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Objective:To investigate the effects of one-lung ventilation with a laryngeal mask airway combined with a bronchial blocker on respiratory function in older adult patients undergoing thoracoscopic surgery.Methods:Sixty older adult patients who underwent thoracoscopic surgery in Zhejiang Veteran Hospital from January 2019 to December 2020 were included in this study. They were randomly divided into a single group (a simple bronchial blocker) and a combined group (a bronchial blocker combined with a laryngeal mask airway), with 30 patients in each group. Awakening (time to extubation, spontaneous respiration and eye opening), respiratory function [peripheral oxygen saturation, vital capacity, maximum voluntary ventilation measured before and 3 days after surgery], hemodynamics [heart rate and mean arterial pressure were recorded before (T 1) and immediately after placement of a bronchial blocker or a laryngeal mask (T 2) and at the time of removal of a bronchial block or a laryngeal mask (T 3)], and adverse events (hoarseness, throat pain, dysphagia and choking) were recorded. Results:Time to extubation, time to spontaneous respiration, and time to eye opening in the combined group were (5.62 ± 1.23) minutes, (6.85 ± 1.34) minutes, and (7.34 ± 1.52) minutes, respectively, which were significantly shorter than (8.62 ± 1.55) minutes, (10.25 ± 1.78) minutes, (11.38 ± 1.85) minutes in the single group ( t = 9.94, 10.00, 11.06, all P < 0.05). At 3 days after surgery, peripheral oxygen saturation, vital capacity, and maximum voluntary ventilation in the combined group were (98.23 ± 1.05)%, (2.18 ± 0.60) L, (54.23 ± 5.36) L, respectively, which were significantly higher than (96.23 ± 1.01)%, (1.82 ± 0.50) L, (48.12 ± 4.23) L in the single group ( t = 7.51, 2.52, 4.90, all P < 0.05). Mean arterial pressure measured at T 3 was significantly lower in the combined group than that in the single group [(98.25 ± 2.32) mmHg vs. (93.35 ± 2.48) mmHg, t = 7.90, P < 0.05]. The incidences of hoarseness, throat pain and choking in the combined group were 6.66% (2/30), 10.00% (3/30), 6.66% (2/30), respectively , which were significantly lower than 33.33% (10/30), 43.33% (13/30), 43.33% (13/30) in the single group (χ 2 = 6.66, 8.52, 10.75, all P < 0.05). There was no significant difference in the incidence of dysphagia between the two groups ( P > 0.05). Conclusion:Use of a laryngeal mask airway combined with a bronchial blocker during thoracoscopic surgery in older adult patients facilitates postoperative recovery, has little impact on hemodynamics, and is highly safe.
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Objective To investigate the effect of transverse extrapedicular unilateral percutaneous vertebroplasty (PVP) via transverse process in treating the osteoporotic vertebral compression fractures.Methods A retrospective study was performed on 16 patients with osteoporotic vertebral compression fractures of upper lumbar treated from August 2016 through December 2016.There were seven males and nine females,at a mean age of 73.5 years (range,62-90 years).All the patients reported severe back pain,with an average history of 2 weeks (range,1-24 weeks).MRI confirmed the diagnosis of osteoporotic vertebral compression fractures,and the compression degree of the affected vertebral body was (25.4 ± 5.3) ％.All the patients were treated with extrapedicular unilateral PVP via transverse process under local anesthesia.The operation time,fluoroscopy frequency,bone cement injection volume,and bone cement dispersion were recorded.Back pain and function recovery were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI),respectively.Results All patients were followed up for 6-12 months (mean,8 months).All operations were successful without complications.The average operation time was 20 min (range,15-30 minutes),and there were 3-6 times of fluoroscopy with successful incubation.The average volume of bone cement injected to each injured vertebral body was 6.2 ml (range,5-9 m1).The bone cement dispersed satisfactorily in the vertebral body.Complete relief of lumbar and back pain was achieved in 14 patients,and remarkable relief in two patients.The postoperative VAS and ODI at 24 hours,72 hours,and 6 months were significantly lower than those before operation (P ＜0.01).Conclusion Extrapedicular unilateral percutaneous vertebroplasty via transverse process has the advantages of uniform fractured bone cement perfusion,significant pain relief,and rapid recovery,and hence is a simple,safe and effective treatment for osteoporotic vertebral compression fractures of the upper lumbar vertebrae.
