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Objective To observe the effect of supplemental Revolvin D1 (RvD1) on Toll-like receptor 4 (TLR4) in skeletal muscle of type 2 diabetic mice.Methods 35 male C57BL/6 mice were randomly divided into control group (NC group) and high glucose and high fat diet group.After 8 weeks,mice in high glucose and high fat diet group were given intraperitoneal injection of streptozotocin (STZ) 100 mg/ kg.Then they were randomly divided into two groups:Type 2 diabetes group (T2DM group) and type 2 diabetes + RvD1 intervention group (T2DM + RvD1 group).Mice in T2DM group mice were injected with phosphate buffer saline 0.2 ml and T2DM + RvD1 group mice were injected with Revolvin D1 100 ng/day respectively.The levels of fasting blood glucose,serum insulin and inflammatory factors were detected.The mRNA expression level of TLR4 was detected by real-time quantitative polymerase chain reaction (RT-qPCR) method,and the expression of TLR4 protein was detected by Western blot.Results The levels of insulin resistance index,interleukin(IL)-6 and tumor necrosis factor-α (TNF-α) in T2DM group and T2DM + RvD1 group increased (P ＜ 0.05).Compared with the T2DM group,the levels of insulin resistance index,IL-6 and TNF-α in T2DM + RvD1 group decreased (P ＜0.05).The expression of TLR4 protein in T2DM group and T2DM + RvD1 group was higher than that in NC group (P ＜ 0.05).The expression of TLR4 protein in T2DM + RvD1 group,was lower than that in T2DM group (P ＜0.05).The mRNA level of TLR4 in mice was consistent with the above results by RT-qPCR.Conclusions Moderate supplementation of RvD1 can not only decrease the level of inflammatory factors in type 2 diabetic mice,but also reduce the expression of TLR4 and insulin resistance in skeletal muscle of type 2 diabetic mice.
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Objective To investigate the effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance.Methods Two hundreds and thirteen children cases undergoing elective operation under general anesthesia were selected,aged 2-12 years old,ASA grade Ⅰ-Ⅱ,developmental normal,without mental system and cognitive dysfunction,and randomly divided into the experimental group 1,2 and control group.The children cases in the experimental group 1 conducted the anesthesia induction by their parents accompany on the operation day,while those in the experimental 2 conducted the anesthesia induction on the operation day after conducting the comfort anesthesia technique guidance.The control group was performed the conventional follow up before operation,the anesthesia induction was performed by the operation nurses and anesthesia doctor accompany on the operation day.Results There were statistically significant differences between the cases of slightly large age,with surgical experience,parents non-anxiety and psychological internal control type with the control group(P＜0.05).The difference between conducting the anesthesia induction guidance and non-conducting the anesthesia induction guidance was not statistically significant(P＞0.05).Conclusion The parents accompany comfort anesthesia induction technique can effectively increase the compliance during the anesthesia induction period in the children patients with slightly large age,operation experience,parents non-anxiety and psychological internal control type.
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Objective To investigate the effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance.Methods Two hundreds and thirteen children cases undergoing elective operation under general anesthesia were selected,aged 2-12 years old,ASA grade Ⅰ-Ⅱ,developmental normal,without mental system and cognitive dysfunction,and randomly divided into the experimental group 1,2 and control group.The children cases in the experimental group 1 conducted the anesthesia induction by their parents accompany on the operation day,while those in the experimental 2 conducted the anesthesia induction on the operation day after conducting the comfort anesthesia technique guidance.The control group was performed the conventional follow up before operation,the anesthesia induction was performed by the operation nurses and anesthesia doctor accompany on the operation day.Results There were statistically significant differences between the cases of slightly large age,with surgical experience,parents non-anxiety and psychological internal control type with the control group(P＜0.05).The difference between conducting the anesthesia induction guidance and non-conducting the anesthesia induction guidance was not statistically significant(P＞0.05).Conclusion The parents accompany comfort anesthesia induction technique can effectively increase the compliance during the anesthesia induction period in the children patients with slightly large age,operation experience,parents non-anxiety and psychological internal control type.
