Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study.

OBJECTIVE: To review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management. METHOD: We searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients' disease course and follow-up records were analyzed and summarized. RESULTS: The airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia. CONCLUSION: During the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

Management practice of the entire process of stem cells clinical research in medical institutions / 中华医学科研管理杂志

Objective:The study aims to analyze the problems faced in the clinical research and management of stem cells, explore the construction of the entire process of stem cells clinical research, and promote the healthy and orderly development of the clinical research of stem cells.Methods:By consulting the literature and retrieval of relevant policies and regulations, this study analyzed the problems faced by the supervision and management department, medical institutions and researchers, this study and discussed the countermeasures for strengthening the management of the entire process of clinical research of stem cells in medical institutions.Results:There were imperfect internal system and poor management process, insufficient quality control of cell products, low quality of project management, and insufficient clinical research consciousness of stem cell clinical research management in medical institutions.Conclusions:Combined with the current management measures, guidance principles and medical institutions, we should improve the internal system of medical institutions, promote the centralized management and informatization construction of projects, strengthen cell quality control in the hospital, cultivate talent echelons and improve academic and ethical review capabilities, actively explore the management model that is suitable for the entire process of stem cell clinical research for medical institutions in China.

Current situation and management practice of qualified person system for stem cell clinical research in medical institutions / 中华医学科研管理杂志

Objective:To analyze and study the difficulties and countermeasures in the implementation of the Qualified Person(QP) system for stem cell clinical research, and share the experience of QP management practice in our hospital in order to promote and improve the construction of the QP management system in medical institutions.Methods:Comprehensive investigations were conducted to summarize and analyze the shortage of talents, unclear qualifications, unclear responsibilities, and lack of assessment standards in the QP system of medical institutions.Results:In view of the difficulties in the implementation of the current QP system, it is suggested to consider a combination of improving the system of laws and regulations, strengthening the top-level design of stem cell research institutions, clarifying the qualification threshold, refining QP responsibilities, continuing training and assessment system, establishing QP support system, etc.Conclusions:Medical institutions are responsible for stem cell clinical research, and the improvement of the QP system can promote the development of the cell industry in China.

The effect of arrival time on emergency retention and prognosis in patients with severe trauma / 中华急诊医学杂志

Objective:To explore the relationship between arrival time and the retention in emergency room and the prognosis in patients with severe trauma.Methods:The clinical data of 1 738 emergency trauma patients in emergency intensive care from trauma center information system of the First Affiliated Hospital of Soochow University were extracted. The emergency retention was the time in the emergency room ≥ 4 h. The 24 h of the day was divided into three shifts at 8:00, 15:00 and 22:00. Logistic regression model was used to calculate the crude OR and adjusted OR after adjustment by age, sex and RTS of emergency shifts, and COX regression analysis was performed with emergency death as the endpoint. Results:Among the total of 1 738 patients with severe trauma, there were 852 (49.02%) cases of emergency retention. Taking the morning shift as the reference baseline, the risks of emergency retention in middle shift and night shift were increased gradually. The OR value of night shift was statistically significant ( P<0.01), and the crude OR and adjusted OR were 2.21 (95% CI: 1.71-2.86) and 2.36 (95% CI: 1.76-3.18), respectively. The univariate COX regression model indicated that the crude HR of night shift was statistically significant ( HR=0.26, 95% CI: 0.08-0.90, P=0.033). However, the multivariate COX regression model showed no statistically significant differences in the adjusted HR of middle shift ( HR=0.96, 95% CI: 0.43-2.14, P=0.914) and night shift ( HR=0.40, 95% CI: 0.08-1.85, P=0.238), respectively. Conclusions:The arrival time of emergency trauma patients might be a contributor to the emergency retention, and night shift patients are more likely to encounter retention, but there is no significant effect on patient death.

Determination of Ginsenoside Rg1 ,Ginsenoside Re and Ginsenoside Rb1 in Xueluotong Capsules by HPLC / 中国药师

Objective:To establish an HPLC method for the determination of ginsenoside Rg1 ,ginsenoside Re and ginsenoside Rb1 in Xueluotong capsules. Methods:A column of Waters Symmetry C18 ( 250 mm × 4. 6 mm,5 μm) at the temperature of 35 ℃ was used to separate the target components, the mobile phase consisted of acetonitrile-water with gradient elution, the flow rate was 1. 0 ml ·min-1 , the detection wavelength was 203 nm and the injection volume was 10 μl. Results:The linear range of ginsenoside Rg1 was 0. 055-2. 732 μg(r=0. 9998), and the average recovery was 107. 23% with RSD of 1. 17%(n=6). The linear range of ginsenoside Re was 0. 341-8. 542 μg(r=0. 9999), and the average recovery was 101. 63% with RSD of 3. 52%(n=6). The linear range of gin-senoside Rb1 was 0. 717-14. 336 μg(r=0. 9997), and the average recovery was 100. 63% with the RSD of 3. 79%(n=6). Conclu-sion:The method is simple, accurate and reliable, which can be used for the quality control of Xueluotong capsules.

