Aged ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Male ; Middle Aged ; Phytotherapy ; Silicosis ; drug therapy ; Treatment Outcome

Objective To observe the safety and efficacy of different concentration of remifen-tanil TCI combined with dexmedetomidine for awake nasal intubation in cervical spine surgery patients and explore the clinical suitable concentrations for remifentanil TCI.Methods Sixty cervical spine surgery patients undergoing selective surgery under general anaesthesia (male 40 cases,female 20 ca-ses,aged 18-68 years,ASA Ⅰ or Ⅱ)were randomly divided into three groups according to TCI con-centration of remifentanil.The plasma concentration of remifentanil TCI of group A,B,C were 1.5 ng/ml,2.0 ng/ml,2.5 ng/ml respectively,which combined with dexmedetomidine 1 μg/kg.The value of MAP,HR,SpO2 ,RR were recorded when patients entering the operating room(T1 ), before intubation(T2 ),immediately after tracheal tube passing through nasopharynx(T3 ),immedi-ately after tracheal intubation(T4 ),immediately after tracheal tube cuff inflated(T5 )and 1min after intubation(T6 ).The success rate of first intubation were recorded.The incidence of cough,limb movement,respiratory depression,awareness and other adverse reactions during intubation were re-corded.Results In group A,MAP and HR at T3-T5 were significantly higher than those at T1 (P <0.05);SpO2 at T4-T6 and RR at T3-T6 were significantly lower than those at T1 (P <0.05)in group C.In group A,the incidence of cough and limb movements were significantly higher than those in group B,C(P <0.05).In group C,the incidence of respiratory depression was significantly higher than that in group A,B(P <0.05).Conclusion TCI concentration 2.0 ng/ml for remifentanil com-bined with dexmedetomidine can effectively inhibit the stress response to intubation with little respira-tory depression and can be widely used for awake nasal intubation in cervical spine surgery patients.

Objective To compare the efficacy of laryngeal mask of Supreme and i-gel for the airway management in patients undergoing elective lumbar vertebral surgery in prone position. Methods A total of 264 patients,ASA physical status Ⅰ or Ⅱ,scheduled for elective lumbar verte-bral surgery in prone position under general anesthesia were divided into two groups (n =132)using a random number table:laryngeal mask of Supreme group (group S)and laryngeal mask of i-gel group (group I).The laryngeal mask of Supreme or i-gel were respectively placed in group S and group I im-mediately after anesthesia induction according to manufacturers’specification.Volume-controlled ven-tilation was used to observe the ventilation quality.The number of laryngeal mask insertion,laryngeal mask insertion time and the ventilation quality in supine and prone position were recorded,as well as the airway seal pressure.The position of laryngeal mask was evaluated by fibero ptic examination in both supine and prone positions.The blood on the laryngeal mask was noted.Finally,the occurrence of laryngeal mask related complications was observed.Results One patient in group I was excluded due to the failure of laryngeal mask insertion after three attempts.No significant difference in type of laryngeal mask,insertion time,adjusted cases,peak airway pressure,and fiber optic examination in both supine and prone positions between two groups.Compared with group S,group I required signif-icantly more attempts of insertion (P < 0.01 ).Nevertherless,ventilation quality in prone position was improved and airway seal pressure in supine and prone position increased (P <0.01 or P <0.05) in group I.No significant difference was found in the occurrence of laryngeal mask related complica-tions.Conclusion In the airway management of patient undergoing elective lumbar vertebral surgery in prone position,laryngeal mask of i-gel is more difficult to be inserted but can maintain higher air-way seal pressure compared with laryngeal mask of Supreme.