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<p><b>OBJECTIVE</b>To systematically assess the benefits and harms of a thromboela-stogram (TEG) guided transfusion strategy with severe bleeding.</p><p><b>METHODS</b>In this prospective study, 60 patients scheduled for scoliosis were included in the Fourth Affiliated Hospital, Xinjiang Medical University, from May 2014 to February 2014.Patients were allocated into either an TEG group or a standard management group.</p><p><b>RESULTS</b>There was no significant difference in age, weight, height and operation time between the two groups (P>0.05). There were significant differences in red blood cell concentration((4.5±1.5)units and(7.1±1.2)units)(t=4.343, P=0.001), platelet((2.5±1.3)units and (4.2±0.6)units)(t=4.554, P=0.002), fresh frozen plasma((234±46)ml and(514±41)ml)(t=3.723, P=0.004), fibrinogen((2.4±0.6)g and (4.6±0.7)g)(t=3.451, P=0.006) between the TEG group and the standard management group.The two groups in intraoperative blood loss((1 023±103)ml and (1 314±116)ml)(t=2.260, P=0.120), incidence of rebleeding after operation(3.1% and 3.6%)(χ(2)=0.340, P=0.450), hospitalization time((18±4)d and (16±6)d)(t=2.140, P=0.160) had no statistically significant differences.</p><p><b>CONCLUSION</b>Application of a TEG guided transfusion strategy seems to reduce the amount of bleeding during correction operation of scoliosis.</p>
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Humans , Blood Loss, Surgical , Blood Transfusion , Monitoring, Physiologic , Prospective Studies , Scoliosis , General Surgery , ThrombelastographyABSTRACT
Objective To statistically analyze the bacterial flora change and drug resistance situation in the patients with bacteri‐al infection to provide reference for clinical rational drug use and the management of nosocomial infection .Methods The clinical samples were conventionally isolated and cultured .The bacteria identification and drug sensitivity test were performed by using the bioMerieux company VITEK2 automatic microorganism analyzer .The confirmation test of drug susceptibility adopted the disk dif‐fusion method recommended by the American Clinical and Laboratory Standardization Committee (CLSI) .Results The sample sources in the hospital infection during 2011-2013 were main sputum ,secretions and midstream urine ;the main infectious bacteria showed the increasing trend ,the top 5 of bacteria were :Escherichia coli (ECO) ,Klebsiella pneumoniae (KPN) ,Acinetobacter bau‐manii (ABA) ,Pseudomonas aeruginosa (PAE) ,Staphylococcus aureus (SAU);the top three of common multi‐drug resistant bacte‐ria were ABA ,PAE and ECO ,their constituent ratio during these three years had a small amplitude increase ;the antibiotics for Gram negative bacilli (G -) resistance rate of more than 70% during these 3 years were :ampicillin ,cefuroxime sodium and cefu‐roxime axetil;the antibiotics for Gram positive cocci (G+ ) resistance rate of more than 70% during these 3 years were penicillin and erythromycin ..Except for 4 cases of Enterococcus faecalis ,no other vancomycin‐resistant strains were found .Conclusion The sam‐ple source of bacterial infection is dominated by sputum ,the gram negative bacteria are the main force of hospital infection ,showing a increasing trend every year ,multi- drug resistant strains are also continuously rising ,penicillin is unsuitable to the clinical treat‐ment of bacterial infection ;imipenem has very high sensitivity to ECO and KPN .The hospital should attach great importance to the infection management ,strengthen the application and management of antibiotics ,decrease the outbreak and prevalence of bacterial infection and reduce the increase of drug resistant strains .
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BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.
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Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.
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Objective To investigate the effect of acute hypervolemic hemodilution (AHHD) on pharmacokinetics of propofol given by target-controlled infusion (TCI). Methods Thirty-six ASA Ⅰ-Ⅱpatients (18 male, 18 female) undergoing elective surgery were randomized to one of two groups: control group (n = 18) and AHHD group ( n = 18). The patients were premedicated with atropine 0.007-0.01mg?kg-1 and phenobarbital 1-2mg?kg-1 i.m. . Radial artery and right internal jugular vein were cannulated before induction of anesthesia. Anesthesia was induced with TCI of propofol. The target plasma propofol concentration was set at 3 ?g?ml-1. When the patients lost consciousness, fentanyl 2?g? kg-1 was given i.v. and tracheal intubation was facilitated by vecuronium 0. 1 mg?kg-1 . Ten minutes after tracheal intubation an additional dose of fentanyl 2 ?g?kg-1 and vecuronium 0.08 mg?kg-1 was given i.v.. TCI of propofol continued for 1 hour. In AHHD group lactated Ringer's solution 10 ml?kg-1 was infused over 30 min before induction of anesthesia. 10 min after TCI propofol was started, 6 % HES 20 ml ?kg-1 was infused within 30 min. In control group the patients received only lactated Ringer's solution 10 ml? kg-1 . All fluid infused was prewarmed to 35℃ Arterial blood samples were taken before and 2,5, 10, 20, 30, 40, 50 and 60 min after TCI propofol was started and 2.5, 5, 10, 15, 20, 30 min after termination of TCI propofol for determination of blood concentration of propofol by gas-chromatography-mass spectrometry (GC-MS) . The TCI system consisted of Graseby 3500 infusion pump controlled by Stelpump 1.07 software, which included Tackley pharmacokinetic parameters. Results The demographic data including sex, age, body weight and amount of propofol consumed were comparable between the two groups. The pharmacokinetic profile of propofol given by TCI was best described by a two-compartment open model during AHHD. The pharmacokinetic parameters tor the final model; K10 was0.116, K12 0.0907 and K210.024mm-1 ; V, was 0.311 and V2 0.446L?kg-1 ; Cl1 was 33.31 and Cl2 16.65 ml?min-1?kg-1 respectively. V1 and V2 were significandy larger, and transfer and clearance rates were significantly higher in AHHD group than those in control group. At the end of AHHD, Hb decreased by 31.0% and Hct by 31.3%; total plasma protein decreased by 30.1% and plasma albumin by 25.7% as compared with the baseline values before AHHD. Conclusion AHHD has significant effect on pharmacokinetics of propofol. Less propofol is bound to plasma protein and duration of action is relatively shorter. During AHHD the target plasma propofol concentration should be increased to some extent to achieve the same depth of anesthesia.
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Obuective To assess the population pharmacokinetic parameters and analyze thecharacteristics of pharmacokinetics of propofol given by target-controlled infusion (TCI) in Chinese using anoulinear mixed effect model (NONMEM) program. Methods Sixty-one ASA Ⅰ-Ⅱ patients (26 male, 35female) aged 18-64yr, weighing 41-83kg undergoing elective operation under general anesthesia were studied. TheTCI system consisted of (1 ) Stel pump Software 1 .07 designed by Coetzee, (2) cable R232 connector, (3)Graseby 3500 infusion pump, (4 ) pharmacokinetic parameters developed by Tackley. The patients werepremedicated with intramuscular phenobarbital sodium 1-2 mg?kg~(-1) and atropine 0. 5 mg. Anesthesia was inducedwith TCI of propofol. Target plasma concentration of propofol was set at 3?g?ml~(-1). Fentanyl 2?g?kg~(-1) andvecuronium 0. 1mg?kg~(-1) were given i. v. when the patients lost consciousness. TCI of propofol lasted 60 min. 976blood samples were obtained before induction of anesthesia and at 2, 5, 10, 20, 30, 40, 50, 60, 62. 5, 65, 70,75, 80, 85, 90 min ther TCI was started for determination of plasma propofol concentration by gas-chromatography-mass spectrometry (GC-MS). Population pharmacokinetic parameters were assessed and thecharacteristics of the pharmacokinetic profile was analyzed using NONMEM program. Results The pharmacokineticprofile of propofol given by TCI in Chinese was best described by an open two-compartment model. Thepharmacokinetic parameters for the final model: K_(10) was 0.111, K_(12) 0 .064 and K_(21) 0 .023 min~(-1); V_1 was 0 .205and V_2 0.404 L?kg~(-1); CL_1 was 22 .76 and CL_2 13 .24 ml?min~(-1). The estimated concentrations were well correlatedwith the measured concentrations in the final model. Weight was found to covariate significandy with V_1 and CL_1and age with K_(21). However gender had no significant effect on pharmacokinetic parameters.Conclusion Thepopulation pharmacokinetic profile of propofol administered by TCI in Chinese can be well described by an open two-compartment model. The volume of central compartment was smaller and the inter-compartmental transfer ratefrom central compartment to peripheral compartment was faster in Chinese.
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1 000 rnl were randomly divided into 2 groups : AHHD group ( n = 18) and control group ( n = 18). The patients were premedicated with intramuscular atropine 0.007-0.01 mg?kg-1 . Radial artery and right internal jugular vein were cannulated before induction of anesthesia for MAP and CVP monitoring, blood sampling and fluid administration. Anesthesia was induced with TCI of propofol. The target plasma propofol concentration was set at 3 ?g ? ml -1 . When the patients lost consciousness, fentanyl 2 ?g ? kg-1 was given intravenous and tracheal intubation was facilitated by vecuronium 0.1 mg? kg-1 , 10min after intubation additional fentanyl 2 ?g? kg-1 and vecuronium 0.08 mg? kg-1 were given. In AHHD group lactated Ringer's solution 10 ml ? kg-1 was infused over 30 min before TCI propofol was started. 10 min after start of TCI propofol 6% HES 20 ml? kg-1 was infused within 30 min. In control group the patients received only lactated Ringer's solution 10 ml?kg-1 . TCI of propofol was maintained for 1 h. Arterial blood samples were taken before and 2, 5, 10, 20, 30, 40, 50 and 60 min after TCI propofol was started, and at 2.5, 5, 10, 15, 20, 25, 30 min after termination of TCI propofol for determination of blood concentration of propofol by gas-chromatography - mass spectrometry (GC-MS) . The TCI system comprising Graseby 3 500 infusion pump controlled by Stelpump 1.07 software which included Tackley pharmacokinetic parameters. Results In AHHD group Hb was reduced from initial (130? 14)g?L-1 to (90? 15)g?L-1 and Hct from initial 38% ? 3% to 26% ? 4 % at the end of AHHD. The measured blood propofol concentrations were significantly lower in AHHD group than those in control group at the corresponding time points (P