Ultrasound Combined with CTA in Diagnosis of Painless Aortic Dissection Combined with Carotid Artery Active Thrombosis: A Case Report

Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases and might be misdiagnosed due to its atypical symptoms leading to catastrophic outcomes. Case presentation: The patient was admitted to the hospital due to right limb weakness with speech inability for more than 10 hours. In the routine cardiac ultrasound examination, the avulsion intimal echo was found in the initial segment of the descending aorta. The rupture range was about 11 mm, and the lumen was separated into real and false lumen. Further computed tomography angiography (CTA) examination confirmed the major arterial dissection (De Bakey Type I). Conclusion: We report a case of painless aortic dissection with active carotid artery thrombosis diagnosed by ultrasound and CTA, and to improve the understanding of painless aortic dissection by reviewing relevant domestic and foreign literature.

Effectiveness of Remimazolam Benzenesulfonate Combined with Alfentanil in Elderly Patients Undergoing Painless Gastroenteroscopy

Objective:To observe the effects of remimazolam benzenesulfonate combined with alfentanil during painless gastroenteroscopy in elderly patients.Methods:This study analyzes patients aged 60–85 years old undergoing painless gastroenteroscopy.A total of 140 patients,examined between February 2023 and February 2024,voluntarily participated and were randomly divided into an experimental group and a control group.The control group received alfentanil combined with propofol for anesthesia,while the experimental group received alfentanil combined with remimazolam benzenesulfonate.The relevant indices of both groups were separately analyzed.Results:Patients in the experimental group had a shorter awakening time,a faster discharge rate(P<0.05),and a shorter examination duration;however,the difference in examination time between the two groups was not statistically significant(P>0.05).Before anesthesia,there was no significant difference in the basic information and vital signs of the two groups(P>0.05).Two minutes after anesthesia,both groups showed a decline in vital signs,but the vital signs of the experimental group remained more stable after the procedure,with the group’s indices showing improvement over the control group(P<0.05).Additionally,the incidence of adverse reactions in the experimental group was lower than in the control group(P<0.05).Conclusion:In painless gastroenteroscopy for elderly patients,anesthesia using a combination of remimazolam benzenesulfonate and alfentanil improves anesthesia effectiveness,hastens patient recovery,enhances the stability of vital signs,and effectively controls adverse reactions,thereby improving patient comfort.

Two Case Studies of Painless Thyroiditis with Special Presentation

This article reports two cases of painless thyroiditis with special manifestations. Patient 1 was a 76-year-old female patient who presented with palpitations and chest tightness and was diagnosed with hyperthyroidism by thyroid ultrasound and electrocardiogram, which is a painless thyroiditis with atrial fibrillation as the first symptom. Patient 2 is a 44-year-old male patient, with only palpitations, diagnosed as T3 thyroiditis by liver function and thyroid function tests, and accompanied by abnormal liver function, belonging to the painless thyroiditis with elevated FT3 only. This article points out that painless thyroiditis has multiple manifestations and is easily misdiagnosed as other diseases. Therefore, patients with symptoms such as palpitations and chest tightness should undergo cytologic or pathologic examination in time to avoid missed diagnosis and misdiagnosis.

Study of wrist-ankle acupuncture therapy for optimizing anaesthesia scheme of painless gastroscopy and improving painless gastroscopy related complications