Objective To determine the median effective target plasma concentration (EC50) of remifentanil inhibiting responses to skull-pin placement when combined with propofol in the female patients undergoing neurosurgery.Methods Sixteen female patients,aged 20-60 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective neurosurgery under general anesthesia,were enrolled in this study.Anesthesia was induced with propofol and remifentanil given by target-controlled infusion and iv rocuronium 0.6 mg/kg.The target plasma concentration (Cp) of remifentanil and propofol was set at 5 ng/ml and 3 μg/ml,respectively.At 3 min after tracheal intubation,the target Cp of remifentanil was adjusted and set at 5 ng/ml in the first patient.The skull-pin was placed after the target effect-site and plasma concentrations were balanced.The Cp increased/decreased by 20％ each time in the next patient depending on whether or not the response to skull-pin placement was positive.The ratio between the two successive concentrations was 1.2.The response to skull-pin placement was defined as positive when heart rate and/or mean arterial pressure increased by 20％ of the baseline value within 1 min after placement.The EC50 and 95％ confidence interval of remifentanil required to inhibit responses to skull-pin placement were calculated when combined with propofol.Results The EC50 (95％ confidence interval) of remifentanil required to inhibit responses to skull-pin placement was 3.74 (3.43-4.09) ng/ml when combined with propofol.Conclusion When combined with propofol,the EC50 of remifentanil inhibiting responses to skull-pin placement is 3.74 ng/ml in the female patients undergoing neurosurgery.

Objective To evaluate the effect of sodium potassium magnesium calcium and glucose (SPMCG) injection on the internal environment and metabolism of glucose,fat and protein in the patients undergoing craniotomy.Methods Forty-four patients of both sexes,aged 18-64 yr,of American Society of Anesthesiology Anesthesiologists physical status Ⅰ-Ⅲ,with body mass index of 18-30 kg/m2,were divided into either lactated Ringer's solution group (group R) or SPMCG injection group (group S) using a random number table.Before anesthesia induction,6％ hydroxyethyl starch 130/0.4 was infused intravenously at 15 ml · kg-1 · h-1 for 30 min,followed by iv infusion of 6％ hydroxyethyl starch 130/0.4 and corresponding volume of crystalloid solution in a ratio of 1 ∶ 2 at a rate of 5-10 ml · kg-1 · h-1 until the end of surgery.Before fluid infusion (baseline),immediately after the beginning of surgery,at 2 and 4 h after the beginning of surgery,at the end of surgery and at 1 h after surgery,arterial blood samples were collected for blood gas analysis,the pH value and concentrations of base excess,Na +,K+,Ca2+,Mg 2+and lactic acid were recorded,and the blood glucose concentration was determined.Before fluid infusion (baseline) and at the end of surgery,venous blood samples were taken for determination of the concentrations of plasma insulin,β-hydroxybutyric acid and 3-methylhistidine (3-MH).Results No hyperglycemia was found in the two groups.Compared with group R,the Mg2+ concentration was significantly increased,the concentrations of lactic acid and plasma β-hydroxybutyric acid and 3-MH were decreased (P＜0.05),and no significant change was found in the other parameters in group S (P＞0.05).Compared with the baseline,the blood glucose concentration was significantly increased after fluid infusion in the two groups,the Mg2+concentration was significantly decreased,and the concentrations of lactic acid and plasma insulin,β-hydroxybutyric acid and 3-MH were increased after fluid infusion in group R (P＜0.05),and no significant change was found in the parameters mentioned above in group S (P＞0.05).Conclusion For the patients undergoing craniotomy,SPMCG injection can maintain homeostasis,and the component 1％ glucose can inhibit the decomposition of fat and protein without inducing hyperglycemia and glucose metabolic disorders.

Objective This study was designed to explore the incidence rate of occuIt HBV infection in patients with anti-HBc positive alone and analyze the possible reasons of occuIt infection.Methods Sera of 183 patients carrying anti-HBc alone(A≤0.1) were collected and real-time PCR was used to select samples with HBV DNA positive.HBV pre-S/S amplification products were obtained by PCR,and clonal sequencing were then used for these samples with HBV DNA positive.Results DNA quantitative results of three samples were greater than 103 copies/ml in 183 samples,with a fraction of 1.6%.Pre-S/S sequencing results of two samples from these three samples were obtained.Point mutations within "a" determinant with Q129R/P mutations and co-existence of the mutant type and wild type were found in the two samples.Conclusions Occult HBV infection existed in samples with anti-HBc alone.Factors contributing to the loss of HBsAg detection by immunoassays include S gene mutations and low levels of cireulating antigen which are below the assay limit of detection.Occult HBV infection not only can lcad to a false clinical diagnosis,but also can result in hematological pollution due to such occult infection of blood donors.

