Objective To analyze the clinical data of laparoscopic total hysterectomy after cervical cold knife conization (CKC) in patients with cervical intraepithelial neoplasia (CIN), and study the supplemental treatment methods after cervical cold knife conization in patients with CIN Ⅲ. Methods The clinical data of 101 patients with CIN Ⅲ were retrospectively analyzed, the patients were treatment with laparoscopic total hysterectomy after cervical cold knife conization. Results Among the 101 patients, the accordant pathological result of cervical biopsy under colposcopy and cervical cold knife conization was in 68 cases (67.3%), while 6 cases (5.9%) pathological upgraded to invasive carcinoma. The positive margins after cervical cold knife conization was in 23 cases, and negative margins was in 78 cases. Among the positive margins patients, 11 cases had residual lesion, including 2 cases of CINⅠ, 2 cases of CINⅡ, 5 cases of CIN Ⅲ, 2 cases of microinvasive carcinoma. The rate of residual lesions was 47.8%(11/23). Among the negative margins patients, 7 cases had residual lesion, including 4 cases of CINⅠ, 2 cases of CIN Ⅱ, 1 case of CIN Ⅲ. The rate of residual lesions was 9.0% (7/78). There was statistical difference in the rate of residual lesions between 2 groups (P<0.05). Conclusions The cervical biopsy under colposcopy has high risk of missing diagnosis of cervical cancer, thus it can not replace the diagnosis of cervical cold knife conization. There is still a certain percentage of residual lesions in the negative margins of cervical cold knife conization. The patients with recurrence or residual risk factors may be considered further surgical treatment.

Objective To observe the effect of total intravenous anesthesia (TIVA) on intrapulmonary shunt fraction and arterial oxygenation during one-lung ventilation (OLV) for thoracoscope surgery.Methods Forty patients scheduled for thoracoscope surgery were randomly assigned to two groups ( n =20),group of TIVA (A) and group of intravenous anesthesia combined with inhalational anesthesia(B).After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol ( group A)or with sevoflurane ( group B) in order to maintain a BIS between 40 and 60.Mean arterial pressure (MAP),heart rate (HR),SpO2 and Paw were measured in four phases,always in the lateral position,10min after beginning two-lung ventilation (TLV),15 min after beginning OLV (OLV + 15 ),30 rain after beginning OLV ( OLV + 30) and 60 min after beginning OLV ( OLV + 60).Blood samples were drawn simultaneously and analyzed within 5 min.The Qs/Qt at each phase was calculated.Adverse events including hypotension,bradycardia,hypoxemia,delayed emergence and restlessness in recovery period were recorded.Results In all patients,a decrease in PaO2 and an increase in the Qs/Qt occurred during OLV were observed.But PaO2 values in group A were significantly higher than those in group B ( 177 ±88 vs 125 ±63;150 ±65 vs 110 ±67;188 ±69 vs 128 ±52) ( P ＜0.05).The Qs/Qt in group B was significantly higher than those in group A (34.2 ±5 vs 28.8 ±2;38.4 ±8 vs 32.1 ±6;37.1 ±2 vs 29.5 ±2,P ＜0.05).MAP values in group A were significantly lower than those in group B at the phase:OLV + 15 and OLV +30(72 ± 10 vs 88 ± 14;74 ± 12 vs 89 ± 10) ( P ＜ 0.05 ).The incidence of hypotension and delayed emergence in group A was higher than those in group B ( 10 case vs 4 case;9 case vs 2 case).The incidence of restlessness in recovery period in group B was more than those in group A (9 case vs 3 case).The differences between two groups were significant ( P ＜ 0.05).Conclusions Compared with sevoflurane-sufentanyl combined anesthesia,TIVA with propofol can efficiently decrease intrapulmonary shunt fraction and improve arterial oxygenation during OLV for thoracoscope surgery,which is good for the prevention of hypoxemia.

