[Preliminary clinical application of novel magnetic navigation and ultrasound-guided percutaneous transhepatic cholangiography drainage through the right liver duct for malignant obstructive jaundice].

Objective: To analyze the clinical application value of a novel magnetic navigation ultrasound (MNU) combined with digital subtraction angiography (DSA) dual-guided percutaneous transhepatic biliary drainage (PTCD) through the right hepatic duct for the treatment of malignant obstructive jaundice. Methods: Randomized controlled trial. The clinical data of 64 patients with malignant obstructive jaundice requiring PTCD through the right hepatic duct at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People's Hospital) from December 2018 to December 2021 were retrospectively analyzed. The MNU group (n=32) underwent puncture guided by a novel domestic MNU combined with DSA, and the control group (n=32) underwent puncture guided by traditional DSA. The operation time, number of punctures, X-ray dose after biliary stenting as shown by DSA, patients' tolerance of the operation, success rate of the operation, pre- and post-operative total bilirubin, and incidence of postoperative complications were compared between the two groups. Results: The operation time of the MNU group was significantly shorter than that of the control group [(17.8±7.3) vs. (31.6±9.9) min, t=-6.35,P=0.001]; the number of punctures in the MNU group was significantly lower [(1.7±0.6) vs. (6.3±3.9) times, t=-6.59, P=0.001]; and the X-ray dose after biliary stenting as shown by DSA in the MNU group was lower than that in the control group [(132±88) vs. (746±187) mGy, t=-16.81,P<0.001]; Five patients in the control group were unable to tolerate the operation, and two stopped the operation, however all patients in the MNU group could tolerate the operation, and all completed the operation, with a success rate of 100% (32/32) in the MNU group compared to 93.8%(30/32) in the control group; the common complications of PTCD were biliary bleeding and infection, and the incidence of biliary bleeding (25.0%, 8/32) and infection (18.8%, 6/32) in the MNU group was significantly lower than that in the control group, 53.1% (17/32) and 28.1% (9/32), respectively. Conclusion: Magnetic navigation ultrasound combined with DSA dual-guided PTCD through the right biliary system for the treatment of malignant obstructive jaundice is safe and feasible.

[Observation of effective dosage of remimazolam tosilate used for moderate-to-deep sedation in fiberoptic bronchoscopy].

Objective: To estimate the safety and efficacy of remimazolam tosilate used for moderate-to-deep sedation in fiberoptic bronchoscopy with its 50% effective dosage (ED50) and 95% effective dosage (ED95) calculated. Methods: A total of 50 patients aged from 18 to 65 years and classified as Class Ⅰ or Ⅱ according to the American Society of Anesthesiologists (ASA) Classification who underwent fiberoptic bronchoscopy in Hainan Cancer Hospital from April to August of 2020 were included in this study. For each patient, bronchoscopy was only started when the eyelash reflex disappeared and MOAA/S score was<1 after a trial dose of remimazolam tosilate combined with 0.1 µg/kg sufentanil was intravenously given. The dosage of remimazolam tosilate for the first patient was 0.18 mg/kg, based on which the dosages for the following patients were increased or decreased by 1∶1 times for one another, forming an equal ratio sequence. A maintenance dose of remimazolam tosilate was pumped intravenously in a rate of 1 mg/(kg·h) during the bronchoscopic examination and treatment. The result of the sequential trial, the time to achieve proper sedation, the analepsia time and the adverse effects were recorded. Results: All the 50 patients went through bronchoscopy completely. The regression function of the sequential trial was Y=12.589+16.593X, the ED50 and the ED95 of remimazolam tosilate were 0.174 (95%CI: 0.162-0.186) mg/kg and 0.219 (95%CI: 0.199-0.312) mg/kg, respectively. The time to achieve proper sedation was (50±11) s and the mean analepsia time after the use of flumazenil was (56±16) s. There was one patient with respiratory inhibition, one with headache and dizziness, one with fatigue among the 50 patients. Conclusions: The strategy of moderate-to-deep sedation based on remimazolam tosilate is safe and effective in bronchoscopic examination and treatment. When combined with 0.1 µg/kg sufentanil, the ED50 and the ED95 of remimazolam tosilate are 0.174 mg/kg and 0.219 mg/kg, respectively.

MiR-328 inhibits cell apoptosis and improves cardiac function in rats with myocardial ischemia-reperfusion injury through MEK-ERK signaling pathway.

