[In-Vivo Noninvasive Measurement of Human Blood Glucose Levels by Mid-Infrared Spectrograph with External CO(2) Laser Source].

Diabetes is a kind of diseases which does harm to people's health, and the detection of human blood glucose levels utilizing blood samples will result in pain even infection for patients. Thus the in-vivo noninvasive measurement of human blood glucose levels has vital value in clinical diagnosis, detection and therapy, and it also is a very hot research topic with challenging. At present, as to various noninvasive detection methods, the technology based on mid-infrared absorption spectrophotometry with ATR has been gaining increasing attention. However, when carrying out noninvasive measurement of human blood glucose levels by means of the spectrophotometry equipped with routine light sources, the penetration depth of probe light in human tissues is low and thus it is very difficult to reach the stromal layer containing body fluids and especially dermis layer containing blood for probe light, which resulting in low relativity between experimental data and real human blood glucose levels and thus limiting the clinical application. Generally, not only the mid-infrared laser with high strength and high purity can deeper penetrate the human tissues, but also the output wavelengths at 1 035 cm(-1) of CO2 laser very coincide with the fundamental frequency characteristic absorption at 1 029 cm(-1) of glucose. Thus, in this work, a novel noninvasive mid-infrared measurement system to detect human blood glucose levels has been successfully assembled, in which a CO2 laser was used a self-defined external light source of the new mid-infrared absorption spectrophotometry with ATR. In this system, the absorbance of human fingertip at 1 035 cm(-1) has been measured when external CO2 laser source was used as probe light, at the same time, the mid-infrared absorption spectra of fingertip have been also obtained and absorbance at 1 492 cm(-1) has been recorded. The human blood glucose levels were determined synchronously by means of the routine medical method. The experimental results showed that the ratio in fingertip between absorbance at 1 035 cm(-1) from the laser source and one at 1 492 cm(-1) from mid-infrared absorption spectrophotometry could synchronously change with the human blood glucose levels, and the ratio presents certain positive relativity with the real human blood glucose levels(R=0. 812 5). Thus the measurement data could be used as a new index of blood glucose level in human body, which showed the potential in clinical diagnosis of the ATR mid-infrared absorption spectrophotometry with external CO(2) laser source in noninvasive measurement of human blood glucose levels.

Proteinase-activated receptor 1 contributed to up-regulation of enkephalin in keratinocytes of patients with obstructive jaundice.

BACKGROUND: Skin synthesis of endogenous opioids such as enkephalin is considered to be increased in cholestatic rodents, which may induce antinociception in cholestatic liver disease. No studies have reported yet the expression of skin enkephalin in patients with cholestasis. METHODS: Electrical pain threshold, postoperative morphine consumption, and skin enkephalin expression were measured in patients with jaundice (n = 18) and control patients (n = 16). Male Sprague-Dawley rats (n = 52) and human keratinocyte cell line HaCaT were used in vivo and in vitro studies, respectively. Nociceptive thresholds and plasma and skin levels of methionine-enkephalin were compared in protease-activated receptors-1-antagonized and control bile duct-ligated rats. In in vitro study, the effect on thrombin-induced enkephalin expression was examined and the role of extracellular regulated protein kinases 1/2 and p38 was investigated. RESULTS: The authors found that: (1) the electrical pain threshold (mean ± SD) was 1.1 ± 0.1 mA in control patients, whereas it was significantly increased in patients with jaundice (1.7 ± 0.3 mA); 48-h postoperative morphine consumption was approximately 50% higher in the control group than that in the group with jaundice; (2) Skin keratinocytes enkephalin expression was increased in the patients with jaundice; (3) Protease-activated receptors-1 antagonist 1 µg·kg(-1)·day(-1) treatment to the bile duct-ligated rats significantly reduced plasma levels of methionine-enkephalin, nociceptive thresholds, and keratinocytes enkephalin expression; and (4) protease-activated receptors-1 activation induced enkephalin expression through phosphorylation of extracellular regulated protein kinases 1/2 and p38 in keratinocytes. CONCLUSION: Protease-activated receptors-1 activation in peripheral keratinocytes may play an important role in the local synthesis of enkephalin during cholestasis.

Glutamine supplementation for critically ill adults.

