Objective:To observe the clinical application of flexible endoscope assisted by general versus pillow-under-shoulder supine position in nasotracheal intubation of the patients with difficult airway, and to explore the influence of intubation position in the intubation effect.Methods: A total of 168 patients with difficult airway who underwent nasotracheal intubation and oromaxillofacial surgery under general anesthesia were randomly divided into general supine position (control group) and pillow-under-shoulder supine position (experimental group) with 84 cases in each group.The first-time and the total success rate of intubation, the intubation time, and the rate of direct glottis exposure of the patients in two groups were recorded.The mean arterial pressure(MAP), heart rate (HR), and complications of intubation of the patients in two groups before induction, before tracheal intubation, during intubation, 1 and 5 min after intubation, were also recorded.Results:The first-time success rate of intubation in experimental group (94.0 %, 79/84) was significantly higher than that in control group (71.4%, 60/84) (P<0.01);the total success rate of intubation (98.8%, 83/84) had no difference compared with control group (97.6 %, 82/84) (P>0.05);the intubation time (57 s±12 s) was significantly shorter than that in control group (146 s±29 s) (P<0.01);the rate of direct glottis exposure (47.6%, 40/84) when the flexible endoscope passed through the posterior nasal apertures was obviously higher than that in control group (15.5 %, 13/84) (P<0.01).The values of MAP and HR of the patients in two groups before and during intubation were decreased significantly compared with the baselines (P<0.01), and came back to the baselines 1 and 5 min after intubation (P>0.05).There were no significant differences in the MAP and HR between different time points (P>0.05).The incidence rates of complications including pharyngalgia, hoarseness and epistaxis had no differences between two groups (P>0.05).Conclusion: Flexible endoscope assisted by pillow-under-shoulder in nasotracheal intubation has a higher intubation success rate, shorter intubation time and it is a superior procedure for the patients with difficult airway.

Egypt’s medical insurance is mainly covered by government and commercial insurance. The low coverage of commercial insurance and the quality of medical services needs more improvement in Egypt. Recently, the incidence rate of diabetes, chronic kidney disease, hypertensive heart disease, COPD and liver cancer is rising. Traditional Egyptian medicine is similar to Traditional Chinese Medicine (TCM), and its modern traditional medicine is mainly Arabian medicine. Acupuncture, as the main form of TCM, was introduced into Egypt in the 1970s, but it has not been covered by the medical insurance system. The development of TCM in Egypt needs improvement. It is suggested that further explorated fields should be focused on the acupuncture therapy, TCM education and TCM treatment of keeping health in Egypt.

