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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative acute lung injury (ALI) in the pediatric patients undergoing living-related liver transplantation.Methods:Sixty pediatric patients of either sex, aged 4-24 months, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with New York Heart Association (NYHA) class Ⅰ or Ⅱ, with Child-Pugh B or C, scheduled to undergo elective left external lobe piggyback living-related liver transplantation, were divided into 2 groups ( n=30 each) using a computer-generated table of random numbers: control group (group C) and TEAS group (group T). In group T, bilateral Zusanli (ST36), Neiguan (PC6), and Feishu (BL13) acupoints were stimulated with disperse-dense waves at the initial intensity of 0.5 mA and frequency of 2/15 Hz, the current intensity was gradually increased until local slight muscle shaking appeared, and continuous stimulation lasted for 30 min at a 30-min interval (a cycle) until the end of operation. TEAS was performed for 30 min at the same time every day up to 1 week after surgery. Stimulus locations in group C were selected at 0.5 cm lateral to the acupoints, and the electrodes with inert medium were attached to the location, with no effective current output from acupuncture treatment instrument. The peak inspiratory pressure, plateau pressure, and pulmonary compliance were recorded before skin incision (T 0), at 30 min after portal vein occlusion (T 1), at 1 h after portal vein opening (T 2), at the end of operation (T 3), and the difference between peak inspiratory pressure and plateau pressure was calculated. Blood samples from the jugular vein were collected at T 0-3 to determine the levels of plasma club cell protein 16 (CC16), surfactant protein D (SP-D), soluble receptor for advanced glycation end products (sRAGE), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay. Blood samples from the radial artery were collected at T 0-3 for blood gas analysis, PaO 2 and A-aDO 2 were recorded, and oxygenation index (OI) and respiratory index (RI) were calculated. The indwelling time of postoperative tracheal tube and length of ICU stay were also recorded. The lung injury was assessed and scored using ultrasound at 48 h after surgery. The occurrence of ALI within 1 week after operation was also recorded. Results:Compared with baseline at T 0, OI was significantly decreased, RI was increased, and plasma IL-10 concentrations were increased at T 2, 3, and the plasma concentrations of TNF-α, CC16, sRAGE and SP-D were increased at T 1-3 in both groups ( P<0.05). Compared with group C, OI was significantly increased, RI was decreased, the plasma concentrations of sRAGE were decreased, and the plasma concentrations of IL-10 were increased at T 2, 3, and the concentrations of plasma TNF-α, CC16 and SP-D were decreased at T 1-3, the indwelling time of postoperative tracheal tube and length of ICU stay were shortened, the ultrasound score of lung injury was decreased ( P<0.05), and no significant change was found in the incidence of ALI in group T ( P>0.05). Conclusions:TEAS can alleviate ALI in the pediatric patients after living-related liver transplantation.
