OBJECTIVE To explore the efficacy of otoscope assisted dissection myringoplasty.METHODS Fifty-nine patients with otitis media suppurative admitted from January 2019 to August 2022 were underwent otoscope assisted dissection myringoplasty.Tympanic membrane healing,hearing improvement,and complications were observed.RESULTS The total perforation healing rate was 98.3%(58/59).One case had obtuse angle healing at the anterior lower part of the tympanic membrane,and one case had local cholesteatoma beads on the tympanic membrane.The preoperative average speech frequency air conduction hearing threshold was(40.2±7.9)dB HL,and postoperative one year was(22.5±8.3)dB HL,with statistically significant differences(t=11.31,P<0.01);The preoperative average speech frequency and bone conduction was(26.3±6.1)dB HL,and postoperative one year was(12.8±5.7)dB HL,with statistically significant differences(t=9.54,P<0.01).CONCLUTION The mezzanine tympanoplasty under otoscopy owning the advantages of both otoscopy and mezzanine methods,have the outcomes of minimal damage,high healing rate,and postoperative hearing improvement.It is an ideal tympanoplasty for repairing perforation of tympanic membrane.

Objective To evaluate the value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0. Methods One hundred and sixteen patients of both sexes, aged 16-85 yr, of A-merican Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective surgery in our hospital in August 2016, were included in this study and assigned into empirical analgesia group(group E, n=79) and stratified analgesia group(group S, n=73). The risk of postoperative pain was estimated by an expe-rienced associate chief anesthesiologist based on his clinical experience, and the perioperative analgesic protocol was determined in group E. The risk of postoperative pain was assessed using the perioperative pain risk scale PPRS-CYMZ 2.0 by another experienced associate chief anesthesiologist, the risk was stratified according to the scores, and the corresponding stratified analgesic protocol was determined in group S. Vis-ual analog scale scores and parents′satisfaction with analgesia were recorded on postoperative day 30. The requirement for preventive analgesia, total pressing times of patient-controlled analgesia(PCA)pump in 0-6 h, 6-24 h and 24-72 h periods, PCA background infusion dose and consumption of rescue analgesics were recorded. The development of adverse events during postoperative hospital stay and postoperative re-covery were also recorded. Analgesia-related parameters of medical economics were calculated. Results There was no significant difference in postoperative pain risk stratification between group E and group S(P>0.05), and the majority of patients were at moderate risk. Compared with group E, no significant change was found in visual analog scale scores on postoperative day 30, PCA background infusion dose or incidence of postoperative adverse effects(P>0.05), the requirement for preventive analgesia and satisfaction scores were significantly increased in high risk patients, the consumption of rescue analgesics was decreased in moderate risk patients(P<0.05), no significant change was found in the total pressing times of PCA pump in each time period in low risk patients(P>0.05), the total pressing times of PCA pump was significantly decreased, and the direct analgesic cost per patient and total analgesic cost were decreased in moderate and high risk patients, and the first ambulation time and length of postoperative hospital stay were shortened in high risk patients in group S(P<0.05). Conclusion PPRS-CYMZ 2.0 can achieve perioperative multi-modal stratified analgesia and individualized treatment.

Objective To determine the risk factors for emergence agitation (EA) during the recovery period after general anesthesia.Methods One thousand and thirty-four patients of both sexes aged 18-89 yr undergoing general anesthesia were divided into EA group and non-EA group.EA occurring during recovery from general anesthesia was assessed by using Riker sedation-agitation scale.Age,sex,complication,education,medical history,ASA physical status,type and duration of anesthesia and operation,volume of blood loss,fluid replacement,urine volume,duration of stay in PACU,number of drainage tubes and so forth were recorded.Multivariate logistic regression was used to analyze the risk factors for the occurrence of EA.Results Thirty-six patients developed EA during recovery from anesthesia.The incidence of EA was 3.5 ％.Logistic regression indicated that high risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation were the risk factors for EA (P ＜ 0.05).Conclusion High-risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation are the risk factors for EA during recovery from general anesthesia.

ObjectiveTo investigate the role of Nav1.7 in dorsal root ganglia (DRG) in a rat model of diabetic neuropathic pain (DNP).MethodsThirty-two female Wistar rats aged 3 months weighing 180-220 g were randomly divided into 4 groups ( n ＝ 8 each):control group ( group C),sham operation group ( group S),DNP group and ProTx- Ⅱ (a selective Nav1.7 blocker) group (group E).Diabetes mellitus was induced by intraperitoneal streptozocin 65 mg/kg.Blood glucose level and mechanical paw withdrawal threshold (MWT)to von Froy filamentstimulation were measured 2 weeks later.DNP was confirmed by blood glucose level ≥ 16.0 mmol/L and MWT decreased by more than 50％ of the baseline value.Intrathecal catheter was implanted at L5,6 interspace on day 10 after successful induction of DNP.On day 4 after placement of the intrathecal catheter,ProTx- Ⅱ 10 μg/kg was injected intrathecally in group E,while the equal volume of normal saline was given in groups DNP and S.MWT and never conduction velocity (NCV) were measured 1 h after intrathecal injection.The rats were then sacrificed and DRGs of the lumbar segment (L4-6) were removed for determination of Nav1.7 protein expression (by immuno-histochemistry and Western blot) and Nav1.7 mRNA expression (by RT-PCR).ResultsThe MWT and NCV were significantly lower and the Nav1.7 mRNA and protein expression was significantly higher in groups DNP and E than in group C.ProTx- Ⅱ significantly attenuated the diabetes-induced changes in MWT,but had no effect on NCV and Nav1.7 mRNA and protein expression.ConclusionNav1.7 in DRG is involved in the maintenance of DNP in rats.