Adult ; Coronary Occlusion ; therapy ; Extracorporeal Membrane Oxygenation ; Humans ; Male ; Treatment Outcome

Objective To compare the EC50 ～ EC95 for propofol and remifentanil targetcontrolled infusion(TCI)at loss of consciousness (LOC) and without response to a standard Hoxious painful stimulus in elderly and young adult patients.Methods A total of 102 (American society of anesthesiologists) ASA Ⅰ-Ⅱ patients undergoing elective surgery under general anesthesia were enrolled in this study and divided into control group (aged 18-64 years,n=52) and elderly group (aged≥65 yrs,n=52).Propofol TCI was started at target plasma concentration (Cp) of 1.2 mg/L and the Cp increased by 0.3 mg/L every 30s until loss of consciousness (LOC),kept the target effectsite concentration (Ce) of propofol at LOC.Remifentani TCI was started at Cp of 2.0 μg/L,increased by 0.3 μg/Levery 30s until loss of somatic response to a tetanic stimulus (50Hz,80mA,0.25ms,4s) Cp,Ce,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean artery pressure (MAP) and heart rate(HR) were recorded.The Ce of propofol at LOC,the Ce of remifentanil at loss of somatic response to noxious stimulus in 50％-95％ of the patients (EC50-EC95),and 95％ confidence interval were determined by probit method.The adjustment required for TCI propofol with remifentanil in elderly patients was explored.Results In elderly group,the propofol Ce at LOC was (2.0±0.3) mg/L,significantly lower than that in control group (2.9±0.2) mg/L (t=6.168,P＜0.01) and EC50-EC95 of remifentanil at loss of somatic response to noxious stimulus in elderly group (3.5-5.4) μg/L was similar to that in control group (3.7-5.9) μg/L.Conclusions For TCI propofol and remifentanil in elderly patients,the requirement of Ce of propofol is significantly decreased and Ce of remifentanil required in elderly patients is similar to adult patients.

Objective To investigate the pharmacodynamics of sufentanil required to inhibit the body movement induced by tetanic stimulation and skin incision when combined with propofol in patients undergoing thoracic or abdominal surgery. Methods Fifty ASA Ⅰ or Ⅱ patients aged 18-57 yr undergoing elective thoracic or abdominal surgery were randomized into 5 groups sufentanil target effect-site concentration (Ce) (n = 10 each):0.07, 0.10, 0.14, 0.20 and 0.28 ng/ml groups. Anesthesia was induced with TCI of propofol at the target plasma concentration of 3.0-3.2 μg/ml. As soon as the patients lost consciousness, infusion of sufentanil with the corresponding Ce was started in the each group. One tetanic stimulus (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) was given after the target effect-site and plasma concentrations were balanced. Tracheal intubation was facilitated with succinylcholine 1.5 mg/kg. The concentrations of propofol and sufentanil were maintained until 4 min after skin incision. The body movement was observed during tetanic stimulation and skin incision. The effective effect-site concentration (EC50, EC94) of sufentanil and 95% confidence interval (CI) were calculated using probit regression analysis. Results The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation when combined with propofol were 0.12 (95% CI 0.09-0.14) ng/ml and 0.20 (95% CI 0.17-0.31) ng/ml respectively. The EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 (95% CI 0.11-0.16) ng/ml and 0.21 (95% CI 0.17-0.29) ng/ml respectively. There was no significant difference in the EC50 and EC95 of sufentanil between the two different stimuli (P ＞ 0.05). Conclusion The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) when combined with propofol were 0.12 and 0.20 ng/ml respectively, the EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 and 0.21 ng/ml respectively and there was no significant difference in the pharmacodynamics between the two different stimuli, indicating that tetanic stimulation as an alternative to skin incision can be used to evaluate the pharmacodynamics of anesthetics.

An overall improvement of teaching quality is the core task of the reform and the development of higher education. Based on the analysis of the main factors of affecting the teaching quality in universities and combined with the implementation of “views on improving the overall qual-ity of higher education”by the Education Ministry, countermeasures for improving the teaching quality of undergraduates have been proposed such as increasing higher education funds investment to im-prove the condition of running a school, paying attention to the construction of teaching management staff to improve the level of teaching management, establishing Teacher Development Research Center to consolidate the fundamental position of undergraduate teaching , utilizing the high-quality social resources to implement the collaborative education innovation, and improving the personnel training system to strengthen the teaching quality standard .

