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Reperfusion injury occurs after return of spontaneous circulation (ROSC) in patients with cardiac arrest (CA), which leads to multiple organ dysfunction, called post-cardiac arrest syndrome (PCAS). PCAS is closely related to the prognosis of CA patients, and is an independent risk factor of survival. Integrated traditional Chinese and Western medicine diagnosis and treatment is critical for improving prognosis of PCAS. In order to guide and standardize integrated traditional Chinese and Western medicine diagnosis and treatment in PCAS among clinicians, nurses and research personnel in China, the Emergency Medicine Professional Committee of the Chinese Society of Integrated Chinese and Western Medicine has established an expert group to determine 14 clinical issues related to the diagnosis and treatment of PCAS with integrated traditional Chinese and Western medicine through clinical survey. The working group formulates a search strategy for each clinical issue according to the PICO principle. Chinese and English literature were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, and Cochrane Library. The grade of recommendations assessment, development and evaluation (GRADE) were used to form the level of evidence and recommendation. When the literature evidence was insufficient, the recommendations and level of recommendation were formed after expert discussion. Combined with the aspects of generalizability, suitability, and resource utilization, the expert consensus developed 28 recommendations around the 14 aspects of three stages of PCAS, including early circulation, respiratory support and reversible cause relief, mid-term neuroprotection, improvement of coagulation, prevention and treatment of infection, kidney and gastrointestinal protection and blood sugar control, post rehabilitation treatment, providing references for the integrated traditional Chinese and Western medicine of the diagnosis and treatment for PCAS.
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Objective To evaluate the risk of disease of Vibrio parahaemolyticus in aquatic products of raw food animals for population in guangzhou,and determine risk management points. Methods VP quantitative detection was carried out in aquatic products of raw food animals sold in Guangzhou from 2009 to 2022.sQMRA was applied to assess Vibrio parahaemolyticus risk of aquatic products of raw food animals. According to stratified analysis based on the pollution of Vibrio parahaemolyticus and evaluation results,carry out risk management and analysis. Results Among the 98 samples were detected positive of VP from 1 343 samples from 2009 to 2022 , with an overall positive rate of 7.30%.The number of Vibrio parahaemolyticus infection cases caused by eating aquatic products of raw food animals in Guangzhou was 3012. If the proportion of raw food is reduced , the number of Vibrio parahaemolyticus infection cases will be significantly reduced. The number of cases caused by eating raw fash will be reduced from 2128 to 217.The detection rate of Vibrio parahaemolyticus in raw fresh water products was much higher than that in marine products. The probability of infection in the population was higher. The number of cases caused by eating raw fash was the highest.The detection rate of Vibrio parahaemolyticus was higher in raw crustaceans and molluscs. The incidence of Vibrio parahaemolyticus infection cases caused by eating raw fash in the four quarters varied from high to low as such sequence ,4.93×10-5 in the three quarters , 2.53×10-5 in the second quarter , 2.40×10-5 in the first quarter ,1.77×10-5 in the fourth quarter . Conclusion The risk of disease of Vibrio parahaemolyticus in aquatic products of raw food animals was higher. The public health education should be done well. Aquatic products should be cooked thoroughly before eating . Reduce the intake of raw aquatic products and avoid cross contamination. Focus on the risks of summer and autumn seasons and seafood such as crustaceans and molluscs. Concentrate on scientific research on Vibrio parahaemolyticus pollution of fresh water products.
