Objective:To explore the effect of ultrasound-guided nerve block combined with dexmedetomidine (DEX) on postoperative oxidative stress in patients with hip fracture and diabetes.Methods:From March 2017 to December 2019, 78 patients with diabetes who underwent hip fracture surgery were enrolled and divided into two groups by random number table method, with 39 cases in each group. After the operation, the control group was treated with ultrasound-guided femoral nerve combined with lateral femoral cutaneous nerve block with 0.375% ropivacaine, and the study group was treated with ultrasound-guided femoral nerve combined with lateral femoral cutaneous nerve block with 0.375% ropivacaine and DEX 0.5 μg/kg. Patients in both groups were received patient controlling intravenous analgesia (PCIA) after the operation, and visual analogue scoring (VAS) was used to evaluate the resting pain score of the patients at 4 h (T 1), 8 h (T 2), 16 h (T 3), 24 h (T 4), 36 h (T 5) and 48 h after operation (T 6). The levels of serum superoxide dismutase (SOD), malondialdehyde (MDA), 8-hydroxydeoxyuridine (8-OHdG), at T 1 and T 6 were compared between the two groups. The management system of continuous glucose monitoring system (CGMS) was used to calculate the mean amplitude of glycemic excursions(MAGE), largest amplitude of glycemic excursions (LAGE), absolute means of daily differences (MODD) of the patients during 48 h after operation, and the correlation between the blood glucose fluctuation indicators and the oxidative stress of the study group were compared. Results:The scores of VAS in the study group at T 1-T 6 were lower than those in the control group , the difference were statistically significant ( P<0.05). At T 6, the level of serum SOD in the study group was higher than that in the control group: (79.58 ± 13.55) kU/L vs. (64.16 ± 11.95) kU/L; the level of serum MDA and 8-OhdG in the study group were higher than those in the control group: (4.36 ± 0.81) μmol/L vs. (5.64 ± 0.94) μmol/L, (1.06 ± 0.19) μg/L vs.(1.42 ± 0.22) μg/L, the differences were statistically significant ( P<0.05). The levels of MAGE, LAGE, MODD in the study group were lower than those in the control group: (2.42 ± 0.47) mmol/L vs. (5.19 ± 0.96) mmol/L, (3.47 ± 0.64) mmol/L vs. (7.61 ± 1.32) mmol/L, (1.21 ± 0.27) mmol/L vs. (2.74 ± 0.46) mmol/L, the differences were statistically significant ( P<0.05). The correlation analysis showed that the blood glucose fluctuation indicators MAGE, LAGE and MODD of the study group were negatively correlated with SOD, and were positively correlated with MDA, 8-OHdG ( P<0.05). Conclusions:The use of ultrasound-guided nerve block combined with dexmedetomidine (DEX) for patients with hip fracture and diabetes can improve the analgesic effect, reduce oxidative stress of the patients, and improve the blood glucose fluctuation indicators.

Objective:To understand the occurrence of intraoperative memory (dream, halluci- nation, and intraoperative awareness) following anesthesia with propofol and sufentanil and analyze its influen- cing factors in patients undergoing painless curettage of the uterine cavity.Methods:The modified Brice questionnaire survey results in patients who underwent painless curettage of the uterine cavity under propofol and sufentanil anesthesia in Shuangqiao Hospital from January 2017 to September 2018 were retrospectively analyzed. The memory of patients from anesthesia induction to consciousness recovery after anesthesia was evaluated, and the incidences of dream, hallucination (including sexual hallucination), and intraoperative awareness were calculated. The possible influencing factors (including age, weight, operation time, initial and total dose of propofol, and total dose of sufentanil) of intraoperative memory after anesthesia with propofol and sufentanil were analyzed using logistic regression method.Results:A total of 2 142 patients were enrolled, aged (28.3±7.4) years and weighing (61.8±10.2) kg, with gestational age of (7.8±1.3) weeks and a median operation time of 5 (3-28) min; the initial dose of propofol was (94.1±20.9) mg, with a total dose of (110.0±39.8) mg; the total dose of sufentanil was (9.9±0.4) μg. Among the 2 142 patients, 1 038 (48.5%) had memory from anesthesia induction to consciousness recovery after anesthesia, 1 019 (98.2%) of which were defined as dreams, 19 (1.8%) as hallucinations, and no one had intraoperative awareness. Eleven of 1 038 patients were defined as having sexual hallucinations and the incidence was 0.5%. There was no significant correlation between the occurrence of intraoperative memory and age, weight, operation time, initial dose and total dose of propofol, and total dose of sufentanil ( P>0.05 for all). Conclusion:The anesthesia of propofol combined with sufentanil may lead to dreams and hallucinations in patients undergoing painless curettage of the uterine cavity, and occurrence of sexual hallucinations should be more paid attention to.

