Objective To analysis effect of midazolam combined with etomidate on liver function, malondialdehyde(MDA) , superoxide dismutase (SOD) levels after laparoscopic cholecystectomy.Methods 80 patients who were undergoing laparoscopic cholecystectomy were collected,all patients were randomly divided into control group and experimental group, 40 cases in each group,who were given the appropriate anesthesia induction drugs before surgery.After operation,the serum levels of MDA, SOD, glutathione peroxidase(GSH-Px) and the liver function were detected in all patients. Results After operation, compared with control group, the serum alanine aminotransferase(ALT) , aspartate aminotransferase (AST) and total bilirubin (TBIL)levels were lower in the experimental group (P<0.05);the serum MDA level was lower in the experimental group (P<0.05);the serum SOD and GSH-PX levels were higher in the experimental group (P<0.05) .Conclusion Midazolam combined with etomidate can reduce oxidative stress reaction in patients after laparoscopic cholecystectomy, which is conducive to the recovery of liver function.

Objective To study the clinical effect of sevoflurane combined with remifentanil in laparoscopic cholecystectomy (LC).Methods50 cases of laparoscopic cholecystectomy in Tianjin Haihe Hospital from February 2015 to September 2016 were selected as the research object, and randomly divided into the control group and the experimental group, each group had a total of 25 cases.The patients in control group were treated with continuous intravenous infusion of propofol.The experimental group received sevoflurane.Patients in the experimental group and the control group were given remifentanil after surgery.Compared with the experimental group and control group of patients with the degree of recovery and related Linchuan indicators.ResultsAfter the corresponding anesthesia, the control group of patients with recovery time was (13.4±3.1) minutes, the score was (4.1±1.2) points, extubation time was (14.6±3.7) minutes.However, the extubation time and recovery time of the control group were significantly longer than those of the experimental group, and the recovery score was lower than that of the experimental group, with statistical difference (P<0.05).There was no obvious adverse reaction in the experimental group and the control group, and there was no significant difference in the changes of cardiovascular factors.ConclusionSevoflurane combined with remifentanil for laparoscopic cholecystectomy can improve the anesthetic effect to a great extent, stable operation and postoperative patients with cardiovascular function, recovery time is short, the clinical significance of only one step promotion and application.

Objective To evaluate the application of flexible thoracoscopy in the diagnosis of pleural effusion.Methods Thoracoscopy was performed in 20 pleural effusion patients in our hospital from May to December 2007.Biopsies were performed in 16 patients,not in the other 4 patients since difinite diagnosis had been reached before thoracoscopy.Results Rate of accurate diagnosis via thoracoscopy was 93.75%(15/16).Results Of biopsy were as follows:adenocarcinoma 8 cases,squamous carcinoma 1 case,adenosquamous carcinoma 1 case,malignant pleural effusion 1 case,tuberculous pleuritis 4 cases,malignant mesothelioma 3 cases,chronic suppurative pleuritis 1 case,failed diagnosis 1 case.Presentations of lesions under thoracoscope were as follows:diffused miliary nodules 10 cases(10/20),multiple mass 7 cases(7/20),fibrous compartmentation or conglutination 9 cases(9/20).There were no severe complications.Conclusion Flexible medical thoracoscopy is a safe and efficient method of etiologic diagnosis of pleural effusion.

Objective:To isolate and identify SARS-CoV-2 epidemic strains and analyze the sequence characteristics of the virus strains following serial passages.Methods:Eleven nasopharyngeal swabs positive for SARS-CoV-2 antigen were collected from December 2022. Quantitative real-time PCR was used to detect SARS-CoV-2 nucleic acid, and positive specimens were inoculated onto Vero cells for virus isolation. The isolated strains were identified by Western blot and indirect immunofluorescence assay. The morphology of the isolated strains was observed using transmission electron microscopy. Nucleic acid was extracted from the isolates and passaged viruses for further sequencing and analysis.Results:All 11 specimens tested positive for SARS-CoV-2 using quantitative real-time PCR. SARS-CoV-2 strains were successfully isolated from seven specimens, and could be adaptively cultured, passaged, and expanded on Vero cells, achieving a peak titer exceeding 10 6.25 50% cell culture infectious dose (CCID 50)/ml. Western blot and indirect immunofluorescence results showed that the isolates could be specifically recognized by monoclonal antibodies and convalescent serum against SARS-CoV-2. Transmission electron microscopy revealed oval-shaped viral particles with diameters of approximately 100 nm. Next-generation sequencing of the viral isolates demonstrated a sequence homology greater than 99.50% with the Wuhan-Hu-1 reference strain (NC_045512) and 99.98% among the seven isolated strains, and all of the isolates belonged to the Omicron BF.7 variant. Sequence analysis after continuous passage and plaque purification of the BJ-NVSI-20230005 isolate showed that compared with passages 1-3, passages 4-6 had one nucleotide site mutation (C→T) in the ORF1ab gene and a deletion of 3 bp in the E gene, which resulted in a change from leucine to phenylalanine and the deletion of valine, respectively. Polymorphisms were observed in the sequences of plaque-purified clones. Conclusions:The seven successfully isolated SARS-CoV-2 strains all belong to the SARS-CoV-2 BF.7 variant, which is consistent with the prevalence trend in mainland China in December 2022.