Comparison of nursing delirium screening scale and intensive care delirium scale in the evaluation of delirium after percutaneous coronary intervention / 中华行为医学与脑科学杂志

Objective:To compare the evaluation ability and effect of the nursing delirium screening scale (Nu-DESC) and the intensive care delirium screening checklist (ICDSC) on the patients with delirium after percutaneous coronary intervention(PCI).Methods:A total of 128 patients who were admitted to cardiovascular surgery from June 2018 to June 2019 for PCI intervention were selected by convenient sampling method.Data were collected by general data questionnaire, restless sedation scale (RASS), Nu-DESC and ICDSC.SPSS 18.0 was used to analyze the collected data.The patients' receiver operating characteristic(ROC) curve and area under the ROC curve(AUC) were used to analyze Nu-DESC scale and ICDSC scale to evaluate the delirium ability of patients after PCI. Kappa value was used to test the consistency of the scale.Bayes discriminant analysis was used to analyze the accuracy of Nu-DESC and ICDSC in judging delirium after PCI.Results:The AUC of Nu-DESC and ICDSC was 0.902 and 0.857 respectively, and the difference between them was AUC=0.045 ( Z=3.489, P<0.001); the best critical value of Nu-DESC and ICDSC for delirium evaluation was 2 and 4. The cross validation accuracy of Nu-DESC and ICDSC for delirium determination was 87.5% and 83.6%, respectively.The delirium rates of DSM-Ⅳ, Nu-DESC and ICDSC were 33.6%, 34.4% and 43.7%, respectively. Conclusion:Compared with ICDSC, Nu-DESC is more suitable for the evaluation of delirium after PCI.

Clinical study on microcirculation resistance index for predicting major adverse cardiac events after PCI operation in patients with ST segment elevation myocardial infarction / 重庆医学

Objective To investigate the clinical value of the index of microcirculation resistance(IMR) in the prediction of major adverse cardiac events after PCI in the patients with ST segment elevation myocardial infarction.Methods Forty-eight inpa tients with acute ST segment elevation myocardial infarction(STEMI) in the cardiology department CCU of our hospital from December 2013 to June 2015 were selected,including 38 males and 10 females,and divided into 3 groups according to the measured IMR value after PCI operation:the group A,IMR≤25(n=18);group B,IMR 25 ～ 32 (n =16);group C,IMR≥32 (n =14).Serum NT-ProBNP was collected,and the data in cardiac color ultrasound after PCI and at postoperative 1 year:left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD),and major adverse cardiac events within 1 years after PCI were also collected.Results The serum of concentrations NT-ProBNP were compared among the three groups[(2 734.83 ± 1 009.40) vs.(4 929.68±611.52) vs.(7 480.64±2 082.78)],and the difference among 3 groups was statistically significant (F=35.449,P=0.000).The difference of LVEF among the three groups had statistal significance[(54.00-±-5.99) vs.(52.31 ± 4.35)vs.(49.29 ±4.68),F=3.376,P=0.043)],and there was no statistical difference among the three groups in LVEDD(P＞0.05).The difference of LVEF at postoperative 1 year among 3 groups had statistical significance[(57.28 ± 5.21)vs.(54.43 ±3.69)vs.(46.43±5.33),F=16.744,P=0.000],and the difference of LVEDD (48.94±1.95)vs.(50.63±2.68)vs.(52.14±2.69) among 3 groups was statistically significant(F=6.875,P=0.002).The differences in the major adverse cardiac events,cases of cardiac death and cases of heart failure after postoperative 1 year among 3 groups were statistically significant(x2 value=6.707,P=0.035;x2 value=6.084,P=0.048);the occurrence of again ACS,again PCI and malignant arrhythmia had no statistical difference among 3 groups(P＞0.05).Conclusion Measurement of IMR after PCI in the patients with STEMI can effectively predict the heart function and the risk of major adverse cardiac events within 1 year.

Discusion on Improvement of Standardized Teaching Based on the Teaching Mode of PBL Teaching Method Combined with the Situational Teaching of the Internal Medicine / 浙江中医药大学学报

[Objective] Based on the combination of teaching in the scientific scenario of PBL teaching mode improving the status of implementation of standardized teaching.[Methods]Firstly,domestic science teaching methods summary review and classification details of the traditional teaching methods,problem-centered teaching methods,teaching scenarios and situational approach combining four kinds of PBL teaching content as well as the first three inadequate teaching methods.And analysis showed that this method can promote standardization within science teaching implemented.[Results] The combination of PBL teaching scenarios for students can play an active role,while teachers also have some pedagogical implications.[Conclusion]The combination of PBL teaching scenario of higher professional level of teachers,innovation and professionalism requirements,etc.,in the teaching process,also requires teachers to have a certain ability to manage the classroom and modern teaching philosophy to fully mobilize students active learning.

