Peri-anesthetic dental trauma(PADT)occurs during anesthesia,which may obstruct eating,affect postoperative recovery and even mental health of patients.Natural aging decreases the stability of teeth and periodontal tissue.As the percentage of elderly sur-gical patients increases year by year,anesthesiologists are confronted with tricky situations during oral tracheal intubation frequently,which poses a new challenge for anesthesiologists.In recent years,dental protection has received increasing attention in perioperative medicine and many protective products have been introduced.This article reviews the causes of damage,treatment of the complications,protective measures and innovative evaluation in PADT,so as to assist clinical practice.

Objective:To evaluate the relationship between the occipitocervical angle(basilar vertebral angle [O-C 2 angle], mento-pharyngeal angle [M-P angle], and cervical range of motion [CROM]) and difficult airway after occipitocervical fusion surgery in the patients. Methods:This was a retrospective study. The clinical data from patients who underwent occipitocervical fusion surgery at our hospital from March 2018 to March 2023 were retrospectively collected. Preoperative and last follow-up airway assessment data and cervical lateral X-rays were collected to measure the O-C 2 angle, M-P angle and CROM. Patients were divided into negative group (Mallampati grade Ⅰ or Ⅱ, suggesting no difficulty in intubation) and positive group (Mallampati grade Ⅲ or Ⅳ, suggesting possible difficulty in intubation) based on the last follow-up modified Mallampati classification. Results:A total of 53 patients were finally included, with 18 cases in positive group and 35 in negative group. There were no statistically significant differences in the O-C 2 angle and CROM between preoperative and last follow-up in the 53 patients ( P>0.05), and the M-P angle was significantly decreased at the last follow-up compared with that before operation ( P<0.05). Compared with negative group, O-C 2 angle and M-P angle were significantly decreased at the last follow-up ( P<0.05), and no significant change was found in CROM in positive group ( P<0.05). Compared with that before operation, the M-P angle was significantly decreased at the last follow-up in both groups, and the O-C 2 angle was significantly decreased at the last follow-up in positive group ( P<0.05). The areas under the receiver operating characteristic curves of O-C 2 angle, M-P angle and CROM in predicting difficult airway were 0.895, 0.888 and 0.519 respectively. Conclusions:The decrease in the O-C 2 angle and M-P angle after occipitocervical fusion surgery can increase the risk of difficult airway, and both can be used for airway assessment in the patients undergoing this kind of surgery.

Objective:To investigate the clinical efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide (NT-pro BNP) level.Methods:The clinical data of 89 patients with chronic heart failure who received treatment in Jinan 2 nd People's Hospital from January 2020 to April 2022 were retrospectively analyzed. These patients were divided into Group A ( n = 48) and Group B ( n = 41) according to different treatment methods. Group A was treated with sacubitril and valsartan combined with bisoprolol. Group B was treated with sacubitril and valsartan combined with metoprolol. All patients were treated for 3 months. Clinical efficacy as well as heart function and NT-pro BNP level pre- and post-treatment were compared between the two groups. The incidence of adverse reactions was calculated in each group. Results:Total response rate in group A was significantly higher than that in group B [95.83% (46/48) vs. 82.93% (34/41), χ2 = 4.05, P < 0.05]. After treatment, the left ventricular ejection fraction in both groups increased significantly and the left ventricular ejection fraction in group A was significantly higher than that in group B ( t = 2.19, P < 0.05). After treatment, NT-pro BNP level in group A was (416.51 ± 30.56) ng/L, which was significantly lower than (450.20 ± 35.79) ng/L in group B ( t = 4.79, P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure is superior to that of sacubitril and valsartan combined with metoprolol. The former can greatly decrease NT-pro BNP level. Corresponding drugs can be selected for the treatment of chronic heart failure according to the actual needs of patients.

