Objective To explore the influence of fluid management and prognosis guided by goal direction on patients undergoing gastrointestinal surgery.Methods Eighty ASA grade Ⅰ-Ⅲ,consecutive consenting patients undergoing gastrointestinal surgery were divided into observation group (40 patients)and control group (40 patients) by random digits table method.The intraoperative fluid management in control group was based on central venous pressure(CVP),and kept CVP at 8-10 mmHg(1 mmHg =0.133 kPa).The intraoperative fluid management in observation group was based on stroke volume variation (SVV),and kept SVV at 10 ％-12％.The operation time,intraoperative and postoperative 3 d fluid management,time of defecation and exhaust,time of full or semi-liquid diet,length of stay in hospital,rate of complications after operation for 48 h between two groups were compared.Results The volume of total fluid,colloid solution and crystalloid solution received during operation in observation group were significantly lower than those in control group[(2 686.0 ± 977.5) ml vs.(4 837.5 ± 1 566.0) ml,(792.4 ± 197.6) ml vs.(1 284.6 ± 356.7)ml,(1 894.9 ± 460.4) ml vs.(3 569.9 ± 1 318.7) ml] (P ＜ 0.05).The time of semi-liquid diet,length of stay in hospital in observation group were significantly lower than those in control group [(171.1 ± 45.3) h vs.(235.8 ±89.5) h,(11.4 ±1.8) d vs.(14.7 ±4.9) d] (P＜0.05).The time of full liquid diet,time of defecation and exhaust between two groups had no significant difference(P ＞ 0.05).The rate of complications between two groups had no significant difference(P ＞ 0.05).Conclusion Compared with monitoring CVP,the fluid management based on SVV can decrease the fluid volume during operation and shorten the length of stay in hospital.

OBJECTIVE: To observe the effects of different maintain doses of Dexmedetomidine on plasma cortisol and glucose during anesthesia recovery period in patients undergoing uvulopalatopharyngoplasty under sevoflurane inhalation anesthesia. METHOD: In this prospective, randomized, double-blind study, 120 ASA I and II patients undergoing selective uvulopalatopharyngoplasty under general anesthesia were included. The patients were randomly allocated to three groups (n = 40): Dexmedetomidine low maintain dose group (D1), Dexmedetomidine high maintain dose group (group D2) and control group (group C). The Dexmedetomidine groups and control group were given Dexmedetomidine 1 microg/kg and normal saline in 20 ml within 15 min just before induction of anesthesia. Then Dexmedetomidine were maintained at 0.2 microg x kg(-1) x h(-1) and 0.7 microg x kg(-1) x h(-1) in group D1 and group D2 and were withdrawed 5 min before the end of operation, the same maintained speed of normal saline was given in group C. BIS value was maintained at 40-60 by adjusting the inhaled concentration of sevoflurane. Anesthetic was withdrawed 10 min before the end of operation. Thus, plasma cortisol concentration and blood glucose was needed to be detected just before anesthesia (T0), tracheal extubation (T1), 5 min after extubation (T2) and 15 min after extubation (T3). Duration of operation and anesthesia, consumption of sevoflurane, emergence time, extubation time, the occurrence of dysphoria, bucking and hypoxemia (SpO2 < 90%) during extubation were recorded. RESULT: Compared with group C, MAP and HR at T1, plasma cortisol concentration and blood glucose at T1 - T3 were all significantly lower in group D1 and group D2 (P < 0.05), and so were the consumption of sevoflurane and the occurrence of dysphoria (P < 0.05). The emergence time and extubation time were significantly prolonged in group D2 compared with group D1 and group C (P < 0.05). There was no significant difference in the occurrence of bucking and hypoxemia in three groups (P > 0.05). CONCLUSION In the patients undergoing UPPP under sevoflurane inhalation anesthesia, Dexmedetomidine infused at 0.2 microg x kg(-1) x h(-1) maintains a stable hemodynamics without respiratory depression, alleviates stress response during extubation and reduces both the consumption of sevoflurane and the occurrence of dysphoria without prolonging emergence time and extubation time.
Adult ; Anesthesia Recovery Period ; Anesthesia, Inhalation ; Blood Glucose ; metabolism ; Dexmedetomidine ; administration & dosage ; Double-Blind Method ; Female ; Humans ; Hydrocortisone ; blood ; Hypnotics and Sedatives ; administration & dosage ; Male ; Methyl Ethers ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; Palate, Soft ; surgery ; Pharynx ; surgery ; Sevoflurane ; Uvula ; surgery

