目的 观察七氟烷吸入复合骶管阻滞、基础麻醉复合骶管阻滞及单纯静脉全麻在小儿腹股沟区手术的应用。 方法 将2008年5月-2009年8月收治的90例ASAⅠ~Ⅱ级择期手术患儿分为3组：Ⅰ组为七氟烷吸入复合骶管阻滞组，Ⅱ组为静脉麻醉复合骶管阻滞组，Ⅲ组为全凭静脉麻醉组。每组30例，观察3组麻醉效果。 结果 Ⅰ组患儿心率、平均动脉压、呼吸频率变化不明显，Ⅱ组和Ⅲ组患儿术中和术后心率、平均动脉压较术前升高（Plt;0.05），呼吸频率明显低于术前；Ⅲ组患儿苏醒时间明显延长，Ⅰ组和Ⅱ组患儿苏醒期并发症低于Ⅲ组，其中Ⅲ组患儿术后躁动与哭闹多见。 结论 七氟烷吸入复合骶管阻滞用于小儿腹股沟区手术，患儿易于接受，麻醉过程中呼吸循环功能稳定，苏醒快，清醒质量高，苏醒期不良反应少，是临床上值得推广的麻醉方法。
ObjectiveTo study the correlation of postoperative cognitive dysfunction (POCD) with type-2 diabetes and glycosylated hemoglobin (HbA1c) levels in elderly patients. MethodsA total of 140 elderly patients who were going to undergo non-cardiothoracic surgery in our hospital between January 2011 and February 2013 were included in this study.ASA classification was between I and Ⅲ.There were 78 males and 62 females,aged between 65 and 86 years old.Group A had 70 patients with diabetes,while group B had another 70 corresponding patients without diabetes.One day before surgery and a week after surgery,Mini-mental State Examination (MMSE) and Montreal Cognitive Functioning Scale (MoCA) were used to test patients'cognitive function,and the incidence of POCD was compared between the two groups.Group A patients,according to HbA1c levels,were divided into group AH (HbA1c>7.5%) and group AL (HbA1c<7.5%).And we compared the relationship between group AL and group B,and the relationship between group AH and group B. ResultsThe incidence of POCD in group A was significantly higher than that in group B (P<0.05).Group AH had a significantly higher incidence of POCD than group AL (P<0.05).No significant difference was found in fasting plasma glucose among the groups. ConclusionElderly diabetic patients with poor glycemic control is a risk factor for POCD occurrence,but fasting glucose as a predictor of POCD is not as good as HbA1C.
ObjectiveTo evaluate systematically the relationship between obesity and clinical prognosis in acute respiratory distress syndrome (ARDS) patients.MethodsA systematic search was performed in Pubmed, EMBASE, Cochrane databases, Wiley, Ovid, Medline, CNKI, VIP and Wanfang. All studies that reported obesity in the clinical prognosis of ARDS and acute lung injury were included. A meta-analysis was performed using RevMan 5.0 and Stata 10.0.ResultsA total of 28 368 patients from 9 studies were included in this meta-analysis. The combined results showed that obesity was associated with the decreased mortality of ARDS [odds ratio(OR)=0.63, 95% confidence intervals (95%CI) 0.41 to 0.98, P=0.04]. In subgroup analysis, the result showed no obvious relationship between obesity and 28-day mortality in ARDS/ALI (OR=0.92, 95%CI 0.55 to 1.54, P=0.76). However, obesity was associated with lower risk of 60days and 90-day mortality in ARDS/ALI (60-day: OR=0.84, 95%CI 0.75 to 0.94, P=0.002; 90-day: OR=0.38, 95%CI 0.22 to 0.66, P=0.000 5). Compared with normal weight patients with ARDS, hospital length of stay, ICU length of stay, and duration of mechanical ventilation did not differ significantly [hospital length of stay: weighted mean difference (WMD)=3.61, 95%CI –0.36 to 7.57, P=0.07; intensive care unit (ICU) length of stay: WMD=1.52, 95%CI –0.22 to 3.26, P=0.09; duration of mechanical ventilation: WMD=–0.50, 95%CI –2.18 to 1.19, P=0.56], but ventilator-free days was significantly longer in obese patients (WMD=2.68, 95%CI 0.86 to 4.51, P=0.004).ConclusionsObesity is not associated with hospital length of stay, ICU length of stay, and duration of mechanical ventilation in patients with ARDS. However, obesity is associated with a reduction of long-term mortality and increased ventilator-free days in the patients with ARDS. Additional larger randomized controlled studies are needed to confirm the possible role of obesity in the clinical prognosis of ARDS.
