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Objective:To evaluate the effect of medical compression elastic stockings or intermittent pneumatic pressure pumps on intraoperative hemodynamics in patients in the lithotomy position under general anesthesia.Methods:A total of 100 patients, aged 30-59 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective colorectal surgery or gynecological surgery in the lithotomy position under general anesthesia, with expected operation time>60 min, were divided into 2 groups ( n=50 each) using a random number table method: pressure pump group (group PP) and elastic stocking group (group ES). After entering the operating room (T 0), immediately after anesthesia induction (T 1), at 5 and 30 min of the lithotomy position (T 2, 3) and at the end of surgery (T 4), systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured, and the requirement for vasoactive agents was recorded. Results:Compared with the values at T 0, SBP was significantly decreased at T 1-3 in group PP and at T 1 in group ES ( P<0.05). Compared with group PP, SBP was significantly increased at T 2, 3 in group ES ( P<0.05), no significant change was found DBP and HR at each time point ( P>0.05), and the intraoperative consumption of ephedrine was reduced ([16±9]mg vs.[8±5]mg, P<0.05). Conclusion:Medical compression elastic stockings produces less interference in intraoperative hemodynamics in patients in the lithotomy position under general anesthesia, and its safety is better than intermittent pneumatic pressure pumps.
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Objective@#To assess the effectiveness of seasonal influenza vaccine among children aged 6 to 72 months.@*Methods@#The test-negative case control study was conducted based on available surveillance data which was from China Influenza Surveillance Information system (CSIS). From October 2016 to April 2017 and from October 2017 to April 2018,1 161 cases aged 6-72 months with influenza-like illness in Yongkang and Yiwu city, were selected as the study subjects, and the cases with influenza test-positive were selected as the case group (403 cases). Test-negative subjects were selected as control group (758 cases). The etiology and immunization data of the subjects were obtained from CSIS and Immune Information and Management System (IIMS) respectively. Vaccine effectiveness was estimated using multivariate logistic regression model,and the mixed effects of non-randomized control in TNCC study were equalized by using the propensity score (PS) method in the statistical analysis.@*Results@#The age of the subjects was (2.44±1.60) years,and there were 681 boys (58.66%). The age of case group was (2.62±1.58) years, and there were 246 boys (61.04%). The case group was including of 237 cases (58.81%) of influenza A (H3N2), 92 cases (22.83%) of influenza A (H1N1) pmd09, 62 cases (15.38%) of influenza B(Victoria) lineage, 11 cases (2.73%) of influenza B (Yamagata) lineage and one case (0.25%) co-infection of influenza [A(H3N2)+B (Victoria)]. The mean age of the control group was (2.35±1.61) years,and there were 435 boys (57.39%). Overall vaccine effectiveness (VE) against all type influenza for two seasons combined was 58% (95%CI: 31%-74%). An analysis by age groups showed 68% (95%CI:41%-82%) of the VE estimate among children aged 36-72 months while it was 28%(95%CI:-80%-71%)of the VE estimate among children aged 6-35 months. The VE estimate value was 54% (95%CI:16%-75%) against all type influenza and 65% (95%CI:24%-83%) against influenza A (H3N2) during the 2016-2017 season. During the 2017-2018 season, the VE estimate value was 69% (95%CI:18%-88%) against all type influenza.@*Conclusion@#Influenza vaccine is effective in preventing influenza virus infection during the flu season,especially the effect among children aged 36-72 months is higher compared to that among children aged 6-35 months.
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Objective @#To assess the risk of importation and local transmission of Ebola hemorrhagic fever（EHF）in Jinhua,and to provide reference for prevention policy making.@*Methods @#We collected the information of EHF cases,immigration data and EHF response capacity of Jinhua,then invited 18 experts from Jinhua Entry-Exit Inspection and Quarantine Bureau,Exit-Entry Administration Division of Public Security Bureau and Centers for Disease Control and Prevention in Jinhua. According to the risk assessment criteria recommended by World Health Organization,the risk of EHF importation and local transmission in Jinhua was assessed qualitatively by expert consultation,and the probability of local transmission after EHF importation was assessed quantitatively by compartment model.@*Results @#The results of expert consultation showed that the average scores of possibility and severity of EHF importation in Jinhua was 1.7 and 2.1,which was at low risk after substituted into the risk matrix. The risk of EHF importation in urban areas of Jinhua and Yiwu,where there were more African people,was higher than that in other counties or districts. The average scores of possibility and severity of local transmission was 1.9 and 3.1,which was at medium risk after substituted into the risk matrix. The results of compartment model analysis showed that the possibility of local transmission after the importation of EHF was related to the time interval between the onset of the epidemic and the effective isolation of the imported cases. When the interval was within 2 days,the risk of local transmission was low,but when it exceeded 4 days,the imported epidemic was easy to spread and lead to local transmission.@*Conclusion @#The EHF importation in Jinhua was at low risk;the local transmission caused by imported cases was at medium risk,but was less likely to cause large-scale transmission. Early identification of EHF cases was the key to reducing the risk of local transmission.
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Objective To detect and analyze enteroviruses causing suspected aseptic meningitis in a kindergarten in Jinhua City, Zhejiang Province. Methods Viral RNA was extracted from samples and cDNA was prepared by reverse transcription. PCR was performed to amplify the partial sequences of the 5′-untranslated region ( UTR) and VP1 gene of enteroviruses. Serotypes of the viruses were determined by com-paring the homology between the partial sequences of VP1 gene. Phylogenetic tree of the partial VP1 se-quences was constructed using MEGA6. Results This study included seven patients and twenty-six asymp-tomatic students. Coxsakievirus A10 (CV-A10) was detected in 48. 5％ of the students and echovirus 6 (Echo 6) in 21. 2％. Besides, 12. 1％ of the students might be co-infected by the two viruses. Among the seven patients, six were infected by CV-A10 and the other one might have co-infection. According to the phylogenetic analysis, CV-A10 strains detected in this study were closely related to those isolated in China in recent years, including the strains isolated in Xiamen in 2015 and Yunnan in 2017, while the Echo 6 strains were phylogenetically related to those isolated in Yunnan, Guangzhou and Shandong in 2014. Conclusions CV-A10 and Echo 6 were detected in the cases with suspected aseptic meningitis and had close phylogenetic relationships to the strains appeared in China in recent years.
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Objective To explore the effect of general anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation.Methods Totally 62 patients with gastric cancer who received laparoscopic radical operation were randomly and equally divided into combined group(n =31) and control group (n =31).Combined group and control group was given pure general anesthesia and general anesthesia combined with epidural block,respectively.The perioperative related indicators,hemodynamics and occurrence of POCD in both groups were compared.Results The dosage of propofol in combined group was significantly lower than that in control group (P ＜ 0.05).From T2 moment,the HR was significantly increased,and MAP was reduced in control group compared with T0 moment (P ＜ 0.05).The level of MAP in combined group was significantly higher than that in control group at T2-T4 moment(P ＜ 0.05).At 1 day after operation,MMSE score in control group was significantly reduced compared with before operation,and lower than combined group (P ＜ 0.05).The incidence of POCD in combined group was significantly lower than that in control group (P ＜ 0.05).Conclusion General anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation can reduce the dosage of anesthetic drug,maintain hemodynamic stability,and improve postoperative cognitive ability.
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Objective To observe the anesthesia and analgesia effect of ultrasound guided inter-scalene brachial plexus block (ISPSP)on upper extremity surgery.Methods Fifty-four patients (male 34 cases,female 20 cases,aged 37-73 years,ASA grade Ⅰ or Ⅱ)scheduled for elective upper limb surgery under ISPBP combined with general anesthesia were randomly assigned into two groups:magnesium sulfate group (group M,n =27)and control group (group N,n =27).0.5% ropivacaine 8ml (40 mg)+10% magnesium sulfate 2 ml (0.5 g)were used in group M ,0.5% ropivacaine 8 ml+ normal saline 2ml (40 mg)were used in group N.After the effects of ISBPB were confirmed,pa-tients were inserted laryngeal mask under intravenous induction.Anesthesia was maintained by inha-ling sevoflurane(MAC 0.8)during the operation.The onset time of sensory and motor block,duration of sensory and motor block,duration of analgesia,pain visual analogue digital score (VAS)4,8,12, 24 hours after operationand complications were recorded.Results Duration of sensory block and du-ration of analgesia of group M was significantly longer than those of group N (P <0.05).The patient`s VAS score of 8,12,24 hours after surgery in group M was significantly lower than that on group N (P <0.05).Onset time of sensory and motory block of both groups was similar.Conclusion 0.5%ropivacaine combined with magnesium sulfate in ultrasound-guided ISPBP can extend the duration of sensory block,reduce postoperative pain,as well as prolong analgesia time.
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Objective To compare the safety of dopamine ( DA) and norepinephrine ( NE) in hypovolemic shock , and the impact on the stability of blood pressure and haemodynamics .Methods Eighty two patients with hypovolemic shock were given fluid resuscitation . All the patients were divided into two groups including DA group (n=41) and NE group(n=41).Recovery of blood pressure, hemody-namic parameters were observed at different time point , and the complications and mortality of two groups were recorded .Results Blood pressure of all the patients returned to normal in 15min after the medication, and became stable after 30min.There was no significant difference in the blood pressure in both groups except that of 15min.Compared with T0, There were higher in the numerous of CVP , CI, ELWI, ITBI.The ELWL at T2 in DA group was higher than that of NE group , while there was no significant difference in the other time points between the two groups(P>0.05).After treatment for 24 h, blood oxygen saturation, urine volume in two groups were significantly increased, blood lactic acid markedly reduced , but lactic acid in NE group was obviously lower than that in DA group (P0.05).Conclusion The effect of NE and DA in maintaining the stability of blood pressure and hemodynamic are equivalent , and NE did not increase the risk of acute kidney injury , but can effectively improve tissue perfusion , reduce arrhythmia and case fatality rate , improve clinical outcomes .
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Objective To investigate the clinical efficacy and safety of recombinant tissue type plasminogen activator(rr-PA) and urokinase(UK) in the treatment of acute myocardial infarction (AMI).Methods According to the digital table,128 patients with AMI were randomly divided into two groups,64 cases in each group.The control group adopted UK intravenous thrombolytic therapy,while the observation group adopted rr-PA intravenous thrombolytic therapy.The recanalization condition at different time after thrombolytic therapy,the incidence rate of cardiovascular events and death rate were compared between the two groups.Results The recanalization rate at 30min,60min and 120min after thrombolysis of the observation group were 29.69 ％,59.38 ％ and 93.75 ％,respectively,which were significantly higher than 14.06％,35.94％ and 68.75％ of the control group(x2 =6.34,7.01,7.45,all P ＜ 0.05) ;The incidence rate of cardiovascular events and mortality rate of the observation group after thrombolytic therapy were 17.19％ and 4.64％,respectively,which were significantly lower than 40.63％ and 12.50％ of the control group (x2 =7.83,7.62,all P ＜ 0.05).Conclusion Recombinant tissue type plasminogen activator intravenous thrombolytic therapy has significant effect in the treatment of acute myocardial infarction after thrombolysis,which can reduce the incidence of cardiovascular events and mortality,with good clinical application value.
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BACKGROUND:Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities OBJECTIVE:To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities. METHODS:Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were folowed up for more than 20 months were enroled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted. RESULTS AND CONCLUSION: Al patients were folowed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.
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The majority of patients with malignant tumors have hypercoagulable state,which easily leads to thrombosis,and is closely related with recurrence of tumor metastasis.The formation mechanism of hypercoagulable state is related to tumor,tumor treatment,complications etc.The main diagnostic indicators are the platelet,cruor and fibrinolysis,P-selectin and lysosomal protein,blood rheology.Tumor patients with the high risk of thrombus should use low molecular weight heparin.Thromboembolism should be prevented in bedridden patients with tumor and tumor associated operation.Tumor patients with venous thromboembolism should be given thrombolytic treatment.Tumor patients with hypercoagulable state should be treated by antico-agulant therapy combined with chemotherapy.
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Comprehensive therapy is widely received for esophageal carcinoma in our country and worldwide. The treatment approaches consist of sugery,radiotherapy and chemotherapy,and chemoradiation therapy is very important. Many randomized controlled studies and meta-analysis reveal that preoperative neoad-juvant chemoradiotherapy and radical concurrent chemoradiation are the preferred modalities for local advanced esophageal carcinoma.
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Objective To evaluate the immune effects of bivalent inactivated rotavirus vaccine (IRV) and investigate the viability of development of bivalent IRV.Methods Firstly,bivalent IRV was prepared by mixing G1 IRV and G3 IRV with equal amount,G1 IRV and G3 IRV as monovalent control,PBS as negative control.Secondly,those vaccines were vaccinated to the mice by intramuscular injection.Then,to evaluate the immune effects of bivalent IRV,the levels of serum or fecal rotavirus specific IgG and IgA were assessed by ELISA,the levels of serum neutralized antibody were measured by microneutralization assay,the number of IFN-γ or IL-4 secreting cells were analyzed by ELISPOT assay.Results Compared to negative control group,bivalent IRV induced the higher levels of serum and fecal G1 and G3 rotavirus specific antibody.It was found that there were no significant differences for the levels of serum IgG and IgA,fecal IgG and IgA,serum neutralized antibody between induced by bivalent IRV and induced by G1 type monovalent vaccines ; but there were significantly increase for the levels of serum IgG (t =2.691,P＜0.05) and serum neutralized antibody (t =2.561,P＜0.05) between induced by bivalent IRV and induced by G3 monovalent vaccines,there were no significant differences for other antibodies between induced by bivalent IRV and induced by G3 monovalent vaccines.At the same time,compared to negative control group,bivalent IRV induced significantly increase in the number of IFN-γ or IL-4 secreting cells in spleen lymphocytes.It was found that there were no significant differences for the number of IFN-γ or IL-4 secreting cells stimulated by G1 rotavirus between bivalent IRV and G1 monovalent vaccines; but there were significantly increase for the number of IL-4 secreting cells (t =2.327,P＜0.05) stimulated by G3 rotavirus between bivalent IRV and G3 monovalent vaccines,there were no significant differences for the number of IFN-γ secreting cells stimulated by G3 rotavirus between bivalent IRV and G3 type monovalent vaccines.Conclusion The bivalent IRV can induce effective immune response,in which there were no inhibitory interference between the components of bivalent IRV,which provided the experimental basis for the development of bivalent IRV.
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Objective To investigate the effects of epidural administration of a mixture of betamethasone and lidocaine on nerve root inflammation and epidural space adhesion in rabbits. Methods Twenty-four adult male New Zealand white rabbits weighing 2.0-2.1 kg, were randomly divided into 2 groups ( n = 12 each): control group and treatment group. A catheter was inserted into epidural space at L2,3 interspace. Twenty-four hour after epidural catheter placement, talcum powder 0.5 mg/kg was injected into epidural space to make the model of nerve root inflammation and epidural space adhesion. Three days later a mixture of lidocaine 2.5 mg/kg and betamethasone 0.25 mg/kg was injected via the epidural catheter in treatment group, while the equal volume of normal saline was given in control group. At 21 days after administration of lidocaine and betamethasone, the spinal cord was removed, and dura mater and nerve root were checked with naked eye, light microscope and electron microscope.The neutrophil count in the dura mater was determined. Results There was nerve root inflammation and epidural space adhesion in control group. The nerve root inflammation and epidural space adhesion was not observed in treatment group. The neutrophil count was reduced in treatment group (21 ± 12) compared with control group (250 ±43) ( P < 0.01) . Conclusion Epidural administration of a mixture of betamethasone and lidocaine can alleviate nerve root inflammation and epidural space adhesion.
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Objective To investigate the classification and its application in one-stage repair of massive posttraumatic bone defects which are infection-induced and refractory in lower extremities. Methods From March 2002 to December 2008, we treated 42 patients with massive posttraumatic refractory infection-induced bone defects in lower extremities. We classified the defects into 3 types: simple massive infection-induced bone defects (type Ⅰ), massive infection-induced bone and soft-tissue defects (type Ⅱ) and massive infection-induced bone defects plus limb shortening (type Ⅲ). After thorough debridement, various types of vascularized fibular grafts were used to repair the 3 kinds of defects accordingly. Simple fibular grafts were used in 6 cases, transplantation with fibular and skin flaps was used in 31 cases, fibular grafts combined with anterior lateral thigh flap in 4 cases, and one-stage limb lengthening and fibular graft in one. Results The follow-ups of 6 to 41 (average, 26. 3) months revealed that the refractory bone defects were repaired successfully in 38 cases, amputation due to necrosis of fibular grafts in 2 cases and uncontrolled infection in 2 cases. In the 38 cases, infections were controlled effectively, circulation of the traumatic limbs was good,contour and function were restored satisfactorily, and no obvious complication was found in donor limbs. By Johner-Wruhs evaluation, 17 cases were excellent, 18 cases good, 3 cases fair and 4 cases poor, with a total excellent and good rate of 83.33%. Conclusions Refractory and massive posttraumatic infection-induced bone defects in lower extremities can be classified into 3 types. They can be repaired using various types of vascularized fibular grafts according to the defect types at one-stage.
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Objective To analyze causes for postoperative coxa vara and anti-rotation nail cutting-out after treatment of brittle femoral intertrochanteric fractures with proximal femoral nails ( PFN ).Methods An retrospective study was done on 227 patients with intertrochanteric fracture treated with PFN from June 2006 to February 2009. The causes for postoperative coxa vara and anti-rotation nail cutting-out were analyzed. Harris score was used to evaluate the functional recovery of the hip joint. Results Of all, 221 patients were followed up for 12-48 months (mean 23 months) and six patients were died from serious internal disease within one year. According to Harris evaluation system, the results were excellent and good in 183 patients, fair in 30 and poor in 14. Postoperative coxa vara and anti-rotation nail cuttingout occurred in 16 patients, eight of whom received reoperation to remove internal fixation and skeletal traction at abducent position and the other eight received prosthetic replacement. Conclusions Treatment of proximal femoral fracture with PFN requires a high precision of reduction and operation. Many factors including lateral cortical bone conditions of tuberosity, postoperative patient's cognitive condition,use of improved Jensen-Evans classification and Singh's classification may affect operation outcome.
