Influence of anaesthesia and muscle relaxation on intubating conditions and sympathoadrenal response to tracheal intubation

Background : The study aimed to assess the relative influence of anaesthesia and muscle relaxation on intubating conditions and the haemodynamic and catecholamine responses to tracheal intubation.
Methods : Sixty ASA 1 or 2 patients were randomly assigned to one of four groups (15 patients each) that differed in the depth of anaesthesia (thiopentone plus fentanyl 2.5 μg kg^-1 or thiopentone alone) and the degree of vecuronium–induced neuromuscular block (100% or _>: 65%) at intubation. Muscle relaxation was measured at 0.1 Hz by means of mechanomyography. Heart rate (HR) and mean arterial blood pressure (MAP) were measured before and after induction of anaesthesia, and 1 min and 5 min following intubation, while adrenaline (A) and noradrenaline concentrations (NA) were determined from arterial blood samples.
Results : Intubating conditions were improved primarily by providing complete muscle relaxation at the adductor pollicis muscle (P<0.001) and to a lesser extent by adding fentanyl to thiopentone (P=0.04). The response of HR and MAP to tracheal intubation was attenuated mainly by fentanyl (P<0.001). Complete muscle relaxation further diminished the response of MAP to intubation (P=0.03). Changes in A and NA were dependent on the depth of anaesthesia only (P =>0.01).
Conclusion : The results of the study demonstrate that the sympathoadrenal response to intubation is attenuated by adding fentanyl (2.5 kg^-1) to an induction regimen with thiopentone, whereas provision of complete muscle relaxation at the adductor pollicis muscle is necessary to attain smooth intubating conditions.     

N-Alkoxycarbonyl-glutamic and aspartic acids

N-Alkoxycarbonylaminodicarboxylic acids were reacted in dichloromethane with N-ethyl-N′-(dimethylaminopropyl)carbodiimide hydrochloride, and with methyl chloroformate in the presence of N-methylmorpholine. Removal of secondary products by washing the mixtures with aqueous solutions gave good yields of the pure crystalline internal anhydrides. Anhydrides of N-benzyloxycarbonyl- (Z) and N-9-fluorenylmethoxycarbonyl-(Fmoc) L-glutamic and L-aspartic acids and of N-tert.-butoxycarbonyl-L-aspartic acid were prepared in this way. The compounds were shown to be amenable to normal phase high-performance liquid chromatography (NP-HPLC) on a CN-column using tert.-butanol-hexane as solvent. The products of the reactions of Z- and Fmoc-glutamic acid with hot acetic anhydride were examined by nuclear magnetic resonance and NP-HPLC before and after methanolysis in an attempt to establish if any of the corresponding pyroglutamates were formed. The reaction of Fmoc-chloride with Fmoc-glutamate was examined for the same reason. It is concluded that the side product generated during the reaction of Fmoc-chloride with glutamic acid which is used for analysis of the latter is the N-protected internal anhydride and not the pyroglutamate as reported in the literature.     

肝硬化大鼠肝切除术后肠内营养联合白介素-6应用研究

目的探讨肠内营养联合白介素-6在肝硬化大鼠肝切除术后的作用。方法6只正常大鼠作为正常对照组,将24只肝硬化大鼠随机分为术前组6只,肝切除术后1d组6只,肝切除术后行肠内营养（EN）5d组6只,肝切除术后行EN＋IL-65d组6只。测定大鼠肝功能、免疫功能、炎症反应和脂质过氧化。结果与EN5d组比较,EN＋IL-65d组血清ALB、IGF-1显著升高（P〈0.05）,外周血CD3^＋、CD4^＋、CD4^＋/CD8^＋、NK细胞显著升高（P〈0.05）,外周血CD8＋显著下降（P〈0.05）,血清IFN-γ、TNF-α、MDA显著下降（P〈0.05）,血清SOD活性显著升高（P〈0.05）。结论EN＋IL-6可以加快肝硬化大鼠肝切除术后肝功能的恢复,促进肝脏蛋白合成,改善术后免疫功能低下,减轻炎症反应和脂质过氧化损伤。     

Fetal habituation in high-risk pregnancies

Summary. Habituation is a basic form of learning and probably requires an intact central nervous system. Habituation in the behavioural response to vibration in 40 normal human fetuses was compared with that in a group of high-risk pregnancies with an increased risk of fetal neurological damage. Highly significant differences in habituation patterns between the high-risk groups and normal control subjects were found. This test may offer a method of assessing the integrity of the fetal central nervous system.     

