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Arterial cannulation can be used to monitor blood pressure in real time and facilitate frequent arterial blood gas analysis.It is one of the commonly used clinical techniques in anesthesia,emergency,and intensive care units.Studies have demonstrated that ultrasound guidance can increase the success rate of arterial cannulation and reduce the incidence of related complications.In recent years,ultrasound guidance technology has developed rapidly and is increasingly used in clinical practice.This article reviews the latest advances in the application of ultrasound guidance in radial artery cannulation.
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Blood Pressure , Catheterization, Peripheral/methods , Radial Artery/diagnostic imaging , Ultrasonography , Ultrasonography, Interventional/methodsABSTRACT
To identify the possible factors that may influence the success and the complications of ultrasound-guided out-of-plane radial arterial cannulation. Multivariate Logistic regression analysis was used to analyze the clinical data of 131 patients undergoing elective surgery and ultrasound-guided out-of-plane radial artery cannulation,dynamic needle tip positioning(DNTP) technique or angular distance(AD) technique and to find out the factors associated with the one-attempt success rate,overall success rate,posterior arterial wall perforation,and local hematoma. The depth of the anterior arterial wall≥3 mm was the factor associated with posterior arterial wall perforation(=0.314,95%:0.143-0.691,=0.004) and local hematoma(=0.250,95%:0.107-0.585,=0.001).The use of DNTP method was significantly associated with posterior arterial wall perforation(=0.303,95%:0.138-0.667,=0.003). During ultrasound-guided out-of-plane radial cannulation,puncture at the arterial anterior wall sites with a depth of≥3 mm can reduce the incidence of posterior arterial wall perforation and local hematoma.Compared with AD,DNTP can lower the incidence of posterior arterial wall perforation.
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Objective To study the effect of electronic daily assessment on the application of standardized training for residents of anesthesiology department. Methods Compared the feedback rate of the previous paper evaluation form and the electronic daily evaluation submission,and summarized the results of the daily evaluation of residents of different grades and different sources through the electronic system. Results The feedback rate of the paper form and the electronic for was 59.5% and 96.7% separately. Comparing the scores of different grads, the total score and sub option scores gradually increased from grade one to grade three. The lowest score of sub options in all grades were anesthetic plan/crisis management scores. The worst overall rating(performance worse than expected)happened in the second-year residents. The best overall rating(performance better than expected) happened in the third-year resident. The residents form other hospitals had higher scores than PUMCH(Peking Union Medical Col-lege Hospital)'s residents and graduate students except for the score of theoretical knowledge. The PUMCH's resi-dents got lower score in overall rating.The teaching staff rescheduled and modified the training program according to the educational defect,so as to individualize resident training. Conclusions The daily electronic assessment helps to monitor daily performance of residents in a timely and comprehensive manner, so to adjust teaching methods, and contributes to conduct formative evaluation,which has a positive impact on improving teaching effectiveness.
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Objective To investigate the need, methods and effects training on perioperative point-of-care tran-sthoracic echocardiography (POC-TTE) in anesthesiologists.Methods In 2013, forty anesthetic attendings of Pecking Union Medical College Hospital (PUMCH) had two rounds of transthoracic echocardiography(TTE) training. In the following year, six anesthetic attendings from PUMCH experienced in intraoperative transesopha-geal (TEE) were trained by cardiologists as TTE instructors. In 2015, we conducted a survey about basic TTE education prevalence and need. Based on the results of the survey, POC-TTE workshops were hosted from 2015 to 2017. The didactic lecture, simulation practice, as well as hypotension differential diagnosis were included in those workshops. Different teaching methods were tested for their effectiveness. Results A total of 95 surveys were collected. Fifteen (15.8%) participants reported their hospital had the resources for perioperative POC-TTE exams; fourteen(14.7%)reported basic knowledge about ultrasound or other images techniques. Eighty (84.2%) acknowledged a lack of understanding about perioperative TTE. Four rounds of POC-TTE work-shops were hosted by the anesthesia department of PUMCH and a total of 83 trainees participated. Sixty three participants finished all training and testing sessions. Forty eight percent of the participants voiced the need for more hand-practice opportunities, 39% suggested that training covering more basic ultrasound knowledge, 22.5% suggested more frequent training and testing. Conclusions These training methods may increas the prevalence and acceptance of perioperative POC-TTE application. It's learning outcome has positive impact on patients' prognosis.