BACKGROUND Painless gastroscopy is a widely used diagnostic and therapeutic technology in clinical practice.Propofol combined with opioids is a common drug for painless endoscopic sedation and anaesthesia.In clinical work,adverse drug reactions of anaesthesia schemes are often one of the important areas of concern for doctors and patients.With the increase in propofol dosage,the risk of serious adverse drug reactions,such as respiratory depression and hypotension,increases significantly;the use of opioids often causes gastrointestinal reactions in patients after examination,such as nausea,vomiting,delayed recovery of gastrointestinal function and other complications,which seriously affect their quality of life.AIM To observe the effect of wrist-ankle acupuncture therapy on the anaesthesia regimen and anaesthesia-related complications during and after painless gastroscopy examination.METHODS Two hundred patients were selected and randomly divided into a treatment group(n=100)and a control group(n=100).Both groups were routinely anaesthetized with the nalbuphine and propofol regimen,gastroscopy began after the patient lost consciousness,and given supportive treatment and vital sign monitoring.If the patient interrupted the surgery due to intraoperative torsion,intravenous propofol was used to relieve his or her discomfort.The treatment group received wrist-ankle acupuncture on this basis.RESULTS The general data before treatment,American Society of Anesthesiologist(ASA)grade and operation time between the two groups was no significant difference.The Wakeup time,and the Selfambulation time in the treatment group was significantly faster than that in the control group(P<0.05).The total dose of propofol in the treatment group was 109±8.17 mg,significantly lower than that in the control group(P<0.05).The incidence of respiratory depression and hypotension was not significantly different,but the incidence of hiccups was significantly lower than that in the control group(P<0.05).After the examination,the incidence of nausea,vomiting,abdominal distension,and abdominal pain was 11%,8%,6%,and 5%,respectively,which was significantly lower than that in the control group(P<0.05).In addition,both the operators and the patients were more satisfied with this examination,with no significant difference between the groups(P>0.05).CONCLUSION Wrist-ankle acupuncture treatment can optimize the painless gastroscopy and anaesthesia scheme,reduces propofol total dose;shortens patient Wakeup time and Self-ambulation time,improves patient compliance and tolerance,is beneficial to clinical application.

Effect of modified ShengYangYiwei decoction on painless gastroscopy and gastrointestinal and immune function in gastric cancer patients

BACKGROUND Painless gastroenteroscopy is a widely developed diagnostic and treatment technology in clinical practice.It is of great significance in the clinical diagnosis,treatment,follow-up review and other aspects of gastric cancer patients.The application of anesthesia techniques during manipulation can be effective in reducing patient fear and discomfort.In clinical work,the adverse drug reactions of anesthesia regimens and the risk of serious adverse drug reactions are increased with the increase in propofol application dose application dose;the application of opioid drugs often causes gastrointestinal reactions,such as nausea,vomiting and delayed gastrointestinal function recovery,after examination.These adverse effects can seriously affect the quality of life of patients.AIM To observe the effect of modified ShengYangYiwei decoction on gastrointestinal function,related complications and immune function in patients with gastric cancer during and after painless gastroscopy.METHODS A total of 106 patients with gastric cancer,who were selected from January 2022 to September 2022 in Xiamen Traditional Chinese Medicine Hospital for painless gastroscopy,were randomly divided into a treatment group(n=56)and a control group(n=50).Before the examination,all patients fasted for 8 h,provided their health education,and confirmed if there were contraindications to anesthesia and gastroscopy.During the examination,the patients were placed in the left decubitus position,the patients were given oxygen through a nasal catheter(6 L/min),the welling needle was opened for the venous channel,and a multifunction detector was connected for monitoring electrocardiogram,oxygen saturation,blood pressure,etc.Naporphl and propofol propofol protocols were used for routine anesthesia.Before anesthesia administration,the patients underwent several deep breathing exercises,received intravenous nalbuphine[0.nalbuphine(0.025 mg/kg)],followed by intravenous propofol[1.propofol(1.5 mg/kg)]until the palpebral reflex disappeared,and after no response,gastroscopy was performed.If palpebral reflex disappeared,and after no response,gastroscopy was performed.If any patient developed movement,frowning,or hemodynamic changes during the operation(heart rate changes during the operation(heart rate increased to>20 beats/min,systolic blood pressure increased to>20%of the base value),additional propofol[0.propofol(0.5 mg/kg)]was added until the patient was sedated again.The patients in the treatment group began to take the preventive intervention of Modified ShengYangYiwei decoction one week before the examination,while the patients in the control group received routine gastrointestinal endoscopy.The patients in the two groups were examined by conventional painless gastroscopy,and the characteristics of the painless gastroscopies of the patients in the two groups were recorded and compared.These characteristics included the total dosage of propofol during the examination,the incidence of complications during the operation,the time of patients'awakening,the time of independent activities,and the gastrointestinal function of the patients after examination,such as the incidence of reactions such as malignant vomiting,abdominal distension and abdominal pain,as well as the differences in the levels of various immunological indicators and inflammatory factors before anesthesia induction(T0),after conscious extubation(T1)and 24 h after surgery(T2).RESULTS There was no difference in the patients’general information,American Society of Anesthesiologist classification or operation time between the two groups before treatment.In terms of painless gastroscopy,the total dosage of propofol in the treatment group was lower than that in the control group(P<0.05),and the time of awakening and autonomous activity was significantly faster than that in the control group(P<0.05).During the examination,the incidence of hypoxemia,hypotension and hiccups in the treatment group was significantly lower than that in the control group(P<0.01).In terms of gastrointestinal function,the incidences of nausea,vomiting,abdominal distension and abdominal pain in the treatment group after examination were significantly lower than those in the control group(P<0.01).In terms of immune function,in both groups,the number of CD4+and CD8+cells decreased significantly(P<0.05),and the number of natural killer cells increased significantly(P<0.05)at T1 and T2,compared with T0.The number of CD4+and CD8+cells in the treatment group at the T1 and T2 time points was higher than that in the control group(P<0.05),while the number of natural killer cells was lower than that in the control group(P<0.05).In terms of inflammatory factors,compared with T0,the levels of interleukin(IL)-6 and tumor necrosis factor-alpha in patients in the two groups at T1 and T2 increased significantly and then decreased(P<0.05).The level of IL-6 at T1 and T2 in the treatment group was lower than that in the control group(P<0.05).CONCLUSION The preoperative use of modified ShengYangYiwei decoction can optimize the anesthesia program during painless gastroscopy,improve the gastrointestinal function of patients after the operation,reduce the occurrence of examination-related complications.

