Objective To evaluate the application of the LMA CTrach for airway management during cervical spine surgery.Methods A total of 80 patients received cervical spine surgery under general anesthesia. During the operation, the LMA CTrach was used for ventilation and insertion of endotracheal tube. The authors recorded the time of laryngeal mask insertion, the success rate of ventilation, the success rate of the first attempt of endotracheal intubation, the number of attempts of endotracheal intubation, the time from insertion of the LMA CTrach to the completion of tracheal intubation. Results The LMA CTrach insertion was successfully completed in all but 2 patients. In 78 patients with good ventilation, the first attempt of endotracheal intubation failed in 5 patients. Except for unsuccessful ventilation in 2 patients and intubation failure for 3 times in 3 patients, the endotracheal intubation by using the LMA CTrach was accomplished in 75 patients. The mean time from insertion of the LMA CTrach to the completion of tracheal intubation was 192 s (range, 156～273 s). Conclusions The LMA CTrach system has the ability to align the LMA outlet with the larynx under direct view, and can increase the success rate of intubation and avoid some unnecessary injuries, giving certain advantages for airway management during cervical spine surgery.

0.05).Various degrees of pharyngalgia and hoarseness occurred in 2 patients in the Group Ⅰ,3 patients in the Group Ⅱ,and 2 in the Group Ⅲ,the incidence of complications being not statistically different(?2=0.323,P=0.851).Conclusions Compared with local anesthesia or endotracheal intubation,percutaneous dilational tracheostomy under laryngeal mask airway ventilation offers more stable circulation,higher reliability,and less influence to tracheostomy.This technique may give certain protection against cervical spinal cord injury during anesthetic induction.

The present study was to estimate pharmacokinetic parameters of metformin hydrochloride in 20 Chinese healthy volunteers with a limited sampling strategy (LSS), which will provide scientific data for bioequivalence and clinical application. A single dose of metformin was administrated to 20 healthy volunteers. The concentration of metformin in whole blood was determined by validated high performance liquid chromatography (HPLC) method. Multi-linear regression analysis was performed to establish a model to estimate AUC(0-24 h) and Cmax of metformin by LSS method. The LSS models were validated by the Jackknife method. The result indicated: the linearity relationship between AUC(0-24 h) or Cmax and single concentration point was poor. Several models for metformin AUC(0-24 h) or Cmax, estimation were better (r2 > 0.9, P < 0.05). Validation tests indicated that most informative sampling points (C2, C6 for AUC(0-24 h), C1.5, C2 for Cmax) provided accurate estimations of these parameters. So, a multi-linear regression model for estimation pharmacokinetic parameters of metformin by using LSS method is feasible.
Adult ; Area Under Curve ; Chromatography, High Pressure Liquid ; methods ; Humans ; Hypoglycemic Agents ; administration & dosage ; pharmacokinetics ; Linear Models ; Male ; Metformin ; administration & dosage ; pharmacokinetics ; Sample Size ; Therapeutic Equivalency ; Young Adult

Objective: To explore the molecular features of chronic myelomonocytic leukemia (CMML) . Methods: According to 2022 World Health Organization (WHO 2022) classification, 113 CMML patients and 840 myelodysplastic syndrome (MDS) patients from March 2016 to October 2021 were reclassified, and the clinical and molecular features of CMML patients were analyzed. Results: Among 113 CMML patients, 23 (20.4%) were re-diagnosed as acute myeloid leukemia (AML), including 18 AML with NPM1 mutation, 3 AML with KMT2A rearrangement, and 2 AML with MECOM rearrangement. The remaining 90 patients met the WHO 2022 CMML criteria. In addition, 19 of 840 (2.3%) MDS patients met the WHO 2022 CMML criteria. At least one gene mutation was detected in 99% of CMML patients, and the median number of mutations was 4. The genes with mutation frequency ≥ 10% were: ASXL1 (48%), NRAS (34%), RUNX1 (33%), TET2 (28%), U2AF1 (23%), SRSF2 (21.1%), SETBP1 (20%), KRAS (17%), CBL (15.6%) and DNMT3A (11%). Paired analysis showed that SRSF2 was frequently co-mutated with ASXL1 (OR=4.129, 95% CI 1.481-11.510, Q=0.007) and TET2 (OR=5.276, 95% CI 1.979-14.065, Q=0.001). SRSF2 and TET2 frequently occurred in elderly (≥60 years) patients with myeloproliferative CMML (MP-CMML). U2AF1 mutations were often mutually exclusive with TET2 (OR=0.174, 95% CI 0.038-0.791, Q=0.024), and were common in younger (<60 years) patients with myelodysplastic CMML (MD-CMML). Compared with patients with absolute monocyte count (AMoC) ≥1×10(9)/L and <1×10(9)/L, the former had a higher median age of onset (60 years old vs 47 years old, P<0.001), white blood cell count (15.9×10(9)/L vs 4.4×10(9)/L, P<0.001), proportion of monocytes (21.5% vs 15%, P=0.001), and hemoglobin level (86 g/L vs 74 g/L, P=0.014). TET2 mutations (P=0.021) and SRSF2 mutations (P=0.011) were more common in patients with AMoC≥1×10(9)/L, whereas U2AF1 mutations (P<0.001) were more common in patients with AMoC<1×10(9)/L. There was no significant difference in the frequency of other gene mutations between the two groups. Conclusion: According to WHO 2022 classification, nearly 20% of CMML patients had AMoC<1×10(9)/L at the time of diagnosis, and MD-CMML and MP-CMML had different molecular features.
Humans ; Aged ; Middle Aged ; Leukemia, Myelomonocytic, Chronic/genetics* ; Prognosis ; Splicing Factor U2AF/genetics* ; Mutation ; Myelodysplastic Syndromes/genetics* ; Leukemia, Myeloid, Acute/genetics*