As a threat to human health， steroid-induced osteonecrosis of femur head is a common refractory orthopedic disease mainly caused by glucocorticoids， with poor prognosis and unclear pathogenesis. Osteogenesis-associated signaling pathways play an important role in bone formation. Glucocorticoid-induced abnormal activation and transport of these signaling pathways lead to abnormal differentiation of bone marrow mesenchymal stem cells， dysfunction of bone metabolism， and osteogenesis disorders， which may be the main reasons for the occurrence and development of steroid-induced osteonecrosis of femur head. Bone formation and remodeling need the participation of bone marrow mesenchymal stem cells， which are stem cells characterized by continuous self-renewal and differentiation. The key to strengthening bone remodeling is to improve the osteogenic differentiation capacity， which is the key point to inhibit bone resorption and prevent bone marrow mesenchymal stem cells from differentiating into osteoclasts. Traditional Chinese medicine （TCM） has been used in the treatment of osteonecrosis in ancient times. It is recorded in the Treasury of Words on Materia Medica （《本草汇编》） that "The deficiency in the lower energizer cannot be tonified without Eucommiae Cortexz.The soreness in lower legs cannot be alleviated without Eucommiae Cortex...The pain in the waist and knee cannot be relieved without Eucommiae Cortex...Tonifying liver and invigorating kidney， Eucommiae Cortex is an essential medicine." This indicates that ancient physicians have already begun to use the liver-tonifying， kidney-invigorating， and sinew-bone-strengthening effects of Eucommiae Cortex for the treatment of osteonecrosis. As the national support for the development of TCM strengthens， increasing studies have been conducted on the TCM prevention and treatment of steroid-induced osteonecrosis of femur head. Studies have suggested that Chinese medicinal herbs can exert a positive effect on the differentiation of bone marrow mesenchymal stem cells by affecting targeted signaling molecules， and promote osteogenesis and bone defect repair， thus combating the occurrence and development of steroid-induced osteonecrosis of femur head. The regulation of osteogenic signaling pathway by Chinese medicines to prevent steroid-induced osteonecrosis of femoral head has become a hot research topic. This article reviews the studies about the prevention and treatment of steroid-induced osteonecrosis of femur head with the active components in Chinese medicinal herbs by regulating osteogenic signaling pathways. We then explore the mechanism of the active components in promoting the differentiation of bone marrow mesenchymal stem cells into osteoblasts and inhibiting their differentiation into osteoclasts to facilitate bone formation， aiming to provide a reference for the further study of treating steroid-induced osteonecrosis of femoral head with Chinese medicinal herbs.

Objective:To compare the effects of esketamine and opioids on postoperative cellular immune function in the patients undergoing laparoscopic gynecological surgery.Methods:Fifty patients, of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged 20-65 yr, with height 150-180 cm, weighing 50-80 kg, who underwent laparoscopic non-oncologic gynecological surgery with general anesthesia in the Second Hospital of Shanxi Medical University from September 2020 to February 2021, were divided into 2 groups using a random number table method: esketamine group (group K) and opioid analgesic group (group O), with 25 patients in each group.Anesthesia was induced as follows: esmketamine 0.25-0.50 mg/kg was intravenously injected in group K, sufentanil 0.2-0.4 μg/kg was intravenously injected in group O, and propofol 2 mg/kg and rocuronium 0.6-0.9 mg/kg were intravenously injected in two groups.Anesthesia was maintained as follows: esketamine was intravenously infused at 0.5 mg·kg -1·h -1 in group K, remifentanil was intravenously infused at 10-20 μg·kg -1·h -1 in group O, and propofol 4-10 mg·kg -1·h -1 was intravenously infused, and rocuronium 0.2-0.3 mg/kg was intermittently injected in two groups.Blood samples from elbow veins were collected before anesthesia induction (T 1) and immediately after extubation (T 2) for determination of T lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4 + CD25 + CD127 low) and NK cells and B lymphocyte (by flow cytometry) and serum interleukin-6 (IL-6) and IL-10 concentrations (by multiplexed fluorescent microsphere immunoassay). Routine blood tests were performed on preoperative day 1 and postoperative day 3, and neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were calculated. Results:Compared with group O, the percentages of CD3 + and CD4 + cells, ratio of CD4 + /CD8 + and percentage of NK cells were significantly increased, serum IL-6 concentrations were decreased, and serum IL-10 concentrations were increased after extubation, white blood cell, monocyte and neutrophil counts were increased, and lymphocyte count was decreased on postoperative day 3 ( P<0.05), and no significant change was found in neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in group K ( P>0.05). Conclusion:Compared with opioid analgesics, esketamine has less inhibition of postoperative cellular immune function in the patients undergoing laparoscopic gynecological surgery.

