Objective:To investigate the efficacy and safety of fospropofol disodium(FP)in the induction and maintenance of general anesthesia in the adult patients graded Ⅰ or Ⅱ by the American Society of Anesthesiologists(ASA)undergoing elective surgery,and to provide the theoretical basis for application of EP in the induction and maintenance of general anesthesia.Methods:Adult patients of ASA grade Ⅰ or Ⅱ undergoing elective surgery were selected with a total of 100 patients recruited sequentially according to the time of visit,and they were randomly divided into FP group(50 cases)and propofol group(50 cases).All patients were prepared preoperatively,and received a slow injection of midazolam(2 to 3 mg)and sufentanil(0.3 μg·kg-1),followed by induction of anaesthesia 1 to 2 min later.The patients in FP group were given FP(10.0-12.5 mg·kg-1)intravenously,and the patients in propofol group were given propofol(1.5-2.0 mg·kg-1)intravenously.After the Modified Obserational Assessment Alertness/Sedation(MOAA/S)score dropped to 1,muscle relaxant was administrated and the induction was completed.During the maintenance of anaesthesia,the patients in FP group received a continuous intravenous infusion of FP at a rate of 12.5-15.0 mg·kg-1·h-1,and the patients in propofol group received a continuous infusion of propofol at a starting rate of 6 mg·kg-1·h-1.The patients in two groups additionally received remifentanil(0.1-0.4 μg·kg-1·min-1)for co-analgesia,and the rate of administration was adjusted according to the patient's status.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and bispectral index(BIS)values of the patients in two groups were recorded at different time points:before induction(T1),immediately after tracheal intubation(T2),5 min after induction(T3),10 min after induction(T4),20 min after induction(T5),30 min after induction(T6),40 min after induction(T7)and at the end of the procedure(T8).The time to onset of sedation/anaesthesia(MOAA/S≤1),the time to eye opening,and the time to awakening(MOAA/S=5)of the patients in two groups were recorded.The lowest intraoperative SBP and BIS values and the time required of the patients in two groups were observed.The incidence of adverse reactions related to agitation,choking,nausea,vomiting and cardiovascular system or respiratory system were compared between two groups.Results:There were no statistically differences in the general informations and the duration of surgery of patients between two groups(P＞0.05).The induction time of the patients in FP group(2.39 min)was significantly longer than that in propofol group(0.70 min)(P＜0.05).In the recovery period of general anesthesia,the eye opening time and recovery time of the patients in FP group were significantly longer than those in propofol group(P＜0.05).There were no significant differences in MAP of the patients between two groups at different time points(P＞0.05).The HR at T4,T5,T6,and T7 time points of the patients in FP group were lower than those in propofol group(P＜0.05).The lowest value of BIS of the patients in FP group was significantly smaller than that in propofol group,and the time taken to reach the lowest value of BIS in FP group was significantly longer than that in propofol group(P＜0.05).The time taken to reach the lowest value of SBP of the patients in FP group was longer than that in propofol group(P＜0.05).However,the lowest value of SBP of the patients and the incidence of adverse reations of the patients in two groups showed no statistical differences(P＞0.05).Conclusion:Compared with propofol,FP injection is safe and effective in the induction and maintenance of general anesthesia in adult patients with ASA class Ⅰ or Ⅱ undergoing elective surgery,with a low incidence of adverse reactions,which is a new anesthesia option.

