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In order to improve the success rate of supraclavicular deep venous catheterization and reduce mechanical complications, we present an auxillary maneuver in regard to supraclavicular subclavian catheterization basing on the relatively fixed anatomy of subclavian vein and its adjacent surroundings, furthermore, we revised the standardized procedure of supraclavicular subclavian catheterization. The maneuver is summarized in the shape of verses (verses: thumb navigation is well designed according to anatomy. Needle penetrated into vein should be parallel to coronal plane. Fine needle in position should be immobilized. Is it difficult for parallel puncture? Pressure determination is required when needle is in place. It is critical to distinguish which vessel has been inserted. Guidewire is advanced smoothly. Check blood return after expansion of skin and catheterization.). For teaching convenience, verses are considered to be more concise and memorable, as well as applicable to clinical practice, in order to provide some help for clinical teaching.
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Objective:To explore the clinical efficacy of consolidation chemotherapy combined with microtransplantation in the treatment of elderly patients with acute myeloid leukemia (AML).Methods:The clinical data of 45 elderly patients with AML in Suzhou Yongding Hospital from January 2016 to December 2018 were retrospectively analyzed. After 1 or 2 courses of induced chemotherapy, the patients achieved complete response (CR). Among them, 20 patients were given consolidation chemotherapy (single group), and 25 patients were given consolidation chemotherapy combined with microtransplantation (combined group). After 3 courses of treatment, the minimal residual disease (MRD), quantitative expression of WT1 gene and adverse reactions were compared between 2 groups; the quality of life before treatment and after treatment was evaluated by quality of life-BREF (QOL-BREF). The patients were followed up to November 1, 2020, and the median follow-up was 30 months. The overall survival and progress-free survival (PFS) were recorded.Results:The MRD negative rate and WT1 gene negative rate after treatment in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 25.00% (5/20) and 52.00% (13/25) vs. 20.00% (4/20), and there were statistical differences ( P<0.05). The recovery times of neutrophils and platelets in combined group were significantly shorter than those in single group: 10 (8, 12) d vs. 16 (13, 20) d and 14 (11, 17) d vs. 24 (19, 30) d, and there were statistical differences ( Z = 3.152 and 4.285, P<0.05). No adverse reactions such as liver and kidney abnormalities or gastrointestinal reactions occurred in 2 groups; and no specific graft versus host disease (GVHD) occurred in the combined group. The each item scores of QOL-BREF after treatment in combined group were significantly higher than those in single group, and there were statistical differences ( P<0.01). The 2-year overall survival rate and PFS rate in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 35.00% (7/20) and 52.00% (13/25) vs. 25.00% (5/20), and there were statistical differences ( χ2 = 4.235 and 4.742, P = 0.040 and 0.029). Conclusions:Consolidation chemotherapy combined with microtransplantation is effective and safe in the treatment of elderly patients with AML. It can significantly improve the quality of life, and improve the overall survival rate and PFS rate.
