Research on the mechanism of mechanical ventilation induced endoplasmic reticulum stress promoting mechanical ventilation-induced pulmonary fibrosis / 中华危重病急救医学

OBJECTIVE@#To demonstrate the mechanism of mechanical ventilation (MV) induced endoplasmic reticulum stress (ERS) promoting mechanical ventilation-induced pulmonary fibrosis (MVPF), and to clarify the role of angiotensin receptor 1 (AT1R) during the process.@*METHODS@#The C57BL/6 mice were randomly divided into four groups: Sham group, MV group, AT1R-shRNA group and MV+AT1R-shRNA group, with 6 mice in each group. The MV group and MV+AT1R-shRNA group mechanically ventilated for 2 hours after endotracheal intubation to establish MVPF animal model (parameter settings: respiratory rate 70 times/minutes, tidal volume 20 mL/kg, inhated oxygen concentration 0.21). The Sham group and AT1R-shRNA group only underwent intubation after anesthesia and maintained spontaneous breathing. AT1R-shRNA group and MV+AT1R-shRNA group were airway injected with the adeno-associated virus one month before modeling to inhibit AT1R gene expression in lung tissue. The expressions of AT1R, ERS signature proteins [immunoglobulin heavy chain-binding protein (BIP), protein disulfide isomerase (PDI)], fibrosis signature proteins [collagen I (COL1A1), α-smooth muscle actin (α-SMA)] in lung tissues were detected by immunofluorescence and Western blotting. Hematoxylin-eosin (HE) staining was used to evaluate lung injury and Masson staining was used to evaluate pulmonary fibrosis.@*RESULTS@#Compared with the Sham group, the degree of pulmonary fibrosis and lung injury were more significant in the MV group. In the MV group, the protein expressions of AT1R, BIP, PDI, COL1A1 and α-SMA were increased (AT1R/β-actin: 1.40±0.02 vs. 1, BIP/β-actin: 2.79±0.07 vs. 1, PDI/β-actin: 2.07±0.02 vs. 1, COL1A1/α-Tubulin: 2.60±0.15 vs. 1, α-SMA/α-Tubulin: 2.80±0.25 vs. 1, all P < 0.01). The number of E-cad+/AT1R+ and E-cad+/BIP+ cells in lung tissue increased, and the fluorescence intensity of COL1A1 and α-SMA increased. Compared with the MV group, the degree of pulmonary fibrosis and lung injury were significantly relieved in the MV+AT1R-shRNA group. In the MV+AT1R-shRNA group, the protein expressions of AT1R, BIP, PDI, COL1A1 and α-SMA were decreased (AT1R/β-actin: 0.53±0.03 vs. 1.40±0.02, BIP/β-actin: 1.73±0.15 vs. 2.79±0.07, PDI/β-actin: 1.04±0.07 vs. 2.07±0.02, COL1A1/α-Tubulin: 1.29±0.11 vs. 2.60±0.15, α-SMA/α-Tubulin: 1.27±0.10 vs. 2.80±0.25, all P < 0.01). The number of E-cad+/AT1R+ and E-cad+/BIP+ cells in lung tissue decreased, and the fluorescence intensity of COL1A1 and α-SMA decreased. There was no statistically significant difference in the indicators between AT1R-shRNA group and Sham group.@*CONCLUSIONS@#MV up-regulate the expression of AT1R in alveolar epithelial cells, activate the AT1R pathway, induce ERS and promote the progression of MVPF.

Research status of organizational structure and service process of enhanced recovery after surgery / 中华医院管理杂志

Enhanced recovery after surgery(ERAS)is not only an evidence-based set of perioperative interventions, but also a highly innovative multidisciplinary collaboration model and organizational system. The authors reviewed the research status of the organizational structure and service process of ERAS at home and abroad, elaborated the establishment mode and management operation system of ERAS-multidisciplinary team(ERAS-MDT), discussed the communication mechanism between the teams to strengthen the communication and cooperation of ERAS-MDT, and emphasized the reasonable allocation of human resources of ERAS-MDT to reduce the workload of members. At the same time, the authors reviewed the standardized clinical pathway to facilitate the connection of all aspects during the perioperative period, and through the quality control and quality improvement measures of ERAS mode, the authors hope to further standardize the ERAS service process and escort the efficient operation of ERAS.

Efficacy of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative analgesia in patients undergoing pancreaticoduodenectomy / 南方医科大学学报

OBJECTIVE@#To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy.@*METHODS@#This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups.@*RESULTS@#At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05).@*CONCLUSIONS@#In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.