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Objective To investigate the characteristics of epidemic and genotype/subtype distribution of hepatitis C virus (HCV) among entry travelers at Tengchong port,to provide references for HCV prophylaxis and treatment.Methods A total of 54 serum samples were collected from anti-HCV positive travelers at Tengchong port from June 2009 to June 2016.HCV NS5B gene was amplified using reverse transcription polyonerase chain reation (RT-PCR) and subsequently sequenced.Based on the obtained sequences and retrieved reference sequences,phylogenetic analysis was conducted to determine HCV genotype/subtype.Results HCV infection rate among entry travelers at Tengchong ports was 0.45 ％ (54/12 059).Forty five samples were successfully genotyped.Phylogenetically,HCV genotype 3b was revealed to be the predominant subtype (28.89 ％,13/45) in this population,followed by genotype 6n (20.0％,9/45),genotype 1b (17.78％,8/45),genotype 3a (13.33％,6/45),genotype 2a (11.11％,5/45),genotype 1a (2.22％,1/45) and genotype 6a (2.22％,1/45).The major genotype in Myanmar travelers was genotype 6,while in Chinese population,genotype 1 predominated.Genotype 6 in the population showed close phylogenetic relationship with strains prevalent in China and Southeast Asia.Genotype 3 was closely clustered with strains prevalent in China.Conclusions The distribution of HCV genotypes among entry travelers at Tengchong port is impacted by HCV epidemic strains both in Yunnan province and neighboring regions.This population serves as a transmitting media which may influence the epidemiological characteristics of HCV in Tengchong and neighboring areas.
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<p><b>OBJECTIVE</b>To review the current knowledge about the pathophysiological mechanisms, preclinical models, novel contributors and potential therapies of cardiorenal syndrome.</p><p><b>DATA SOURCES</b>The literature concerning cardiorenal syndrome in this review was collected from PubMed published in English up to January 2014.</p><p><b>STUDY SELECTION</b>Original articles and critical reviews related to cardiorenal syndrome were selected and carefully analyzed.</p><p><b>RESULTS</b>Cardiorenal syndrome is a condition characterized by kidney and heart failure where failure of one organ worsens the function of the other thus further accelerating the progressive failure of both organs. The pathophysiology of cardiorenal syndrome is not fully understood, but may be caused by a complex combination of neurohormonal system activation, endothelial dysfunction, proteinuria, oxidative stress, uremic toxins and other factors. Managing cardiorenal syndrome is still a major therapeutic challenge in clinical practice because many of the drugs used to control heart failure can worsen renal function, and vice versa. Non-dialyzable uremic toxins, such as indoxyl sulfate, causing detrimental effects on the heart and kidney as well as stimulation of inflammatory responses, may be an effective therapeutic target for cardiorenal syndrome.</p><p><b>CONCLUSIONS</b>Suitable disease models of cardiorenal syndrome are urgently needed to investigate the pathophysiology and effective therapeutic approaches to the condition. Non-dialyzable protein-bound uremic toxins that may have cardiac and renal effects may provide therapeutic benefit to cardiorenal syndrome patients.</p>
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Female , Humans , Male , Cardio-Renal Syndrome , Metabolism , Toxins, Biological , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To review the advances in studies on renal denervation.</p><p><b>DATA SOURCES</b>References concerning renal denervation and resistant hypertension cited in this review were collected from PubMed published in English and those of renal denervation devices from official websites of device manufacturers up to January 2014.</p><p><b>STUDY SELECTION</b>Articles with keywords "renal denervation" and "resistant hypertension" were selected.</p><p><b>RESULTS</b>Renal and systemic sympathetic overactivity plays an important role in pathology of hypertension as well as other diseases characterized by sympathetic overactivity. Renal denervation is a new, catheter based procedure to reduce renal and systemic sympathetic overactivity by disruption of renal sympathetic efferent and afferent nerves through radiofrequency or ultrasound energy delivered to the endoluminal surface of both renal arteries. Although several studies have shown the efficacy and safety of renal denervation in the treatment of resistant hypertension and the potential benefit of the procedure in other diseases, Symplicity HTN 3 study, the most rigorous clinical trial of renal denervation to date, failed to meet its primary endpoint. The procedure also has other limitations such as the lack of long term, efficacy and safety data and the lack of the predictors for the blood pressure lowering response and nonresponse to the procedure. An overview of current renal denervation devices holding Conformité Européenne mark is also included in this review.</p><p><b>CONCLUSIONS</b>Renal denervation is a promising therapeutic approach in the management of resistant hypertension and other diseases characterized by sympathetic overactivity. In its early stage of clinical application, the efficacy of the procedure is still controversial. Large scale, blind, randomized, controlled clinical trials are still necessary to address the limitations of the procedure.</p>