STUDIES ON RACEMIZATION DURING COUPLINGS USING A SERIES OF MODEL TRIPEPTIDES INVOLVING ACTIVATED RESIDUES WITH UNFUNCTIONALIZED SIDE CHAINS

Racemization studies have been carried out using as model tests couplings of N-benzyloxycarbonylglycyl-l -χ with benzyl N^e-benzyloxycarbonyl-l -lysinate followed by deprotection and analysis for the diastereomeric tripeptides with an amino acid analyzer, for χ = alanine, leucine, phenylalanine, valine and isoleucine. The order of susceptibility to racemization of residues during these segment couplings depends on whether the solvent is polar or apolar, with isoleucyl and valyl, followed by phenylalanyl, being the most susceptible ones in polar solvents. The racemization depressing effect of some additives on carbodiimide-mediated couplings has been examined. Reconciliation of apparent discrepancies in data in the literature on the relative merits of l-hydroxy-benzotriazole and N-hydroxysuccinimide is made on the basis of the nature of the model tests used in acquiring the data.     

FOLIC ACID IN THE TREATMENT OF PERNICIOUS ANEMIA

1. Folic acid in daily doses of 15 to 50 mg., orally, or 20 mg. intramuscularly,usually produced a submaximal reticulocytosis in patients with pernicious anemia.

2. In 3 patients the hemoglobin and red cells rose to a level of about 12.0 Gm.and 4.3 million respectively without further rise after 3 months of therapy.

3. Folic acid in the above doses failed to prevent the development or progressionof neurological symptoms indicative of subacute combined sclerosis.

4. In 5 patients folic acid in doses of 5 or 10 mg. orally daily combined with unit of liver extract injected intramuscularly daily produced a reticulocytosisgreater than that anticipated from adequate liver extract therapy alone.

5. With combined liver extract and folic acid therapy there was evidence ofimprovement in the symptoms and signs of subacute combined sclerosis in 3patients.

6. Folic acid, combined with unit of liver extract, was found to produce acomplete hematological remission.

7. Folic acid, alone or in combination with small doses of liver extract, producedan improvement in appetite and general well-being in patients with perniciousanemia.

8. The possible enhancing effect of liver extract when combined with folic acidcannot be due to the folic acid content of the former since 1 unit of liver extractcontains only 0.38 micrograms of folic acid.³¹

9. Folic acid administered to a patient with macrocytic anemia due to faultypostoperative intestinal digestion and absorption, produced a complete remissionin the blood picture and a marked improvement in signs and symptoms.

     

神经外科围术期预防用抗菌药物干预效果分析

目的:评价干预措施对我院神经外科围术期预防用抗菌药物的有效性和可行性。方法:随机抽取我院神经外科干预前手术病历200份作为对照组和干预后手术病历200份作为干预组,对围术期预防用抗菌药物情况进行统计、分析。结果:选取的病历基本资料差异无统计学意义(P>0.05),具有可比性。对照组与干预组抗菌药物预防性应用率均为100%。与对照组比较,干预组预防用抗菌药物选择合理例数显著增加(P<0.01),预防用药时间合理例数显著增加(P<0.05);无指征联用例数显著减少(P<0.05),无依据换药的例数也显著减少(P<0.01)。平均预防用药时间对照组为8.5d,干预组为5.4d,干预组平均预防用药时间显著缩短(P<0.05);2组手术部位感染发生率差异无统计学意义(P≥0.05)。结论:我院实施的合理用药干预措施有效、可行,对规范神经外科围术期预防用抗菌药物起到了一定的促进作用。     

尽情宠爱他

不要以为走在时代尖端的现代女性就不应该对她的男人温柔相待!若他对你百般疼惜、有求必应，那么也请你用他所渴望的方式，尽情宠爱他吧!因为他值得。[编者按]