AIM: To observe the efficacy of intravitreal injection with ranibizumab combined with laser photocoagulation for macular edema ( ME ) secondary to macular branch retinal vein occlusion( MBRVO) .
METHODS:A retrospective analysis included 33 patients (33 eyes) with ME secondary to MBRVO were taken. All patients received intravitreal injection of 0. 5mg ranibizumab ( 0. 05ml ) at first visit. The continue PRN treatment and laser photocoagulation were based on the visual acuity changes and optical coherence tomography findings. The changes of best corrected visual acuity ( BCVA) , central macular thickness( CMT) , and amplitude density and latency of P1 wave in mfERG were observed before treatment and 6mo after treatment.
RESULTS: Before the treatment, logMAR was 0. 68±0.35, 6mo after treatment was 0. 34±0. 23, BCVA was improved obviously ( P < 0. 01 ), BCVA in 21 patients ( 63.64%) were improved in two rows among all the patients. CMT before treatment was(487. 30±63. 58) μm, after treatment was(238. 84±52. 66) μm(P<0. 01). The amplitude densities of P1 wave in ring 1, ring 2 and ring 3 after treatment were significantly increased(all P<0. 01), and the latencies were decrease ( all P < 0. 05 ). The conjunctival hemorrhage was observed in 2 eyes after treatment.
CONCLUSION: Intravitreal injection with ranibizumab combined with laser photocoagulation for ME secondary to MBRVO can reduce the CMT and improve visual function.

G) in PTPS gene were identified in 7 families. The third fetus from two families were not affected by PTPS deficiency.

Objective:To study the effects of glutamine on the rehabilitation and the immune function in patients with acute stroke. Methods: The study included 57 patients with cerebral ischemia and 29 patients with brain hemorrhage.Nutritional and immune function parameters were evaluated at admission and after 2 weeks following stroke respectively.Neurological deficit was also evaluated by the Chinese Stroke Scale at admission and after 28 days following stroke.The infective complications were investigated. Results:At the same duration after acute stroke,the extent of neurological deficit recovery was significantly lower in the control group than the glutamine group.The rate of the infective complications was significantly higher and it's duration was significantly longer in the control group than the glutamine group.The degree of nutriture and immune function deteriorating was significantly severer in the control group than the glutamine peptide group. Conclusion:Parenteral glutamine supplements is helpful for the rehabilitation and in preventing deterioration of nutrition status and immune function following acute stroke.

Acclimatization ; physiology ; Animals ; Animals, Newborn ; Chickens ; Cold Temperature ; Endocrine Glands ; physiology ; Female ; Male ; Rats ; Rats, Wistar

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Ⅰ-gel for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients,aged 26-64 yr,weighing 54-90 kg,of ASA physical status Ⅰ-Ⅲ (Mallampati Ⅰ-Ⅲ),scheduled for elective laparoscopic surgery,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA I-gel.In group Ⅱ,the nasogastric tube was inserted through the nostril before surgery.In group Ⅲ,the nasogastric tube was inserted through the nostril before surgery,and another nasogastric tube was inserted through the drain tube of LMA I-gel after induction of anesthesia.The hemodynamic parameters,SpO2,PET CO2 and peak airway pressure were monitored during surgery.The fiberoptic laryngoscopy scores were assessed and the development of nasogastric tube displacement was recorded after successful LMA placement.The LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,and occurrence of air leakage of LMA and nasogastric tube drainage were recoded.The bloodstains and gastroesophageal reflux were observed after removal of LMA Ⅰ-gel.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA by using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after surgery.Results The hemodynamics was stable and SpO2,peak airway pressure and PETCO2 were all within the normal range during surgery,and Ppeak was lower than airway sealing pressure in the three groups.There were no significant differences between the three groups in LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,incidence of air leakage of LMA,fiberoptic laryngoscopy scores,time for removal of LMA I-gel,incidences of adverse reactions in the oropharynx,bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA.There was no nasogastric tube displacement in Ⅱ and Ⅲ groups.There were 7 patients developing gastric juice outflow from drainage tube of the LMA I-gel and 2 patients developing gastric juice outflow from the nostril gastrictubes in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA I-gel is easy,and I-gel LMA can assure good airway sealing and adequate ventilation.

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment.