ABSTRACT
Objective:To investigate the safety and efficacy of remimazolam combined with afentanyl for fiberoptic bronchoscopy.Methods:Sixty patients admitted to Chifeng Hospital for fiberbronchoscopy from January to April 2022 were selected and divided into two groups by random number table method: remimazolam group (group R) and propofol group (group P), 30cases in each group. After intravenous injection of alfentanil for anesthesia induction, group R was sedated by intravenous injection of remidazolam besylate, and group P was sedated by intravenous injection of propofol emulsion. When sufficient sedation was achieved, fiberoptic bronchoscopy was performed. The patients were scored with the Mini-Mental State Examination (MMSE) before examination and before leaving the room. The recovery rate of sedation and the recovery rate of drugs during operation were compared. Blood pressure, heart rate (HR), bispectral index (BIS), SpO 2 value and Modified Observer′s Assessment of Alertness/Sedation (MOAA/S) score were compared before induction (T 0), at the beginning of examination (T 1), immediately when fiber bronchoscope reached juga (T 2), at the end of surgery (T 3), immediately, when patients regained consciousness (T 4). Drug onset and recovery time (time out of hospital) as well as the incidence of intraoperative and postoperative adverse reactions were recorded in both groups. Results:There was no statistically significant difference in general condition, MMSE score and examination time between the two groups (all P>0.05). There was no statistically significant difference between the two groups in the success rate of sedation and the number of sedative remedy times (all P>0.05). The number of additional drugs in group R was significantly higher than that in group P ( P<0.05). The systolic blood pressure, diastolic blood pressure and BIS values of patients in group P at T 1 and T 2 were significantly lower than those in group R (all P<0.05). After administration, the MOAA/S score of the two groups began to decrease, and the decrease of the P group was significantly greater than that of the R group, and the MOAA/S value of the patients was the lowest at the 3rd and 4th minutes after administration, respectively. The time from the beginning of administration to the MOAA/S score ≤3 in group P was significantly shorter than that in group R (all P<0.05). The incidence of pain and respiratory depression after injection in group P was significantly higher than that in group R ( P<0.05). Conclusions:The application of afentanil combined with remimazolam in the patients undergoing fiberoptic bronchoscopy has good sedative effect and high anesthesia quality, and has no obvious effect on cognitive function and few adverse reactions, so it is safe and effective.
ABSTRACT
It's the duty of contemporary teachers to cultivate students' independent learning, independent thinking, and self-management ability. This paper reviews the significance of independent learning for cultivating medical students with forward-looking learning ability and cutting-edge medical knowledge. It focuses on the strategies and ideas of cultivating medical students' independent learning ability from the aspects of strategy and evaluation, and tries to provide inspiration and reference for the application of independent learning teaching method in the cultivation of medical students.
ABSTRACT
Objective:To investigate the effect of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery, and provide guidance for postoperative micturition of these patients.Methods:From August 2020 to August 2021, 208 patients admitted to Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University, undergoing craniocerebral surgery under general anesthesia and indurating catheter were selected as the study subjects by convenient sampling. They were divided into control group ( n=69), observation group A ( n=69) and observation group B( n=70) by random number table method. The control group received routine catheter clipping training and routine ureteral catheter removal, the observation group A received optimized catheter clipping training and routine ureteral catheter removal, and the observation group B received optimized catheter clipping training and automatic balloon retraction ureteral catheter removal. The first micturition time, first micturition volume, micturition circumstance, pain score and urethral irritation sign of the three groups were observed and compared. Results:The first urination time in observation group A and B were (11.58 ± 6.59) min and (10.06 ± 5.91) min, respectively, lower than (37.14 ± 13.74) min in control group, and the difference was statistically significant ( t=13.94, 15.07, both P<0.05); there was no significant difference between observation group B and observation group A ( P>0.05). The first urine volume were (303.66 ± 43.74) ml in control group, (299.06 ± 41.26) ml in observation group A and (299.28 ± 43.17) ml in observation group B, and the difference was not statistically significant ( P>0.05). The incidence of urination (spontaneous urination, induced urination and urinary retention) in observation group A was better than control group ( χ2=16.47), while observation group B was better than observation group A and control group ( χ2=8.59, 37.83), the differences were statistically significant (all P<0.05). There was no significant difference in pain score of ureteral catheter removal between observation group A (2.71 ± 0.67) and control group (2.87 ± 0.78) ( P>0.05). The score of observation group B (1.41 ± 0.65) was lower than that of control group and observation group A, the differences were statistically significant ( t=11.93, 11.62, both P<0.05). There was no significant difference of the incidence of urethral irritation (grade 0, 1, 2, and 3) between observation group A and control group ( P>0.05). Observation group B was lower than control group and observation group A, the differences were statistically significant ( t=38.81, 25.27, both P<0.05). Conclusions:Optimized catheter clipping training and automatic balloon retraction ureteral catheter removal can effectively shorten the first urination time of patients after neurosurgery, reduce the pain of ureteral catheter removal and urethral irritation during the first urination, improve the success rate of the first urination, and effectively prevent the occurrence of urinary retention.