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Standardized patients (SPs) are trained to portray a specific patient in a consistent, standardized fash-ion. SPs are widely used in many medical schools,and its efficacy for education and evaluation in the medical com-munity has been well established. Preoperative evaluation by anesthesiologist is a critical aspect of patient safety. But there are several defects in the current anesthesia education of preoperative evaluation and management. The residents are not provided with enough skills that are needed in the clinical practice and this sbortage may be com-pansated by SPs simulation. As a supplement of traditional teaching methods,SPs may improve the efficiency in the teaching of preoperative evaluation and enhance the competence of anesthesia residents.
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ObjectiveTo study the effect of IL-6 on the development of zygotes of mice after controlled ovarian hyperstimulation. Methods The present experiment included three parts: a) Addition of IL-6: 80 female ICR mice were divided into 7 groups by random number table including 6 groups of superovulation (10 each) and a group of natural ovulation cycle (n=20). According to addition of IL-6 in different concentration to culture media, the superovulated ICR mice were divided into superovulation control group (0pg/ml IL-6 group), 1pg/ml IL-6 group, 5pg/ml IL-6 group, 10pg/ml IL-6 group, 25pg/ml IL-6 group, and 50pg/ml IL-6 group, with ICR mice in natural ovulation cycle served as control. b) Addition of IL-6 receptor antibody (RA): 90 female ICR mice were divided into 7 groups according to the random number table, including 5 groups of superovulation (10 each) on the basis of addition of different concentrations IL-6 and IL-6 RA to culture media (0pg/ml IL-6+RA groups, 1pg/ml IL-6+RA group, 5pg/ml IL-6+RA group, 10pg/ml IL-6+RA group, 25pg/ml IL-6+RA group), and 2 groups of normal natural cycle (20 each), including control group and the control group+IL-6 RA (100pg/ml) group. Mice in normal control group conceived naturally while those in superovulation group conceived after superovulation. The zygotes were collected and cultured in vitro for 1 day till the formation of 2-cell embryos, then the rate of 2-cell formation was observed under microscope. Experiments of each group were repeated three times. c) Immunofluorescence identification: 10 female ICR mice were divided into control group and superovulation group (5 each) by random number table method. The expressions of IL-6 in zygotes were determined with confocal immunofluorescence method. Results IL-6 addition experiment: the rate of 2-cell formation was significantly lower (P<0.05) in superovulated control group, 1pg/ml IL-6, 25pg/ml IL-6 and 50pg/ml IL-6 groups than in control group (P=0.023, P=0.026, P=0.000 and P=0.000, respectively). IL-6 receptor antibody (RA) addition experiment: compared with normal control group, the rate of 2-cell formation decreased in superovulation group (P=0.017), so did in other IL-6 RA groups (P=0.000). Immunofluorescence identification: the expression of IL-6 in zygote was obviously lower in superovulation group than in control group. Conclusion Controlled superovulation can reduce the expression of IL-6 in zygote, and it may be related to its effect on embryonic development of mice.
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<p><b>OBJECTIVE</b>To identify the incidence and risk factors of perioperative major adverse cardiac events (MACE) in elderly patients with coronary heart disease (CHD) undergoing non-cardiac surgery.</p><p><b>METHODS</b>We prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010. The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established.</p><p><b>RESULTS</b>Perioperative MACE occurred in 11.94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months (P=0.001), hypertension(P=0.014), preoperative haematocrit (HCT) <40% (P=0.050), serum creatinine (Scr)>150 mmol/L (P=0.014), ejection fraction(EF) <50% (P=0.019), intraoperative hyoxemia (P=0.019), and operative time>150 min (P=0.001). The risk indexes of these factors were 4,3,3,6,4,5, and 4, respectively. The rate of perioperative MACE increased significantly as the level of risk stratification elevated.</p><p><b>CONCLUSIONS</b>Elderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension, preoperative HCT<40%, Scr>150 mmol/L, EF<50%, intraoperative hyoxemia, and operative time>150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.</p>