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Objective To investigate the clinical effect of low-temperature plasma radiofrequency with endoscopic laryngoscope in the treatment of adult patients with laryngeal papilloma.Methods From January 2014 to April 2018,60 adult patients with laryngeal papilloma in Zhuji Central Hospital were enrolled in this study.According to the treatment methods,they were divided into control group and observation group,with 30 cases in each group.The control group was treated with laryngoscope tweezers,and the observation group was treated by low temperature plasma radiofrequency with endoscopic laryngoscope.The operation time,intraoperative blood loss,hospitalization time and postoperative complications were recorded.The follow-up was performed on the first day after operation.The recurrence rate and average recurrence time were recorded.Results The average operation time in the observation group was (29.54 ± 4.52)min,which was significantly shorter than (38.85 ± 5.47)min in the control group (t =7.186,P =0.000).The intraoperative blood loss of the observation group was (1.24 ± 0.76) mL,which was significantly lower than (35.69 ± 5.88) mL of the control group (t =31.825,P =0.000).The length of hospital stay of the observation group was (3.83 ± 1.17) d,which was significantly shorter than (4.79 ± 1.47) d of the control group (t =2.798,P =0.006).The incidence rate of postoperative complication in the observation group was 3.33％ (1/30),which was significantly lower than 23.33％ in the control group (x2 =5.192,P =0.022).The mean duration of postoperative recurrence in observation group was (2.42 ± 0.57) months,which was significantly longer than (1.28 ± 0.36) months in the control group(t =9.261,P =0.000).The postoperative recurrenc.e rate of the observation group was 6.67 ％ (2/30),which was significantly lower than that of the control group [40.00 ％ (12/30),x2 =9.316,P =0.002].Conclusion Low temperature plasma radiofrequency with endoscopic laryngoscope in the treatment of adult patients with laryngeal papilloma has less trauma,and can extend the recurrence time,reduce the postoperative recurrence rate.
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Objective To investigate the clinical effect of coagulation therapy in patients with gastric ulcer bleeding.Methods From January 2013 to January 2016 in Xiaoshan First People's hospital 150 cases of gastric ulcer patients with bleeding,using SPSS16.0 software to generate randomly divided into hemocoagulase group(basic treatment + hemocoagulase injection therapy)and control group(basic treatment)of the 75 cases,compared two groups of hemostatic time,hemostatic effect.Results After 72h treatment,the average hemostasis time of hemocoagulase group were significantly lower than the control group(P<0.05),the blood coagulation enzyme in patients with serum VEGF,EGF levels higher than the control group(P<0.05),gastrin and somatostatin levels lower than the control group(P<0.05),hemocoagulase group cure rate is 64％,effective in 22.67％,effective 9.33％,invalid 4％,the control group were 46.67％,25.33％,18.67％,9.33％,two groups compare difference was statistically significant(P<0.05).Conclusion Treatment of gastric ulcer bleeding patients with coagulation enzyme can shorten the hemostatic time,improve the clinical effect of hemostasis.
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Objective To investigate the effect of dexmedetomidine on the incidence of POCD and the inflammatory response of central nervous system in elderly patients with radical gastrectomy,so as to provide reference for the selection of POCD prophylaxis in elderly patients.Methods A total of 86 elderly patients aged 36-79 years with ASA grade Ⅰ-Ⅲ underwent radical gastrectomy with general anesthesia were enrolled.They were randomly divided into two groups using computer random software:dexmedetomidine group (D group) and saline group (S group),43 patients in each group.MMSE score and MoCA score were recorded 1 day before anesthesia (T0),6h after operation (T1),24h after operation (T2) and 48h after operation (T3).Interleukin-1β (IL-1β),interleukin -6 (IL-6) and C-reactive protein (CRP) were measured at different time points.The incidence of hypotension and bradycardia was recorded.Results There were no significant differences in MMSE scores and MoCA scores between the two groups 1 day before anesthesia (t =0.356,0.403,all P ＞0.05).The MMSE score and MoCA score of the D group were significantly higher than those of the S group at T1,T2 and T3 (t =5.998,6.886,5.943,6.180,6.947,7.151,all P ＜0.05).The levels of IL-1β,IL-6 and CRP in the D group were significantly lower than those in the S group at T1,T2 and T3 (t =2.239,2.731,2.134,15.47,17.28,12.93,4.583,6.444,7.544,all P ＜ 0.05).Conclusion Dexmedetomidine can significantly reduce the risk of POCD in elderly patients with radical gastrectomy,and can inhibit the inflammatory response.It is worth to use in clinic.