ABSTRACT
Objective:To evaluate the effect of electroacupuncture (EA) on pyroptosis in renal tubular epithelial cells of rats with acute kidney injury (AKI) induced by endotoxin.Methods:Twenty-four healthy clean-grade Sprague-Dawley rats of either gender, aged 6-8 weeks, weighing 160-182 g, were divided into 4 groups ( n=6 each) using a random number table method: control group (group C), group AKI, EA plus AKI group (group EA), sham EA at non-acupoint plus AKI group (group SEA). The model of endotoxemia was established by intraperitoneally injecting 10 mg/kg lipopolysaccharide.Bilateral 30 min EA stimulation of Zusanli and Shenyu (according to atlas of animal acupoint) was performed starting from 5 days before establishing the model (once a day) and at 30 min before lipopolysaccharide administration on the day of establishing the model, with disperse-dense waves, frequency of 15 Hz, and the needle was kept until 6 h after injection of LPS in group EA.EA was performed at the points 0.5 cm lateral to the acupoints of Zusanli and Shenyu in group SEA.At 6 h after LPS injection, blood was taken from the heart, and the concentrations of serum blood urea nitrogen (BUN) and creatinine (Cr) were detected by an automatic biochemical analyzer, and the serum concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) by enzyme-linked immunosorbent assay.The rats were then sacrificed, and the left renal cortex was obtained for determination of pyroptosis rate of renal tubular epithelial cells (by TUNEL). The right renal cortex was obtained to detect the expression of caspase-1 and IL-1β by Western blot, and the expression of caspase-1 mRNA and IL-1β mRNA was detected by real-time polymerase chain reaction. Results:Compared with group C, the concentrations of BUN, Cr, NGAL, KIM-1, TNF-α, and IL-6 were significantly increased, the pyroptosis rate of renal tubular epithelial cells was increased, the expression of caspase-1 and IL-1β protein and mRNA in the renal cortex was up-regulated in group AKI ( P<0.05). Compared with group AKI, the concentrations of BUN, Cr, NGAL, KIM-1, TNF-α, and IL-6 were significantly decreased, the pyroptosis rate of renal tubular epithelial cells was decreased, the expression of caspase-1 and IL-1β protein and mRNA in the renal cortex was down-regulated in group SEA ( P>0.05). Conclusion:The mechanism by which EA reduces AKI may be related to inhibiting pyroptosis in renal tubular epithelial cells of rats.
