ABSTRACT
Objective To explore the influencing factors of different bowel preparation before colonoscopy on the intestinal cleanliness and polyp detection rate .Methods From March to August in 2018, at the Center of Endoscopy of Huashan Hospital Affiliated to Fudan University , the patients who underwent colonoscopy were selected and their general data of bowel preparation regimens were collected .Self-factors of the patients, different bowel preparation regimens , bowel preparation quality and polyp detection rate were observed.The quality of bowel preparation was evaluated by Boston bowel preparation scale (BBPS).T test, and analysis of variance and chi-square test were used for statistical analysis .Results Among 1008 patients who underwent colonoscopy , there were 506 males and 502 females, and average age was (57.3 ±13.7) years. There were statistically significant differences in BBPS score of patients with different body mass index (BMI), Parkinson disease and history of abdominal surgery (F=3.319, t=-2.060 and -2.544;all P<0.05).The BBPS score of patients with three-day low residue diet before examination was higher than that of those without preparation before examination (6.04 ±2.50 vs.5.54 ±2.73), and the difference was statistically significant (t=2.514, P=0.010).The BBPS scores of 2000 mL polyethylene glycol electrolyte lavage solution (PEG) taken once , 2000 mL PEG taken separately , 3000 mL PEG taken once and 3000 mL PEG taken separately were 5.06 ±2.88, 6.11 ±2.44, 5.94 ±2.32 and 6.10 ±2.47, respectively, and the difference was statistically significant (F=7.242,P<0.01).There were significant differences in polyp detection rates among the patients with different age , gender, BMI, and with history of constipation , hypertension and diabetes mellitus (χ2 =33.170, 8.489, 12.024, 4.034, 26.790, 10.381;all P<0.05).The polyp detection rate of patients with oral methyl silicone oil was higher than that of patients without oral methyl silicone oil (52.6％, 30/57 vs.29.7％, 221/744), and the difference was statistically significant (χ2 =12.934, P<0.01).Age (odds ratio (OR)=1.328, 95％confidence interval (CI) 1.162 to 1.517) and BMI (OR=1.412, 95％CI 1.115 to 1.787) were independent risk factors for polyp detection rate .Conclusions Parkinson disease, history of abdominal surgery and BMI are the related factors affecting the quality of bowel preparation before colonoscopy .Age and BMI are independent risk factors for polyp detection rate .
ABSTRACT
Objective To retrospectively analyze the results of treatment with Asian proximal femoral nail anti rotation intramedullary nail (PFNA Ⅱ) in senile patients with unstable intertrochanteric femoral fractures. Methods 1 06 cases of unstable intertrochanteric femoral fracture with internal fixation of PFNAⅡ were analyzed retrospectively,and the treatment effect was observed.Results 1 06 cases were followed -up(mean 1 3.5 months, ranged 1 0 -22 months).Bone union occurred in all cases,average fracture healing time was 3.8 months.The average operation time was 48 minutes,the average volume of blood loss was 1 06mL.The hip functions were analyzed using Harrison score.And found 80 excellent cases,1 4 good cases,1 2 fair cases,with 88.7% of excellent and good rate. Conclusion For the senile patients of unstable intertrochanteric femoral fractures,PFNAⅡ has the biomechanical advantages of intramedullary fixation,small trauma,short operation time,reliable internal fixation,early functional exercise,low incidence of complications,significant functional recovery,and is a preferred treatment option.
ABSTRACT
Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section.Methods Sixty patients,aged 20-35 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective cesarean section,were randomly divided into 2 groups (n =30 each) using a random number table:hemodiluted autotransfusion group (group HAT) and allogeneic blood transfusion group (group ABT).Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia,and the autologous blood was collected in group HAT.The autologous blood transfusion timing:intraoperative blood loss was expected to exceed 20％ of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20％ of blood volume,bleeding was stopped,and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing:when hemoglobin ＜ 70 g/L,packed red blood cells 1-5 U were infused intravenously;when prothrombin time,or activated partial thromboplastin time ＞ 1.5 times of the normal value,the fresh frozen plasma 100-400 ml was infused intravenously;when platelet count＜50× 109/L,platelets 10-40 U were infused intravenously.When entering the operating room (T0),on 1st day after operation (T1),and on 5th day after operation (T2),blood samples were collected to detect the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ (using FACScan flow cytometer),and serum interleukin-2 (IL-2) and IL-6 concentrations (by enzyme-linked immunosorbent assay).CD4+/CD8+ ratio was calculated.Results Compared with the values at T0,the levels of CD3+ and CD4+,CD4+/CD8+ ratio,and serum IL-2 concentrations were significantly decreased,and the serum IL-6 concentrations were increased at T1,2 in group ABT,and at T1 in group HAT (P＜0.05).Compared with group ABT,the CD3+ and CD4+ levels,CD4+/CD8+ ratio and serum IL-6 concentrations were significantly increased at T1,and the serum IL-2 concentrations were increased at T1,2 in group HAT (P＜0.05).Conclusion Compared with allogeneic transfusion,hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section.
