全麻联合椎旁神经阻滞在胸腔镜下肺叶切除术中的麻醉效果及对术后认知功能和炎症反应的影响

摘要 目的：研究全身麻醉联合椎旁神经阻滞在胸腔镜下肺叶切除术患者的应用效果,探讨其对患者术后认知功能和炎 症反应的影响。方法：选取2017年-2021年在我院接受胸腔镜下肺叶切除术治疗的患者100例,根据其麻醉方式的不同分为对照组（50例）和研究组（50例）,对照组给予全身麻醉,研究组给予全身麻醉联合椎旁神经阻滞。比较两组患者手术时间、麻醉时间、术中出血量、舒芬太尼和瑞芬太尼用量、术后疼痛情况、简易智力状态检查量表（MMSE）评分和血清C-反应蛋白（CRP）、白介素-6（IL-6）水平。结果：两组患者手术时间、麻醉时间和术中出血量比较无显著差异（P>0.05）,而研究组患者舒芬太尼用量和瑞芬太尼用量均低于对照组（P<0.05）;研究组患者术后6、12、24和48小时疼痛评分均较对照组患者低（P<0.05）;两组患者术前MMSE评分无差异（P>0.05）,研究组患者术后6、12、24和48小时MMSE评分均较对照组高（P<0.05）;两组患者术前血清CRP和IL-6水平无显著差异,但研究组患者术后24小时血清CRP和IL-6水平均显著低于对照组（P<0.05）。结论：全身麻醉联合椎旁神经阻滞用于胸腔镜下肺叶切除术患者可有效减少手术中麻醉药物用量,术后镇痛效果更好,对患者认知功能损伤更低,并且术后炎症更低。     

术前超声引导下腰方肌阻滞联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响

摘要 目的：探讨术前超声引导下腰方肌阻滞（QLB）联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响。方法：选择我院2019年9月~2021年8月期间收治的行肾移植手术的患者82例作为观察对象。根据随机数字表法分为A组和B组,分别为41例。A组给予全身麻醉,B组给予术前超声引导下QLB联合全身麻醉,对比两组静息视觉疼痛模拟（VAS）评分、自控静脉镇痛中的舒芬太尼使用量、有效按压次数,对比两组术后血清应激反应和疼痛相关指标变化,对比两组不良反应发生情况。结果：B组术后6 h、12 h、24 h、48 h静息VAS评分低于A组（P<0.05）。B组自控静脉镇痛中的舒芬太尼使用量少于A组,有效按压次数少于A组（P<0.05）。B组拔管后、术后24 h血糖（Glu）、皮质醇（Cor）低于A组（P<0.05）。两组术后24 h P物质（SP）、前列腺素E₂（PGE₂）及5-羟色胺（5-HT）均升高,但B组低于A组（P<0.05）。两组的不良反应发生率对比无差异（P<0.05）。结论：术前超声引导下QLB联合全身麻醉用于肾移植手术患者,可有效减轻疼痛和应激反应,减少自控静脉镇痛中的舒芬太尼使用量、有效按压次数,且不增加不良反应发生率。     

超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质PGE2、SP和认知功能及睡眠质量的影响

摘要 目的：观察超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质前列腺素E₂（PGE₂）、P物质（SP）和认知功能及睡眠质量的影响。方法：选取2018年8月~2021年9月期间我院收治的择期行手术治疗的老年股骨近端骨折患者80例,根据随机数字表法分为对照组（40例,常规全麻方案）和观察组（40例,超声引导下髂筋膜神经阻滞联合全麻方案）,对比两组麻醉效果、血流动力学、疼痛情况、认知功能和睡眠质量,观察不同模式麻醉下的安全性。结果：观察组的苏醒及拔管时间均短于对照组,丙泊酚使用量少于对照组（P<0.05）。两组置入喉罩时（T1）~术毕时（T3）心率（HR）先升高后下降,平均动脉压（MAP）先下降后升高（P<0.05）;观察组T1~T3时点HR低于对照组,MAP高于对照组（P<0.05）。两组术后24 h血清PGE₂、SP水平和视觉疼痛模拟量表（VAS）评分均升高,但观察组低于对照组（P<0.05）。两组术后1 d、2 d、3 d 蒙特利尔认知评估量表（MoCA）评分较术前先下降后升高（P<0.05）;观察组术后2 d、3 d MoCA评分高于对照组（P<0.05）。两组术后1 d、2 d、3 d匹兹堡睡眠质量评估量表（PSQI）评分较术前先升高后下降（P<0.05）;观察组术后1 d、2 d、3 d PSQI评分低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：老年股骨近端骨折患者术中选用超声引导下髂筋膜神经阻滞联合全麻,镇痛效果显著,可稳定机体血流动力学,减少对认知功能和睡眠质量的影响,且安全性良好。     

Binary Responses and the Three-period Cross-over

Problems with carry-over effects in the simple two-period cross-over have lead to interest in more complex cross-over designs. A method for analysing the optimum two-treatment three-period design with binary response variables is given by making a simple extension to Gart's logistic model. The method gives independent tests for, and estimates of the difference in treatment and first-order carry-over effects. An example of the analysis is given, using the loglinear models facility in GLIM.     