ABSTRACT
Objective:To evaluate the sedative efficacy of remimazolam in outpatients undergoing curettage.Methods:Eighty outpatients, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged ≥18 yr, undergoing curettage, were divided into 2 groups according to the random number table method: remimazolam group (group R, n=41) and propofol group (group P, n=39). Anesthesia was induced with alfentanil 10 μg/kg injected intravenously in two groups, and in addition remimazolam 7 mg was intravenously injected in group R, and propofol 1.5 mg/kg was intravenously injected in group P. If the Modified Observer′s Assessment of Alertness/Sedation score ≥3 or the patient could not tolerate the surgical procedure, remimazolam 2.5 mg was given for rescue sedation in group R and propofol 0.5 mg/kg was given for rescue sedation in group P, and alfentanil 1 μg/kg was given as rescue analgesic.The onset time of sedatives, time to eye opening, emergence time and time to discharge were recorded.The success of sedation, intraoperative BIS value, requirement for rescue medications, and occurrence of adverse reactions were recorded. Results:The intraoperative BIS values were maintained at 61-72 and 40-64 in group R and group P, respectively.The success rate of sedation was 95% in group R and 100% in group P, and there was no significant difference between the two groups ( P>0.05). Compared with group P, the rate of rescue sedative agents used and rate of rescue alfentanil given were significantly increased, the onset time of sedative agents was significantly prolonged, the incidence of postoperative nausea and vomiting was increased, and the incidence of respiratory depression and injection pain was decreased in group R ( P<0.05 ). Conclusion:Remimazolam (given according to the instructions) is safer when used for outpatient curettage, but it can only maintain a light sedation status, and the sedative efficacy is inferior to propofol.
ABSTRACT
Objective:To compare the efficacy and safety of programmed death-1 (PD-1) inhibitors monotherapy and combined with chemotherapy/targeted therapy in the treatment of advanced malignant tumors.Methods:The clinical data of 52 patients with advanced malignant tumors treated with PD-1 inhibitors from January 2017 to August 2018 in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were analyzed. All the patients were divided into monotherapy group ( n=23) and combined therapy group ( n=29) according to the therapeutic regimen. The monotherapy group received only PD-1 inhibitors and the combined therapy group received PD-1 inhibitors combined with chemotherapy/targeted therapy. The therapeutic effects and adverse reactions of the two groups were compared. Results:Of the 52 patients, 38 were evaluated according to the imaging results, including 15 in the monotherapy group and 23 in the combined therapy group. The overall response rates of the monotherapy group and combined therapy group were 33.33% (5/15) and 34.78% (8/23) respectively, with no significant difference ( P=0.604). The disease control rates of the monotherapy group and combined therapy group were 80.00% (12/15) and 73.91% (17/23), with no significant difference ( P=0.490). The median overall survival (OS) of the monotherapy group was 6.0 months, and that of the combined therapy group was 5.0 months, with no significant difference ( χ2=0.790, P=0.374). The median progression-free survival (PFS) of the monotherapy group was 6.0 months, and that of the combined therapy group was 5.0 months, with no significant difference ( χ2=0.371, P=0.542). The incidence of abdominal pain and diarrhea was lower in the monotherapy group [grade 1-2: 8.7% (2/23), grade 3 and above: 0] than that in the combined therapy group [grade 1-2: 27.59% (8/29), grade 3 and above: 6.90% (2/29); Z=2.211, P=0.027]. There were no significant differences in the incidence of bone marrow suppression, nausea and vomiting, rash, liver and kidney function impairment or treatment-related pneumonia between the two groups (all P>0.05). Conclusion:For patients with advanced malignant tumors, there is no significant difference in OS and PFS whether PD-1 inhibitors are taken separately or together, but the incidence of abdominal pain and diarrhea in patients treated with PD-1 inhibitors alone is lower than that in patients treated with combined therapy.
