Objective To evaluate the optimized efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia via the research on the postoperative cellular immune function in the patients undergoing radical resection for esophageal cancer.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 45-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical resection for esophageal cancer,were divided into 2 groups (n =20 each) using a random number table:general anesthesia group (G group) and TPVB combined with general anesthesia group (TPVB+G group).In group TPVB+G,TPVB was performed at T4 and T6 on the operated side under ultrasound guidance with 0.5％ ropivacaine 15 ml before anesthesia induction.Anesthesia induction was started after the level of block was confirmed.Anesthesia was maintained with propofol given by target-controlled infusion at the target plasma concentration of 1-4 μg/ml,and bispectral index value was maintained at 40-50.Patient-controlled intravenous analgesia was performed after operation,and visual analog scale score was maintained ≤ 3.Before anesthesia induction,at the end of operation and at 24 and 48 h after operation,blood samples were collected from the central vein for determination of the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ and CD4+/CD8+ ratio.Ricker Sedation-Agitation Scale scores were recorded at 10 min,20 min,30 min and 1 h after extubation and 6,24 and 48 h after operation.The consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia,the number of unsuccessfully delivered doses and the total number of attempts were also recorded.Results Compared with group G,Ricker Sedation-Agitation Scale scores were significantly decreased at 10 min after extubation,the consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia and the number of unsuccessfully delivered doses were decreased,and the postoperative CD4+ level and CD4 +/CD8 + ratio were increased in group TPVB+G (P＜0.05).Conclusion TPVB combined with general anesthesia can improve the postoperative cellular immune function and is an optimal anesthesia regimen in the patients undergoing radical resection for esophageal cancer.

Objective To explore the application value of videolaryngoscope and Macintosh la ryngoscope in double-lumen endobronchial intubation.Methods Eighty patients (50 males,30 females,aged 18-70 years,ASA grade Ⅰ-Ⅲ) of both sexes,scheduled for thoracic surgery and double lumen endobronchial intubation were randomly divided into two groups using a random number table:videolaryngoscope group and Macintosh laryngoscope group.The intubation time,the success rate of intubation,the views of glottis,the hemodynamics during the first 4 minutes of intubation,the number of positive responses to intubation and the incidence of pharyngalgia at 24 h after the operation were observed and compared between the two groups,the condition of oral hemorrhage and the injury of the tracheal walls were recorded as well.Results Compared with videolaryngoscope group,the C-L grade and the success rate of the first intubation of Macintosh laryngoscope group was significantly higher,the intubation time of Macintosh laryngoscope group was significantly shor ter (P＜0.05).In addition,the positive cases of responses to intubation and the incidence of pharyngalgia at 24 h after the operation of Macintosh laryngoscope group were obviously less than those of videolaryngoscope group (P＜0.05).There was no significant difference between the two groups of oral injury bleeding and the injury of tracheal wall and protuberance.At T2,T3,the two groups of MAP were significantly lower than that of T1,and the MAP of videolaryngoscope group was significantly lower than that of t Macintosh laryngoscope group at T2,T3 (P ＜ 0.05).Conclusion Compared with videolaryngoscope,Macintosh laryngoscope is more suitable for the doublelumen endobronchial intubation in patients predicted without difficulty in intubating.

Objective To evaluate the modifying efficacy of thoracic paravertebral block ( TPVB) combined with general anesthesia in the patients undergoing single-port video-assisted thoracoscopic radical operation for lung cancer. Methods Sixty-six American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes, aged 18-64 yr, with body mass index of 20-24 kg∕m2 , undergoing elective sin-gle-port video-assisted thoracoscopic radical resection of lung cancer, were divided into TPVB plus general anesthesia group ( group TPVB+GA, n=33) and general anesthesia group ( group GA, n=33) using a random number table method. Ultrasound-guided TPVB was performed at T4 and T7 before induction of gen-eral anesthesia, and 0. 5％ ropivacaine 10 ml was injected into the two sites. General anesthesia was in-duced with midazolam, etomidate, sufentanil and rocuronium. Anesthesia was maintained by inhaling sevoflurane and infusing remifentanil. Patient-controlled intravenous analgesia ( PCIA ) with fentanyl 2μg∕kg, flurbiprofen 100 mg and 10 mg in 100 ml of normal saline. Sufentanil 0. 1μg∕kg was intravenously injected when VAS score≥4 during postanesthesia care unit ( PACU) . Propofol 0. 5-1. 0 mg∕kg was intra-venously injected when Sedation-Agitation Scale scores>5 during PACU. Nicardipine 0. 2 mg was injected intravenously when mean arterial pressureheart was increased by 30％ of baseline value during PACU. Es-molol 20 mg was given inravenously when heart rate was>100 bpm during PACU. The end-tidal concentra-tion of sevoflurane was recorded at 5 min after incision and at 5, 20, 30 and 60 min after inserting thoraco-scopic cannula. Venous blood samples were collected before operation, at 5 min after inserting thoracoscop-ic cannula, at closing chest and at 6 and 24 h after operation for determination of plasma norepinephrine concentrations by enzyme-linked immunosorbent assay. The consumption of remifentanil during opertion, requirement for sufentanil, propofol, nicardipine and esmolol during PACU, duration of PACU stay and development of postoperative nausea and vomiting were recorded. Results Compared with group GA, the intraoperative end-tidal concentration of sevoflurane and consumption of remifentanil were significantly re-duced, the concentration of norepinephrine was decreased at each time point during and after surgery, and the requirement for sufentanil, propofol, nicardipine and esmolol was decreased during PACU, and dura-tion of PACU stay was shortened during stay in PACU in group TPVB+GA ( P<0. 05) . Postoperative nause-a and vomiting was not found in the two groups. Conclusion TPVB combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and in improving the quality of recovery from anesthesia and is more helpful in inhibiting intraoperative and postoperative stress responses and post-operative pain responses than general anesthesia alone when used for the single-port video-assisted thoraco-scopic radical operation for lung cancer.

