Objective To compare the effects of general anesthesia versus combined epidural?general anesthesia on postoperative complications in the patients undergoing thoracic surgery. Methods Two hundred twenty?one patients of both sexes, aged 18-80 yr, weighing 36-100 kg, of American Society of Anesthesiologists physical status Ⅰ?Ⅲ, scheduled for elective thoracic surgery, were randomly divided into either combined epidural?general anesthesia group ( group GE, n=112) or general anesthesia group ( group GA, n=109) . The patients were further allocated to high?risk population and low?risk population. Anesthesia was induced with target?controlled infusion of remifentanil and iv injection of propofol, sufentanil and rocuronium. A double?lumen endotracheal tube was placed, and the patients were mechanically ventilated. Partial pressure of end?tidal CO2 was maintained at 30-40 mmHg. Anesthesia was maintained with inhalation of 1% sevoflurane, target?controlled infusion of remifentanil, iv infusion of propofol, and intermittent iv boluses of sufentanil. 2% lidocaine 4 ml∕h was infused epidurally in group GE, and normal saline 4 ml∕h was given in group GA. Bispectral index value was maintained at 40-60 during surgery. Patient?controlled epidural analgesia ( PCEA ) was performed after surgery. PCEA solution contained
0.125% ropivacaine and sufentanil 0.5μg∕ml ( in 250 ml of normal saline) . The PCEA pump was set up to deliver a 2 ml bolus dose with a 20?min lockout interval and background infusion at 4 ml∕h, and visual analogue scale ( VAS) score was maintained less than 4. When VAS score ≥ 5, sufentanil 5 μg was injected intravenously as the rescue analgesic. The requirement for rescue analgesics after surgery, length of hospital stay after surgery, complications during postsurgical hospital stay ( cardiovascular events, cardiac insufficiency, acute coronary syndrome, pulmonary infection, stroke, transient cerebral ischemic attack) , and death within 30 days after surgery were recorded. Results Compared with group GE, the incidence of postsurgical cardiovascular events and atrial fibrillation was significantly decreased in group GA ( P<0.05) . In the high?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened, and the incidence of postsurgical atrial fibrillation was decreased in group GA ( P<0.05) . In the low?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened (P<0.05), and no significant change was found in the incidence of postsurgical complications, requirement for rescue analgesics after surgery, and fatality rate in group GA (P>0.05). Conclusion Compared with combined epidural?general anesthesia, general anesthesia alone provides lower occurrence of postsurgical complications for the patients undergoing thoracic surgery, and offers advantage for the high?risk patients having underlying diseases before surgery.

Objective To study the effects of isoflurane anesthesia on the medium- and longterm cognitive function in mice at different months of age. Methods Male C57BL/6J mice at ages of 4 month (n =45)and 20 month (n 45) were randomly assigned to control group,short- term anesthesia and long term anesthesia groups,respectively (n=15 per group).Inhalation anesthesia was applied with 3％ isoflurane for induction and 1.2 ％ isoflurane for maintain in 30 ％ oxygen,and control group received 30％ oxygen only for 60 min.Short- and long- term anesthesia group anesthesia was maintained for 30 min and 60 min,respectively.Cognitive function was determined by alternative behavior and water maze.Alternative behavior was assessed at 1 d before ancsthesia and 7,14 and 28 d after anesthesia,and water maze was assessed from 7 d to 8 d,9 d,10 d,11 d and 28 d after anesthesia. Results The correct rate of alternative behavior at age of 4 month in long-term anesthesia group [(58=6)％] was lower than relative control [(69±9)％] (t=4.26,P＜0.01) at 28 d.The number of arm entries at age of 20 month in short- term anesthesia group (31 ± 6) was increased than control(24±6) and long-term anesthesia group (24±8)(F=5.34,P＜0.01) at 14 d after anesthesia,while the number in long-term anesthesia group (24± 6) was decreased than control (29±7) and short term anesthesia group(30±6)(F=3.29,P＜0.05) with no significant difference in correct rate at 28 d after anesthesia.There was no difference in latent time of water maze between groups at age of 4 month.The ratios of spent time in the target quadrant to the whole time at age of 4 month at 11 d and 28 d after anesthesia in short-term anesthesia group[( 36.6 ± 14.4)％,(34.7 ±9.5)％] and long term anesthesia group [( 36.8 ± 16.4)％ ,(31.8± 12.0)％] were reduced as compared with control [(49.5±8.8) ％,(42.8±12.2) ％] (F=3.31,3.30,all P＜0.05).The latent time of mice at age of 20 month at 11 d after anesthesia in short-term anesthesia[(31±6)s] and longterm anesthesia group [(30±7)s ] were longer than control [(23±6)s](F =3.34,P＜0.05).There were no differences in the ratios of spent time in the target quadrant to the whole time and the number of cross -platform among the groups. Conclusions Isoflurane anesthesia may impact the mediumand long- term cognitive funclion in mice at ages of 4 month and 20 month.

