2 groups ( n=25 each) using a random number table method: conventional group (C group) and dexmedetomidine group (D group). Bilateral regoinal oxygen saturation (rSO 2) was monitored using a cerebral oxygen saturation monitor. In D group, dexmedetomidine was intravenously infused as a bolus of 0.5 μg/kg before anesthesia induction, and 10 min later dexmedetomidine was then given by an infusion of 0.5 μg·kg -1·h -1 until 30 min before the end of operation. The equal volume of normal saline was given instead in C group. The remaining anesthesia regimen was the same in two groups. The maximum (LrSO 2max, RrSO 2max) and minimum (LrSO 2min, RrSO 2min) of bilateral rSO 2 were recorded from entry to 2 min after induction (D 1), from >2 min after induction to completion of tracheal intubation (D 2), from completion of tracheal intubation to the end of skin incision (D 3), from skin incision to completion of pneumoperitoneum (D 4), from pneumoperitoneum to completion of Trendelenburg position (D 5), within 20 min of Trendelenburg position (D 6), >20-40 min of Trendelenburg position (D 7), >40-60 min of Trendelenburg position (D 8), and from >60 min of Trendelenburg position to 10 min after return to supine position (D 9). The occurrence of 60% baseline value <rSO 2 <75% baseline value and rSO 2≤60% baseline value were also recorded. Results:Compared with D 1 period, LrSO 2min, LrSO 2max, RrSO 2min and RrSO 2max were significantly decreased in D 4-D 8 periods in C group ( P<0.05), and no significant change was found in the parameters mentioned above in the other periods in D group ( P>0.05). Compared with C group, the LrSO 2min, LrSO 2max, RrSO 2min, and RrSO 2max were significantly increased in D 4-D 8 periods in D group ( P<0.05). No bilateral rSO 2 <75% baseline value was found in group D. Conclusions:Dexmetomidine-based anesthesia can elevate intraoperative rSO 2 in the patients undergoing total laparoscopic hysterectomy.
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Primary biliary cholangitis (PBC) is an inflammatory and cholestatic liver disease caused by autoimmune response targeting the small- and medium-sized intrahepatic bile ducts. The most specific manifestations of this diseases in clinical practice were positive anti-mitochondrial antibody and selective destruction of small- and medium-sized bile ducts based on liver histology. Since it is difficult to obtain the clinical samples of early-stage PBC, the construction and optimization of mouse models is an important method to investigate the pathogenesis of PBC. An understanding of the modeling principles of PBC animal models and disease features in serology, histology, and cytology not only helps to improve the awareness of PBC, but also helps to design scientific and rational research protocols.
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Primary biliary cholangitis (PBC) is an inflammatory and cholestatic liver disease caused by autoimmune response targeting the small- and medium-sized intrahepatic bile ducts. The most specific manifestations of this diseases in clinical practice were positive anti-mitochondrial antibody and selective destruction of small- and medium-sized bile ducts based on liver histology. Since it is difficult to obtain the clinical samples of early-stage PBC, the construction and optimization of mouse models is an important method to investigate the pathogenesis of PBC. An understanding of the modeling principles of PBC animal models and disease features in serology, histology, and cytology not only helps to improve the awareness of PBC, but also helps to design scientific and rational research protocols.
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Background: The revised Atlanta classification (RAC) and determinant-based classification (DBC) are widely used in assessing the severity of acute pancreatitis (AP). However, studies on comparison between RAC and DBC are scarce. Aims: To explore the accuracy of RAC and DBC in the assessment of AP severity. Methods: The clinical data of 481 AP patients from September 2015 to September 2019 at Taizhou People's Hospital were collected and severity were stratified according to RAC and DBC. The treatment and prognosis of each subgroup were compared. Results: On the basis of RAC, 269 (55.9%), 174 (36.2%) and 38 (7.9%) patients were classified as mild AP (MAP), moderate severe AP (MSAP) and severe AP (SAP), respectively. There were significant differences in mortality, ICU monitoring rate, ICU stay, operation rate and hospital stay among the above groups (P<0.05). On the basis of DBC, 319 (66.3%), 117 (24.3%), 34 (7.1%) and 11 (2.3%) patients were classified as MAP, MSAP, SAP and critical AP (CAP), respectively. There were significant differences in mortality, ICU monitoring rate, ICU stay, operation rate and hospital stay among the above groups (P<0.05). The ICU monitoring rate (100% vs. 63.2%, P=0.014), median ICU stay (35 days vs. 15 days, P=0.001), hospital stay [(50.36±21.54) days vs. (22.78±14.56) days, P=0.038] were significantly increased in CAP patients (classified by DBC) than those in SAP patients (classified by RAC), however, no significant differences in mortality and operation rate were found between the two groups (P=0.136; P=0.202). Conclusions: Both RAC and DBC can accurately stratify the severity of AP. SAP patients (classified by RAC) complicated with infected necrosis should be further classified into CAP.
