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With the aggravation of global aging process and the strengthening of patients’ awareness of rights, the realization of the elderly and end-of-life patients’ right to know and autonomy, and the satisfaction of physical and mental needs have become new indicators to measure social development. Advance care plan focuses on the discussion process of patients, their families and medical staff on end-of-life medical decisions and death intentions, which greatly promotes the development concept of palliative care and optimal death. To promote this process in the context of traditional Chinese culture, it is also necessary to combine with the local family concept and collectivism. Therefore, this paper introduced a sustainable social support system involving multiple subjects such as families, communities, social workers, and legal workers, with a view to benefiting the elderly and end-of-life patients.
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Objective To evaluate the changes in the status of macrophages during the non-ventilated lung injury in the patients undergoing long-time one-lung ventilation (OLV).Methods Thirty patients of both sexes,aged 35-64 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective pulmonary lobectomy for lung cancer,were divided into 2 groups (n=15 each) according to the time of OLV:short-time OLV group (＜30 min,group S) and long-time OLV group (＞2 h,group L).Anesthesia was routinely induced and maintained.Normal lung tissues around the cancer tissues from the lobe of the lung excised were obtained for microscopic examination of pathologic changes which were scored.The activated macrophages (CD68 positive),polarized M1 macrophages (CD86 positive) and polarized M2 macrophages (CD206 positive) in lung tissues were detected using immunofluorescence.The ratio of CD86 positive cells to CD206 positive cells was calculated.Results Compared with group S,lung injury scores on the non-ventilated side were significantly increased,the number of CD68,CD86 and CD206 positive cells in lung tissues was increased,and the ratio of CD86 positive cells to CD206 positive cells was increased in group L (P＜0.05).Conclusion Long-time OLV (＞2 h) can result in increased number of activated macrophages,especially the polarized M1 macrophages,which may be one of the mechanisms underlying lung injury on the non-ventilated side.
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Objective To investigate the relationship between maintaining concentration and loss of consciousness (LOC) concentration of propofol target controlled infusion (TCI) in patients undergoing heart valve replacement.Methods Thirty patients undergoing elective heart valve replacement were enrolled to receive propofol by ladder plasma TCI for anesthesia induction,8 males and 22 females.The initial plasma concentration (Cp) of propofol was set to 1.0 μg/ml,0.3 μg/ml Cp was increased every 1 min until LOC when the prediction effect-cite concentration (Ce) reached 0.5 μg/ml,then sufentanil 0.8-1.0 μg/kg and rocuronium 0.6-0.9 mg/kg were given for intubation.When BIS reached 50,Cp was decreased to the level of Ce.All the surgeries were performed under hypothermia CPB.MAP,HR,CVP,CO,SV,SVR,BIS,propofol Cp and Ce values were recorded at baseline (T0),LOC (T1),BIS reached 50 (T2),and other time points during operation (T3-T9).The correlation analysis between propofol Ce at LOC and perioperative variables were completed.Results In correlation analysis,there was a significant positive correlation between propofol Ce at LOC and baseline CO,SV (P<0.01),there was a significant negative correlation between propofol Ce at LOC and age (P<0.05),there was a significant positive correlation between propofol Ce at LOC and propofol Ce at T2-T9(P<0.01).Conclusion In patients undergoing valvular replacement,the Ce of propofol at maintenance are related to the concentration of propofol at LOC,which is helpful for adjusting the Ce of propofol at maintenance according to the Ce of propofol at LOC.
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Objective To evaluate the effect of sevoflurane on cognitive function of mice with Alzheimer's disease.Methods Twenty male mice carrying mnutations in amyloid precusor protein (APP) and presenilin 1 genes,weighing 30-40 g,aged 7 months,were divided into either sevoflurane group (group Sev) or control group (group C),with 20 mice in each group.Mice inhaled 3％ sevoflurane for 4 h in group Sev,and mice inhaled 30％ oxygen for 4 h in group C.At 1 month after inhaling sevoflurane or oxygen,the mice underwent continuous multiple-trail inhibitory avoidance training.The mice were then sacrificed and hippocampi were isolated for determination of the number of Aβ plaques (by immunohistochemistry) and expression of APP and Tau (S396) phosphorylation (by Western blot).Results Compared with group C,the memory lateucy was significantly shortened,the number of Aβ plaques was increased,the phosphorylation of Tau (S396) was increased,and the expression of APP was up-regulated in group Sev (P＜0.05).Conclusion Sevoflurane can decrease the cognitive function of mice with Alzheimer's disease.