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Objective:To evaluate the role of nicotinamide adenine dinucleotide-dependent deacetylase Sirtuin3 (Sirt3) expression in peritoneal macrophages in dexmedetomidine-induced inhibition of inflammatory responses in septic mice.Methods:Sixty-four healthy male C57BL/6 mice, aged 7 weeks, weighing about 20 g, were divided into 4 groups ( n=16 each) using a random number table method: sham operation group (S group), sepsis group (Sep group), dexmedetomidine group (DEX group), and dexmedetomidine plus Sirt3 inhibitor 3-TYP group (TYP group). Sepsis was induced by cecal ligation and puncture.In group DEX, normal saline 0.25 ml was intraperitoneally injected at 1 h before development of the model, and 30 min later dexmedetomidine 50 μg/kg (in 0.25 ml of normal saline) was intraperitoneally injected.In group S and group Sep, the equal volume of normal saline was intraperitoneally injected at 1 h and 30 min before development of the model, respectively.In group S, laparotomy and cecal extraction were performed without ligation and perforation.Peritoneal lavage was obtained at 24 h after operation, and peritoneal macrophages were cultured for 1 h. The expression of Sirt3, interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) mRNA in peritoneal macrophages was detected using quantitative real-time polymerase chain reaction.Western blot was used to detect the expression of Sirt3 in peritoneal macrophages.The concentrations of IL-1β and TNF-α in peritoneal fluid were measured by enzyme-linked immunosorbent assay.The 10-day survival of mice in each group was observed, and the survival rates were calculated. Results:Compared with group S, the expression of Sirt 3 protein and mRNA in peritoneal macrophages was significantly down-regulated, the expression of IL-1β and TNF-α mRNA was up-regulated, the concentrations of IL-1β and TNF-α in peritoneal lavage were increased, and the 10-day survival rates were decreased in Sep, DEX and TYP groups ( P<0.05). Compared with group Sep, the expression of Sirt3 protein and mRNA in peritoneal macrophages was significantly up-regulated, the expression of IL-1β and TNF-α mRNA was down-regulated, the concentrations of IL-1β and TNF-α in the peritoneal lavage were decreased, and the 10-day survival rate was increased in group DEX ( P<0.05). Compared with group DEX, the expression of Sirt3 protein and mRNA and IL-1β and TNF-α mRNA in peritoneal macrophages was significantly up-regulated, the concentrations of IL-1β and TNF-α in peritoneal lavage were increased, and the 10-day survival rate was decreased in group TYP ( P<0.05). Conclusions:Up-regulation of Sirt3 expression in peritoneal macrophages is involved in the process of dexmedetomidine-induced inhibition of inflammatory responses in septic mice.
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Ectopic pregnancy is a common gynecological acute abdomen disease. Once the pregnant tissue is ruptured, it will rapidly develop into hemorrhagic shock or even death. In recent years, blood transfusion from the body is widely used in the rescue of intra-abdominal hemorrhage of ectopic pregnancy, which can reduce the time of cross matching and blood collection, reduce the risk of allogeneic blood transfusion, and enable patients with hemorrhagic shock to receive timely and effective treatment. Hemolysis caused by autologous blood transfusion is rarely reported. Once hemolysis occurs, if it is not handled in time, severe cases can occur acute renal injury, hyperkalemia, or cardiac arrest or even sudden death. We retrospectively analyzed the diagnosis and treatment of a patient with hemolysis after autologous blood transfusion, suggesting that the adverse reactions of blood transfusion occur not only in allogeneic blood transfusion, but also in autologous blood transfusion. It should be handled reasonably in clinical work to reduce the occurrence of similar complications.
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Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.
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Humans , Brain/physiopathology , Brain Waves/physiology , Electroencephalography/methods , Stroke/therapy , Stroke Rehabilitation/methods , Transcranial Direct Current Stimulation/methodsABSTRACT
Objective:To evaluate the effect of propofol postconditoning on retinoblastoma protein (Rb)-E2F1 signaling pathway in hippocampal neurons in a rat model of oxygen-glucose deprivation and restoration (OGD/R).Methods:Pregnant Wistar rats at 16-18 days of gestation were sacrificed, and the hippocampal neurons of fetal rats were obtained and primarily cultured for 7 days.The neurons were divided into 3 groups ( n=42 each) using a random number table method: control group (group C), OGD/R group (group O) and propofol postconditoning group (group P). In group O, the neurons were subjected to oxygen-glucose deprivation for 1 h, followed by restoration of oxygen-glucose.In group P, propofol (final concentration 1.2 μg/ml) was added immediately after restoration of oxygen and glucose, and the cells were cultured for 2 h and then the culture medium was replaced with plain culture medium.At 24 h of culture, the expression of p-Rb and E2F1 was determined by Western blot, and the cell cycle and apoposis rate were assessed by flow cytometry. Results:Compared with group C, the apoptosis rate was significantly increased, expression of p-Rb and E2F1 was up-regulated, the ratio of p-Rb nuclear/plasmosin protein and the proportion of neurons in G 0/G 1 phase were decreased, and the proportion of neurons in S and G 2/M phases was increased in O and P groups ( P<0.05). Compared with group O, the apoptosis rate was significantly decreased, expression of p-Rb and E2F1 was down-regulated, the ratio of p-Rb nuclear/plasmosin protein and the proportion of neurons in G 0/G 1 phase were increased, and the proportion of neurons in S and G 2/M phases was decreased in group P ( P<0.05). Conclusion:The mechanism by which propofol postconditioning decreases the apoptosis in hippocampal neurons is related to inhibiting Rb-E2F1 signaling pathway in a rat model of OGD/R.
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Objective:To evaluate the role of transient receptor potential melastatin 2 (TRPM2)-calcineurin A (CnA)-dynamin-related protein 1 (Drp1) pathway in propofol-induced reduction of renal injury induced by hepatic ischemia-reperfusion (I/R) in mice.Methods:Twenty-four SPF male C57BL6 mice, aged 8 weeks, weighing 20-23 g, were divided into 4 groups ( n=6 each) using a random number table method: sham operation group (group S), hepatic I/R group (group IR), propofol group (group P) and TRPM2 agonist (ADPR) combined with propofol group (AP group). Hepatic I/R injury was induced by occluding the portal vein and hepatic artery supplying the left and middle lobes of the liver for 60 min followed by reperfusion in anesthetized rats.In group P, 0.2 ml normal saline was injected intraperitoneally at 1 h before establishing the model and 1% propofol 30 mg/kg was injected intraperitoneally at 30 min before establishing the model.In group AP, ADPR 10 mg/kg (in 0.2 ml of normal saline) was injected intraperitoneally at 1 h before establishing the model, and 1% propofol 30 mg/kg was injected intraperitoneally at 30 min before establishing the model.The equal volume of normal saline was given intraperitoneally at 1 h and at 30 min before establishing the model in group S and group IR.Blood samples were taken from the eyeballs for determination of the levels of serum urea nitrogen (BUN), creatinine (Cr), aminotransferase (ALT) and aspartate aminotransferase (AST) at 6 h of reperfusion.The animals were then sacrificed and the kidney tissues were taken, the ultrastructure of myocardial mitochondria was observed using transmission electron microscopy, the average diameter of mitochondria was calculated, and the expression of TRPM2, CnA, phospho-Drp1 Ser637 (p-Drp1 Ser637) and cleaved caspase-3 was detected (by Western blot). Results:Compared with group S, the concentrations of serum BUN and Cr were significantly increased, the expression of TRPM2, CnA and cleaved caspase-3 in kidney tissues was up-regulated, the expression of p-Drp1 ser637 was down-regulated, and the average diameter of mitochondria was shortened in IR, P and AP groups ( P<0.05). Compared with group IR, the concentrations of serum BUN and Cr were significantly decreased, the expression of TRPM2, CnA and cleaved caspase-3 in kidney tissues was down-regulated, the expression of p-Drp1 Ser637 was up-regulated, the average diameter of mitochondria was prolonged ( P<0.05), mitochondrial injury was attenuated, and no significant change was found in the serum ALT and AST concentrations in group P, and no significant change was found in concentrations of BUN and Cr in serum in group AP ( P>0.05). Compared with group P, concentrations of BUN and Cr in serum was significantly increased, the expression of TRPM2, CnA and cleaved caspase-3 in kidney tissues was up-regulated, the expression of p-Drp1 Ser637 in kidney tissues was down-regulated, and the average diameter of mitochondria was shortened ( P<0.05), and mitochondrial injury was accentuated in group AP. Conclusion:The mechanism of propofol-induced reduction of renal injury induced by hepatic I/R is related to inhibiting the expression of TRPM2 in kidney tissues, decreasing the level of intracellular CnA and inhibiting dephosphorylation of Drp1 Ser637 in mice.
