Effect of goal-directed fluid therapy on gastrointestinal function of patients after laparoscopic radical resection of cervical cancer / 肿瘤研究与临床

Objective:To explore the effect of goal-directed fluid therapy (GDFT) on the gastrointestinal function of patients after laparoscopic radical resection of cervical cancer.Methods:A total of 60 patients who were scheduled for laparoscopic radical resection of cervical cancer in Shanxi Provincial People's Hospital from October 2016 to September 2018 were selected. They were randomly divided into observation group and control group by random number table method, with 30 cases in each group. Patients in the observation group received GDFT, they were connected to the Flotrac/Vigile monitoring system, and the fluid supplementation was guided according to the changes in mean arterial pressure (MAP), stroke volume variability (SVV) and cardiac index, the goal was to maintain MAP≥60 mmHg (1 mmHg = 0.133 kPa), SVV≤13%, and cardiac index 2.5-4.0 L·min -1·m -2. The conventional fluid therapy was applied in the control group, and the liquid's input speed was adjusted according to the changes of MAP and central venous pressure (CVP) which were respectively maintained at 60-110 mmHg and 8-12 cmH 2O (1 cmH 2O = 0.098 kPa). The crystal/colloid input, bleeding volume and urine output were recorded. The first bowel sounds recovery time, exhaust time, postoperative hospitalization time, and the incidence of nausea and vomiting after surgery were recorded. Arterial blood and central venous blood were drawn before anesthesia induction and 12, 24 and 36 hours after operation to determine the concentrations of arterial blood lactate and central venous oxygen saturation (ScvO 2) as well as intestinal type fatty acid binding protein (IFABP). Results:Compared with the control group, the urine output was increased ( t = -7.738, P < 0.01), the crystal input was reduced ( t = -13.439, P < 0.01), the colloid input was increased ( t = -8.360, P < 0.01), the recovery time of first bowel sounds after surgery was shortened ( t = 6.694, P < 0.01), the exhaust time was shortened ( t = -10.326, P < 0.01), and the time of postoperative hospitalization was shortened ( t = -7.377, P < 0.01). The incidence of nausea and vomiting in the observation group were 10.0% (3/30) and 6.7% (2/30), which were lower than 33.3% (10/30) and 26.7% (8/30) in the control group ( χ2 = 4.812, P = 0.028; χ2 = 4.320, P = 0.038). Compared with the control group, the concentration of IFABP in the observation group was reduced at 12 h ( t = 2.983, P = 0.004), 24 h ( t = 6.452, P < 0.01), and 36 h ( t = -3.880, P < 0.01) after surgery; the concentration of lactate in the observation group was reduced at 12 h ( t = -7.377, P < 0.01), 24 h ( t = -6.036, P < 0.01), and 36 h ( t = -8.933, P < 0.01) after surgery; the value of ScvO 2 in the observation group was increased at 12 h ( t = 2.710, P = 0.009) and 24 h ( t = 2.387, P = 0.020) after surgery. Conclusion:GDFT can maintain the balance between oxygen delivery and oxygen consumption in the gastrointestinal mucosa cells, which can promote the recovery of gastrointestinal function of patients undergoing laparoscopic radical resection of cervical cancer.

Median effective dose of 0.5% ropivacaine for ultrasound-guided femoral nerve block when combined with dexmedetomidine: dose based on per unit femoral nerve cross-sectional area / 中华麻醉学杂志