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Objective:To study the early-onset epilepsy of intracerebral hemorrhage and build a prediction model to evaluate its prediction efficiency.Methods:A cross-sectional investigation was conducted to construct a specialized optimized prediction model. The prediction model was converted into a visual optimized scoring scale, so as to quantify the probability of secondary epilepsy after intracerebral hemorrhage. Based on the current prediction model of acute cerebral infraction and post-stroke seizure (AIS-PSS), the evaluation efficacy of optimized score for secondary epilepsy after hemorrhagic stroke was explored.Results:① After sample size calculation and sufficient inclusion and exclusion, 159 patients with cerebral hemorrhage were continuously selected as the model group of this cross-sectional study. A total of 29 patients with early-onset epilepsy and 130 patients without secondary epilepsy were enrolled. The time span was from January 2021 to August 2021. In addition, 77 patients with acute cerebral hemorrhage from August 2021 to February 2022 were selected as the verification group, among which 12 patients had early-onset epilepsy and 65 patients had not any secondary epilepsy. ② There were significant differences in demographic characteristics such as diabetes history, cerebral infarction history, smoking history, National Institutes of Health Stroke Scale (NIHSS) score, intracerebral hemorrhage hematoma volume, serum creatinine (SCr), neuron-specific enolase (NSE), S-100 protein and intracerebral hemorrhage site between the two model groups with different prognosis (all P < 0.05). ③ The above indexes were included in univariate and multivariate Poisson regression analysis, and the results showed that the duration of diabetes [relative risk ( RR) = 1.229, 95% confidence interval (95% CI) was 1.065-1.896, P = 0.036], smoking history ( RR = 1.419, 95% CI was 1.133-2.160, P = 0.030), history of cerebral infarction ( RR = 1.634, 95% CI was 1.128-2.548, P = 0.041), hematoma volume of cerebral hemorrhage ( RR = 1.222, 95% CI was 1.024-2.052, P = 0.041), NES content ( RR = 1.146, 95% CI was 1.041-1.704, P = 0.032), were independent influencing factors to constitute the prediction model. The prediction model was converted into a visual optimized scoring scale in the form of a line diagram to obtain the prediction probability corresponding to the corresponding score. ④ Receiver operator characteristic curve (ROC curve) was used to test the evaluation efficiency of optimized score and AIS-PSS score for early-onset cerebral hemorrhage epilepsy. Relevant data of patients in the verification group were extracted according to the information of two scores, and the final score of each patient in the verification group was obtained. The score and prognosis were put into the ROC curve to evaluate the predictive ability of different prediction models. The results showed that the cut-off value of the optimized score and the AIS-PSS score were 144 points and 7 points, respectively, and the area under the ROC curve (AUC) and the Yoden index of the optimized score were slightly lower than the AIS-PSS score. However, compared with AIS-PSS score, there was no significant difference in the evaluation efficiency of optimized score for early-onset epilepsy ( Z = 1.874, P > 0.05). Conclusion:This study constructed a specific early-onset epilepsy prediction model for patients with hemorrhagic stroke, and transformed it into an optimized score that is easy for clinical use, and its evaluation efficiency is reliable.
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@#Objective To verify the reliability of Anticlot Assistant, a patient self-management system for warfarin therapy assisted by artificial intelligence. Methods It was a single-center, prospective cohort study. The eligible 34 participants were recruited consecutively between November 29, 2017 to September 27, 2018 and managed by warfarin therapy via Anticlot Assistant. The recommendations of Anticlot Assistant were examined and verified by the doctors to ensure the security. Medical records were exported from the the background management system. An univariate analysis compared the outcomes between accepted and overridden records and a logistic regression model was built to determine independent predictors of the outcomes. The research team analyzed 153 medical records, which were from 18 participants and were input by 19 doctors. There were 97 records with doctor accepting the suggestion and 56 records with doctor rejecting the suggestion . Results When the doctors accepted the recommendations, the percentage of the next-test international normalized ratio (INR) in the therapeutic range was higher (64.95% vs. 44.64%, RR=2.298, 95%CI 1.173 to 4.499, P=0.014). The logistic regression analysis revealed that accepting the recommendations was an independent predictor for the next-test INR being in the therapeutic range after controlling potentially confounding factors (OR=2.446, 95%CI 1.103 to 5.423, P=0.028). Conclusion The algorithm of Anticlot Assistant is reasonable and reliable.