Objective To evaluate whether the measurement of tibialis anterior muscle thickness(TA-MT)in sepsis can be used as an alternative method to understand systemic changes in skeletal muscle mass by comparing the trend of ultrasonic measurement of TA-MT with bioelectrical impedance analysis(BIA)in detecting skeletal muscle mass.Methods A single-center prospective study was conducted.The patients with tumor sepsis who were treated in the department of intensive care unit(ICU)of Tianjin Medical University Cancer Hospital from March to December 2022 were selected as the study subjects.The changes of TA-MT within 6 hours after sepsis and 3 days after treatment were measured by ultrasound.The changes of body mass,body mass index(BMI),lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,skeletal muscle index(SMI),arm circumference,right lower limb lean body mass,and body water were measured by BIA.The 28-day prognosis was followed up.The correlation between TA-MT and skeletal muscle indicators measured by BIA was analyzed by Pearson correlation analysis.Results Eventually,40 patients were included.Compared with before treatment,the levels of TA-MT by ultrasound and acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and oxygen metabolism index blood lactic acid(Lac)measured after treatment were significantly reduced[TA-MT(cm):2.31±0.35 vs.2.50±0.36,APACHEⅡscore:11.00±3.18 vs.17.50±5.44,SOFA score:3.28±2.18 vs.6.30±3.11,Lac(mmol/L):1.38±0.35 vs.2.40±1.02,all P＜0.05].Meanwhile,the BIA test showed that body mass,body mass index,lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,SMI,arm circumference,right lower limb lean body mass and body water were also significantly decreased after treatment[body mass(kg):63.87±13.96 vs.66.58±14.95,BMI(kg/m2):22.57±4.37 vs.23.52±4.59,lean body mass(kg):46.32±6.89 vs.49.66±7.84,whole body protein(kg):9.36±1.37 vs.9.93±1.55,skeletal muscle mass(kg):26.23±4.17 vs.27.96±4.72,SMI(kg/m2):7.12±1.04 vs.7.78±1.18,arm circumference(cm):29.41±3.66 vs.30.17±3.59,right lower limb lean body mass(kg):7.21±1.26 vs.7.77±1.42,total body water(L):36.38±5.44 vs.39.11±6.19,all P＜0.05],body fat percentage and body fat were significantly elevated[body fat percentage:(21.96±8.30)%vs.(19.98±8.43)%,body fat(kg):14.81±8.64 vs.14.12±8.81,both P＜0.05].Pearson correlation analysis showed that:the right TA-MT was negatively correlated with the electrical impedance of the right lower extremity(r =-0.445 2,P＜0.001),the right side TA-MT was positively correlated with the right lower limb lean body mass,whole body protein,skeletal muscle mass,SMI and lean body mass(r values were 0.571 4,0.629 9,0.628 3,0.575 9,0.634 4,all P＜0.000 1).Conclusion Significant skeletal muscle depletion can be observed in tumor patients with sepsis,and ultrasound measurement of TA-MT is an effective alternative method to assess systemic skeletal muscle mass trends.

Objective:To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods:The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected. The characteristics of cancer pain, the use of analgesic drugs, the effects of analgesic drugs and its influencing factors were analyzed.Results:The incidence of cancer pain in 373 patients was 93.0% (347/373), and the proportion of moderate to severe cancer pain was 55.6% (193/347). Analgesics were used in 304 patients, among whom 233 (76.6%) patients used oral analgesics, 297 (97.7%) used on time, 97.6%(285/292) used sustained-release opioids, and 94 (30.9%) used combinedly. Breakout pain occurred in 100 cases (32.9%), all of which was controlled with immediate-release morphine. Cancer pain was not relieved in 132 cases (43.42%), and multivariate logistic regression analysis showed that the pain degree on admission (moderate: OR=3.69, 95 %CI:2.09-6.49; severe: OR=5.52, 95 %CI:2.43-12.53), the presence of burst pain ( OR=3.28, 95 %CI:1.77-6.06), the type of analgesics used (non-steroidal+weak opioids: OR=0.39, 95 %CI:0.20-0.76; nonsteroidal+strong opioids: OR=0.20, 95 %CI:0.08-0.51) and the adverse reactions ( OR=1.92, 95 %CI:1.03-3.60) were the influencing factors of pain relief in cancer pain patients (all P<0.05). Conclusion:The pain of cancer patients admitted to community palliative care wards cannot be ignored. Although most cancer pain patients use analgesic drugs in a standard way, there are still a high proportion of patients whose pain is not controlled. Various factors affect the effect of analgesic treatment.

Objective: To evaluate the primary clinical outcomes of immediate provisionalization with a monolithic crown utilizing a novel chairside computer aided design and computer aided manufacture (CAD/CAM) workflow for single tooth immediate implant placement. Methods: This pilot study was a prospective within-subjects design. Thirteen consecutive patients were included and diagnosed with untreatable single incisor or premolar with fine general and local anatomical conditions. The trial was conducted at Department of Implantology, Peking University School and Hospital of Stomatology, Beijing, between January 2016 and June 2016. The teeth were extracted atraumatically and implants were immediately placed in the fresh sockets. Two screw-retained interim crowns were fabricated for the same site utilizing different workflows, a monolithic lithium disilicate (LS2) crown produced by CEREC (Sirona, Germany) chairside CAD/CAM system (CER group) and a manually fabricated resin crown utilizing conventional workflow (CONV group) respectively. The patients were blinded to the group allocation of the two interim crowns. After the clinical try-in for both crowns in a randomized sequence, the patients' level of satisfaction was assessed with a virtual analogue scale (VAS) questionnaire. The restorations chosen by patients themselves were seated in the implants by one experienced prosthodontist. The accuracy, aesthetic effect and clinical time consumption of both groups were compared. Statistical analyses were performed with the Wilcoxon signed rank test. Results: All patients were treated with atraumatic tooth extraction, immediate implant placement using flapless surgery and immediate provisionalization in a single visit. The interim crowns of both groups could be fitted with or without slight adjustments. For each patient, the interim crown of CER group was chosen to be seated with a relatively higher VAS result. The white esthetic score (WES) results demonstrated no statistically significant difference between CER group (7.5±1.1) and CONV group (7.9±0.9) (P>0.05). The mean total work time was significantly different resulting in (131.9±5.0) min for CER group and (205.2±6.3) min(P<0.05). The major difference lied in the laboratory work time, resulting in (113.5±6.3) min for CER group which was significantly shorter than (185.6±6.6) min for CONV group. As for impression taking time, the CER group (7.5±0.8) min was significantly shorter than CONV group (11.7± 1.1) min (P<0.05). However, analysis for clinical adjustment time showed a significantly longer time for CER group [(11.0±2.1) min vs (8.0±2.8) min, P<0.05]. After 3-6 months of observation, the overall survival rate was 100%. Screw loosening occurred in 4 patients and was tightened again. No other major complication soccurred. Conclusions The full digital workflow utilizing CEREC chairside CAD/CAM system to fabricate interim crowns after immediate implant placement in one single visit was feasible. It was more time-efficient and could effectively shorten the laboratory work time compared to the conventional workflow. Patients demonstrated high satisfaction and there was no statistical difference in WES results compared to the conventional workflow. Favorable clinical outcomes were gained in this short-term follow-up study.

