Objective To compare the effects of dexmedetomidine (DEX) and remifentainil (REM) combined with sevoflurane (SEV) for general anesthesia on recovery quality in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients (ASA grade Ⅰ-Ⅱ) who underwent LC were divided into DEX combined with SEV for general anesthesia group (DEX group) and REM combined with SEV for general anesthesia group (REM group) by table of random digit,with 30 cases each.Time of first inspiration,eye opening,extubation,orientation recovery and passage of gas by anus were recorded.Vital sign,numeric rating score (NRS),Ramsay score and untoward reaction were recorded.Degree of satisfaction of patients,post-anesthesia care unit (PACU) nurse and surgeon were evaluated.Results The time of extubation and passage of gas by anus in DEX group were significantly shorter than those in REM group [(12.0 ±3.9) min vs.(15.9 ±5.6) min,t =-3.130,P =0.003; (18.5 ±3.4) h vs.(23.6 ±5.8) h,t =-5.455,P =0.000].However,the time of eye opening and orientation recovery in DEX group were significantly longer than those in REM group [(15.5 ± 4.2) min vs.(11.7 ± 2.9) min,t =4.078,P =0.000;(19.5 ± 4.5) min vs.(14.8 ± 3.6) min,t =4.315,P =0.000].During the first 2 h after operation,Ramsay score in DEX group was significantly higher than that in REM group (P ＜ 0.05),but NRS in DEX group was significanty lower than that in REM group (P ＜ 0.05),the patients with additional analgesics was minor than REM group (2 cases vs.9 cases,P ＜ 0.05).The percentages of patients suffering shivering and postoperative nausea and vomiting in DEX group were significantly lower than those in REM group [3.3％(1/30) vs.33.3％(10/30),6.7％(2/30) vs.30.0％ (9/30),P ＜0.05].Degree of satisfaction of patients and PACU nurse in DEX group were higher than those in REM group [89.0(72.0-100.0) scores vs.80.0(70.0-95.0) scores,Z =-4.066,P =0.000; 92.0 (80.0-99.0) scores vs.90.0 (80.0-95.0) scores,Z =-2.906,P =0.004],but degree of satisfaction of surgeon in REM group was higher than that in DEX group [(91.8 ± 5.8) scores vs.(81.7 ±6.1) scores,t =-6.568,P =0.004].Conclusion Compared with REM combined with SEV for general anesthesia,DEX combined with SEV for general anesthesia has a faster recovery for respiration and passing of gas by anus,lower NRS and incidence rates of shivering,nausea and vomiting,improves the quality of recovery for patients undergoing LC.

Objective To evaluate the effects of different doses of dexmedetomidine on propofol-induced inhibition of responses to laryngeal mask airway (LMA) insertion when combined with fentanyl in patients undergoing gynecological operation.Methods One hundred and twenty-five ASA Ⅰ-Ⅱ female patients,aged 20-60 yr,scheduled for elective short-time surgery,were randomly divided into 5 groups (n =25 each):normal saline group (group NS) and different doses of dexmedetomidne groups (groups D1-4).Normal saline 40 ml and dexmedetomidne 0.4,0.6,0.8,1.0 μg/kg (in 40 ml of normal saline) were infused over 10 min in groups NS and D1-4,respectively.1％ propofol was then given by target-controlled infusion.The concentration of propofol was determined by using modified Dixon's up-and-down method.The initial plasma concentration of propofol was 3.0 μg/ml and the ratio between the 2 successive concentrations was 1.1.Fentanyl 1.5 μg/kg was injected intravenously when the effect-site concentration of propofol reached the preset plasma concentration.LMA was inserted 4 min later.When LMA insertion was successful,the concentration of propofol was decreased in the next patient and when LMA insertion failed,the concentration of propofol was increased in the next patient.Failure of LMA insertion was defined as difficulty in inserting LMA or body movement,corner of mouth movement,biting LMA,swallowing and/or lacrimation during insertion.The median effective target effect-site concentration and 95％ confidence interval of propofol blunting responses to LMA insertion when combined with fentanyl were calculated.Results The median effective target effect-site concentration (95％ confidence interval) of propofol blunting responses to LMA insertion when combined with fentanyl were 3.09 (2.83-3.36),2.48 (2.26-2.73),2.29 (2.18-2.41),2.04 (1.95-2.12) and 1.67 (1.55-1.81) μg/ml in groups NS and D1 4,respectively.Conclusion Dexmedetomidine can enhance propofol-induced inhibition of responses to LMA insertion when combined with fentanyl in dose-dependent manner in patients undergoing gynecological operation.