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Objective:To investigate the effect of long-term oral administration of β-blocker on septic myocardial injury and prognosis.Methods:A retrospective study was conducted. Patients who were admitted to the emergency intensive care unit (EICU) and intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2020 were enrolled. A total of 289 patients who met the criteria of myocardial injury induced by sepsis were included in the analysis. Among them, 187 patients who had never taken β-blocker within 3 months before diagnosis were divided in the non-β-blocker group, and 102 patients who took β-blocker daily for more than 3 months before diagnosis were in the β-blocker group. The physiological and biochemical characteristics were compared between the two groups, including heart rate, mean arterial pressure (MAP) at the time of diagnosis, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), MB isoenzyme of creatine kinase (CK-MB), blood lactic acid (Lac), central venous oxygen saturation (ScvO 2), sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours of diagnosis, left ventricular ejection fraction (LVEF), early and late mitral orifice diastolic peak flow velocity ratio (E/A), utilization rate of vasoactive drugs during hospitalization and 28-day mortality. Results:The heart rate in the β-blocker group at the time of diagnosis was significantly lower than that in the non-β-blocker group (bpm: 107±8 vs. 110±7, P < 0.01), and the levels of cTnI and BNP within 24 hours of diagnosis were significantly lower than those in the non-β-blocker group [cTnI (μg/L): 0.191 (0.220) vs. 0.291 (0.300), BNP (ng/L): 627 (133) vs. 690 (201), both P < 0.05]. However, there were no significant differences in MAP, CK-MB, Lac, ScvO 2, SOFA score, APACHE Ⅱ score, LVEF, E/A, vasoactive drug utilization rate, and 28-day mortality between the β-blocker and non-β-blocker groups [MAP (mmHg, 1 mmHg = 0.133 kPa): 70.6±3.9 vs. 69.9±3.8, CK-MB (μg/L): 4.24 (3.33) vs. 4.32 (3.13), Lac (mmol/L): 3.50 (1.80) vs. 3.50 (1.90), ScvO 2: 0.729±0.032 vs. 0.735±0.041, SOFA score: 7.74±2.34 vs. 7.25±2.23, APACHE Ⅱ score: 17.19±5.13 vs. 18.27±6.12, LVEF: 0.567±0.058 vs. 0.557±0.051, E/A: 0.71 (0.20) vs. 0.69 (0.20), vasoactive drug utilization rate: 60.8% (62/102) vs. 56.7% (106/187), 28-day mortality: 23.5% (24/102) vs. 25.7% (48/187), all P > 0.05]. Conclusion:Long-term oral administration of β-blocker reduce myocardial injury in septic patients, and has no effect on disease severity and prognosis.
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Objective To investigate the contamination status of food-borne pathogens in foods sold in Guangzhou, and find the potential food safety hazards, and to provide a scientific basis for formulating food safety measures. Methods From 2013 to 2018, a total of 5 021 food samples from 15 common diets of residents were collected for monitoring Vibrio parahaemolyticus, Staphylococcus aureus, Diarrheagenic Escherichia coli, Vibrio vulnificus, Salmonella, Bacillus cereus, Listeria monocytogenes and Vibrio cholerae. Results Among 5 021 samples, a total of 424 samples were found to carry foodborne pathogens, with a total detection rate of 8.44%. Vibrio parahaemolyticus had the highest detection rate among food-borne pathogens (11.20%), followed by Vibrio vulnificus (9.20%), Bacillus cereus (7.26%), and Staphylococcus aureus (1.72 %), Listeria monocytogenes (1.08%), Escherichia coli (0.86%), and Salmonella (0.48%). Vibrio cholerae was not detected. Among different food categories, the detection rate of aquatic products was the highest, reaching 43.52%, followed by raw aquatic animal food products (16.24%), imported raw livestock and poultry meat (11.11%), foods sold in vendors (10.62%), and baked foods (10.56%). The difference in the detection rate of food-borne pathogens among different foods was statistically significant. Analysis of the detection rate of foods from different sampling locations showed that the highest detection rate was in online shops (22.92%), followed by caterings (12.49%), vendors (11.21%), supermarket (8.995), farmers’ markets (8.59%), and the lowest was retail stores (5.63%). The highest detection rate was found in the third quarter (10.04%), followed by the second quarter (9.81%), and the lowest was in the first quarter (6.43%). Conclusion There was contamination with food-borne pathogens at different degrees in foods sold in Guanghzou. The food safety risk monitoring should be carried out continuously. The prevention and control should be focused on foods with a higher risk of contamination of food-borne pathogens including aquatic animal products, frozen livestock and poultry meat, foods sold in vendors and baked foods.
