ObjectiveTo determine the depth of sedation induced by target-controlled infusion (TCI) of propofol required to inhibit the swallowing reflex.MethodsThirty-five ASA Ⅰ or Ⅱ healthy volunteers,aged 20-60 yr,with body mass index ＜ 30 kg/m2,were enrolled in the study.Sedation was performed with TCI of propofol.The initial target plasma concentration (Cp) of propofol was set at 2.4 μg/ml and the Cp increased or decreased by 0.2 μg/ml every 5 min until the BIS value reached the predetermined level.The initial Cp of propofol was increased or decreased by 0.3 μg/ml in the next subject according to the BIS value in the previous one.The up-and-down sequential experiment was pedormed.The BIS value was set at 65 in the first subject and the ratio of the BIS value between the two consecutive subjects was 1.1.The BIS value was increased or decreased depending on the occurrence of the swallowing reflex in the previous subject.The half-effective BIS value (BIS50) and 95％confidence interval (CI) of propofol inhibiting the swallowing reflex were calculated by up-and-down sequential method.ResultsThe BIS50 of propofol required to inhibit the swallowing reflex was 64.4 (95％ CI 59.3-69.8).ConclusionThe BIS50 and 95％ CI of propofol administered by TCI and required to inhibit the swallowing reflex is 64,4 (59.3-69.8).

Objective To observe and compare the control effect of monitored anesthesia care on stress reaction of operation under local anesthesia.Methods Fourty-five patients who undered ophthalmology and otolaryngology operation and ASA Ⅰ or Ⅱ class,aged 20-55 years were enrolled.They were randomly divided into 3 groups:monitored anesthesia care(M group),general anesthesia (G group),and local anesthesia (L group).All of three groups were performed local nerve block anesthesia.Mean arterial blood pressure (MAP)、heart rate (HR) were recorded at enter room (T1),the strongest operation stimulation (T2),the end of operation (T3).At the same time,the levels of blood glucose,plasma cortisol (Cor) were assayed.The scores of state of anxiety (S-AI) before operation and after operation in two groups were compared.Results The levels of MAP and Cor at T2,T3 and HR at T2 in G group and M group were significantly lower than those at T1:(68.1 ± 8.2),(78.8 ± 12.8) mmHg (1 mmHg =0.133 kPa) vs.(95.7 ± 11.3) mmHg;(80.8 ± 11.7),(86.2 ± 9.0)mmHg vs.(94.7 ± 11.5) mmHg;(207.0 ±71.8),(135.2 ± 60.9) nmol/L vs.(336.7 ± 121.4) nmol/L;(220.8 ± 113.2),(190.4 ± 149.0) nmol/L vs.(347.8 ± 154.6) nmol/L;(68.1 ± 10.6) beats/min vs.(79.9 ± 14.2)beats/min;(70.3 ± 10.1) beats/min vs.(80.6 ± 12.2) beats/min,there were significant differences (P ＜0.05).The level of blood glucose at T3 was significantly lower than that at T1 in G group [(4.9 ± 0.7) mmol/L vs.(5.5 ± 0.6) mmol/L],there was significant difference (P ＜ 0.05).The levels of MAP,Cor at T2 in G group and M group,at T3 in G group were significantly lower than those at the same point in L group:[(68.1 ± 8.2),(80.8 ± 11.7) mmHg vs.(93.4 ± 12.5) mmHg,(207.0 ± 71.8),(220.8± 113.2) nmol/L vs.(367.1 ± 157.3)nmol/L,(78.8 ± 12.8) mmHg vs.(92.6 ± 15.3) mmHg,(135.2 ± 60.7) nmol/L vs.(311.9 ± 165.6) nmol/L],there were significant differences (P ＜ 0.05).The scores of S-AI at postoperative in G group and L group were significantly lower than that at preoperative:(31.5 ± 6.6) scores vs.(44.3 ± 15.0) scores,(35.2 ± 11.5) scores vs.(49.3 ± 14.2) scores,there were significant differences (P ＜ 0.05).Conclusion Monitored anesthesia care can alleviate stress reaction in operation with local anesthesia,while its effect is similar with general nesthesia.

