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Objective:To analyze the effect of lung protective ventilation on lung ventilation function and serum Clara cell protein 16 (CC16) level in patients undergoing gynecological laparoscopic surgery.Methods:The clinical data of 80 gynecological patients who underwent laparoscopic surgery in Yancheng City Jianhu County People′s Hospital from October 2018 to December 2020 were randomly divided into group A and group B by random number table, each group with 40 cases. The patients in group A were treated with intermittent positive-pressure ventilation, and the patients in group B were ventilated with whole course ventilation mode. The pulmonary ventilation function, CC16 level and postoperative pulmonary complications were observed before anesthesia, 10 min of pneumoperitoneum, 30 min of pneumoperitoneum, 5 min of pneumoperitoneum stop and 2 h after operation. The patients were divided into groups according to whether with pulmonary complications, and their pulmonary ventilation function and serum CC16 level were compared. The predictive value of the above indexes for pulmonary complications was analyzed by receiver operating characteristic (ROC) curve.Results:Repeated measurement analysis of variance showed that alveolar arterial oxygen differential pressure (PA-aDO 2) were significant differences in time point factors, time point interaction factors and group factors ( P<0.05); CC16 index were significant differences in time point factor and group factor ( P<0.05). According to the observation from postoperative to discharge, 4 patients (10.0%) in group A had pulmonary complications, 15 cases (37.5%) had pulmonary complications in group B, the levels of PA-aDO 2 and CC16 in patients with complications were significantly higher than those in patients without complications: group A:(332.9 ± 2.0) mmHg (1 mmHg = 0.133 kPa) vs. (290.4 ± 13.2) mmHg, (53.5 ± 1.5) μg/L vs. (39.5 ± 6.5) μg/L; group B: (339.1 ± 8.8) mmHg vs. (305.7 ± 17.9) mmHg, (41.5 ± 4.2) μg/L vs. (39.7 ± 5.8) μg/L, there were statistical differences ( P<0.05). ROC curve analysis showed that the area under the curve(AUC) of PA-aDO 2 and CC16 in predicting pulmonary complications in group A were 0.882 and 0.833, in group B was 0.885 and 0.731. Conclusions:Lung protective ventilation has little effect on lung ventilation function and serum CC16 in patients with gynecological laparoscopic surgery, and the probability of pulmonary complications is lower. The pulmonary ventilation function and CC16 have certain value in predicting postoperative pulmonary complications.
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Objective:To evaluate the effect of intraoperative cell salvage (ICS) on the number and viability of cancer cells in salvaged autologous blood from the patients undergoing liver cancer surgery.Methods:Twenty patients undergoing open radical primary hepatocellular carcinoma were selected, and blood from the operative field was collected after exposing the liver and treated with ICS. Blood specimens 20 ml from the surgical field (S 1), blood specimens 20 ml before ICS treatment-leukocyte depletion filter (LDF) filtration (S 2) and blood specimens 20 ml after LDF filtration (S 3) were collected and enriched, of which the blood sample 10 ml was used for cancer cell identification and count by immunofluorescence staining, and the remaining blood sample 10 ml was continuously cultured for 3 weeks, and then cell viability was observed by immunofluorescence method. Results:Hepatocellular carcinoma(HCC) cells were identified in 19 S 1 specimens, 18 S 2 specimens, and 16 S 3 specimens, but there was no significant difference in the detection rate among the three specimens ( P>0.05). Compared with S 1 specimens, HCC cell count was significantly reduced in S 2 and S 3 specimens ( P<0.05). There was no significant difference in the HCC cell count between S 3 specimens and S 2 specimens ( P>0.05). After 3 weeks of culture, the results of light microscopy showed that: hepatocellular carcinoma cell clusters were found in S1 specimens, and no hepatocellular carcinoma cell cluster was found in S 2 and S 3 specimens; the results of fluorescence microscopy showed that: 400 and 14 mixed epithelial-mesenchymal HCC cells and 100 and 21 mesenchymal HCC cells were found in S 1 and S 2 specimens, respectively, while no HCC cells were identified in S 3 specimens, among which HCC cells mainly presented as clusters of hepatocellular carcinoma cells in S 1 specimen, while no clusters of hepatocellular carcinoma cells were found in S 2 and S 3 specimens. Conclusions:After treatment with ICS or ICS-LDF, the number and viability of hepatocellular carcinoma cells in salvaged autologous blood are significantly reduced, and hepatocellular carcinoma cells exist as single cells and fail to develop clusters of hepatocellular carcinoma cells; LDF can reduce the risk of hepatocellular carcinoma cell autotransfusion to a certain extent, although it can not effectively filter out hepatocellular carcinoma cells continuously.