ABSTRACT
Objective@#To preliminarily compare the efficacy and safety of Pembrolizumab and Nivolumab in the treatment of advanced malignant tumors.@*Methods@#Clinical data of 50 patients diagnosed with advanced malignant tumors treated with Pembrolizumab and Nivolumab from January 2017 to August 2018 in our hospital were retrospectively analyzed. All patients were divided into the Pembrolizumab (n=26) and Nivolumab groups (n=24). The incidence of adverse reactions was statistically compared between two groups by using χ2 test. The survival analysis was performed by using Kaplan-Meier method.@*Results@#The median progression-free survival in the Pembrolizumab group was 213 d, and 146 d in the Nivolumab group (P>0.05). The incidence of aminotransferase elevation and hypothyroidism in the Nivolumab group was significantly higher than that in the Pembrolizumab group (63% vs. 23%, 12% vs. 0%, both P<0.05), whereas the incidence of oral mucositis in the Nivolumab group was 0%, significantly lower than 15% in the Pembrolizumab group (P<0.05). The median overall survival time in the Pembrolizumab group was 579 d, and 238 d in the Nivolumab group (P>0.05).@*Conclusion@#Clinical efficacy does not significantly differ, whereas the incidence of adverse reactions slightly differs between the Pembrolizumab and Nivolumab groups.
ABSTRACT
Objective To preliminarily compare the efficacy and safety of Pembrolizumab and Nivolumab in the treatment of advanced malignant tumors.Methods Clinical data of 50 patients diagnosed with advanced malignant tumors treated with Pembrolizumab and Nivolumab from January 2017 to August 2018 in our hospital were retrospectively analyzed.All patients were divided into the Pembrolizumab (n =26) and Nivolumab groups (n =24).The incidence of adverse reactions was statistically compared between two groups by using x2 test.The survival analysis was performed by using Kaplan-Meier method.Results The median progression-free survival in the Pembrolizumab group was 213 d,and 146 d in the Nivolumab group (P＞0.05).The incidence of aminotransferase elevation and hypothyroidism in the Nivolumab group was significantly higher than that in the Pembrolizumab group (63％ vs.23％,12％ vs.0％,both P＜0.05),whereas the incidence of oral mucositis in the Nivolumab group was 0％,significantly lower than 15％ in the Pembrolizumab group (P＜0.05).The median overall survival time in the Pembrolizumab group was 579 d,and 238 d in the Nivolumab group (P＞0.05).Conclusion Clinical efficacy does not significantly differ,whereas the incidence of adverse reactions slightly differs between the Pembrolizumab and Nivolumab groups.
ABSTRACT
Objective@#To investigate the magnetic resonance imaging (MRI) findings and clinicopathological features of primary lesions in patients with occult breast cancer (OBC).@*Methods@#The imaging reports from the Breast Imaging Reporting and Data System in 2013 were retrospectively analyzed to investigate the morphology and the time signal intensity curve (TIC) of breast lesions in patients with OBC. The clinical and pathological characteristics of these patients were also included.@*Results@#A total of 34 patients were enrolled. Among these patients, 24 patients underwent modified radical mastectomy and 18 of them had primary breast carcinoma in pathological sections. MRI detected 17 cases of primary lesions, including six masse lesions with a diameter of 0.6-1.2 cm (average 0.9 cm), and 11 non-mass lesions with four linear distributions, three segmental distributions, three focal distributions, and one regions distribution. Five patients had TIC typeⅠprimary lesions, ten had TIC type Ⅱ primary lesions, and two had TIC type Ⅲ primary lesions. Among all 34 cases, 23 of them had complete results of immunohistochemistry: 11 estrogen receptor (ER) positive lesions (47.8%), tenprogesterone receptor (PR) positive lesions (43.5%), seven human epidermal growth factor receptor 2 (HER-2) positive lesions (30.4%), and 20high expression(>14%) of Ki-67 (87.0%). The proportion of type luminal A was 4.3%, type luminal B was 43.5%, triple negative breast cancer (TNBC) was 30.4%, and HER-2 over expression accounted for 21.7%.@*Conclusions@#The primary lesions of OBC usually manifested as small mass lesions, or focal, linear or segmental distribution of non-mass lesions. The positive rate of ER and PR was low, but the positive rate of HER-2 and the proliferation index of Ki-67 was high. Type luminal B is the most common molecular subtype.