Effect of dexmedetomidine on gastric mucosal injury induced by intestinal ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on gastric mucosal injury induced by intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy male Sprague-Dawley rats,aged 4-5 months,weighing 200-250 g,were randomly divided into 4 groups (n =9 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),low-dose dexmedetomidine group (group LD),and high-dose dexmedetomidine group (group HD).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 1 h followed by 2 h reperfusion in anesthetized rats.Dexmedetomidine 2.5 and 5.0 μg · kg-1 · h-1 were infused via the caudal vein for 1 h starting from 1 h before ischemia in LD and HD groups,respectively.The rats were sacrificed at 2 h of reperfusion,and the gastric mucosa was obtained for examination of the pathological changes (with light microscope) and for determination of the expression of serine/threonine kinase (Akt),phosphorylated Akt (p-Akt),activated caspase-3 and caspase-3 (by Western blot).The ratio of p-Akt to Akt (p-Akt/Akt)was calculated to reflect the phosphorylation of Akt.The ratio of activated caspase-3 to easpase-3 (activated caspase-3/caspase-3) was calculated to reflect the activation of caspase-3.Results Compared with group S,the expression of Akt was significantly up-regulated,the expression of p-Akt was significantly downregulated,the phosphorylation of Akt was significantly decreased,and the activation of caspase-3 was significantly increased in group I/R,and the expression of p-Akt was significantly up-regulated,and the phosphorylation of Akt and activation of caspase-3 were significantly increased in LD and HD groups (P＜0.05).Compared with group I/R,the expression of Akt was significantly down-regulated,the expression of p-Akt was significantly up-regulated,the phosphorylation of Akt was significantly increased,and the activation of caspase-3 was significantly decreased in LD and HD groups (P＜0.05).The degree of gastric mucosal injury was significantly lower in LD and HD groups than in group I/R,and there was no significant difference in the degree of gastric mucosal injury between group LD and group HD.Conclusion Dexmedetomidine can attenuate gastric mucosal injury induced by intestinal I/R,and the mechanism may be related to activation of PI3K/Akt signaling pathways and inhibition of cell apoptosis in rats.

Effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats.</p><p><b>METHODS</b>Fifty male SD rats were randomly divided into 5 groups, including a control group, a myocardial fibrosis model (established by injections of isopropyl adrenaline for 10 days) group, and 3 edaravone groups with edaravone treatment at low, medium, or high doses for 14 days. After the treatments, the rats were examined for the degree of myocardial fibrosis, left ventricular mass index (LVMI), collagen volume fraction (CVF), and myocardial contents of collagen I (Col I), collage III (Col III), hydroxyproline (Hyp), superoxide dismutase (SOD), malondialdehyde (MDA), and nitric oxide (NO); The expression of transforming growth factor-β1 (TGF-β1) in the myocardial tissues was examined by immunofluorescence assay and Western blotting.</p><p><b>RESULTS</b>Compared with the control rats, the rat models of myocardial fibrosis showed significantly increased CVF and LVMI (P=0.000), which were lowered by edaravone treatments in a dose-dependent manner (P<0.05). The myocardial contents of Col I, Col III and Hyp also increased in the model group (P=0.000) and were lowered dose-dependently by edaravone; the contents of MDA was higher (P=0.000) and SOD and NO were lower in the model group (P=0.000), and edaravone treatments obviously increased SOD and NO contents (P<0.05). The model rats showed significantly increased myocardial expression of TGF-β1 (P=0.000), which was markedly lowered by edaravone treatments (P=0.000). The myocardial content of MDA was positively correlated while SOD and NO were negatively with LVMI, CVF, Col I, Col III and Hyp; TGF-β1 was positively correlated with LVMI, CVF, Col I, Col III, Hyp and MDA but negatively with SOD and NO.</p><p><b>CONCLUSION</b>Edaravone can relieve oxidative stress and inhibit TGF-β1 activation to ameliorate myocardial fibrosis in rats.</p>

Effect of dexmedetomidine in preventing shivering after general anesthesia for laparoscopic surgery: a randomized, single-blinded, and placebo-controlled trial / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate efficacy of dexmedetomidine in preventing shivering after general anesthesia in women undergoing laparoscopic surgery.</p><p><b>METHODS</b>Eighty patients scheduled for laparoscopic gynecological surgery were randomized into dexmedetomidine group (n=40) and control group (n=40) to receive 1.0 µg/kg dexmedetomidine or an equal volume of saline slowly injected (for over 10 min) at 30 min before the anticipated completion of surgery. The postoperative incidences of shivering and the side effects were recorded.</p><p><b>RESULTS</b>The patients in the control group showed a significantly higher postoperative incidence of shivering (37.5%) than those in dexmedetomidine group (P<0.05). Heart rate and mean arterial pressure showed significant variations postoperatively in dexmedetomidine group (P<0.05), which had a significantly greater sedation score (P<0.05), a higher incidence of dry mouth (P=0.000), but a significantly lower incidence of nausea and vomiting than the control group (P<0.05).</p><p><b>CONCLUSION</b>Dexmedetomidine can lower the incidence of shivering after general anesthesia for laparoscopic gynecological surgery.</p>