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Objective@#To evaluate response to public health emergencies in colleges and universities and associated factors, and to provide references for emergency response mechanisms in colleges.@*Methods@#Using stratified random sampling, recruited 7 719 students in 6 universities in Shandong Province during April May 2020, and analyzed the data with SPSS 25.0 software.@*Results@#About 65.5% of college students reported response to public health emergencies in their college, 67.7% of the students reported that colleges have emergency plans, 53.9% of the students reported that colleges have carried out simulated emergency training, and 64.7% of the students reported that colleges have carried out health education. Evaluation from students for responding to public health emergencies in colleges and universities scored(24.15±4.59), of which measures and policies related to epidemic control were highest(4.05±0.81), while mental health education or counselling services were lowest (3.95±0.85). Gender, grade, major, type of household registration, emergency response measures, emergency response plan, emergency simulation training, health education were associated with the evaluation of the measures by college students(t/F=5.04，43.83，79.92，-3.40，26.86，34.83，29.35，35.01，P<0.01).@*Conclusion@#While recognizing the overall performance on public health responses in universities, college students believe certain limitations still exist; colleges and universities should continuously improve the emergency prevention and control system of public health emergencies in response to the effectiveness and deficiencies in the prevention and control process.
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Objective:To explore the changes of neuron-specific enolase (NSE) and S-100β protein (S-100β) during perioperative period in infants undergoing living liver transplantation and examine the effect of brain injury.Methods:From January 2015 to January 2016 in Department of Anesthesiology First Central Clinical College Tianjin Medical University, study group was composed of forty infants of congenital biliary atresia with an age range of (4-12) months, a body weight of (4-10) kg and American Society of Anesthesiologists (ASA) class Ⅲ/Ⅳ. Another 40 infants undergoing general surgery were selected as control group. In study group, blood samples were harvested from central vein pre-operation (T0), before skin incision (T1), 30 min after anhepatic phase (T2), 1 h of neohepatic phase (T3) and 24h after hepato-reperfusion (T4). In control group, blood samples were collected at pre-operation (T0) and 24 h post-operation (T4). Serum levels of S-100β, NSE, heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP) and bispectral index (BIS) were monitored at T1-4 and end of surgery. All children were assessed by Bayley Scale of Infant Development (BSID) at Day 1 pre-operation and 2/4 weeks post-operation for observing mental and motor development status. The results were described with mental development index (MDI) and psychomotor development index (PDI). Pediatric anesthesia emergence delirium (PAED) was employed for evaluating the severity of delirium during the recovery stage at 30 min and 2/4h post-extubation.Results:In study group, serum levels of S-100β and NSE changed significantly during non-hepatic and neohepatic reperfusion phases. After inferior vena cava occlusion, serum concentrations of S-100β and NSE spiked ( P<0.05) and gradually recovered during neohepatic reperfusion period ( P<0.05). No significant inter-group difference existed in serum S-100β or NSE at T4 ( P>0.05). In study group, as compared with Day 1 pre-operation, MDI/PDI decreased at Week 2 post-operation ( P<0.05) and increased from Month 1 post-operation ( P<0.05). Both MDI and PDI were lower than control group before and at Week 2 post-operation ( P<0.05). MDI/PDI of study group basically reached the preoperative level at Month 1 post-operation ( P<0.05). In control group, no significant difference existed in MDI/PDI at Day 1 pre-operation and Week 2/4 post-operation ( P>0.05). In study group, the delirium rate was up to 30% post-extubation and decreased at 2/4h post-extubation. In control group, the incidence of delirium was low at 30 min and 2/4h post-extubation ( P<0.05). Conclusions:Perioperative evaluations of serum levels of NSE and S-100β are significant for predicting the postoperative onsets of delirium and cognitive impairment in children with living donor liver transplantation.