Lactation breast abscess treated with Gualou Xiaoyong decoction and painless lactation manipulation:A case report and review of literature

BACKGROUND Breast abscess during lactation is a severe complication of acute mastitis,which can lead to discomfort,high fever,breast fistula,sepsis,septic shock,breast damage,disease persistence and frequent hospitalization.Breast abscesses may also lead the mother to discontinue breastfeeding,thereby harming the infant’s health.The predominant pathogenic bacteria are Staphylococcus aureus,Staphylococcus epidermidis and Streptococcus.The incidence of breastfeeding abscesses in breastfeeding women ranges between 4.0%and 11.0%.In cases of breast abscess,the rate of cessation of lactation is 41.0%.In instances of breast fistula,the rate of cessation of lactation is very high(66.7%).Furthermore,50.0%of women with breast abscesses must be hospitalized and treated with intravenous antibiotics.Treatment includes antibiotics,abscess puncture and surgical incision and drainage.The patients suffer from stress,pain and easily induced breast scarring;the disease’s progression is prolonged and recurrent,interfering with infant feeding.Consequently,it is crucial to discover an adequate cure.CASE SUMMARY A 28-year-old woman with a breast abscess was treated with Gualou Xiaoyong decoction and painless breast opening manipulation 24 d after cesarean delivery.On the 2nd d of treatment,the patient’s breast mass was significantly reduced,the pain was significantly reduced,and the general asthenia was improved.All conscious symptoms disappeared after 3 d,breast abscesses faded after 12 d of treatment,inflammation images disappeared after 27 d,and normal lactation images were restored.CONCLUSION In treating breast abscesses during breastfeeding,the combination of Gualou Xiaoyong decoction and painless lactation provides a positive therapeutic impact.This disease’s treatment offers the advantages of a short course of treatment,no need to discontinue breastfeeding and the ability to rapidly mitigate symptoms,which can be used as a reference in clinical practice.

Clinical observation on the efficacy and safety of different doses of alfentanil for painless gastroscopy

Objective:To observe the Effective dose and safety of different doses of alfentanil combined with propofol in painless gastroscopy.Method:240 patients who underwent painless gastric examination from January 2021 to December 2021 were randomly divided into a control group and a different dose group of alfentanil(N1 group,N2 group,N3 group,N4 group,and N5 group,with injection doses of 5,6,7,8,and 10ug/kg,respectively)using a number table method,with 40 patients in each group.The control group was anesthetized with propofol injection,while different dosage groups of alfentanil were anesthetized with different doses of alfentanil combined with propofol.Evaluate the anesthesia effect after the examination is completed.Compare the heart rate(HR),systolic blood pressure(SBP),apnea time,incidence of intolerance to gastroscopy insertion,and adverse reactions in each group.Result:Compared with before administration,SBP and HR in all groups decreased before gastroscopy placement(P<0.01);At 1 minute after gastroscopy insertion,both SBP and HR in the control group increased(P<0.01),while SBP in the N3 and N4 groups decreased(P<0.01),while HR remained unchanged(P>0.05).Both SBP and HR in the N5 group decreased(P<0.01).Compared with before gastroscopy insertion,SBP and HR in the control group,N1,N2,and N3 groups increased 1 minute after gastroscopy insertion(P<0.01),while there was no significant change in SBP and HR in the N4 and N5 groups(P>0.05).The apnea time of different dosage groups of alfentanil was lower than that of the control group(P<0.01),and the apnea time of N5 group was higher than that of N1 group,N2 group,N3 group,and N4 group(P<0.01).There was no significant difference in the Incidence of intolerant reactions during gastroscopy insertion,cough reaction,retching reflex,swallowing reflex and limb movement reaction rate between the six groups(P>0.05);There was no statistically significant difference in the incidence of itching,nausea,vomiting,anxiety,dizziness,drowsiness,diarrhea,and constipation after painless gastroscopy examination among the six groups(P>0.05).Conclusion:The combination of 8ug/kg alfentanil and propofol has a definite anesthesia effect,stable respiratory and circulatory system,and low incidence of adverse reactions when used for painless gastroscopy.

