Objective To investigate the optimal dose of remifentanil combined with dexmedetomidine for awake tracheal intubation.Methods 60 cases with difficult airway general anesthesia surgery from March 2014 to August 2016 in Jinhua People's Hospital were selected and divided into group R1,R2,R3,20 cases in each group.0.6μg/kg dexmedetomidine 10 minutes micro pump intravenously,Simultaneous target-controlled infusion effect of the chamber concentration of remifentanil.2.0ng/mL remifentanil in group R1,2.3ng/mL remifentanil in group R2,2.5ng/mL remifentanil in group R3.All patients underwent full surface anesthesia with 2％lidocaine under visual soft mirror guidance.The heart rate(HR),mean arterial pressure(MAP)and Ramsay sedation score at before anesthesia(T0),at the end of the administration(T1),intubation(T2),immediately after intubation(T3),tracheal catheter placement reaction score and record tracheal intubation during respiratory depression,cardiovascular adverse events,postoperative follow-up of tracheal intubation process satisfaction.Results MAP,HR and RR at T2,T3 in group R1 were significantly higher than those in group R2 and R3,the difference was statistically significant(P<0.05).The incidence of hypertension in the group R3 was significantly lower than that in group R1,while the incidence of respiratory depression and tachycardia was significantly higher than that in group R1,the difference was statistically significant(P<0.05),RSS score and satisfaction scores in group R3 were significantly higher than those in group R1,the reaction score in group R3 was significantly lower than the group R1,the difference was statistically significant(P<0.05).Within group comparison,the mean arterial pressure and heart rate and respiratory rate at T2 and T3 in group R1 was significantly higher than those at T1,heart rate was significantly faster than T1,the respiratory rate was significantly faster than T1,the difference was statistically significant(P<0.05),T2 and T3 in group R3 were significantly slower than those at T0,the difference was statistically significant(P<0.05).Conclusion Remifentanil combined with dexmedetomidine can be safely and effectively used for awake intubation under glidescope guiding in difficult airway patients.In the full airway surface anesthesia,dexmedetomidine micropump 0.6μg/kg simultaneous target transfusion effect of the concentration of remifentanil 2.3ng/mL is a more reasonable medication.

AIM: To establish the methods of quality control of Kangxian Pills (Redix Astragali,Radix Angelicale Sinensis,Rhizoma Chuanxiong,Radix Scutellariae,Fructus Schisandrae Chinensis,etc.). METHODS: Radix Angelicae sinensis;Rhizoma Chuanxiong;Radix Astragali;Radix Scutellariae were identified with TLC and the content of deoxyschizandrin and schisandrin B in the Kangxian Pills were determined by HPLC The separation was performed on Diamonsil~(TM) C_(18)(4.6 mm?250 mm,5 ?m)analytical column with a mobile phase consisted of methanol and water(78(∶)22) at the flow rate of 1.0 mL/min.The UV detection wavelength was set at 254 nm first and was altered to 220 nm after 17 min. RESULTS: The same color spots in the TLC graphs of sample existed at the corresponding position compared with the reference solution.The linear range of deoxyschizandrin was within 0.39-(1.95) ?g(r=0.999 9).The average recovery was 98.8%,RSD was 1.7%.The linear range of schisandrin B was within 0.09-0.45 ?g(r=0.999 9).The average recorery was 99.1%,RSD was 1.7%. CONCLUSION: The methods are simple and have good reproducibility.

The efficacy of constructivism teaching mode in physical diagnostics teaching was evaluated in this study. We built up the constructivism teaching mode in diagnostics teaching taking the clinical symptoms as the theme, and through such aspects as courseware design, teaching plan preparation, SP playing and inquiry, SimMan simulated physical examination, condition analysis, etc. Then questionnaires were conducted to analyze the role of the constructivism teaching mode in diagnostics teaching. The diagnostics constructivism teaching mode can provide students with a platform for self-construction of diagnostics and integrated application of knowledge. Meanwhile, students' sense of participation can be improved and multiple learning skills are enhanced during the course.

Objective To analyze the clinical characteristics of cerebral syphilitic gunma.Method The clinical characteristics,brain CT and MRI results and prognosis of 7 patients with cerebral syphilitic gumma admitted in Beijing Ditan Hospital from June 2012 to October 2016 were retrospectively analyzed.Results There were 5 females and 2 males in 7 patients.The symptoms or signs at onset were headache (n =5),increased white blood cells in cerebrospinal fluid (n =6) and increased protein contents in cerebrospinal fluid (n =6).Total 10 lesions were detected in 7 cases,including 7 in cerebral lobe,and 3 in cerebellum,corpus callosum or intercrural space.The brain MRI showed nodular reinforcement in 5 cases,irregular circular reinforcement in 2 cases and obvious edema around the lesions in 6 cases.The patients were given intravenous infusion of 400 million units common penicillin,q.4h for 2 wks,sequential intramuscular injection of 240 million units long-term penicillin q.w for 3 wks.Among 7 patients,1 case died,1 case showed symptomatic improvement and 5 cases obtained complete improvement with the significant imaging improvement.Conclusion Headache is the most common symptom at onset of cerebral syphilitic gumma,and the lesions mostly are located in the cerebral lobes with nodular enhancement in brain imaging,and the prognosis is generally good.