Subject(s)
Aged , Humans , China , Coronary Disease , Elective Surgical Procedures , Electrocardiography , Incidence , Logistic Models , Perioperative Care , Risk FactorsABSTRACT
Previous studies have demonstrated a strong association between carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and HLA-B*1502 in Han Chinese. Here, we extended the study of HLA-B*1502 susceptibility to two different antiepileptic drugs, oxcarbazepine (OXC) and phenobarbital (PB). In addition, we genotyped HLA-B*1511 in a case of CBZ-induced SJS with genotype negative for HLA-B*1502. The presence of HLA-B*1502 was determined using polymerase chain reaction with sequence-specific primers (PCR-SSP). Moreover, we genotyped HLA-B*1502 in 17 cases of antiepileptic drugs (AEDs)-induced cutaneous adverse drug reactions (cADRs), in comparison with AEDs-tolerant (n=32) and normal controls (n=38) in the central region of China. The data showed that HLA-B*1502 was positive in 5 of 6 cases of AEDs-induced SJS (4 CBZ, 1 OXC and 1 PB), which was significantly more frequent than AEDs-tolerant (2/32, 18 CBZ, 6 PB and 8 OXC) and normal controls (3/38). Compared with AEDs-tolerant and normal controls, the OR for patients carrying the HLA-B*1502 with AEDs-induced SJS was 6.25 (95% CI: 1.06-36.74) and 4.86 (95% CI: 1.01-23.47). The sensitivity and specificity of HLA-B*1502 for prediction of AEDs-induced SJS were 71.4%. The sensitivity and specificity of HLA-B*1502 for prediction of CBZ-induced SJS were 60% and 94%. HLA-B*1502 was not found in 11 children with maculopapular exanthema (MPE) (n=9) and hypersensitivity syndrome (HSS) (n=2). However, we also found one case of CBZ-induced SJS who was negative for HLA-B*1502 but carried HLA-B*1511. It was suggested that the association between the CBZ-induced SJS and HLA-B*1502 allele in Han Chinese children can extend to other aromatic AEDs including OXC and PB related SJS. HLA-B*1511 may be a risk factor for some patients with CBZ-induced SJS negative for HLA-B*1502.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Alleles , Anticonvulsants , Asian People , Genetics , Carbamazepine , China , Genetic Predisposition to Disease , Ethnology , Genetics , Genotype , HLA-B15 Antigen , Genetics , Phenobarbital , Polymerase Chain Reaction , Stevens-Johnson Syndrome , Ethnology , GeneticsABSTRACT
Previous studies have demonstrated a strong association between carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and HLA-B*1502 in Han Chinese. Here, we extended the study of HLA-B*1502 susceptibility to two different antiepileptic drugs, oxcarbazepine (OXC) and phenobabital (PB). In addition, we genotyped HLA-B*1511 in a case of CBZ-induced SJS with genotype negative for HLA-B*1502. The presence of HLA-B*1502 was determined using polymerase chain reaction with sequence-specific primers (PCR-SSP). Moreover, we genotyped HLA-B*1502 in 17 cases of antiepileptic drugs (AEDs)-induced cutaneous adverse drug reactions (cADRs), in comparison with AEDs-tolerant (n=32) and normal controls (n=38) in the central region of China. The data showed that HLA-B*1502 was positive in 5 of 6 cases of AEDs-induced SJS (4 CBZ, 1 OXC and 1 PB), which was significantly more frequent than AEDs-tolerant (2/32, 18 CBZ, 6 PB and 8 OXC) and normal controls (3/38). Compared with AEDs-tolerant and normal controls, the OR for patients carrying the HLA-B*1502 with AEDs-induced SJS was 6.25 (95% CI: 1.06-36.74) and 4.86 (95% CI: 1.01-23.47). The sensitivity and specificity of HLA-B*1502 for prediction of AEDs-induced SJS were 71.4%. The sensitivity and specificity of HLA-B*1502 for prediction of CBZ-induced SJS were 60% and 94%. HLA-B*1502 was not found in 11 children with maculopapular exanthema (MPE) (n=9) and hypersensitivity syndrome (HSS) (n=2). However, we also found one case of CBZ-induced SJS who was negative for HLA-B*1502 but carried HLA-B*1511. It was suggested that the association between the CBZ-induced SJS and HLA-B*1502 allele in Han Chinese children can extend to other aromatic AEDs including OXC and PB related SJS. HLA-B*1511 may be a risk factor for some patients with CBZ-induced SJS negative for HLA-B*1502.
