ObjectiveTo compare the efficacy of dexmedetomidine and remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope.MethodsForty ASA Ⅰ -Ⅲ aged 18-73 patients with difficult airways undergoing awake nasotracheal intubation assisted by fiberoptic bronchoscope were randomly divided into 2 groups ( n =20 each): dexmedetomidine group (group D) and remifentanil group (group R).A loading dose of dexmedetomidine 1.0 μg/kg was injected iv and then infused at a rate of 0.5 μg·kg-1 ·h-1 in group D.Remifentanil was target controlled-infused with target plasma concentration of 3.2 ng/ml in group R.Awake nasotracheal intubation was performed after dexmedetomidine loading dose was injected in group D and when the target plasma concentration of remifentanil was reached.Ramsay score was recorded during intubation,and intubation conditions (vocal cord movement,coughing,limb movement) and tolerance (during and after intubation) were evaluated.The intubation time,rate of successful intubation,side effects during intubation and 24 h after surgery,satisfactory score of patient with intubation and memory of intubation were recorded.ResultsRamsay score,the first attempt success rates of intubation and satisfactory score of patients with intubation were significantly higher,intubation conditions and tolerance were better,intubation time was shorter,incidence of side effects and memory score of intubation were lower in group D than in group R ( P ＜ 0.05).ConclusionDexmedetomidine provides better intubation conditions,less side effects and awareness of intubation than remifentanil for awake nasctracheal intubation assisted by fiberoptic bronchoscope.

Objective To compare the efficacy of dexmedetomidine and pethidine for prevention of postoperative shivering in patients requiring general anesthesia.Methods Sixty ASA Ⅰ-Ⅲ patients of both sexes,aged 18-75 yr,weighing 40-85 kg,were randomly divided into 2 groups (n =30 each) ∶ pethidine group (group P) and dexmedetomidine group (group D).At the end of pneumoperitoneum,pethidine 0.5 mg/kg and dexmedetomidine 1 μg/kg were infused intravenously over 10 min in groups P and D,respectively.The shivering,respiratory depression,somnolence,nausea and vomiting,bradycardia and hypotension were recorded within 1 h after operation.Results There were no significant differences in the incidence and degree of shivering between group D and group P (P ＞ 0.05).The incidences of respiratory depression and nausea and vomiting were significantly lower,and the incidence of bradycardia was significantly higher in group D than in group P(P ＜ 0.05).Conclusion The efficacy of dexmedetomidine for prevention of postoperative shivering is better than pethidine in patients requiring general anesthesia.

Objective To evaluate the efficacy of I-gel laryngeal mask airway (LMA) for airway management in patients undergoing radical mastectomy.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients (Mallampati Ⅰ or Ⅱ),aged 25-64 yr,weighing 45-90 kg,with body mass index ＜ 30 kg/m2,scheduled for elective radical mastectomy under general anesthesia,were randomized into 2 groups (n=60 each): I-gel LMA group (group Ⅰ) and Classic LMA (group C).Anesthesia was induced with iv midazolam 0.04 mg/kg and vecuronium 0.10 mg/kg.I-gel and classic LMAs were inserted in I and C groups,respectively,after induction of anesthesia.The success rate of LMA placement at first attempt,LMA placement time,airway sealing pressure,peak airway pressure,leaks and hypoxemia,and complications (nauseas and vomiting,bucking,aspiration and blood stain on the LMAs,sore throat and hoarseness within 24 h after surgery) were recorded.Correct position of the LMAs was verified by fiberoptic bronchoscopy.Results The success rate of LMA placement were 100 ％ in both groups.The success rate of LMA placement at first attempt and fiberoptic bronchoscope scores were higher,the LMA placement time was significantly shorter,and the incidence of blood stain on the LMAs and sore throat were significantly lower in group Ⅰ than in group C (P ＜ 0.05).A transient increase in airway pressure and leaks occurred in 5 patients in group C,and the airway pressure returned to normal and no leaks developed after treatment.No transient increase in airway pressure and leaks occurred in group Ⅰ.Hypoxemia was not found in both groups.Conclusion The placement of I-gel LMA is easier than that of Classic LMA and the success rate of placement at first attempt is high,with fewer complications.I-gel LMA can be safely and effectively used for airway management in patients undergoing radical mastectomy.

