Objective To investigate the application value of different doses of remifentanil combined with sevoflurane under pain threshold index(PTi)monitoring in ambulatory laparoscopic cholecystectomy.Methods 152 patients undergoing laparoscopic cholecystectomy under general anesthesia were selected from December 2023 to June 2024 at the Second Affiliated Hospital of Kunming Medical University.Patients were randomly divided into R1 group(n=38),R2 group(n=38),R3 group(n=38),and R4 group(n=38)using a random number table.On the basis of sevoflurane at 0.7 minimum alveolar concentration(MAC),patients in R1～R4 groups were combined with 0.1,0.2,0.3,and 0.4 μg/kg·min remifentanil,respectively.The changes in PTi at different time points,pre-and post-operative blood stress indicators[cortisol(Cor),norepinephrine(NE),and blood glucose(Glu)concentrations]were compared,and the incidence of intraoperative hypertension,hypotension,tachycardia,bradycardia,and postoperative nausea and vomiting were recorded.Results Compared with R1 group,PTi in R2,R3,and R4 groups decreased from the start of surgery(T3)to 5 min after extubation(T11)(P<0.05);compared with R2 group,PTi in R3 and R4 groups was lower at T3～T11(P<0.05);no statistically significant difference was found in PTi changes between R3 and R4 groups at different time points(P>0.05).Postoperative Cor,NE,and Glu concentrations showed statistically significant differences among the four groups(P<0.001),but no significant difference was found preoperatively(P>0.05).Compared with preoperative values,Cor,NE,and Glu levels significantly increased in all groups(P<0.001),with R1 group>R2 group>R4 group>R3 group.The incidence of intraoperative hypertension,hypotension,bradycardia,and tachycardia showed statistically significant differences(P<0.001),with R4>R1>R2=R3.The incidence of postoperative nausea and vomiting also showed statistically significant differences(P<0.001),with R1 group>R4 group>R2 group>R3 group.Conclusion Sevoflurane at 0.7 MAC combined with 0.3 μg/kg·min remifentanil provides good analgesic effects for patients undergoing ambulatory laparoscopic cholecystectomy,reduces stress response,and has high safety,making it worthy of clinical promotion.

Objective To compare the efficacy of electroacupuncture in traditional Chinese medicine with the opioid adjuvant drug dezocine.Methods 122 patients undergoing elective laparoscopic cholecystectomy at the Second Affiliated Hospital of Kunming Medical University between October 12,2023,and April 05,2024,were randomly allocated into three groups:dezocine group(D group,n=40),electroacupuncture group(E group,n=42),and electroacupuncture combined with dezocine group(ED group,n=40).Patients received 10 mg dezocine,electroacupuncture,or electroacupuncture+10 mg dezocine after cholecystectomy.Pain threshold index(PTi),pain index(Pi),and visual analogue scale(VAS)scores were observed at different time points during surgery.Vital signs were recorded,and adverse reactions within 24 hours postoperatively were noted.Results There were no statistically significant differences in PTi among groups before electroacupuncture(T1)(P>0.05).At the end of electroacupuncture(T2)and after cholecystectomy(T3),the PTi values in the E and ED groups were lower than the D group(P<0.05).At the end of surgery(T4)and upon extubation(T5),the PTi values of all three groups reached a tolerable level for patients,with the E and D groups showing higher PTi values compared to the ED group(P<0.05).There were no statistically significant differences in postoperative pain scores(Pi)and VAS at various time points(P>0.05).Conclusion Electroacupuncture demonstrates analgesic efficacy non-inferior to opioid drugs and can be recommended as a postoperative pain management technique for laparoscopic cholecystectomy patients.

Animals ; Macaca mulatta ; Optic Disk ; Glaucoma ; Craniocerebral Trauma ; Intraocular Pressure ; Low Tension Glaucoma

Humans ; Diagnosis, Differential ; Constriction, Pathologic/diagnosis* ; Bile Duct Neoplasms/diagnosis* ; Endoscopy, Digestive System

