OBJECTIVE: To identify the incidence and the risk factors for emergence agitation (EA) in adults undergoing general anesthesia for nasal surgery. METHOD: We examined 674 patients aged ≥ 18 years who underwent general anesthesia for nasal surgery between February 2013 and February 2015. The patients were divided into control group (518 cases) and EA group (156 cases) by Sedation-agitation scale (SAS) method. Demographic and clinical variables were assessed and the data were analyzed by multiple logistic regression analysis. RESULT: The overall incidence of emergence agitation was 23. 15%. Significant difference was observed between EA and the control group in many aspects, such as sex, age, ASA classify, smoking history, history of cerebrovascular disease, preoperative anxiety, the use of midazolam, anesthesia means, postoperative pain, postoperative analgesia, presence of a tracheal tube, and presence of a urinary catheter. The results of multiple logistic regression analysis indicated that the occurring of EA was significantly correlated with younger age, male, preoperative anxiety, inhalation anesthesia, postoperative pain, presence of a tracheal tube, and presence of a urinary catheter, while seniors, with the use of midazolam, total intravenous anesthesia, analgesia and natural awakening were protective factors. CONCLUSION EA following general anesthesia is a common complication in patients with adult nasal surgery. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in patients with risk factors.
Adult ; Age Factors ; Analgesia ; Anesthesia Recovery Period ; Anesthesia, General ; adverse effects ; Anesthesia, Inhalation ; Anxiety ; Female ; Humans ; Incidence ; Male ; Midazolam ; therapeutic use ; Nasal Surgical Procedures ; Pain, Postoperative ; Psychomotor Agitation ; physiopathology ; Risk Factors

Objective To investigate the influence of inhalation anesthestic desfluran (Des) on the learning and memory abilities of rats and the protective role of chrysophanol.Methods Totally,50 male and 50 female rats,aging 24 months and weighing (500 ± 10) g,were randomly divided into five groups:normal control group,Des group,low-,mediumand high-dose Chr group (0.1,1.0 and 10.0 mg·kg-1),with 20 rats in each group.After anesthetization for 24 h,the Morris water maze was used to investigate the abilities of learning and memory of rats.The amount of Aβ1-42 was determined by ELISA assay,and the apoptosis of rat hippocampal neurons in five group was observed by TUNEL assay.Furthermore,the expression levels of Bcl-2,Bax and Caspase-3 were examined by Western blotting.The activity of acetylcholinesterase in each rats hippocampus was determined using iron trichloride chromogenic spectrophotometer colorimetric analysis method.Results Compared with the normal control group,the mean escape latency of the rats in Des group was significantly prolonged;the spatial exploring time (29.85 ± 4.51) s was reduced;the apoptotic rate of neurons (0.742 ± 0.052)％,the amount of Aβ1-42 peptide (9 618.72 ± 1 076.43) pmol· g-1,the expression levels of Caspase-3 (1.132 ± 0.217),and Bax (1.298 ± 0.209) were increased;the expression of Bcl-2 (0.318 ±0.038) were reduced;the activity of acetylcholinesterase (96.38 ±7.62) U·mL-1 was increased.Compared with the Des group,the rats in all Chr groups obtained shorter escape latency and longer spatial exploring time;the amount of Aβ1-42 peptide and the expression levels of Caspase-3 and Bax were down-regulated;the activity of acetylcholinesterase was reduced.In addition,chrysophanol improved the abilities of learning and memory of anesthetic rats in a dose-dependent manner.Conclusion Chrysophanol could improve the abilities of the learning and memory of rats after desflurane anesthesia,along with inhibition of Aβ deposition.

Objective To investigate the effect of resveratrol (RES)on sevoflurane-induced nerve cell injury and its mechanism.Methods Fetal hippocampal tissues were taken from SD pregnant rats and primary nerve cells were isolated and cultured,then the cells were randomly divided into four groups:group control (group C),normal primary nerve cells;group 3% sevoflurane (group S),cells treated with 3% sevoflurane gas;group 3% sevoflurane+RES (group SR),cells treated with RES for 6 h,and then treated with 3% sevoflurane gas;group RES (group R),cells treated with RES.Flow cytometry assay was used to detect the apoptosis of nerve cell;CCK-8 Kit was used to detect cell proliferation;Western blot was used to detect the expression level of Caspase-3,Bax,Bcl-2 and Bace-1;ELISA method was used to detect the protein level of amyloid precursor protein (APP)andβ-amyloid peptide (Aβ).Results Compared with the group C,cell apoptosis was increased (P <0.05),cell proliferation was decreased (P <0.05),the expression levels of Caspase-3 and Bax were up-regulated (P <0.05),the expression level of Bcl-2 was down-regulated (P <0.05), and the protein levels of Bace-1,APP and Aβwere significantly decreased by 3% sevoflurane treat-ment (P <0.05),which were all significantly reversed by RES treatment.Compared with group S, cell apoptosis was decreased (P <0.05),cell proliferation was increased (P <0.05),the expression levels of Caspase-3 and Bax were down-regulated (P <0.05),the expression level of Bcl-2 was up-regulated (P <0.05),and the protein levels of Bace-1,APP and Aβwere increased in group SR (P <0.05).Conclusion Resveratrol alleviated sevoflurane-induced nerve cell injury in vitro by reducing cell apoptosis and promoting cell proliferation,which may be related with the reduction of Aβexpression and the reduced Aβ-induced neurotoxicity.