Objective To evaluate the efficacy and safety of two forms of preparations of dexamethasone palmitate in the treatment of rheumatoid arthritis (RA).Methods A multicenter,double-blind,randomized,parallel-group clinical trial was carried out according to good clinical practice (GCP).A total of 237cases of RA patients with mild to moderate knee swelling were randomly divided into the treatment group (n=118 ) or the control group (n=119) and were treated with two kinds of dexamethasone palmitate 8 mg injection respectively.The primary efficacy endpoints were the circumference of the knee joint at the upper and the lower edge after the intra-articular injection.The secondary efficacy endpoints were joint tenderness index and patients general assessment.The adveme events were recorded.Analysis of covariance,t test or Wilcoxon test,x2 test or Fisher exact test were used for statistical analysis.Results The upper edges of the treatment group and the control group after treatment were (37.2±3.3) cm and (36.4±3.9) cm respectively,and the lower edges of the two groups were (34.4±2.9) cm and (33.9±3.4) cm respectively.They were all significantly smaller than the edges before treatment [(38.1± 3.3) cm and (37.3±4.0) cm of the upper edges,(35.1±3.0)cm and (34.6±3.6) cm of the lower edges respectively ) (P＜0.O1)].After treatment,the joint tenderness index were improved (P＜0.01).A total ratio of great improvement and improvement of patients general assessment of the two group patients were 67.5％ (79/117) and 74.8％ (86/115) respectively.No statistical significant difference was found in all primary and secondary efficacy endpoints between the two groups (P＞0.05).During the clinical trial,the incidence of adverse events related to the treatment of two groups were 4.2％ and 6.8％,without any significant difference (P＞0.05).Conclusion New preparation of dexamethasone palmitate has the same efficacy and safety as the imported producted in the treatment of RA.The circumference of the knee joints at the upper and the lower edge may be used to assess the effects of intra-articular injections.

OBJECTIVETo investigate the association of two single nucleotide polymorphisms (SNPs) of beta 2-adrenoceptor (beta 2-AR) gene with hypertension in elderly patients.

METHODSThe study samples were collected from unrelated Chinese Han population of Dabie Mountain in Anhui province. Eighty-six elderly patients with hypertension and 43 controls were selected. Genotypes of +1053 and +1239 SNPs were typed by polymerase chain reaction-restriction fragment length polymorphism.

RESULTSThe frequencies of the two SNPs complied well with the Hardy-Weinberg equilibrium in normal group. The distribution of genotypes AA, GA,GG of the SNP at locus +1239 in moderate and severe hypertension group was significantly different from that in normal group (chi square=8.67, P<0.05). There were evident differences in the frequencies of alleles of the two groups (chi square=4.02, P<0.05). No significant difference was observed in the distribution of genotypes of the SNP at locus +1053 between the two groups.

CONCLUSIONThese data indicate that the SNP at locus +1239 of beta 2-AR gene is associated with hypertension in elderly patients.

Aged ; Aged, 80 and over ; Alleles ; DNA ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertension ; genetics ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; genetics ; Receptors, Adrenergic, beta-2 ; genetics

Objective:To discuss the influencing factors of neonatal scalp hematoma, and provide a basis for reducing the occurrence of neonatal scalp hematoma.Methods:Retrospectively analyzed the data of 13 151 parturients and their newborn infants who delivered in the Hangzhou Women′s Hospital from January to December 2020, counted the incidence of neonatal scalp hematoma, and Logistic regression analysis was used to analyze its influencing factors.Results:Among 13 151 newborn baby, 68 cases of neonatal head hematoma occurred, the incidence was 0.52%. Vaginal delivery, forceps, intraspinal analgesia were statistically significant in the occurrence of neonatal scalp hematoma ( χ2=19.26, 19.59, 6.11, all P<0.05). Conclusions:Vaginal delivery, forceps, and intraspinal analgesia are the risk factors for neonatal scalp hematoma. Lateral perineal incision during delivery did not reduce the incidence of neonatal scalp hematoma. In this study, many cases of neonatal scalp hematoma occurred before the crown of the fetal head. Labor management, improve the rate of non-drug analgesia, promote natural delivery, early detection, early prevention, and reduce the incidence of neonatal hematoma.

