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There is a high incidence of tooth injury or loss due to endotracheal intubation or extubation. Tooth injury may be costly or even life threatening. In particular, tooth aspiration may cause airway obstruction, aspiration pneumonitis, or lung collapse, but tooth aspiration after tracheal extubation is rarely reported and easily overlooked. A missing tooth after extubation can be more dangerous. However, there are no practical guidelines and standard intervention strategies to deal with a loose or missing tooth. This article presents the case of a 67-year-old man who underwent laparoscopic colectomy for a colonic tumor under general anesthesia, and whose left maxillary incisor was loose. After surgery, the loose tooth was missing and we had to go through a difficult process to find it. Finally, a chest X-ray revealed a foreign body located in the trachea, and it was successfully removed by fiber-bronchoscopy. The patient woke up with no discomfort and was discharged without complications on the third day after surgery. Based on our experience in this case, we put forward a complete and effective flowchart named "VICTOR" as an option for the prevention of tooth loss and aspiration during surgical procedures and for locating a missing tooth in a timely, appropriate and safe way during the perioperative period.

BACKGROUND Double outlet right ventricle (DORV) is a rare and complex congenital heart defect, and the surgical repairs vary with type and pathophysiology consequences. Due to prolonged progressive hypoxemia, severe polycythemia is common in patients with DORV, which ultimately leads to coagulation dysfunction and increases the risk of thrombosis and infarction. Consequently, the anesthetic management is challenging and how to manage severe polycythemia and avoid hypoxia-related complications in such patients is of great significance. CASE SUMMARY Herein, we report the anesthetic management of a 10-year-old female patient with a DORV. She lived in the low-oxygen Qinghai-Tibet Plateau, and presented with severe polycythemia (hemoglobin, 24.8 g/dL; hematocrit, 75%). She underwent a modified Fontan surgery, which was satisfactory and without any perioperative complications. Our anesthetic management highlights the importance of perioperative hemodilution in decreasing the risk of thromboembolism and the importance of correcting coagulopathy in preventing hemorrhage. CONCLUSION Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia. It is important to adopt perioperative hemodilution and correction of coagulopathy in preventing thrombosis and hemorrhage.

Background:Fospropofol disodium for injection (FospropofolFD) is a prodrug that is metabolized into propofol to produce a general anesthesia effect when administered intravenously.Objective:This study aimed to assess the efficacy and safety of FospropofolFDin comparison with propofol medium/long-chain fat emulsion injections (propofol-MCT/LCT) for general anesthesia induction in adult patients undergoing elective surgeries.Setting:Nine academic medical centers in China.Method:This multicenter, randomized, double-blind, double-simulated, controlled, and non-inferiority trial evaluated 540 eligible adult patients randomly assigned (2:1) to the intervention (20 mg/kg FospropofolFD) or control (2 mg/kg propofol-MCT/LCT) groups.Main Outcome Measure:The primary efficacy endpoint was the success rate, defined as a Modified Observer’s Assessment of Alertness/Sedation Scale score of 1 within 5 min after study drug administration. The safety endpoints consisted of adverse events (AEs) related to consciousness, cognitive function, hemodynamic status, liver and kidney function, and blood tests.Results:A total of 347 (96.3%) and 175 (97.2%) patients in the intervention and control groups, respectively, completed the study. The success rate for the primary outcome was 97.7% for both study drugs. The most frequent AEs in the intervention group were abnormal feeling (62.0%), blood pressure reduction (13.5%), and injection site pain (13.3%). No AEs related to consciousness and mental and cognitive functions or serious adverse events were reported.Conclusion:FospropofolFD(20 mg/kg) is not inferior to propofol-MCT/LCT (2 mg/kg) in general anesthesia induction for American Society of Anesthesiologists (ASA) physical status I-II adult patients undergoing elective surgeries. It is safe and effective for clinical use under anesthesiologist monitoring.Impact on Practice Statement:FospropofolFDcan produce a general anesthesia effect and reduce the incidence of pain at the site of injection.

Objective This study is aimed at assembling, through a systematic review and meta-analysis, scientific evidence related to the effects of mandibular setback (MdS) surgery and bimaxillary surgery for the correction of Class III malocclusion on the cross-sectional area (CSA) and volume of the upper airway as assessed using CT. Methods An electronic search was conducted on Cochrane Library, EMBASE, PubMed, Scopus and Web of Science up to June 20, 2016. The inclusion criteria were prospective or retrospective studies, with the aim of comparing the impact on the upper airway space of orthognathic surgery for the treatment of the skeletal class III malocclusion. The methodological index for non-randomized studies (MINORS) was chosen as the evaluation instrument and Revman5.3 was used for the meta-analysis. Results A total of 1213 studies were retrieved, of which only 18 met the eligibility criteria. The results of meta-analysis showed that the mean decrease in the upper airway volume after MdS surgery was 3.24 cm 3 [95%CI (−5.25,-1.23), p = 0.85]; the mean decrease in minimum CSA after a combined surgery of maxillary advancement with mandibular setback (MdS + MxA) was 27.66 mm 2 [95%CI (−52.81,−2.51), p = 0.51], but there was no significant decrease in upper airway volume (mean 0.86 cm 3 ); comparison between MdS + MxA and isolated MdS showed significant differences in the CSA of the posterior nasal spine plane (PNS) and epiglottis plane (EP); statistically significant differences in nasopharynx volume (P Conclusion The results of this study suggest that bimaxillary surgery promotes less decrease on the upper airway than mandibular setback surgery alone for the correction of the skeletal class III malocclusion.

We assessed the prevalence characteristics of single and multiple high-risk human papillomavirus (HR-HPV) infections. A total of 1783 women who underwent colposcopy and cervical biopsy for abnormal ThinPrep Cytology Test and/or HR-HPV subtype genotyping results were enrolled in the study. Among the participants, 770 were diagnosed with cervicitis, 395 with cervical intraepithelial neoplasia grade 1 (CIN1), 542 with CIN2-3, and 76 with squamous cell carcinoma (SCC), with HR-HPV infection rates of 75.8%, 85.8%, 95.9%, and 88.4%, respectively. The prevalence of total and multiple HR-HPV infections exhibited a bimodal age distribution with a peak at ≤25 years, a decline with age and a second peak at ≥55 years, whereas single HR-HPV infections exhibited one peak from 35 to 44 years. The four most dominant HPV genotypes were HPV 16 (29.5%), 52 (15.0%), 58 (14.2%), and 18 (10.4%). In total, 67.0%, 70.4%, and 82.1% of patients with CIN1, CIN2-3, and SCC, respectively, had a single HR-HPV infection, which increased significantly with the aggravation of the cervical lesion grade (P = 0.045). Patients with a single HPV 16 infection had higher incidences of CIN2+ (62.2%) than those with multiple HPV 16 infections (52.4%) (P = 0.021). Patients coinfected with HPV 16 had higher CIN2+ incidence than those with single HPV 52, 31, 33, 35, 39, 45, 51, 56, or 59 infections (P < 0.001). This study provided baseline data on the prevalence characteristics of single and multiple HR-HPV infections in women attending a gynecological outpatient clinic in Beijing.

To evaluate the effects of lesion location on adhesion and angiogenesis of transplanted endometriotic lesions in SCID mice.Three groups of female SCID mice included intraperitoneal (i.p.) (n = 12), subcutaneous (s.c.) (n = 12), and mock surgery (control) (n = 12). At 2 weeks after ovariectomy, the mice were transplanted with eutopic endometrium from endometriosis patients either subcutaneously or sutured within the peritoneal, or underwent mock surgery. After 4 weeks, the mice were sacrificed to evaluate the adhesion and volume changes of the implanted lesions. Furthermore, semiquantitative immunohistochemical staining was performed to analyze expression of MMP-2 and TIMP-2 as adhesion makers, and vWF, VEGF, and HIF-1α as angiogenesis markers.Adhesion occurred in 9 of 12 mice in the i.p. group, 3 of 12 mice in the s.c. group, and 3 of 12 mice in the control group. Fisher's exact test showed that the difference of adhesion occurrence between i.p. and s.c. groups was statistically significant (p 0.05). Graft volume changes were higher in the s.c. group than those in the i.p. group. MMP-2 expression was higher in the s.c. group than that in the i.p. group (p 0.01). There was no significant difference of TIMP-2 expression between s.c. and i.p. groups. vWF, VEGF, and HIF-1α expression was significantly higher in the s.c. group than that in the i.p. group (p 0.01).Lesion location might be involved in the pathological changes of endometriosis. The intraperitoneal location is related to endometriotic adhesion, whereas the subcutaneous location is related to the infiltration of endometriotic lesions.