Objective:To determine the median effective dose (ED 50) of 0.5% ropivacaine when combined with dexmedetomidine based on femoral nerve cross-sectional area for ultrasound-guided femoral nerve block. Methods:American Society of Anesthesiologists physical statusⅠor Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 20-30 kg/m 2, scheduled for elective open reduction and internal fixation for patella fracture or removal of patella fracture by internal fixation, were randomly divided into dexmedetomidine and ropivacaine group (group DR) and ropivacaine group (group R). In group DR, 0.5% ropivacaine and 0.5 μg/kg dexmedetomidine were injected.In group R, 0.5% ropivacaine was injected.Ultrasonic localization of femoral nerve was performed for measurement of the femoral nerve cross-sectional area, and 0.5% ropivacaine was injected based on the area.ED 50 was determined by Dixon′ s up-and-down sequential method.The initial dose was 0.22 ml/mm 2, and the difference between the two successive doses was 0.02 ml/mm 2.The effective block was defined as complete loss of pain sensation in the areas of anterior skin of knee joint, skin on the inner side of the calf and dorsal medial skin of the foot and the degree of motor block was in stages 1-3 assessed using Brunnstrom motor function within 30 min after nerve block.Nerve block was considered ineffective if pain occurred in any nerve distribution area mentioned above.The study was terminated if 7 effective and ineffective alternating waves occurred.ED 50 and 95% confidence interval (CI) were calculated using Probit analysis. Results:In group R, 27 patients were enrolled in the study, and ED 50 (95%CI) of 0.5% ropivacaine for ultrasound-guided femoral nerve block was 0.106 (0.069-0.125) ml/mm 2.In group DR, 23 patients were enrolled in the study, and ED 50 (95% CI) of 0.5% ropivacaine for ultrasound-guided femoral nerve block was 0.038 (0.011-0.059) ml/mm 2.Compared with group R, ED 50 of 0.5% ropivacaine for femoral nerve block was significantly decreased in group R. Conclusion:When combined with dexmedetomidine 0.5 μg/kg, ED 50 of 0.5% ropivacaine based on femoral nerve cross-sectional area for ultrasound-guided femoral nerve block is 0.038 ml/mm 2.

Research on ligase-ELISA method for detecting K-ras gene mutations / 重庆医学

Objective To research a simple and sensitive K-ras gene mutations detection method in order to be suitable for the routine mutation detection.Methods The corresponding detection locus oligonucleotide probe was designed.By the connection,amplification,labeling and ELISA reaction in probe,the mutation locus genotype was determined by the ELISA reaction detection value.With the six point mutations of G12S,G12R,G12C,G12D,G12A and G12V in 12 codons of K-ras gene as the detection objects,the plasma circulation DNA sample in 72 cases of lung cancer was detected,then the results were compared with those obtained by the direct sequencing.Results Three samples were identified as the G12S,G12R and G12A mutatins by the established method.But no K-ras mutations were detected in the samples by using the direct sequencing,indicating that the direct sequencing had lower sensitivity and was not suitable for the mutation detection of heterogeneous samples such as circulating DNA.Conclusion The simple and sensitive K-ras gene mutation detection method is established and can conduct the routine mutation detection for the heterogeneous samples.

Research progress of tuina for children with diarrhea / 国际中医中药杂志

Infantile diarrhea is pediatric clinical common diseases. In this paper, according to the related literature in recent years, the effect mechanism of massage treatment of infantile diarrhea, according to syndrome differentiation treatment based on different massage for parting with Chinese medicine and massage, acupuncture and so on has carried on the induction.

Study on drug resistance genes forβ-lactams in multidrug-resistant Acine-tobacter baumannii / 中国感染控制杂志

Objective To investigate prevalence of resistance genes for β-lactams in clinically isolated multidrug-resistant Acinetobacter baumannii (MDRAB)in a hospital.Methods 22 clinically isolated MDRAB strains were performed antimicrobial susceptibility testing,resistance genes forβ-lactams (TEM,SHV,CTX-M,PER,DHA, IMP ,VIM ,SIM,OXA-23,OXA-24,and OXA-58)in these strains were detected with polymerase chain reaction. Results The resistant rates of 22 isolates of MDRAB to ceftazidime,cefotaxime,cefepime,gentamycin,amikacin, ciprofloxacin,and compound sulfamethoxazole were all 100.00%;to imipenem,meropenem,and cefoperazone/sul-bactam were 50.00%,40.91 %,and 31 .82% respectively,intermediated rates were 31 .82%,36.36%,and 31 .82% respectively.The carriage rates of OXA-23,TEM,IMP ,and PER were 100.00% (n =22),72.73 %(n=16),54.55% (n = 12),and 18.18% (n =4)respectively.Detection results of SHV,CTX-M,DHA,VIM , SIM,OXA-24,and OXA-58 were all negative.Conclusion Carriage of IMP ,TEM,PER,and OXA-23 resistance genes are the major resistance mechanisms of MDRAB to β-lactamase antimicrobial agents in this hospital.