Effects of 630 nm Red and 460 nm Blue Light Emitting Diode Irradiation on Healing of the Skin Wound in Japanese Big-ear White Rabbit / 中国医学科学院学报

Objective To observe the effects of 630 nm red light and 460 nm blue light emitting diode irradiation on the healing of skin wounds in Japanese big-ear white rabbits. Methods The skin wound model was established with 8 Japanese big-ear white rabbits. Three parts of vulnus in each rabbit were used:two parts of vulnus were irradiated vertically by red and blue LED light,respectively(15 min/time),and the distance between lights and wounds was 15 cm;the 3part of the wound was used as a control. On the 21day of the wounds exposure to light,the number of healing wounds and the percentage of healing area were recorded and the treatment effect of these two light sources was compared. HE staining was used to analyze the newborn tissue structure. Masson staining was used to observe the proliferation of skin collagen fibers. Immuohistochemical staining was used to analyze fibroblast growth factor(FGF),epidermal growth factor(EGF),endothelial growth factor(CD31),proliferating cell nuclear antigen(Ki-67),and inflammatory cytokines(CD68)infiltration in the skin. Results The healing rate in the red light,blue light,and control groups was 50.0%(4/8),25.0%(2/8),and 12.5%(1/8),respectively. Since the 12day after modeling,the healing area percentage in the red light group was significantly higher than those in the blue light and control groups(P<0.05,P<0.01). On the 21day after modeling,the skin thickness of the red light group was(2.95±0.34)mm,which was significantly higher than that in control group [(2.52±0.42)mm;F=3.182,P=0.016)]. The average optical density of collagen fibers was 0.15±0.03 in red light group,which was significantly higher than that of the blue light group(0.09±0.01;F=7.316,P=0.012)and control(0.07±0.01;F=7.316,P=0.003). The results of immunohistochemistry showed the expression levels of EGF,FGF,CD31 antigen,and Ki-67 in the red light group were significantly higher than those in the blue light and control groups,whereas the CD68 expression was significantly lower(P<0.05 or P<0.01). Conclusion LED red light irradiation can promote the healing of skin wounds in Japanese big-ear white rabbits,which may be achieved by the effect of red light irradiation in stimulating the proliferation of skin epidermal cells,vascular endothelial cells,and fiberous tissue.

Molecular mechanism of tumor vasculogenic mimicry:research advances / 国际药学研究杂志

Vasculogenic mimicry(VM) refers to the plasticity of malignant tumor cells forming vessel networks to provide blood supply to perfusion of rapidly growing tumors. Key proteins associated with classical, stem cell, hypoxia-related and other multiple signaling pathways, which are involved in regulating functional plasticity of tumor cell VM, have become potential clinical therapeutic targets and diagnostic indicators of the aggressive, metastatic phenotype. VM has been observed in several tumor types and its occurrence is strongly associated with a poor prognosis. This review focuses on the origin and signal molecules and cascades involved in VM, and the clinical significance of VM regarding anti-angiogenesis treatment modalities.

A survey on diseases suffering in 5 068 members of rescue teams in Weachuan earthquake / 中华急诊医学杂志

Objective To investigate the incidence of diseases in member of rescue teams in the Wenchuan earthquake in Sichuan Province.Method Twenty days afer the Wenchuan earthquake in 2008,5 068 resucing staff of rescue learns as random and cluster sample were investigated and analyzed to find the factors impacting their fitness associated with their characters,diseases,work,and encampment styles.Results Members of rescue teams suffered from the following diseases:insect dermatitis (18.37%),tinea pedis (10.83%),acute upper respiratory infection (10.56%)and solar dermatitis (6.20%).Contrasted by work tasks,staff resucing on the front line had the highest incidence of acute upper-respiratory infection(11.04%) ,logistics workers had the highest incidence of tinea pedis(15.21% ),and more patients of acute gastroenteritis,insect dermatitis,gingivitis emerged from medical personnel group(P<0.05).The encampment sites were devided into three sorts:plain land,hillside and valley.The staff stayed at valley had higher incidence of acute upper respiratory infection (24.90%),insect dermatitis (36.50%) and tinca pedis (20.02%)than those worked at plain land and hillside (P<0.01).The incidence of acute gastroerrteritis(1.26%) ha staff resides hillside is lower than that in valley or plain land (P<0.05).Conclusions In the period of rescue actions in the guake-hit region,the members of rescue teams suffered from famihar diseases such as dermatitis and acute upper-respiratory infection,etc.The incidence of diseases is associated with their work tasks and the topography of cantonment.