Objective To determine the median effective dose (ED50) of 0.375 ％ ropivacaine for ultrasound-guided subgluteus approach to the sciatic nerve block in the elderly patients.Methods Thirty ASA Ⅰ-Ⅲ patients of both sexes,aged 65-85 yr,scheduled for foot or ankle surgery under the sciatic nerve block,were enrolled in this study.The patients were placed in the Sim's position and received the sciatic nerve block using the posterior subgluteus approach guided by ultrasound.The initial dose of 0.375％ ropivacaine was 14.5 ml in the first patient and the ratio between the 2 successive doses was 1.2.The ED50 and 95 ％ confidence interval of ropivacaine were calculated by up-and-down technique.Results The ED50 and 95％ confidence interval of 0.375％ ropivacaine resulting in complete block of the sciatic nerve by using the ultrasound-guided subgluteus approach were 13.4 and 11.5-16.2 ml,respectively.Conclusion The ED50 of 0.375 ％ ropivacaine for ultrasound-guided subgluteus approach to the sciatic nerve block is 13.4 ml in the elderly patients.

Objective To observe the clinical effects of budesonide inhalation combined with psychotherapy on patients with chronic obstructive pulmonary disease.Methods 90 cases diagnosed with chronic obstructive pulmonary disease from January 2014 to June 2015 were randomly divided into two groups, 45 cases in each group.The control group received budesonide inhalation, and observation group received psychotherapy on the basis of control group.The serum airway remodeling indexes, sputum inflammatory indicators and blood gas indexes were compared between two groups .Results After two weeks’ treatment, the serum basic fibroblast growth factor (b-FGF), nerve growth factor (NGF) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in observation group were significantly lower than those in control group (P <0.05), the sputum interleukin-8 (IL-8), IL-18 and tumor necrosis factor-α(TNF-α) in observation group were significantly lower than those in control group (P<0.05), PaO2in observation group was higher and PaCO2was lower than those in control group (P <0.05).There was no significant difference in pH value between two groups (P <0.05). Conclusion Budesonide inhalation combined with psychotherapy has a good effect on patients with chronic obstructive pulmonary disease, which is better than that of budesonide alone.

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing gynecological laparoscopic surgery. Methods Eighty ASA Ⅰ or Ⅱ patients, aged 40-64 yr,weighing 50-70 kg, undergoing elective gynecological laparoscopic surgery, were randomized into 2 groups ( n = 40 each): LMA Supreme group (group S) and LMA ProSeal group (group P). Mallampati test was performed before operation in both groups. The patients were classified as Ⅰ or Ⅱ . LMA Supreme and LMA ProSeal were inserted in group S and P respectively after induction of anesthesia with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA. The number of attempt, success rate, LMA placement time, success rate of gastric tube placement, cuff volume, peak airway pressure, and airway seal pressure, BP, HR, ECG, SpO2, PET CO2 and complications were recorded. The duration of surgery and pneumoperitoneum, and emergence time were also recorded. The fiberoptic bronchoscope scores were assessed after successful LMA placement. Results There were no significant differences in the duration of operation and pneumoperitoneum, emergence time between the two groups (P ＞ 0.05). The BP, HR,SpO2, PET CO2 and peak pressure were within the normal range during operation in both groups. The first attempt success rates of LMA placement and gastric tube placement were significantly higher, the LMA placement time was significantly shorter, and the fiberoptic bronchoscopic scores were significantly higher in group S than in group P ( P ＜ 0.05). Conclusion LMA Supreme is helpful for ventilation during operation with less complications and can be used effectively for gynecological laparoscopic surgery.

Objective　To analyze the clinical features, etiological examination, laboratory examination, imaging examination, and treatment of patients with diabetes combined with Klebsiella pneumoniae liver abscess (KPLA), and to provide a reference for clinical work. Methods　The clinical data of patients with diabetes combined with KPLA in the First People's Hospital of Neijiang City from 2021 to 2022 were retrospectively analyzed. Results　Among the 12 patients with diabetes combined with KPLA, there were 8 males and 4 females, aged 47-74 years old. Five cases were combined with biliary tract diseases, 3 cases were combined with syphilis, and 2 cases were combined with hepatitis B.The main clinical manifestations included fever (12 cases), anorexia (10 cases), stomachache (6 cases), dizziness (2 cases), weakness (3 cases), cough and sputum (2 cases), disturbance of consciousness (2 cases), and visual impairment (1 case). Laboratory test results showed an increase in the percentage of neutrophils, glycosylated hemoglobin, transaminase, C-reactive protein, and procalcitonin, as well as a decrease in platelets and albumin. Abdominal CT findings were predominantly unilateral lesions, mostly found in the right liver, mainly manifested as mass, flaky, and nodular shadows. Two patients presented with invasive syndromes, 2 cases had lung abscesses, and 1 case had concomitant endophthalmitis and meningitis. The etiological examination of 12 patients with Klebsiella pneumoniae showed that they were all sensitive bacteria. After actively controlling blood glucose, effectively using antibiotics, and performing liver puncture and drainage, 11 cases improved, while 1 case was left with permanent blindness. Conclusions　The clinical features of diabetes combined with KPLA are atypical and easy to misdiagnose, thus early imaging and etiological examination should be performed. Aggressive glucose control, and selection of sensitive antimicrobial drugs based on drug sensitivity tests combined with liver abscess puncture and drainage can help to improve the prognosis.