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Objective To study the auditory perception and speech ability outcomes after cochlear implantation in prelingually deaf children with extremely severe neurosensory hearing loss and comorbid leukoencephalopathy.Methods Our study included 14 prelingually deaf children with leukoencephalopathy (confirmed by preoperative MRI scanning) who were treated with cochlear implantation in the Department of Otorhinolaryngology Head and Neck Surgery of Hainan Provincial People''s Hospital, including 8 males and 6 females of 1~6 yr with a mean age of 3.8 yr.Sixteen synchronous prelingually deaf children without central nervous system (CNS) diseases were also included as the control group, including 11 males and 5 females of 1~6 yr with a mean age of 4.4 yr.All the patients underwent pre-surgical assessments of audiology, radiology, speech ability and intelligence before cochlear implantation via transmastoid facial nerve recess approach was done, after which rehabilitation was provided at the Hainan Rehabilitation Center for Deaf Children.Categories of auditory performance (CAP) and speech intelligibility rate (SIR) were employed as the assessment criteria for the outcome of surgery, the scores of which at different timepoints after surgery were statistically compared through paired t-test between the two groups.Results All the patients gained post-surgical hearing and speech abilities to different degrees, whereas CAP and SIR scores both chronologically improved in the both groups.No statistical difference was revealed either in CAP or in SIR scores between the two groups at 6, 12 and 24 months after surgery (P>0.05).Conclusion Children with extremely severe neurosensory hearing loss can be reated with cochlear implantation even if they have comorbid leukoencephalopathy.The effects of auditory and speech rehabilitation for the same age patients with leukoencephalopathy are similar to those without leukoencephalopathy in 2 years after surgery.
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Primary biliary cholangitis (PBC) is a chronic cholestatic autoimmune disease caused by the attack of the liver by the immune system and is commonly seen in middle-aged women.The pathological features of this disease include the infiltration of a large number of innate immune cells (NK cells,NK T cells,and monocytes,etc.) and adaptive immune cells (T lymphocytes and B lymphocytes) at the portal area and injury of small intrahepatic bile ducts.In addition,PBC patients have high serum levels of anti-mitochondrial antibodies and inflammatory cytokines such as interferon-γ,tumor necrosis factor-α,interleukin-6,and interleukin-12.Although current studies have shown that autoreactive T cells are the major effector cells for PBC,NK cells,NK T cells,monocytes,and B cells around the portal vein also directly or indirectly participate in the development and progression of PBC.This article systematically summarizes the role of innate immune cells,adaptive immune cells,and related chemokines in the pathogenesis of PBC,in order to provide a theoretical basis for a deep understanding of the immunological pathogenesis of PBC.
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Objective To evaluate the accuracy of ultrasound-measured inferior vena cava (IVC) diameter in assessment of the preoperative blood volume in elderly patients.Methods Sixty patients,aged 60-75 yr,with body mass index 20-25 kg/m2,of ASA physical status Ⅰ-Ⅲ,scheduled for elective transurethral resection of prostate,were randomly divided into 3 groups (n =20 each):control group (group C),lactated Ringer's solution group (group RL),and hydroxyethyl starch group (group H).Lactated Ringer's solution 8 ml/kg was infused intravenously in group RL.Hydroxyethyl starch 130/0.4 8 ml/kg was infused intravenously in group H.SpO2,mean arterial pressure (MAP),HR and central venous pressure (CVP) were monitored before and after fluid therapy.The IVC diameters,both during expiration (IVCe) and inspiration (IVCi),were measured using ultrasound.IVC collapsibility index (IVC-CI) was calculated.Results The IVCeand IVCi were significantly increased,and IVC-CI was decreased after fluid therapy as compared with those before fluid therapy in RL and H groups.Compared with group C,the IVCe and IVCi were significantly increased,and IVC-CI was decreased after fluid therapy in RL and H groups.IVCe and IVCi were positively correlatedwith CVP (r=0.746 and 0.697,respectively).IVC-CI was negatively correlated with CVP (r =-0.547).Conclusion Ultrasoundmeasured IVC diameter provides better accuracy in assessing the preoperative blood volume in elderly patients.