AIM: To explore the influence of clonidine on inflammatory response in lung injury mice and its possible mechanism.METHODS: Clonidine solution was intravenously injected into the mice with lung injury induced by LPS.The left upper lobe of the lung was collected to detect lung wet/dry weight ratio (W/D) and total lung water content (TLW).The concentrations of IL-6, IL-1β and TNF-α were measured by ELISA.The expression of α7 nicotinic acetylcholine receptor (α7nAChR) and high-mobility group box protein 1 (HMGB1) at mRNA and protein levels was determined by RT-PCR and Western blot.After importing α7nAChR siRNA lentiviral vector or injecting exogenous HMGB1 protein, the inflammatory cytokines were detected.RESULTS: Clonidine attenuated lung injury and inhibited inflammatory reaction.Clonidine promoted the activation of cholinergic anti-inflammatory pathway by promoting α7nAChR expression.Clonidine inhibited HMGB1 expression, which promoted the secretion of IL-6, IL-1β and TNF-α.HMGB1 was negatively regulated by α7nAChR.CONCLUSION: Clonidine functions as an anti-inflammatory reagent to the lung injury mice.The mechanism may be related to activating the cholinergic anti-inflammatory pathway and inhibiting the expression of HMGB1.

Objective To study the method and efficacy of repairing cup ear deformity.Methods The mild cup ears were corrected by V-Y advanced flaps and retroauricular flaps(seventeen ears),and the severe cup ears corrected by rotate composite flaps of concha auriculae and retroauricular flaps(six ears).The donor defects were sutured in place in seven cases and repaired by skin grafting in six cases.From March 2000 to November 2005,sixteen cases(twenty-three ears),eleven patients were male and five female,with age range from eight to thirty-six years,were treated by the procedures mentioned above.Among them,twelve cases were mild cupping(five bilateral ears) and four cases severe cupping(two bilateral ears).Results All flaps survived with primary healing after operation.Follow-up from six months to two years showed that all the patients had achieved satisfactory appearance of external ear and obvious improvement of contour of auricle and cavity of concha.Conclusion V-Y advanced flap and rotate composite flap are effective methods for the correction of cup ear deformity.The rational using of retroauricular flap and fixation of contour of auricle and cavity of concha are also the key points for the operation.

BACKGROUND:Nano-Ag is increasingly used as antibacterial materials in medical products due to its excelent antibacterial activity. Antibacterial activated nano-Ag-SiO2 OBJECTIVE: To evaluate the biosecurity of nano-Ag-SiO urethral catheter can reduce the incidence of catheter-associated urinarytract infections obviously. As more and more nano-Ag medical products have been developed, their biological security is becoming a focused issue. 2 urethral catheter through comparing the active influence of nano-Ag-SiO2 METHODS: Mechanical separation and enzymatic digestion were used to isolate and culture urothelial mucosa of benign prostatic hyperplasia patients to make cellsuspension after proliferationin vitro. The medium was replaced by nano-Ag-SiO urethral catheter and ordinary urethral catheter extracts onin vitro cels of human prostatic urethra epithelial cels in different periods. 2 and general catheter tube extracts, respectively. MTT assay was performed to quantify thein vitro cytotoxicity of two extracts on human urethra epithelial cels which were cultured for 2, 5 and 7 days. Absorbance values of nano-Ag-SiO2 RESULTS AND CONCLUSION:The cytotoxicity of extract of nano-Ag-SiO and general urinary catheter groups were measured by enzyme-linked immunosorbent assay to calculate the relative growth rate, and toxicity evaluation was compared and evaluated. Under an inverted microscope, cellmorphology, growth and proliferation were observed. 2 catheter was 1 grade, and that of general medical catheter extract was 0 to 1 grade. There was no statistical difference in group effect of relative proliferation rate (F=0.544,P=0.475); there was statistical difference in time effect of relative proliferation rate (F=3.031,P=0.086); no statistical difference was found in the interaction between group and time (F=0.130, P=0.879). These findings indicate that nano-Ag-SiO2 catheter has no or low cytotoxicity effect on cellgrowth and proliferation, which is consistent with the biological evaluation standards of medical devices.

Objective To study the relationship between serum macrophage migration inhibitory factor (MIF) levels and clinical features in the patients with colorectal cancer. Methods Enzyme-linked immunosorbent assays was used to detect the concentration of MIF in sera of 75 patients with colorectal cancer (35 case with primary colorectal cancer and 40 cases with lymphnode metastasis of colorectal cancer) and 40 healthy controls. The relationship between serum MIF levels and clinical features was analyzed. Results Serum MIF was found to be significantly elevated in the patients with colorectal cancer(mean value 31.2ng/ml) compared with healthy subjects (mean value 13.6ng/ml) (P <0. 001). The levels of MIF in colorectal cancer were significantly correlated with advanced clinical progression pathology stages (P <0. 05) and lymph node metastasis (P < 0. 05). Conclusions Increased expression level of MIF in serum may promote the pathogenesis of colorectal cancer and M1F is closely associated with the stages and lymph node metastasis of colorectal cancer.