ObjectiveTo systematically review the effectiveness of outdoor activities in preventing myopia progression, and to provide scientific evidence for myopia prevention and management.MethodsPubMed, MEDLINE, EMbase, CNKI and WanFang Data databases were searched from establishment to October 2017. Two researchers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 studies involving 24 667 participants were included. The results of meta-analysis showed that the incidence of myopia in outdoor activities group was lower than that in control group (OR=0.67, 95%CI 0.55 to 0.81, P<0.000 1).ConclusionThe current evidence shows that outdoor activities have protective effects on emmetropia children myopia onset. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.
ObjectiveTo know the fundamental status of painless digestive endoscopy in China. MethodsA 23-item survey including multiple choices and fill-in-the-blank questions on 3 pages was performed on anesthesiologists in China excluding Taiwan, Macao and Hong Kong on www.xqnmz.com and www.dxy.cn/bbs from November 1 to December 31, 2013, among which 5 questions were on personal details, 9 on hospital and department, and 9 on clinic details. The results about the basic facts, risk factors of anesthesia and drug use and monitoring of painless digestive endoscopy in China were analyzed. ResultsA total of 726 questionnaires were collected, among which 667 (91.87%) were considered valid. Interviewed hospitals included hospitals from 31 provinces, municipalities and autonomous regions excluding Taiwan, Macao and Hong Kong. Thirty questionnaires were from the first-grade hospitals (4.5%), 292 from the second-grade (43.78%), and 345 from the third-grade (51.72%). And 69.12% of the questionnaires showed these hospitals could only carry out painless gastroscopy and/or colonoscopy, while 80.81% showed the number of the mean painless endoscopy cases was 0-30 per day; 47.23% of the respondents working in digestive endoscopy center had to complete the anesthesia procedure alone, and 35.83% of the respondents illustrated their digestive endoscopy centers had established the post anesthesia care unit; 62.97% were equipped with anesthesia apparatus or ventilator; 89.96% were equipped with tracheal intubation tool; and 21.44% were equipped with defibrillator. Among them, 25.79% did not prepare rescue medicines regularly in digestive endoscopy center. Propofol was the most frequently used anesthetic, and composited fentanyl was at the highest use rate for gastrointestinal endoscopy. Respondents who used electrocardiogram, non-invasive blood pressure and pulse oxygen saturation the least to monitor during painless gastroscopy and colonoscopy took up 43.48% and 46.08% respectively. ConclusionPainless digestive endoscopy needs further development and standardization with the regulation of related guidelines and standardized residents training.
Objective To evaluate the influence of dexmedetomidine on the stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery. Methods From August 2014 to December 2015, 210 patients undergoing elective laparoscopic gastrointestinal operations were randomly divided into three groups, including the low concentration group (group D1), the high concentration group (group D2), and the control group (group C), with 70 cases in each group. The patients in group D1 and group D2 were injected with dexmedetomidine (0.4 and 0.8 μg/kg respectively) by infusion pump before anesthesia induction, and were continuously pumped with dexmedetomidine [0.4 and 0.8 μg/(kg·h) respectively] until the end of the surgery. Meanwhile, the patients in group C were injected with normal saline of the equal volumes. The heart rate and mean arterial pressure (MAP) was recorded before anesthesia, after endotracheal intubation and extubation. Myocardial ischemia and cardiovascular adverse events thatneeded to be handled were recorded. The concentrations of dopamine, adrenaline (AD) and noradrenaline (NE) were monitored at 15:00 one day before surgery (Ty), one hour after the beginning of surgery (T0), and at 15:00 of the 1st, 2nd, and 3rd day after surgery (T1, T2, T3). Results A total of 178 patients completed the study and were enrolled in this study, including 60 cases in group D1 and 59 cases in group D2 and C respectively. In group D1 and D2, the heart rates after intubation [(80.4±9.6), (68.2±10.5) times/minutes], extubation [(70.1±6.2), (69.7±7.8) times/minutes] and MAP after extubation [(100.2±12.0), (98.0±13.1) mm Hg (1 mm Hg=0.133 kPa)] were lower than those in group C [(98.4±10.5) and (95.2±7.3) times/minutes; (121.8±10.5) mm Hg], and the differences were significant (P<0.05). The bradycardia and hypotension in group D2 (27.12%, 22.03%) was significantly higher than those in group C (3.39%, 8.47%). Hypertension in group D1 and D2 (5.00%, 1.69%) was significantly lower than that in group C (37.29%), and the differences were significant (P<0.05). Compared with the base value at Ty in the three groups, the concentration of dopamine at T0-T3 in group C, at T0-T1 in group D1, and at T0 in group D2 increased significantly (P<0.05); the AD at T0-T3 in group C, at T0-T2 in group D1, and at T0-T1 in group D2 increased significantly (P<0.05); the NE at T0-T2 in group C, and at T1 in group D1 increased significantly (P<0.05). Compared with group C at the same time, the DA at T3 in group D1 and at T1-T3 in group D2, the AD at T2-T3 in group D1 and at T0-T3 in group D2, the NE at T0-T1 in group D1 and T0-T3 in group D2, decreased significantly (P<0.05). Conclusions Dexmedetomidine can effectively restrain the changes of hemodynamics and catecholamine induced by perioperative stress responses in a dose-dependent manner. During the surgery of elderly patients with cardiovascular risk, the concentration of dexmedetomidine should be controlled moderately to gain the optimal effect.