OBJECTIVE: To explore the influences of micro ribonucleic acid (miR)-328 on rats with myocardial ischemia-reperfusion (IR) injury through the methyl ethyl ketone (MEK)/extracellular signal-regulated kinase (ERK) signaling pathway. MATERIALS AND METHODS: A total of 36 Sprague-Dawley rats were randomly assigned into the sham group (n=12), model group (n=12), and miR-328 group (n=12). The model of myocardial IR injury was established by ligating the left anterior descending coronary artery, without any intervention in the model group, while 200 µL of miR-328 antagomir was intravenously injected before modeling in the miR-328 group. The activity of the serum myocardial enzymes lactate dehydrogenase (LDH) and creatine kinase-muscle/brain (CK-MB) was determined via ELISA to assess the cardiac function in the three groups of rats, and the mRNA expression level of miR-328 in myocardial tissues was measured through real-time fluorescence qRT-PCR in the sham group, model group, and miR-328 group. TUNEL staining was performed to detect apoptotic cells, and the levels of myocardial apoptosis-associated protein Caspase-3 and phosphorylated MEK1/2 (p-MEK1/2) and p-ERK1/2 proteins were determined using Western blotting. RESULTS: Compared with the sham group, the model group exhibited increased activity of LDH and CK-MB, miR-328 expression level, apoptotic cells, the relative expression level of Caspase-3, and protein levels of p-MEK and p-ERK, with statistically significant differences (p<0.05). Besides, in comparison with the model group, miR-328 group showed a decreased activity of LDH and CK-MB, miR-328 expression level, the relative expression level of Caspase-3, and protein levels of p-MEK and p-ERK, displaying statistically significant differences (p<0.05). CONCLUSIONS: MiR-328 modulates the MEK-ERK signaling pathway to inhibit cell apoptosis and improve the cardiac function in rats with myocardial IR injury.

[Effects of functional electrical stimulation based on normal gait pattern on walking function in subjects with recovery of stroke].

OBJECTIVE: To observe the effects of functional electrical stimulation(FES) based on normal gait pattern on walking function in subjects with recovery of stroke. METHODS: From December 2010 to January 2013, 58 patients with recovery of stroke were recruited from the Rehabilitation Medicine Departments of Sun Yat-sen Memorial Hospital and the Guangdong Provincial Traditional Chinese Medicine Hospital. And the Minimize software was used to divide them randomly into 1 of the 3 groups: four-channel FES group (n=29), single-channel FES group (n=15) and placebo electrical group (n=14) at the rate of 2∶1∶1. All received standardized rehabilitation program. The four-channel FES group received four-channel FES treatment based on normal gait pattern, the single-channel FES group received single-channel FES treatment, the placebo electrical group received the same electrical stimulation as the four-channel FES group, but without current output when stimulating. Stimulation lasted for 30 min/d, 1 session / d, 5 d/w for 3 weeks. All subjects in the three groups received Fugl-Meyer Assessment scale (FMA), Berg Balance scale (BBS), gait speed during a 10-meter walking test, muscle co-activation index (CI) of the lower extremity during walking and the Modified Barthel index (MBI) assessments before and after 3 weeks treatment. RESULTS: Before treatment, the FMA, BBS and gait speed during a 10-meter walking test of the four-channel FES group were (23.0±2.2), (31±71) and (0.23±0.10), respectively. After 3 weeks treatment, the scores were improved to (28.4±1.5), (42±6)and(0.43±0.09), respectively. And the FMA, BBS and gait speed during a 10-meter walking test of the ingle-channel FES group increased from (21.9±3.4), (31±6) and (0.24±0.09) to (26.6±1.8), (38±5) and (0.34±0.08), respectively. The placebo electrical group increased from (23.6±3.0), (33±5) and (0.25±0.09) respectively to (26.0±2.4), (36±4) and (0.29±0.08). And the FMA, BBS and gait speed during a 10-meter walking test of the three groups were significantly higher than those in pre-treatment (P<0.05), and the scores in four-channel FES group were significantly higher than the single-channel group and the placebo electrical group's (P<0.05). The MBI score of the three groups were all improved, but it didn't show difference among the three groups (P>0.05). The results of surface electromyography showed significant decrease in CI of quadriceps / hamstring of the 3 groups, and the four-channel FES group had more significant decrease than the other two groups (P<0.05). CONCLUSION: Functional electrical stimulation based on normal gait pattern could improve walking function in subjects with recovery of stroke.

Source and risk factors of a cutaneous anthrax outbreak, Jiangsu, Eastern China, 2012.