BACKGROUND: Glutamine is a non-essential amino acid which is abundant in the healthy human body. There are studies reporting that plasma glutamine levels are reduced in patients with critical illness or following major surgery, suggesting that glutamine may be a conditionally essential amino acid in situations of extreme stress. In the past decade, several clinical trials examining the effects of glutamine supplementation in patients with critical illness or receiving surgery have been done, and the systematic review of this clinical evidence has suggested that glutamine supplementation may reduce infection and mortality rates in patients with critical illness. However, two recent large-scale randomized clinical trials did not find any beneficial effects of glutamine supplementation in patients with critical illness. OBJECTIVES: The objective of this review was to:1. assess the effects of glutamine supplementation in critically ill adults and in adults after major surgery on infection rate, mortality and other clinically relevant outcomes;2. investigate potential heterogeneity across different patient groups and different routes for providing nutrition. SEARCH METHODS: We searched the Cochrane Anaesthesia Review Group (CARG) Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 5); MEDLINE (1950 to May 2013); EMBASE (1980 to May 2013) and Web of Science (1945 to May 2013). SELECTION CRITERIA: We included controlled clinical trials with random or quasi-random allocation that examined glutamine supplementation versus no supplementation or placebo in adults with a critical illness or undergoing elective major surgery. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the relevant information from each included study using a standardized data extraction form. For infectious complications and mortality and morbidity outcomes we used risk ratio (RR) as the summary measure with the 95% confidence interval (CI). We calculated, where appropriate, the number needed to treat to benefit (NNTB) and the number needed to treat to harm (NNTH). We presented continuous data as the difference between means (MD) with the 95% CI. MAIN RESULTS: Our search identified 1999 titles, of which 53 trials (57 articles) fulfilled our inclusion criteria. The 53 included studies enrolled a total of 4671 participants with critical illness or undergoing elective major surgery. We analysed seven domains of potential risk of bias. In 10 studies the risk of bias was evaluated as low in all of the domains. Thirty-three trials (2303 patients) provided data on nosocomial infectious complications; pooling of these data suggested that glutamine supplementation reduced the infectious complications rate in adults with critical illness or undergoing elective major surgery (RR 0.79, 95% CI 0.71 to 0.87, P ＜ 0.00001, I² = 8%, moderate quality evidence). Thirty-six studies reported short-term (hospital or less than one month) mortality. The combined rate of mortality from these studies was not statistically different between the groups receiving glutamine supplement and those receiving no supplement (RR 0.89, 95% CI 0.78 to 1.02, P = 0.10, I² = 22%, low quality evidence). Eleven studies reported long-term (more than six months) mortality; meta-analysis of these studies (2277 participants) yielded a RR of 1.00 (95% CI 0.89 to 1.12, P = 0.94, I² = 30%, moderate quality evidence). Subgroup analysis of infectious complications and mortality outcomes did not find any statistically significant differences between the predefined groups. Hospital length of stay was reported in 36 studies. We found that the length of hospital stay was shorter in the intervention group than in the control group (MD -3.46 days, 95% CI -4.61 to -2.32, P < 0.0001, I² = 63%, low quality evidence). Slightly prolonged intensive care unit (ICU) stay was found in the glutamine supplemented group from 22 studies (2285 participants) (MD 0.18 days, 95% CI 0.07 to 0.29, P = 0.002, I² = 11%, moderate quality evidence). Days on mechanical ventilation (14 studies, 1297 participants) was found to be slightly shorter in the intervention group than in the control group (MD - 0.69 days, 95% CI -1.37 to -0.02, P = 0.04, I² = 18%, moderate quality evidence). There was no clear evidence of a difference between the groups for side effects and quality of life, however results were imprecise for serious adverse events and few studies reported on quality of life. Sensitivity analysis including only low risk of bias studies found that glutamine supplementation had beneficial effects in reducing the length of hospital stay (MD -2.9 days, 95% CI -5.3 to -0.5, P = 0.02, I² = 58%, eight studies) while there was no statistically significant difference between the groups for all of the other outcomes. AUTHORS' CONCLUSIONS: This review found moderate evidence that glutamine supplementation reduced the infection rate and days on mechanical ventilation, and low quality evidence that glutamine supplementation reduced length of hospital stay in critically ill or surgical patients. It seems to have little or no effect on the risk of mortality and length of ICU stay, however. The effects on the risk of serious side effects were imprecise. The strength of evidence in this review was impaired by a high risk of overall bias, suspected publication bias, and moderate to substantial heterogeneity within the included studies.

[Influence of cationic cyclopeptide on microstructure and permeability of Caco-2 cell membrane].

The microstructure of cationic cyclopeptide (TD-34) treated Caco-2 cell membrane was observed, and we discussed the relationship between membrane structure and insulin transmembrane permeability. Atomic force microscope (AFM) was used to observe living cell membrane in air condition and tapping mode. Results showed that the surface of Caco-2 cell membrane treated with TD-34 lost its smoothness and nearly doubled its roughness. Apparent permeability coefficients (P(app)) of insulin in Caco-2 cell monolayers increased 2.5 times. In conclusion, AFM can be used to observe microstructure of cationic cyclopeptide treated cell membrane and cationic cyclopeptide enhanced insulin delivery across Caco-2 cell membrane by increasing membrane fluidity.

A simple, fast correction method of triglyceride interference in blood hemoglobin automated measurement.

BACKGROUND: To establish a reliable correction method for automated hemoglobin (HGB) measurement by minimizing the interference from blood high triglyceride (TG). METHODS: Fifty whole blood samples and 50 plasma samples containing variable TG concentrations were used to determine the centrifugation speed and time. Complete blood cell counts (CBCs) were performed by an automated hematology analyzer for 102 blood samples, in which high-level TG were artificially added. The same blood samples were centrifuged at low -speed to separate the plasma from blood cells. Then the plasma was analyzed by the same analyzer. By using the two CBC results, a correction formula was established to calculate the corrected HGB, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) values. Comparisons were also made of HGB, MCH, and MCHC values before and after correction of in-patient individuals who received intralipid and developed lipemia. RESULTS: The percentage differences between the corrected and true values of HGB, MCH and MCHC were -0.28%, 0.06%, and -0.31%, respectively. The correlation coefficients of corrected values versus true values of HGB, MCH, and MCHC were 0.989, 0.935, and 0.717, respectively. This correction method was also effective for native lipemic samples. CONCLUSION: High blood TG level can cause blood turbidity and erroneously high HGB results by hematology analyzers commonly used in clinical laboratories. Adding a simple step of low-speed centrifugation and measurement of HGB in the plasma fraction allows a quick correction of HGB measurement in lipemic blood samples.

[Determination of nine organic amine compounds in CO2 absorption liquid by hydrophilic interaction liquid chromatography-electrostatic field orbitrap high resolution mass spectrometry].

Carbon dioxide (CO2) absorption and capture is an effective measure to achieve the "dual carbon" goal of carbon peak and carbon neutrality in China. Organic amine compounds are widely used in the industrial separation and recovery of CO2. Thus, the establishment of analytical methods for organic amine compounds is of great significance for the research and development of carbon capture and storage (CCS) technology and carbon capture, utilization and storage (CCUS) technology. In this study, a method was developed for the determination of nine organic amine compounds in CO2 absorption liquid by hydrophilic interaction liquid chromatography (HILIC)-electrostatic field orbitrap high resolution mass spectrometry. The sample was diluted with water and filtered through a 0.22 µm nylon membrane before sampling and analysis. An Accucore HILIC column (100 mm×2.1 mm, 2.6 µm) was used for separation at 30 ℃. Gradient elution was conducted using 90% acetonitrile aqueous solution containing 5 mmol/L ammonium formate and 0.1% formic acid as mobile phase A and 10% acetonitrile aqueous solution containing 5 mmol/L ammonium formate and 0.1% formic acid as mobile phase B. Determination was performed using an electrospray ion source (ESI) in the positive ion mode. The quantitative analysis was carried out by standard addition method. The chromatographic retention performance of different chromatographic columns and the influence of different mobile phases on the separation of the organic amine compounds were compared, and the method was validated. The results showed that the linear ranges of the nine organic amine compounds were 0.04-25000 ng/mL with the linear correlation coefficients (R2) greater than 0.9910. The limits of detection (LODs) of the method were in the range of 0.0004-0.0080 ng/mL, and the limits of quantification (LOQs) of the method were in the range of 0.0035-0.0400 ng/mL. The average recoveries of the method ranged from 85.30% to 104.26% with relative standard deviations (RSDs) of 0.04%-7.95% at the spiked levels of 1, 1.5 and 3 times sample concentration. The established method was applied to detect the absorption waste liquid of a cement plant, and nine organic amine compounds could be effectively detected. The stability of the actual sample was tested, and the RSDs were 0.10%-6.35% in 48 h at 4 ℃. The method is sensitive, rapid and accurate for the determination of the nine organic amine compounds in industrial waste water. It can provide reference for the detection of organic amine compounds, and provide strong technical support for the research and industrial application of CO2 capture technology.

Citation classics in main pain research journals.

The number of citations of an article in scientific journals reflects its impact on a specific biomedical field and its recognition in the scientific community. In the present study, we identified and analyzed the characteristics of the 100 most frequently cited articles published between 1970 and 2010 in journals pertaining to pain research and related fields. These articles were identified using the database of the Science Citation Index (1970 to present). The most cited article received 3,017 citations and the least cited article received 302 citations, with a mean of 585 citations per article. These citation classics were published in six high-impact journals, led by Pain (84 articles). Of the 100 articles, 39 were observational studies, 25 were review articles, and 20 concerned basic science. The articles originated from 14 countries, with the United States contributing 47 articles; 67 institutions produced these 100 top-cited articles, led by National Institutes of Health of the United States (8 articles) and University College London (6 articles); 18 persons authored 2 or more of the top-cited articles. This analysis of the top citation classics allows for the recognition of major advances in pain research and gives a historical perspective on the scientific progress of this specialty.

Zero-Dimensional Hybrid Indium Halides with Efficient and Tunable White-Light Emissions.

Two-dimensional hybrid lead perovskites have attracted a great deal of attention in white-light-emitting diodes, but the serious toxicity of Pb2+ and the limited photoluminescence quantum yield (PLQY) still restrict further optoelectronic application. To address these issues, a new combining photon strategy was proposed to achieve highly efficient broadband white-light emission in a new family of zero-dimensional (0D) indium halides based on an [InCl6]3- octahedron. Remarkably, these 0D halides display dual-band white-light emission derived from the synergistic work of blue- and yellow-light-emitting bands, which can be ascribed to the radiative recombination of bound excitons in organic cations and self-trapped excitons in inorganic anions, respectively, based on spectroscopy and theoretical studies. In-depth first-principles calculation demonstrates that the increased structural deformability effectively improves the PLQY from 7.01% to 18.56%. As a proof of concept, this work provides a profound understanding for advancing the rational design of novel single-component 0D lead-free halides as high-performance white-light emitters.

0D hybrid indium halides with highly efficient intrinsic broadband light emissions.

Two new zero-dimensional (0D) hybrid indium halides of [H2DMP]2InX7·2H2O (X = Cl, Br) were designed based on [InX6]3- octahedra as optically active centers. Remarkably, these 0D halides display intrinsic broadband yellow-orange light emissions with highest quantum yield of 58.53% exceeding all previously reported 0D indium halides.

Zero-dimensional Hybrid Antimony Halide with Intrinsic Cyan Light Emission.

Recently, zero-dimensional (0D) hybrid metal halides have attracted intensive attention with wide applications in solid-state lighting and display diodes. Herein, by using a facile wet-chemistry method, we prepared one new 0D hybrid antimony halide of [HMHQ]2 SbCl5 ⋅ 2H2 O (MHQ=2-methyl-8-hydroxyquinoline) based on the discrete [SbCl5 ]2- unit. Remarkably, the bulk crystals of [HMHQ]2 SbCl5 ⋅ 2H2 O exhibit strong cyan light emission with a promising photoluminescence quantum yield (PLQY) of 18.92%. Systematical studies disclose that the cyan emission is mainly derived from the radiative recombination within conjugated organic cation. Benefiting from the promising luminescent performance, this 0D antimony halide can be utilized as an excellent down-conversion light emitting luminescent material to assemble white light-emitting diodes with high color rendering index (CRI) of 90.2.

Congestive heart failure after extensive catheter ablation for atrial fibrillation: prevalence, characterization, and outcome.