Objective To observe the effect of one-lung ventilation (OLV) on cerebral oxygen balance and energy metabolism during total intravenous anesthesia for thoracoscopic surgery.Methods Thirty patients scheduled for thoracoscopic surgery were selected.After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol by target controlled infusion in order to maintain a bispectral index(BIS) between 40 and 60,and end-tidal partial pressure of carbon dioxide (PETCO2) between 30mmHg and 35mmHg.Mean arterial pressure (MAP),heart rate (HR),SpO2,PetCO2,cerebral blood flow velocity (CBFv),BIS value and nasopharyngeal temperature(NPT) were measured,always with the patients in the lateral position,in four phases:10min after beginning twolung ventilation (TLV),15 min after beginning OLV (OLV + 15),30min after beginning OLV (OLV + 30) and 60 min after beginning OLV(OLV + 60).Blood samples were drawn simultaneously and analyzed within 5min.The Da-jvO2,CERO2,CMRO2,Da-jvLac and Da-jvGlu at each phase were calculated.Results In all patients,a decrease in PaO2 [(172±85) vs (428±42);(162±54) vs (428±42);(185±61) vs (428±42)] and MAP [(70±10) vs (81 ±11) ; (71 ± 12) vs (81 ± 11)] occurred during OLV (t =15.02,13.14,23.25,20.16,18.02,all P ＜ 0.05).SjvO2 at the phase:OLV + 15 and OLV + 30 were significantly lower than those at TLV [(54.0 ± 1.2) ％ vs (65.0 ± 0.8) ％ ;(55.0±1.5)％ vs (65.0 ±0.8)％] (t =3.12,2.14,all P＜0.05).Ca-jvO2[(50 ± 12)％ vs(40 ± 12)％ ;(54±11)％ vs (40 ± 12)％],CMRO2 [(186 ±40) vs (162 ± 35);(191 ±24) vs (162 ±35)]and CERO2 [(36 ± 12) vs (30 ± 1 1) ; (35 ± 10) vs (30 ± 11)] atthephase:OLV + 15 andOLV + 30weresignificantlyhigher than those at TLV (t =5.23,4.28,1.86,2.01,8.21,10.11,all P ＜ 0.05).After OLV,Da-jvGlu [(0.45 ± 0.10) vs (0.22 ± 0.30) ; (0.52 ± 0.20) vs (0.22 ± 0.30) ; (0.40 ± 0.20) vs (0.22 ± 0.30)] significantly increased (t =6.45,12.03,15.10,all P ＜ 0.05).The differences of Da-jvLac and CBFv at every phase were not significant (P ＞0.05).Conclusion During total intravenous anesthesia,OLV resulted in an increase of consumption of cerebral oxygen and energy.It may be not good for cerebral oxygen balance and energy metabolism.The efficient prevention is necessary clinically.

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.

[ ABSTRACT] AIM:To investigate the effects of Chaihu Shugan powder ( CSP) on lipid metabolism and the pro-teins involved in adenosine 5’-monophosphate-activated protein kinase (AMPK)/sirtuin 1 (SIRT1) pathway in the liver tissues of the rats with non-alcoholic fatty liver disease (NAFLD).METHODS: Sprague-Dawley rats were randomly di-vided into normal control ( NC) group, with HFD ( HFD) group and CSP group.The NAFLD models were established by feeding with HFD for 16 weeks in the rats.The rats in CSP group were intragastrically administered with CSP extracts (9.6 g· kg-1 · d-1 ) , and blood and liver samples were collected 16 weeks later.Serum and liver levels of total cholesterol ( TC) and triglyceride ( TG) , and serum levels of alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) were measured using an automatic biochemical analyzer.The histological changes of liver tissues were observed with HE staining, while the lipid deposition was observed with Oil Red O staining.The ultrastructural changes of the liver tissues were observed under transmission electron microscope.Moreover, the protein levels of AMPK, phosphorylated AMPK (pAMPK), SIRT1 and uncoupling protein 2 (UCP2) in the liver were detected by Western blot.RESULTS:The results of HE staining, Oil Red O staining and electron microscopy demonstrated that NAFLD rat model was successfully estab-lished.Compared with NC group, the serum and liver levels of TC and TG, and serum level of AST in model group were markedly elevated ( P<0.01) .Moreover, the protein levels of pAMPK and SIRT1 in HFD group were markedly reduced (P<0.01), whereas UCP2 level was elevated (P<0.01).Furthermore, liver levels of TC and TG, and serum level of AST in GSP group were markedly reduced as compared with HFD group ( P<0.05 ) .The protein levels of pAMPK and SIRT1 were elevated ( P<0.05 ) , whereas the UCP2 level was reduced as compared with HFD group ( P<0.01 ) .The protein level of AMPK between the 3 groups had no significant difference.CONCLUSION: CSP attenuates hepatic lipid disorder and hepatic lipid deposition in NAFLD rats induced by feeding with HFD for 16 weeks, which is associated with the activation of AMPK/SIRT1 pathway.