Objective To analyze and compare the anti-HCV reactivity,HCV nucleic acid detection results and HCV recom binantion immunoblot assay(RIBA) confirmatory test results in blood donors.Methods The blood samples collected from the volunteer blood donors from October 2013 to March 2015 were performed the HCV screening by using the domestic ELISA reagents from two different manufacturers and an imported nucleic acid detection reagent and matching detection system.The samples of anti-HCV reactivity or/and NAT detection positive were performed RIBA.Then the results of reactivity detected by two kinds of ELISA reagents,nucleic acid detection reagent and RIBA confirmatory test results were analyzed and compared.Results A total of 133959 samples of volunteer blood donors were detected,in which 113 380 samples covered the nucleic acid detection results,the reactivity samples proportion of anti-HCV detection was 0.19 ％ (252/133959),27 cases were positive in NAT detection with the positive detection ratio of 0.02 ％ (27/113 380);the proportion of HCV reactive samples confirmed by RIBA was 19.8 ％ (50/252),the negative proportion was 54.8％ (138/252),and the uncertain proportion was 25.4％ (64/252);27 samples of nucleic acid detection positive were double reagent reactivity in ELISA detection and positive in confirmatory test.The difference among the results of two ELISA reagents,RIBA confirmatory test results and nucleic acid detection results had statistical significance(P＜0.05).Conclusion The detection strategy selecting twice ELISA+1 kind of nucleic acid detection is more secure.Aiming at higher proportion of false positive samples,the follow up system of blood donors should be established for maximizing the retention of blood donors.

Objective To investigate the clinical effects of different doses of propranolol in treatment of infantile mixed and deep hemangioma,and to provid theoretical and experimental evidence for the treatment of hemangioma. Methods The selected 62 patients with mixed and deep hemangioma were divided randomly into low dose (1.5mg·kg-1 ·d-1 )and high dose (3.0 mg·kg-1 ·d-1 )of propranolol groups,3 times a day,6 months as a course,the changes in hemangioma size and the incidence of adverse reactions were recorded.Results The efficacy was evaluated using Achauer system.The total effective rate was 80.65% in low dose of propranolol group and 93.55% in high dose of propranolol group,including 6 cases of class Ⅰ (poor),9 cases of class Ⅱ (moderate), 11 cases of classⅢ (good),and 5 cases of class Ⅳ (excellent)in low dose propranolol group;while 2 cases of class Ⅰ (poor),4 cases of class Ⅱ (moderate),10 cases of class Ⅲ (good)and 15 cases of Ⅳ (excellent)in high dose of propranolol group.The efficacy in high dose of proprandol group was significantly better than that in low dose of proprandol group (P<0.05),there were no significant differences in the efficacies between different sites and different types (P>0.05)and there was no significant difference in the incidence of adverse reaction between two groups (P>0.05).Conclusion The efficacy of oral 3.0 mg·kg-1 ·d-1 propranolol in treatment of infantile mixed and deep hemangioma is increased significantly, and there is no significant adverse reactions after increasing doses.Therefore,high dose of propranolol should be recommended in order to improve the therapeutic effect.

