Case series of tracheal extubation in prone position after endoscopic retrograde cholangiopancreatography general anesthesia

OBJECTIVE

The study aims to present a 15-patient case series of tracheal extubation in the prone position after endoscopic retrograde cholangiopancreatography (ERCP) general anesthesia.

PATIENTS AND METHODS

Fifteen inpatients who underwent elective ERCP in our hospital were prospectively enrolled, and a series of case studies were conducted with the prone extubation technique after general anesthesia. All patients underwent routine operation of tracheal intubation under general anesthesia. After the surgery, when the train-of-four ratio (TOFr) ≥0.9, bispectral index (BIS) ≥80, tidal volume ≥6 ml/kg and the required actions could be performed, the endotracheal catheter was removed after sufficient negative pressure suction of oral secretions. After the endotracheal catheter was removed, the patient autonomously turned to the transport bed with the assistance of medical staff and was then admitted to the post-anesthesia care unit (PACU) for further observation. When the patient awoke, he had regained orientation, and presented stable vital signs, no nausea and vomiting, and no other discomfort symptoms, he/she was able to leave PACU and returned to the ward with a Steward score of ≥5.

RESULTS

All 15 patients who underwent ERCP elective surgery were successfully extubated in the prone position after surgery. Transient hypoxemia with SpO2 below 90% occurred in 2 of the 15 patients and returned to normal with oxygen mask administration. 7 patients had coughs and were without special treatment. Another 1 patient showed transient abnormal hemodynamic fluctuations after extubation, mean airway pressure (MAP) was higher than 20% of the baseline value, and hemodynamics was stable after drug treatment.

CONCLUSIONS

The prone extubation technique is feasible for ERCP general anesthesia patients. However, a larger sample size is needed to validate its safety and to verify whether there exist advantages of the extubation technique in a prone position over a supine position.

Rational design of spontaneous reactions for protecting porous lithium electrodes in lithium-sulfur batteries

A rechargeable lithium anode requires a porous structure for a high capacity, and a stable electrode/electrolyte interface against dendrite formation and polysulfide crossover when used in a lithium-sulfur battery. Here, we design two simple steps of spontaneous reactions for protecting porous lithium electrodes. First, a reaction between molten lithium and sulfur-impregnated carbon nanofiber forms a fibrous network with a lithium shell and a carbon core. Second, we coat the surface of this porous lithium electrode with a composite of lithium bismuth alloys and lithium fluoride through another spontaneous reaction between lithium and bismuth trifluoride, solvated with phosphorous pentasulfide, which also polymerizes with lithium sulfide residual in the electrode to form a solid electrolyte layer. This protected porous lithium electrode enables stable operation of a lithium-sulfur battery with a sulfur loading of 10.2 mg cm-2 at 6.0 mA cm-2 for 200 cycles.

[Chromosome aberration and carcinogenicity of CHO dhfr- cells transformed by plasmid containing S+ and Pre S1 of fusion gene of hepatitis B virus]

OBJECTIVE

To investigate the chromosome aberrations and carcinogenicity of CHO-dhfr- cell induced by integration of plasmid containing S+ and Pre S1 fusion gene of hepatitis B surface antigen (HBsAg).

METHODS

The plasmid pCHBSS1G was constructed with S+ Pre S1 of HBsAg. CHO-dhfr- cells were transformed with this recombinant plasmid DNA and CHO cells lines with integrated DNA were cloned and named GdSS118. The GdSS1 18 cell lines secreting the S+ Pre S1 fusion protein of HBsAg at high level were developed by screening in increased concentration of MTX and MSX in cultured media. To make sample of cells chromosome, the cells integrated DNA were subcutaneously injected into nude mouse.

RESULTS

The CHO-dhfr- cell lines integrated with S and Pre S1 fusion protein of HBsAg were developed and named GdSS1-18 cell lines. The frequencies and type of chromosome aberrations of the GdSS1-18 cell lines with different passage generations were 11%, 56% and 29%, respectively, while that of the control CHO-dhfr- cell lines was 6%. There was no change in the mode of chromosomes, both cell lines having 20 chromosome s. Both cell lines were non-oncogenic in nude mouse.

CONCLUSIONS

The chromosome aberration of CHO-dhfr- cells with integrated DNA were obviously higher than that of the original CHO-dhfr- cells without integrated DNA. Both cell lines were non oncogenic in nude mouse.

Antigenic relationship between H1 and H2 of influenza A virus

Using cloned viruses of proven purity, and by the methods of hemagglutination inhibition, single radial hemolysis, strain-specific complement fixation and neutralization tests we have demonstrated the serological cross reaction between late H1N1 variant (Dutch/56) and H2N2 of influenza A virus with fowl and hamster antisera. Such a cross reaction is not detected with earlier H1N1 variants. Serological crossing covers variants of H2N2 virus isolated from 1957-1966 but in decreasing titers, and disappears with the last variant of H2N2 isolated late in 1967. Analysis with mono-specific antisera or antigens prepared with recombinants reveal that the hemagglutinins of late H1N1 and H2N2 are related, while their neuraminidases are distinct. We have discussed the bearing of such antigenic relationships to previous epidemiological observations on the partial protection of patients convalescent from late H1N1 disease against H2N2 and to the recombination theory for the origin of H2N2 virus.