Objective To compare shikani optical stylet and Mc coy laryngoscope on elder patients with intratracheal intubation anesthesia.Methods 112 cases of elder patients with intratracheal intubation anesthesia were enrolled as study objects, all patients were divided into shikani optical stylet group (52 cases), Mc coy laryngoscope group (60 cases) according to different intubation way. Then detect the hemodynamic parameters, stress-related indicators, EEG relevant indicators of the two groups.Results One time success rate and total success rate in Shikani visual laryngoscope group was higher than Mc Coy visual laryngoscope group, while many times intubation rate was lower (P < 0.05); T1, T2 MAP, HR levels were lower in Shikani optical stylet group than Mc Coy laryngoscope group patients (P < 0.05); Plasma levels of epinephrine, norepinephrine, and glucose on T1, T2 in Shikani optical stylet group was lower than that in Mc Coy laryngoscope group (P < 0.05); T1, T2 BIS, ECoG grading, αβ% values in Shikani optical stylet group was lower than that in Mc coy laryngoscope group (P < 0.05).Conclusions Elderly patients with intratracheal intubation anesthesia received shikani optical stylet can enhance the success rate of intubation and effectively stabilize patients circulatory system, reduce excessive physical stress caused by various system dysfunction, which shows positive significance.

Objective To explore the effects of positive end-expiratory pressure on intraoperative pulmonary function and respiratory mechanics in patients receiving continuous hyperthermic peritoneal perfusion.Methods Ninety patients (55 males,35 females,aged 40-70 years,ASA grade Ⅰ-Ⅲ) undergoing continuous hyperthermic peritoneal perfusion were selected and divided into 3 groups (n=30 each): regular volume controlled ventilation group (group A),5 cm H2O PEEP group (group B) and 10 cm H2O PEEP group (group C).After tracheal intubation,the mechanical ventilation parameters in groups A,B and C were respectively given tidal volume (VT) 10 ml/kg without positive end-expiratory pressure (PEEP),VT 6 ml/kg with 5 cm H2O PEEP,and VT 6 ml/kg with 10cm H2O.PETCO2 was maintained at 35-45 mm Hg.Arterial blood samples were collected for blood gas analysis 5 min after (T1),before CHPP (T2),the end of CHPP (T3),and before the end of mechanical ventilation (T4).Besides,Pplat,Pmean,Ppeak,PaCO2,PaO2were recorded and Cdyn,OI,RI,A-aDO2 as well as VD/VT were calculated at all time points simultaneously.Pulmonary complications during 7 days after surgery were also recorded.Results Compared with group A,Ppeak,Pplat,A-aDO2 and RI were all significantly lower (P<0.05),while OI and VD/VT were higher in groups B and C at T1-T4 (P<0.05);at T2-T4,Cdyn and PaO2 were higher with lower Pmean in groups B and C (P<0.05).Compared with T1,Ppeak,Pplat and Pmean were higher (P<0.05) while Cdyn was lower (P<0.05) in group A at T2-T4;In Group B,Ppeak and Pplat were higher at T3 (P<0.05),Pmean was higher at T2-T4 (P<0.05) and Cdyn was lower at T3,T4 (P<0.05);in group C,Ppeak,Pplat and Pmean were all higher at T2-T4 (P<0.05),Cdyn was lower at T3,T4 (P<0.05);OI and PaO2 were lower (P<0.05),while A-aDO2,VD/VT and RI were all higher (P<0.05) at T2-T4 in the three groups.In addition,the incidence rates of pulmonary infection,hypoxemia,and atelectasis were significantly lower in groups B and C during 7 days after surgery than those of group A (P<0.05).Conclusion PEEP (5 cm H2O) with VT (6 ml/kg) could effectively improve intraoperative pulmonary function and reduce the risk of perioperative pulmonary complications of the patients receiving continuous hyperthermic peritoneal perfusion.