Objective To study the effects of dexmedetomidine on the swallowing reflex. Methods Sixty adult volunteers (ASAⅠ-Ⅱ) were randomly divided into two groups, dexmedetomidine sedation group and propofol sedation group respectively. The BIS value was maintained between 60-65 in both groups. Swallowing reflex was induced by water injection in the pharynx at different depths of sedation, and the swallowing movements were observed. Meanwhile, the RR, SpO2 and OAA/S scores were recorded. Results The swallowing reflex existed in dexmedetomidine sedation group when BIS values was maintained at 60, which had significant difference compared with that in propofol sedation group. The RR, SpO2, OAA/S score in dexmedetomidine sedation group also had statistical difference compared with that in propofol sedation group during swallowing reflex test. Conclusions Slow infusion of dexmedetomidine to maintain the BIS value above 60 will not affect swallowing reflex, and can obtain satisfactory hemodynamic stability. It′clinical safety is high.

AIM: To establish HPLC fingerprint of Venenum Bufonis in an attempt to become a standard of quality control. METHODS: The HPLC method was set up using Alltima C_(18)(250 mm?4.6 mm,5 ?m) column with mobile phase of acetonitrile-0.5% potassium dihydrogen phosphate solution of water;UV detection wavelength at 296 nm and column temperature at 30 ℃ with the flow rate of 1.0 mL/min;20 ?L of the injection volume. RESULTS: In this chromatogram condition,10 peaks were identified as the characteristic fingerprints of Venenum Bufonis.All samples showed the content differences among the samples.The retention times for resibufogenin、cinobufagin、bufalin、bufotalin and cinobufotalin in Venenum Bufonis were consistent with each other.The fingerprint showed good similarity up to 93% in samples from different habitats. CONCLUSION: The method is exact、simple and accurate,and can be used for the identification and quality control of Venenum Bufonis.

Objective: To analyze the clinical characteristics and current treating status from atrial ifbrillation (AF) patients with different gender in 20 emergency departments.
Methods: A total of 2015 consecutive AF patients from 20 emergency departments nationwide from 2008-11 to 2011-10 were retrospectively investigated. The patients were divided into 2 groups: Female group,n=1104 and Male group,n=911. The baseline clinical characteristics and current treating status were compared between groups, the risk of stroke in non-valvular atrial ifbrillation (NVAF) patients was evaluated by CHADS2 score and the factors affecting walfarin application were studied by Logistic regression analysis.
Results: Compared with Male group, Female group had the elder age (69.11 ± 12.96) years vs (67.67 ± 13.63) years,P=0.015, lower body mass index (BMI) (23.24 ± 3.73) kg/m2 vs (23.89 ± 3.47) kg/m2,P=0.000, more patients combining with heart failure (39.7% vs 34.6%,P=0.019), more patients with valvular heart disease (26.6% vs 12.4%,P=0.000). In contrast, Male group had more smokers (41.4% vs 5.1%,P=0.000), more patients combining with coronary artery disease (45.1% vs 39.1%,P=0.007) and more patients with previous history of myocardial infarction (9.5% vs 5.5%,P=0.001). The average CHADS2 score was higher in Female group than Male group (2.0 ± 1.4) vs (1.8 ± 1.4),P=0.008 and the proportion of patients with CHADS2 score ≥2 was higher in Female group than Male group (58.0% vs 51%,P=0.005). There were 407 patients of valvular heart disease with AF and 167 (41%) of them received walfarin treatment including 119 female and 48 male,P=0.713; 1608 NVAF patients with CHADS2 score≥ 2 and 105 of them received anticoagulation therapy including 54 female and 51 male,P=0.636.
Conclusion: The clinical characteristics and current treating status are different by gender from AF patients in 20 emergency departments in China.