ABSTRACT
Objective@#To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery.@*Methods@#A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival.@*Results@#Among the 95 cases, 5 cases occured local recurrence, 21 cases developed, 3 cases including both locally recurrence and distant metastasis, 19 died and 47 had no recurrence or metastasis at the last of follow-up. Univariant analysis showed that MRI signs before chemoradiation, namely, mr circumferential resection margin, mr levator ani muscle invasion, mr lymphatic vessel invasion, mr tumor deposition and postoperative pathological parameters, yp circumferential resection margin, yp lymphatic vessel invasion were related to PFS (P<0.05). Multivariate analysis of Cox proportional hazard model showed that mr lymphatic vessel invasion and mr tumor deposition were independent factors for PFS (OR=2.774 and 3.029, P<0.05).@*Conclusions@#Lymphatic vessel invasion and tumor deposition on MRI are independent prognostic factors for progression free survival of locally advanced rectal cancer after neoadjuvant chemoradiotherapy and TME surgery. To some extent, MRI signs can assess local recurrence and distant metastasis in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and mesorectal excision.
ABSTRACT
Objective To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in combination with peripheral serum tumor markers in the diagnosis and therapeutic evaluation of small cell lung cancer (SCLC) brain metastases.Methods Retrospective analysis of 368 SCLC cases diagnosed by histopathology or cytology from February 2009 to February 2012 in Shanxi Provincial Cancer Hospital was made.All patients underwent pathological examination of progastrin-releasing peptide (ProGRP),neuron-specific enolase (NSE) and brain DWI,and measured the apparent diffusion coefficient (ADC) of DWI sequences of brain metastases.The difference between the positive rates of ProGRP and NSE in patients with or without brain metastases was compared by the X2 test,and the diagnostic efficiency of ProGRP,NSE,DWI and combined detection for brain metastases were analyzed.The Kruskal-Wallis H test was used to compare the changes of ADC value,ProGRP and NSE before and after brain irradiation therapy in brain metastases of SCLC.Pearson correlation analysis was made to evaluate the correlation between the changes of ADC value and the levels of ProGRP and NSE in SCLC patients with brain metastases before and after treatment.Results The median expression of serum ProGRP in 169 SCLC patients was 2 664.7 pg/ml (98.4-4 876.8 pg/ml),with a positive rate of 98.2 ％ (166/169).The median expression of NSE was 41.9 μg/L (9.4-264.3 μg/L),with a positive rate of 70.4 ％ (119/169).The median expression of serum ProGRP level was 514.3 pg/ml (3.9-2 899.3 pg/ml) in 199 SCLC patients without brain metastasis,the positive rate was 89.4 ％ (178/199).The median expression of NSE was 40.4 μg/L (0.3-176.1 μ,g/L),with a positive rate of 64.8 ％ (129/199).The difference of ProGRP level between the two groups was statistically significant (u =121.47,P ＜ 0.001),but there was no significant difference in NSE level (u =1.35,P =0.12).The sensitivities of ProGRP,NSE,DWI,ProGRP+DWI and NSE+DWI were 68.4 ％,41.2 ％,66.7 ％,92.2 ％,and 82.4 ％,and the specificities were 52.9 ％,35.3 ％,76.5 ％,94.1％,and 88.2 ％.The sensitivity and specificity of ProGRP+DWI and NSE+DWI were higher than those of single test,and the differences were statistically significant (all P ＜ 0.001).One hundred and fifty-six SCLC patients with brain metastases were treated with whole brain radiotherapy.Pearson correlation analysis showed that ADC values were negatively correlated with ProGRP and NSE levels (r =-0.945,P ＜ 0.001;r =-0.995,P ＜ 0.001).Conclusion DWI combined with ProGRP and NSE can provide objective evidence and clinical guidance for the diagnosis of SCLC brain metastases and the evaluation of whole brain radiotherapy.