This research was aimed to find the skin irritation and burns treatment effect of wound dressing with microspheres containing levofloxacin. We used reference GB/T16886.10-2005 to evaluate the dressing skin irritation. We prepared rabbit models divided into three groups. The control group was rapped with Vaseline gauze bandage, while the positive control group was rapped with the wounds of nano-silver paste bandage. The experimental sample group was rapped with wound dressing with microspheres containing levofloxacin. We measured the wound without healing area and the hydroxyproline content at the ends of 3 d, 6 d, 9 d, 14 d, 21 d, 28 d. and meanwhile performed histopathological examination. The experimental results showed that the dressing primary irritation index was 0. The nonhealing wound area of theexperimental sample group and positive control group at the ends of 6 d, 9 d, 14 d, 21 d were less than that of the control group (P<0.05). The nonhealing wound area of the experimental sample group at the ends of 9 d and 14 d was significantly lower than that of the positive control group (P<0.05). The hydroxyproline content of the experimental sample group at the ends of 6 d, 9 d and 14 d was significantly higher than that of the positive control group and blank control group (P<0.05). The pathology observed of the experimental sample group at 21 d were the earliest appendages. The wound dressing with microspheres containing levofloxacin has minimal skin irritation, effectively promote wound healing of burn.
ObjectiveTo explore the value of a radiomics model based on ultrasound imaging in predicting the HER-2 status of breast cancer prior to surgery.MethodsA total of 230 patients with invasive breast cancer were retrospectively analyzed, all the patients underwent preoperative breast ultrasound examination. According to the order of examination time, the patients were categorized into training group (n=115) and validation group (n=115). Image J software was used to manually delineate the lesion area in the ultrasound image along the tumor boundary. Pyradiomics was used to extract 1 820 features from each lesion area, and three statistical methods were used to screen features. A logistic regression model was used to construct ultrasound imaging radiomics model. The receive operating characteristic curve (ROC), calibration curve and decision curve were used to evaluate the performance and value of ultrasound imaging radiomics model in predicting HER-2 status.ResultsNine key image features were identified to construct ultrasound imaging radiomics model. The area of under the ROC curve of the model in the training group and the validation group were 0.82 (95%CI 0.74 to 0.90) and 0.81 (95%CI 0.72 to 0.89), respectively. The calibration curve showed that the model had a good calibration in both the training and validation groups.ConclusionsUltrasound-based imaging radiomics model is of significant value in predicting the HER-2 status of breast cancer prior to surgery.
ObjectiveTo systematically review the association between inhaled corticosteroids (ICS) and the risk of lung cancer in patients with chronic obstructive pulmonary disease (COPD). MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies on the risk of lung cancer in COPD patients using ICS from inception to August 15, 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 cohort studies involving 1 184 238 patients were included. The results of meta-analysis showed that ICS use decreased risk of lung cancer in COPD patients (HR=0.68, 95%CI 0.62 to 0.75, P<0.01). The dose of ICS was an influencing factor for the risk of lung cancer in COPD patients and a large dose of ICS could significantly reduce the risk. ConclusionCurrent evidence shows that the use of ICS can reduce the risk of lung cancer in patients with COPD, especially in high-dose patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.