INTRODUCTION: This study sought to describe a new complication of catheter ablation for atrial fibrillation (AF): new onset congestive heart failure (CHF) after extensive ablation for AF. METHODS AND RESULTS: Data from 12 patients developing CHF after ablation were prospectively collected. All patients underwent extensive ablation for AF including circumferential pulmonary venous ablation and complex fractionated atrial electrograms guided ablation. CHF was diagnosed using the following criteria: symptoms or signs of heart failure, elevated BNP, and echocardiographic evidence of left ventricular diastolic dysfunction. Twelve patients (5 persistent and 7 permanent AF) had CHF after extensive ablation out of 484 consecutive AF patients who underwent catheter ablation (prevalence 2.5%). None of these 12 patients had CHF prior to the procedure. The mean onset of the symptoms was 39 ± 14 hours after the index procedure. Dyspnea and pulmonary rales were the most observed symptoms or signs. White blood cell count, serum CRP, BNP, and echocardiographic parameters of left ventricular diastolic dysfunction (E/A, E/E') were significantly increased after the onset of symptoms. All patients had complete recovery with supportive therapy within 3 days of the onset of symptoms. CONCLUSIONS: In this single-center experience, CHF after extensive ablation for AF was a well-recognized complication with a relatively high incidence of 2.5%. Measurement of BNP, CRP, and E/A, E/E' is useful in managing these patients.

Scientific publications in anesthesiology journals from East Asia: a 10-year survey of the literature.

The scientific publications in anesthesiology research from East Asian authors have not been reported yet. The present study was designed to analyze the contribution of articles from East Asia to anesthesiology research. Articles published in 17 journals in anesthesiology originating from Japan, China, and South Korea from 2000 to 2009 were retrieved from the PubMed database and Web of Science. From 2000 to 2009, there were 3,076 articles published from East Asia. During this period, there were a notable decrease in publications from Japan and modest increases in publications from both China and South Korea. The average 5-year impact factor of the published articles was similar among the three regions, and China had the highest average number of citations to each article. Anesthesia & Analgesia published more articles than any other journal from all three regions. Our analysis showed that Japan was the most productive region in East Asia, but there was a notable decrease in publications from Japan in 2000-2009. The impact factor of the articles suggests similar levels of scholarship. Anesthesia & Analgesia was the most popular journal in East Asia.

Pharmacokinetic study of lappaconitine hydrobromide in mice by LC-MS.

A high sensitive and rapid method was developed for the analysis of lappaconitine in mouse plasma using liquid chromatography coupled to mass spectrometry (LC-MS). Detection was performed by positive ion electrospray ionization (ESI) in multiple reaction monitoring (MRM) mode, monitoring the transitions m/z 585 --> m/z 535 and m/z 356 --> m/z 192, for the quantification of lappaconitine and tetrahydropalmatine (internal standard, IS), respectively. The method was linear over the concentration range of 3.0-2000.0 ng x mL(-1). The lower limit of quantification was 3.0 ng x mL(-1). Intra- and inter-run precisions (RSD) were both less than 9.9% and accuracy (RE) within +/- 4.8%. After single intravenous injections of lappaconitine hydrobromide at 1.0, 2.0 and 4.0 mg x kg(-1), the elimination half-lives (t(1/2)) were 0.47, 0.48 and 0.49 h, and the areas under the curve (AUC(0-t)) were 55.5, 110.5 and 402.9 ng x h x mL(-1), separately. The pharmacokinetic profile of lappaconitine was linear at relatively lower dose levels (1.0-2.0 mg x kg(-1)). When the dose increased farther to 4.0 mg x kg(-1), the Vz and CL decreased, and the increase fold of the AUC was much larger than that of the dose.

[Treatment strategy and microsurgical operation of complex cerebral arteriovenous malformations].

OBJECTIVE: To study the treatment strategies and operative principles of complex cerebral arteriovenous malformation (CAVM). METHODS: Total 27 cases of complex CAVM were microsurgically resected from June 2004 to May 2011. These account for 67.5% of CAVMs in the same time. Of the CAVM, 25 were eloquent CAVMs and 2 were non-eloquent CAVM. Among the 27 cases, the size of CAVM was large in 12 cases, median in 8, and small in 7. According to Spetzler-Martin CAVM grading, 8 cases were grade II, 5 cases were grade III, 9 cases were grade IV, and 5 cases were grade V. Pre-operative endovascular embolizations were carried out in 2 large CAVMs. All CAVMs were resected by microsurgical techniques. RESULTS: There were 23 cases of complex CAVMs totally removed. The total resection rate was 85.2%. The residual CAVMs were found in postoperative digital subtraction angiography (DSA) in 4 cases. Three of these residual cases were treated with gamma knife. Nineteen cases recovered very well after operation. The main complications were hemianopsia in 2 cases, moderate weakness in 4 cases. Two patients in coma before operation were still comatose after operation. The follow-up period were 2 months to 6 years. Twenty-two cases were Glasgow outcome scale (GOS) 5, 3 cases were GOS 4, and 2 comatose patients were improved a little during the follow-up. CONCLUSIONS: The microsurgical total resection of the CAVMs is the most effective method to cure the disease. With the use of microsurgical technique skillfully, mose complex CAVMs can achieve good outcomes. Preoperative embolization and radiosurgery on the residual nidus are good supplementary methods to treat the complex CAVMs.

Intrathecal siRNA against Toll-like receptor 4 reduces nociception in a rat model of neuropathic pain.

BACKGROUND: Neuropathic pain is characterized by hyperalgesia, allodynia and spontaneous pain. It often occurs as a result of injury to peripheral nerves, dorsal root ganglions (DRG), spinal cord, or brain. Recent studies have suggested that Toll-like receptor 4 (TLR4) might play a role in neuropathic pain. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we investigated the role of TLR4 in a rat chronic constriction injury (CCI) model and explored the feasibility of treating neuropathic pain by inhibiting TLR4. Our results demonstrated that intrathecal siRNA-mediated suppression of TLR4 attenuated CCI-induced mechanical allodynia and thermal hyperalgesia through inhibiting the activation of NF-kappaB p65 and production of proinflammatory cytokines (e.g., TNF-alpha and IL-1 beta). CONCLUSIONS/SIGNIFICANCE: These findings suggest that suppression of TLR4 mediated by intrathecally administered siRNA may be a new strategy for the treatment of neuropathic pain.

Scientific publications in critical care medicine journals from Chinese authors: a 10-year survey of the literature.

BACKGROUND: People of Chinese ethnicity are the largest population in the world. Critical care medicine in China is developing rapidly and has achieved great advances in recent 20 years. The research contribution in critical care medicine among Chinese individuals in the three major regions of China--Mainland (ML), Hong Kong (HK), and Taiwan (TW)--is unknown. METHODS: Articles published in 18 journals on critical care medicine originating from ML, TW, and HK from 1999 to 2008 were retrieved from the PubMed database and Science Citation Index Expanded. Quantity and quality analyses were conducted for the total numbers of articles, clinical trials, randomized controlled trials, impact factors (IF), citations, and articles published in high-impact journals. RESULTS: There were 932 articles from ML (268), TW (506), and HK (158) from 1999 to 2008. The annual total numbers of articles of the three regions increased gradually from 1999 to 2008 (from 57 to 157). From 2002 onward, the number of articles published from ML exceeded that from HK, but TW still has the dominance in both annual and total number of articles published compared with ML and HK. The accumulated IF of articles from TW (1676.67) was higher than that from ML (708.25) and HK (449.51). TW had the highest average IF of 3.31 followed by HK of 2.85 and ML of 2.64. HK had the highest average citations of each article of 10.73, followed by TW of 6.74 and ML of 5.34. The Journal of Trauma was the most popular journal in the three regions. CONCLUSIONS: The total numbers of articles in China increased markedly from 1999 to 2008. TW published the most number of articles, clinical trials, and randomised controlled trials among the three regions. The Journal of Trauma was the most popular journal in the three regions.

[Microsurgical treatment of ophthalmic segment aneurysms of internal carotid artery: 28 cases report].