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Transcranial direct current stimulation (tDCS) is a brain stimulation intervention technique, which has the problem of different criteria for the selection of stimulation parameters. In this study, a four-layer real head model was constructed. Based on this model, the changes of the electric field distribution in the brain with the current intensity, electrode shape, electrode area and electrode spacing were analyzed by using finite element simulation technology, and then the optimal scheme of electrical stimulation parameters was discussed. The results showed that the effective stimulation region decreased and the focusing ability increased with the increase of current intensity. The normal current density of the quadrilateral electrode was obviously larger than that of the circular electrode, which indicated that the quadrilateral electrode was more conducive to current stimulation of neurons. Moreover, the effective stimulation region of the quadrilateral electrode was more concentrated and the focusing ability was stronger. The focusing ability decreased with the increase of electrode area. Specifically, the focusing tended to increase first and then decrease with the increase of electrode spacing and the optimal electrode spacing was 64.0-67.2 mm. These results could provide some basis for the selection of electrical stimulation parameters.
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Brain , Electric Stimulation , Electrodes , Head , Transcranial Direct Current StimulationABSTRACT
Transcranial direct current stimulation (tDCS) is an emerging non-invasive brain stimulation technique. However, the rehabilitation effect of tDCS on stroke disease is unclear. In this paper, based on electroencephalogram (EEG) and complex network analysis methods, the effect of tDCS on brain function network of stroke patients during rehabilitation was investigated. The resting state EEG signals of 31 stroke rehabilitation patients were collected and divided into stimulation group (16 cases) and control group (15 cases). The Pearson correlation coefficients were calculated between the channels, brain functional network of two groups were constructed before and after stimulation, and five characteristic parameters were analyzed and compared such as node degree, clustering coefficient, characteristic path length, global efficiency, and small world attribute. The results showed that node degree, clustering coefficient, global efficiency, and small world attributes of brain functional network in the tDCS group were significantly increased, characteristic path length was significantly reduced, and the difference was statistically significant (
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Humans , Brain , Electroencephalography , Stroke , Stroke Rehabilitation , Transcranial Direct Current StimulationABSTRACT
Objective To evaluate the efficacy of transversus abdominis plane (TAP) block combined with butopenol patient-controlled intravenous analgesia (PCIA) for analgesia after cesarean section under general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 18-42 yr,weighing 52-88 kg,at 38-42 weeks of gestation,scheduled for elective cesarean section under general anesthesia,were divided into 3 groups (n=30 each) using a random number table method:TAP block group (group TAP),butopenol PCIA group (group B) and TAP block plus butopenol PCIA group (group TB).In group TAP,bilateral TAP blocks were performed under ultrasound guidance at the end of surgery,and 0.375％ ropivacaine 20 ml was injected into each side.In group B,butopenol 1 mg was intravenously injected at 30 min before the end of operation,PCIA was performed at the end of surgery,PCIA solution contained butopenol 8 mg and ondansetron 8 mg (diluted to 100 ml in sodium chloride injection),and the PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Butopenol 1 mg was intravenously injected at 30 min before the end of operation,and TAP block in combination with butopenol PCIA was performed at the end of operation in group TB.When the postoperative visual analog scale score was greater than or equal to 4 points,morphine 10 mg was intramuscularly injected as rescue analgesic.The requirement for morphine was recorded within 48 h after operation.The occurrence of agitation during emergence from anesthesia and adverse reactions within 48 h after operation were also recorded.Results No adverse reactions such as hematoma at the puncture site or local anesthetic intoxication were observed in TAP group and TB group.Compared with group TAP,the incidence of postoperative shivering and requirement for morphine were significantly decreased in group TB (P＜0.05).The incidence of postoperative nausea and v omiting and requirement for morphine were significantly lower in group TB than in group B (P＜0.05).Conclusion The combination of TAP block and butopenol PCIA exerts better efficacy for analgesia after cesarean section under general anesthesia than either alone.