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Objective:To explore the etiology and treatment of craniopharyngioma with aneurysm.Methods:Seven cases of craniopharyngioma with aneurysm from March 2014 to October 2019 treated in Sanbo Brain Hospital, Capital Medical University were retrospectively analyzed. Among the 7 patients, there were 5 males and 2 females. There were 4 cases of recurrent craniopharyngiomas, 1 case of primary tumor and 2 cases of non-recurrence tumor. Three patients with blood blister-like aneurysms were treated with microsurgical suture after craniopharyngioma resection. Among the three cases with internal carotid artery fusiform aneurysm, 1 case underwent craniopharyngioma resection after internal maxillary artery-radial artery-middle cerebral artery bypass and isolation of the aneurysm; 1 case only underwent internal maxillary artery-radial artery-middle cerebral artery bypass and isolation of the aneurysm for non-recurrence tumor; 1 case underwent craniopharyngioma resection and dynamic observation of aneurysm. One case with a cystic aneurysm of the middle cerebral artery was clipped and the craniopharyngioma did not relapse.Results:All patients had no serious postoperative complications. During the follow-up period, there was no recurrence of craniopharyngioma, no recurrence of treated aneurysms, and the stability of aneurysms was observed.Conclusions:Inflammatory stimulation of craniopharyngioma cystic fluid and operation itself are the important reasons for the occurrence of aneurysms after craniopharyngioma surgery. Choosing appropriate surgical methods can complete the removal of craniopharyngioma and the treatment of aneurysms at one time.
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Objective:To retrospectively summarize the imaging and clinical features of craniopharyngioma in order to improve the preoperative diagnosis level.Methods:One hundred and twenty-seven patients with craniopharyngioma diagnosed by pathology in Sanbo Brain Hospital, Capital Medical University from March 2019 to June 2021 were selected and the pathological coincidence rate of imaging diagnosis were analyzed.Results:The coincidence rate of MRI diagnosis was 89.3%. The coincidence rate of CT diagnosis was 71.5%. On T 2WI and T 1WI enhanced sequences, the solid portion of the tumor may showed uneven hyperintensity, diffuse striation and spotty hyperintensity. MRI sagittal view was helpful in showing small tumors, but less sensitive to calcification than CT. MRI enhancement was very important, especially for patients with solid lesions. Conclusions:The imaging findings of craniopharyngioma are diverse. Some characteristic manifestations provide important information for the diagnosis and differential diagnosis of craniopharyngioma, which can improve the diagnostic accuracy combined with clinical data.
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Objective:To evaluate the clinical effect of anterior clinoid process grinding in the treatment of ophthalmic / superior clinoid process aneurysms and sellar tumors.Methods:The clinical data of 16 patients who underwent anterior clinoid process grinding in Sanbo Brain Hospital, Capital Medical University from January 2015 to July 2021 were analyzed retrospectively. There were 1 patient with recurrent craniopharyngioma, 1 patient with recurrent pituitary adenoma, 13 patients with aneurysms, and 1 patient with suprasellar granulosa cell tumor combined with ophthalmic aneurysm of right internal carotid artery. The Modified Rankin Scale (mRS) score was used to evaluate the situation at discharge and in the medium-and-long term.Results:Sixteen patients underwent anterior clinoidprocess grinding. At discharge and the latest follow-up, the mRS scores of the patients were 0-2. A total of 15 aneurysms were treated, and there were no symptoms of visual loss or visual field defect after operation. No cerebrospinal fluid leakage occurred in all patients.Conclusions:The grinding of anterior clinoid process can effectively and fully stretch the optic nerve and internal carotid artery, and can observe the tumor neck at the lower end of pituitary stalk and the ocular segment/superior clinoid process of internal carotid artery under direct vision. It is one of the important auxiliary methods for the treatment of sellar lesions.
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Objective:To investigate the effect of ultrasound measurement of optic nerve sheath diameter (ONSD) in adult patients with elevated intracranial pressure (ICP).Method:From June 2017 to March 2020, A total of 64 patients (32 patients with elevated ICP and 32 patients with normal ICP) were placed with invasive intracranial pressure monitoring probe in Beijing Pinggu Hospital. Their ICP and ONSD were continuously monitored. Thirty-two healthy volunteers were recruited as control group to check ONSD. The correlation between ONSD and ICP, and the changes of ICP and ONSD after osmotic therapy were observed.Results:The ONSD in ICP increased group was significantly higher than that in normal ICP group: (5.77 ± 0.3) mm vs. (5.01 ± 0.1) mm, with statistical difference ( P<0.05), and there was a positive correlation between ONSD and ICP. There was no significant difference in ONSD between normal ICP group and control group ( P>0.05). Conclusions:Ultrasound monitoring ONSD can reflect the level of ICP and evaluate the effect of osmotic therapy and the prognosis of patients. Bedside ultrasound examination of optic nerve sheath diameter could be used to judge ICP and to evaluate the curative effect of osmotic therapy, with high clinical application value.