OBJECTIVE: To investigate the operative modalities and outcomes of 28 cases of ophthalmic segment aneurysms of internal carotid artery. METHODS: Twenty-eight cases of ophthalmic segment aneurysms of internal carotid artery were operated on from May 2004 to August 2009. Of all 28 cases, 20 were large or giant. Nineteen aneurysms were directly clipped or resected with internal carotid artery revascularization. Since 2006, high-flow extracranial-intracranial (EC-IC) bypass were available and performed in 9 patients of large or giant aneurysms and then the aneurysms were resected or trapped. RESULTS: Seventeen patients underwent digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA) postoperatively. The images demonstrated that 5 grafts of bypass were in patency, and 2 were occluded. Only 1 aneurysm was partially clipped and the others disappeared on imaging. The 78% of these cases had good results (GOS 4-5). One patient died after EC-IC bypass due to neck hematoma. CONCLUSIONS: The treatment of ophthalmic segment aneurysms of internal carotid artery, especially the large and giant ones, remains a challenge for neurovascular neurosurgeon. The accessory high-flow EC-IC bypass procedures and selection of suitable aneurysm clips are very important to improve the effectiveness of the operation.

Baroreflex sensitivity is impaired in patients with obstructive jaundice.

BACKGROUND: Obstructive jaundice is associated with enhanced susceptibility to hypotensive shock, renal failure, and toxic effects of endotoxin, which results in high perioperative morbidity and mortality. Since the normal arterial baroreflex function is necessary for hemodynamic homeostasis and improving survival in sepsis, this study aimed to determine whether baroreflex sensitivity was impaired in jaundiced patients. METHODS: Thirty-five patients with obstructive jaundice scheduled for surgery were included, and 30 nonjaundiced patients served as controls. A modified Oxford pharmacologic technique was used for evaluating baroreflex sensitivity immediately before the surgery. Potential factors that may affect baroreflex sensitivity in jaundice, such as liver biochemistry, plasma concentrations of methionine-enkephalin, atrial natriuretic peptide and nitrate, were also measured. RESULTS: Patients with obstructive jaundice had decreased sensitivity in both the sympathetic and vagal components of the baroreflex, as compared with the controls (P < 0.01). There was a significant inverse correlation between plasma atrial natriuretic peptide concentration and decreased sympathetic baroreflex sensitivity in the jaundiced group (r = -0.44, P = 0.008). CONCLUSIONS: Baroreflex sensitivity is impaired in patients with obstructive jaundice, which may contribute to their enhanced susceptibility to the well-known perioperative complications. The underlying mechanisms for such a change may be associated with an increased level of plasma atrial natriuretic peptide.

[Clinical study on sodium ferulate for intracerebral hemorrhage in early stage].

OBJECTIVE: To evaluate the clinical application value of sodium ferulate for intracerebral hemorrhage in early stage. METHOD: Sixty patients with cerebral hemorrhage in basal ganglia onset within 24 h were randomly divided into two groups. The two groups showed no evident differences in age, hematoma volume and edema volume, computerized tomography number, and Chinese Stroke Scale. Both groups were given basic treatment with dehydrating, cytidine diphosphocholine, controlling blood pressure, blood sugar and complicating diseases, while the observation group added the treatment of sodium ferulate intravenous drip after 24 h. The hematoma volume, edema volume, and computerized tomographynumber were examined in the 1st day and 14th day, Chinese Stroke Scale in the 1st day, 14th day and 28th day, and the level of serum endothelin in the 1, 3, 5, 7, 14th day. RESULT: After treatment, edema volume and computerized tomography number in the observation group were lower than those in the control group (P < 0.01, P < 0.05). Patients' recovery of neural function were markedly improved in the observation group better than that in the control group (P < 0.05), and also the therapeutic effectiveness (P < 0.05). The serum endothelin level of the 60 patients showed higher significantly than the healthy group in 24 h after hemorrhage (P < 0.01). The control group kept higher in 14 days (P < 0.05), while the observation group showed declined significantly in the 3rd day and close to the healthy group, and lower than the healthy group in the 14th day (P < 0.05). CONCLUSION: With the basic medical therapy, applying sodium ferulate can effectually improve the resolution of the haematoma, reduce the peripheral edema, and enhance the recovery of neural function for the patients with intracerebral hemorrhage in early stag. The therapeutic effectiveness of adding sodium ferulate in patients with intracerebral hemorrhage in early stage is better than that of the basic medical therapy in most of the fields as the above. No evident effect on secondary hemorrhage, or harmful impact on heart, liver and kidney function was found.