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Individual differences of P300 potentials lead to that a large amount of training data must be collected to construct pattern recognition models in P300-based brain-computer interface system, which may cause subjects' fatigue and degrade the system performance. TrAdaBoost is a method that transfers the knowledge from source area to target area, which improves learning effect in the target area. Our research purposed a TrAdaBoost-based linear discriminant analysis and a TrAdaBoost-based support vector machine to recognize the P300 potentials across multiple subjects. This method first trains two kinds of classifiers separately by using the data deriving from a small amount of data from same subject and a large amount of data from different subjects. Then it combines all the classifiers with different weights. Compared with traditional training methods that use only a small amount of data from same subject or mixed different subjects' data to directly train, our algorithm improved the accuracies by 19.56% and 22.25% respectively, and improved the information transfer rate of 14.69 bits/min and 15.76 bits/min respectively. The results indicate that the TrAdaBoost-based method has the potential to enhance the generalization ability of brain-computer interface on the individual differences.
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Humans , Algorithms , Brain-Computer Interfaces , Discriminant Analysis , Electroencephalography , Event-Related Potentials, P300 , Support Vector MachineABSTRACT
Objective To evaluate the effect of dexmedetomidine on renal function in pediatric pa-tients undergoing living donor liver transplantation. Methods Sixty pediatric patients of both sexes with congenital biliary atresia, aged 5-15 months, weighing 5. 5-10. 0 kg, of American Society of Anesthesiol-ogists physical status Ⅱ or Ⅲ, scheduled for elective living donor liver transplantation, were randomly di-vided into either control group (group C) or dexmedetomidine group ( group D) with 30 patients in each group. The infants were tracheally or nasotracheally intubated and mechanically ventilated after induction of anesthesia. Dexmedetomidine was intravenously infused in a loading dose of 1 μg∕kg for 10 min, followed by a continuous infusion of 0. 3 μg·kg-1·h-1until the end of operation in group D. While the equal vol-ume of normal saline was given instead of dexmedetomidine in group C. At skin incision (T1), at 30 min of anhepatic phase (T2), at 1 h of neohepatic phase ( T3), immediately after peritoneum closure ( T4) and at 24 h after operation (T5), blood samples from the central vein and urine specimens were collected for determination of creatinine and blood urea nitrogen (BUN) concentrations in serum (by colorimetric assay) and β2-microglobulin (β2-MG) concentrations in serum and urine (using immunoturbidimetric method), and concentrations of tumor necrosis factor-α, interleukin-6 (IL-6) and IL-18 in serum (by enzyme-linked immunosorbent assay). The urine volume was recorded during surgery. Results Compared with group C, the urine volume was significantly increased, and the serum creatinine, BUN and β2-MG concentrations and urine β2-MG concentrations at T3-5, serum BUN concentrations at T4,5, and serum tumor necrosis fac-tor-α, IL-6 and IL-18 concentrations at T2-5were decreased in group D (P＜0. 05). Conclusion Dexme-detomidine can improve renal function in pediatric patients undergoing living donor liver transplantation.
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Objective To observe the effect of hypothermia in reperfusion stage on prognosis during adult liver transplantation.Methods Data of 107 patients (62 males, 45 females, aged 25～65 years, ASA physical status Ⅲ or Ⅳ) underwent adult liver transplantation from January 2015 to December 2016 in our hospital were retrospectively analyzed.The temperature at the time of anesthesia induction (T0), skin incision (T1), anhepatic phase immediately (T2), immediate reperfusion (T3), 5 min after reperfusion (T4), abdomen-closing (T5) and the end of surgery (T6) were recorded to observe the trend of overall temperature change.Patients were devided into normal temperature group (core temperature was≥35℃ or ＜35℃ but the duration was less than 5 min in reperfusion period) and hypothemia group (core body temperature was ＜35℃ and the duration was>5 min) to compare difference between the two groups of perioperative blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time.The influence of hypothermia during the new liver phase (T4-T6) on prognosis and correlation between duration of hypothermia and blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time were analyzed.Results This study found that during the perioperative adult liver transplantation, the body temperature showed a decreasing trend first (T0-T4) and then an increasing one (T4-T6).The body temperature droped to the lowest at T4, which was lower than the normal body temperarure.Compared with T0, the temperature decreased obviously at T2-T5 (P＜0.05);Compared to normal temperature group, the amount of bleeding was more and the extubation time was longer in hypothermia group (P＜0.05), and there was no significant difference in urine volume, ICU staying time and hospitalization time between the two groups.There were positive correlations between the time of hypothermia and bleeding, extubation time, ICU staying time and negative correlations with urine output, while no obvious relations with postoperative hospital staying time.Conclusion During the perioperative liver transplantation, hypothermia increased the blood loss and postoperative extubation time.The longer the hypothermia time is, the poorer the prognosis is.