Ethical Thinking on Hospital Laboratory Information System / 中国医学伦理学

This paper discussed the existing problems of Information System ( LIS) from six aspects, inclu-ding:the security and the expansion of the function, protection of patients′privacy, the establishment of emergency response mechanisms, authenticity and accuracy of data and the risks for auto-approval rules, etc.The authors also analysed the necessity of its rectification from the perspective of ethics, proposed improvement programme and suggestions: strengthening the safety management systems and data, ensuring special check the confidentiality of the project, protect the patient′s privacy;setting up emergency mechanism;hospital based on the actual workload and resources to determine the LIS function module; regularly checking the test data, to avoid occupational inju-ries;continuously improving the rigour of automatic approval rules.

Utilization of IQM data of GEM3000 blood gas analyzer for evaluating instrument performance / 国际检验医学杂志

Objective To apply the IQM quality data of the GEM 3000 blood gas analyzer to evaluate the instrument performance and to compared it with the traditional evaluation method .Methods The precision and accuracy were calculated by using the IQM data ,the external quality control substance was adopted to verify the main performance indexes of the blood gas analyzer .Results The precision of PH ,PCO2 and PO2 calculated by using the IQM data was 0 .02% ,2 .16% and 0 .63% ,which by the traditional e-valuation method was 0 .07% ,1 .68% and 1 .28% respectively ,the accuracy of PH ,PCO2 and PO2 calculated by using the IQM data was 0 .00% ,1 .15% and 0 .49% ,which by the traditional evaluation method was 0 .11% ,2 .91% and 1 .07% respectively .Conclu-sion The intelligent quality management can provide objective and reliable indicators for the performance evaluation of the blood gas analyzer ,and compared with the traditional performance evaluation scheme which is more simple and convenient to operate .

Identification and virulence gene detection of non-O1 and non-O139 Vibrio chol-erae isolates causing septicemia / 中国感染与化疗杂志

Objective To identify an suspected Vibrio cholerae isolated from Xiangyang Central Hospital and characterize the strain in terms of antibiotic resistance and relevant virulence genes.Methods Pathogen identification and susceptibility testing were completed with MicroScan WalkAway 40 Automated Microbiology System.Slide agglutination was used for serotyping. PCR and sequencing technology were employed for 16s RNA gene analysis.PCR technique was used to detect six major viru-lence genes.Results This suspectedVibrio cholerae isolate was confirmed as non-O1 and non-O139 Vibrio cholerae .Suscep-tibility testing results indicated that the strain was sensitive to ampicillin,chloramphenicol,trimethoprim-sulfamethoxazole, and tetracycline.16s RNA gene sequence analysis showed 100% homologous with the registered sequence in National Center for Biotechnology Information database.Virulence genes rtxC and toxR were identified.The other virulence genes such as tcpAET,ctxA,hlyA,and tcpACL were negative.Conclusions This suspected Vibrio cholerae isolate is confirmed as non-O1 and non-O139 Vibrio cholerae .The pathogenic factors may be related to the virulence genes rtxC and toxR.

Rapid determination of plasma concentration of Digoxin with Abbott i4000 and its clinical application / 中国基层医药

Objective To explore the possibility of guiding clinical fast diagnosis and rational use of drugs by rapid detection of plasma digoxin concentration(PDC) with i4000.Methods The plasma samples of 132 patients were collected and digoxin concentration was detected by i4000,and the relationship between PDC and clinical effect was analyzed.Then,the regularities of distribution of digoxin concentration also analyzed according to the age and PDC.The patients whose PDC beyond the effective concentration 0.8 ～ 2.0 μg/L,were treated with adjusted dose respectively according to the circumstance and continuous monitoring of PDC.Results In 132 cases,PDC of 106 patients within the therapeutic dose,accounted for 80.30％,and the total effective rate was 86.36％ after treatment.The effective rates in ＜0.8μg/L group,0.8 ～2.0μg/L group and ＞2.0μg/L group were 10.91％,95.28％and 75.00％,respectively.After dosage adjusted for 1 1 cases with PDC ＜ 0.8μg/L and 4 cases ＞ 2.0μg/L,the PDC returned to the effective concentration.The PDC in over 60 years old group was higher than that in 50 ～ 60 years old group.Poisoning symptoms occurred in 7 cases,and symptoms disappeared through adjustment dosages.Conclusion The PDC detection by Abbott i4000 is rapid and easy to operate,and the result is accurate and reliable.