Objective: To improve the physical properties of micromeritics of the extracts of Fengshilin capsule, such as anti moisture. Methods: Critical relative humidity, absoption curve of moisture, angle of repose were used as the norms of the research. The suitable excipients and formulation process of Fengshilin capsule have been sieved. Results: It was feasible that the combined excipients of microcystalline cellulose and starch (in a ratio of 1∶1) were mixed with the extract powder. The absorption of moiture of the extract powder was improved. The humidity of mass production and store was lower than 45%. Conclusion: The research has been found to be an effective in the process of Fengshilin capsule.

Objective To investigate the effect of small dose of dexmedetomidine on the development of postoperative nausea and vomiting in the patients undergoing laparoscopic gynecologic surgery.Methods A total of 207 patients,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic gynecologic surgery under general anesthesia,were randomly divided into either dexmedetomidine group (group D,n=103) or control group (group C,n=104) using a random number table.Before induction of anesthesia,dexmedetomidine 0.1 μg/kg was injected intravenously over 1 min in group D,while the equal volume of normal saline was given instead in group C.At 20 min before the end of surgery,dexmedetomidine 0.04 μg/kg was injected intravenously over 30 s in group D.For the patients requiring patient-controlled analgesia (PCA),PCA solution contained sufentanil 125 μg in 125 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 8 min lockout interval and background infusion at a rate of 1 ml/h.Pethidine was used for PCA after surgery in the patients who did not require PCA.Numeric rating scale scores were maintained ＜4 after surgery.Sufentanil 3 μg was injected intravenously as rescue analgesic in postanaesthesia care unit (PACU).The occurrence of nausea and vomiting was recorded within 0-1 h,1-6 h,6-12 h,and 12-24 h periods after surgery.The occurrence of hypotension and bradycardia during surgery,emergence time,Ramsay sedation score on admission to PACU,requirement for sufentanil as rescue analgesic in PACU,requirement for PCA and antiemetics,and occurrence of somnolence and shivering were recorded.Results Pethidine was not given in the patients who did not require PCA in the two groups.Somnolence and shivering were not found in the two groups.Compared with group C,the incidence of bradycardia was significantly increased,the requirement for antiemetics in PACU and incidence of nausea and vomiting within 1 h after surgery were significantly decreased (P＜0.05),and no significant change was found in the emergence time,Ramsay sedation score,requirement for sufentanil as rescue analgesic,requirement for PCA and total incidence of postsurgical nausea and vomiting in group D (P＞0.05).Conclusion For the patients undergoing laparoscopic gynecologic surgery,small dose of dexmedetomedine can only decrease the development of nausea and vomiting in the early postsurgical period (in PACU),and does not influence the recovery from anesthesia.

Objective To evaluate the relationship between single nucleotide polymorphism(SNP) of candidate genes and radiation-induced esophagitis (RIE) in patients with lung cancer. Methods Between Jan. 2004 and Aug. 2006,170 patients with pathologically diagnosed lung cancer were enrolled in this study. The total target dose was 45-70 Gy( median 60 Gy). One hundred and thirty-two patients were treated with three-dimensional conformal radiotherapy(3DCRT) and 38 with two-dimensional radiotherapy(2DRT).Forty-one patients received radiotherapy alone, 78 received sequential chemoradiotherapy and 51 received concurrent chemoradiotherapy. Thirty-seven SNPs in 20 DNA repair genes were analyzed by using PCR-based restrieted fragment length polymorphism(RFLP). These genes were apoptosis and inflammatory cytoking genes including ATM, ERCC1, XRCC3, XRCC1, XPD, XPC, XPG, NBS1, STK15, ZNF350, ADPRT,TP53, FAS, FASL, CYP2D6 * 4, CASPASE8, COX2,TGF-β, CD14 and ACE. The endpoint was grade ≥2 R I E. Results Forty of the 170 patients developed grade ≥2 R I E, including 36 in grade 2 and 4 in grade 3. Univariate analysis revealed that radiation technique and concurrent chemoradiotherapy were statistically significant relatives to the incidence of R I E (P = 0. 032,0.049) , and both of them had the trend associating with the esophagitis( P = 0.072,0. 094 ). An increased incidence of esophagitis was observed associating with the TGF-β1-509T and XPD 751 Lys/Lys genotypes ( χ2 = 5.65, P = 0.017 ;χ2 = 3.84, P = 0. 048 )in multivariate analysis. Conclusions Genetic polymorphisms in TGF-β1 gene and XPD gene have a significant association with radiation-induced esophagitis.