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Objective To evaluate the effect of therapeutic hypercapnia on the balance between cer-ebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the beach chair posi-tion(BCP). Methods Forty-eight patients of both sexes, aged 21-64 yr, weighing 45-80 kg, of Ameri-can Society of Anesthesiologists physical statusⅠorⅡ, scheduled for elective arthroscopic shoulder surgery in the beach chair position, were divided into 2 groups(n=24 each)using a random number table: control group(group C, end-tidal pressure of carbon dioxide 35-40 mmHg)and therapeutic hypercapnia group (group H, end-tidal pressure of carbon dioxide 45-50 mmHg). The regional cerebral oxygen saturation (rSO2)was recorded after induction and before BCP, immediately after BCP, at 3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 min after BCP and at the end of surgery(T0-12). The occurrence of cerebral desaturation events, extubation time, duration of stay in postanesthesia care unit, development of nausea and vomiting and requirement for vasoactive drugs were recorded during surgery. Results Compared with the baseline at T0, the rSO2was significantly decreased at T1-12in group C and at T2-6in group H(P<005). The rSO2was significantly higher at T1-12, and the incidence of cerebral desaturation events was lower in group H than in group C(P<005). There was no significant difference between the two groups in the extubation time, dura-tion of stay in postanesthesia care unit, incidence of nausea and vomiting or requirement for vasoactive drugs (P>005). Conclusion Therapeutic hypercapnia can improve the balance between cerebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the BCP.
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Objective To observe the clinical effects of ultra-sound guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia on elderly patients undergoing hip replace-ment surgery.Methods Eighty elderly patients scheduled for unilateral hip replacement surgery were randomly divided to lumbar plexus and sciatic plexus nerve block combined with general anesthesia group (group N)and general anesthesia group (group G).The airways of all the patients were con-trolled by laryngeal mask airway (LMA)in both groups.The bispectral index (BIS)of patients in both groups was maintained in the range of 45-55.The dosage of sulfentanyl,visual analogue scale (VAS)at 2,4,8 and 24 h after surgery,and the dosage of patient controlled analgesia (PCA)drugs were recorded.The period from end of surgery to extubation,off-bed activity and discharged from hospital,mortality in 30 days after surgery were recorded.Meanwhile,postoperative delirium (POD) and postoperative cognitive dysfunction (POCD),and severe cardiovascular and pulmonary complica-tions were evaluated.Results No patient died in 30 days after surgery in both two groups.One patient suffered from severe pulmonary infection in group G.The dosage of sulfentanyl of group N was less than the value of group G (P <0.05),the periods from end of surgery to extubation,off-bed activity and discharged from hospital of group N were shorter than those in group G (P <0.05 ).The VAS scores and incidence of POD and POCD in group N were lower than those in group G (P < 0.01 ). Conclusion In elderly patients undergoing hip replacement surgery,ultrasound-guided lumbar plexus and sciatic plexus nerve block combined with general anesthesia could help reduce usage of opioids during operation,offer better analgesia effect,shorten the period of off-bed activity and discharged from hospital and reduce incidence of POD and POCD in elderly patients.
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The epidemic characteristics and genotype of Bacillus anthracis strains in Liaoning Province ,China was analyze in this study .Six Bacillus anthracis strains from 2001 to 2011 were studied with multiple‐locus variable‐number tandem repeat analysis (MLVA) .BioNumerics4 .0 software was used to analyze the DNA fingerprint of statistics ,and cluster analysis results were obtained .Clustering analysis found that the 6 strains could be divided into two genotypes .For anthrax outbreaks ,the ge‐netic markers of multiple‐locus variable‐number tandem repeat were highly similar .It's suggested that MLVA is quite useful for investigation of strain relatedness in regions of outbreaks .
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Objective To evaluate free or pedicled perforator flaps for repairing chronic osteemylitis with soft-tissue defect in the distal lower extremity. Methods From May of 2006 to October of 2007, 28 consecutive patients of chronic osteomylitis with soft-tissue defect in the distal lower extremity underwent surgical debridement and reconstruction with free or pedicled perforator flaps. There were 13 free flaps. The free anterolateral thigh flaps were used in 2 cases to repair the soft defects in the front of leg, 3 cases in the front of the malleolus, 2 cases in the dorsum of foot, 2 cases in the heel. The free lateral crural flaps nourished by perone al artery were used in 4 cases to repair the soft defects in the dorsum of foot. There were 15 pedicled flaps. Posterior tibial artery perforator flaps were used in 4 cases to repair the soft defects in the front of leg, and 2 cases in the medial malleolus. Lateral retromalleolar perforator flaps nourished by peroneal artery were used in 6 cases to repair the soft-defects in the heel, 1 case in the lateral malleolus and 1 case in the dorsum of foot, the first dorsal metatarsal artery perforator flap was used to repair the proximal dorsum of hallux. The wound was closed with irrigation-suction in 7 cases and with vancomycin-impregnated gelatin in 8 cases. Results All 27 flaps were successfully survived except insuffcient vein refluence in 1 posterior tibial artery perforator flap, which resulted in a superficial necrosis and healed spontaneously. The follow-up period from 6 months to 2 years revealed that recurrence developed in two diffuse type patients and both were treated once and twice with success, respectively. The others healed without any signs of recurrences. No debulking procedure was necessary in any case. Secondary bone graft was performed in 3 cases. All patients were ambulatory and fully weight-bearing with normal clinical parameters at the time of last review. According to the evaluating criteria for the treatment of foot disease, the mean score was 84.5. Conclusion Free or pedicled perforator flap has been shown to be well vascularised, and it is feasible for the treatment of chronic osteomyelitis with soft-tissue defect in the distal lower extremity.
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Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.