Objective To investigate whether intranasal dexmedetomidine prevents the emergency delirium after sevoflurane-based anesthesia (ASA) in children.Methods Ninety children (ASA I,2 to 7years) undergoing elective tonsillectomy with or without adenoidectomy,were randomly divided into group D1 (intranasal dexmedemidine 1.0 μg/kg),group D2 (intranasal dexmedemidine 0.5 μg/kg),and group NS (intranasal normal saline).Anesthesia was induced with sevoflurane (30 min after intranasal administration) and maintained with sevoflurane in 50/50％ O2/N2O.Heart rate (HR),blood pressure (BP),and hemoglobin oxygen saturation (SpO2) were monitored before intranasal administration to 2 hours after extubation.Time of operation and extubation were recorded.Pediatric anesthesia emergence delirium (PAED) scale,Modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) Pain scale and the adverse effects were observed.Results The PAED scales of group D1 and Group D2 were significantly lower than group NS.No significant differences were found in hemodynamic and respiratory variables,pain scale,time of extubation and adverse effects among three groups.Conclusions Intranasal dexmedetomidine decreased the severity of emergence delirium after sevoflurane-based anesthesia in children without prolonging the time to extubate and affect hemodynamics and respiratory variables.

With the rapid development of general anesthesia technology and the occurrence of new types of inhalation and intravenous anesthetics,safety and comfort requirements of general anesthesia become increas-ingly higher. Therefore,emergence agitation and its adverse consequences gradually receive more and more atten-tion . Thus the etiology and prevention of emergence agitation is an important issue in pediatric anesthesia at pres-ent. In recent years, some achievement has been made in emergence agitation following general anesthesia in children. This article will summarize the related factors,possible mechanisms and prevention strategics of pediat-ric emergence agitation.

Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Arthralgia ; therapy ; Female ; Humans ; Male ; Middle Aged ; Needles

Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P<0 .05) .There was no significant difference between 2 groups in the field of recur-rence and metastasis although the recurrence adjacent to the primary tumor had happened in FSG group in 5 months after operation (P>0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .

Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Severe Acute Respiratory Syndrome ; therapy

Adult ; Aged ; Humans ; Male ; Middle Aged ; Radiographic Image Enhancement ; Silicosis ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Afferent Pathways ; Animals ; Female ; Nerve Block ; Olfactory Bulb ; metabolism ; Parvalbumins ; metabolism ; Rats ; Rats, Wistar

Objective To quantify the incidental irradiation dose (ⅡD) to lymph node stations of esophagus when treating patients with T1-4N0 M0 thoracic esophageal squamous cell carcinoma (ESCC) with a dose of 60 Gy/30f.Methods Twenty-nine patients with medically inoperable T1-4N0M0 thoracic ESCC were treated with three-dimensional radiotherapy on involved-field.The conformal CTV was re-created using a 3 cm margin in the proximal and distal direction (following the course of the esophagus) beyond the barium esophagogram,endoscopic examination and CT defined GTV and a 0.5 cm margin in the lateral and anteroposterior directions of the CT defined GTV.The PTV encompassed 1 cm proximal and distal margins,0.5 cm radiaI margin on the basis of CTV.Cervical,mediastinal and abdominal lymph nodes were delineated respectively.Equivalent uniform dose (EUD) and other dosimetric paraneters were calculated for each nodal station.Nodal region whose metastasis rate is greater than 5％ was considered a high risk lymph node subgroups.Results Under a 60 Gy dose prescription,the median Dmean and EUD,V40 and V50 were ≥40 Gy,≥85％ and ≥75％ in most of the high risk nodal regions.For the subgroups whose EUD were less than 40 Gy,most of the ⅡD of these regions was significantly associated with the length and location of esophageal tumor (r =0.892,P =0.000).Conclusions Lymph node stations nearby of ESCC received considerable ⅡD with involved-field irradiation which could control subclinical lesions.But more clinical studies should be needed.

Objective To study the incidence frequency of prothrombin G20210A (FⅡ G20210A)mutation in the patients with pulmonary thromboembolism(PTE)in northeast China,and to clarify the predictive value of FⅡG20210A mutation detection in PTE of the population in northeast China.Methods 60 PTE patients(PTE group) and 80 sex-matched healthy controls(control group)from the same geographic area were selected.All the patients were diagnosed by lung ventilation/perfusion scan and/or multi-slice CT pulmonary angiography(CTPA)as well as medical history.The genome DNA was extracted from the whole blood using alcohol.Polymerase chain reaction (PCR),restriction fragment length polymorphisms(RFLP)analysis with HindⅢ restriction enzyme and sepharose gel electrophoresis were used to identify the F Ⅱ G20210A mutation in PTE group and control group. Results After digested by HindⅢ restriction enzyme,only the fragments of 407 and 99 bp were found in PTE group.The frequency of FⅡ G20210A mutation was 0%,there was no statistical difference compared with contol group(P>0.05).There were no heterozygote and homozygote mutation of FⅡ G202210A gene in PTE group and control group.Conclusion The incidence of FⅡ G20210A mutation in the PTE patients in northeast China is very low,and the detection of FⅡ G20210A mutation may have no predictive value in PTE of the population in northeast China.

Objective To evaluate the clinical efficacy and toxicities of radical intensity-modulated radiotherapy (IMRT) combined with reduction in dose of prophylactic irradiation in the treatment of stage Ⅲ small cell lung cancer (SCLC).Methods A retrospective analysis was performed on the clinical data of 40 patients with stage Ⅲ SCLC who were admitted from January 2010 to August 2012.The prescribed dose was 60 Gy in 30 fractions to the primary gross tumor volume and was 54 Gy in 30 fractions to the planning target volume.All patients received induction chemotherapy,31 patients received adjuvant chemotherapy,and 22 patients received concurrent chemoradiotherapy;the platinum-based chemotherapy combined with etoposide or teniposide was adopted.Prophylactic cranial irradiation (25 Gy in 10 fractions) was administered to 17 patients.The short-term tumor response was evaluated by RECIST 1.0,and radiation-related toxicities were assessed by CTCAE 4.0.Overall survival (OS),local recurrence-free survival (LRFS),and progression-free survival (PFS) were calculated by Kaplan-Meier method.Results The short-term tumor response rate was 98％.The follow-up rate was 100％.Twenty-two patients were followed up for at least 2 years.The 1-and 2-year OS rates were 84％ and 48％,respectively; the LRFS rates were 89％ and 85％,respectively; the PFS rates were 61％ and 41％,respectively.Grade 0-1 radiation-related pneumonia was observed in 65％(26/40) of all patients,grade 2 in 25％ (10/40),grade 3 in 5％ (2/40),and grade 5 in 5％ (2/40).Grade 0-1 radiation-related esophagitis was observed in 53％ (21/40) of all patients,grade 2 in 43％ (17/40),and grade 3 in 5 ％ (2/40).Conclusions Preliminary results from this study suggested that IMRT combined with reduction in dose of prophylactic irradiation is safe and effective in patients with stage Ⅲ SCLC and is worth further evaluation in a large,prospective,randomized study.