Study on application effect of cyclooxygenase-2 inhibitor in perioperative pain management in patients with laparoscopic cholecystectomy / 重庆医学

Objective To investigate the application effect of selective cyclooxygenase-2 (COX-2) inhibitor in perioperative preemptive on-demand analgesia of the patients with laparoscopic cholecystectomy under enhanced recovery after surgery(ERAS).Methods The clinical data in 206 cases of gallstones undergoing selective COX-2 inhibitor for preemptive analgesia (new type analgesic group) from June to December 2015 and 198 cases of gallstones undergoing tramadol postoperative analgesia (traditional analgesia group) in the biliary surgery department of West China Hospital of Sichuan University were retrospectively analyzed.The intraoperative anesthesia schemes in the two groups were consistent.The same pain resolution scheme was adopted after operation.Then the VAS pain score,pain relief drug use rate,adverse reactions,analgesic satisfaction and hospitalization time were compared between the two groups.Results The VAS scores at postoperative 2,6,12,24 h in the new type analgesia group were lower than those in the traditional analgesia group,the difference was statistically significant (P＜0.05);the analgesic drug use rate in the new type analgesia group was lower than that in the traditional analgesia group (14.56％ vs.44.95％,P＜0.05),and the use rate of tramadol hydrochloride and pethidine hydrochloride was lower than that in the traditional analgesia group (P＜0.05).The incidence rate of adverse reactions in the new type analgesia group was lower (2.43％ vs.36.36％,P＜0.05).The incidence rate of nausea and vomiting in the new type analgesia group was lower than that in the traditional analgesia group (P＜0.05),and the incidence rate of other complications had no statistically signifiwas higher than that in the traditional analgesia group (P＜0.05);the average hospital stay and postoperative hospital stay had no statistical difference between the two groups (P＞0.05).Conclusion COX-2 inhibitors can effectively reduce perioperative pain degree in the patients with laparoscopic cholecystectomy,reduces the use frequency of analgesic drugs,shortens the hospital stay time and increases the patient satisfaction.cant difference (P＞0.05).The perioperative patient analgesia satisfaction the in the new type analgesia group

Influencing factors for aspirin resistance in women with ischemic stroke / 心血管康复医学杂志

Objective: To study influencing factors for aspirin resistance in women with ischemic stroke.Methods: A total of 150 women with ischemic stroke, who visited to our hospital from Jun 2013 to Jun 2015, were selected.According to presence of aspirin resistance, they were divided into aspirin resistance group (n=61) and aspirin sensitive group (n=89).All patients received aspirin enteric-coated tablets on morning, then arachidonic acid pathway platelet aggregation inhibition rate and glycosylated hemoglobin A1c (HbA1c) level were measured in two groups on 10 h after administration.According to HbA1c level, patients were divided into normal blood glucose group (n=83) and elevated blood glucose group (n=67), then aspirin resistance rate was compared between two groups.Logistic regression analysis was used to analyze influencing factors for aspirin resistance.Results: Compared with aspirin sensitive group, there was significant rise in body weight[(63.5±7.9) kg vs.(66.9±10.2) kg]in aspirin resistance group, P=0.041.Compared with normal blood glucose group, there was very significant rise in aspirin resistance rate (14.46% vs.73.13%) in elevated blood glucose group, P=0.008.Multi-factor Logistic regression analysis indicated that body mass index (BMI) and blood glucose level were independent risk factors for aspirin resistance (OR=4.012, 3.012, P=0.016, 0.018).Conclusion: Incidence rate of aspirin resistance is high in women with ischemic stroke.Blood glucose control and body weight status may affect incidence of aspirin resistance.

The effects of doctor-nurse integrated care management model on fast track perioperative management of colorectal cancer patients / 中国实用护理杂志

Objective To explore effects of doctor-nurse integrated care management model on fast track (FT) perioperative management of colorectal cancer patients.Methods Between January 2014 and September 2014,112 colorectal cancer patients (innovation group) underwent doctor-nurse integrated care and FT management in West China Hospital were analyzed retrospectively;who were compared with 96 patients (control group) underwent FT management from the same period of 2011.Early postoperative rehabilitation indicators,length of hospital stay,30d readmission rates,total hospitalization costs and patients satisfaction were compared.Results Innovation group of patients for the first time of post-operative flatus,defecation,oral feeding,ambulation,gastric and drainage tubes removal time were all earlier than those in control group,P ＜0.05,while the difference of urinary catheter tube removal time between the two groups was not statistically significant,P ＞ 0.05;the length of hospital stay in innovation group(6.05±2.05) d was significantly shorter than that in control group (7.85±3.22) d,P ＜ 0.05;preoperative hospital stay in innovation group was (1.35±0.45) d,shorter than that in control group (2.56±0.63)d,P ＜ 0.05;the patients satisfaction points in innovation group was (94.t2±3.12) points,which was higher than that in control group (86.36±5.51) points,t=2.589,P ＜0.05.Conclusion Doctor-nurse integrated care management model can improve postoperative rehabilitation effects,can reduce average hospital stay,total hospitalization costs and improve patients satisfaction.