Objective To investigate the effect of edaravone pretreatment on myocardial injury induced by carbon dioxide pneumoperitoneum in patients undergoing laparoscopic gynecologic surgery.Methods Thirty patients undergoing laparoscopic gynecologic surgery,ASA Ⅰ or Ⅱ grade,were divided into two groups by random digits table with 15 cases each:control group and edaravone group.Edaravone group following tracheal intubation received vein infusion of edaravone 0.5 mg/kg,control group received equal volume of 0.9％ sodium chloride.The carbon dioxide pneumoperitoneum pressure was maintained at 10-15 mm Hg (1 mm Hg =0.133 kPa).Venous blood samples were collected before anesthesia induction and after operation 8 h for the measurement of the serum creatine kinase (CK),creatine kinase-MB (CK-MB),aspartate aminotransferase (AST) and lactate dehydrogenase (LDH).Results The serum levels of CK and AST were significantly higher after operation 8 h in control group than those of before anesthesia induction in control group and after operation 8 h in edaravone group [(205 ± 27) U/L vs.(123 ± 25) and (123 ± 29)U/L,(48±5) U/L vs.(34 ±3) and (36 ±5) U/L,P＜0.05].There was no significant difference in the serum levels of CK-MB and LDH between two groups and the group (P ＞ 0.05).Conclusion Pretreatment with edaravone 0.5 mg/kg can protect myocardium in patients undergoing laparoscopic gynecologic surgery.

Objective To evaluate the effect of epidural block on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 65-75 yr,with preoperative Mini-Mental State Examination (MMSE) score ＞ 23,scheduled for elective laparoscopic radical operation for gastric cancer under general anesthesia,were randomized into epidural block group (group E,n =30) and control group (group C,n =30) using a random number table.Epidural block was performed at T8,9 interspace before induction of anesthesia.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg,propofol 1.0-1.5 mg/kg,fentanyl 3-4 μg/kg and rocuronium 0.9 mg/kg.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of remifentanil 0.15-0.25 μg· kg-1· min 1 and propofol target-controlled infusion (target plasma concentration 2.5-3.0μg/ml).In group E,10 ml of mixture of 0.25％ ropivacaine and 0.04 mg/ml butorphanol was injected via the epidural catheter at 30 min before skin incision.In the two groups,the mixture 10 ml mentioned above was administered via the epidural catheter at 10 min before the end of operation followed by patientcontrolled epidural analgesia.The development of postoperative cognitive dysfunction (MMSE score ＜ 21) was recorded within 72 h after operation.Blood samples were collected from the internal jugular vein to detect the concentration of serum protein S-100β.Results The concentration of serum protein S-100β was significantly lower at 6,12 and 24 h after operation,and the incidence of postoperative cognitive dysfunction within 72 h after operation was lower in group E than in group C (P ＜ 0.05).Conclusion Epidural block can decrease the development of postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia.

OBJECTIVE To study the genetic supports of OXA-23 in Acinetobacter baumannii isolates and investigate the relationship between imipenem resistance acquiring and use of antibiotics.METHODS Consecutive selection of the 24 highly susceptive A.baumannii clinical isolates by imipenem was carried out.Genes of carbapenemases were detected by PCR and the colonial relationship of these isolates was evaluated by ERIC-PCR.Plasmids conjugation experiments and blaOXA-23 hybridization were performed to explore the gene location of blaOXA-23.RESULTS From all 24 susceptible A.baumannii isolates 10 were selected,including 6 multi-colonial blaOXA23 harboring strains.Plasmid conjugation experiments and Southern blotting experiments demonstrated that blaOXA-23 was not associated with integrons.CONCLUSIONS BlaOXA-23 may exist in a certain subset of apparently carbapenem sensitive Acinetobacter strains.When under consecutive selective pressure,bacteria harboring blaOXA-23 become the predominant group and subsequently the antibiotics resistance properties appear.It highlights the reasonable use of this category of antibiotics.