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<p><b>BACKGROUND</b>Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system.</p><p><b>METHODS</b>This retrospective observational clinical study included 482 patients aged ≥60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis.</p><p><b>RESULTS</b>Perioperative MACE occurred in 61(12.66%) of the study patients. Five independent risk factors for perioperative MACE were identified: history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure ≤75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710±0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk.</p><p><b>CONCLUSIONS</b>Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Disease , Elective Surgical Procedures , Postoperative Complications , Retrospective Studies , Risk AssessmentABSTRACT
<p><b>OBJECTIVE</b>To evaluate the effects of methylene blue (MB) on refractory hemorrhagic shock.</p><p><b>METHODS</b>Totally 24 rabbits subjected to prolonged hemorrhagic shock and resuscitation were randomly divided into hemorrhagic shock group (12 rabbits) and MB group (12 rabbits; MB was administered immediately after resuscitation was performed). The plasma levels of tumor necrosis factor alpha (TNFalpha) , interleukin (IL)-6, IL-8, nitric oxide (NO), lactic acid (LA) , and mean arterial pressure (MAP) were detected before shock, immediately after resuscitation, and 0.5, 2, and 4 hours after resuscitation. The 12-hour survival rates were observed.</p><p><b>RESULTS</b>The plasma levels of TNFalpha, IL-6, IL-8, NO and LA after shock were significantly higher than before shock (P <0.01), and maintained at high levels. Compared with the shock group, higher MAP and lower plasma levels of TNFalpha, IL-6, IL-8, NO, and LA were observed in the MB group after resuscitation (P<0.01). The 12-hour survival rates were not significantly different between shock group and MB group.</p><p><b>CONCLUSION</b>Although MB can not improve the prognosis of refractory hemorrhagic shock, it can increase and maintain the MAP and thus play a beneficial role in the treatment of hemorrhagic shock.</p>
Subject(s)
Animals , Female , Male , Rabbits , Blood Pressure , Disease Models, Animal , Interleukin-6 , Blood , Interleukin-8 , Blood , Lactic Acid , Blood , Methylene Blue , Therapeutic Uses , Nitric Oxide , Blood , Random Allocation , Shock, Hemorrhagic , Blood , Drug Therapy , Mortality , Survival Rate , Tumor Necrosis Factor-alpha , BloodABSTRACT
<p><b>OBJECTIVE</b>To investigate the changes in the expressions of Bcl-2 protein and C-myc protein in the spermatogenic cells of rats after exposure to high power microwave (HPM) and to elucidate the possible mechanisms underlying the apoptosis induced by HPM at the genetic translation level.</p><p><b>METHODS</b>One hundred and twenty-five healthy male SD rats were divided randomly into unexposed control and experimental groups. The latter were radiated with S wave band 10 W/cm2, 20 W/cm2 HPM for 5 min and 10 min. Testicular samples were taken 6 h, 24 h, 48 h, 72 h and 120 h after radiation and studied respectively. Five blank radiation groups served as controls. Then immunohistochemical SP staining was performed to test the expressions of Bcl-2 protein and C-myc protein in the spermatogenic cells in the rats.</p><p><b>RESULTS</b>The expression of Bcl-2 protein in the 24 h group was up-regulated after radiated for 5 minutes and 10 minutes by HPM, higher in the 20 mW/cm2 group than in the 10 mW/cm2 group (P < 0.01). There was no expression of C-myc/Bcl-2 protein in the control group.</p><p><b>CONCLUSION</b>Exposure to HPM for 24 h can up-regulate the expressions of C-myc protein and Bcl-2 protein in the spermatogenic cells of rats, which might be one of the mechanisms of the apoptosis induced by HPM.</p>
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Animals , Male , Rats , Apoptosis , Radiation Effects , Microwaves , Proto-Oncogene Proteins c-bcl-2 , Proto-Oncogene Proteins c-myc , Random Allocation , Rats, Sprague-Dawley , Spermatozoa , Metabolism , Testis , Cell Biology , Metabolism , Radiation EffectsABSTRACT
<p><b>OBJECTIVE</b>The aims of the present study were to assess the characteristics of MSCs which were induced and proliferated in vitro, then to learn the interfaces between them and metal materials.</p><p><b>METHODS</b>Adult dogs were selected as experimental animals, the MSCs (marrow stem cells) were aspirated from the femur, which were induced to the phenotype of OB (osteoblast), then to proliferated in vitro with metal materials. Using biochemical tests, phase contrast microscopy, transmit electromicroscope, scanning electromicroscope to detect MSCs and the image of interface.</p><p><b>RESULTS</b>MSCs had powerful osteogenic phenotype when they were induced in vitro, and they also attached to the metal materials. And there were more cells which attached on tensile stress area than other areas.</p><p><b>CONCLUSION</b>The MSCs induced in vitro could be used as source of osteoblast. The affects of air--abrasion with alumina are not significant, but they have relation to the extent of strain and property of stress.</p>