Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

The research of sleep staging is not only the basis of diagnosing sleep related diseases, but also the precondition of evaluating sleep quality, and has important clinical significance. In recent years, the research of automatic sleep staging based on computer has become a hotspot and made some achievements. Feature extraction and feature classification are two key technologies in automatic sleep staging system. In order to achieve effective automatic sleep staging, we proposed a new automatic sleep staging method which combines the energy features and least squares support vector machines (LS-SVM). Firstly, we used FIR band-pass filter to extract the energy features of Pz-Oz channel sleep electroencephalogram (EEG) signals, and compared them with those from wavelet packet transform method. Then we designed an LS-SVM classifier to realize the automatic sleep stage classification. The research showed that FIR band-pass filter (with the Kaiser window) performed better than wavelet packet transform (WPT) for energy feature extraction just in terms of the data from the Sleep-EDF Database and the LS-SVM classifier (with the RBF Kernel function) designed was good, and the automatic sleep staging method proposed in this paper was better than many similar methods from other studies with an average accuracy of 88.89% and had a very prosperous application future.
Electroencephalography ; Humans ; Least-Squares Analysis ; Sleep Stages ; Support Vector Machine

OBJECTIVE:To observe the effect of Bilobalide on ischemical reperfusion injury in orthotopic liver transplantation model rats and to discuss its protective effect on ischemical reperfusion injury of rats undergoing liver transplantation.METHODS:The model of orthotopic liver transplantation was established by in rats by setting up the bridge between portal vein and left renal vein and building blood bypass by inlaying of canal in the inferior vena,after modeling,the rats were treated with Bilobalide,then levels of NO(active medium of blood vessel)and ET1 before ischemia and at 10 min,30min and 2h after reperfusion were determined by nitratase reduction method;serum levels of ALT,AST,ALP,LDH enzymology,ATP and MDA in the liver tissues were determined as well.The hepatic tissue sample was taken at 2h and fixed with formalin to be made into specimen for observation of the ultrastructure of liver cells and hepatic lobules under electron microscope.RESULTS:After being treated by Bilobalide,serum NO level was elevated and the pathological elevated levels of ALT,AST and LDH were brought down,the microcirculation in ischemical reperfusion injury rats was improved and the extent of damage in the ultrastructure of liver cells was lessened in rats.CONCLUSION:Bypass of portal vein and inferior vena cava prior liver transplantation is helpful for the prevention of ischemical reperfusion injury of liver.The balance of NO/ET1 is possibly a factor influencing the blood flow in the microcirculation of transplanted liver.Bilobalide was proved to be of protective effect on ischemical reperfusion injury in rats.

[Objective]To compare the effects of anatomical lateral distal tibial plate and clover plate fixation for the treatment of closed distal tibial fracture.[Method]A retrospective survey was analyzed in our hospital from May 1999-May 2008.A total of 85 cases of closed distal tibial fracture were followed up.Forty-three were fixed by the lateral distal tibial anatomy plate and 42 cases by alfalfa grass plate.The clinical effects were analyzed and compared by operative time and fracture healing time.T test and x2 test were used for statistical analysis.P

AIM To investigate the mechanism of apoptosis induced by oxymatrine on MCF 7 cell line METHODS Using light microscopy, electron microscopy, laser scanning confocal microscopy, flow cytometry (FCM) and DNA gel electrophoresis to demonstrate the presence of apoptosis RESULTS Morphological characteristics of apoptosis were observed on oxymatrine treated MCF 7 cells, such as condensation of nucleus, bubble of cytoplasm, fragment of nucleus, a ladder like pattern of DNA fragmentation in agarose gel eletrophoresis Laser scanning confocal microscopy showed decreasing of the content of DNA Sub G1 peak and increased S period ratio were analysed by FCM CONCLUSION Oxymatrine can induce the inhibition of cell growth by apoptosis and the mechanism of apoptosis is involved in blocking of S period cells