ABSTRACT
Objective To explore the effect of different concentrations of sevoflurane combined with propofol on CPR and complement in patients with laparoscopic hysterectomy.Methods 80 patients with hysteromyoma were randomly divided into A group with 27 cases, B group with 27 cases and C group with 26 cases.3 groups of patients were underwent laparoscopic hysterectomy surgery, and preoperative anesthesia with different concentrations of sevoflurane, A group with 2.5% sevoflurane anesthesia, B group with 3% sevoflurane anesthesia, C group with 3.5%.The clinical efficacy, CRP, complement levels and adverse reactions were compared among 3 groups.Results Compared with A group, the Karnofsky score of group B and group C was higher(P<0.05), there was no significant difference in Karnofsky score between the two groups of B and C, and the level of CRP in 3 groups increased and C3 and C4 decreased(P<0.05).Compared with group A, the level of CPR in group B and C were lower(P<0.05), C4 and C3 were higher( P<0.05 ) .There was no significant difference in the incidence of adverse reactions among 3 groups.Conclusion 3% concentration of sevoflurane combined with propofol in the induction of anesthesia in laparoscopic hysterectomy has better anesthetic effect, and has little effect on the CRP and the complement of the body .
ABSTRACT
Objective To investigate the effect of acute normovolemic hemodilution on immune function by observing the level change of lymphocyte subsets in maternity sera.Methods 60 ASA I ～ Ⅱ parturients were divided into 2 groups,30 cases in each group.Parturients of group A received acute normovolemic hemodilution and parturients of group C received allogeneic blood transfusion.Blood pressure,heart rate,duration of the cesarean section and blood loss were observed.2mL blood samples were taken from the mothers'vein before the surgery,1 day after the surgery,5 days after the surgery.Flow cytometry was used to measure T lymphocyte subsets.Results The levels of CD3+,CD4+,CD8+,CD4+/CDs+ before the surgery had no statistically significant differences between two groups (P ＞ 0.05).The levels of CD3+ [(52.35 ±5.62)％,(48.44±6.45)％],CD4+ [(36.90±7.93)％,(32.05 ± 8.94)％],CD4+/CD8+ [(1.15 ± 0.26),(0.97 ± 0.22)] were much lower 1 day after the surgery than those of preoperation [CD3+:(59.67 ± 3.45) ％,(60.58 ± 4.27) ％ ; CD4+:(43.71 ± 8.45) ％,(43.21 ± 8.45) ％ ; CD4+/CDs+:(1.41 ±0.38),(1.45 ±0.48)] in both two groups(t =6.10,2.50;3.22,4.97;3.09,4.98;P ＜0.05).In group A,the levels of CD3+,CD4+,CD4+/CD8+ [(58.78 ± 5.24) ％,(43.18 ± 8.48) ％,(1.41 ± 0.41)] had no statistical differences 5 days after the surgery(P ＞ 0.05) compared with those of preoperation.While in group C,the levels of CD3+ [(57.11 ± 6.81) ％],CD4+ [(38.68 ± 7.70) ％],CD4+/CDs+ [(1.19 ± 0.37)] were lower than the levels before the surgery[(60.58 ± 4.27) ％,(43.21 ± 8.45) ％,(1.45 ± 0.48)],and of the differences were statistically significant (t =2.46,2.17,2.35 ;P ＜ 0.05).Conclusion Compared with allegeic transfusion,acute normovolemic hemodilution could benefit the recovery of parturients by alleviate the inhibitory effect of transfusion on the immune function.