豌豆蚜温度受体基因Painless的克隆及时间和组织表达

【目的】从豌豆蚜(Acyrthosiphon pisum)触角中克隆候选的温度受体基因——Painless,分析该基因所编码的蛋白结构特点,研究该基因在昆虫不同发育时期和不同组织中的表达谱,探讨该基因的功能。【方法】通过生物信息学的方法,使用果蝇(Drosophila melanogaster)Painless从豌豆蚜基因组数据库AphidBase中预测ApisPainless的假定全长序列,之后根据预测得到的假定全长序列,使用Primer premier 5.0设计全长引物,使用RT-PCR方法从豌豆蚜触角cDNA中克隆ApisPainless的全长序列,并应用DNAMAN软件对预测序列与克隆序列进行比对,确定克隆序列与预测序列一致后,使用在线工具SMART(simple modular architecture research tool)对克隆得到的ApisPainless蛋白结构进行预测,分析其序列N端的锚蛋白重复序列及跨膜域,通过使用在线比对软件Clustal Omega对ApisPainless与DmelPainless的3个可变剪切型(isoform A、B、C)进行多序列比对,分析ApisPainless的可变剪切类型,通过构建昆虫TRP(transient receptor potential)离子通道超家族的进化树,分析ApisPainless的进化地位,并通过绘图直观地比较TRPA亚家族4个成员TRPA1、Painless、Pyrexia和Water witch的序列长短及N端锚蛋白重复序列的差异,使用实时定量荧光PCR技术,研究ApisPainless在1—4龄若虫以及成虫这5个不同发育时期的相对表达量,以及其在豌豆蚜成虫的触角、头、足和胸腹这4个不同组织中的相对表达量。【结果】预测并克隆得到ApisPainless全长序列,该基因的全长序列为2 832 bp,编码943个氨基酸,蛋白结构分析表明ApisPainless具有8个锚蛋白重复序列以及6次跨膜结构,通过序列比较发现ApisPainless与DmelPainless isform A的相似性最高,达到42.3%。进化树分析结果表明昆虫TRP超家族分为TRPA、TRPC、TRPM、TRPN、TRPV、TRPP和TRPML 7个亚家族,而ApisPainless聚类于TRPA亚家族Painless一支,在TRPA亚家族TRPA1、Painless、Pyrexia和Water witch这4个成员中,TRPA1的序列最长,约为1 200个氨基酸,其后依次是Water witch、Pyrexia和Painless,氨基酸数目约有920—1 000个。从N端的锚蛋白重复序列上看,Water witch和Pyrexia约有9个重复序列,Painless约为8个,而TRPA1则高达15—16个,发育时期表达谱分析结果显示ApisPainless在豌豆蚜的各个发育阶段均有表达,其中以1龄若虫期表达量最高。组织表达谱分析结果显示,ApisPainless在豌豆蚜的触角、头、足和胸腹各组织中均有表达,其中以在触角中的表达量最高,足中的表达量居其次。【结论】克隆得到的ApisPainless是TRPA亚家族Painlss基因,其在触角及足中表达量高,推测其功能可能类似于果蝇的Painless,参与高温伤害识别、机械刺激识别及味觉探测等过程。

Effect of wrist-ankle acupuncture on propofol dosage during painless colonoscopy:A randomized controlled prospective study

BACKGROUND The clinical advantages of painless colonoscopy can reduce the fear and discomfort of patients and increase the detection rate of diseases.Propofol has the characteristics of fast effect and short action time.It is a common choice for painless endoscopic sedation and anesthetics.However,propofol can cause severe respiratory and circulatory depression.Therefore,it is important to find a way to reduce the dose of propofol.AIM To explore the effect of wrist-ankle acupuncture on propofol dose during colonoscopy.METHODS Two hundred patients who were going to receive selective painless colonoscopy in Hebei Hospital of Traditional Chinese Medicine were selected and divided into wrist-ankle acupuncture group(WAA group,n=100)and control group(CON group,n=100).After entering the operation room,patients were given 0.025 mg/kg nabufine intravenously and propofol at the initial dose of 0.5 mg/kg.In patients who did not fall asleep,propofol(10 mg/time)was given until loss of consciousness.Prior to anesthesia,patients in WAA group were punctured by specialist in the inferior 1,2 and 3 regions according to the zoning principle of wrist-ankle acupuncture.The primary endpoint was required dose of propofol,and the secondary endpoints were the incidence of hypoxemia and hypotension.Furthermore,the following data were recorded:The operation time,wake-up time,incidence of nausea and vomiting,incidence of abdominal distention,post colonoscopy pain,examiners'satisfaction,patients'satisfaction and Borg fatigue index.This study has been registered in the Chinese Clinical Trial Registry(Registration Code:ChiCTR1900022177).RESULTS The induced dose of propofol and the total dose of propofol in WAA group were 80 mg and 110 mg,respectively,which were significantly lower than those in CON group(P<0.05).The incidences of hypoxemia and hypotension in the WAA group were 2.2%and 3.3%,respectively,significantly lower than those in the CON group(P<0.05).The incidence of abdominal distension in the WAA group was 8.8%,which was significantly lower than that in the CON group(P<0.05,28.9%).The waking time of WAA group was 3.26±0.87 min,which was significantly lower than that of CON group(6.06±0.88 min,P<0.05).CONCLUSION Wrist-ankle acupuncture can reduce the induction dose and total dose of propofol as well as the incidence of adverse reactions in painless colonoscopy without affecting the satisfaction of examiners and patients.This procedure is simple in operation and easy to promote in clinical practice.

Awareness that early cancer lump is painless could decrease breast cancer mortality in developing countries

There are several factors which contribute to patients' reporting late to healthcare facility even after detecting the breast lump(patient delay). Amongst these, one of the important factors in low- and middle-income countries is lack of awareness that early cancer lump is painless(ECLIPs). Pain is often taken as a danger sign and absence of pain is often not taken seriously. The studies have shown that up to 98% of women in lowincome countries are unaware that a painless lump could be a warning sign of early breast cancer. This fact is significant because this could be one of the prime reasons for the women having discovered a painless lump in the breast, accidentally or by breast self-examination, presume it to be harmless and don't report early to health care facility. Therefore, creating awareness about ECLIPs could be an effective strategy to reduce mortality due to breast cancer in low- and middle-income countries. Moreover, unlike modifying risk factors which requires long term behavior modification, creating awareness about ECLIPs is easy and cost effective.

Analysis of Clinical Features of Painless Aortic Dissection

The clinical characteristics of painless aortic dissection were investigated in order to improve the awareness of diagnosis and treatment of atypical aortic dissection. The 482 cases of aortic dissection were divided into painless group and pain group, and the data of the two groups were retrospectively analyzed. The major clinical symptom was pain in 447 cases（92.74%）, while 35 patients（7.26%） had no typical pain. The gender, age, hypertension, hyperlipidemia, diabetes, smoking and drinking history had no statistically significant differences between the two groups（P〉0.05）. The proportion of Stanford type A in painless group was significantly higher than that in pain group（48.57% vs. 21.03%, P=0.006）. The incidence of unconsciousness in the painless group was significantly higher than that in the pain group（14.29% vs. 3.58%, P=0.011）. The incidence of hypotension in painless group was significantly higher than that in pain group for 4.26 folds（P=0.01）. Computed tomography angiography（CTA） examination revealed that the incidence of aortic arch involved in the painless group was signifi-cantly higher than that in the pain group（19.23% vs. 5.52%, P=0.019）. It was concluded that the incidence of painless aortic dissection was higher in Stanford A type patients, commonly seen in the patients complicated with hypotension and unconsciousness. CTA examination revealed higher incidence of aor-tic arch involvement.