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Objective To explore the surgical treatment of spindle aneurysms in V4 segment of vertebral artery. Methods The clinical data, surgical methods and prognosis of 6 patients with V4 spindle aneurysms of vertebral artery admitted from 2011 to November 2018 in Sanbo Brain Hospital were retrospectively analyzed,Results There were 4 males and 2 females aged from 45 to 65 years. Aneurysm rupture and bleeding occurred in 3 cases. Far lateral approach was used in all patients. One case was clipped with window aneurysms, 2 cases were treated with occipital artery (OA)- posterior inferior cerebellar artery (PICA) bypass, and 3 cases were treated with vertebral artery occlusion. Postoperative patients were generally in good condition. Postoperative CT arteriography confirmed that the bypass vessels were unobstructed in 2 cases. All vertebral aneurysms were treated satisfactorily and PICA arteries were preserved. Tracheotomy was performed in 5 patients (1 case was incised before operation). Three patients were removed 3 months after operation. The Glasgow Prognosis Score (GOS) was 4 points. Long-term tracheotomy was performed in 1 case, and GOS score was 3 points. Two patients died 4 months and 3 years after operation. Conclusions Craniotomy is an important method for the treatment of spindle aneurysm of V4 segment of vertebral artery. Different surgical methods should be selected according to the size of the aneurysm, the relationship between the location of the aneurysm and PICA, and the compensation of the vertebral artery.
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The microstructure of cationic cyclopeptide (TD-34) treated Caco-2 cell membrane was observed, and we discussed the relationship between membrane structure and insulin transmembrane permeability. Atomic force microscope (AFM) was used to observe living cell membrane in air condition and tapping mode. Results showed that the surface of Caco-2 cell membrane treated with TD-34 lost its smoothness and nearly doubled its roughness. Apparent permeability coefficients (P(app)) of insulin in Caco-2 cell monolayers increased 2.5 times. In conclusion, AFM can be used to observe microstructure of cationic cyclopeptide treated cell membrane and cationic cyclopeptide enhanced insulin delivery across Caco-2 cell membrane by increasing membrane fluidity.
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A high sensitive and rapid method was developed for the analysis of lappaconitine in mouse plasma using liquid chromatography coupled to mass spectrometry (LC-MS). Detection was performed by positive ion electrospray ionization (ESI) in multiple reaction monitoring (MRM) mode, monitoring the transitions m/z 585 --> m/z 535 and m/z 356 --> m/z 192, for the quantification of lappaconitine and tetrahydropalmatine (internal standard, IS), respectively. The method was linear over the concentration range of 3.0-2000.0 ng x mL(-1). The lower limit of quantification was 3.0 ng x mL(-1). Intra- and inter-run precisions (RSD) were both less than 9.9% and accuracy (RE) within +/- 4.8%. After single intravenous injections of lappaconitine hydrobromide at 1.0, 2.0 and 4.0 mg x kg(-1), the elimination half-lives (t(1/2)) were 0.47, 0.48 and 0.49 h, and the areas under the curve (AUC(0-t)) were 55.5, 110.5 and 402.9 ng x h x mL(-1), separately. The pharmacokinetic profile of lappaconitine was linear at relatively lower dose levels (1.0-2.0 mg x kg(-1)). When the dose increased farther to 4.0 mg x kg(-1), the Vz and CL decreased, and the increase fold of the AUC was much larger than that of the dose.
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Objective To analyze the features of supraclinoid internal carotid aneurysms. The experience and mistakes in the microsurgery of supraclinoid internal carotid aneurysms were summarized to improve the results. Methods The data of 24 cases of supraclinoid internal carotid aneurysms that were operated from May 2004 to March 2009 were reviewed. There were 6 cases of small or middle aneurysms, 18 cases of large or giant aneurysms. The operative methods included direct clipping, partial excision of aneurysm with reconstruction of the parent artery, aneurysm trapping with extracerebral/intracerebral (EC-IC) bypass, etc. Results Among the 24 cases, 8 cases had good results. Ten cases occurred hemiplegja post operation immediately, with 5 cases recovered to grade IV ,3 cases had aphasia,5 cases with vision acuity fall,4 cases had abnormal eyeball movement,2 cases had continued coma and died finally. Second operations were performed in 3 cases. The total operation rate of well results was 66.7% (16/24). Mortality rate was 8.3% (2/24). Conclusions The operative technique of the supraclinoid internal carotid aneurysms is difficult because of the location and the large size of the aneurysms. The temporary obstruction' of the parent artery is often needed, so the aneurysm can be partially resected and clipped. The results of clipping of large or giant aneurysms are better than the other methods. But in large or giant aneurysms that had thrombus, the EC-IC bypass is needed to prevent large infarction. The bypass procedure may induce some severe complications that result in some poor outcome.