ABSTRACT
Objective To evaluate the efficacy of continuous incision analgesia with 0.2％ levobupivacaine for postoperative analgesia in parturients undergoing cesarean section.Methods Thirty ASA physical status Ⅰ or Ⅱ parturients who were at full term,aged 20-30 yr,weighing 60-80 kg,undergoing elective cesarean section,were enrolled in the study.The parturients received 0.2％ levobupivacaine 2 ml/h via a continuous incision analgesia device at the end of surgery.Pain was evaluated by visual analogue scale (VAS).Additional tramadol 50 mg was given when VAS score was above 3 and the consumption was recorded.The effective analgesia within 48 h after surgery (no addition of tramadol,VAS score ≤3) was recorded.The serum prolactin level was measured at 30 min before cesarean section and 24 and 48 h after cesarean section.The colostrum time was recorded.The toxic reaction and side effects were recorded.Results The effective analgesia rate was 80 ％.The consumption of tramadol was (95 ± 15) mg.The colostrum time was (24 ± 6) h.No toxic reaction was found.The serum prolactin level was significantly higher at 24 and 48 h after surgery than that at 30 min before surgery (P ＜ 0.05).Conclusion Continuous incision analgesia with 0.2％ levobupivacaine provides better efficacy,earlier colostrum time and fewer side effects for postoperative analgesia in parturients undergoing cesarean section.
ABSTRACT
Objective The clinical effects of endoprotheses in the palliative treatment of malignant biliary obstruction were evaluated.Methods The palliative treatment of endoprothese in 74 cases(including 42 Wallstents and 32 plastic stents )were analyzed retrospectively.Results There were remarkable effects on reducing the level of serum bilirubin and improving the symptoms.The bilirubin was decreased more obviously in the first week,and tended to normal in 3 weeks.Stenting was performed on upper bileduct obstruction mostly(accounted for 52.7%).The early complications were less;late complications were blockage mainly.The half-year obstructive rate in metal stent group was 19%;plastic stent 25%.Average stent patency was 214 days in metal stent versus 122 days in plastic stent.Conclusion Endoprotheses are an efficient means of treating malignant biliary strictures and reducing the level of serum bilirubin,particularly of upper biliary obstructions.As its micro-invasion,it is fit for old age and asthenic (such as dyscrasia),whose survival time may be shorter(estimated less than 6 months),doctor may choose metal stent.If patient is impoverished,the doctor could use plastic stent.
ABSTRACT
This is the first report of the sensitizing effect of cation surfactant on the enhanced resonance light scattering (RLS) resulted from the interaction of organic dyes with Deoxyribonucleic acid (DNA). On the conditions of pH 10.4 ～11.8 and ionic strength being less than 0.050, the interaction of brilliant green (BG) with DNA results in enhanced RLS signals at 398.0 and 467.2 nm overloaded some shoulder peaks in the enhanced region. It was found that the interaction was sensitized by the presence of cetyltrimethylammonium bromide (CTMAB). If 2.0～3.2×10-5 mol/L CMAB was used in the interacting medium, DNA in the range of 0～1.2 (mg/L could be detected with the limit of detection being less than 5 μg/L. Four synthetic samples were analyed with reproducibility
ABSTRACT
Purpose:To evaluate the efficacy and toxicity of the low dose 5 Fluorouracil and Cisplatin continuous infusion for treatment of advanced gastric carcinoma. Methods:A total of 21 patients were enrolled in the trial, FP therapy consisted of 5 FU (0 25/m 2/d) every day by continuous infusion and cisplatin (6 mg/m 2/d) every day by continuous infusion for 3 weeks.Results:A complete response was observed in 2 cases and a partial response in 10 cases, for and overall response rate of 57.1%. Toxic effects included leukopenia, thrombocytopenia, nauesa and vomiting.Conclusions:FP therapy is a promising regimen for patients with advanced gastric carcinoma.
ABSTRACT
In domestic market, there was a rise in prices of chemicals owing to the cost oriented type of pricing in 1988, and the prices have been lowered due to sales promotion since the last quarter of 1989. Based on these aspects ,the problems and disadvantages existing in the present policy of price-fixing for chemicals in China are evaluated. It is, therefore, necessary to reform the price-fixing policy and some assumptions and suggestions are made.