Objective To evaluate the effect of electroacupuncture (EA) pretreatment on NODlike receptor pyrin domain-containing 3 (NLRP3) in neurons during cerebral ischemia-reperfusion (I/R) in rats.Methods Fifty-four adult male Sprage-Dawley rats,aged 7 weeks,weighing 250-280 g,were randomly divided into 3 groups (n =18 each) using a random number table:sham operation group (group S),group I/R,and EA pretreatment group (group E).Cerebral I/R was induced by occlusion of the right middle cerebral artery for 90 min using a nylon thread inserted into the internal carotid artery and advanced intracranially to block the blood flow,followed by reperfusion.In group E,the acupoint Baihui was stimulated with an electric stimulator (sparse-dense wave,frequency 2 Hz/15 Hz,intensity ≤ 1 mA) for 30 min once a day for 5 consecutive days,and the model of cerebral I/R was established at 24 h after the last stimulation.At 72 h of reperfusion,neurological function was assessed and scored.The rats were then sacrificed,and their brains were removed for determination of cerebral infarct volume (using TTC staining),expression of NLRP3,caspase-1 and interleukin-1beta (IL-1β) in brain tissues (by Western blot),and expression of NLRP3 protein in neurons (by immunofluorescence histochemistry).The percentage of cerebral infarct volume was calculated.Results Compared with group S,the percentage of cerebral infarct volume and neurological scores were significantly decreased,and the expression of NLRP3,caspase-1 and IL-1β in brain tissues was significantly up-regulated in group I/R (P＜0.05).Compared with group I/R,the percentage of cerebral infarct volume and neurological scores were significantly increased,and the expression of NLRP3,caspase-1 and IL-1β in brain tissues was significantly down-regulated ingroup E (P＜0.05).Conclusion The mechanism by which EA pretreatment reduces inflammatory responses during cerebral I/R injury may be related to down-regulation of NLRP3 expression in neurons in rats.

Objective To investigate the clinical features and human papillomavims (HPV) types in 12 cases of HPV infection characterized by pseudocondyloma of vulvae. Methods Twelve women, who had a history of sexual behavior with non-spouses and presented with pseudocondyloma of vulvae, were included in this study. Tissue specimens were scraped or resected from the lesions of pseudocondyloma of vulvae. PCR-based reverse hybridization assay was performed to determine the genotypes of HPV. Results All the 12 specimens were HPV positive. The reverse hybridization assay generated 13 subgenotypes of HPV, including 3 low-risk genotypes (11, 42 and 43) and 10 high-risk genotypes (16, 18, 31, 33, 35, 39, 51, 52, 58 and 59). All the patients were found to be infected by at least one high-risk genotype. Of the 12 patients, 4 were infected by single type of HPV, 6 by 2 types of HPV, and 2 by 3 or 4 genotypes of HPV. Conclusion The patients characterized by pseudocondyloma of vulvae may suffer from high-risk HPV infection.

Objective To explore an effective method for enhancing basic clinical skill of students.Methods Selective course of basic clinical skill was launched for the fourth grade clinical medicine students by using simulation-based medical education (SBME).Elective courses have 21 class hours,involving 15 items of basic clinical skills in internal medicine,surgery and nursing.Training methods include preparation,explanation,demonstration,operation,group competition,examination and questionnaire.Selective course examination includes class activation and final examination,accounting for 20％ and 80％ of the final scores,respectively.Scores were classified into A (excellent),B (good) and C (moderate) levels.Scores and questionnaire data were processed by Microsoft Office Excel 2007 software and percentages of score and questionnaire feedback were calculated.Results Results suggested that the scores of 70％ students were more than 90.Results of questionnaire indicated that the basic clinical skills of 76.6％ of the students were improved a lot.79.2％ considered that it was useful for their clinical practices.Conclusion Clinical-skill course based on SBME is conducive to enhancing basic clinical skills of students.

Objective:To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis.Method:A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003,of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis.Result:The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%,disease free survival rate was 55.3%,local relapse free survival rate was 75.2% and distant metastasis free survival rate was73.4%.Periods of cranial nerve involvement,clinical stage,the diameter of the lymph nodes,involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P<0.05).With multivariate analysis,the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR=2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival(RR=1.954 and 2.136,respectively).Conclusion:Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.