Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective To investigate the clinical features of neurobrucellosis and improve the diagnosis and treatment of the disease.Methods The epidemiological information,clinical manifestation,laboratory examination,and imaging characteristics of 30 cases with neurobrucellosis were summarized retrospectively.Results There were 23 men,seven women in this group of cases.The mean age was 43 years.There were six cases with definite history of brucellosis,24 with exposure history of cattle and sheep or their diary products.Brucella blood serum agglutination tests were all positive in 30 cases.Meningitis or meningoencephalitis (29 cases),spinal cord lesion (20 cases) and auditory nerve's damage (18 cases) were the most common forms of neurobrucellosis in these patients.In the cerebral spinal fluid inspection tests,there were 29 cases with increasing leukocyte ((10-599) × 106/L),30 cases with elevated protein (0.5-4.0 g/L),29 cases with decreased glucose (0.8-2.6 mmol/L) in this group of patients.There were 17 cases with white matter lesion on cranial magnetic imaging.The combinations of doxycycline,rifampin and ceftriaxone sodium were given to most cases.The prognosis was good in most cases.Conclusions Neurobrucellosis is not unusual clinically,clinical presentation of which varies greatly.The most common form is meningitis or meningoencephalitis,whereas spinal cord damage and hearing damage are also common.Patients who come from epidemic area and develop unexplained neurological symptoms should be screened and distinguished with neurobrucellosis.

Objective To investigate the potential pathogenesis of Focal cortical dysplasia (FCD), we performed cDNA microarray analysis to obtain gene expression profile of FCD. Methods Three FCD samples and three normal controls were enrolled. Total RNA of the brain tissues were extracted. The difference gene expressions between FCD group and control group was detected using Affymetrix gene chip. The up and down-regulated genes were confirmed by Real-time PCR. Further, the related signal pathways involved in the pathogenic mechanisms of FCD were predicted by bioinformatics. Result In FCD, two up-regulated genes C21orF2 and AU152162 and 5 down-regulated genes ENPP2, ANLN, IP6K3, UGT8, and AZGP were found. Compared the FCD samples with the normal controls , there were significantly different in all down-regulated genes (P < 0.05), while the up-regulated genes were not (P > 0.05). Using bioinformatics analysis, the ENPP2 , UGT8 , and AZGP1 protein which located in the cell membrane or secreted into the extracellular matrix may be involved in the formation of the myelin sheath and the development of the nervous system by the lipid metabolism and LPA signaling pathway. Conclusion ENPP2, UGT8 and AZGP1 may be involved in pathogenesis of FCD through the process of myelin sheath formation and LPA signal pathway , which warrants further study to know their roles in the pathogenesis of FCD.

Objective: The present study aims to summarize the clinical experience in the surgical treatment of thoracic aortic dissecting aneurysm.Methods: We retrospectively analyzed the clinical data of 115 cases of thoracic aortic dissecting aneurysm treated by surgery from December 1995 to December 2006.Thirty-eight of them were DeBakey type I aortic dissection,18 type Ⅱ,and 59 type Ⅲ.Of the 38 DeBakey type I patients,30 underwent ascending aorta with total aortic arch replacement(2 cases of total thoracic aortic artificial vessel replacement,25 Wheat procedure and 3 aortic valvuloplasty) and the other 8 received ascending aorta with semi-aortic arch replacement.Of the 59 DeBakey type Ⅲ patients,36 underwent descending aortic aneurysm resection with artificial vessel replacement via left posterolateral thoracic incision by left heart bypass or aorta to artery bypass(using Cott tubes),while the other 23 received endovascular stent-graft exclusion in descending aorta via the femoral artery.Results: All the patients were successfully treated except 5 that died during the perioperative period.The survivors were followed up for 3-118 months,among whom 2 died long-term death after the operation and the others were living healthy.Conclusion: Surgical treatment improves the clinical outcome of thoracic aortic dissecting aneurysm.Bilateral perfusion via the carotid artery in aortic arch replacement has a definite cerebral protective effect.Surgical procedures can be simplified by using the modified elephant trunk technique.Endovascular stent-graft exclusion is safe and effective in the treatment of DeBakey type Ⅲ aortic dissection.