Objective To evaluate the efficacy of fiberoptic bronchoscope (FOB)-guided tracheal intubation with laryngeal mask airway i-gel (LMA i-gel) in patients undergoing cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients, aged 36-62 yr, weighing 57-78 kg, scheduled for cervical spine surgery under general anesthesia, were randomly divided into 2 groups (n = 20 each): FOB-guided tracheal intubation with oropharynx ventilation tube group (group O) and FOB-guided tracheal intubation with LMA i-gel (group I). Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 2-3 μg/kg and rocuronium 0.9 mg/kg. The intubation time, fiberoptic bronchoscope score, the number of successful intubation, hypertension, tachycardia and hypoxemia were recorded. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness, etc. Results The rate of successful LMA i-gel placement at first attempt was 100%, placement time was (10 + 3) s, and the rate of successful intubation in the two groups was 100%. The intubation time was significantly shorter, the rate of successful intubation at first attempt and fiberoptic bronchoscope score were significantly higher in group I than in group O (P ＜ 0.05). Hypertension, tachycardia and hypoxemia were not found in the two groups. There was no significant difference in the incidence of adverse effects between the two groups (P ＞0.05). Conclusion FOB-guided tracheal intubation with LMA i-gel can provide adequate ventilation during operation, improve the success rate of FOB-guided intubation and shorten the intubation time in patients undergoing cervical spine surgery.

Objective To study the 18F-FDG PET/CT features of tuberculous and malignant diffuse peritoneal lesions and to discuss the diagnostic value of 18F-FDG PET/CT in diagnosing and differentiating the lesions. Methods The 18F-FDG PET/CT features of 72 patients with tuberculous peritonitis,28 primary serous papillary carcinoma of the peritoneum and 135 peritoneal metastases confirmed by clinic and/or histopathology, were retrospectively reviewed. The peritoneal thickening features of tuberculous and malignant peritoneal lesions were observed. The maximal standardized uptake value (SUVmax) of peritoneal lesions and ascites, ascites SUVmax/liver SUVmax (T/NT) were compared between tuberculous peritonitis and cancerous peritonitis. The ROC curve was used to analyze the diagnostic efficiency of T/NT, SUVmax of peritoneal lesions and ascites. Results The typical 18F-FDG PET/CT features of tuberculous peritonitis were uniformity thickening of parietal peritoneum, mesenteric and omental stain like changes, widely and even distribution of the peritoneal 18F-FDG, while the cancerous peritonitis was obvious uneven thickening of parietal peritoneum, mesenteric and omental nodules and pie-shape changes, uneven distribution of the peritoneal 18F-FDG. The degree of 18F-FDG uptake was increased in all peritoneal lesions, and there was no significant difference between the tuberculous group (SUVmax=10.53±5.44) and the cancerous group (SUVmax=11.45±6.78, t=1.017, P>0.05). The 18F-FDG concentration in malignant ascites (SUVmax=1.88±0.65,T/NT=0.73± 0.18) was obvious higher than that of tuberculous ascites (SUVmax=1.67±0.69,T/NT=0.57±0.27, t=2.243 and 5.045,both P<0.05). The area under the ROC curve of T/NT, SUVmax of ascites, SUVmax of peritoneal lesions were 0.707, 0.593, 0.536, respectively. Conclusion The 18F-FDG PET/CT imaging can reflect the morphology and metabolic changes of peritoneal lesions. It is important to combine the SUVmax of ascites in order to improve the efficiency of diagnosing the diffuse peritoneal diseases.

Objective:To analyze the clinical parameters of the patients with femoral neck fracture such as general condition,therapy method,hospitalized expense so as to provide more effective management plan for the clinical work.Methods:The patients with femoral neck fracture above 50 years who received in-patient treatment from 2008 January to 2012 December were admitted into this study.We collected and analyzed the information,such as age,chronic medical disease,therapy method,hospitalized duration and expense and so on.Results:There were 1 794 femoral neck fracture patients above 50 years (male/female=1/2.06)in our hospital in recent 5 years and the annual average rate of increase was 7.3%. The average age of the patients was (69.9 ±10.7)years and the annual average rate of increase was 0.6%.The chronic medical disease diagnosis ratio was 55.0%.The average waiting time for operation was (6.8 ±4.2)days and the average hospitalized duration was (12.9 ±4.9)days which showed down-ward trend in recent years. The most popular operations were cannulated screw internal fixation (41.8%)and artificial femoral head replacement (34.1%).In the study,146 cases (7.9%)received nonsurgical treatment which showed downward trend.The average hospitalized expense was (35 075 .7 ± 1 1 343.2)yuan which showed no obvious change in recent years.The cost for the females was more than that for the males.The expense for hemiarthroplasty and total hip arthroplasty increased while that for cannulated screw internal fixation decreased gradually.Conclusion:The cannulated screw internal fixa-tion and artificial femoral head replacement were the most important operations for the patients with femo-ral neck fracture.The number and the average age of the patients were on the rise while the expense showed no obvious change in recent years.