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Objective To evaluate the nursing effect of orientation of traditional Chinese medicine drug therapy combined with multiple frequency vibration therapeutic instrument in treating pediatric pneumonia with dyspneic cough. Methods A total of 277 children (pneumonia with dyspneic cough syndrome of wind-cold invading lung, wind-heat invading, lungphlegm-heat congesting lung) were enrolled in this study. They were divided into the orientation of traditional Chinese medicine drug therapy combined with multiple frequency vibration therapeutic instrument group (lung therapy and sputum excretion group,100 cases), the orientation of traditional Chinese medicine drug therapy group (lung therapy group, 94 cases) and the multiple frequency vibration therapeutic instrument group (sputum excretion group, 83 cases) by random digits table method.The main symptoms improvements, therapeutic evaluation, the comfortable level of the children, family satisfaction degree of the 3 groups were evaluated before and after 5 days of treatment. Results After 5 days, the main symptoms score was (7.22±2.74) points in the lung therapy and sputum vibration group, and (8.98±3.40), (8.78±2.91) points in the lung therapy group and sputum excretion group, there were significant differences among 3 groups, F=9.756, P0.05. The family satisfaction degree in the lung therapy and sputum vibration group was higher than that in the other two groups, and there were significant differences among 3 groups, χ2=9.102, P<0.05. Conclusions The nursing effect of orientation of traditional Chinese medicine drug therapy combined with multiple frequency vibration therapeutic instrument has more advantages in treating pediatric pneumonia with dyspneic cough.
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<p><b>OBJECTIVE</b>To investigate the effect of atorvastatin on platelet aggregation and activation in the acute phase following balloon-induced carotid artery injury in rabbits fed cholesterol-enriched diet.</p><p><b>METHODS</b>Thirty rabbits were randomly divided into 5 equal groups, namely control group, high-cholesterol group, model group, low-dose (5 mg/kg daily) atorvastatin group, and high-dose (10 mg/kg daily) atorvastatin group. Platelet aggregation rate was measured in the rabbits by turbidimetric platelet aggregometry, and the changes of serum P-selectin and thromboxane B2 (TXB2) levels were detected with enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>Compared with those in the control group, serum P-selectin level increased significantly (P<0.01) but platelet aggregation rate and TXB2 level exhibited no obvious changes in high-cholesterol group. After carotid artery balloon injury, P-selectin and TXB2 levels and platelet aggregation significantly increased in cholesterol-fed rabbits, reaching the peak level at 24 h after the injury (P<0.01). Compared with the model group, low-dose atorvastatin treatment significantly decreased P-selectin and TXB2 levels and inhibited platelet aggregation in cholesterol-fed rabbits following carotid artery balloon injury (P<0.01), and such effects of atorvastatin were more prominent at a higher daily dose of 10 mg/kg (P<0.05).</p><p><b>CONCLUSIONS</b>Carotid artery balloon injury in rabbits fed cholesterol-enriched diet can induce platelet activation and aggregation, which reaches the peak level at 24 h after balloon injury and can be dose-dependently inhibited by atorvastatin in the acute phase following the injury.</p>
Subject(s)
Animals , Rabbits , Atorvastatin , Blood Platelets , Carotid Artery Injuries , Drug Therapy , Cholesterol , Enzyme-Linked Immunosorbent Assay , Heptanoic Acids , Pharmacology , P-Selectin , Metabolism , Platelet Activation , Platelet Aggregation , Pyrroles , Pharmacology , Thromboxane B2 , MetabolismABSTRACT
Objective Introduce a technique for creating 3-dimensional (3D) brain models of subdural electrodes , ideal for demonstrating the space-relationship of seizure localization and eloquent cortices , and discuss its usefulness for presurgical evaluation of epileptic patients. Methods Patients with medically intractable epilepsy were underwent a thorough preoperative MR brain scan including a T1-weighted high-resolution 3D sequence. Intraoperative photographs were taken with the digital camera. After the surgical implantation of subdural electrodes for epileptic zone localization , the thin-slice CT scan of the electrodes were taken and coregistered to preoperative brain 3D MR images in the Medtronic StealthMerge software environment. After the iEEG monitoring , multiple habitual seizures were recorded , eloquent areas were also identified by electrical stimulation of the cortex. The epileptic zone and the eloquent areas were marked on the subdural electrodes respectively. Then, 3D tessellations of the epileptic zone and the eloquent areas were rendered. Results Six patients (4 male, 2 female) were enrolled in this study. The mean time of iEEG monitoring was 13.7 days. After the coregistration of postoperative CT with preoperative 3D MRI , the 3D stereoscopic reconstruction provided an accurate representation of the implanted electrodes with highly detailed visualization of the underlying anatomy. The visual comparison between 3D reconstructions and intraoperative photographs indicated a good correspondence. The patients were followed for 3 to 6 months after the secondary operation , and had continuing improvement in seizure control. Conclusions The results indicate that the 3D reconstruction of subdural electrodes can reveal the precise localization of subdural electrodes , and can be useful for the presurgical evaluation of epileptic patients.
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Objective To explore the value of afterdischarges monitoring for intraoperative electrical stimulation for brain mapping. Methods 34 patients received cerebral cortex electrical stimulation for brain mapping during operation of brain function area , afterdischarges were monitored simultaneously to determine the upper limit of stimulus intensity. Results 34 cases underwent electrical stimulation successfully , and received surgery without neurologic decline except 2 cases of hypokinesia. Conclusion After discharges monitoring improve the accuracy, reduce the risk of intraoperative cerebral cortex electrical stimulation.
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[ABSTRACT]AIM:ToevaluatetheeffectsofantisenseTGF-β1oligodeoxynucleotide(ASTGF-β1)ontheex-pression of TGF-β1 , deposition of extracellular matrix ( ECM) and the neointima formation in the arteries after balloon inju-ry.METHODS:The unmodified and phosphorothioate-modified AS TGF-β1 which containing 15 bases and surrounding the initiation codon region (ATG) of rat TGF-β1 complementary DNA (cDNA) were designed.At the same time, sense TGF-β1 oligodeoxynucleotide ( S TGF-β1 ) with the base sequence complement to AS TGF-β1 was synthesized as a control . The oligodeoxynucleotides were introduced into in vivo and in vitro experiments , respectively .RESULTS:The AS TGF-β1 significantly inhibited the protein expression of TGF-β1 in a concentration-dependent manner , and S TGF-β1 did not have the same effect.Furthermore, no effect of the AS TGF-β1 on the mRNA expression of TGF-β1 in injured VSMCs was ob-served.Moreover, for the injured VSMCs, AS TGF-β1 significantly and concentration-dependently inhibited the basal DNA synthesis.Both AS TGF-β1 and S TGF-β1 did not exhibit dose-dependent effects on DNA synthesis in uninjured VSMCs . Fibronectin ( FN) mRNA expression in injured VSMCs was significantly decreased by AS TGF-β1 in a concentration (0.01~1 μmol/L)-dependent manner .AS TGF-β1 significantly increased the mRNA expression of contractile marker SM 22α, and decreased the mRNA expression of synthetic markers osteopontin and matrix Gla , especially at the concentration of 0.01μmol/L and 0.1 μmol/L.After treatment with AS TGF-β1 (90 μg· kg-1 · d-1 ) for 28 d, the neointima formation was significantly inhibited , and the area ratio of intima/media was markedly decreased by 68% compared with untreated group , but S TGF-β1 had no effect on neointimal formation .CONCLUSION:The AS TGF-β1 specifically inhibits the pro-tein expression of TGF-β1 in the VSMCs derived from injured arteries .Moreover , it significantly inhibits DNA synthesis and cell proliferation, and decreases the expression of FN .Therefore, AS TGF-β1 dramatically attenuates neointima formation after balloon njury .The effects of AS TGF-β1 on the injured VSMCs may be associated with its reverse effects on the altera-tion of VSMC phenotype after balloon injury .
