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Objective To compare the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery. Methods A total of 78 patients undergoing urologic endoscopy in our hospital from July 2016 to December 2017 were recruited ,and randomly divided into the Remifentanil group(n= 39)with Remifentanil anesthesia and the Fentanyl group(n= 39)with Fentanyl anesthesia. The changes in mean arterial pressure and heart rate ,anesthetic effects and adverse reaction rates during anesthesia were compared between the two groups. Results The reduction of mean arterial pressure of premedication/induction of anesthesia(T0)was more pronounced in the Fentanyl group than in the Remifentanil group(t=2.855 ,P=0.003) ,but the heart rate was lower in the Remifentanil group than in the Fentanyl group(t= 4.405 ,P= 0.000).The changes of heart rate and mean arterial pressure were more significant in the Fentanyl group than in Remifentanil group immediately after tracheal intubation (T1) ,during incision of skin(T2) ,immediately after suture of the abdomen (T3) and immediately after removal of the tracheal tube (T4) ( P ＜ 0.05 ). The spontaneous respiration recovery time ,blinking time ,extubation time ,force recovery time and recovery time were shorter in the Remifentanil group than in the Fentanyl group(P＜0.05).The incidence of anesthetic adverse reactions was lower in the Remifentanil group than in the Fentanyl group (10.3% , 4/39 vs.28.2% ,11/39 ,χ2= 4.044 ,P= 0.044). Conclusions Both Remifentanil and Fentanyl groups have good anesthetic effects in urological anesthesia ,but Remifentanil has less fluctuations of perioperative blood pressure and heart rate ,has higher recovery quality and less anesthetic adverse reactions. Therefore ,Remifentanil anesthesia is worthy of promotion.
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Objective To survey the point prevalence of healthcare-associated infection(HAI) in 13 tertiary hospitals in Dongguan,understand the occurrence of HAI in tertiary hospitals,so as to provide guidance for the prevention and control of HAI.Methods Through bedside investigation and medical record reviewing,HAI among inpatients in 13 tertiary hospitals in Dongguan at 0:00-24:00 of September 24,2014 were investigated.Results A total of 11 344 patients were investigated,379 patients developed 404 times of HAI,HAI rate was 3.34％,HAI case rate was 3.56％.Incidence of HAI in the intensive care unit was highest (12.82％).The main infection site was respiratory tract(n =173,42.48％).The usage rate of antimicrobial agents was 30.50％,most were for therapeutic use (including therapeutic+ prophylaxis) (n =2 545,73.55 ％)and single use (n =2 689,77.72％),pathogenic microorganism detection of specimens from patients receiving therapeutic antimicrobial use was 53.79％.A total of 299 strains of pathogenic orgamisms were detected from infected patients,the major were Escherichia coli (n =56,18.73 ％),Pseudomonas aeruginosa (n =54,18.06 ％),and Klebsiella pneumoniae (n =35,11.71 ％),92 strains of multidrug resistant organisms(MDROs) were isolated,accounting for 30.77％ of total isolated pathogens.Conclusion The basic characteristics of HAI in tertiary hospitals in this city were preliminarily investigated,identification of high risk departments,high risk population,and high risk links should be strengthened,HAI prevention and control measures should be implemented.
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Aim To investigate the effect of intrathecal injection of PI3 K inhibitor LY294002 on pain behav-iour and expression of p-Akt in spinal dorsal horns in bone cancer pain( BCP) rats. Methods Forty female SD rats weighing 180~200 g were randomly divided in-to five groups ( n =8 each ):(Ⅰ) sham group;(Ⅱ) sham+LY294002 group;(Ⅲ) BCP group;(Ⅳ) BCP+DMSO group;( V) BCP+LY294002 group. BCP rat model was induced by inoculating Walker 256 mamma-ry gland carcinoma cells into the medullary cavity of the left tibia. Rats received i. t. injections of either PI3 K inhibitor LY294002 10μL ( 2. 5 g · L-1 ) or 5%DMSO 10 μL at the time of d 7~9 after the operation. Mechanical withdrawal threshold( MWT) test was per-formed before and after i. t. injections on d7(till 8h). The rats were sacrificed after inoculation and the L4~6 segments of the spinal cords were removed for immu-nohistochemistry to determinate the expression changes of spinal p-Akt. Results Compared with I group, the rats inⅢ,Ⅳ,Ⅴgroup showed obvious mechanical hy-peralgesia. The MWT of V group increased apparently from 2nd hour to 4th hour(P<0. 05),and reached the peak in 3rd hour(P<0. 01). Compared with I group, the expression of p-Akt in the spinal cord in Ⅲ,Ⅳgroup increased obviously ( P <0. 01 ) . Compared withⅢ,Ⅳ group,i. t. injections of LY294002 obviously cut down the expression of p-Akt in the spinal cord ( P <0. 05). Conclusion PI3K/Akt singaling pathway may take part in the development of bone cancer pain.
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Aim To investigate the effect of intrathecal injection of CCR2 antagonist on pain behaviours,spinal astrocytes activation in the spinal cord in a rat model of bone cancer pain. Methods Forty female SD rats weighing 150 ~180 g were randomly divided into five groups ( n=8 each ):(Ⅰ) sham group;(Ⅱ) sham +RS102895 group;(Ⅲ) bone cancer pain group;(Ⅳ) bone cancer pain + DMSO group;(Ⅴ) bone cancer pain+RS102895 group. Rats received i. t. injections of either RS102895 (3 g·L-1 ) 10 μl or 10%DMSO 10 μl at the time of 10-12 days after the operation. Bone cancer was induced by intra-tibial inoculation of 1 × 105 Walker 256 breast cancer cell. Mechanical hind paw withdrawal threshold test was performed one day before and at 3rd,6th,9th, 10th,11th and 12th days after surgery. Immunofluorescence was used to observe the activation of the spinal astrocytes. Results Compared with group Ⅰ, the rats in bone cancer pain group appeared obvious mechanical hyperalgesia (Ⅲ、Ⅳ、Ⅴ) ,the volume,shape and mean optical den-sity ( MOD) of spinal astrocytes could be seen obvious-ly increased,groupⅡhad no obvious statistical signifi-cance (P>0. 05). Compared with group Ⅳ ,i. t. in-jections of RS102895 increased the paw mechanical withdrawal threshold, suppressed the action of astro-cytes,reduced the MOD of spinal astrocytes. Conclu-sion CCR2 might participate in the formation of bone cancer pain via activating spinal astrocytes. CCR2 will be a potential target for the treatment of bone cancer pain.
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Objective To evaluate the role of spinal phosphatidyl-inositol 3-kinase/Akt (PI3k/Akt) signaling pathway in the maintenance of bone cancer pain (BCP) in rats and its relationship with microglial activation.Methods Forty healthy female Sprague-Dawley rats,weighing 180-200 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S) ; PI3K inhibitor LY294002 group (group L) ; group BCP; BCP + dimethyl sulfoxide (DMSO) group (group BCP + D) ; BCP + LY294002 group (group BCP + L).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibia.At 7-9 days after inoculation,LY294002 2.5 μg/10 μl was injected intrathecally in L and BCP + L groups,normal saline 10 μl was injected intrathecally in S and BCP groups,and 5％ DMSO 10 μl was injected intrathecally in BCP+ D group once a day.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before inoculation and 1,3,5,7,8 and 9 days after inoculation.The rats were sacrificed after MWT was measured on day 9 after inoculation and the L4-6 segments of the spinal cord were removed to determinate the activation of spinal microglia using immunofluorescence.Results Compared with group S,MWT was significantly decreased,and the activation of spinal microglia was increased in BCP,BCP + D and BCP+ L groups.Compared with BCP and BCP + D groups,MWT was significantly increased,and the activation of spinal microglia was decreased in BCP + D group.Conclusion Spinal PI3K/Akt signaling pathway is involved in the maintenance of BCP possibly through activating microglia in spinal dorsal horns of rats.