Objective To evaluate the antidepressant action of melatonin in stress model of depres-sion and the effects of the melatonin on depressive-like behavior.Methods Forty male Wistar rats were ran-domly divided into four groups(n=10):controls group(CON),chronic unpredictable mild stress group (CUS),chronic unpredictable mild stress group + melatonin group(CUS+MT)and chronic unpredictable mild stress group +ketamine group(CUS+KET).The rats in CUS group,CUS+MT group and CUS+KET group were given different stress stimulation for 42 days to establish the chronic mild unpredictable stress ani-mal model.Sucrose preference experiments was used to detect the depression model and the level of depres-sion was tested by forced swim test.The influence of Short-term low doses of melatonin on the level of BDNF and GluR1 in the prefrontal cortex,was detected by immunohistochemistry(IHC)on 58 day after the start of the experiment.Results (1)The CUS showed depressant-like behavior,and the percent sucrose uptake scores and the cumulative immobility time of the CUS group were decreased significantly(P<0.05).(2)After injection melatonin 14 d,the cumulative immobility time of CUS+MT group((60.70±18.56)s)and CUS+KET group((56.43±20.46)s)were decreased significantly in comparison to the CUS group(146.34±34.10) s).It was observed a highly significant(P<0.05)decrease of and up-regulation of the BDNF cells in CUS+MT group((1 328.99±282.46)/mm2)and CUS+KET group((1 224.76±116.53)/mm2)in comparison to the CUS group,the number of BDNF cells in CUS+MT group was increased significantly in comparison to the CUS+KET group;(3)After administration drug 14 days,the number of GluR1 cells of CUS+KET((807.82± 153.25)/mm2)but not CUS+MT((632 ± 156.34)mm2)significantly increased compared with CUS ((807.82±193.25)/mm2).Conclusion The results indicate that the melatonin induce an antidepressant-like action like ketamine.The antidepressant effects of melatonin may be related with the level of BNDF.

An innovative,ternary nanocomposite composed of overoxidized poly(3,4-ethylenedioxythiophene)(OPEDOT),gold nanoparticles (AuNPs),and electrochemically reduced graphene oxide (ERGO) was prepared on a glassy carbon electrode (GCE) (OPEDOT-AuNPs-ERGO/GCE) through homogeneous chemical reactions and heterogeneous electrochemical methods.The morphology,composition,and structure of this nanocomposite were characterized by transmission electron microscopy,scanning electron microscopy,X-ray diffraction,and X-ray photoelectron spectroscopy.The electrochemical properties of the OPEDOT-AuNPs-ERGO/GCE were investigated by cyclic voltammetry using potassium ferricyanide and hexaammineruthenium(Ⅲ) chloride redox probe systems.This modified electrode shows excellent electro-catalytic activity for dopamine (DA) and uric acid (UA) under physiological pH conditions,but inhibits the oxidation of ascorbic acid (AA).Linear voltammetric responses were obtained when DA concentrations of approximately 4.0-100 μM and UA concentrations of approximately 20-100 μM were used.The detection limits (S/N=3) for DA and UA were 1.0 and 5.0 μ.M,respectively,under physiological conditions and in the presence of 1.0 mM of AA.This developed method was applied to the simultaneous detection of DA and UA in human urine,where satisfactory recoveries from 96.7％ to 105.0％were observed.This work demonstrates that the developed OPEDOT-AuNPs-ERGO ternary nano-composite,with its excellent ion-selectivity and electro-catalytic activity,is a promising candidate for the simultaneous detection of DA and UA in the presence of AA in physiological and pathological studies.

Respiratory mucosal immune system is the body''s first line of defense against infection.Since the outbreak of novel coronavirus disease 2019 (COVID-19) in 2019,nasal mucosal immune vaccine, with its ability to induce cellular, humoral and mucosal triple immune responses, has become a research hotspot.This article focuses on novel coronavirus, with an understanding of its structure and pathogenesis, a brief introduction to the immune mechanism of nasal mucosa, a summary of the different types of nasal mucosal immune vaccines and their clinical research, aiming to provide some theoretical reference for the development of new vaccines, and exploration of the best methods and strategies to combat COVID-19.