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Objective To observe the clinical effect of Levosimendan for treatment of patients with refractory heart failure in order to provide a reference for doctors treating this disease. Methods One hundred and eighty patients with refractory heart failure were admitted to Tongde Hospital of Zhejiang Province from February 2014 to December 2017, and they were divided into two groups by random number table method: a western medicine routine treatment group (western control group) and a Levosimendan group, each group 90 cases. The patients in western control group were given conventional anti-cardiac failure drugs ; and those in Levosimendan group were treated with the therapies as above group, and additionally Levosimendan continuous intravenous infusion for 24 hours was given. The clinical efficacy of the two groups was evaluated after 3 days of treatment. After treatment, the differences of ejection fraction (EF), stroke volume (SV), end-systolic volume (ESV), end-diastolic volume (EDV) and the levels of N-terminal brain natriuretic peptide precursor (NT-proBNP) and cardiac troponin I (cTnI) were compared between the two groups. Results After treatment, the EF and SV levels were significantly increased, while the ESV, EDV, NT-proBNP and cTnI levels were decreased obviously compared with those before treatment in the two groups (all P <0.05); the changes of the levels of EF, SV and NT-proBNP and cTnI of Levosimendan group were more significant than those of the western control group [EF: 0.49±0.06 vs. 0.44±0.06, SV (mL): 86.54±17.63 vs. 81.48±18.46, NT-proBNP (μg/L): 5.50±1.28 vs. 6.64±1.54, cTnI (μg/L): 0.08±0.01 vs. 0.14±0.13, all P < 0.05], while there were no significant differences of the levels of ESV and EDV between the two groups [ESV (mL): 111.56±32.53 vs. 128.76±32.13, EDV (mL): 187.95±39.28 vs. 185.06±41.23, both P > 0.05]. The total effective rate of the Levosimendan group was obviously higher than that of the western control group [97.78% (88/90) vs. 78.89% (71/90), P < 0.05]. Conclusion Levosimendan can effectively improve the hemodynamics in patients with refractory heart failure, the elevation of patients' heart function, and the short-term therapeutic effect is very remarkable.
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Objective To approach the nursing experience and clinical therapeutic effect of using aerosol inhalation of Scutellaria baicalensis leachate to prevent occurrence of ventilator-associated pneumonia (VAP) in critically ill patients in intensive care unit (ICU). Methods Ninety-two severe patients who received mechanical ventilation (MV) in ICU of Hangzhou Geriatric Hospital from April 2016 to August 2017 were enrolled, and they were divided into a test group and a control group according to their wishes and self-selection, 46 cases in each group. The patients in both groups were given fine nursing care model, in the control group aerosol inhalation of physiological saline was used; in the test group aerosol inhalation of Scutellaria baicalensis leachate was applied. The incidence of VAP, the duration of MV and time of ICU stay were compared between the two groups. Results Compared to the control group, the total incidence of VAP, duration of MV, time of ICU stay in the test group were significantly lower than those in control group [total incidence of VAP: 17.39% (8/46) vs. 36.95% (17/46), duration of MV (days): 11.37±5.23 vs. 15.21±5.93, time of ICU stay (days): 18.54±5.92 vs. 27.33±5.27, all P < 0.05]. Conclusion Under the fine nursing care pattern, compared with the aerosol inhalation of saline, the aerosol inhalation of Scutellaria baicalensis leaching can be more effectively to prevent VAP in ICU critically ill patients and reduce their duration of MV and of ICU stay, so the latter one's clinical therapeutic effect is better.