The size of the microhotplates based on MEMS is micron-grade, typically rectangular membrane of 270 μm × 70 μm in micropellistors. Coating carrier catalytic materials on the microhotplate appeared to be an extremely critical step in practice. To solve this problem, this paper presents a droplet generator based on microfluidic pulse inertia force, which can be used for dispersing carrier catalytic materials into uniform fine droplets and coating them on the microhotplate. The principle of the generator is to actuate a hollow PZT stack by a signal generator and a voltage amplification to provide an enough pulse inertia force for a glass micro-nozzle and catalytic materials inside to eject droplets. The micro-nozzle was fabricated by glass heating process without complicated microfabrication technology. So it has the advantages of good chemical resistance, low friction, easy to manufacture and low cost. The porous Al 2 O 3 matrix thickness and the amount of platinum palladium catalyst can be controlled accurately using the droplet generator. The micropellistor with original signal of 75 mV was fabricated and 36 mV was remained after aging treatment. The power consumption can remain as low as 75 mW as well.

For existing local severe vibration problems on the pipeline system of conveying ethylene booster in ethylene cracking system of a petrochemical company, the detailed analysis by CAESARII was carried out to its pipeline system natural frequency and vibration modal; The flow of ethylene gas within the booster pipeline from the suction pipe to exhaust pipe inside including the buffer tank was analyzed using fluid analysis software--FLUENT, the pressure field and velocity field of the flow was obtained. According to the law of the suction and exhaust valve open-closed mouth, dynamic boundary conditions was set on the suction valve and exhaust valve. The ethylene flow non-steady-state analysis calculations was carried out within the pipeline from the suction tube inlet to suction valve and from the exhaust valve to the exhaust tube outlet , the law of the pressure pulsation frequency response was obtained on the suction pipe inlet and the exhaust pipe outlet. The results show that ethylene gas pipeline pressure pulsation frequency response was basically equal to the frequency of the suction and exhaust valve open-closed mouth; The actual pipe vibration modals of the pipeline system on the scene and the pipeline vibration modals a few corresponding to the natural frequencies of the pipeline system close to the pulsation frequency in flow pressure are very similar, indicating that the vibration of the pipeline system is due to the pressure pulse frequency of the ethylene gas internal pipeline close to the natural frequency of the local pipeline, caused due to local resonance. Changing the form of hangers in vibration system can change the natural frequency of pipeline to avoid resonance. Tube fluid dynamic pressure caused by the stress of the pipeline is limited and will not cause damage to the tube material. Mass flow rate does not match with the tube diameter will cause too large flow velocity, the inertia force caused by the larger on the suction valve and exhaust valve before and after, resulting in the forced vibration of the compressor body.

Non-linear wave influence is considered in the elliptic mild-slope equation including higher-order terms of water depth, and a non-linear wave mathematical model is derived in which reflection and transmission boundary conditions are involved based on Behrent radiation boundary condition. The model was verified with data obtained from experiment of elliptic shoal topography, and numerical simulation result accord with experiment value well. The model is applied to simulate waves in a permeable breakwater harbor and a sound wave height distribution in the harbor is obtained, can reflect reflection and transmission of the boundary impact on wave condition in the harbor well.

Implementation of pulsed-pump technique in fiber amplifier is highly useful in the situation of low repetition rate and high energy pulses operation. In this paper, the ASE (Amplified Spontaneous Emission) dynamics simulation in a pulsed-pumped ytterbium-doped double-clad fiber amplifier is presented for the first time, which provides important guidance about optimizing the pulsed-pump mode. The simulations of ASE dynamics are carried out by solving the rate equations and light power propagation equations in fiber using the finite elements analysis method, including variations of ASE output power at two terminals of the fiber in the time span from 0 ~ 740μs after pump light injection. Furthermore, a way of optimizing signal injection time is discussed.

Background Neuromyelitis optica (NMO) is a serious idiopathic inflammatory demyelinating disorder characterized by acute transverse myelitis and optic neuritis. A significant proportion of NMO patients are seropositive for NMO-IgG, an autoantibody targeting aquaporin-4 (AQP4) water channel. Paraneoplastic NMO associated various tumors were recently reported. Aim We studied the expression of AQP4 by thymoma from patients with and without myasthenia gravis (MG). Methods Thymoma obtained from thymomectomy in patients with and without MG were studied by immunohistochemistry and western blot. Results Ten thymoma patients (9 with MG) and two control patients without thymoma or MG were studied. Immunohistochemistry revealed AQP4 immunoreactivity in cell membrane of thymoma cells from all ten thymoma specimens whereas thymic tissues from patients without thymoma or MG were negative for AQP4 immunoreactivity. Western blot revealed that lysates of nine of the ten thymoma specimens reacted with anti-human AQP4 antibody with a band of ~ 30 kDa compatible with the molecular weight of AQP4. Interestingly, immunofluorescence revealed that IgG isolated from 2 NMO patients seropositive for NMO-IgG bound to cell membrane of thymoma cells from all ten thymoma specimens while IgG from healthy control subject did not. Conclusion Thymoma cells of patients with and without MG express AQP4. AQP4 autoantibodies from serum of NMO patients bound to AQP4 expressed on thymoma cell membrane.

The quantum imaging (ghost) has attracted many attention in recent years. In the ghost imaging scheme, the object information is captured by the “bucket” detector which has no spatial information. In practical scheme, the CCD array or the APD are utilized as the “bucket” detector, but the saturation effect of the detector may exist due to the limited sampling depth of the detector. The two methods are presented to reduce the effect of the saturation for different “bucket” detectors. The method for CCD array is based on the statistic principle of ghost imaging, and the other is based on the compressed sensing. After that, we compare the difference between the ghost imaging and compressed sensing in the low light level condition.

AIM: To analyze the composition of the Chinese herbal medicine Sanjie Zhentong Capsule (SJZTC) and test the therapeutic efficacy of each component in a rat model of endometriosis. METHODS: A rapid resolution liquid chromatography (RRLC) method coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry (Q-TOF MS) has been developed for the analysis of SJZTC. Two main ingredients, Drac(h)onis sanguis and saponin, were tested in the endometriosis model. Sixty Lewis female rats were in the estrous cycle stage when endometriosis was experimentally initiated by peritoneal implantation of endometrial tissue. Four weeks later, a second laparotomy was performed and implant volumes were measured. After that, the implanted rats were randomized into five study groups: control group (treatment with saline), anastrozole group (treatment with anastrole, 18 μg per day), loureirin A group (treated with loureirin A, 97.2 mg), ginsenoside Re group (treated with ginsenoside Re, 64.8 mg), and SJZTC groups (treated with SJZTC, 86.4 mg) administered once a day for 4 weeks via gastric gavage. After four weeks of treatment, a third laparotomy was performed, implant volumes were re-measured, and the levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α) were tested. RESULTS: A total of 38 compounds including, both the target and unknown compounds, were rapidly predicted in the capsule extract by the developed method. Compared with the control group, the anastrozole group, loureirin A group, ginsenoside Re group, and SJZTC treated group showed smaller implant volumes, as well as lower levels of VEGF and TNF-α in the peritoneal focus (P < 0.01 for all comparisons). Furthermore, parameters in the groups treated with SJZTC, loureirin A and ginsenoside Re were significantly better than the control group and the anastrozole group. These results indicate that SJZTC and its two main components are effective in reducing the development of endometriosis.

Cellular network has low accuracy and GPS in complex environment has insufficient information, aiming at the irresistible detects in respective positioning system, present combined positioning method based on the GPS and cellular network, to improve the availability of the positioning, and improve the positioning accuracy. And the main factor of current effect on GPS / cellular hybrid positioning is non-line-of-sight propagation ( NLOS ). In this paper, based on the two scatter model inhibition of NLOS propagation effect, the idea is to transformed the NLOS error into a deterministic model factors, so the precision is mainly depends on the orientation of the measuring accuracy of the parameters and unrelated to non direct wave caused by parameter deviation, take scatter as a virtual base station, inhibition of cellular NLOS error, and auxiliary GPS positioning, to improve the dilution of position ( DOP ), namely in the GPS blind auxiliary positioning, further improving GPS / cellular hybrid positioning accuracy. Through the static, movement, ROS model, Gauss noise propagation environment, and use of error cumulative density function and RMSE to evaluate algorithm for hybrid positioning in this paper, the result has higher accuracy and stronger robustness.