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Objective To evaluate the clinical value of subclavian vein puncture with 16 G arteriovenous indwelling needle for emergency treatment of hemorrhagic shock,so as to provide a new approach for the rapid establishment of deep venous passage.Methods 80 patients with acute hemorrhagic shock were randomly divided into patients with arteriovenous indwelling needle group (catheter group) and conventional guide wire deep vein puncture group(routine puncture group),40 cases in each group.The two groups were treated with supraclavicular subclavian vein puncture.The operation time,success rate of the first puncture,puncture times and rehydration rate,incidence of complications were observed in the two groups.Results The operation time of indwelling needle group was (62 ±22)s,which was significantly shorter than (672 ± 178)s of the conventional puncture group,there was significant difference between the two groups (t =15.062,P =0.000).The first time success rate of puncture in the indwelling needle group was 70％ (28 cases),which in the conventional group was 80％ (32 cases),the difference was not statistically significant(x2 =1.067,P =0.439),all patients were in 3 attempts in successful puncture.The velocity of infusion of 500 mL hydroxyethyl starch in the indwelling needle group was (198 ± 51)s,which was better than (456 ± 86)s in the conventional puncture group,the difference between the two groups was statistically significant (t =9.318,P =0.000).The two groups had no deep vein puncture related complications.Conclusion Arteriovenous indwelling needle by supraclavicular subclavian vein puncture with conventional guide wire supraclavicular subclavian vein puncture catheter can be used for emergency treatment of hemorrhagic shock,but the indwelling needle group in the operation time and velocity is superior to conventional guide wire group,more suitable for the rescue of patients with acute hemorrhagic shock time is pressing,stay with stable circulation can be through the guide wire inserted catheter indwelling subclavian vein catheter.
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Objective To study the arthroscopy-assisted minimally invasive treatment of chondromalacia patella. Methods The clinical data of 140 patients with chondromalacia patella, with a mean age of 51.9 ± 5.71 years ( range, 41 to 62 years), undergoing surgical or Non-surgical treatment in our hospital from June 2005 to December 2008 were analyzed. In non-surgical group, 72 cases (96 knees) underwent intra-articular injection of sodium hyaluronate and other non-surgical treatment. In surgical group, 68 cases (84 knees) underwent variorus Arthroscopy-Assisted minimally invasive surgery, according to the extent of the patella cartilage injury and the situation of the patellofemoral joint. Joint functional exercise were carried out after operations. Regular follow-up were done after leaving hospital. Lysholm scoring system was used to evaluate the clinical effects. Judet's evaluation criteria was used to evaluate the improvement of range of motion. Results In non-surgical group, the knee function have been improved 24. 82%. In surgical group the knee function have been improved 35.37%. At the postoperative and final follow-up, the effect in surgery group was significantly better than non-surgical group. Conclusion For the chondromalacia patella with Ⅱ, Ⅲ class cartilage injury, minimally invasive arthroscopic surgery is a good treatment method, which can reduce pain, improve function, slow down the progress of the disease, and improve the quality of life of patients.
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Objective To find the way of predicting invasive blood pressure.Methods 47 subjects were enrolled into the study.Non-invasive blood pressure (NBP) measurements were performed by the oscillometric device.The corresponding invasive blood pressure (IBP) reading was obtained from a radial intra-arterial catheter on the same arm.The index of the blood vessel structure was measured by two-dimensional ultrasound,homodynamic parameters of carotid and radial artery were measured by using the color Doppler ultrasound.Linear relation between IBP and NBP,as well as IBP and indices measured by non-invasive methods Was analyzed by regression method. Canonical correlation analysis was also conducted to find out the potential predictive factors of invasive blood pressure. Results The regression equation was:Y=17.21-64.357X1+2.802X2+1.324X3(Yrepresents ISBP,Xl represents RRI,X2 represents RPI,X3 represents NSBP).The first canonical correlation coefficients can be explained the correlation between index measured by non-invasive methods and invasive blood pressure.Conclusion Invasive blood pressure can be predicted from non-invasive blood pressure and hemodynamic parameters.In addition to noninvasive systolic hlood pressure and radial artery resistance index.the potential predictive factors of invasive blood pressure includes explmned by non-invasive diastolic blood pressure,radial pulsating index,carotid shear rate and carotid peak systolic velocity.
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PThirty-seven patients suffering from internal fixation failure in treating intertrochanteric fracture were selected from Department of Orthopaedics, First People’s Hospital of Chenzhou between July 2000 and March 2008, including 20 males and 17 females aged 74 years (range 63-84 years). All were treated by total hip replacement (THR) due to cutting damage of screws to femoral head, neck and acetabulum. The THR was performed 13-23 months from the first internal fixation. All patients had no severe cardiorespiratory dysfunction, local infection or other contraindication for replacement. Preoperative Harris scores were (40.0?12.2) points. Among all patients, 18 were treated by cemented THR, and the others by un-cemented. All 37 patients were followed up for average of 6.3 months. The average operative time was (81?13.6) minutes; the average amount of bleeding in operation was (662?51.8) mL. No infection, hypostatic pneumonia, pressing sore or deep venous embolism of lower limbs was found after replacement. Hip pain, weakness, limitation of motion did not occur during the follow-up period. In addition, no loosening or breaking of prosthesis was found on X-ray films, but the osteoporosis was gradually improved. The Harris scores were (83.0?12.4) postoperatively. The outcomes were excellent in 20 cases, good in 12 cases, fair in 4 cases, and poor in 1 case, and the rate of excellent and good was 86.49%. THR is an effective method for intertrochanteric fracture after internal fixation failure.
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BACKGROUND: Inadequate hyperventilation may trigger cerebrovascular contraction and lead to lowered cerebral perfusion and oxygen supply-demand imbalance.OBJECTIVE: To investigate the influence of hyperventilation on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the cerebral arteries and veins in patients with serious traumatic brain injury.DESIGN: Case analysis.SETTING: Department of Anesthesiology, First Hospital Affiliated to Shantou University.PARTICIPANTS: Sixteen patients who received emergency operations in the First Hospital Affiliated to Shantou University between January and July 2002.METHODS: Patients with traumatic brain injury underwent operation under general anesthesia, and the PaCO2 was maintained at 30 mm Hg for 15 minutes by regulating the respiration rate, followed by decrease to 25 mm Hg, maintained for 15 minutes before restoration to 30 mm Hg for 15 minutes. The fractional concentration of inspired oxygen was adjusted to maintain blood PaO2 at around 100-150 mm Hg, and the blood sample was collected from the artery and internal jugular vein 15 minutes after adjustment of PaCO2 for blood gas analysis. The PaO2 was then increased to 200-250 mm Hg by increasing the fractional concentration of inspired oxygen, and the PaCO2 was adjusted from 30 to 25 and then back to 30 mm Hg in the described manner, and the oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins were measured.MAIN OUTCOME MEASURES: Influence of blood PaO2 and PaCO2 on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins.RESULTS: Sixteen patients met the diagnostic criteria and completed data collection. The arterial PaCO2 decreased from 30 to 25 mm Hg when arterial blood oxygen pressure increased from 100-150 to 200-250 mm Hg, which leads to obvious decrease of oxygen saturation in the internal jugular vein and obvious increased difference in oxygen content between the cerebral artery and vein. However the absolute value of oxygen saturation in the internal jugular vein was obviously higher at PaO2 of 200-250 mm Hg than that at PaO2 of 100-150 mm Hg, while the absolute value of cerebral arteriovenous difference of brain oxygen content was obviously lower. Compared to the basal level, the arteriovenous lactic acid difference was obviously increased at PaO2 of 100-150 mm Hg,PaCO2 of 30 and 25 mm Hg, and at PaO2 of 200-250 mm Hg and PaCO2 of 25 mm Hg.CONCLUSION: Relatively higher PaO2 (200-250 mm Hg) and mild hyperventilation (PaCO2 of 30 mm Hg) has no obvious effect on brain oxygen supply-demand balance.
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Aim To investigate the ability of chymase inhibitors o n histamine release from human colon mast cells. Methods Human ma st cells were dispersed from colon tissue with collagenase and hyaluronidase, an d were challenged with stimulus for 15 min at 37℃.A glass fibre-based fluorome tric assay was used to measure histamine in the supernatants of dispersed mast c ells.Results chymase inhibitors ZIGPFM, TPCK and ? 1-antitry psin failed to induce significant histamine release from colon mast cells. All t he chymase inhibitors were able to inhibit anti-IgE induced histamine release i n a concentration dependent manner with a maximum of 37%, 26% and 36.8% inhibit ion being achieved with 1 mmol?L -1 of ZIGPFM, 80 mmol?L -1 of TPCK , 30 mmol?L -1 of ? 1-antitrypsin, respectively. Preincubation of inhib itors of ZIGPFM and TPCK with cells for 20 min at 37℃ before challenging with a nti-IgE was able to slightly enhance their inhibitory actions. All the chymase inhibitors were able to inhibit calcium ionophore induced histamine release, th e maximum inhibition was 23.6%～35%.And the extent of inhibition by TPCK was in creased when colon mast cells were preincubated for 20 min before calcium ionoph ore being added. However, the same treament failed to improve the action of ZIGP FM. Conclusion In the current study, we found that inhibitors o f chymase were able to inhibit anti-IgE and calcium ionophore induced histamine release from human colon mast cells, which may indicate a potential of a novel therapy for the treatment of inflammatory bowel disease or other mast cell relat ed diseases.
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Objective To investigate the preemptive analgesic effects of somato-visceral blockade in laparoscopic cholecystectomy (LC). Methods One hundred patients were randomly divided into four groups: Group A received peri-portal infiltration of 25 ml 0.25% bupivacaine (contained 1:200 000 epinephrine) before incision; Group B received intraperitoneal spray of 35ml 0.25% bupivacaine immediately after the establishment of pneumoperitoneum; Group C received the management of both Group A and Group B; Group D was control group without management. The extent and location of pain and nausea were recorded and assessed at 1, 2, 3, 6, 12, 24 and 48 postoperative hours, respectively. Results In the control group the incisional pain dominated over other pain locations within 24 hours postoperatively (P
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Objective:To investigate the ability of chymase inhibitors on tryptase release from human colon mast cells.Methods:Human mast cells were dispersed from colon tissue with collagenase and hyaluronidase,and were challenged with stimulus for 15 min at 37℃.Tryptase assay performed following previous procedures.In brief,a 96-well microtitre plate was coated with antiserum to human tryptase.The tryptase levels in the samples were detected with a monoclonal antibody specific to tryptase and the reaction was visualized by addition of OPD.Results:At 15 min and 35 min following incubation,anti-IgE and calcium ionophore were able to provoke significant tryptase release from human colon mast cells.Chymase inhibitors ZIGPFM,TPCK and ?1-antitrypsin had no stimulatory effect on colon mast cells at both 15 min and 35 min incubation periods.All the chymase inhibitors were able to inhibit anti-IgE induced tryptase release in a concentration dependent manner with a maximum of 37%,40% and 36.6% inhibition being achieved with 1 ?mol/mL of ZIGPFM,80 ?mol/mL of TPCK,30 ?mol/mL of ?1-antitrypsin,respectively.Preincubation of inhibitors of ZIGPFM and TPCK with cells for 20 min at 37℃ before challenging with anti-IgE was able to slightly enhance their inhibitory actions.Amastatin,a specific inhibitor of aminopeptidase,had no effect on anti-IgE induced tryptase release.All the chymase inhibitors were able to inhibit calcium ionophore induced tryptase release,the maximum inhibition were 23%-35.3%.And the extent of inhibition by ZIGPFM was increased when colon mast cells were preincubated for 20 min before calcium ionophore being added.However,the same treament failed to improve the action of TPCK.Conclusion:We found for the first time that inhibitors of chymase were able to inhibit anti-IgE and calcium ionophore induced tryptase release from human colon mast cells,which may indicated a potential of a novel therapy for the treatment of inflammatory bowel disease or other mast cell related diseases.
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Objective To study the effects of ultraviolet(UV)radiation disinfection on purified wecter in water dis-penser.Methods The original structure of water dispenser was modified by installing additional UV lamps.The water samples were collected from the tap of the newly modified water dispenser simulated the practical status of water supply in indoor environment under the different conditions including different intensities of UV lamps and water flow rates.The total counts of bacteria of water samples were determined based on the Sanitary Standard for Bottled Purified Drinking water(GB17324-1998).Results The total counts of bacteria of water samples collected from the tap of the newly mod-ified water dispenser were below20cfu/ml,which was lower than those of control water sample(P