Objective:To analyze the therapeutic effect and safety of simultaneous integrated boost intensity-modulated radiotherapy for lung cancer brain metastases.Methods:A total of 300 patients with lung cancer brain metastases admitted to the Department of Oncology, Qingdao Municipal Hospital from March 2021 to March 2023 were selected as the study objects. The patients were divided into control group ( n=150) and study group ( n=150) by random number table method. The control group received sequential three-dimensional conformal radiotherapy, while the study group received simultaneous integrated boost intensity-modulated radiotherapy. The short-term and medium-term efficacy, target dose, and adverse reactions were compared between the two groups. Results:The short-term and medium-term total effective rates of the study group were 73.33% (110/150) and 88.67% (133/150), respectively, which were higher than those of the control group [51.33% (77/150) and 71.33% (107/150) ] ( χ2=15.46, P<0.001; χ2=14.08, P<0.001). The D min in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (23.78±1.11) and (58.46±0.55) Gy, respectively, which were higher than those in the control group [ (16.67±1.08) and (53.44±0.74) Gy], with statistically significant differences ( t=56.22, P<0.001; t=66.68, P<0.001). The D mean in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (44.12±0.87) and (62.19±0.57) Gy, respectively, which were higher than those in the control group [ (37.55±0.89) and (57.78±0.82) Gy], with statistically significant differences ( t=64.65, P<0.001; t=54.08, P<0.001). The total incidence of adverse reactions was 30.67% (46/150) in the study group and 36.67% (55/150) in the control group, with no significantly significant difference ( χ2=1.20, P=0.271) . Conclusion:Compared with sequential three-dimensional conformal radiotherapy, simultaneous integrated boost intensity-modulated radiotherapy has better short-term and medium-term efficacy in patients with lung cancer brain metastases. Target dose can be increased without increasing adverse reactions.

Objective:To study the clinical and CT features of the abnormal whole-course wide of eustachian tube (AWWET) with microtia and atresia(MA).Methods:The clinical and CT data of 19 patients (20 ears) from January 2017 to December 2021 with AWWET with MA were retrospectively analyzed, including 15 males and 4 females. The age ranged from 5 to 16 years, with an average of 9.5 years. 50 patients with common MA without wide eustachian tube(ET) as a case control group, including 32 males and 18 females.The age ranged from 5 to 16 years, with an average of 9.2 years. 20 patients (40 ears) who had normal ear CT for tinnitus, otalgia as a normal control group, including 12 males and 8 females. The age ranged from 5 to 16 years, with an average of 12.5 years. We measured the dimension and length of the bony portion of the ET, the total length, the angle between the bony portion and the cartilage portion, and the horizontal angle of ET on CT imagings, and compared with 40 normal ears by SPSS 27.0 software.Results:According to the relationship between AWWET and tympanum, patients were divided into the communicated group and the blocked group. A male predominance, left ear predominance, with high incidence of hemifacial microsomia exhibited in both groups. AWWET was presented as a widened lumen on CT. In 11 ears (4 ears in the communicated group, 7 ears in the blocked group), ETs bifurcated, the upper bony tube extended to the sphenoid body, the lower part continued down to cartilaginous ET and opened onto the nasopharynx, with"mastoid-like"pneumatization of the sphenoid body in 6 ears. The middle ear deformity in case group was more serious than MA control group, especially the blocked group. The incidence of otitis media in the communicated group was lower than that in the MA control group, and 4 cases in the blocked group had effusion in the ET. Compaired with normal ear, the bony ET elongated significantly in the AWWET groups, and the whole course of ET was significantly shortened, specially in the blocked group. The angle between the bony ET and the cartilaginous ET was decreased and the horizontal angle of the ET increased in the AWWET groups, the difference was considered to indicate statistical significance( P<0.05). Conclusions:AWWET with MA is rare, a male predominance, left ear predominance, and with high incidence of hemifacial microsomia. The middle ear deformity is more serious than common MA, especially in the blocked group. The incidence of otitis media in the communicated group is significantly lower than that in the common MA, and the blocked group may be accompanied by ET inflammation.

Objective To develop a convolution neural network (CNN) model to classify multi?sequence MR images of the prostate. Methods ResNet18 convolution neural network (CNN) model was developed to classify multi?sequence MR images of the prostate. A deep residual network was used to improve training accuracy and test accuracy. The dataset used in this experiment included 19 146 7?sequence prostate MR images (transverse T1WI, transverse T2WI, coronal T2WI, sagittal T2WI, transverse DWI, transverse ADC, transverse PWI), from which a total of 2 800 7?sequence MR images was selected as a training set. Three hundred and eighty eight 7?sequence MR images were selected as test sets. Accuracy was used to evaluate the effectiveness of ResNet18 CNN model. Results The classification accuracy of the model for transverse DWI, sagittal T2WI, transverse ADC, transverse T1WI, and transverse T2WI was as high as 100.0% (44/44,52/52), and the accuracy for transverse PWI was also as high as 96.7% (116/120). The accuracy for coronal T2WI was 77.5% (31/40). 0.8% (1/120) of transverse PWI was incorrectly assigned to transverse T2WI, and 2.5% (3/120) incorrectly assigned to sagittal T2WI. 15.0% (6/40) of coronal T2WI was incorrectly assigned to transverse T2WI, and 7.5% (3/40) to sagittal T2WI. Conclusion The experimental results show the effectiveness of our deep learning method regarding accuracy in the prostate multi?sequence MR images detection.