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Objective To investigate the role of peroxisome proliferator-activated receptor γ (PPARγ) in hematogenous spread of hepatocellular carcinoma after hepatic ischemia reperfusion in mice and its mechanism.Methods One hundred and sixty mice were randomly divided into 4 groups,sham,control,Rosiglitazone(R group) and Rosiglitazone + GW9662 (R + GW).The mice models with hepatic ischemia reperfusion combined with portal vein metastasis of hepatocellular carcinoma were well established.Serum ALT level,expressions of MMP-9,NF-κB and PPARγ,hepatic replacement area (HRA) and survival of mice were compared.Results (1) The median survival in sham group was 16.3 d,R group 12.1 d,control group 9.6 d,R + GW group 8.7 d.(2) Impact on portal venous metastasis:compared with left hepatic lobe (ischemic hepatic lobe) of control group,the HRA was significantly decreased in the left hepatic lobe of sham group (29.1% vs.13.2%,P <0.05).Tumor load was higher in control group than R group (29.1% vs.13.0%,P < 0.05).(3) Serum ALT level:after 2 h,8 h and 24 h hepatic ischemia reperfusion injury (HIRI),the ALT levels in control group [(1 134.2 ± 320.5) U/L],R group [(1 017.3 ± 365.9)U/L] and R + GW group [(1 344.0 ± 304.3) U/L] were all higher than sham group [(20.6 ± 7.8) U/L],P <0.05.With 8 and 24 h HIRI,ALT levels were highest in R + GW group [(4 101.7 ± 462.2) U/L,(3 730.8 ± 582.7) U/L],following by control group [(3 649.1 ± 440.1) U/L,(2 226.7 ± 442.7) U/L],andRgroup [(1691.9±398.6)U/L,(1 109.2±237.4)U/L],P<0.05.(4) MMP-9 expression:after 8 h HIRI,MMP-9 expression level was predominantly elevated in control group than R group [(41.3 ± 10.7) vs.(4.7 ± 1.1),P < 0.05].Similarly,MMP-9 expression was higher in R + GW group than both control and R groups [(166.9 ± 7.9) vs.(41.3 ± 10.7) and (4.7 ± 1.1),P < 0.05].(5) Expressions of PPARγand NF-κB:in the control group,PPARγ expression emerged after 2 h HIRI,and reached the peak with 8 h HIRI,decreased significantly with 24 h HIRI.NF-κB expression elevated with time,and at the peak with 24 h HIRRI.In R + GW group,the PPARγ expression was similar to control group and high expression of NF-κB were detected at all three endpoints.In R group,marked expression of PPARγ was observed after 2 h HIRI,and reached to peak after 24 h HIRI.NF-κB showed weakly positive expression after 2 h HIRI.Conclusions Rosiglitazone could significantly reduce hematogenous spread of hepatocellular carcinoma after hepatic ischemia reperfusion in mice.This may be attributed to NF-κB expression inhibition by PPARγ up-regulation and decreased MMP-9 production after pretreatment with Rosiglitazone.