Objective To analyze the emergency-event in patients with obstructive sleep apnea-hypopnea syndrome( OSAHS), and to discuss the risk factors and preliminary strategies for prevention of emergency-event. Method A total of 257 OSAHS patients in Zhejiang Provincial Peoples Hospital, were enrolled from January 2000 to December 2009 for the retrospective study. Demographics of patients include age, sex,height, weight, related diseases, AHI and LSaO2 before operation , the way of anesthesia and operation,when and how the emergency-events happened, the way to cure and the results. Risk facts of emergency-event were analyzed by using univariate analysis and multiple logistic regression analysis. Results Of the 257patients, the incidents of emergency-event was 7.3%. The independent risk factors of emergency-event were general anesthesia, multiple level surgery in one time, BMI and AHI. Performing CPAP treatment before operation had a beneficial effect to the avoidance of emergency-event. Conclusions Emergency-event are more common in severe OSAHS patients, especially when they were operated under general anesthesia and multiple level surgery in one time. Performing CPAP treatment before operation had a beneficial effect to the avoidance of emergency-event.

BACKGROUND:Propagation phase contrast tomography can greatly improve the spatial resolution of chondrocytes and microvessels depending on the high colimation and high coherence performance of hard X-ray. OBJECTIVE: To detect the alteration of angioarchitecture after spinal cord injury in rats using propagation phase contrast tomography. METHODS: Eight male Sprague-Dawley rats were divided into two groups: in experimental group, an acute spinal cord injury model was induced in rats by the modified Alen’s method; in sham control group, rats were subjected to laminectomy. At 1 day after operation, normal and injured spinal cord segments were taken and treated with formaldehyde-methyl salicylate sequentialy for 48 hours. The segments were scanned by propagation phase contrast tomography in BL13W1 beamline experimental station of Shanghai Synchrotron Radiation Facility, China. Harvested data were analyzed by VGStudio Max 2.1 software for three-dimensional reconstruction and microvasculature quantitative analysis. RESULTS AND CONCLUSION:The propagation phase contrast tomography successfuly simulated the morphology of angioarchitecture folowing spinal cord injury. After acute spinal cord contusion, the destruction of nerve tissues was accompanied by severe microvasculature damage. Intramedulary tissue damage and loss of blood supply was spread from the central zone to the ends. Three-dimensional microvascular quantitative data showed that after spinal cord contusion, the number of microvessels and vascular perfusion volume drasticaly reduced (P < 0.01). These findings indicate that the propagation phase contrast tomography without angiography has potential as a new ultra high-resolution visualization technique for three-dimensional microvessel imaging and quantitative analysis.

Objective To compare the efficacy of perioperative volume therapy guided by throm?boelastography(TEG)versus massive transfusion protocol(MTP)in patients undergoing spinal surgery. Methods Seventy?two American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 14-64 yr, weighing 42-89 kg, undergoing elective scoliosis correction surgery or lumbar spinal stenosis de?compression, were divided into TEG group(group T, n=36)and MTP group(group M, n=36)using a random number table. Fresh frozen plasma(FFP), platelet(PLT)and fibrinogen(FIB)were trans?fused or protamine and tranexamic acid were given according to the results of TEG in group T. In group M, FFP and PLT were transfused after allogeneic RBCs or autologous blood were transfused according to the ra?tio allogeneic red blood cells(RBCs)1 U(or autologous blood 200 ml): FFP 100 ml: PLT 1 U;when ACT>110% of baseline, protamine was given;tranexamic acid was given according to the experience of an?esthesiologists. Venous blood samples were collected before induction of anesthesia(T0), at the end of surgery(T1)and at 24 h after operation(T2)for measurement of hemoglobin and blood coagulation. Blood loss, volume of fluid infused, transfusion of allogeneic blood(RBC, FFP and PLT), FIB, and consumption of protamine and tranexamic acid during the perioperative period, intraoperative volume of au?tologous blood transfused and time for initial infusion of FFP and PLT were recorded. The development of re?operation due to massive bleeding within 24 h after operation and death was recorded. The allogeneic blood transfusion cost, TEG detection cost, comprehensive cost(sum of allogeneic blood transfusion cost and TEG detection cost)and length of hospital stay were also recorded. Results Compared with group M, PLT count and FIB concentration were significantly decreased at T1, the perioperative consumption of FFP and PLT was reduced during the perioperative period, the time for initial infusion of FFP and PLT was pro?longed, the allogeneic blood transfusion cost was decreased, the comprehensive cost was increased(P<0.05), and no significant change was found in blood loss, volume of fluid infused, transfusion of autolo?gous blood, transfusion of RBC and FFP in allogeneic blood and consumption of protamine and tranexamic acid during the perioperative period, incidence of re?operation, mortality rate or length of hospital stay in group T(P>0.05). Conclusion TEG produces better efficacy in guiding perioperative volume therapy than MTP in the patients undergoing spinal surgery.