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Objective To evaluate the role of spinal microglial C-C chemokine receptor type 2 (CCR2) in the maintenance of bone cancer pain (BCP) in rats.Methods Fifty unmated female Sprague-Dawley rats,aged 2 months,weighing 160-180 g,were randomly divided into 5 groups (n =10 each):sham operation group (group Ⅰ),sham operation + RS102895 (CCR2 antagonist) group (group Ⅱ),BCP group (group Ⅲ),BCP + dimethylsulfoxide (DMSO) group (group Ⅳ),and BCP + RS102895 group (group Ⅴ).The rats were anesthetized with intraperitoneal chloral hydrate.BCP was induced by intra-tibial inoculation of 1 × 105 Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibial metaphysis.On 10-12 days after operation,3 μg/μl RS102895 10 μd was injected intrathecally once a day in Ⅱ and Ⅴ groups,10％ DMSO 10 μl was injected intrathecally once a day in Ⅳ group,and normal saline 10 μl was injected intrathecally once a day in Ⅰ and Ⅲ groups.Mechanical paw withdrawal threshold was measured at 1 day before operation and 3,6,9,10,11 and 12 days after operation.After measurement of pain threshold at day 12 after operation,the lumbar segments (L4-6) of the spinal cord were removed for determination of the level of ox-42 (spinal microglial activation marker) (by immuno-histochemistry) and contents of IL1-β,IL-6 and TNF-α (by ELISA).Results Compared with group Ⅰ,mechanical paw withdrawal threshold was significantly decreased at 6-12 days after operation,the number of ox-42 positive cells and contents of IL1-β,IL-6 and TNF-α were increased in Ⅲ,Ⅳ and Ⅴ groups,and no significant change was found in the parameters mentioned above in group Ⅱ.Compared with group Ⅲ,mechanical paw withdrawal threshold was significantly increased at 10-12 days after operation,the number of ox-42 positive cells and contents of IL1-β,IL-6 and TNF-α were decreased in group Ⅴ,and no significant change was found in the parameters mentioned above in group Ⅳ.Conclusion Spinal microglial CCR2 is involved in the maintenance of BCP via activating microglia and promoting the release of inflammatory cytokines of rats.
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Objective To evaluate the role of c-Jun N-terminal kinase (JNK)/monocyte chemoattractant protein-1 (MCP-1) signaling pathway in the spinal cord in the maintenance of bone cancer pain (BCP) in rats.Methods Fifty female Sprague-Dawley rats,weighing 150-180 g,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S),sham operation + JNK inhibitor SP600125 (group SP),BCP group,BCP + dimethyl sulfoxide (DMSO) group,and BCP+ SP600125 group (group BCP+ SP).BCP was induced by injecting Walker 256 mammary gland cancer cells into the bone marrow of the left tibia.On 10-12 days after BCP,SP600125 10 μg(10 μ1) was injected intrathecally once a day in SP and BCP + SP groups,and 5％ DMSO 10 μl was injected intrathecally once a day in BCP + DMSO group.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before BCP and 3,6,9,10,11 and 12 days after BCP.After measurement of MWT at 12 days after BCP,the rats were sacrificed and L4-6 segments of the spinal cord were removed for determination of MCP-1 expression by using immuno-histochemistry and Western blot.Results Compared with S group,MWT was significantly decreased at 6-12 days after BCP,MCP-1 expression was upregulated in BCP,BCP + DMSO and BCP + SP groups (P ＜ 0.01),and no significant change was found in the parameters mentioned above in SP group (P ＞ 0.05).Compared with BCP group,MWT was significantly increased at 10-12 days after BCP,MCP-1 expression was down-regulated in BCP + SP group (P ＜ 0.01),and no significant change was found in the parameters mentioned above in BCP + DMSO group (P ＞ 0.05).Conclusion JNK/MCP-1 signaling pathway in the spinal cord may be involved in the maintenance of BCP in rats.
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Objective To evaluate the relationship between MEK/extracellular signal-regulated kinase (ERK) signal transduction pathway and CX3CR1 in the spinal dorsal horns in a rat model of bone cancer pain (BCP).Methods Fifty female Sprague-Dawley rats,weighing 150-180 g,were randomly divided into 5 groups (n =10 each):sham operation group (group Ⅰ),BCP group (group Ⅱ),sham operation + U0126 group (group Ⅲ),BCP+ 5％ dimethyl sulfoxide (DMSO) group (group Ⅳ),BCP + U0126 (MEK inhibitor) group (group Ⅴ).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibia.In Ⅲ and Ⅴ groups,U0126 10 μg/10 μl was injected intrathecally once a day starting from day 10 after inoculation to day 12 after inoculation,while the equal volume of 5％ DMSO was injected in group Ⅳ.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before inoculation (baseline),3,6,9,and 10 days after inoculation,and after administration on 11 and 12 days after inoculation.The rats were sacrificed after administration on day 12 after inoculation and the L4.6 segments of the spinal cord were removed for determination of CX3CR1 expression in spinal dorsal horns (by Western blot and immunohistochemistry).Results Compared with Ⅰ and Ⅲ groups,MWT was significantly decreased at 6-12 days after inoculation,and the expression of CX3CR1 in spinal dorsal horns was up-regulated in Ⅱ,Ⅳ and Ⅴ groups (P ＜0.01).Compared with Ⅱ and Ⅳ groups,MWT was significantly increased at 10-12 days after inoculation,and the expression of CX3CR1 in spinal dorsal horns was down-regulated (P ＜ 0.01).Conclusion MEK/ERK signal transduction pathway in the spinal dorsal horns is involved in the development and maintenance of BCP in rats possibly through regulating the expression of CX3CR1.
