Effect of sequel reperfusion coronary intervention on heart rate variability of patients with acute ST-segment elevation myocardial infarction / 中国基层医药

Objective:To explore the effect of sequel reperfusion percutaneous coronary intervention (PCI) therapy on heart rate variability (HRV) during myocardial reperfusion in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:With a randomly case controlled study method, 180 patients with STEMI in Yidu Central Hospital Affiliated to Weifang Medical College were selected as study objects, and they were randomly divided into two groups: sequel recanalization PCI(sPCI) group(observation group) and conventional primary PCI(pPCI) group(control group), with 90 cases in each grouop.The rate of SDNN<70 mm of the two groups and other indicators of HRV were observed at 14 d after successful PCI.Results:There was statistically significant difference between the two groups in MBG3(77.78% vs.63.33%, χ 2=4.51, P=0.03). There was statistically significant difference between the two groups in the incidence of SDNN<70 mm at 14 d after PCI(10.00% vs.23.33%, χ 2=5.69, P=0.02). If sequel recanalization PCI was served as a variable for predicting SDNN<70 mm, the results of Logistic regression analysis showed that odds ratio ( OR) value was 0.36, 95% confidence interval ( CI) was 0.16-0.85, P=0.02.The other factors that affected the incidence rate of SDNN<70 mm were the level of MBG3( OR=0.45, 95% CI: 0.16~0.95, P=0.03), time-to-reperfusion( OR=2.65, 95% CI: 1.06~5.98, P=0.04), blood sugar level of admission ( OR=1.96, 95% CI: 1.04~7.71, P=0.04), TnI value( OR=2.06, 95% CI: 1.03~5.68, P=0.04), heart function( OR=2.18, 95% CI: 1.08~6.89, P=0.04). Conclusion:The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in obtaining myocardial blush grades.Meanwhile, it can increase the indicators of HRV and decrease the incidence rate of SDNN<70 mm.

Efficacy comparison between two-field and three-field lymphadenectomy for thoracic esophageal squamous cell carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and efficacy between three-field lymphadenectomy and normative Ivor-Lewis two-field lymphadenectomy for thoracic esophageal squamous cell carcinoma METHODS: Clinical data of 375 patients with thoracic esophageal squamous cell carcinoma who underwent three-field lymphadenectomy(3FL) or Ivor-Lewis two-field lymphadenectomy(2FL, Ivor-Lewis) in Fudan University Shanghai Cancer Center during 2013 were retrieved and collected from electronic medical record system. Ninety-one patients received three-field lymphadenectomy (3FL group), including 16 cases of intra-cervical gastro-esophageal anastomosis and 75 cases of intra-thoracic gastro-esophageal anastomosis, while 284 patients received Ivor-Lewis two-field lymphadenectomy (2FL group) with all intra-thoracic gastro-esophageal anastomosis. Short-term outcomes were compared between two groups, including postoperative anastomotic leakage, pneumonia and respiratory failure, chylothorax, reoperation and 90-day death. Total harvested lymph nodes and positive lymph nodes in each group were also compared. A total of 338 patients were enrolled into survival analysis. Survival curve was presented by Kaplan-Meier method.</p><p><b>RESULTS</b>As compared to 2FL group, the 3FL group had significantly higher ratio of N3 patients [19.8% (18/91) vs. 5.3% (15/284), P=0.000], stageIII( patients [58.2%(53/91) vs. 43.0%(122/284), P=0.007], and upper thoracic cancer patients [12.1%(11/91) vs. 3.5%(10/284), P=0.027]; also the 3FL group had more harvested lymph nodes (40.1±14.6 vs. 25.3±9.4, P=0.000) and more positive lymph nodes (3.3±4.0 vs. 1.7±3.2, P=0.000). With respect to pneumonia and respiratory failure, chylothorax, reoperation and 90-day death, no significant differences were found between the group (P=0.447, P=0.751, P=0.678, P=0.685). The 3FL group had a significantly higher incidence of anastomotic leakage than 2FL group [7.7% (7/91) vs. 1.8% (5/284), P=0.011], while its incidence of intrathoracic anastomosis leakage was 4.0% (3/75), which was not significantly different with 1.8%(5/284) of 2FL group (P=0.372). Median follow-up was 33 months. Overall 1-, 2-, 3-year survival rates were 94%, 81% and 70%, while 1-, 2-, 3-year survival rates of 3FL group were 90%, 73% and 66%, of 2FL group were 95%, 84% and 72%, respectively, without significant differences between the two group(P=0.135). Further subgroup analysis showed that no significant differences of postoperative survival in stage I(, II( and III( patients were observed between the two groups (P=0.541, P=0.511, P=0.402), meanwhile no significant differences of postoperative survival in patients with metastasis and without metastasis were found between the two groups as well (P=0.985, P=0.233).</p><p><b>CONCLUSIONS</b>Three-field lymphadenectomy can be performed with acceptable perioperative morbidity and mortality. The prognosis value of three field lymphadenectomy needs further investigation. Patients with thoracic esophageal squamous cell carcinoma may have favorable survival through normative Ivor-Lewis two-field lymphadenectomy.</p>