Anthrax is still a severe public health problem and threat to human health. A cutaneous anthrax outbreak occurred in Jiangsu Province, a non-endemic anthrax region of eastern China, from July to August 2012. Epidemiological and laboratory investigation were initiated to trace the source of infection and identify the risk factors of the outbreak. On 25 July 2012, 17 persons were exposed to a sick cow, which had been imported from northeast China a few days previously. Of the 17 exposed, eight developed symptoms between 1 and 8 days and were diagnosed as cutaneous anthrax cases. Three main genes of Bacillus anthracis were detected from both human and cow meat samples, indicating that the outbreak was associated with this infected cow. A retrospective cohort study showed that contact with blood and presence of skin damage contributed to the case infection with B. anthracis. The outbreak highlights the need to enhance quarantine for imported livestock, which should have been vaccinated prior to importation, the significance of education for high-risk individuals, and training for primary healthcare workers even in anthrax-free areas.

Effect of penehyclidine hydrochloride on the incidence of intra-operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia.

Intra-operative awareness can lead to serious adverse psychological consequences. We conducted a prospective, randomised, double-blinded trial in 920 patients undergoing breast cancer surgery under bispectral index-guided total intravenous anaesthesia to evaluate the effect of penehyclidine hydrochloride on intra-operative awareness. Patients were randomly divided to receive 0.01 mg.kg(-1) penehyclidine hydrochloride or saline intravenously 30 min before surgery. The pre-administration, pre-operative anxiety levels were assessed using a 100-mm visual analogue scale. Intra-operative awareness was defined as recall of intra-operative events using a modified Brice interview administered 2-6 h postoperatively, and in the next 24-48 h. A committee of three experts, blinded to the study conditions, independently scrutinised all reported recollections. We found no differences in depth of anaesthesia and patients' pre-operative anxiety levels between the two groups. The incidence of awareness with penehyclidine hydrochloride (0/456 patients; 0%) was significantly lower than with saline (5/452; 1.1%), p = 0.030. We conclude that penehyclidine hydrochloride reduced the incidence of intra-operative awareness in patients undergoing breast cancer surgery during general anaesthesia.

A smaller endotracheal tube combined with intravenous lidocaine decreases post-operative sore throat - a randomized controlled trial.

BACKGROUND: Post-operative sore throat (POST) has increasingly been a common clinical complication particularly in thyroid surgery. We conducted a trial to evaluate the effect of non-pharmacological [smaller-sized endotracheal tube (ETT)] combined with pharmacological intervention [lidocaine intravenous (i.v.)] on POST in women undergoing thyroid surgery. METHODS: Two hundred and forty patients scheduled for thyroid surgery were randomly divided into four groups: Group A, ETT size 7.0 with saline; Group B, ETT size 6.0 with saline; Group C, ETT size 7.0 with lidocaine; Group D, ETT size 6.0 with lidocaine. Patients in Groups C and D received i.v. 1.5 mg/kg lidocaine that was filled in syringe up to 10 ml 5 min before induction of anaesthesia; whereas patients in Groups A and B received an equal volume of saline. The incidence and severity of POST were evaluated at 1, 6 and 24 h after tracheal extubation. RESULTS: The highest incidence of POST occurred at 6 h after extubation in all groups. The incidence of POST was significantly lower in Group D compared with Groups A (23% vs. 62%, P < 0.01), B (23% vs. 42%, P = 0.03) and C (23% vs. 43%, P = 0.02) at 6 h after extubation. Group D had significantly decreased severity of POST compared with Groups A, B and C 6 and 24 h after extubation (P < 0.05). CONCLUSION: Use of smaller-sized ETT combined with i.v. lidocaine decreases the incidence and severity of POST in women undergoing thyroid surgery.

A semi-automatic approach to the segmentation of liver parenchyma from 3D CT images with Extreme Learning Machine.

This paper presents a semi-automatic approach to segmentation of liver parenchyma from 3D computed tomography (CT) images. Specifically, liver segmentation is formalized as a pattern recognition problem, where a given voxel is to be assigned a correct label - either in a liver or a non-liver class. Each voxel is associated with a feature vector that describes image textures. Based on the generated features, an Extreme Learning Machine (ELM) classifier is employed to perform the voxel classification. Since preliminary voxel segmentation tends to be less accurate at the boundary, and there are other non-liver tissue voxels with similar texture characteristics as liver parenchyma, morphological smoothing and 3D level set refinement are applied to enhance the accuracy of segmentation. Our approach is validated on a set of CT data. The experiment shows that the proposed approach with ELM has the reasonably good performance for liver parenchyma segmentation. It demonstrates a comparable result in accuracy of classification but with a much faster training and classification speed compared with support vector machine (SVM).