Objective To observe the clinical effect of multimodal analgesia for painless artificial abortion . Methods 150 cases of ASA Ⅰ-Ⅱ pregnancy received painless artificial abortion operation ,no contraindication for all patients,were randomly divided into the five groups ,30 cases in each group,the blank control group (group S):do not use any analgesia measure ,intravenous injection of 0.9% sodium chloride 2mL preoperation;the fentanyl group ( F group ) :intravenous injection of fentanyl 1μg/kg preoperation ;the parecoxib group ( group P ) :intravenous injection of parecoxib sodium 40mg preoperation.The patients were given painless artificial abortion after injection the above drugs.Nerve block group ( N group):the implementation of painless induced abortion operation after sleep in patients with the cervical nerve block ,injection of 1%lidocaine 2 mL.Multimodal analgesia group (group M):intra-venous injection of parecoxib sodium 40mg,fentanyl 1μg/kg,then the implementation method the same as N group . The operation time,anesthesia onset time,recovery time,time of accurate orientation and additional dosage of propo-fol;incidence rate of artificial abortion syndrome ,the incidence rate of uterine contraction pain ,10min,30min,1h,6h pain scores after operation; adverse reaction;satisfaction score of analgesic effect postoperative 24h were observed. Results The additional dosage of propofol in the group S ,group F,group P,group N and group M were (78.45 ± 20.36)mg,(15.55 ±12.33)mg,(16.75 ±13.13)mg,(14.55 ±10.25)mg,(9.35 ±8.27)mg.The incidence rates of uterine contraction pain in the group S ,group F,group P,group N and group M were 30%,10%,10%,10%,0. Compared with group M ,the additional dosage of propofol and incidence rate of uterine contraction pain in the other four groups were significantly increased (t=3.05,1.82,1.84,1.78,χ2 =72.1,68.2,68.2,68.2,all P<0.05). Pain scores after operation 10min,30min,1h,6h in the group S were (6.6 ±1.5)points,(5.6 ±1.4)points,(4.6 ± 1.1)points,(3.6 ±1.4)points.Those in group F were (5.1 ±1.5)points,(4.3 ±1.1)points,(3.1 ±0.9)points, (2.8 ±0.8).Pain scores after operation 10min,30min,1h,6h in the group P were (4.6 ±1.5) points,(4.2 ± 0.9)points,(2.9 ±0.8) points,(2.7 ±0.6) points.Those in the group N were (4.5 ±1.5) points,(4.1 ± 0.8)points,(2.9 ±0.8)points,(2.6 ±0.5).Pain scores after operation 10min,30min,1h,6h in the group M were (2.2 ±0.8)points,(1.9 ±0.7)points,(1.5 ±0.5)points,(1.2 ±0.3)points.Compared with the group M,pain scores after operation 10min,30min,1h,6h in the other four groups were significantly elevated ( t=2.03,1.96,1.86, 1.84,1.98,1.82,1.80,1.76,2.05,1.99,1.95,1.86,2.06,1.88,1.82,1.76,all P<0.05).Compared with S group,postoperative 24h satisfaction score of analgesia in the group M was improved significantly ( t =1.98,P<0.05).Compared with group M,the incidence rate of nausea in the other four groups was increased significantly (χ2 =72.2,68.9,68.1,68.1,all P<0.05).Conclusion Multimodal analgesia method can greatly reduce artificial abor-tion postoperative pain ,reduce the adverse reactions ,improve patients'satisfaction score ,ensure the safety of operation .

OBJECTIVE To explore the safe and effective dose of sirolimus (Rapamycin,Sir) and its effect on seizure comorbidities. METHODS Immature C57BL/6 mice at postnatal 10 d of age were administered with kainic acid(KA) 12.0 mg · kg-1 intraperitoneally by a single injection to induce acute seizure. Sir 0.3, 1.0 and 3.0 mg · kg-1 was injected 24 h after seizure every other day until 3 d, 1 week, 3 weeks, 5 weeks and 6 weeks. Western blotting analysis was used to detect the expression and phos?phorylation level of S6 protein and to determine the minimum effective dose of Sir. Effect of the mini?mum effective dose of Sir on cognitive function and body growth was observed by several evaluations. Immunofluorescent intensity of Doublecortin (DCX) immunofluorescent staining was conducted to evaluate the development of neurons in the hippocampus. Morris water maze was used to assess the cognitive function. Tail suspension test, O maze and new object recognition test were used to study the anxiety-like behaviors of mice. RESULTS The result of Western blotting showed that Sir 0.3 mg · kg-1 had no significant effect on the phosphorylation of S6 protein in normal mice or KA mice, whereas 1.0 and 3.0 mg · kg- 1 could significantly inhibit the phosphorylation of S6 protein in KA mice (P<0.05). Sir 1.0 mg·kg-1 had no obvious effect on DCX-positive cells or body wass. Morris water maze showed that KA-induced seizure resulted in prolonged escape latency and swimming length (P<0.05), and a decreased crossing number of target quadrant (P<0.05). Sir 1.0 mg·kg-1 significantly reversed the deficit of cognitive function of KA-induced seizure mice (P<0.05), whereas no significant difference was found between Sir group and normal control group. Compared with normal control group, model group showed increased freezing time in tail suspension test (P<0.05), decreased migration length and reten?tion time in open arms in O maze (P<0.05), decreased retention time and touch frequency with new objects, migration length and average speed in new object recognition test (P<0.05). Sir 1.0 mg · kg-1 significantly reversed the above anxiety and depression status, whereas no significant difference was found between sirolimus group and normal control group. CONCLUSION Sir 1.0 mg · kg-1 inhibits the abnormal activation of mTOR pathway and the formation of epilepsy comorbidity in immature mice. Along with its mild side effect in development, Sir 1.0 mg · kg-1 will be an ideal dose to be used in the treatment of seizure in immature mice.