BACKGROUND: No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. METHODS: Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. RESULTS: A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). CONCLUSIONS The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
Pregnancy ; Female ; Humans ; Post-Dural Puncture Headache/epidemiology* ; Anesthesia, Obstetrical/adverse effects* ; Retrospective Studies ; Punctures ; Starch ; Blood Patch, Epidural

Objective To investigate whether preset epidural catheter and individualized onset time could improve the effect of epidural labor analgesia.Methods This was an open-label,random-ized,controlled trial.The nulliparae aged from 18 to 35 years,with single cephalic term pregnancy, were randomized into two groups.In the individualized group,epidural catheterization was performed at the beginning of labor (emergence of regular contractions and nearly disappearance of cervix),and epidural analgesia was initiated when asked by parturients and the numeric rating scale (NRS,a verbal rating score from 0 to 10 for pain,in which 0 represented no pain and 10 the worst pain imagi-nable)pain score ≥ 5 .In the control group,epidural analgesia was initiated at cervical dilation of≥ 1 cm.The primary outcome measures were the most severe NRS pain score during labor and the pro-portion of the most severe NRS pain score ≥ 7 evaluated at 24 hours after delivery.Results A total of 194 parturients completed the study,among whom 97 were in the individualized group and 97 in the control group.The most severe labor pain score during labor [median 9 (IQR 8-10)in the individ-ualized group vs 9 (8-10)in the control group,P=0.201]and the proportion having the most severe pain score ≥ 7 [94 cases (96.9%)in the individualized group vs 89 cases (91.8%)in the control group,P=0.1 2 1 ]did not differ significantly between the two groups.There were no significant differences of adverse events between the two groups.Conclusion For the nulliparae with single ce-phalic term pregnancy suitable for vaginal delivery, the effects of individualized epidural labor analgesia are comparable to that of traditional analgesia (beginning at cervical dilation of ≥ 1 cm). The individualized analgesia is safe.

Objective To explore the risks and its influencing factors of patients with psychotic disorders in communities.Methods A total of 457 patients with psychotic disorders in communities were investigated by use of the multistage stratified cluster random sampling method.Results Totally 257 patients with psychotic disorders in communities were with risks,which accounted for 56.2％.Among them,200 patients (43.8％) were with level-0 risk,113 patients (24.7％) were level-1 risk,85 patients (18.6％) were level-2 risk,43 patients (9.4％) were level-3 risk,11 patients (2.4％) were level-4 risk,while 5 patients (1.1％) were level-5 risk.There were significant differences in risks among patients with different gender,family income,duration,type of disease,medication and the history of violent behavior.Logistic regression analysis showed that low family income (OR=0.515,95％ CI=0.386-0.689,P＜0.01),long course of disease (OR=1.378,95％CI=1.179-1.609,P＜0.01),patients with schizophrenia (OR=6.285,95％CI=2.456-16.086,P＜ 0.01) and patients with a history of violence history (OR=28.988,95％CI=10.692-78.592,P＜0.01) were the risk factors of the influencing of patients with psychotic disorders in communities.Conclusions Low family income,long course of disease,patients with schizophrenia and a history of violence history are the influencing factors of patients with psychotic disorders in communities,and the management of follow-up and the strength of supervision among these patients should be reinforced.

Objective To observe the expression levels change and it's clinical significance of TNF-α, SP-A in chil-dren with varying degrees of pneumonia. Methods A total 195 cases of pneumonia children patients were divided into ordinary pneumonia and severe pneumonia patients , another 65 cases of non-pneumonic children patients as the con-trol group, ELISA assay was used to detect serum TNF-α and SP-A level. Results The levels of serum SP-A and TNF-αof pneumonia children group were higher than the control group's , and severe pneumonia patients ’ were high-er than ordinary pneumonia. Conclusion The expression level of TNF-α and SP-A increased significant in the patho-genesis of children with severe pneumonia which could reflect the degree of lung injury and as a indicator in clinical testing.

Objective: Traditional uterine manipulator is considered as the main reason for short survival of patients with early-stage cervical cancer during minimally invasive surgery. This study aims to assess the sealing effect of magnetic-sealing uterine manipulators (MUMs) in isolated uteruses. Methods: The study was performed on isolated uterus from patients with early-stage cervical cancer who underwent open abdominal radical hysterectomy between November 2019 to April 2021. Right-angle forceps closure tests (groups 1 and 3) were defined as control tests. One experimental MUM closure test (group 2) and 2 control tests were respectively carried out in each of the isolated uterus. DNA ploidy analysis system was used to observe exfoliated cells. Statistical analysis was performed using Wilcoxon signed-rank test to assess the sealing effect of MUM. Results: We identified 36 patients. No regional node metastasis was discovered and only one tumor was larger than 4.0 cm in diameter. The mean of exfoliated tumor cells in groups 1, 2, and 3 were 1, 1, and 2, respectively. There was no significant difference in the quantity of exfoliated cells between groups 1 and 3 (p=0.476), so the results of the 2 groups were merged. Subsequently, a significant difference was observed between combined right-angle forceps closure tests and MUM closure tests (p=0.022). Conclusion The sealing effect of MUM was better than that of right-angle forceps. MUM can effectively seal cervical cancer cells in the cup cover, avoiding the dissemination of tumor cells.