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Objective To make a systematic review of pressure ulcers risk factors in critically ill patients. Methods We systematically reviewed all articles related to the pressure ulcers risk factors in critically ill patients. The Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, CNKI, WANFANG and SinoMed were searched to August 2016. Results In total, 13 eligible articles were included. These studies included 18, 184 critically ill patients, six studies were classified as high quality, and seven were classified as moderate quality. Risk factors for the development of pressure ulcers include age, ICU stay, diabetes, mean arterial pressure<60-70 mmHg (1 mmHg=0.133 kPa), mechanical ventilation and mechanical ventilation, drugs, sedation and postural changes. Conclusions There is no single factor that can explain the occurrence of pressure ulcers. So it is in a variety of factors interaction, the occurrence of a significant increase in risk.
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Objective To explore the experience and feelings of spouse caregivers of elderly and disable patients with stroke in the process of care. Method Totally 8 spouse caregivers of elderly and disable patients with stroke were selected and investigated by semi structural in-depth interviews. Result Five major themes were found, e.g. responsibility and obligation of husband and wife, mental stress and physical stress, economic pressure, lack of effective information, positive feelings and countermeasures in the predicament. Conclusions The spouse caregivers suffer from psychological, physiological, economical and less information, but they are engaged with responsibility, obligation, positive feelings and coping. It is suggested that health care workers should take full attention to the elderly spouse caregivers and help them to reduce the pressure in the process of care, strive to tap their positive feelings and promote personal growth.
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Objective To evaluate the effect of dexmedetomidine on postoperative brain injury in pediatric patients undergoing living-related liver transplantation.Methods Forty American Society of Anesthesiologists physical status Ⅲ or Ⅳ pediatric patients of both sexes,aged 5-12 months,weighing 5-10 kg,were divided into dexmedetomidine group (group D,n =20) and control group (group C,n =20) using a random number table.After induction of anesthesia,dexmedetomidine was infused in a loading dose of 1 μg/kg for 10 min followed by a continuous infusion of 0.3 μg · kg-1 · h-1 in group D.The equal volume of normal saline was given instead in group C.Immediately before skin incision (T1),at 30 min of anhepatic phase (T2),at 1 h of neohepatic phase (T3),immediately after peritoneum closure (T4) and at 24 h after operation (T5),the blood samples were collected from the central vein to detect the concentrations of neuron-specific enolase (NSE) and S-100β protein in serum by enzyme-linked immunosorbent assay.Postoperative delirium was assessed at 1 day after surgery using Pediatric Anesthesia Emergence Delirium scale.At 1 day before surgery and 1 week after surgery,the Mental Development Index (MDI) and Psychomotor Development Index were recorded using Bayley Scale of Infant Development Ⅱ.Results The concentrations of serum NSE and S-100β protein were significantly higher at T2-5 than at T1 in the two groups (P＜0.05).Compared with group C,the concentrations of serum NSE and S-100β protein were significantly decreased at T2.5,and the Pediatric Anesthesia Emergence Delirium scale score and incidence of delirium were decreased after surgery in group D (P＜0.05).The MDI and Psychomotor Development Index were significantly lower at 1 week after surgery than at l day before surgery in the two groups (P＜0.05).The MDI was significantly higher at 1 week after surgery in group D than in group C (P＜ 0.05).Conclusion Dexmedetomidine can reduce postoperative brain injury in pediatric patients undergoing living-related liver transplantation.