Objective To compare the efficacy of Discoscope endoscope and GlideScope video laryngoscope for difficult glottis exposure.Methods Forty adult patients of both sexes scheduled for elective surgery under general anesthesia whose glottis was not visible at laryngoscopy (grade Ⅲ or Ⅳ according to Cormach-Lehane Grading of laryngoscopic view) were randomized into 2 groups (n =20 each):group GlideScope video laryngoscope (group G) and group Discoscope endoscope (group D).The glottis exposure time,intubating conditions,time from exposure of glottis to completion of tracheal intubation and incidence of postoperative sore throat and throat bleeding were recorded and compared between the 2 groups.Results Compared with group G,the glottis exposure time was significantly longer,the rate of backward pressure of cricoid cartilage lower,the time from exposure of glottis to completion of tracheal intubation shorter and the success rate of tracheal intubation at first attempt higher (P ＜ 0.05).There was no significant difference in the success rate of tracheal intubation at second attempt and postoperative incidence of sore throat and throat bleeding between the 2 groups(P ＞ 0.05).Conclusion DiscoScope endoscope is superior to GlideScope video laryngoscope in the management of difficult intubation in term of glottis exposure and success rate of tracheal intubation at first attempt.

Objective To explore the clinical therapeutic effects of intravenous infusion of dihiazem in com-bination with metoprolol for treating aortic dissection. Method From June 2005 to January 2008, fourteen patients with aortic dissection (male 8, female 4) in the First Hospital of Yichang,were treated with diltiazen 1～5 μg/(kgrate 30 min,60 min, 120 min,6 h, 1 d and 7 d after treatment were recorded. All data were analyzed using self-matching t test. Results The heart rate reduced significantly 60 min after treatment. The heart rate reduced (21±5) beats/min from the baseline. The total effective rate was 100% .The blood pressure reduced significantly 30min after treatment. The systolic pressure reduced to (126.2±11.1 ) mmHg and diastolic pressure declined to (80.3±8.1) mmHg. No severe cardiac side-effect observed. Conclusions Dihiazem in combination with meto-prolol can reduce heart rate and blood pressure markedly and safely in aortic dissection patients.

OBJECTIVE: To explore the feasibility and efficacy of mitomycin C(MMC) in the treatment of airway scarring stenosis. METHOD: The clinical materials of 11 patients with airway stenosis treated with MMC from 2008 to 2012 were analyzed retrospectively,including atresiaofnasopharynx/choanal atresia (2 cases), pharyngostenosis (1 case), and laryngotracheal stenosis (8 cases). All were treated with endoscopic surgery under general anesthesia. Patients received topical application of MMC (0.4 mg/ml) to the lesion for 5 minutes after the scar tissue removed and repeated five times. RESULT: No patients occurred restenosis in 2 months' follow-up postoperative. Two patients with atresiaofnasopharynx/choanal atresia achieved satisfactory ventilation outcome, 8 patients with laryngotracheal stenosis decannulated successfully, 1 patients with pharyngostenosis achieved near normal deglutition. CONCLUSION MMC in endoscopic airway surgery is safe and effective in the treatment of airway stenosis and offers a high success rate for patients with grade 1-2 stenosis. It should be used as a first method in the treatment of airway stenosis.
Adolescent ; Adult ; Child ; Cicatrix ; surgery ; Endoscopy ; methods ; Female ; Humans ; Laryngostenosis ; surgery ; Male ; Middle Aged ; Mitomycin ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult