七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果分析

目的:观察七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果。方法:选取80例行腹股沟疝气手术患儿,按随机数字表法分为两组,对照组(39例)静脉注射氯胺酮,观察组(41例)先吸入8%七氟醚,然后进行骶管阻滞麻醉,通过观察并记录两组患儿生命体征、麻醉诱导时间、苏醒时间、手术麻醉时间、苏醒期躁动评分(Pediatric anesthesia emergence delirium,PAED)和麻醉诱导期合作量表(Induction Compliance Checklist,ICC)及麻醉期间不良反应情况,评价七氟醚联合骶管阻滞麻醉对小儿疝气手术的麻醉效果。结果:两组切皮后T1、T2时心率(HR)、平均动脉压(MAP)水平均高于T0时的值(P0.05),两组切皮后T1、T2时组间HR、MAP水平相比,无统计学差异(P0.05)。两组切皮后T3时HR、MAP水平基本恢复到T0时的水平。两组切皮前后4个时间点的血氧饱和度(Sp O2)相比,无统计学差异(P0.05)。观察组患儿麻醉诱导时间,苏醒时间均明显短于对照组患儿(P0.05),两组术中麻醉持续时间相比,无统计学差异(P0.05),均能达到期望麻醉时间,观察组患儿PAED评分和ICC评分均低于对照组患儿(P0.05),不良反应组间比较无统计学差异(P0.05)。结论:七氟醚联合骶管阻滞麻醉对小儿疝气手术具有良好的麻醉效果,麻醉诱导快,苏醒快,小儿配合度高,术后躁动少,值得临床推广使用。     

Exploration of the possible effect on survival of lead-time associated with implementation of cancer patient pathways among symptomatic first-time cancer patients in Denmark

BackgroundImplementation of standardised cancer patient pathways (CPPs) has provided faster diagnosis of cancer. Cancer survival has improved during the same time period. Concern has been raised that the faster diagnosis may have introduced lead-time bias by elongating the period from diagnosis to death.AimWe aimed to analyse the possible effect of lead time on survival due to expedited cancer diagnosis after the implementation of national CPPs among incident cancer patients diagnosed through Danish primary care.Material and methodsWe used actual observed differences in diagnostic intervals to estimate the lead-time effect. We used data from sub-cohorts from the Danish Cancer in Primary Care (CaP) cohort of first-time cancer patients: before and after CPP implementation. To calculate differences in absolute survival, we estimated the survival function after advancing the date of diagnosis in the before cohort to an earlier point in time and hereby adjusting for lead time for nine cancer types and all combined by using Kaplan-Meier analysis.ResultsAdvancing the date of diagnosis implied that the absolute one-year survival increased from 68.5% to 69.4%. This accounted for 13% of the observed differences in absolute one-year survival from before to after CPPs.ConclusionThe lead time caused by shorter diagnostic intervals after implementation of Cancer Patient Pathways seems to explain less than 15% of the observed changes in the one-year survival estimates for cancer patients in Denmark.     

Preoperative Monocyte-to-Lymphocyte Ratio in Peripheral Blood Predicts Stages,Metastasis, and Histological Grades in Patients with Ovarian Cancer

PURPOSE: The monocyte-to-lymphocyte ratio (MLR) has been shown to be associated with the prognosis of various solid tumors. This study sought to evaluate the important value of the MLR in ovarian cancer patients. METHODS: A total of 133 ovarian cancer patients and 43 normal controls were retrospectively reviewed. The patients'' demographics were analyzed along with clinical and pathologic data. The counts of peripheral neutrophils, lymphocytes, monocytes, and platelets were collected and used to calculate the MLR, neutrophil-to-lymphocyte ratio (NLR). and platelet-to-lymphocyte ratio (PLR). The optimal cutoff value of the MLR was determined by using receiver operating characteristic curve analysis. We compared the MLR, NLR, and PLR between ovarian cancer and normal control patients and among patients with different stages and different grades, as well as between patients with lymph node metastasis and non–lymph node metastasis. We then investigated the value of the MLR in predicting the stage, grade, and lymph node positivity by using logistic regression. The impact of the MLR on overall survival (OS) was calculated by Kaplan-Meier method and compared by log-rank test. RESULTS: Statistically significant differences in the MLR were observed between ovarian cancer patients and normal controls. However, no difference was found for the NLR and PLR. Highly significant differences in the MLR were found among patients with different stages (stage I-II and stage III-IV), grades (G1 and >G1), and lymph node metastasis status. The MLR was a significant and independent risk factor for lymph node metastasis, as determined by logistic regression. The optimal cutoff value of the MLR was 0.23. We also classified the data according to tumor markers (CA125, CA199, HE4, AFP, and CEA) and conventional coagulation parameters (International Normalized Ratio [INR] and fibrinogen). Highly significant differences in CA125, CA199, HE4, INR, fibrinogen levels, and lactate dehydrogenase were found between the low-MLR group (MLR ≤ 0.23) and the high-MLR group (MLR > 0.23). Correspondingly, dramatic differences were observed between the two groups in OS. CONCLUSION: Our results show that the peripheral blood MLR before surgery could be a significant predictor of advanced stages, advanced pathologic grades, and positive lymphatic metastasis in ovarian cancer patients.     

Symmetric faces are a sign of successful cognitive aging

It has been proposed that a common cause underlies individual differences in bodily and cognitive decline in old age. No good marker for this common cause has been identified to date. Here, fluctuating asymmetry (FA), an indicator of developmental stability that relates to intelligence differences in young adults, was measured from facial photographs of 216 surviving members of the Lothian Birth Cohort 1921 at age 83 and related to their intelligence at ages 11, 79 and 83 years. FA at age 83 was unrelated to intelligence at ages 11 and 79 and to cognitive change between 11 and 79 years. It was, however, associated with intelligence and information processing efficiency at age 83 and with cognitive change between 79 and 83 years. Significant results were limited to men, a result predicted by sex differences in life history tradeoffs and life expectancy. Results were stronger when directional asymmetries were corrected in facial FA measures. Thus, FA is a candidate marker for the common cause of differential senescence.     

Restoration of Midwestern U.S. Savannas: One Size Does Not Fit All

Lowland savannas are a rare variant of Midwestern United States savanna occurring on alluvial soils, for which reference information is sparse. To evaluate the appropriateness of using upland savanna as a surrogate source of reference information for lowland savanna, we studied a pre‐Euro‐American lowland savanna using original U.S. Public Land Survey data and other historical records. Historical vegetation was reconstructed and compared among upland savannas, lowland savannas, and lowland forests; we also evaluated potential disturbance dynamics maintaining these systems. We found that all three communities were dominated by members of the genus Quercus but also had extensive representation by many other tree species, especially notable for savannas in this region. There were no clear size–density relationships for species in the genus Quercus, indicating that these historical savannas were not characterized exclusively by large, scattered oak trees but rather by trees of many oak species and nonoak species in a wide range of size classes. Both upland and lowland savannas also contained a substantial shrub component. We found no evidence that lowland savannas were maintained by flooding, although the uneven‐aged canopy structure suggested that periodic disturbance occurred. Restoration of lowland savanna in this region should include provisions for maintaining nonoak species and shrubs, with disturbance timed to maintain an uneven‐aged canopy structure. Although the appropriateness of historical data in the face of climate change may be questionable, in this region, a warmer climate may actually help promote the “oak parkland” that was present from 8,000 BP up to Euro‐American settlement.     

小型猪胰腺十二指肠移植术中的麻醉管理

目的探讨提高小型猪胰腺十二指肠移植术麻醉管理的相关问题.方法供体和受体小型猪各20只,采用氯胺酮加咪唑安定进行基础麻醉,氯胺酮加依托咪酯维持麻醉;行平均颈内动脉压、中心静脉压及血气的监测.结果小型猪胰腺移植术中麻醉良好,受体的平均动脉压在吻合血管开放后有明显下降,与开放前有明显差异(P＜0.05).中心静脉压和血气指标无明显变化.结论在小型猪胰腺移植麻醉手术中,充分补充血容量、加强循环系统的监测和管理,尤其是吻合血管开放后循环系统的管理对受体和移植胰腺的存活至关重要.     

全麻下颈动脉内膜剥脱术的麻醉体会

目的:评价颈动脉内膜剥脱术(CEA)麻醉疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值,以及适合颈动脉内膜剥脱术的适合麻醉方法。方法:回顾性分析苏州大学附属一医院脑卒中中心2012年5月至2013年5月所进行的颈动脉内膜剥脱术治疗的19名颅外颈动脉狭窄患者的资料。患者临床症状均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。所有手术操作均全麻下在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有恢复。未发现过度灌注的并发症。麻醉效果达到预期目的。结论:颈动脉内膜剥脱术在多普勒超声MVD及TCD监测下治疗颅外颈动脉狭窄是一种安全、有效的措施;全身麻醉下行CEA手术安全可靠。     

新型可降解PEI衍生物的表征及其在Brl-3A细胞中的毒性和转染研究

目的:对新型可降解高分子进行表征,研究其在Brl-3A细胞中的毒性和转染效率,以及连接剂比例对以上方面的影响。方法:通过化学方法合成不同比例PEI-Tr高分子,考察其包裹质粒DNA形成纳米颗粒的粒径和电位,以CCK-8方法考察Brl-3A细胞中的细胞毒性,以荧光素酶质粒为报告基因考察Brl-3A细胞中的转染效率。结果:PEI-Tr材料能形成200 nm以下带20 mV左右正电荷的纳米颗粒,具有较好的细胞内吞能力和溶液稳定性,细胞毒性实验证明,随着浓度增加PEI-Tr材料显示了远低于PEI-25kDa的细胞毒性,细胞转染实验表明其拥有高效输送质粒的能力。结论:PEI-Tr是一种高效低毒的可降解聚阳离子载体,在基因输送领域有很大的潜力;连接剂的比例在聚阳离子功能中起到重要作用。     

不同麻醉方式对老年冠心病患者围术期血流动力学及ECG的影响

目的：探讨对择期腹部手术的老年冠心病患者心脏血流动力学及心脏电活动影响较小的麻醉方式。方法：133例择期腹腔手术的老年冠心病患者随机分为硬膜外麻醉组（EA）,全麻组（GA）和腰-硬联合麻醉组（CSEA）。术中连续监测,分时段记录平均动脉压（MAP）、心率（HR）、血氧饱和度（SaO2）及异常心电图,比较3组组间及组内差异。结果：麻醉后15 min和麻醉后30 min,GA组的SaO2明显高于EA组（P〈0.05）。麻醉后15min、30 min和60 min CSEA组MAP值比EA组明显升高（P〈0.05）;麻醉后30 min,CSEA组的HR比EA组明显升高（P〈0.05）;麻醉后15 min和30 min,CSEA组的SaO2比EA组明显升高（P〈0.05）。组内比较,EA组麻醉后15min、30 min、60 min,MAP、HR、SaO2三个指标均比麻醉前明显降低（P〈0.05）,GA组和CSEA组前后比较差异不明显（P〉0.05）。异常ECG,组间比较,GA组和CSEA组ST-T改变发生率在麻醉后15 min、30 min、60 min、术毕时均明显低于EA组（P〈0.05,P〈0.01）,GA组和CSEA组心律失常发生率在麻醉后15 min、30 min、60 min均明显低于EA组（P〈0.05,P〈0.01）;组内比较,GA组和CSEA组的ST-T改变和心律失常发生率在麻醉后15 min、30min、60 min、术毕时均明显低于麻醉前（P〈0.05,P〈0.01）。结论：老年冠心病患者腹腔手术时全麻和腰-硬联合麻醉术中血流动力学较稳定,心电异常发生率较小。     

右美托嘧啶用于喉癌患者局麻下气管切开的临床效果分析

目的：探讨预注右关托嘧啶（dexmedetomindine,Dex）对喉癌患者局麻下行气管切开时的影响。方法：选择择期喉癌手术拟行气管切开的患者40例,随机分为Dex组（D组）和生理盐水组（c组）,D组在局麻前静脉注射Dex0．5μg／kg（10min泵注完毕）,c组以相同方式泵注等量生理盐水,观察5min后开始行局麻下气管切开。分别记录两组患者给药前（TO）、局麻开始时（T1）、切皮时（T2）、气管内麻醉时（T3）、气管切开造口时（T4）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和呼吸次数（RR）;观察并记录患者T1～T4各时间点的VAS评分、Ramsay镇静评分和手术耐受程度评分。结果：与T0相比,C组T1～T4各时点MAP和HR均升高,尤以T3～T4时明显（P〈0．05）,D组T1—4时MAP下降、HR明显减慢（P〈0．05）;与C组相比,D组T1～T4各时间点MAP均显著下降（P〈0．05）,HR均明显减慢（P〈0．01）,VAS评分显著降低（P〈0．05）,手术耐受程度评分和Ramsay镇静评分均显著升高（P〈0．05）。结论：喉癌患者行局麻气管切开前预先静注右关托嘧啶0．5μg／kg（10min泵注完毕）,可有效维持血液动力学稳定,并产生明显的镇静、镇痛作用。