Comparative study of minimally invasive versus open esophagectomy for esophageal cancer in a single cancer center / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In order to minimize the injury reaction during the surgery and reduce the morbidity rate, hence reducing the mortality rate of esophagectomy, minimally invasive esophagectomy (MIE) was introduced. The aim of this study was to compare the postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing minimally invasive or open esophagectomy (OE).</p><p><b>METHODS</b>The medical records of 176 consecutive patients, who underwent minimally invasive esophagectomy (MIE) between January 2009 and August 2013 in Cancer Institute & Hospital, Chinese Academy of Medical Sciences, were retrospectively reviewed. In the same period, 142 patients who underwent OE, either Ivor Lewis or McKeown approach, were selected randomly as controls. The clinical variables of paired groups were compared, including age, sex, Charlson score, tumor location, duration of surgery, number of harvested lymph nodes, morbidity rate, the rate of leak, pulmonary morbidity rate, mortality rate, and hospital length of stay (LOS).</p><p><b>RESULTS</b>The number of harvested lymph nodes was not significantly different between MIE group and OE group (median 20 vs. 16, P = 0.740). However, patients who underwent MIE had longer operation time than the OE group (375 vs. 300 minutes, P < 0.001). Overall morbidity, pulmonary morbidity, the rate of leak, in-hospital death, and hospital LOS were not significantly different between MIE and OE groups. Morbidities including anastomotic leak and pulmonary morbidity, inhospital death, hospital LOS, and hospital expenses were not significantly different between MIE and OE groups as well.</p><p><b>CONCLUSIONS</b>MIE and OE appear equivalent with regard to early oncological outcomes. There is a trend that hospital LOS and hospital expenses are reduced in the MIE group than the OE group.</p>

Multiresistant Genes of Pseudomonas aeruginosa in Different Areas: An Epidemiological Study / 中华医院感染学杂志

OBJECTIVE To investigate the distribution of multiresistant genes produced by Pseudomonas aeruginosa(PAE) isolated from different areas.METHODS Antimicrobial sensitivities of 104 strains of PAE to 13 kinds of antibiotics were determined by K-B method,of which 16 kinds of drug resistant genes were tested by polymerase chain reaction(PCR) and analyzed by clustering method of multi-molecular markers.RESULTS The resistant detective rates to imipenam in three areas were respectively 51.3%,80%,and 100% and that to the third generation cephalosporin were moving from 48.2% to 100%.The detective rate of oprD2 absent was 90-100%.There were similar phenomena of prevalence between some strains in these areas.oprD2 Absent was the main mechanism of prevailing strains in Shaoxing,however,clone strains in Huzhou were caused by TEM,oprD2 absent,aac(3)-Ⅱ,ant(3″)-Ⅰ and qacE△1.CONCLUSIONS There is a multiresistance to antibiotics in PAE isolated from different areas and the phenomena of prevalence are occurred in these areas,but the mechanisms of drug resistant are different.

Correlated Factors in Hospital Acquired Infection of Liver Cirrhosis / 中华医院感染学杂志

OBJECTIVE To study the correlated factors in acquired infection of liver cirrhosis and offer more reliable theory of treatment for clinic. METHODS The liver cirrhosis history of 302 cases was retrospectively analyzed and reviewed. RESULTS From them 43 cases acquired infection during hospitalization, with 61 case-times of infection, the rate of hospital acquired infection was 14.2%, the rate of case-times of infection was 20.20%. Nineteen cases were died and the mortality rate was 44.19%, Among the 259 non-infected patients only 5 cases were died, the mortality rate was 1.93%, the difference was significant (P

Nosocomial Infection with Pseudomonas aeruginosa and Approach of Drug-resistance:A Clinical Overview / 中华医院感染学杂志

