Objective To investigate the effect of sufentanil combined with remifentanil on anesthesia in emergency traumatic brain injury . Methods Retrospective analysed a total of 80 the clinical data of patients with traumatic brain treated in Yuyao Municipal People’s Hospital from March 2015 to August 2016 received surgical treatment in emergency, accorded to the intraoperative anesthesia were divided into remifentanil group and combined anesthesia group(remifentanil combined with sufentanil anesthesia group).The changes of MAP,HR and stress indexes in two groups were observed,awakening quality and complication rate between the two groups were compared.Results Before anesthesia,there was no difference between the two groups of MAP and HR levels,10 minutes after the anesthesia,the beginning of the operation and the end of the operation,the combined anesthesia group was higher than that of the remifentanil group ( P<0.05 );there was no significant difference in blood glucose and cortisol levels between the two groups before and after anesthesia,and the indexes of 12h after operation were lower than those in the remifentanil group (P<0.05);two groups of patients with respiratory recovery time,recovery time,eye opening time command and extubation time showed no significant difference between the two groups;nausea and vomiting,incidence of bradycardia and other complications had no significant difference.Conclusion Sufentanil combined with remifentanil in emergency brain trauma surgery anesthesia was better,has little effect on the mean arterial pressure and heart rate,low complication rate.

Objective To study the impact of earlier tracheotomy on the prevention and treatment of pulmonary infection for the patients with severe head injury.Methods The 68 patients with severe head injury(experimental group) received tracheotomy within 24h after emergency cerebrotomy,controlled by 68 patients(control group) who didn't receive tracheotomy within 24h after emergency cerebrotomy.The third generation cephalosporin and semi-benzylpenicillin were used to prevent infection in all the patients.The patients who had lung infection were taken sputum cultivation test to choose sensitive medicine for the treatment.Results A total of 68 patients occurred pneumonia.There were 35 patients occurred pneumonia in the experimental group and 20 patients were cured.The time of infection control was 4～11d(averaged 7.1 d).There were 53 patients occurred pneumonia in control group, and 21 of them were cured.The time of infection control was 9～21d(averaged 16.9 d).The rate of lung infection and the time of infection were significantly lower in the experimental group than those of the control group(P

Objective To explore the predictive value of the expression of serum forkhead box protein M1(FOXM1)and insulin-like growth factor 2(IGF2)on the prognosis of elderly patients with heart failure complicated with pneumonia.Methods A total of 126 elderly patients with heart failure complicated with pneumonia admitted to Handan Central Hospital from March 2021 to June 2022 were included in case group.According to the follow-up results,the 122 patients were grouped into poor prognosis group(n=33)and good prognosis group(n=89).Meanwhile,126 healthy people in the same period were included as the control group.The levels of serum FOXM1 and IGF2,forced vital capacity(FVC)and forced expiratory volume in the first second(FEV1)in the two groups(case group and control group)were measured.Spearman method was used to analyze the correlation between serum levels of FOXM1 and IGF2 and heart function classification in elderly patients with heart failure complicated with pneumonia.The predictive value of serum FOXM1 and IGF2 levels in elderly patients with heart failure complicated with pneumonia was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of FOXM1(2.39±0.55 vs 1.06±0.21)and IGF2(71.33±7.96pg/ml vs 47.82±5.14pg/ml)in the case group were significantly higher(t=25.358,27.581,all P<0.05).Compared with the good prognosis group,the levels of serum FOXM1(3.87±1.06 vs 1.95±0.51)and IGF2(85.88±9.54pg/ml vs 69.14±8.73pg/ml)in the poor prognosis group were significantly higher,and the differences were statistically significant(t=13.453,9.174,all P<0.05).There were significant differences in heart function classification between the good prognosis group and the poor prognosis group,and the differences were statistically significant(χ2=7.120,P<0.05).Compared with the poor prognosis group,FEV1(1.24±0.32 L vs 1.08±0.25 L)and FEV1/FVC(55.46%±5.77%vs 52.30%±5.38%)in good prognosis group were significantly higher,and the differences were statistically significant(t=2.592,2.735,all P<0.05).The levels of serum FOXM1 and IGF2(r=0.496,0.517,all P<0.05)in elderly patients with heart failure complicated with pneumonia were positively correlated with heart function classification.ROC curve results showed that the area under the curve(AUC)of serum FOXM1 alone in predicting the prognosis of elderly patients with heart failure complicated with pneumonia was 0.854(95CI%:0.779～0.912),with sensitivity and specificity of 75.76%and 86.52%,respectively,and the optimal cut-off value of 2.75.The AUC of IGF2 alone in predicting the prognosis of elderly patients with heart failure complicated with pneumonia was 0.874(95CI%:0.802～0.927),with sensitivity and specificity of 72.73%and 85.39%,respectively,and the optimal cut-off value of 78.30 pg/ml.The AUC of the combination of the two in predicting the prognosis of elderly patients with heart failure complicated with pneumonia was greater than the AUC diagnosed by serum FOXM1 alone and IGF2 alone(Z=2.737,2.413,P=0.006,0.016).Conclusion The serum levels of FOXM1 and IGF2 were increased in elderly patients with heart failure complicated with pneumonia,indicating the combined detection of the two may have a high predictive value for the prognosis of patients.

The vagina contains at least a billion microbial cells,dominated by lactobacilli.Here we perform metagenomic shotgun sequencing on cervical and fecal samples from a cohort of 516 Chinese women of reproductive age,as well as cervical,fecal,and salivary samples from a second cohort of 632 women.Factors such as pregnancy history,delivery history,cesarean section,and breastfeeding were all more important than menstrual cycle in shaping the microbiome,and such information would be necessary before trying to interpret differences between vagino-cervical micro-biome data.Greater proportion of Bifidobacterium breve was seen with older age at sexual debut.The relative abundance of lactobacilli especially Lactobacillus crispatus was negatively associated with pregnancy history.Potential markers for lack of menstrual regularity,heavy flow,dysmenor-rhea,and contraceptives were also identified.Lactobacilli were rare during breastfeeding or post-menopause.Other features such as mood fluctuations and facial speckles could potentially be predicted from the vagino-cervical microbiome.Gut and salivary microbiomes,plasma vitamins,metals,amino acids,and hormones showed associations with the vagino-cervical microbiome.Our results offer an unprecedented glimpse into the microbiota of the female reproductive tract and call for international collaborations to better understand its long-term health impact other than in the settings of infection or pre-term birth.