Concurrent chemoradiotherapy comparison of taxanes and platinum versus 5-fluorouracil and platinum in nasopharyngeal carcinoma treatment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nasopharyngeal carcinoma (NPC) is a squamous-cell carcinoma especially prevailing among the natives of southern China. The regimen of concurrent chemoradiotherapy (CCRT) that include platinum and 5-fluorouracil (5-FU) is considered to be the standard treatment for NPC. However, its clinical use is limited by its toxicity. Our purpose was to evaluate the efficacy and safety of the regimen of CCRT with taxanes and platinum versus the regimen of CCRT with 5-FU and platinum in NPC treatment.</p><p><b>METHODS</b>Medline, the Cochrane library, and the Chinese medical literature database were searched for eligible studies. Meta-analysis was performed using Review Manager (Version 5.2).</p><p><b>RESULTS</b>Six random controlled trials (RCTs) including 514 patients met our criteria. Meta-analysis showed that the regimen of CCRT with taxanes and platinum had an improved significant difference in complete remission (CR) and less incidence rate in adverse reactions such as gastrointestinal impairment grades III-IV, liver and kidney impairment grades I-II, and radiodermatitis grades III-IV versus the conventional regimen of CCRT with 5-FU and platinum, while the longterm effectiveness rate of overall survival, locoregional failure-free survival, or distant metastasis failure-free survival between the two groups was therapeutic equivalence.</p><p><b>CONCLUSIONS</b>The regimen of CCRT with taxanes and platinum in NPC therapy may be more efficient and safe compared to the conventional modality of 5-FU and platinum in CCRT. However, we need more high-quality studies of multi-center and randomized double-blind clinical trials to further compare, analyze, and confirm the findings.</p>

Relationship between the erythrocyte CR1 genomic density polymorphism and erythrocyte immune function in children with asthma / 中国医师进修杂志

Objective To explore the hereditary susceptibility of children with asthma through studying the relationship between erythroeyte CR1 genomic density polymorphism and erythrocyte immune function. Methods The rates of RBC-C3_(3b)RR and RBC-ICRR were detected to the asthma group consisted of 65 children with asthma and the control group consisted of 28 normal children. The CR1 activity and genomic density polymorphism of erythrocyte from the two groups were detected by Hind Ⅲ restriction enzyme digestion, polymerase chain reaction restriction fragment length polymorphism. Results Frequencies of high expression gene (HH), mid expression gene (HL) and low expression gene (LL) genotypes were 43.08% (28/65), 36.92% (24/65) and 20.00% (13/65) in asthma group, and 78.57% (22/28), 17.86% (5/28) and 3.57%(1/28) in control group respectively. A significant difference was found in the distribution frequency of CR1 genotype between the two groups(P< 0.01).The rates of RBC-C_(3b)RR were significant lower and the rates of RBC-ICRR were significant higher in asthma group than those in control group (P < 0.01). The rates of RBC-C_(3b) RR in HH, HL and LL were decreased in order (P < 0.01),while the rates of RBC-ICRR in HH,HL and LL were increased in order (P < 0.01). Conclusion It suggests that CR1 gene polymorphism may play an important role in determining susceptibility to asthma.

康复与康复工程 / 中国康复理论与实践

@#本文就康复概念的“泛化”现象 ,提出了一些看法。对康复科学、康复系统工程及其对工程技术的需求 ,进行了分析探讨。结论 :康复工程的广义内涵是理清边界、拾遗补缺、设置接口、实现系统集成 ,利用现代工程技术的手段和方法促进残疾者的全面康复。

Analysis on Construction of Male Urine Collection Device / 中国康复理论与实践

@#Objective: Finding the essence and regular pattern of the construction of male urine collection devices, and setting up its basic concepts. Methods:Selecting typical construction examples, then analyzing them singly and as a whole. Results:Setting up concepts such as construction module, construction factor, construction factor unit, construction index, construction array etc., and giving out the table of construction factor units. Conclusion:This research has provided mode, methods, means for understanding and further analyzing, studying male urine collection devices.

中国残疾人用品用具工作现状 / 中国康复理论与实践

@#本文对当前我国残疾人用品用具总体工作的状况进行了扼要介绍和评述，包括政策与政府的主导作用、对用品用具的需求、产品开发生产与供应服务、专业人员教育与培训、国际交往与合作等。本文认为，残疾人用品用具作为一个行业在我国已初步形成，指出了该行业目前存在的几个问题。