Objective:To evaluate the role of hypothalamic aromatase in sevoflurane anesthesia-induced epileptic waves in neonatal rats.Methods:Thirty clean-grade healthy neonatal Sprague-Dawley rats of both sexes, aged 5 days, weighing 10-15 g, were divided into 3 groups ( n=10 each) according to a random number table method: control group (group C), sevoflurane group (group S), and aromatase inhibitor formestane plus sevoflurane group (group F). The electroencephalogram (EEG) in the neonatal rat cortex was monitored, 30 min later formestane 2 mg/kg was subcutaneously injected in F group, while the equal volume of normal saline was given instead in C and S groups.At 30 min after subcutaneous administration, 6% sevoflurane was inhaled to induce anesthesia for 3 min, and then the concentration was adjusted to 2.1% to maintain anesthesia for 57 min in S and F groups.The total duration and single duration of epileptic waves and the number of seizure during sevoflurane anesthesia were recorded.After the end of EEG recording, the laparotomy was performed, the left ventricular puncture was performed, and blood samples were collected for blood gas analysis and for determination of corticosterone levels (by enzyme-linked immunosorbent assay). Brain tissues were obtained, and then the hypothalamus was rapidly isolated for determination of the expression of aromatase mRNA, Na + -K + -2Cl - cotransporter-1 (NKCC1) mRNA and K + -Cl - cotransporter-2 (KCC2) mRNA (by polymerase chain reaction). Results:No epileptic waves were found in group C. Compared with group C, the total duration and single duration of cortical epileptic waves were significantly prolonged, and the number of seizures was increased, the serum corticosterone concentration was increased, the expression of aromatase mRNA was up-regulated, and NKCC1/KCC2 mRNA ratios were increased in S and F groups ( P<0.05). Compared with group S, the total duration and single duration of cortical epileptic waves were significantly shortened, and the number of seizures was decreased, the serum corticosterone concentration was decreased, the expression of aromatase mRNA was down-regulated, and NKCC1/KCC2 mRNA ratios were decreased in group F ( P<0.05). Conclusion:Up-regulation of hypothalamic aromatase expression is involved in the development of sevoflurane anesthesia-induced epileptic waves in newborn rats.

Objective To investigate the effect of estradiol on sevoflurane-induced epileptiform cor-tical EEG waves in neonatal rats. Methods Forty neonatal rats,aged 4-6 days,weighting 8-15 g,were di-vided into 5 groups according to random number table:normal saline control group (group C),estradiol group (group E),ICI182780 (group I),Formestane group (group O) and estradiol +ICI182780 (group EI). Af-ter establishing the monitoring model of cortical electroencephalogram in neonatal rats, EEG was recorded continuously for 30 minutes, then different treatment drugs were given according to different groups. After 30 minutes of continuous recording of EEG, anesthesia induction was started with inhalation of 6% sevoflurane for 3 minutes, followed by inhalation of 2. 1% sevoflurane to maintain anesthesia. Sevoflurane anesthesia las-ted for 1 hour. The righting reflex disappearance time was recorded after sevoflurane anesthesia. The total du-ration,single duration and frequency of EEG convulsion waves were recorded. Spike frequencies were recor-ded at different periods. Animal respiratory rate was recorded after sevoflurane induction. Results One rat in group I and one rat in group EI showed convulsion wave before treatment,which were excluded from the study. The righting reflex disappearance time of group S,group E,group I,group O and group EI were (24. 4 ±2. 5)s,(16. 4±4. 2)s,(31. 8±5. 2) s,(29. 8±1. 8) s,(24. 8±2. 7) s respectively,and there were statisti-cally significant differences among the 5 groups (F=16. 693,P<0. 01). There were no significant difference in respiratory frequency among the 5 groups (F=0. 276,P>0. 05). Compared with group S,the total dura-tion,single duration and frequency of convulsion wave were significantly increased in group E during anesthe-sia,and the differences were statistically significant (P<0. 05). Compared with group E and group S,the total duration,single duration and frequency of convulsion wave during anesthesia were significantly reduced in group I,group O and group EI,and the differences were statistically significant (P<0. 05). Compared with group S,the spike frequency of group E increased significantly in each period,and the differences were statis-tically significant (P<0. 05). The frequency of spike wave in group I,group O and group EI at 65-70 min and 90-95 min were lower than that in group S,and the differences were statistically significant (P<0. 05). The frequency of spike wave between group O and group EI during 115-120 min was statistically different with group S and group E(P<0. 05). Conclusion The mechanism of epileptiform EEG wave induced by sevoflu-rane anesthesia may be related with neuroactive steroidal estradiol.

Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.