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Objective To investigate the mutation screening of the GJB3,GJB2,mtDNA 1555 A>G and SLC26A4 gene in Hainan Pronive population with non-syndromic hearing impairment.Methods PCR were performed with one pair of primer in the coding sequence of GJB3,GJB2,mtDNA 1555 A>G and SLC26A4 gene.Bidirectional sequencing of PCR products was subsequently applied in 429 patients with hearing loss.Results 55 patients gene mutation of 429 patients were found. The point mutation in mtDNA was found in 5 patients (1.1 7%).1 5 5 5 A>G mutation of mtDNA was found in 4 patients. 1494 C>T mutation of mtDNA was found in one patients.GJB2 gene mutation was found in 25 patients (5.83%).235 del C mutation of GJB2 gene was found in 9 patients.235 del C/GJB2 299 del AT mutation was found in two patients.235 del C mutation was found in 10 patients.176 del 16 mutation was found in 4 patients.SLC26A4 mutation was found in 22 patients (5.13%).IVS7-2 A>G mutation of SLC26A4 was found in 4 patients.2168 A>G mutation of SLC26A4 was found in one patient.IVS7-2 A>G mutation was found in 12 patients.2168 A>G mutation was found in 5 patients.538 C>T mutation of GJB3 gene was found in 3 patient.IVS7-2A>G mutation and 2168 A>G muation of SLC26A4 gene was found in 4 of 22 EVA patients.Conclusion GJB2 gene and SLC26A4 gene have revealed responsible genes for Hainan deafness patients.
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ObjectiveTo investigate the effects of sevoflurane on short-term memory impairment and the relative synaptic mechanism.MethodsAt 12 h,24 h and 72 h after the mice were exposed to 1.5％ sevoflurane for 1h,the spontaneous alternation and locomotor activity was assessed by Y maze,the short term potentiation (STP) were measured with extracellular recording technique in hippocampal slices.ResultsAt 12h after administration with sevoflurane in vivo,the spontaneous alternation ( (54.7 ± 1.7) ％,P＜0.01 ) and locomotor activity (16.4 ± 1.3,P ＜ 0.01 ) decreased significantly compared with that of control group,and the population spike amplitude after induction of STP ( ( 122.3 ± 13.9) ％,P ＜ 0.05 ) decreased significantly in hippocampal slices,but there was no different at 24h and 72h.After administration with sevoflurane in vitro,the basic ( ( 83.5 ± 8.9) ％,P ＜ 0.01 ) or titanic ( ( 116.5 ± 14.9) ％,P ＜ 0.01 ) population spike amplitude decreased significantly in hippocampal slices,but the amplitude could recovery after wash-out.ConclusionSevoflurane can impair the shortterm memory by suppressing synaptic transmission in the near future but not the long future.
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Objective:To investigate the clinical characters and therapeutic methods of orbital apex syndrome caused by sinus diseases.Method:Six cases of orbital apex syndrome originated from sinus diseases were retrospective analyzed in our hospital from August 2003 to February 2009. Different therapeutic methods were taken according to different causes of disease.Result:Four cases of sinus infection,one cases of sphenoethmoid mucocele , one cases of sinus squamous cell carcinoma. The results of patients with orbital apex syndrome included cure and effectiveness in 2 cases respectively, death from myocardial infarction in one case, and one case is still following up.Conclusion:Orbital apex syndrome originated from sinus diseases was rare, which was mainly caused by sinus infection . The key point is the correct etiology diagnosis in early phase . Treatment with endoscopic sinus surgery early is a good effective method for orbital apex syndrome caused by sinus diseases, in the same time with enough dosage of antibiotic and glucocorticoid therapy intravenously.