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Objective To investigate the changes in ATPase activity of diaphragm in rats with acute organophosphorus poisoning (AOPP) and to explore the effect of Xuebijing injection on the ATPase activity. Methods 24 clean healthy Spraue-Dawley(SD)rats were divided into control group,model group and Xuebijing treatment group by means of random number table,with 8 rats in each group. AOPP model was established by intra-gastrical administration of 50 mg/kg oxide dimethoate. In Xuebijing treatment group,after oxide dimethoate administration,intraperitoneal injection of Xuebijing(10 mL/kg)was given at the same time,while in control group and model group,equal amount of normal saline(NS)was injected via the same route. The rats were sacrificed at 6 hours after model formation,and their diaphragms were taken sterilely. The activities of Na+-K+-ATPase and Ca2+-ATPsae of diaphragms were detected by enzyme linked immunosorbent assay(ELISA). The histopathological changes in diaphragms of rats were observed with light microscopy. Results 6 hours after intoxication,the diaphragm Na+-K+-ATPase activity of rats in model group was markedly lower than that in control group(mmol?h-1?g-1:5.22±0.74 vs. 9.98±0.37,P<0.01),while the Na+-K+-ATPase activity in Xuebijing treatment group(6.93±1.14) was markedly higher than that in model group(P<0.05). The diaphragm Ca2+-ATPase activity of rats in model group was markedly lower than that in control group(mmol?h-1?g-1:7.45±0.74 vs. 12.08±0.74,P<0.01),while the Ca2+-ATPase activity in Xuebijing treatment group(9.35±1.67)was obviously higher than that in model group(P<0.05)after intoxication for 6 hours. Light microscope observation indicated that there were swelling and necrosis in diaphragm in model group,while in Xuebijing treatment group no necrosis was found. Conclusion The diaphragm was degenerated and necrotic in AOPP rats,Xuebijing injection can lessen the injury in such rats,and the curative effect may be related to the improvement of the Na+-K+-ATPase and Ca2+-ATPsae activities of diaphragm.
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Objective To investigate the the effect of Amiodaroneo on acute myocardial infarction (AMI) and atrial fibrillation (AF) in elderly patients,and provide the basis for the treatment.Methods A total of 108 patients with AMI and AF in our hospital from January 2009 to June 2013 were collected and randomly divided into control and experimental groups,each group of 54 cases.The control group was treated with cedilanid and the experimental group were treated with amiodarone.AF control rate,sinus rhythm maintenance rate and adverse reactions of the two groups were analyzed and compared after treatment.Results The AF control rate of experimental group was significantly higher than that of control group in 6 h,12 h,24 h and 48 h after treatment (x2=5.173,5.066,4.757,6.684,P<0.05).Sinus rhythm maintenance rate of experimental group was increased compared with control group (47 cases vs.24 cases,x2=21.748,P<0.01).Adverse reaction rates of the experimental group was lower than the control group (x2 =15.621,P<0.01).Conclusions The treatment of AMI and AF by amiodarone is betterr and safe than cedilanid alone,so it is worth popularizing and applying on clinic.
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Objective To investigate the effect of ischemia/reperfusion(I/R) on tumor metastasis in a experimental mouse model of hematogenous metastasis after I/R; we also quantitated expression of matrix metalloproteinases-9 (MMP-9) during I/R.Methods An experimental mouse model of metastasis after partial hepatic I/R was designed to determine the effects of I/R on tumor metastasis to liver.Tumor loads were valued 7 days after operation.In addition,tissue analysis for alanine transaminase,aspartate transaminase (AST) and matrix metalloproteinases and 8 h reperfusion were performed.Results After 2 h hepatic reperfusion,ALT and AST in I 45 min group were higher than the sham group and I 30 min group (P <0.05).ALT and AST in the sham group were both a little higher than the normal.ALT and AST in the I 45 min group and I 30 min group at 8 h were both higher than those at 2 h reperfusion(P <0.05).The tumor load (valued by Hepatic replacement area) and the expression of MMP-9 in ischemic lobe in I 45 min group were greater than that after 30 min group and sham group.(P =0.013,P =0.007).There was no statistical difference on tumor load between the right lobe of sham operated mice and the right lobe (non-ischemic lobe) of mice subjected to I/R(P =0.089).Mouse survival were compared among the groups.Mice in Sham group lived longer than I 30 min group (P =0.041).And there were no statistical significance between I 45 min group and I 30 min group (P =0.055).MMP-9 expression in I 45 min group was higher than I 30 min group(P < 0.001).Conclusion Hepatic I/R promotes liver hematogenic metastasis of hepatocellular carcinoma in mice through induction of MMP-9 expression.