Objective:To understand the occurrence of intraoperative memory (dream, halluci- nation, and intraoperative awareness) following anesthesia with propofol and sufentanil and analyze its influen- cing factors in patients undergoing painless curettage of the uterine cavity.Methods:The modified Brice questionnaire survey results in patients who underwent painless curettage of the uterine cavity under propofol and sufentanil anesthesia in Shuangqiao Hospital from January 2017 to September 2018 were retrospectively analyzed. The memory of patients from anesthesia induction to consciousness recovery after anesthesia was evaluated, and the incidences of dream, hallucination (including sexual hallucination), and intraoperative awareness were calculated. The possible influencing factors (including age, weight, operation time, initial and total dose of propofol, and total dose of sufentanil) of intraoperative memory after anesthesia with propofol and sufentanil were analyzed using logistic regression method.Results:A total of 2 142 patients were enrolled, aged (28.3±7.4) years and weighing (61.8±10.2) kg, with gestational age of (7.8±1.3) weeks and a median operation time of 5 (3-28) min; the initial dose of propofol was (94.1±20.9) mg, with a total dose of (110.0±39.8) mg; the total dose of sufentanil was (9.9±0.4) μg. Among the 2 142 patients, 1 038 (48.5%) had memory from anesthesia induction to consciousness recovery after anesthesia, 1 019 (98.2%) of which were defined as dreams, 19 (1.8%) as hallucinations, and no one had intraoperative awareness. Eleven of 1 038 patients were defined as having sexual hallucinations and the incidence was 0.5%. There was no significant correlation between the occurrence of intraoperative memory and age, weight, operation time, initial dose and total dose of propofol, and total dose of sufentanil ( P>0.05 for all). Conclusion:The anesthesia of propofol combined with sufentanil may lead to dreams and hallucinations in patients undergoing painless curettage of the uterine cavity, and occurrence of sexual hallucinations should be more paid attention to.

Objective To explore the efficacy and safety of dezocine after laparoscopic cholecystectomy at a high altitude area (average altitude of over 4 500 m).Methods The study was designed as an open randomized controlled study.The subjects were selected from patients who underwent laparoscopic cholecystectomy and required postoperative analgesia in Duilongdeqing District People's Hospital of Lhasa.The patients were randomly divided into the observation group and the control group.They had the same anesthesia method during operation and patient-controlled intravenous analgesia (PCIA) was initiated after the operation.The patients in the observation group were treated with dezocine 0.6 mg/kg plus ondansetron 16 mg diluted in 0.9％ sodium chloride injection 100 ml for PCIA,while in the control group,dezocine was replaced by sufentanil 2 μg/kg.According to the difference in the incidence of excessive sedation between dezocine and sufentanil in previous literature,it was estimated that the sample size in the 2 groups should be ＞ 14 cases and the patients should be terminated when the test efficacy was ＞ 0.8.Visual analogue scale (VAS) score (pain evaluation) and Ramsay sedation scale (sedation evaluation) at 1,4,8,12,24 and 48 hours,frequency of PCIA pump pressing and dosage of anesthetics,and the incidence of adverse events related to analgesics within 48 hours after operation in patients in the 2 groups were compared.Results From January 2015 to November 2017,a total of 50 patients were enrolled in the study,including 25 in the observation group and 25 in the control group.The differences in gender,age,weight,American Society of Anesthesiologists classification,operation time,frequency of PCIA pump pressing and dosage of anesthetics between the 2 groups were not significant (P ＞ 0.05 for all).The differences in VAS scores at all time points after operation were not significant (P ＞ 0.05 for all).The Ramsay sedation scores in patients in the observation group at 1 and 4 hours after operation were significantly lower than those in the control group [(2.5±1.1) scorevs.(3.4±1.4) score,P=0.016;(2.5±1.0) scorevs.(3.5±1.5) score,P=0.007].The incidences of sedation-related adverse events such as nausea,vomiting,respiratory depression within 48 hours after operation in the control group were significantly lower than those in the control group [8.0％ (2/25)vs.36.0％ (9/25),0vs.24.0％ (6/25),4.0％ (1/25)vs.44.0％ (11/25),P＜0.05for all].Conclusions The analgesic effect of dezocine after laparoscopic cholecystectomy at high altitudes was similar to that of sufentanil and the incidences of respiratory depression and excessive sedation were lower than those of sufentanil.Dezocine may be safer for patients at high altitudes.