Clinical Observation of Misoprostol before and after Painless Induced Abortion

Background: Though painless abortion is a safe, effective and excellent method of artificial abortion, intravenous anesthesia cannot effectively expand the cervix. Hard and tight cervix often affects the operation and easily inducesabortion complications. Misoprostol can induce uterine contraction and soften the cervix. Objective: To investigate the clinical effect of misoprostol on abortion before and after painless induced abortion. Methods: 600 case pregnant women were divided into three groups: A, B and C, 200 case in each group. All patients were anesthetized. In group A, misoprostol 0.2 ug was placed in the posterior fornix of vagina 2 hours before the operation of induced abortion;in group B, misoprostol 0.2 ug was not only placed in the posterior fornix of vagina 2 hours before the operation of induced abortion but also taken orally 2 hours and 6 hours after the operation;in group C, misoprostol was not used before and after the operation. The operation time, intraoperative bleeding volume, postoperative bleeding, the percentage of cervical relaxation and the rate of incomplete abortion among the three groups were compared. Results: Compared with group A and group B, the operation time of group C was longer and the amount of bleeding was more (P < 0.05), but there was no significant difference between group A and group B (P > 0.05). The duration of bleeding in group B was less than that in group A (P < 0.05). The percentage of cervical relaxation in group A and B was higher than that in group C (P < 0.05). The rate of incomplete abortion in group B < group A < group C (P < 0.05), and there was no residual uterine cavity in group B. Conclusion: The use of misoprostol before and after painless induced abortion can not only shorten the time of operation, reduce intraoperative and postoperative vaginal bleeding, but also has not incurred incomplete abortion(primary outcome).

Influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response

Objective:To study the influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response.Methods: 117 patients with suspected gastritis who underwent painless gastroscopy in our hospital between July 2015 and August 2016 were divided into propofol group (n=67) and etomidate group (n=50) according to the anesthesia schemes. Propofol group received propofol combined with remifentanil anesthesia, and etomidate group received etomidate combined with remifentanil anesthesia. The differences in serum levels of inflammatory factors, stress hormones and oxidative stress indicators were compared between the two groups before the examination (T0), immediately after the examination (T1) and 15 min after the examination (T2).Results: At T0, there were no significant differences in serum levels of inflammatory factors, stress hormones or oxidative stress indexes between the two groups (P>0.05). At T1 and T2, serum inflammatory factors IL-1, IL-6 and CRP levels of etomidate group were lower than those of propofol group;serum stress hormones Cor, NE and E levels were lower than those of propofol group;serum oxidation indexes AOPPs and LHP levels were lower than those of propofol group while anti-oxidation indexes CAT and SOD levels were higher than those of propofol group (P<0.05). Conclusion: Etomidate for painless gastroscopy is better than propofol in maintaining depth of anesthesia and reducing operation trauma.

Effects of propofol combined with different types of opioids on inflammatory stress response in painless gastroscopy

Objective:To study the effects of propofol combined with different types of opioids on inflammatory stress response in painless gastroscopy.Methods: Patients who underwent painless gastroscopy in our hospital between August 2014 and January 2018 were retrospectively analyzed, divided into those with nalbuphine hydrochloride, dezocine and sufentanil according to different choice of opioids and included in group A, group B and group C of the study respectively. The contents of inflammatory cytokines and oxidative stress products in serum as well as the expression levels of inflammatory pathway molecules and antioxidant pathway molecules in peripheral blood were measured before and 6 h after gastroscopy.Results: HMGB-1, TNF-α, IFN-γ, CRP, MDA, OH- and O2- contents in serum as well as RhoA, ROCK, Wnt3a,β-catenin, JNK, ERK1/2, Nrf2, ARE, HO-1,γ-GCS and Prx1 expression in peripheral blood of three groups of patients after gastroscopy were higher than those before gastroscopy, and HMGB-1, TNF-α, IFN-γ, CRP, MDA, OH- and O2- contents in serum as well as RhoA, ROCK, Wnt3a,β-catenin, JNK and ERK1/2 expression in peripheral blood of group A after gastroscopy were lower than those of group B and group C whereas Nrf2, ARE, HO-1,γ-GCS and Prx1 expression in peripheral blood were higher than those of group B and group C.Conclusion: Propofol combined with nalbuphine hydrochloride can be more effective than dezocine and sufentanil to reduce the inflammatory stress response in painless gastroscopy.