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Objective To evaluate the treatment results and side-reactions of esophageal carcinoma with late course hyperfractionated radiotherapy ( LCHR) plus different chemotherapy. Methods A prospective research was carried out on 287 advanced stage esophageal carcinoma patients whom were randomized into there groups;LCHR + cisplatin +5-fluorouracil +leucovorin group( A group), LCHR +5-fluorouracil polyphase lipo- some group (B group) and LCHR group(C group). 115 patients were in A group and 107 patients in B group and 65 patients in C group. Radiotherapy method; there groups were treated by conventional fractionated radio- therapy during the first two-thirds of the whole course with 40 Cy,then followed by isocenter hyperfractionated radiotherapy to keep away of spinal marrow, 1. 3-1. 5Gy per time,2 times a day and 5 days a week. The total dose was 60-66 Gy in A, B group and 60-70 Gy in C group. The preventive dose was 50 Gy. Results There was no statistically difference among the there groups on the short-term curative effect The 1- ,2- ,3-year local control rate was 80% ,50.4% ,42.6% and 72.9% ,51.4% ,41. 1% and 63.1% ,38.5% ,30.8%
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The central corneal thickness (CCT) in age 48 years or less of Chinese was characterized and its relationship with gender, age, refraction and intraocular pressure (IOP) was investigated.Right eyes of 1669 participants were included in this study (880 men, 52.7 % and 789 women,47.3 %). Mean age of the samples was 23.8±5.9 years. After the examination of corneal topography and refraction, Goldman applanation tonometry was carried out by one physician. Tonometric values were the mean of three consecutive readings. Subsequently, another physician carried out ultrasonic pachymetry with the DGH 2000 AP ultrasonic pachymeter. Six measuremen ts were made at the center of the cornea of each eye. The mean value was used for analysis. The results showed that mean CCT of male participants was 551.33± 34. 62 μm, 5.79 μm more than that of female participants. Linear regression analyses revealed that CCT was negatively related with age only in female and no association was found between refractive status and CCT. IOP was positively related to CCT, and there was a difference in IOP of 1.5 mmHg (1 mmHg=0. 133 kPa) per 100 μm difference in CCT. Ocular hypertension group was prone to have thicker cornea than average. The results indicated that in adult Chinese CCT tended to decrease with aging in female only. IOP measured by Goldmann tonometry was positively related with CCT so that CCT should be measured along with IOP.
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Objective To discuss a new effective method for treatment of chronic subdural hematoma in elderly patients. Methods Flush operation for elderly patients with chronic subdural hematoma(CSDH) by neuroendoscopy through burrhole approach were performed in 37 elderly patients. The mean age of the group was 68.5 years (60-86 years). 5 cases were recurrent after simple drainage. Thoroughly flushs the hematoma cavity under television monitor, removes the clot, coagulates the bleeding focus, break the septum of hematoma cavity to make it communicate with the normal subdural space. Results On following up 2-18 months, all the hematoma disappeared, 34 cases improved in clinic manifestation, no serious complications and death occurred. Conclusions Flush operation for elderly patients with chronic subdural hematoma by flexible neuroendoscopy through burrhole approach can improve the therapeutic effect and avoid the recurrence and the complilcations of the traditional drainage therapy.
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Objective:To compare the immunizing efficiency in mice with recombinant adenovirus inoculated by intranasal, intramuscular or oral routes.Methods:BALB/c mice were immunized with 108 PFU recombinant adenovirus expressing rotavirus VP4 antigen intranasally, intramuscularly or orally.The mice were boosted twice with the same dose by the same route. Serum, stool and intestine specimens were collected to detect rotavirus VP4 specific antibodies by ELISA. Mice were mock treated with adenoviral vector and PBS as the blank control.Results:Inoculation with the recombinant adenovirus by these 3 routes elicted rotavirus VP4 specific serum and intestinal antibodies(P
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Objective:To investigate the expression of multidrug resistance (MDR1) gene and multidrug resistance-associated pro-tein (MRP) gene in patients with non-small-cell lung cancer (NSCLC) and its relation to histopathological type. Methods:The MDRi and MRP genes were determined by reverse transcription-polymerase chain reaction (RT-PCR) in 48 NSCLCspecimens. Results:The positive rates of the MDR1 and MRP gene expression were 62.5％ and 66.7％ respectively in the48 patients. Twenty-one of the 48 NSCLCs (43.8％) expressed both MDR1 and MRP genes. The positive rates of the MRPgene expression in squamous cell carcinoma was significantly higher than those in adenocarcinoma (P＜0.01), and therewas no significant difference in MDR1 gene expression between the two groups (P＞0.05). Conclusion: The MDR1 andMRP gene expressions were both or respectively in the NSCLCs. The incidence of the MRP gene expression in squamous cellcarcinoma was higher than that in adenocarcinoma.