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Objective To evaluate the effect of Da Vinci surgical system for the treatment of hepatopancreatobiliary diseases.Methods The clinical data of 29 patients with hepatopancreatobiliary diseases who had undergone operations with Da Vinci surgical system from March to November 2009 at the General Hospital of PLA were retrospectively analyzed.Results The operations were successfully done on 28 patients,except 1 patient was converted to open pancreaticoenterostomy.The total operation time was(339±149)minutes,and the time for operations done with Da Vinci surgical system was(285±117)minutes.The postoperative bowl movement recovery time was(33±21)hours,and the length of postoperative hospital stay was(8±6)days.No blood transfusion was needed.Three patients had postoperative complications and were cured by conservative treatment.Conclusion Laparoscopic operations for hepatopancreatobiliary diseases can be applied with the help of the threedimensional imaging system and flexible surgical instruments of the Da Vinci surgical system,and its superiority is more obvious when applied for intractable hepatopancreatobiliary diseases.
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Objective To investigate and cure major complications after percutaneous transhepastic biliary drainage(PTBD).Methods The clinical data of 13 major complications after PTBD were retrospectively analyzed,5 complications were acute and the other 8 complications were delayed.Two cases were dealed with intervention.and operations were performed for the other 11 patients immediately.Results Among the 7 patients who received one-stage operation,3 patients were accompanied with acute kidney failure,and 2 patients were died.Two patients who received the second-stage operation recovered snccessfully.Two patients who surrendered were surrived 3 and 8 months respectively.Conclusions It is difficult to deal with the major complications after PTBD,and the main cause of postoperative death is acute kidney failure.It will be helpful to deal with the primary disease on the second-stage.
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Objective To evaluate the accuracy of bispectral index (BIS) for monitoring the depth of sevoflurane anesthesia in children of different ages.Methods One hundred and five children (0-14 yr) undergoing abdominal surgery were divided into 3 age groups (n=35 each): group Ⅰ 4-14 yr (older children); group Ⅱ 1-3 yr (young children) and group Ⅲ < 1 yr (infants). All of the patients were anesthetized with sevoflurane combined with epidural or caudal blockade. Anesthesia was induced with 5 % sevoflurane in O_2. After tracheal intubation, the patients were mechanically ventilated. P_(ET) CO_2 was maintained at 35-45 mm Hg. The end-tidal sevoflurane concentration (C_(ET)Sev) Was maintained at 3.2%, 2.6%, 1.9% and 1.4% in infants < 6 months andat 2.5%, 2.0%, 1.5% and 1.0% in children > 6 months. Each C_(ET)Sev was maintained for at least 15 min. MAP, HR, P_(ET)CO_2 and BIS were monitored and recorded before anesthesia (T_1, baseline), at loss of consciousness (T_2), immediately after tracheal intuhation (T_3), at the 4 C_(ET)Sev (T_(4-7)), recovery of pharyngeal reflex (T_8), extubation (T_9) and emergence of anesthesia (T_10). Results BIS values were significantly higher in children of 1-3 yr (group Ⅱ) than in children of 3-14 yr (group Ⅰ) at T_(4,6,7). BIS values were significantly lower in infants (group Ⅲ) than in children of 3-14 yr (group Ⅰ) at T_(5-9). BIS values were significantly lower in infants (group Ⅲ) than in children of 1-3 yr (groupⅡ) at T_(3-10). There was significant negative correlation between BIS and C_(ET)Sev in all 3groups(γ=-0.768,-0.709,-0.357).Conclusion BIS can accurately reflect the depth of sevoflurane anesthesia in children (> 1 yr). BIS should be interpreted cautiously in infants (< 1 yr).
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This paper discussed the methods of developing clinical thinking ability and the key emphasis on the related main medical and teaching activity.