Clinical Observation of Dexmedetomidine Combined with the Mixture of Propofol and Etomidate on Painless Gastroscopy in Children

Objective:To observe the anesthetic effect of dexmedetomidine combined with the mixture of propofol and etomidate on painless gastroscopy in children.Methods:A total of 80 pediatric patients who underwent painless gastroscopy in the Guangxi Minzu Hospital from January 2019 to September 2020 were randomly divided into two groups,A and B,with 40 patients in each group.Group A was given A mixture of etomidate 20 mg and propofol 0.2g,Dexmedetomidine was pumped into group B 10min before surgery,0.4 g/kg.HR,SBP,DBP,SpO2 and BIS were continuously monitored after entering the room.The doses of propofol and etomidate were recorded,as well as the time of waking and leaving the hospital.Adverse reactions such as hypotension,hypoxemia,nausea,vomiting and dizziness were recorded too.Results:Compared with group A,the dosage of propofol and etomidate in group B was significantly reduced(P<0.001),the time of waking and out of the chamber were significantly shortened(P<0.001),the body movement in the incidence of intraoperative was significantly reduced(P<0.001),and the nausea,vomiting and dizziness in the incidence of postoperative were significantly reduced(P<0.05).Conclusion:Dexmedetomidine combined with propofol and etomidate mixture can be safely used in painless gastroscopy in children,which can significantly reduce the dosage of propofol and etomidate,reduce the occurrence of adverse reactions,and shorten the time of resuscitation and discharge.

Effect of dexmedetomidine combined with propofol on stress response and early cognitive function in hypertensive patients undergoing painless gastroscopy

Objective:To investigate the effect of dexmedetomidine combined with propofol on stress response and early cognitive function in hypertensive patients undergoing painless gastroscopy. Methods: A total of 70 cases of hypertensive patients undergoing painless gastroscopy from March 2016 to March 2017 were selected as the subjects. They were randomly divided into the observation group and the control group. The control group was injected with physiological saline before injection and injected with propofol 2 mg/kg. The observation group was injected with propofol 0.4 g/kg before injection, and 1 mg/kg by intravenous injection of propofol. 2 groups of patients before administration (T0), after administration (T1), gastroscopy (T2), gastroscope examination at the end of the 10 min (T3) collected venous blood, plasma epinephrine by radioimmunoassay (E), norepinephrine (NE), cortisol (COR) levels of T0 records;T1, T2, T3 at the time of breathing (HR), mean arterial pressure (MAP);after 5 min, 30 min, 3 h, 6 h was evaluated with mini mental state examination (MMSE) to evaluate the cognitive function in early stage.Results: 2 groups of patients with T1, NE, COR levels of plasma E and T0 no significant difference, T2, T3, NE, COR and plasma E levels higher than the T0 level, the observation group T2, T3, NE, plasma E COR levels lower than the control group, there was statistical significance the difference between the 2 groups;the control group T1 HR is slower than T0, MAP less than T0, T2, T3 HR faster than T0, MAP is higher than T0, and the observation group HR and MAP each time point did not change significantly between the 2 groups was statistically significant the difference;after 5 min and 30 min compared with the preoperative MMSE score decreased 1 D, 3 h after operation, the 6 h gradually increased, but the observation group after 3 h MMSE score higher than the control group, the difference was statistically significant.Conclusion: Dexmedetomidine combined with propofol can reduce the stress reaction of patients with hypertension during painless gastroscopy, and reduce the early understanding of the occurrence of dysfunction, which is worthy of clinical promotion.

Application of the painless technique for visual induced abortion in early pregnancy clinic female

Objective: This project is to analyze and evaluate the efYect of the painless technique in the visual induced abortion. Methods: 300 pregnant women who needed induced abortion and had no contraindication were selected as the research objects. Under the condition of the informed consent of the pregnant women, they were divided into two groups according to the different methods of the induced abortion. 150 cases in the observation group were treated with the painless technique for visual abortion, and 150 cases in the control group were treated with the painless technique for the blind curettage. Relevant surgical indicators and complications were compared between the two groups. Results: The operation time, the vaginal bleeding time, the induced abortion syndrome, the uterine aspiration incompleteness, and the postoperative infection in the observation group were significantly lower than those in the control group. The difference between the two groups was significant (P 0.05), with the statistical significance. The incidence of complications in the observation group (8.33%) was significantly lower than that in the control group (37.50%). The difference between the two groups was significant (P 0.05), with the statistical significance. Conclusion: The visual induced abortion with the painless technique is of great value in the outpatient induced abortion, and it is worth adopting and applying.