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Objectives: To explore the infulence of early enteral nutrition on nutritional and immunal status and complications for elderly patients with gastric neoplasm. Methods: 84 cases of gastric neoplasm were randomly divided into TPN group( n =42),an EN group ( n =42).Equal calorie and nitrogen were given from the frist day after operation. Nutritional and immune markers were examined before and after nutrition support. The complication and gastrointestinal function were carefully observed . Results: Nutritional markers and immune markers were significantly increased after nutritional support both in TPN and EN group ( P 0.05). EN can promote resumption of gastrointestinal function,decrease complications and reduce the medical cost. Conclusions: Early post operative enteral nutrition for elderly patients with gastric neoplasm is a safe,effective,economic nutritional treatment.
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Objective To study on FBD (composed with Poria cocos, Atractylodes macrocephala, and Angelica sinensis) used to improve learning and memory function of animals. Methods The mice were treated by ig FBD with the doses of 35, 70 and 140 mg/kg for one week continuously. Effect of FBD on dysmnesia of acquired learning of mice induced by scopolamine, dysmnesia of memory retention of mice induced by NaNO2, and dysmnesia of reappearance of memory of mice induced by 45% ethanol were studied. Improvement for the dysmnesia of memory due to chronic blood deficiency in brain of rats induced by ligating the carotid arteries of two sides were observed. Results FBD can improve the dysmnesia of mice induced by scopolamine, NaNO2, and 45% ethanol significantly, also dysmnesia due to chronic blood deficiency in brain of rats induced by ligating the carotid arteries. Conclusion FBD has the function to improve the learning and memory function of animals.
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AIM: To investigate the effect of fluvastatin on the proliferation of vascular smooth muscle cells derived from spontaneously hypertensive rats. METHODS: The aorta smooth muscle cells(ASMCs) of spontaneously hypertensive rats were cultured, and proliferation of cells were detected by measuring cell number and -thymidine(-TdR) incorporation after incubation with Ang Ⅱ, PDGF, fluvastatin and mevalonate acid. RESULTS: (1) The increased cell number and -TdR incorporation stimulated with AngII(10 -6 mol/L) and PDGF(10 ?g/L) were significantly inhibited by fluvastatin in a concentration-dependent manner (10 -5 -10 -7 mol/L); (2) The inhibitory effect of fluvastatin was almost completely reversed by mevalonate acid(10 -3 mol/L). CONCLUSION: The proliferation of ASMCs induced by Ang Ⅱ and PDGF was inhibited by fluvastatin, suggesting that mevalonate acid pathway may play an important role in the proliferation of ASMCs.
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AIM: To investigate the effects of fluvastatin on intimal hyperplasia following balloon injury of rabbit iliac artery. METHODS: The iliac arteries of twelve white New Zealand rabbits were injured with an inflated balloon catheter, six rabbits were given fluvastatin 8 mg?kg~-1 ?d~-1 by gavage, the others served as controls. Serum concentrations of endothelin, thromboxane A_2 and prostacyclin were measured by radioimmunoassay at time points before, 3 hours and 3 days after balloon injury. After 28 days, ratio of intima-to-media area (I/M) of the injured arteries were calculated using a computer image analysis system and the alteration of TGF-?_1 and extracellular matrix (FN, LN) were quantified with immunohistochemistry. RESULTS: ① Serum endothelin-1 and thromboxane A_2 significantly increased after injury, whereas serum prostacyclin markedly decreased. The alterations were completely reversed by the treatment with fluvastatin. ② The expression of TGF-?_1 and deposition of ECM in intimal were much lower than that in the untreatment animals. ③ Intimal hyperplasia after balloon injury was significantly attenuated by fluvastatin treatment. CONCLUSION: The inhibitory effects of fluvastatin on intimal hyperplasia after balloon injury may attribute to its inhibiting thrombosis and deposition of ECM. [