ED50 G Na Block Predictions for Phenyl Substituted and Unsubstituted n-Alkanols

To study the role the phenyl group plays in producing local anesthetic block, a sequence of n-alkanols and phenyl-substituted alkanols (Φ-alkanols) were characterized in their ability to block Na channels. The sequence of n-alkanols studied possess 3–5 carbons (propanol-pentanol). The action of phenol and 3-Φ-alkanols (benzyl alcohol, phenethyl alcohol, 3-phenyl-1-propanol) were also studied. Na currents (I _Na ) were recorded from single frog skeletal muscle fibers using the Vaseline-gap voltage clamp technique. I _Na s were recorded prior to, during, and following the removal of the solutes in Ringer's solution. All alkanols and phenol acted to block I _Na in a dose-dependent manner. Effective doses to produce half block (ED₅₀) of I _Na or Na conductance (G _Na ) were obtained from dose-response relations for all solutes used. The block of G _Na depended on voltage, and could be separated into voltage-dependent and -independent components. Each solute acted to shift G _Na -V relations in a depolarized direction and reduce the maximum G _Na and slope of the relation. All solutes acted to speed up I _Na kinetics and cause hyperpolarizing shifts in steady-state inactivation. The magnitude of the kinetic changes increased with dose. Size was an important variable in determining the magnitude of the changes in I _Na ; however, size alone was not sufficient to predict the changes in I _Na . ED₅₀s for G _Na and AP block could be predicted as a function of intrinsic molar volume, hydrogen bond acceptor basicity (β) and donor acidity (α), and polarity (P) of the solutes. The equivalency of ED₅₀ predictions for AP and G _Na block can be explained by the fact that AP block arises from channel block and solute-induced changes in I _Na kinetics. Φ-alkanols were more effective at blocking and inactivating Na channels than their unsubstituted counterparts. Phenyl-substituted alkanols are more likely to interact with the channel than their unsubstituted counterparts. Received: 11 August 2000/Revised: 21 December 2000     

Likelihood-based experimental design for estimation of ED50

In selecting the best dosage choice for the estimation of ED50, it is natural to try to minimize the length of the confidence intervals. In this presentation, the dose allocation that minimizes the length of the likelihood-based confidence intervals is presented and compared with alternative allocations that have been proposed based on the length of different types of confidence intervals, such as those based on the asymptotic variance or on Fieller's Theorem. Effective strategies to deal with the parameter dependence of these allocations are explored. A series of experiments to evaluate the effect of small doses per fraction on the radiation tolerance of the rat cervical spinal cord provide the motivation and an illustration for the proposed procedures.     

Stereospecific synthesis of "para-hydroxymexiletine" and sodium channel blocking activity evaluation

Both enantiomers of "para-hydroxymexiletine" (PHM), one of the main metabolites of mexiletine, were synthesized and fully characterized. Properties of (R)- and (S)-PHM, in terms of blocking potency and stereoselectivity on frog skeletal muscle Na(+) channels, were evaluated. The presence of a hydroxy group on the aryloxy moiety in the 4-position, as in PHM, reduced potency with respect to mexiletine in reducing I(Na max). However, PHM showed clear use-dependent behavior similar to that of mexiletine and, in contrast with what is observed with the parent compound, maintained its stereoselectivity during the use-dependent block. Chirality 16:72-78, 2004.     

Elongated mouse chromosomes suitable for enhanced molecular cytogenetics

Characterization of genetic disorders in humans and animal models requires identification of chromosomal aberrations. However, identifying fine deletions or insertion in metaphase chromosomes has been always a challenge due to limitations of resolution. In this study we developed a rapid method for chromosome elongation using two different intercalating agents: ethidium bromide and 5-bromo-2′-deoxyuridine (BrdU), together with a short-term mitotic block using colcemid. About 70% of the chromosomes from cells that underwent this elongation procedure reached three times longer than those prepared from control cells. FISH experiments using elongated chromosomes revealed a duplicated region of chromosome 11 that was not visible in cells prepared with conventional methods.     

In silico protein design by combinatorial assembly of protein building blocks

Utilizing concepts of protein building blocks, we propose a de novo computational algorithm that is similar to combinatorial shuffling experiments. Our goal is to engineer new naturally occurring folds with low homology to existing proteins. A selected protein is first partitioned into its building blocks based on their compactness, degree of isolation from the rest of the structure, and hydrophobicity. Next, the protein building blocks are substituted by fragments taken from other proteins with overall low sequence identity, but with a similar hydrophobic/hydrophilic pattern and a high structural similarity. These criteria ensure that the designed protein has a similar fold, low sequence identity, and a good hydrophobic core compared with its native counterpart. Here, we have selected two proteins for engineering, protein G B1 domain and ubiquitin. The two engineered proteins share approximately 20% and approximately 25% amino acid sequence identities with their native counterparts, respectively. The stabilities of the engineered proteins are tested by explicit water molecular dynamics simulations. The algorithm implements a strategy of designing a protein using relatively stable fragments, with a high population time. Here, we have selected the fragments by searching for local minima along the polypeptide chain using the protein building block model. Such an approach provides a new method for engineering new proteins with similar folds and low homology.