Effectof etomidate combined with propofol on stress and inflammatory response in painless gastrointestinal endoscopy

Objective: To study the effect of etomidate combined with propofol on stress and inflammatory response in painless gastrointestinal endoscopy. Methods: A total of 380 subjects who received painless gastrointestinal endoscopy in the hospital were selected as the research subjects and divided into control group and observation group by random number table, 190 cases in each group. Control group received propofol intravenous anesthesia, and observation group received etomidate combined with propofol intravenous anesthesia. The differences in serum levels of stress indexes and inflammatory factors were compared between the two groups 24 h before examination, during examination and 1 h after examination. Results: 24 h before examination, difference in serum levels of stress indexes and inflammatory factors were not statistically significant between the two groups of subjects. During examination and 1 h after examination, serum NE, E, Cor, ALD, AT-Ⅱ, IL-1β, IL-4, IL-6, IL-8, IL-10 and TNF-α contents of both groups were higher than those 24 h before examination, and serum NE, E, Cor, ALD, AT-Ⅱ, IL-1β, IL-4, IL-6, IL-8, IL-10 and TNF-α contents of observation group were lower than those of control group. Conclusion: Etomidate combined with propofol for painless gastrointestinal endoscopy can effectively alleviate the stress and inflammatory response during and early after the examination.

Influence of Painless Delivery Techniques on the Psychology of Primipara in Obstetrics Clinic

Objective:To explore the influence of painless childbirth technique on the psychology of primipara.Methods:From July 2020 to June 2022,108 parturients who received analgesic during delivery in Shaanxi Provincial People’s Hospital were selected as the research subjects(painless delivery group),and 92 parturients who gave birth naturally during the same period were selected as controls(natural delivery group).Psychological tests were performed on the patients.Results:The depression and anxiety scores of parturients in the natural delivery group were significantly higher than those in the painless delivery group(P<0.05);9.0%of the patients had coexisting anxiety and depression.Conclusion:The application of painless delivery techniques in obstetrics can improve the negative emotions experienced by primipara,improve their self-efficacy,and relieve their psychological pressure.

丙泊酚与苯磺酸瑞马唑仑在择期行无痛纤维支气管镜活检术患者血流动力学及苏醒质量的比较

目的探讨丙泊酚与苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术的临床价值。方法选取2020年1月—2022年12月什邡市人民医院拟接受无痛纤维支气管镜活检治疗的60例患者,采用随机数字表法分为丙泊酚组(P组)和苯磺酸瑞马唑仑组(R组),每组30例。对比两组患者血流动力学指标变化趋势、麻醉效果指标、苏醒期质量指标、血糖和乳酸水平变化以及麻醉不良反应的差异。结果R组苏醒时间短于P组(P<0.05)。两组患者麻醉起效时间、苏醒后达离室标准时间比较,差异均无统计学意义(P>0.05)。两组患者麻醉前、内镜检查开始时、开始后3 min、苏醒时的心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)比较,结果:(1)不同时间点的HR、SpO_(2)、MAP比较,差异均有统计学意义(P<0.05);(2)两组患者MAP比较,差异有统计学意义(P<0.05),两组患者HR、SpO_(2)比较,差异均无统计学意义(P>0.05);(3)两组患者MAP变化趋势比较,差异有统计学意义(P<0.05),两组患者HR、SpO_(2)变化趋势比较,差异均无统计学意义(P>0.05)。两组患者麻醉效果分级比较,差异无统计学意义(P>0.05)。两组患者不同时间点Ramsay评分比较,结果:(1)不同时间点间Ramsay评分比较,差异有统计学意义(P<0.05);(2)两组患者Ramsay评分比较,差异无统计学意义(P>0.05);(3)两组患者Ramsay评分变化趋势比较,差异无统计学意义(P>0.05)。两组患者术前、术后即刻、术后4 h血糖、乳酸比较,结果:(1)不同时间点血糖、乳酸比较,差异均有统计学意义(P<0.05);(2)两组患者血糖、乳酸比较,差异均无统计学意义(P>0.05);(3)两组患者血糖、乳酸变化趋势比较,差异均无统计学意义(P>0.05)。R组不良反应发生率低于P组(P<0.05)。结论苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术较丙泊酚能更有利于血流动力学的稳定,可缩短苏醒时间,减少麻醉不良反应。