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Objective To investigate the charaeteristcs of the acute poisoning patients in the emergency department of a general hospital in a new emerging district by analyzing the data of Hangzhou.Methods A retrospective study of the characteristics of the poisoning patients in emergency department of Tongde Hospital of Zhejiang Provinee from January 2004 to December 2004 was conducted and statistically analyzed.Results There were 318 poisoning patients in this year, accounting for 8.3% of the total patients in emergency department.Among these poisoning patients,female was 58.8% and male 41.2%;patients aged 21~30 years old accounted for 53.3%;alcoholic poisoning was the major cause and accounted for 34.3%,and 83.3% were male;as the second eanso,sedative accounted for 34.0%,and 72.4% were female;food poisoning accounted for 6.91%,and students was 90.9%.There was no relation between season and poisoning type.In the poisoning patients,30.8% were career men,and 19.5% were unemployed,19.6% were students,and 85.2 % were deliberate.Conclusion Young persons and career men were the high-risk group of poisoning, poisoning type was connected with work and gender.
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Standardized patients for interview has been widely used in medical education and examinations.Nevertheless the standard training of SP is still not widely used in China up to the present.Referring to the character of SP working as "the people providing case history","the assessor" and"the teacher",we have described how to write scenarioes,establish the score criteria,institute the training steps,form the measures of examination and supervision in detail in this article,and resummarized the experiences we got during the training period.
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<p><b>OBJECTIVE</b>To investigate the HLA-DRB1, DQB1 allele polymorphism in Kunming Yi nationality population.</p><p><b>METHODS</b>HLA-DRB1, DQB1 DNA types in 70 healthy children of Yi nationality in Kunming were analyzed by polymerase chain reaction with sequence specific primer (PCR-SSP).</p><p><b>RESULTS</b>Twelve alleles at HLA-DRB1 locus were observed in the 70 children: the alleles with gene frequencies higher than 10% were HLA-DRB1*12(33.57%), DRB1*0901(11.43%), DRB1*04(11.43%); the alleles with gene frequencies between 10% and 5% were HLA-DRB1*01(8.57%), DRB1*11(7.86%), DRB1*14(7.14%), DRB1*15(7.14%), DRB1*08(5%); the alleles with gene frequencies lower than 5% were HLA-DRB1*03(2.86%), DRB1*13(2.14%), DRB1*07(1.43%), DRB1*16(1.43%). Seven alleles at HLA-DQB1 locus were observed in the 70 children: the alleles with gene frequencies higher than 10% were HLA-DQB1*0301(45%), DQB1*05(22.14%), DQB1*0303(12.14%); the alleles with gene frequencies between 10% and 5% were HLA-DQB1*04(6.43%), DQB1*06(6.43%); the alleles with gene frequencies lower than 5% were HLA-DQB1*0201(4.29%) and DQB1*0302(3.57%).</p><p><b>CONCLUSION</b>The distribution of HLA-DRB1, DQB1 allele polymorphism in the Kunming Yi nationality population is distinctive. It is neither like that in the South Han population nor like that in the North Han population.</p>
Тема - темы
Humans , Alleles , China , HLA-DQ Antigens , Genetics , HLA-DQ beta-Chains , HLA-DR Antigens , Genetics , HLA-DRB1 Chains , Polymorphism, GeneticРеферат
Objective:To study the effect of Cyclosporine A preconditioning on liver preservation and transplantation in rat.Methods:Rats were divided randomly into control group (group A,HTK solution preservation) and CsA precondioning group (groupB,HTK solution preservation+1?M CsA).The livers of two groups were had been all preservated for 12 hours before operation of orthotopic liver transplantation.The content of serum AST,ALT,LDH were all assayed during preservation in 0h,12h and 7d post liver transplantation,as well as determination of mitochondrial respiration function parameters (RCR and P/O).The change of cell morphology and apoptosis were also observed by TUNEL stain,and miclroscopes in two groups.Results:The content of serum ALT,AST and LDH in group B were less than in group A after presenvation for 12 hours.RCR and P/O parameters of mitochondrial respiration in group B on preservation for 12h.and for 30 min after operation were more than in group A.Cell morphology and apoptosis changed slingtly compared with group B.Conclusion:CsA preconditioning can relieve injury of donated liver during cold preseration and reperfusion.It protects mitochondrial fuction of liver cells and inlibits cell apoptosisa.