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OBJECTIVE@#To investigate the clinical characters and therapeutic methods of orbital apex syndrome caused by sinus diseases.@*METHOD@#Six cases of orbital apex syndrome originated from sinus diseases were retrospective analyzed in our hospital from August 2003 to February 2009. Different therapeutic methods were taken according to different causes of disease.@*RESULT@#Four cases of sinus infection,one cases of sphenoethmoidal mucocele, one cases of sinus squamous cell carcinoma. The results of patients with orbital apex syndrome included cure and effectiveness in 2 cases respectively, death from myocardial infarction in one case, and one case is still following up.@*CONCLUSION@#Orbital apex syndrome originated from sinus diseases was rare, which was mainly caused by sinus infection. The key point is the correct etiology diagnosis in early phase. Treatment with endoscopic sinus surgery early is a good effective method for orbital apex syndrome caused by sinus diseases, in the same time with enough dosage of antibiotic and glucocorticoid therapy intravenously.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Nasales , Enfermedades del Nervio Óptico , Enfermedades Orbitales , Estudios Retrospectivos , SíndromeRESUMEN
OBJECTIVE@#To investigate the clinical characteristics and common etiology of vertigo.@*METHOD@#The clinical data of 168 patients with vertigo in the department of otolaryngolology and neurology from December 2007 to March 2009 were retrospectively analyzed The patients were inquired and examined by pure tone average thresholds, videonystagmography, Dix-Hallpike test, cervical spine X-ray, skull CT and (or) MRI and transcranial Doppler.@*RESULT@#One hundred and thirty-four patients with vertigo were of peripheral origin, with 66 cases benign paroxysmal positional vertigo, 30 cases Meniere's disease, 24 cases sudden deafness, 5 cases vestibular neuritis, 5 cases otitis media ,2 cases ear herpes zosters and 2 cases ototoxicity. Among 26 patients with vertigo of central, 20 patients were vertebrobasilar TIA.@*CONCLUSION@#The most common etiology of the vestibular peripheral vertigo is the benign paroxysmal positional vertigo. Detailed history and the features of vertigo, particular about the duration of vertigo and hearing change, may provide the important evidences for the accurate diagnosis and differential diagnosis of vertigo.
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Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Electronistagmografía , Estudios Retrospectivos , Vértigo , DiagnósticoRESUMEN
OBJECTIVE To improve the knowledge on the early diagnosis and treatment of the isolated fungus ball sphenoid sinusitis.METHODS A retrospe ctive study was made on10cases of isolated fungus ball sphenoid sinusitis to discuss the clinical manifestation,radiographic features and treatment with endoscopic sinus surgery.RESULTS The common symptoms in10cases were headache and/or bloody nasal discharge.Radiographic features of the disease were a soft tissue image occupying the sphenoid sinus with bones wall thickening.A soft tissue image with calcification in the sphenoid sinus was the feature of CT image.All the patients were treated by nasal endoscopic sinus surgery and cured after followed up for3to18.CONCLUSION Isolated fungus ball sphenoid sinusitis was difficult to diagnose in early stage because of its non-specif ic symptoms.The nasal endoscopy and CT scan make the early diagnosis possible.The diagnosis can be def initely confi rmed by pathological studies.Treatment with endoscopic sinus surgery is an effective method for fungus ball sphenoid sinusitis.
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OBJECTIVE To evaluate the role of forkhead transcription factor p3(Foxp3) in the pathogenesis of allergic rhinitis(AR).METHODS Nasal tissues and peripheral blood mononuclear cells(PBMCs) were obtained from 17 patients with AR and 11 controls.Foxp3 was detected in nasal tissues by immunohistochemisry and real-time reverse transcription polymerase chain reaction(RT-PCR).Foxp3 and CD4+CD25+T cells were evaluated in PBMCs by using ? ow cytometry.RESULTS The numbers of Foxp3+ cells was(44.2?20.5)cells/mm2 and(129.5? 35.6)cells/mm2 in nasal mucosa of two groups(P
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OBJECTIVE To investigate the best approach of diagnosis and treatment of spontaneous cerebrospinal fluid rhinorrhea.METHODS The clinical data of 13 cases with spontaneous cerebrospinal fluid rhinorrhea performed in our hospital from 1998 to 2007 were analyzed retrospectively.RESULTS The diagnosis of spontaneous cerebrospinal fluid rhinorrhea was established for these 13 cases on a set of diagnostic program,including qualitative determination of sugar in the nasal leakage,nasal endoscopy, CT and MRI scan.All the patients were failed with conservative treatment.All of the 13 patients were cured by surgical repairing under nasal endoscope for follow up of 6 months to 6 years.CONCLUSION The diagnosis program for spontaneous cerebrospinal fluid rhinorrhea includes qualitative determination of sugar in the nasal leakage,nasal endoscopy,CT and MRI scan.Transnasal endoscopic management is the best method for repairing spontaneous cerebrospinal fluid rhinorrhea.