ObjectiveTo observe the effectiveness and safety of the Chinese herbal medicine Mingshi Granules （明视方颗粒） for low myopia in children with heart yang insufficiency. MethodsA multicentre， prospective， double-blind randomised controlled study was conducted， in which 290 children with low myopia from 8 centres were randomly divided into 145 cases in the treatment group and 145 cases in the control group， and the treatment group was given education， dispensing glasses， and Chinese herbal medicine Mingshi Granules， while the control group was given education， dispensing glasses， and granules placebo. Both Mingshi Granules and placebo granules were taken orally， 1 bag each time， twice daily， 4 weeks of oral intake and 2 weeks of rest as 1 course of treatment， a total of 4 courses of treatment （24 weeks）. Equivalent spherical lenses， best naked-eye distance visual acuity， ocular axis， corneal curvature K1， adjustment amplitude， traditional Chinese medicine （TCM） symptom scores， calculate the amount of progression of equivalent spherical lenses， were observed at the 12th and the 24th week of treatment， at the 36th week and 48th week of follow-up， resectively， the control rate of myopia progression was evaluated at the 24th week， and safety indexes were observed before treatment. ResultsThe amount of progression of equivalent spherical lenses was lower in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The control rate of myopia progression at 24 weeks after treatment in the treatment group was higher （57.60%， 72/125） than that in the control group （44.63%， 54/121） （P＜0.05）. The best naked-eye distance visual acuity at 36-week follow-up in the treatment group was higher than that in the control group （P＜0.05）. Equivalent spherical lenses were significantly lower in both groups at all observation time points compared with pre-treatment （P＜0.05）， and were higher in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The ocular axes of both groups were significantly higher at each observation time point after treatment and at follow-up compared with before treatment （P＜0.05）. The amount of eye axis growth in the treatment group was lower than that in the control group at 24 weeks after treatment and at the 48-week follow-up （P＜0.05）. Corneal curvature K1 was significantly lower in the treatment group at the 24th week of treatment compared to pre-treatment （P＜0.05）. The magnitude of adjustment in the treatment group was significantly higher at the 36-week follow-up and at the 48-week follow-up than before treatment （P＜0.05）. The scores of white/dark complexion， white coating thin pulse， fatigue and total TCM symptom scores of children in both groups at the 12th， 24th， 36th and 48th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； the scores of blurred vision at the 24th and 36th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； and the scores of blurred vision in the treatment group at the 48th week of follow-up were signi-ficantly lower than those before treatment （P＜0.05）. In the treatment group， the score of fatigue was higher than that of the control group at the 36-week follow-up， and the score of blurred vision was lower than that of the control group at the 48-week follow-up （P＜0.05）. No adverse reactions or obvious abnormalities of the safety indexes were observed of the two groups during the treatment. ConclusionChinese herbal medicine Mingshi Granules showed the effect of controlling the progression of low myopia， improving the best naked eye distance visual acuity， slowing down the growth of the eye axis， improving some of the TCM symptoms， with good safety.

Background::Endoscopic papillectomy (EP) is recommended as the first-line therapy for ampullary tumors, despite a relatively high incidence of complications. Pancreatic and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP complications. The present study aimed to evaluate the efficacy of different stents.Methods::A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study. These patients were divided into a pancreatic stent group (PS group, n = 47), a biliary stent group (BS group, n = 38), and a two-stent group (PBS [PS and BS] group, n = 32). Relevant clinical data were collected and compared among the three groups. Multivariate logistic analyses were performed to explore risk factors for post-EP complications. Results::The incidence of all complications was 37.6% (44/117). Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5% (17/117) and 17.9% (21/117). The incidence rates of post-EP pancreatitis were 10.6% (5/47), 23.7% (9/38), and 9.4% (3/32) in the PS group, BS group, and PBS group, respectively, with no significant differences. There were also no significant differences in other complications among the three groups. Age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.91-0.99; P = 0.022) was independently associated with post-EP pancreatitis while tumor size (OR: 1.66; 95% CI: 1.06-2.60; P = 0.028) was independently associated with post-EP hemorrhage. Conclusions::While pancreatic stenting is the first choice to prevent post-EP pancreatitis, biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation. Two-stent (biliary and pancreatic stent) placement is unnecessary unless it is required due to other concerns.

Objective:To assess the efficacy of a novel spatial-temporal polyp detection system in colonoscopy.Methods:This research was a retrospective comparative study. Eight hundred and thirty-three participants who underwent computer-aided detection (CADe) colonoscopy at the First Medical Center of Chinese PLA General Hospital between March and June 2023 were enrolled to the experimental group, while 770 individuals who received conventional colonoscopy from March to June 2022, in the identical operation room were to the control group. The primary outcome was the adenoma detection rate (ADR), and the secondary outcomes were the polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC).Results:The ADR [29.3% (244/833) VS 21.7% (167/770), χ2=12.133, P<0.001] and PDR [47.9% (399/833) VS 37.9% (292/770), χ2=16.241, P<0.001] were significantly higher in the experimental group than those in the control group. Adenomas ≤5 mm [23.5% (196/833) VS 16.1% (124/770), χ2=13.808, P<0.001] and flat-type adenomas [15.1% (126/833) VS 7.3% (56/770), χ2=24.519, P<0.001] were detected in a significantly higher proportion of subjects in the experimental group than those in the control group. There were significant difference in APC [0 (0,1) VS 0 (0,1), Z=-3.698, P<0.001] and PPC [0 (0,1) VS 0 (0,1), Z=-4.424, P<0.001] between the experimental and control groups. The use of CADe system significantly increased both ADR [29.5% (167/566) VS 18.9% (89/472), χ2=15.709, P<0.001] and PDR [47.3% (268/566) VS 33.3% (157/472), χ2=21.123, P<0.001] in junior endoscopists. However, in senior endoscopists, there was no statistical significant difference in ADR [28.8% (77/267) VS 26.2% (78/298), χ2=0.502, P=0.479] or PDR [49.1% (131/267) VS 45.3% (135/298), χ2=0.800, P=0.371] with or without CADe system. Conclusion:The use of CADe system significantly increases overall polyp and adenoma detection in clinical practice, especially in the detection of diminutive and flat-type lesions. Junior endoscopists gain greater advantages from the use of CADe system than their senior peers.