Objective To explore effect of different withdrawal time of dexmedetomidine (DEX) on the quality of general anesthesia recovery.Methods Eighty patients of ASA Ⅰ or Ⅱ undergoing lymph surgery were randomly assigned to four groups (n =20).Groups D1,D2 and D3 received DEX 0.5 μg/kg as bolus before induction,continued with 0.5 μg/(kg · h) by infusion until one hour,30 min before the end of operation and the end of operation,respectively.Group C received equal volume of normal saline.Mean artery pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were observed during and after operation.Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time,observer's assessment of alertness/sedation score (OAA/S),restlessness score (RS),and visual analogue scales (VAS) were observed after operation.Results For MAP and HR in Groups D2 and D3,there were no statistically significant difference during extubation compared to those at preoperation,but at the same time point,they were lower than those in group C (P ＜ 0.05).For groups C and D1,MAP and HR at extubation and 5 min after extubation were higher than those at preoperation (P ＜0.05).Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time in group D3 were significantly longer than those in Group C (P ＜ 0.05),while there were no statistically significantly difference between groups D1,D2,and group C.OAA/S in group D3 was significantly lower than that in group C (P ＜ 0.05) at extubation.Incidence of restlessness,VAS,and cases given analgesic 2 hours after operation in groups D2 and D3 were significantly lower than those in groups C and D1.Compared to those in group C,dosages of propofol and remifentanil in groups D2 and D3 were significantly lower.Conclusions Dexmedetomidine administered of 0.5 μg/kg before induction,continued with infusion of 0.5 μg/(kg · h) until 30 min before the end of operation,may improve emergence,without influencing the awakening time of patients,and prolong the duration time of analgesia which comfort the patients.

OBJECTIVETo investigate the effect of distraction osteogenesis (DO) in the treatment of severe mandibular micrognathia with severe obstructive sleep apnea and hypopnea syndrome (OSAHS).

METHODS19 cases of severe mandibular micrognathia with OSAHS were treated by DO. All the patients received PSG and MSCT examination before and after DO to evaluate the therapeutic effect and changes in the upper airway.

RESULTSAccording to the evaluation standard, 17 cases were cured and 2 cases improved markedly. The sagittal distance and area, transverse distance and area of the upper airway increased markedly after DO. The volume of upper airway increased from (15 572.03 +/- 3 370.11) mm3 to (21 182.69 +/- 4 533.15) mm3.The airway change happened mainly in velopharyngeal region and the lingopharyngeal region, but not in the laryngopharyngeal region.

CONCLUSIONSDO can treat severe mandibular micrognathia patients with OSAHS effectively by enlarging the volume of upper airway,especially in the velopharynx and glossopharyngeum region. The MSCT plays an effective and important role.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Male ; Mandible ; surgery ; Micrognathism ; complications ; surgery ; Osteogenesis, Distraction ; methods ; Sleep Apnea, Obstructive ; complications ; surgery ; Young Adult

Objective:To study the pathological changes of nasopharyngeal carcinoma cases after the treat-ment of stereotactic radiosurgery. Method: 15 cases with recurrent or residual squamous cell carcinoma of na-sopharynx diagnosed as T1～4 N0M0 were selected,which had undergone previous radiotherapy. The patients weretreated by Gamma Knife while the isodose curve was 50％00 and the margin dose was 20 Gy. The nasopharynxbiopsy was performed before the treatment and 1,3,6,12 months after the treatment. The biopsy specimen wastaken to make a pathological examination. Result:①Before the Gamma Knife treatment, carcinoma cell could beseen in the tissue;②1～3 months after the treatment, cell necrosis and acute inflammation cell infiltration couldbe seen in the target ;③6～12 months after the treatment ,infiltration of chronic inflammation cell ,proliferation offibrous tissue and capillary could be found in the target. Conclusion:This research implies that the short-termpathological changes after the treatment of stereotactic radiosurgery can be defined as two phases ..The first phaseoccurs from 1 to 3 months after the treatment called necrosis period. The second phase occurs from 6 to 12months after the Gamma Knife treatment named as absorption period.

OBJECTIVETo really realize quality control of Chinese herb purifying process, near-infrared spectroscopy (NIRS) was used not only for fast monitoring quality-control index of the process, but also for fast judgment of absorption endpoint.

METHODThe purification process of Carthamus tinctorius extracts with nonionic macroreticular resin was selected as an example. HPLC was used as the reference method to determine the content of HSYA. Quantitative and qualitative detection modes of purification were developed by NIRS combined with partial least squares (PLS) and moving block of standard deviation (MBSD).

RESULTThe correlation coefficient of the calibration model was 0.999, and the RPD for calibration and validation were above 5, of 5.54 and 5.22, respectively. Based on acquisition spectra, absorption endpoint calculated by MBSD was close to that by HPLC, Only 1 min deviation.