Objective To evaluate the quality of Radix et Caulis Ilicis Asprellae from Pingyuan planting base and Chinese herbal medicine market. Methods The water- and alcohol-soluble extracts from 19 batches of Radix et Caulis Ilicis Asprellae medicinal materials were detected according to Appendix ⅨH, ⅩA of the Chinese Pharmacopoeia ( 2010 edition). And the quality of the medicinal materials was evaluated by microscopic identification technology according to the method for Radix et Caulis Ilicis Asprellae recorded in Guangdong Provincial Chinese Medicine Standard, and then thin layer chromatography ( TLC) was optimized to establish the high performance liquid chromatography (HPLC) fingerprint. The HPLC was performed on Waters XBridgeTM C18 column (250 mm × 4.6 mm, 5μm) with acetonitrile(A)-0.2% (v/v) phosphorus acid (B) as the mobile phase by gradient elution, flow rate was 1.0 mL/min, and detection wavelength was 220 nm. Results The results of sample characters, TLC and microscopic identification showed that the samples of Radix et Caulis Ilicis Asprellae in Chinese herbal medicine markets were certified products, but stems and roots were blended. Seven common peaks were showed by HPLC and confirmed by similarity analytical software. The similarity of 15 batches of planting base samples was all above 0.9. Of 19 batches of the commercial samples, the similarity of 11 batches was above 0.9. The alcohol-soluble extract contents were in the range of 64.55 mg/g to 186.18 mg/g. Conclusion The medicinal materials of Radix et Caulis Ilicis Asprellae from Chinese herbal medicine market are certified products, but the qualities vary greatly for the blending of stems and roots and inadequate growth years. The quality of materials from planting base is better. The established method is helpful for the quality evaluation and control of Radix et Caulis Ilicis Asprellae.

Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Objective To explore the in vivo killing effects of nanosecond pulsed electric fields on mouse breast cancer in tumor bearing BALB/c mice. Methods Twenty four BALB/c mice models with subcutaneous EMT-6 breast cancer were prepared and divided into experimental group and control group (n=12). In experimental group, the mice were treated by the pulsed electric fields with peak voltage of 700 V/cm, rise times of 57 ns, durations of 70μs and duty ratio of 50%on the tumor tissue with two parallel electrodes under anaesthesia. One hundred pulses were given and the energy was just 9.75 J with effective action period of 7 ms. Tumor volume, animal weight and histopathologic changes after 1, 3, 5 and 7 d were observed after irreversible electroporation. Results The tumor volume in experimental group increased more slowly than that in control group, especially at the 1-3 d after treatment with a standstill. Histopathological examination results showed that the tumor tissue had obvious coagulation necrosis and tissue edema after electrical stimulation treatment, and mass vacuole like structure appeared in tumor tissue from the third day after treatment and vascular injury occurred at the early stage. Conclusions In the given field conditions, steep pulsed electric field has inhibitory effect on tumor growth. In order to achieve more ideal tumor therapy effect, further studies on steep pulse dose are needed.

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Symptomatic venous thromboembolism (VTE) has a six-to seven-fold risk of occurring in cancer patients compared with non-cancer patients. VTE is the second most common cause of death among patients with cancer, and cancer-associated VTE is be-coming increasingly prevalent. Therefore, early diagnosis and treatment of cancer-associated VTE is particularly important. This study presents a pancreatic cancer-associated deep vein thrombosis (DVT) patient who engaged in a multidisciplinary comprehensive discus-sion in the Interventional Therapy Department, Tianjin Medical University Cancer Hospital to enhance concern, interdisciplinary com-munication, and cooperation in terms of cancer-associated VTE diagnosis and treatment strategies.