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Objective To explore the efficacy and safety of the bronchoscopic high frequency electrocoagulation combined with balloon dilatation in treating tuberculosis inflammatory airway constriction. Methods According to the different methods of treatment, 55 patients with tuberculosis airway constriction were randomly divided into two groups, the balloon dilatation group (26 cases) and combination group (29 cases). The patients in balloon dilatation group underwent bronchoscopic balloon dilatation and the patients in combination group underwent bronchoscopic balloon dilatation combined with high frequency electrocoagulation. The patients of the two groups accepted endoscopic therapy once a week. Effective rate of recanalization for the narrow airway, frequency of effective treatment and the time of tuberculosis bacterium vanishing was recorded. Intraoperative and postoperative complications were also observed. Three months after the treatment, all patients accepted bronchoscopic to observe and assess the airway restenosis rate. Results After treatment, the effective rate in balloon dilatation group and combination group had no significant difference[69.2%(18/26) vs. 89.7% (26/29 )](P＞ 0.05 ),but frequency of effective treatment and time of tuberculosis bacterium vanishing had significant difference[(3.5 ±1.3) times vs. (1.5 ± 1.1) times, (23.3 ±3.6) d vs.(13.2 ±2.3) d](P<0.01). There was no significant difference on the intraoperative and postoperative complications between two groups (P＞0.05). The airway restenosis rate was 33.3%(6/18) in balloon dilatation group and 7.7%(2/26) in combination group after treatment for 3 months (P ＜0.05). Conclusions Combination of bronchoscopic balloon dilatation and high frequency electrocoagulation is an efficacy and safety way for the tuberculosis inflammatory airway stenosis. It can reduce the frequency of interventional therapy, shorten the time of tuberculosis bacterium vanishing, and may also decrease the airway restenosis rate.
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Objective To investigate the role of p38 mitogen-activated protein kinase(p38MAPK) in bone cancer pain in rats.Methods Fifty-six female SD rats weighing 150-170 g were randomly divided into 4 groups (n= 14 each): group ⅠNS operation; group Ⅱ bone cancer pain; group Ⅲ DMSO and group Ⅳ SB203580. Bone cancer pain was induced by injecting Walker256 mammary gland cancer cell suspension (107 cells/ml) 5 μl into the bone marrow of left tibia in group Ⅱ,Ⅲ and Ⅳ.5% DMSO 10 μl and SB203580 10 μg in 10 μl were injected IT in group Ⅲ and Ⅳ respectively at 10 days after bone cancer pain model was established. Paw withdrawal threshold to von Frey filament stimulation was measured before and at 1,3,5,7,10 d after bone cancer pain model was established and at 1,3,6, 12,24 h after IT DMSO or SB203580 injection. Six animals in each group were killed at 6 h after IT DMSO and SB203580 injection. The L_(4,5) lumbar segment of the spinal cord was removed for determination of pCREB expression in the dorsal born by immuno-histochemistry. Results The rats developed hyperalgesia at 7 d after bone cancer pain had been induced. IT SB203580 significantly increased mechanical pain threshold. The number of pCREB positive neurons in the dorsal horn of L_(4,5) segment of the spinal cord was significantly increased by bone cancer pain. IT SB203580 significantly attenuated the increase in pCREB expression induced by bone cancer pain. Conclusion Intrathecal SB203580 can relieve the hyperalgesia induced by bone cancer pain and inhibit CREB phosphorylation in the spinal dorsal horn. p38MAPK signal pathway plays an important role in bone cancer pain.
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Objective To observe the efficacy and safety of levofloxacin for the theatment of com-munity acquired pneumonia(CAP) in the elderly patients. Methods Thirty-six elderly inpatients with CAP between May 2005 and May 2007 were treated with levofloxacin at a dosage intravenously of 500 mg once a day for 5 to 14 days treatment. Results Streptococcus pneumoniae of multiple drugs-resistant were found in sputum of 22 patients,pseudomonas aeruginosa in 8 patients and haemophilus influenzae in 6 patients de-pending on the results of the sputum culture. The total clinical efficacy rate of levofloxacin was 75.0% and bacteria elimination rate was 82.1%,and 16.7% patients showed related side effect of diarrhea,skin-rash and kidney injury. Conclusions Levofloxacin is an effective with little side effect in treatment of CAP in the elderly.