ObjectiveTo compare the effectiveness and mechanism of Xiangzhu Fanggan Formula （香术防感方） by sniffing and nasal drops for preventing influenza A H1N1flu. MethodsFifty-six BALB/c mice were randomly divided into normal group， model group， zanamivir group， high-concentration sachet group， low-concentration sachet group， high-concentration nasal drops group， and low-concentration nasal drops group， with 8 mice in each group. In the low- and high-concentration sachet groups， 15 g and 30 g of Xiangzhu Fanggan Formula sachet were used for sniffing for 24 h per day； while in the low- and high-concentration nasal drops groups， nasal drops of Xiangzhu Fanggan Formula were given at a concentration of 0.11 and 0.22 g/ml， 20 μl each time， twice a day； in the zanamivir group， zanamivir was given at a concentration of 1.025 mg/ml of 20 μl each time， twice a day； in the normal group and the model group， nasal drops of normal saline were given at 20 μl each time， twice a day. Each group was given prophylactic intervention for 5 days. On day 5， 1 h after the administration of the drug， the mice in all groups except the normal group received 35 μl of 50 LD₅₀ A/PR/8/34/H1N1 viral solution as nasal drops to prepare influenza A H1N1 model mice. The body mass of the mice was recorded and the rate of change of body mass was calculated daily from day 5 to day 9 of the experiment， and the general status was observed. The mice were sampled on day 9， and the lung index and the inhibition rate of lung index were calculated； HE staining was used to detect pathological changes in lung tissues and to score lung tissue lesions； RT-qPCR was used to detect viral load in lung tissues； and ELISA was used to detect secretory immunoglobulin A （sIgA） and serum tumour necrosis factor α （TNF-α） and interleukin 2 （IL-2）， interleukin 6 （IL-6）， and interferon γ （IFN-γ） in the lavage fluid of the upper respiratory tract. ResultsOn days 7， 8 and 9 of the experiment， the rate of change in body mass of mice in the model group significantly lower than that in the normal group at the same time points （P＜0.05 or P＜0.01）. On days 8 and 9 of the experiment， the rate of change in body mass of mice in the zanamivir group and the high-concentration nasal drops group increased when compared with the model group （P＜0.05 or P＜0.01）. Compared with the normal group， mice in the model group had significantly higher lung index， lung tissue lesion score， lung tissue viral load， significantly higher serum TNF-α， IL-6， IL-2， IFN-γ levels， and significantly lower sIgA levels in the upper respiratory lavage fluid （P＜0.01）. Compared with the model group， the lung index and lung tissue viral load reduced， serum IFN-γ， TNF-α， IL-2， IL-6 levels reduced， and sIgA levels increased in the zanamivir group and the high-concentration nosal drops group （P＜0.05 or P＜0.01）； except for low-concentration sachet group， lung tissue lesion scores of the drug intervention groups reduced compared with those of the model group （P＜0.01）. Compared with the zanamivir group， the lung index increased in the low-concentration sachet group and the low- and high-concentration nasal drops groups， and the serum TNF-α and IL-2 levels increased in all Xiangzhu Fanggan Formula intervention groups （P＜0.05 or P＜0.01）. Compared with high-concentration nasal drops group， serum TNF-α and IFN-γ levels elevated in the high-concentration increased group， and lung tissue viral load elevated in the low-concentration nasal drops group （P＜0.05 or P＜0.01）. The lung index inhibition rate was 80.84% in the zanamivir group， 41.61% and 17.90% in the high- and low-concentration sachet groups， and 35.40% and 25.40% in the high- and low-concentration nasal drops groups， respectively. HE staining showed that the lung tissues of the model group showed thickening of alveolar septa， alveolar collapse， and infiltration of inflammatory cells； whereas， in each drug intervention group， the inflammation of the lung tissues of the mice and the damage reduced， and the most obvious improvement was in the zanamivir group and the high-concentration nasal drops group. ConclusionXiangzhu Fanggan Formula by sniffing and nasal drops could both prevent influenza A H1N1 virus infection， with antiviral and anti-inflammatory effects， also could improve the pathological damage of lung tissue， and improve the immunity of respiratory mucosa. The nasal drops may be better than sachets in inhibiting inflammatory response， especially the high-concentration nasal drops showed more effective.

The drug formulation design of self-emulsifying drug delivery systems (SEDDS) often requires numerous experiments, which are time- and money-consuming. This research aimed to rationally design the SEDDS formulation by the integrated computational and experimental approaches. 4495 SEDDS formulation datasets were collected to predict the pseudo-ternary phase diagram by the machine learning methods. Random forest (RF) showed the best prediction performance with 91.3% for accuracy, 92.0% for sensitivity and 90.7% for specificity in 5-fold cross-validation. The pseudo-ternary phase diagrams of meloxicam SEDDS were experimentally developed to validate the RF prediction model and achieved an excellent prediction accuracy (89.51%). The central composite design (CCD) was used to screen the best ratio of oil-surfactant-cosurfactant. Finally, molecular dynamic (MD) simulation was used to investigate the molecular interaction between excipients and drugs, which revealed the diffusion behavior in water and the role of cosurfactants. In conclusion, this research combined machine learning, central composite design, molecular modeling and experimental approaches for rational SEDDS formulation design. The integrated computer methodology can decrease traditional drug formulation design works and bring new ideas for future drug formulation design.

OBJECTIVES: The objectives of this study were to assess the quality of prosthetic prescriptions of removable partial dentures (RPDs) and to analyze the current situation of the communication and information delivery between clinicians and technicians. METHODS: All RPD prosthetic prescriptions received by a major dental laboratory in 4 weeks were involved in a quality audit, and the prescriptions were divided into three groups in accordance with the grades of clients. The filling of prosthetic prescriptions was recorded. The items in the prescriptions for audit included the general information of the patient, the general information of the clinician, the design diagram information, other detailed information, and the return date. The prescriptions were categorized into four levels on the basis of their quality by two quality inspectors who have been working for more than 10 years. RESULTS: A total of 916 prescriptions were collected and assessed. The names in the general information of the patient and the clinician were filled out best, both at the rate of 97.6% (n=894). The return date was filled out worst, only at the rate of 6.4% (n=59). Of those prescriptions, 86.8% (n=795) exhibited inadequate design diagram information. The results of the quality assessment demonstrated that 74.2% of prescriptions were assessed as noncompliant ones and failed to meet the acceptable clinical quality standard. CONCLUSIONS At present, the overall quality of RPD prosthetic prescriptions is poor. The responsibilities of clinicians and technicians are unclear, and the communication between them is not ideal.
Humans ; Denture Design ; Denture, Partial, Removable ; Prescriptions