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 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.

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.

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.

OBJECTIVETo explore the therapeutic alternatives and evaluate the related clinical results of patients with primary central nervous system lymphoma (PCNSL) treated with gamma knife radiosurgery (GKS).

METHODSFrom January 1995 to December 2001, 44 patients suffering from PCNSL, who had undergone stereotactic biopsy or craniotomy, and who had received a confirmed diagnosis through pathological examination, were treated with GKS. All cases were followed up for 1 - 46 months with an average postoperative period of 27 months. The clinical materials, image features, treatment methods and results of follow-up, were retrospectively reviewed.

RESULTSThe symptoms and signs of the patients were markedly improved within 1 - 3 weeks after GKS. The Kanofsky performance status was also improved from a preoperative average of 40% to a postoperative one of 90%. Thirty-eight patients (86.36%) were in complete remission (CR), the other six (13.63%) were in partial remission (PR). The local control rate reached 100%, and the median survival time was 26.5 months. The main side effect was brain edema, which can be treated with dexamethasone and mannitol.

CONCLUSIONGKS is a safe and effective method in multimodality treatment of PCNSL. A stereotactic biopsy coupled with GKS is the first choice for diagnosis and treatment. Adjuvant chemotherapy or radiotherapy should then be given according to the patient's condition.

Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms ; surgery ; Combined Modality Therapy ; Female ; Humans ; Lymphoma ; surgery ; Male ; Middle Aged ; Radiosurgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo extract and purify of solamargine from Solanum nigrum, and to research its antineoplastic effects.

METHODS. nigrum was extracted refluently with 80% alcohol, solamargine was purified with silica gel column chromatography and recrystallization, and then conducted its structure identification and purity checks. Screened the effect on human tumor cell groth inhibition in vitro by MTT assay, and researched on the features in mice with H22 liver cancer or Ehrlich ascites tumor of solamargine.

RESULTThe concent of solamargine reached 97.9%. Solamargine had significantly inhibition on 6 tumor cells in vitro, and it had significantly inhibition on mice with H22 liver cancer or ehrlich ascites tumor in the 2.4 mg x kg(-1) dose of i.v.

CONCLUSIONSolamargine have the antineoplastic effect.

Animals ; Antineoplastic Agents, Phytogenic ; isolation & purification ; Cell Line, Tumor ; Female ; Humans ; Mice ; Mice, Inbred ICR ; Solanaceous Alkaloids ; isolation & purification ; pharmacology

Objective To explore application of nursing intervention of children's fun mode m anesthesia induction of preschool children.Methods A total of 180 preschool children undergoing elective surgery in our hospital were randomly divided into control group and observation group according to the random number table method,with 90 cases in each group,the control group was given routine nursing,and the observation group with children's fun mode nursing intervention,the curative effect is compared between the two groups.Results Before operation,there was no significant difference between the two groups in the improvement of the perioperative anxiety scale (mYPAS) score in the groups (P ＞ 0.05).During induction of anesthesia,mYPAS score of the two groups before operation were significantly higher than one day before surgery,and the differences were statistically significant (P ＜ 0.05),and anxiety score in the observation group was significantly lower than the control group (P ＜ 0.05).Before one day of operation,there was no significant difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the two groups (P ＞0.05).During induction of anesthesia,the SBP,DBP of two groups were significantly higher than one day before operation,and the differences were statistically significant (P ＜ 0.05),and the observation group had lower SBP and DBP than the control group,the difference was statistically significant (P ＜ 0.05).Before one day of surgery,there was no significant difference in heart rate (HR) between two groups (P ＞ 0.0 5).During induction of anesthesia,the two groups had higher HR than one day before operation (P ＜ 0.05),and the observation group had lower HR than the control group (P ＜ 0.05).The observation group during anesthesia induction had lower cooperation scale (ICC) score than the control group(P ＜ 0.05).Conclusion Nursing intervention of children's fun mode for preschool children can improve children's blood pressure,and has less influence on HR so as to improve cooperation of anesthesia induction.

Objective To explore application of nursing intervention of children's fun mode m anesthesia induction of preschool children.Methods A total of 180 preschool children undergoing elective surgery in our hospital were randomly divided into control group and observation group according to the random number table method,with 90 cases in each group,the control group was given routine nursing,and the observation group with children's fun mode nursing intervention,the curative effect is compared between the two groups.Results Before operation,there was no significant difference between the two groups in the improvement of the perioperative anxiety scale (mYPAS) score in the groups (P ＞ 0.05).During induction of anesthesia,mYPAS score of the two groups before operation were significantly higher than one day before surgery,and the differences were statistically significant (P ＜ 0.05),and anxiety score in the observation group was significantly lower than the control group (P ＜ 0.05).Before one day of operation,there was no significant difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the two groups (P ＞0.05).During induction of anesthesia,the SBP,DBP of two groups were significantly higher than one day before operation,and the differences were statistically significant (P ＜ 0.05),and the observation group had lower SBP and DBP than the control group,the difference was statistically significant (P ＜ 0.05).Before one day of surgery,there was no significant difference in heart rate (HR) between two groups (P ＞ 0.0 5).During induction of anesthesia,the two groups had higher HR than one day before operation (P ＜ 0.05),and the observation group had lower HR than the control group (P ＜ 0.05).The observation group during anesthesia induction had lower cooperation scale (ICC) score than the control group(P ＜ 0.05).Conclusion Nursing intervention of children's fun mode for preschool children can improve children's blood pressure,and has less influence on HR so as to improve cooperation of anesthesia induction.

BACKGROUNDCommunity-acquired pneumonia (CAP) remains one of the leading causes of death from infectious diseases around the world. Most severe CAP patients are admitted to the intensive care unit (ICU), and receive intense treatment. The present study aimed to evaluate the role of the pneumonia severity index (PSI), CURB-65, and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.

METHODSA total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated. The ability of different pneumonia severity scores to predict mortality was compared for effectiveness, while the risk factors associated with 30-day mortality rates and hospital length of stay (LOS) were evaluated. The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.

RESULTSAll three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group. As the risk level increased, the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged. The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94, 0.91 and 0.89 for the PSI, CURB-65 and sepsis score, respectively. Compared with the corresponding control groups, the mortality was markedly increased in patients with a history of smoking, prior admission to ICU, respiratory failure, or co-morbidity of heart disease. The differences were also identified in LOS between control groups and patients with ICU treatment, heart, or cerebrovascular disease. Logistic regression analysis showed that age over 65 years, a history of smoking, and respiratory failure were closely related to mortality in the overall CAP cohort, whereas age, ICU admission, respiratory failure, and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group. The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment, but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.

CONCLUSIONSEach severity score system, CURB-65, sepsis severity score and especially PSI, was capable of effectively predicting CAP mortality. Delayed ICU admission was related to higher mortality rates in severe CAP patients.

Adult ; Aged ; China ; Community-Acquired Infections ; mortality ; pathology ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia ; mortality ; pathology ; Sepsis ; mortality ; pathology ; Severity of Illness Index