Objective To explore the efficacy and safety of dezocine after laparoscopic cholecystectomy at a high altitude area (average altitude of over 4 500 m).Methods The study was designed as an open randomized controlled study.The subjects were selected from patients who underwent laparoscopic cholecystectomy and required postoperative analgesia in Duilongdeqing District People's Hospital of Lhasa.The patients were randomly divided into the observation group and the control group.They had the same anesthesia method during operation and patient-controlled intravenous analgesia (PCIA) was initiated after the operation.The patients in the observation group were treated with dezocine 0.6 mg/kg plus ondansetron 16 mg diluted in 0.9％ sodium chloride injection 100 ml for PCIA,while in the control group,dezocine was replaced by sufentanil 2 μg/kg.According to the difference in the incidence of excessive sedation between dezocine and sufentanil in previous literature,it was estimated that the sample size in the 2 groups should be ＞ 14 cases and the patients should be terminated when the test efficacy was ＞ 0.8.Visual analogue scale (VAS) score (pain evaluation) and Ramsay sedation scale (sedation evaluation) at 1,4,8,12,24 and 48 hours,frequency of PCIA pump pressing and dosage of anesthetics,and the incidence of adverse events related to analgesics within 48 hours after operation in patients in the 2 groups were compared.Results From January 2015 to November 2017,a total of 50 patients were enrolled in the study,including 25 in the observation group and 25 in the control group.The differences in gender,age,weight,American Society of Anesthesiologists classification,operation time,frequency of PCIA pump pressing and dosage of anesthetics between the 2 groups were not significant (P ＞ 0.05 for all).The differences in VAS scores at all time points after operation were not significant (P ＞ 0.05 for all).The Ramsay sedation scores in patients in the observation group at 1 and 4 hours after operation were significantly lower than those in the control group [(2.5±1.1) scorevs.(3.4±1.4) score,P=0.016;(2.5±1.0) scorevs.(3.5±1.5) score,P=0.007].The incidences of sedation-related adverse events such as nausea,vomiting,respiratory depression within 48 hours after operation in the control group were significantly lower than those in the control group [8.0％ (2/25)vs.36.0％ (9/25),0vs.24.0％ (6/25),4.0％ (1/25)vs.44.0％ (11/25),P＜0.05for all].Conclusions The analgesic effect of dezocine after laparoscopic cholecystectomy at high altitudes was similar to that of sufentanil and the incidences of respiratory depression and excessive sedation were lower than those of sufentanil.Dezocine may be safer for patients at high altitudes.

Objective To investigate the activation state of and expressions of surface co-stimulatory molecules on peripheral CD4+ T cells from patients with pemphigus and healthy human controls.Methods Ninety patients with pemphigus including 24 patients with first-onset pemphigus,51 with quiescent pemphigus and 15 with recurrent pemphigus,as well as 30 healthy human controls were enrolled in this study.Peripheral blood samples were obtained from these subjects followed by lymphocyte isolation.Flow cytometry was performed to detect the expressions of CD69,intercellular adhesion molecule-1 (ICAM-1),inducible co-stimulatory molecule (ICOS),CD40 ligand (CD40L) and OX40 on CD4+ T cells.Statistical analysis was done by Mann-Whitney test using Graphpad 5.0 software.Results The expression rate of CD69 on peripheral CD4+ T cells from the healthy human controls was significantly lower than that from patients with pemphigus,patients with first-onset pemphigus,patients with quiescent pemphigus,and patients with recurrent pemphigus ((1.26 ± 0.19)％ vs.(2.46 ± 0.19)％,(2.77 ± 0.40)％,(2.15 ± 0.25)％ and (2.36 ± 0.35)％,all P ＜ 0.05).The patients with pemphigus also showed a significant increase in the expression rates of ICAM-1,CD40L and OX40 compared with the healthy human controls ((55.88 ± 1.67)％ vs.(47.75 ± 2.52)％,P＜ 0.05; (2.23 ± 0.22)％ vs.(0.73 ± 0.07)％,P＜ 0.01; (2.55 ± 0.29)％vs.(0.62 ± 0.17)％,P ＜ 0.01).No significant differences were observed between patients with different stages of pemphigus in the expression rates of CD69,ICAM-1,CD40L or OX40 (all P ＞ 0.05).The percentage of ICOS-expressing CD4+ T cells was significantly up-regulated in only patients with first-onset pemphigus as compared to the healthy controls ((3.73 ± 0.60)％ vs.(2.39 ± 0.16)％,P ＜ 0.05).Conclusions The peripheral blood CD4+ T cells from patients with pemphigus are in a relatively active state with up-regulated surface expressions of many costimulatory molecules,suggesting that CD4+ T cells are involved in the initiation and progression of pemphigus by interacting with B cells through co-stimulatory molecules.