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AIM: To examine the effect of acrylic ester and thermosol respectively as pressure sensitive adhesive matrix of zhitong huoxue extract ( Rhizoma Corydalis,Radix aconiti,Radix Paeoniae alba,Radix et notoginseng ginseng,etc) on the dissolution of effective constituent from zhitong huoxue extract.METHODS: The in vitro release experiment was carried out on Permcell diffusion cell,HPLC method was applied to determining the cumulative elease rate of tetrahydropalmatine,aconitine,paeoniflorin and ginsenoside Rg_1 from zhitong huoxue pressure sensitive adhensive.RESULTS: The acrylic ester matrix had sound controlled release profile in vitro of alkaloid components.In KT-A thermosol matrix,the in vitro release rate proved to be inversely proportional to the molecular weight (R = 0.91 ) of the effective constituents,while the 2501 s matrix presented a steadily cumulative release rate over 12 h (30% -43% ).CONCLUSION: Good release rates are observed with effective constituent with small molecular weight,adhesive composition of matrix has an obvious effect on the in vitro release behavior of zhitong huoxue extract.
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Objective To study percutaneous absorption kinetics and synergistic penetration enhancement of tetrahydropalmatine,aconitine and ginsenoside Rg1.Methods The in vitro intact and stripped skin permeation experiments were carried out by using Permcell KH-5P horizontal proliferation system.The percutaneous kinetic parameters of tetrahydropalmatine,aconitine and ginsenoside Rg1 were determined by HPLC,and the transdermal behaviors of the three active ingredients and interactions of combination were investigated.Result The cumulative amounts in 24 h of intact skin of tetrahydropalmatine,aconitine and ginsenoside Rg1 were 123.95,50.32,96.25(?10-10 cm2/s).The cumulative amounts in 24 h of stripped skin of them were 539.00,93.60,354.70(?10-10 cm2/s).The LogP were 1.66,0.66 and 0.57 respectively.Each component had cumulated amount permeated of improvement by 64%～293% in coexistence system of three active ingredients.Conclusion The combination of three active ingredients results in a synergistic enhancement effect on percutaneous absorption of every active ingredient,and it is shown that the maximal enhancement effect appears between aconitine and ginsenoside Rg1.
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G1.(3)Among 5 groups,the highest incidences of nausea,vomiting and pruritis were observed in group G1 for about 24% 32%,but with no statistical difference compared with other groups.Conclusion: With equal doses of bupivacaine and fentanyl mixed,the concentration/volume ratios may affect the analgesic effects of postoperative epidural analgesia in patients with hepatectomy.
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The use of genetic approaches to probe relative genes that control sensitivity to volatile anesthetics in intact model has recently emerged as the powerful tools and strategies in dissecting mechanisms of anesthesia. Multiple model organisms such as yeast, nematodes, fruitflies and mammals are currently being exploited, and a number of sensitive genes have been screened, with some of them being cloned, located, and function identified. The emerging technologies are likely to provide further great advances for elucidating the specific anesthetic molecular sites.
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AIM:To examine the effect of acrylic ester and thermosol respectively as pressure sensitive adhesive matrix of zhitong huoxue extract(Rhizoma Corydalis,Radix aconiti,Radix Paeoniae alba,Radix et notoginseng ginseng,etc)on the dissolution of effective constituent from zhitong huoxue extract.METHODS:The in vitro release experiment was carried out on Permcell diffusion cell,HPLC method was applied to determining the cumulative elease rate of tetrahydropalmatine,aconitine,paeoniflorin and ginsenoside Rg_1 from zhitong huoxue pressure sensitive adhensive.RESULTS:The acrylic ester matrix had sound controlled release profile in vitro of alkaloid components.In KT-A thermosol matrix,the in vitro release rate proved to be inversely proportional to the molecular weight(R= 0.91)of the effective constituents,while the 2501 s matrix presented a steadily cumulative release rate over 12 h(30%-43%).CONCLUSION:Good release rates are observed with effective constituent with small molecular weight,adhesive composition of matrix has an obvious effect on the in vitro release behavior of zhitong huoxue extract.