ABSTRACT
Objective To evaluate the value of 3.0T magnetic resonance multi-b value diffusion-weighted imaging (DWI) in evaluating the efficacy of chemotherapy for patients with central lung squamous cell carcinoma and atelectasis. Methods Twenty patients with lung squamous cell carcinoma were examined by magnetic resonance imaging (MRI) (including T1WI, T2WI and multi-b value DWI) before chemotherapy, 2 cycles of chemotherapy and 4 cycles of chemotherapy. The images, the tumor volume and changes of apparent diffusion coefficient (ADC) were analyzed. Results In the patients with central lung cancer and atelectasis, the tumor and atelectasis could be distinguished on MRI examination before radiotherapy. It was more easily identified on T2WI images after radiotherapy. In the 20 patients, the ADC values in the effective group (partial remission or complete remission) and the invalid group were increased, but the differences of ADC values in the effective group before chemotherapy, 2 cycles and 4 cycles of chemotherapy were statistically significant [b=800 s/mm2:(1.09 ± 0.52) × 10-6 mm2/s, (1.22 ± 0.59) × 10-6 mm2/s, (1.24 ± 0.52) × 10-6 mm2/s, F = 31.19, P < 0.001]. There was no significant difference in ADC values between before and after chemotherapy (b = 800 s/mm2: (1.10 ± 0.49) × 10-6 mm2/s, (1.16 ± 0.60) × 10-6 mm2/s, (1.20 ± 0.72) × 10-6 mm2/s, F=2.86, P=0.089]. When b=800 s/mm2, the ADC curve slope in the effective group was more stable, better linearity. Conclusions The MRI technique can accurately distinguish the tumor from atelectasis before and after chemotherapy. The change of ADC value after chemotherapy is earlier than that of morphological change. The change rate of b value can better evaluate the curative effect of chemotherapy.
ABSTRACT
ObjectiveTo analyze the imageology appearance and clinical characteristics of primary squamous cell carcinoma of the breast.MethodsFeatures of MRI(4 patients)and B-type ultrasonic inspection(5 patients)of nine patients with primary squamous cell carcinoma of the breast pathologically confirmed were retrospectively reviewed. Compared with postoperative pathological appearance, the correlation between imageology appearance and clinical, pathological characteristics was analyzed. ResultsImageology appearance:In MRI:The tumor diameter was around 50 mm;The tumors were located at nearby papillae;There were two patients with pachymenia at the same time;The tumor margin was unclear,which has clear tumor wall structure and heterogeneous pachymenia,and without corpora mammillaria shadow which was toward interior;The tumors were low signal on T1WI and partially high signal on T2WI;The image with enhancement scanning showed that parenchymatous part of tumor were enhanced,while enhancements were not obviously at the centre of tumor with necrosis.In B-type ultrasonic inspection:The average diameter of tumors was around 40 mm, there were NT=0 mm in 4 cases. NT=19 mum in 1 case. The tumors presented as shape of clump or sublobe,which had unclear margin and high echoic region behind the tumor.There were also normal echo at the tumor lateral in 2 cases at the same time,and 4 cases showed blood supply was abundant, and 2 cases showed that there were colliquation and necrosis which had cystic hypoechoic signal at the tumor interior.MMG:There were class-4 in 2 cases,and Class-3 in 1 case.The tumor with little calcification which had no obvious veining showed uniformly high densities.All patients were treated with entire mastectomy. The patho-staging showed 3 cases were in ⅢB, 1 case was Ⅱ B, and 1 case was in Ⅱ A. Theresults of ER and PR with all patients were negative by using immunohistochemistry. 3 cases were also treated with chemotherapy after surgery; other organs (brain and lung) were found metabasis by follow-up visit of post-operation.ConclusionFor patients with primary squamous cell carcinoma of the breast,MMG inspection before surgery did not have specific imageology characteristics, while MRI has. The combination of MRI, B-type ultrasonic inspection and CNB can detect pathologic types and invasive circumscription,so it may have great applications for choose of surgery style and directions of therapy in the future.