OBJECTIVE To investigate nosocomial infection and drug-resistance of Pseudomonas aeruginosa(PAE) in our hospital to provide the evidence for clinical monitoring and control of nosocomial infection.METHODS The microbiological system MicroScan WalkAway-40 was used to identify PAE and the drug-resistance in vitro was determined by K-B methods.RESULTS Among 325 strains of PAE in two years,imipenem-resistant P.aeruginosa(IRPA) accounted for 14.8%.The highest isolating rates occurred in the intensive care unit(ICU),accounted for 20.9%.The following was senile disease department,accounted for 19.4%.The respiratory department rated the third,accounted for 16.9%.The resistance of IRPA to 11 kinds of common antibiotics was significantly higher than imipenem-sensitive P.aeruginosa(ISPA).Except the drug-resistance of IRPA to ceftazidime,cefepime and aztreonam was below 50.0%,that to the other eight antibiotics was all over 50.0%.CONCLUSIONS The drug-resistance of PAE is very serious in our hosptial.We should perform rigorous monitoring and prevent the outbreak of nosocomial infection with PAE.

Study on resistant genes of beta-lactam antibiotics from clinical isolates of Pseudomonas aeruginosa / 中华检验医学杂志

Objective To investigate ?-Lactamase coding genes and OprD2 gene in multidrug-resistant Pseudomonas aeruginosa isolated from Xiangfan region in Hubei province.Method Polymerase chain reaction(PCR) was used to detect various ?-Lactamase coding genes including TEM、SHV、OXA、PER、GES、IMP、VIM、plasmid type AmpC ?-Lactamase DHA 、MIR and OprD2 in 35 strains of Pseudomonas aeruginosa.Results The detection rate of ?-Lactamase coding genes TEM、OXA、plasmid type AmpC ?-Lactamase DHA were 51.4%、17.1% and 2.9% respectively, all of the tested strains of Pseudomonas aeruginosa lossed OprD2 gene,but SHV、PER、GES、IMP、VIM、MIR genes were negative.Conclusion The study indicated that these Pseudomonas aeruginosa carried genes of TEM、OXA、plasmid type AmpC ?-Lactamase DHA and lossed OprD2 gene, which was the essential resistance mechanism of Pseudomonas aeruginosa to Beta-lactam antibiotics in local aera.

Imipenem Resistance Mechanisms in Pseudomonas aeruginosa / 中华医院感染学杂志

OBJECTIVE To study the mechanisms of imipenem resistance in Pseudomonas aeruginosa.METHODS PCR method was used to detect and analyze P.aeruginosa imipenem-resistance associated IMP gene and VIM gene of metallo-?-lactamases and outer membrane protein D2(OprD_2) gene.RESULTS All 35(imipenem)-resistant P.aeruginosa strains were negative for IMP gene and VIM gene of metallo-?-lactamases;and for OprD_2 gene;but 23S rRNA gene of all 35 P.aeruginosa strains was positive.CONCLUSIONS The study suggested that in(Xiangfan) area,Hubei Province P.aeruginosa doesn′t produce metallo-?-(lactamases),but in genetics it is(identified) that the loss of outermembrane protein D2(OprD_2) gene is the(essential) mechanisms of imipenem(resistance) in P.aeruginosa in Xiangfan area,Hubei Province.

Paragonimus skrjabini Infection in Animal Reservoir Hosts and Questionnairing in Residents at a Village of Hubei Province / 中国寄生虫学与寄生虫病杂志

Freshwater crabs (Sinopotamon denticulatum) were examined for metacercariae. Cats and dogs were also examined for Paragonimus infection. Questionnairing was carried out on health knowledge and behaviors among local residents in a village of Baokang County, Hubei Province. Results showed that the infection rate of Paragonimus skrjabini metacercariae in Sinopotamon denticulatum was 20.5% (46/214), with 15.6% (20/128) in a mining area and 30.2%(26/86) for the non-mining area respectively ( ?2=6.5, P0.05). Questionnairing showed that dogs and cats were with the habit of foraging and defecating at streams and children had the habits of eating raw or under-cooked crabs. The natural and ecological environments are in favor of the life cycle of P. skrjabini.