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

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.

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.

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

ObjectiveTo evaluate the therapeutic effect of endoscopic full-thickness resection (EFTR) for gastric stromal tumors.MethodsA total of 33 patients with gastric stromal tumor orgination from deep muscularis propria layer received EFTR from January 2010 to July 2011.The effectiveness and safety of EFTR were compared with those of other 34 patients with gastric stromal tumor origination from muscularis propria layer who underwent endoscopic submucosal dissection (ESD).ResultsExcept in 2 patients with lesions larger than 3.0 × 3.0 cm,EFTR was successful in others 31 patients,who recovered well and had no recurrence during the follow-up within 12 months.There were no significant differences in resection rate,incidence of complications,body temperature,white blood cell counts or recovery time between 2 procedures (P ＞ 0.05 ).However,the number of clips used in EFTR ( 7.0 ± 3.5 vs.4.9 ± 3.1,P =0.013 ) and postoperative fasting days (3.4 ± 1.5 vs.2.0 ± 1.0,P =0.001 ) were significantly higher than those of ESD procedures.ConclusionEFTR is effective and safe for gastric stromal tumors with no higher risk than ESD,but it is more complex technically.EFTR can be used as an expanding method of ESD in endoscopic treatment of gastric stromal tumors.

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel in patients required insertion of nasogastric tube before laparoscopic surgery. Methods Fifty-five ASA Ⅰ - Ⅲ patients ( Mallampati Ⅰ -Ⅲ ), aged 26-64 yr, weighing 54-73 kg, scheduled for elective laparoscopic surgery were randomly divided into 2 groups: group Ⅰ ( n= 28) and group Ⅱ ( n = 27). The size of i-gel LMA was chosen based on the patient' s weight, and i-gel LMA was inserted after induction of anesthesia with TCI of propofol and remifentanil, and iv injection of rocuronium. In group Ⅰ , the nasogastric tube was inserted through the drain tube of i-gel LMA. In group Ⅱ , the nasogastric tube was inserted through the nostril before operation. The hemodynamic parameters, SpO2 ,PETCO2 and peak airway pressure were monitored during operation. The fiberoptic laryngoscopy scores were assessed and nasogastrice tube displacement was recorled after successful LMA placement. The LMA placement time, success rate of LMA placement at the first attempt, airway sealing pressure, the occurrence of air leakage of LMA, and nasogastric tube drainage were recorded. The problems after removal of the LMA were observed and the adverse reactions within 24 h after operation were recorded. Results The hemodynamics was stable and the SpO2,peak airway pressure were within the normal range during operation in both groups. There was no significant difference in the LMA placement time, success rate of LMA placement at the first attempt, nasogastric tube drainage rate, airway sealing pressure, incidence of air leakage, fiberoptic laryngoscopy scores, problems after removal of the LMA and adverse reactions between the two groups ( P ＞ 0. 05). Conclusion i-gel LMA can provide adequate ventilation and does not interfere with the nasogastric tube drainage during laparoscopic surgery and can be used effectively for the patients required insertion of nasogastric tube before operation.