Objective:To evaluate the efficacy and safety of phacoemulsification combined with gonioscopy-assisted angle plasty (Phaco-GAAP) for primary angle closure glaucoma (PACG) with cataract.Methods:A case series study was carried out.Twenty-five eyes of 22 patients with PACG and cataract were enrolled in Beijing Tongren Hospital from April 2022 to August 2022.All of the patients received Phaco-GAAP surgery.During the operation, viscoelastic-assisted goniosynechialysis was performed at first, followed by a secondary angle plasty for residual peripheral anterior synechiae (PAS) based on the quantified assessment by gonioscopy, and the extent of PAS was recorded intraoperatively.The operated eyes were followed at 1 day, 1 week, 1 month and 3 months after surgery to evaluate intraocular pressure (IOP), PAS range, the number of anti-glaucoma drugs application, operation-related complications, and success rate.The qualified success rate was defined as medicine-controlled IOP ≤21 mmHg after surgery, and complete success rate was defined as IOP ≤21 mmHg without any anti-glaucoma medication.This study complied with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital (TRECKY2021-136). Written informed consent was obtained from each patient prior to entering the research cohort.Results:The extent of PAS was [270(225, 360)°], [165(110, 215)°] and [100(35, 175)°] at preoperation, first and secondary angle plasty, respectively, showing a significant difference among them ( χ2 =40.742, P<0.001). The PAS range was significantly reduced at first angle plasty in comparison with preoperation and was significantly reduced at secondary angle plasty in comparison with at first angle plasty (both at P<0.001), and the proportion of the angle PAS range ≥180° decreased from 48% to 24% after second angle plasty.In 13 eyes finished gonioscopy, the PAS range was [240(195, 305)°], [60(25, 182.5)°], [170(120, 275)°]and [180(140, 280)°]at preoperation, at the end of operation, postoperative 1 month and 3 months, respectively, with a significant difference ( χ2 =23.631, P<0.001). The PAS range was significantly smaller at postoperative 1 month, 3 months than that at preoperation (both at P=0.004) and larger than that at the end of operation ( P=0.011, P=0.003). The IOP was (40.19±17.23), (15.80±7.98), (13.89±5.09), (12.80±3.79) and(13.24±2.78) mmHg before operation and 1 day, 1 week, 1 month and 3 months after operation, respectively, showing a significant difference ( F=44.031, P<0.001), and the IOP was significantly reduced after operation (all at P<0.001). The PAS range at the end of operation was positively correlated with preoperation ( rs=0.409, P=0.042). The complete and qualified success rates were 95.8%, 95.8% for postoperative 1 month, 95.8% and 100% for postoperative 3 months, respectively.The primary complication was intraoperative anterior chamber angle hemorrhage, with an incidence of 68%. Conclusions:Phaco-GAAP can intraoperatively quantify PAS range and guide secondary angle plasty, therefore, it is an effective and safe surgical intervention for PACG with cataract.

Objective To compare the effects of 4 different shaping angle tubes on the success rate of tracheal intubation and postoperative pharyngeal complications among anesthetic beginners.Methods 160 patients who underwent laparoscopic cholecystectomy under general anesthesia,with ASA classification Ⅰ to Ⅱ,no history of difficult airway,were randomly divided into 4 groups according to the catheter shape and tip shaping angle:35°banana-shaped elbow group(A Group),50°banana-shaped bent pipe group(Group B),35°straight pipe group(Group C),50°straight pipe group(Group D),with 40 cases in each group.After induction of general anesthesia,tracheal intubation is performed using a video laryngoscope.The Cormack-Lehane grade of laryngoscope exposure,external laryngeal compression,one-time success rate of intubation and intubation time were recorded.SPO2,HR and MAP were recorded before anesthesia induction(T0),at the end of anesthesia induction drug injection(T1),immediately after intubation(T2)and 1min after intubation(T3).The incidence of pharyngeal pain and hoarseness immediately after extubation and 24 hours after operation were followed up.Results There were no statistically significant differences in Cormack-Lehane classification,HR,and MAP among the four groups of patients at each time point(P>0.05).The number of cases requiring external laryngeal compression,intubation time,first-time intubation success rate,immediate postoperative sore throat,and immediate postoperative hoarseness rates in Groups B and D were all lower than those in Groups A and C,and the differences were statistically significant(P<0.05).Conclusion When using video laryngoscope for tracheal intubation,50°banana-shaped curved tube and 50°straight tube can shorten the intubation time,reduce postoperative complications,and have no obvious hemodynamic fluctuations.

Esophageal Achalasia/surgery* ; Esophagoscopy ; Humans ; Muscles ; Myotomy ; Tissue Adhesions