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Objective To observe the effectiveness of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy.Methods Seventy patients (17 males,53 females,aged 20-65 years,ASA grade Ⅰ or Ⅱ) undergoing laparoscopic cholecystectomy were randomized to receive either dexmedetomidine (group R,n=35) or dexamethasone (group D,n=35).The patients in the group R received 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine before intubation.The patients in the group D received 8 mg dexamethasone before intubation.The BP and HR were recorded at the following points: on arrival in the operating room (T1),before intubation (T2),5 minutes after intubation (T3),5 minutes after the beginning of the operation (T4),30 minutes after the beginning of the operation (T5),at the end of operation (T6) and 5 minutes after extubation (T7).The inhaling concentration of sevoflurane,extubation time,operation time and anesthesia time were recorded.The incidence of nausea and vomiting were recorded at 8,24,48 hours after operation.Results The incidence of nausea and vomiting at each point were similar between two groups.The HR at T2-T7 in group D was significantly lower.But MAP was similar between two groups.Conclusion 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy,similar to dexamethasone.
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Objective To prepare thermosensitive chitosan (CTS) hydrogels containing astragalus polysaccharides (APS)/CTS microshperes (MS), and evaluate its physicochemical properties. Methods The APS/CTS MS (APS-MS) were prepared by spray drying method, and characterized by Scanning Electron Microscopy (SEM) and Laser Granularity Analyzer. Depending on the gelation temperature and gelating time, thermosensitive CTS hydrogels (HG) containing APS-MS (APS-MS-HG) were optimized by signal factor experiments, and the morphological characteristics were observed by SEM. In vitro release behaviors of APS-MS, hydrogels containing APS (APS-HG) and APS-MS-HG in pH 6.8 phosphate buffer were evaluated by dialysis tube method. Results The APS-MS were well dispersed with nearly spherical shapes and slightly wrinkled surfaces. The surface weighted mean D[3,2] of APS-MS was 8.078μm. The optimal APS-MS-HG, APS-MS-HG J, contained 3.012% APS-MS which were agitated with a magnetic stirrer for 3h. Observed by SEM, APS-MS were stayed spherical and dispersed unevenly in HG J, but the porous structure of HG J was disappeared in APS-MS-HG J. The release of APS from APS-MS-HG J was without initial burst release, and the cumulative amount of APS was about 74.75% after 36h. Conclusion Suppressing the phenomenon of sudden release at the first stage of delivery, APS-MS-HG J holds great promise for topical applications as a sustained-release nasal delivery system.
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Objective To construct the drug delivery system of gentamicin/chitosan microspheres for local injection, and evaluate its physicochemical properties and cell cytotoxicity.Methods Gentamicinwas used as model drug, chitosan as carrier, lecithinand hydroxypropyl-β-cyclodextrin as accessories, and the microspheres of gentamicin/chitosan/lecithin/hydroxypropyl-β-cyclodextrinwas prepared by spray drying method.The physicochemical properties and cell cytotoxicity of themicrospheres were investigated by UV spectrophotometry , scanning electron microscopy, X-ray diffraction, dynamic membrane dialysis and MTT assay.Results Five kinds of chitosan microspheres ( A, B, C, D and E) with different drug/carrier ratios were successfully prepared by spray drying method.The yield, drug loading and entrapment efficiency of the drug-loaded microspheres were 34.38%~46.94%, 10.20% ~18.67%, 61.20% ~74.72%, respectively.SEM results showed that compared with microspheres A, B and C, microspheres D and E own the spherical shape with wrinkled surface and uniform particle size, particle size between 0.5 ~3 μm, no adhesion.X-ray diffraction analysis showed that the drug was encapsulated in the microspheres.The results of in vitro release indicated that microspheres D had a good sustained release effect in the four drug-loaded microspheres.The results of cytotoxicity test showed that when the concentration of gentamicin reached 400 μg/mL, the relative growth rate of microspheres D was still higher than 80% with the cytotoxicity grade was one, ie, no cytotoxicity.Conclusion The microspheres D with good physicochemical properties, sustained-release effect and biocompatibility, is expected to be a good carrier of prostate local drug delivery.