ObjectiveTo investigate the risk factors for airway management after tracheal extubation in old patients. Methods280 patients underwent general anesthesia were enrolled in the study. The procedure of anesthesia induction and maintenance were in the routine method. The patients were with tracheal extubation under clinical standards after operation. Dyspnea was recorded after tracheal extubation. They were divided into dyspnea group and general group. Twelve perioperative variables, ten variables in operation and six post-operative variables of two groups were compared respectively. ResultsThe incidence of dyspnea after tracheal extubation was 8.6％. Analysis identified that obesity( BMI ≥25kg/m2 ), preoperative lung disease and without postoperative neostigmine were the significant risk factors for dyspnea. ConclusionBMI≥25kg/m2 ,preoperative lung disease and without antagonist muscular relaxant were the main risk factors for dyspnea after tracheal extubation in old patients.

Objective To evaluate the clinical value of subclavian vein puncture with 16 G arteriovenous indwelling needle for emergency treatment of hemorrhagic shock,so as to provide a new approach for the rapid establishment of deep venous passage.Methods 80 patients with acute hemorrhagic shock were randomly divided into patients with arteriovenous indwelling needle group (catheter group) and conventional guide wire deep vein puncture group(routine puncture group),40 cases in each group.The two groups were treated with supraclavicular subclavian vein puncture.The operation time,success rate of the first puncture,puncture times and rehydration rate,incidence of complications were observed in the two groups.Results The operation time of indwelling needle group was (62 ±22)s,which was significantly shorter than (672 ± 178)s of the conventional puncture group,there was significant difference between the two groups (t =15.062,P =0.000).The first time success rate of puncture in the indwelling needle group was 70％ (28 cases),which in the conventional group was 80％ (32 cases),the difference was not statistically significant(x2 =1.067,P =0.439),all patients were in 3 attempts in successful puncture.The velocity of infusion of 500 mL hydroxyethyl starch in the indwelling needle group was (198 ± 51)s,which was better than (456 ± 86)s in the conventional puncture group,the difference between the two groups was statistically significant (t =9.318,P =0.000).The two groups had no deep vein puncture related complications.Conclusion Arteriovenous indwelling needle by supraclavicular subclavian vein puncture with conventional guide wire supraclavicular subclavian vein puncture catheter can be used for emergency treatment of hemorrhagic shock,but the indwelling needle group in the operation time and velocity is superior to conventional guide wire group,more suitable for the rescue of patients with acute hemorrhagic shock time is pressing,stay with stable circulation can be through the guide wire inserted catheter indwelling subclavian vein catheter.

OBJECTIVE: To explore the genetic basis for a child with Rothmund-Thomson syndrome (RTS). METHODS: The child has featured poikeloderma, short stature, cataract, sparse hair and skeletal malformation. Peripheral blood samples of the child and her family members were collected and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing. RESULTS: The child was found to harbor compound heterozygous variants of the RECQL4 gene, namely c.1048_1049delAG and c.2886-1G>A, among which c.2886-1G>A was unreported previously. According to the ACMG guidelines, the c.1048_1049delAG was predicted to be pathogenic (PVS1+PM3_Strong+PM2), while the c.2886-1G>A was predicted to be likely pathogenic (PVS1+PM2). CONCLUSION The compound heterozygous variants of the RECQL4 gene probably underlay the pathogenesis of RTS in this patient. Above finding has enriched the mutational spectrum of the RECQL4 gene.
Child ; Family ; Female ; Humans ; Mutation ; RecQ Helicases/genetics* ; Rothmund-Thomson Syndrome/genetics* ; Whole Exome Sequencing