Objective To explore the effect of amlodipine atorvastatin calcium tablets in the treatment of patients with hypertension and coronary heart disease complicated with carotid atherosclerosis .Methods From August 2013 to August 2017,280 patients with hypertension and coronary heart disease complicated with carotid atherosclerosis in the Second People＇s Hospital of Ji＇nan were selected,and they were divided into two groups by envelope randomization packet mode,with 140 cases in each group.The control group was treated with amlodipine benzenesulfonate.The observation group was treated with amlodipine atorvastatin calcium tablets .The incidence of adverse reactions,diastolic blood pressure (DBP) level,systolic blood pressure (SBP) level,total effective rate,hs-CRP,TC,TG,HDL-C,LDL-C,IMT,PV were compared between the two groups.Results There were no statistically significant differences in PV,IMT,SBP and DBP between the two groups (t ＝1.150,0.861,0.195,0.637,all P＞0.05).The incidence rate of adverse reactions (2.86%),DBP level[(78.95 ±3.11)mmHg],SBP level[(121.63 ±5.42)mmHg],total effective rate (96.43%),hs-CRP levels[(4.15 ±1.65)mg/L],TC level [(3.28 ±1.98)mmol/L],TG level[(1.22 ±0.34)mmol/L],HDL-C level[(1.98 ±0.75)mmol/L],LDL-C level[(1.33 ±0.54)mmol/L],IMT[(1.12 ±0.05)mm],PV[(0.11 ±0.03)cm3]in the observation group were better than those in the control group (χ2＝22.630,t＝15.839,37.209,χ2＝25.053,t＝20.056,7.381,8.659,15.110,21.951,15.665,12.951,all P＜0.05).Conclusion The effect of amlodipine atorvastatin calcium tablets in the treatment of patients with hypertension and coronary heart disease complicated with carotid atherosclerosis is remarkable.

Recent studies have shown that TCM treatment for bone metabolic diseases, such as steroid-induced avascular necrosis of the femoral head, has definite efficacy and has received extensive attention. However, due to lack of molecular biological basis of pharmacodynamics mechanism, it has not yet reached the standard of scientific treatment. The discovery of OPG/RANK/RANKL system has become a new breakthrough point in the prevention and treatment of bone metabolic diseases. The pathogenesis of deficiency of spleen and kidney - blood stasis - caused by phlegm arthralgia caused by blood stasis is closely related to the system. The effect of the final control of the system from the deficiency theory can be expressed through the axial micro-information. This article discussed the TCM syndrome differentiation of steroid-induced osteonecrosis of the femoral head and the relation of regulation of bone metabolism combined with the OPG/RANK/RANKL system, and provided the basis for prevention and treatment of this disease.

Heart Atria ; Humans ; Speech ; Tachycardia

OBJECTIVE:To observe the efficacy and economy of omeprazole and esomeprazole in the treatment of brain trauma and cerebral hemorrhage complicated with upper gastrointestinal hemorrhage. METHODS:The data of 110 patients with trauma cere-bral hemorrhage complicated with upper gastrointestinal hemorrhage were retrospectively analyzed and divided into omeprazole group (56 cases)and esomeprazole group(54 cases). All patients were given conventional treatment. On this basis,omeprazole group was treated with Omeprazole for injection 40 mg by intravenous infusion;esomeprazole group was treated with Esomeprazole injection 40 mg by intravenous infusion,twice a day. The treatment course for 2 groups was 5 d. The efficacy and economy of patients were com-pared. RESULTS:The total effective rates in esomeprazole group were significantly higher than omeprazole group higher,the cost-ef-fectiveness in esomeprazde group(1 397.71)were significantly lower than omeprazole group(1 512.09)(P<0.05),andΔC/ΔE=91.52. CONCLUSIONS:Esomeprazole has good efficacy,safety and economy in the treatment of brain trauma cerebral hemorrhage compli-cated with upper gastrointestinal hemorrhage.

Referring to the anatomical characterization of natural spongy bone and channel network in cortical bone, we designed a new pattern of biomimetic impalnt with preset channel for blood vessel inserting to treat early femoral head necrosis. The surgical ptrocedure was simulated by CAD model. Ceramic stereolithography was applied to fabricate the green part. Other process, such as dehydration, rinsing, drying and sintering, were taken successively. The final ceramic part kept identical with the engineered part either in the shape or in the internal structure. No deformation or crack happened. Pore size, interconnected pore size, porosity and interconnected porosity of ceramic part could satisfy cellular grouth. Spectrum analysis showed that no phase transition or chemical reaction happened during fabrication process. The biocompatibility of the final part kept the same with original during beta-TCP powder. The compressive strength was 23.54 MPa, close to natural spongy bone. It is an ideal implant to treat early femoral head necroseis because it makes preimplantation of cells and biological factors, blood velssel inserting, early establishment of blood supply possible. At the same time, it could provide enough mechanical support to prevent collapse of femoral head. It could provide a wide clinical foreground.
Biocompatible Materials ; chemistry ; Bone Substitutes ; chemical synthesis ; chemistry ; Calcium Phosphates ; chemistry ; Computer-Aided Design ; Femur Head Necrosis ; therapy ; Humans ; Porosity ; Prostheses and Implants ; Tissue Engineering ; Tissue Scaffolds ; chemistry