Objective:To treat the mixed and deeper infantile hemangioma with ladder dosage propranolol, and to explore its efficacy and safety.Methods:A total of 98 infants with hemangioma were treated by ladder treatment of propranolol.Before treatment,comprehensive assessments of electrocardiogram(ECG),heart color ultrasound, blood glucose,liver function,kidney function,myocardial enzymes and blood routine were conducted.After excluding contraindications,the dose of propranolol incrementally doubled from 0.5 mg·kg-1·d-1 to 4.0 mg·kg-1·d-1.Propranolol was taken 3 times a day.Before and after medication for 1 and 2 h,ECG was monitored.The changes of tumor size,texture,color and other changes or an onset of adverse reactions were dynamicly observed.The infants were visited every month.The efficacy was evaluated using Achauer system.Results: After medication,98 cases had different degrees of color changes or tumor consistency softening.After the dosage of propranolol was increased to 4.0 mg·kg-1·d-1,the change of tumor was the fastest.According to the 4-grade method, there were 84 cases(85.71%) as gradeⅣ (excellent),2 cases (2.04%) as grade Ⅲ (good),4 cases (4.08%) as gradeⅡ (medium)and 8 cases (8.16%) as gradeⅠ (poor).The curative effect of mixed hemangioma was better than that of deeper hemangioma(P<0.05).The recovery time of 74 cases of hemangiomas was 6 months.The major adverse reactions were heart rate decline(5/98,5.10%),drowsiness(3/98,3.06%),diarrhea(7/98,7.14%),loss of appetite (1/98,1.02%), and convulsions (2/98,2.04%).After treatment,all adverse reactions disappeared.Two months after drug withdrawal there were 4 cases of recurrence,and they were continously treated with propranolol.Conclusion: The efficacy of oral ladder dosage propranolol in treatment of mixed and deeper infantile hemangioma is increased significantly and there are no significant adverse reactions.

Objective To compare the diagnostic value of DWI and ultrasound elastography(UE) in staging hepatic fibrosis in patients with chronic viral hepatitis B(CHB). Methods Fifteen healthy volunteers (control group) and 69 patients with CHB (disease duration more than 1 year) (patient group) were prospectively recruited. All of the subjects underwent DWI and UE experiments twice with the interval of less than 3 days. Liver ADC and shear wave velocity(SWV) values were obtained for subsequent analysis. Sixty?nine patients who had biopsy were grouped according to their pathological grading of fibrosis, from S0 to S4. One?way ANOVA was used to compare the ADC and SWV values between the five different fibrosis groups and control group. Spearman correlation analysis was used to analyze the correlations between the ADC and SWV values and those staging factors. Finally, receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of ADC and SWV values in discriminating different stages of hepatic fibrosis. Results Based on the pathological results, the 69 patients were reclassified to five subgroups with 11, 13, 12, 15 and 18 patients in the S0, S1, S2, S3 and S4 groups respectively. ADC values were(1.39±0.09)×10-3,(1.39±0.08)×10-3,(1.38±0.10)×10-3,(1.20±0.06)×10-3,(1.12±0.07)×10-3 and(1.01±0.07)×10-3mm2/s for the control group and stages S0 to S4 respectively.SWV values were(1.17±0.07),(1.16±0.08),(1.23±0.10),(1.48±0.14),(1.85±0.14)and(1.97±0.12)m/s for stages S0 to S4 and the control group respectively. Statistically significant differences were observed among them (P<0.01). Both ADC (r=-0.894,P<0.01) and SWV (r=0.904,P<0.01) values were highly correlated with the stages of liver fibrosis. The area under ROC(AUC) for predicting fibrosis stages (≥S1, ≥S2, ≥S3 and S4) with ADC values was 0.893, 0.991, 0.966 and 0.952 respectively. Accordingly, the AUC for SWV values were 0.937, 0.993, 0.994 and 0.914. Conclusions The two imaging methods of DWI and UE showed good and similar diagnostic performance in discriminating the different stages of hepatic fibrosis.

Objective To observe the synthesis of melanin and tyrosinase activity of the cultured normal human melanocytes after treated with baicalin and NB-UVB, and to provide theoretical evidence for study on the new therapy method of vitiligo.Methods The normal human menlanocytes cultured in vitro were divided into control group,different concentrations of baicalin groups,different doses of NB-UVB group and baicalin combined NB-UVB group.The proliferation rate of melanocytes was measured by MTT assay,the level of melanin was tested by NaOH pyrolysis,and the tyrosinase activity was measured by dopa oxidization.Results Compared with control group,the proliferation rates in 10-4 mol·L-1 baicalin group and 30 mJ·cm-2 NB-UVB group had no significant difference(P>0.05 ). Compared with control group, the levels of melanin and tyrosinase activities in baicalin group,NB-UVB group and combined group were increased (P<0.05 or P<0.01);compared with baicalin group and NB-UVB group,the level of melanin and tyrosinase activity in combined group were increased(P<0.01). Conclusion Baicalin combined with NB-UVB has better promotion effect on melanin synthesis than used alone.