Objective To detect the distribution of cerebral microbleeds (CMBs) in patients with lacunar infarction (LI) and/or leukoaraiosis (LA) and to analyze the correlation between the CMB related risk factors and cognitive impairment.Methods Thirty-eight patients with LI and/or LA were divided into either a CMB group or a non-CMB group according to the findings of susceptibility weighted imaging.The number of CMB lesions was recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to conduct cognitive function tests,and the patients were also divided into a cognitive impairment group and a non-cognitive impairment group according to the MoCA scores.The demographic and clinical data in each group were compared.The independent risk factors for CMBs and cognitive impairment were identified.Results Thirteen patients had 58 CMBs in the CMB group.Their distributions were as follows:36 CMBs in basal ganglia and thalamus,14 in cortical and subcortical regions,3 in brain stem,and 5 in cerebellum.There were 25 patients in the non-CBM group,26 in the cognitive impairment group,and 12 in the non-cognitive impairment group.There were significant differences in age and the proportions of hypertension,taking antithrombotic drugs and the patients with LA between the CMB group and the non-CMB group (all P ＜ 0.05).Multivariable logistic regression analysis showed that only age was an independent risk factor for CMBs (odds ratio 1.103,95％ confidence interval 1.034-1.454; P =0.045).MMSE (26.92±2.87vs.29.00± 1.44; t=2.452,P=0.027) and MoCA (21.62±3.36vs.25.04 ± 2.59; t =-3.493,P =0.001) scores in the CMB group were significantly lower than those in the non-CMB group.There was only significant difference in the number of CMBs between the cognitive impairment group and the non-cognitive impairment group (2.08-± 3.64 vs.0.33 ±0.78; t =-1.629,P =0.010).Multivariate logistic regression analysis showed that only the number of CMBs was an independent risk factor for cognitive impairment (odds ratio,1.534,95％ confidence interval 1.100-2.576; P=0.046).Spearman rank correlation analysis showed that the number of CMBs was significantly negatively correlated with the MoCA language (r =-0.229,P=0.003) and the delayed recall (r =-0.332,P=0.042) scores.Conclusions In patients with LI and/or LA,CMBs were correlated with age.Their existence and number were associated with cognitive impairment.

Objective To investigate the value of preoperative contrast -enhanced ultrasound (CEUS)in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer.Methods A retrospective analysis was performed for the clinical data of 25 patients with pancreatic cancer confirmed by surgical exploration or postoperative pathological examination,who visited Shengjing Hospital of China Medi-cal University from December 2012 to October 2014,and all the patients underwent CEUS before surgery.The relationship between the le-sion and the peripancreatic vessels was observed,the degree of invasion was evaluated,and related scores were measured.These results were compared with the results of intraoperative exploration and postoperative pathological results.The rate of peripancreatic vascular invasion, sensitivity and specificity of preoperative CEUS in evaluating the degree of peripancreatic vascular invasion,and sensitivity,specificity,pos-itive predictive value,negative predictive value,overall coincidence rate,and Youden index of CEUS in evaluating the resectability of pan-creatic cancer were calculated.Results Preoperative CEUS showed that 42 vessels were invaded,while intraoperative exploration showed 41 vessels were invaded.A total of 17 patients were considered resectable by CEUS,while 15 patients were considered resectable by intraop-erative exploration.In evaluating the resectability of pancreatic cancer,CEUS had a sensitivity of 93.3%,a specificity of 70.0%,an over-all coincidence rate of 84.0%,a false positive rate of 30.0%,a false negative rate of 6.7%,a positive predictive value of 82.4%,a nega-tive predictive value of 87.5%,and a Youden index of 0.633.Conclusion Compared with intraoperative exploration,CEUS has higher sensitivity and specificity in evaluating the degree of peripancreatic vascular invasion and higher sensitivity,specificity,and coincidence rate in evaluating the resectability of pancreatic cancer.CEUS can accurately evaluate the degree of peripancreatic vascular invasion and provides a new method for preoperative evaluation of the resectability of pancreatic cancer.

Biliary atresia is a disease characterized by progressive inflammation and fibrosis of intrahepatic and extrahepatic bile ducts, which is an important cause of persistent jaundice in infants, Without timely treatment, it can develop rapidly into cirrhosis, and the child will die of liver failure. Therefore, the early diagnosis of biliary atresia is particularly important. The diagnosis of biliary atresia mainly depends on intraoperative cholangiography and liver biopsy, but they have the disadvantages including invasion, complex operation and many complications, which is not conducive to the early diagnosis of biliary atresia. In comparison, some non-invasive examination methods such as laboratory examination and imaging examination have obvious advantages. In this paper, the value of various diagnostic methods of biliary atresia is analyzed, which provides new ideas for its early diagnosis.