Objective : To optimize the primary prevention strategies of birth defects in Zhejiang Province by Delphi method, so as to promote the capacity of birth defects prevention. Methods: The expert consultation questionnaire was developed based on the relevant policies of Zhejiang Province and literature. Ten experts from medical institutions and health administrative departments were employed for one round Delphi expert consultation. The weighted scores and priorities of ten measures for the primary prevention of birth defects in Zhejiang Province were determined, as well as the suggestions of optimizing the current policies. Results : The response rate of the experts was 90.91%; the coefficient of authority was 0.92; the coefficients of variation of ten measures were all less than 0.25; the coefficient of coordination was 0.31 ( P<0.05 ) , which indicated the opinions of the experts tended to be consistent. In the order of priority, ten primary prevention measures of birth defects were the improvement of birth defects surveillance network ( province, city and county level ) , the training of birth defects prevention talents, the construction of genetic consultation clinics, health education and publicity, the reproduction outpatient service construction for older people, free premarital medical examination, free pre-pregnancy eugenics test, the construction of drug consultation clinics, career planning and training of birth defect prevention and control consultants and free folic acid supplement to the whole population. Nine experts suggested that the following policies need to be optimized: birth defects surveillance system, free premarital medical examination, and health education and publicity. Conclusion In the primary prevention of birth defects in Zhejiang Province, the most urgent problem to be solved is the improvement of the three-level birth defects surveillance network.

OBJECTIVETo explore the genetic etiology for two Chinese families affected with hypergonadotropic amenorrhea and normal number of antral follicles.

METHODSPeripheral venous blood samples were collected from the families for the extraction of genomic DNA. Mutations of FSHR and LHCGR genes were screened using PCR and Sanger sequencing. Suspected pathogenic mutations were verified in other members of the families. Bioinformatics software and NCBI were used to analyze the pathogenicity of the mutations.

RESULTSTwo previously unreported homozygous mutations, c.419delA and c.1510C>T of the FSHR gene were found in the probands of family I and II, respectively. Pedigree and bioinformatics analysis suggested that both mutations were pathogenic. Literature review suggested that both families were affected with resistant ovary syndrome rather than premature ovarian failure.

CONCLUSIONTwo novel mutations of the FSHR gene have been identified, which have enriched the spectrum of FSHR gene mutations and provided a basis for genetic counseling and direction for reproduction.

Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; China ; Female ; Humans ; Male ; Molecular Sequence Data ; Mutation ; Ovarian Diseases ; diagnosis ; genetics ; Pedigree ; Receptors, FSH ; genetics ; Young Adult

Thirty patients with gastric cancer,ASA Ⅱ or Ⅲ,scheduled for selective radical gastrectomy under tracheal intubation general anesthesia in Zhejiang Provincial People's Hospital from November 2016 to February 2017 were enrolled in the study.The gastric tubes were placed by a nurse before operation.The position of gastric tube was judged under gastric ultrasonography by a sonographer and anesthesiologist respectively;and confirmed by the surgeon during the operation.With the position judged by the surgeon as gold standard,the sensitivity,specificity,positive predictive value,negative predictive value of the judgment of ultrasonographer were 96％,80％,96％,50％,respectively with the Kappa value 0.760 of (P ＜0.001),those of the judgment of anesthesiologist were 92％,40％,92％ and 60％,respectively with a Kappa value of 0.280 (P =0.125);those of the judgment of nurse were 92％,0％,100％ and 71.4％,with a Kappa value of-0.105 (P =0.513).The results suggest that ultrasound examination is a simple,reliable and sensitive method for confirming correct gastric tube placement.