The effect of early intravenous thrombolysis combined with atorvastatin in the treatment of acute myocardial infarction / 中国医师进修杂志

Objective To observe the clinical curative effect of early intravenous thrombolysis combined with atorvastatin in the treatment of acute myocardial infarction.Methods Seventy-two patients with acute myocardial infarction from March 2011 to March 2012 were divided into experimental group and control group by random number table method,with 36 cases in each.Experimental group was given early intravenous thrombolysis combined with atorvastatin treatment,and control group was given atorvastatin treatment.The effects in 2 groups was observed.Results The recanalization rate in experimental group was significantly higher than that in control group [80.6％ (29/36) vs.52.8％ (19/36)],and the incidence of post infarction angina,heart failure and reperfusion arrhythmia were significantly lower than those in control group [11.1％(4/36) vs.27.8％(10/36),8.3％(3/36) vs.25.0％(9/36),44.4％(16/36) vs.72.2％(26/36)],there were significant differences(P＜ 0.05).The leukocyte differentiation antigen,matrix metalloproteinases and C reactive protein between 2 groups before treatment had no significant difference (P ＞ 0.05),but those indexes after treatment were obviously improved,the improvement in experimental group was better than that in control group,there was significant difference (P ＜0.05).The United States National Institutes of Health Stroke Scale (NIHSS) score between 2 groups before treatment had no significant difference (P ＞ 0.05),the NIHSS score after treatment in experimental group was better than that in control group [(4.2 ± 3.7) scores vs.(7.9 ± 4.1) scores] (P ＜ 0.05).The proportion of mRS score 0-1 after 3 months of treatment in experimental group was higher than that in control group [52.8％(19/36) vs.33.3％(12/36)],the proportion of 2-6 scores was lower than that in control group [47.2％ (17/36) vs.66.7％ (24/36)] (P ＜0.05).Conclusion Early intravenous thrombolysis combined with atorvastatin has obviously curative effect in the treatment of acute myocardial infarction and has some clinical value.

Clinical effect of the application of mechanical ventilation in brainstem hemorrhage complicated with respiratory failure / 中国基层医药

Objective To observe the clinical efficacy of ventilator-assisted breathing for the treatment of respiratory failure brainstem hemorrhage.Methods Clinical data of 29 cases of brainstem hemorrhage complicated with respiratory failure were retrospectively analyzed.Patients were treated with conventional symptomatic treatment based on ventilator-assisted breathing therapy and before and after treatment of ventilator-assisted breathing index changes were analyzed.Results After treatment,29 patients improved and discharged 11 patients(37.9％),and automatically discharged 10 patients(34.5 ％),8 patients died(27.5％);R,PaO2,PaCO2,SaO2 significantly improved than before treatment(t=4.932,4.393,3.784,3.297,all P＜0.05);compared with pre-treatment plasma albumin level,Glasgow score improved significantly(t=2.675,4.947,all P＜0.05),blood glucose level before and after treatment,peripheral blood leukocytes count had no statistically significant differences(t=1.037,0.852,all P＞0.05).Conclusion Ventilator-assisted respiratory therapy brainstem hemorrhage complicated with respiratory failure can significantly improve various respiratory indicators,improve the survival rate.

Application of teaching method of case-based learning into physiology education of clinical medical undergraduates / 中华医学教育探索杂志

According to the advantages and disadvantages of the clinical medical educa-tion of the ordinary specialized subject-to-undergraduate,the traditional teaching method has been improved in two aspects:choosing case and teaching process.It can be conformed that teaching method of case-based learning is very suitable for physiological teaching.It can improve the effective interaction of teachers and students,and enchance the students' abilities of self-study and theory with practice.