CONCLUSIONThe method mentioned above is proved to be convenient, rapid and nondestructive, and is applicable for fast monitoring the content of HSYA and fast judgment of absorption endpoint in purifying process of C. tinctorius extracts.

Carthamus tinctorius ; chemistry ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; analysis ; isolation & purification ; Spectroscopy, Near-Infrared ; methods

Objective To analyze the epidemiological characteristics of tuberculosis in Haikou from 2016 to 2020, and to provide theoretical support for the implementation of TB prevention and control measures in this region . Methods Collect data of active tuberculosis patients registered and managed in Haikou for 2016-2020 years, analyze the registration rate of tuberculosis in Haikou in 5 years. Comparison of tuberculosis registration rates among different gender, age groups, nationalities and occupation. Results In 2016-2020 years, 3 256 cases of tuberculosis were registered in Haikou. The average annual TB registration rate was 27.09/100 000, showing a gradual decrease. The incidence rate was the highest in 2016 (34.99/100 000) and the lowest in 2020 (17.99/100 000). The registration rate of tuberculosis in men was significantly higher than that of women (P<0.05). Compared with the registration rate of tuberculosis in different age groups, the incidence rate of the 0-14 year old group was the lowest, and the registration rate of people aged 60 or above was the highest, with a statistically significant difference (P<0.05). From 2016 to 2020, the highest tuberculosis registration rate among different ethnic groups was Han nationality (92.63%), followed by Li nationality (3.53%), Miao nationality (2.09%), Hui nationality (1.14%) and others (0.61%).The three highest occupation rates of tuberculosis were farmers, unemployed workers and workers, 55.80%, 14.74% and 8.88% respectively. Conclusion The registration rate of pulmonary tuberculosis in Haikou has a downward trend overall, and prevention and control work needs to focus on the male and the elderly in order to better prevent and control the epidemic of tuberculosis in this area.

Background:Acute myeloid leukemia (AML) with t(8;21) is a heterogeneous disease. Identifying AML patients with t(8;21) who have a poor prognosis despite achieving remission is important for determining the best subsequent therapy. This study aimed to evaluate the impact of Wilm tumor gene?1 (WT1) transcript levels and cellular homolog of the viral oncogenev?KIT receptor tyrosine kinase (C?KIT) mutations at diagnosis, andRUNX1?RUNX1T1 transcript levels after the second consolidation chemotherapy cycle on outcomes.
Methods:Eighty?eight AML patients with t(8;21) who received chemotherapy only or allogeneic hematopoietic stem cell transplantation (allo?HSCT) were included. Patients who achieved remission, received two or more cycles of consolidation chemotherapy, and had a positive measureable residual disease (MRD) test result (deifned as<3?log reduction inRUNX1?RUNX1T1 transcript levels compared to baseline) after 2–8 cycles of consolidation chemotherapy were recommended to receive allo?HSCT. Patients who had a negative MRD test result were recommended to receive further chemotherapy up to only 8 cycles.WT1 transcript levels andC?KIT mutations at diagnosis, andRUNX1?RUNX1T1 transcript levels after the second consolidation chemotherapy cycle were tested.
Results:Patients who had aC?KIT mutation had signiifcantly lowerWT1 transcript levels than patients who did not have aC?KIT mutation (6.7%±10.6% vs. 19.5%±19.9%,P<0.001). LowWT1 transcript levels (≤5.0%) but notC?KIT mutation at diagnosis, a positive MRD test result after the second cycle of consolidation chemotherapy, and receiv?ing only chemotherapy were independently associated with high cumulative incidence of relapse in all patients (hazard ratio [HR]=3.53, 2.30, and 11.49; 95% conifdence interval [CI] 1.64–7.62, 1.82–7.56, and 4.43–29.82;P=0.002, 0.034, and<0.001, respectively); these conditions were also independently associated with low leukemia?free survival (HR=3.71, 2.33, and 5.85; 95% CI 1.82–7.56, 1.17–4.64, and 2.75–12.44;P<0.001, 0.016, and<0.001, respectively) and overall survival (HR=3.50, 2.32, and 4.34; 95% CI 1.56–7.82, 1.09–4.97, and 1.98–9.53;P=0.002, 0.030, and<0.001, respectively) in all patients.
Conclusions: Testing forWT1 transcript levels at diagnosis in patients with AML and t(8;21) may predict outcomes in those who achieve remission. A randomized study is warranted to determine whether allo?HSCT can improve prog?nosis in these patients.