Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review / 中华创伤杂志(英文版)

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

Effect of remifentanil combined anesthesia on cytokines and oxidative stress in patients undergoing laparoscopic surgery for colon cancer

Objective: To investigate the effect of remifentanil combined anesthesia on serum cytokines and oxidative stress indices in patients undergoing laparoscopic surgery for colon cancer

Study design: Experimental study

Place and duration of study: Department of anesthesiology, Yuhuangding Hospital affiliated to Qingdao University, Yantai, China, from may 2016 to march 2018

Methodology: A total of 154 patients undergoing laparoscopic surgery for colon cancer were randomly divided into control group and observation group, with 77 cases in each group. Control group received fentanyl combined anesthesia, and observation group received remifentanil combined anesthesia. Levels of serum cytokines IL-8, IL-6, CRP, TNF- alpha; and the levels of oxidative stress indices SOD, MDA, CAT, and GSH on the first day after operation were compared. Occurrence of adverse reactions during anesthesia recovery was observed and recorded in both groups

Results: On the first day after surgery, levels of serum cytokines IL-8, IL-6, CRP, TNF- alpha; and MDA in the observation group were lower than those in the control group [all p<0.001]; levels of serum SOD, GSH, and cat in the observation group were higher than those in the control group [all p<0.001]. The frequency of adverse reactions such as nausea and vomiting, chills, restlessness, cough, and tachycardia in the observation group was lower than that in the control group [p=0.029, 0.016, 0.009, 0.025, and 0.003, respectively]

Conclusion: Compared with fentanyl combined anesthesia, the remifentanil combined anesthesia can significantly reduce serum levels of cytokines IL-8, IL-6, CRP, TNF- alpha; and oxidative stress level, and is, therefore, more secure for patients undergoing laparoscopic surgery for colon cancer

General gastroscopy of gastroesophageal reflux disease: Analysis of 4086 cases / 解放军医学杂志

Objective To analyze the characteristics ofgastroesophageal reflux disease (GERD) under general gastroscope.Methods The detection rates of GERD related abnormalities such as esophagitis,Barrett esophagus and hiatal hernia under the first gastroscopy of the adult GERD patients from January 2013 to January 2017 in our center and the statistical relationship between the abnormal findings were analyzed retrospectively.Results A total of 4086 GERD patients,2004 males and 2082 females,were included in this study,and the age was 18-89(50.4 ± 13.3) years old.The detection rate of non erosive GERD was 78.7％,esophagitis 21.3％;non Barrett esophagus 87.7％,suspected Barrett esophagus 8.3％,Barrett esophagus 3.9％;generally normal cardia 61.4％,short segment hiatus hernia 20.4％,and long segment hiatal hernia 18.2％.The detection rates of esophagitis showed statistically significant differences (P＜0.001) between the three groups of generally normal cardia,short segment hiatal hernia and long segment hiatal hernia;The detection rate of Barrett esophagus was significantly higher in long segment hiatal hernia group than in generally normal cardia group and short segment hiatal hernia group (P＜0.001,P=0.012),but the difference between the later two groups was not statistically significant (P＞0.013).Comparing the three age groups of 18-39,40-59 and ≥60 years old,the detection rate of hiatal hernia was significantly higher in the group of≥60 years old than in the 18-39 and 40-59 years old groups (P=0.007),while there was no significant difference (P＞0.013) between the 18-39 and 40-59 years old groups.The detection rate of esophagitis was significantly higher in ≥60 years old group than in 18-39 and 40-59 years old groups (P=0.004,P=0.008),while no significant statistically difference (P＞0.013) was found between the later two groups.Conclusions Gastroscopy can be used as a basic examination means for GERD;short segment hiatal hernia can be regarded as an early form of hiatal hernia,and is of important reference value for the diagnosis and treatment of GERD;more serious hiatal hernia and esophagitis could be found in elderly GERD patients.

Efficacy of Yangxueqingnao Granule combined with Flunarizine Hydrochloride Capsules in treatment of acute cerebral infarction with headache / 药物评价研究

Objective Discuss the efficacy of Yangxueqingnao granule combined with Flunarizine Hydrochloride capsules in treatment of acute cerebral infarction with headache.Methods 110 patients with acute cerebral infarction with headache were selected,they were divided into two groups randomly.The control group (55 cases) was given Flunarizine Hydrochloride Capsules.The observation group (55 cases) was given Yangxueqingnao granule combined with Flunarizine Hydrochloride capsules.The efficacy of Yangxueqingnao granule combined with Flunarizine Hydrochloride capsules in treatment of acute cerebral infarction with headache was evaluated by the efficacy,headache symptom score,ADL scores and adverse reactions during treatment.Results 25 cases were cured in the observation group,markedly effective in 19 cases,effective in 6 cases,the effective rate was 90.9％;18 cases were cured in the control group,markedly effective in 12 cases,effective in 13 cases,the effective rate was 78.2％.The effective rate was higher in the observation group (P ＜ 0.05).Before treatment,there were no statistical significance on headache scores in two groups.2 and 4 weeks after treatment,the headache scores were decreased and the scores were lower in the observation group (P ＜ 0.05).Before treatment,there were no statistical significance on ADL scores between two groups.2 and 4 weeks after treatment,the ADL scores were increased and the scores were higher in the observation group (P ＜ 0.05).During treatment,there were no statistical significance on adverse reaction between two groups.Conclusion Yangxueqingnao granule combined with Flunarizine Hydrochloride capsules have a good therapeutic effect on acute cerebral infarction with headache symptoms.The patients can significantly reduce headache and headache attack frequency.The therapy can improve the ability of daily life of patients with good safety.

Research of inhibitory mechanism of salidroside B on proliferation and metastasis of gastric cancer SNU-1 cells / 中国免疫学杂志

Objective:To investigate the related mechanism of salidroside B on proliferation and metastasis of Rhodiola glucoside glioma cell.Methods:The inhibitory rate of salidroside B on SNU-1 cells were determined using MTT method .The effect of salidroside B on inhibiting metastasis of SNU-1 cells was determined by transwell assay .Finally the effect of expression of related proteins of SNU-1 cells was discussed.The SNU-1 cells apoptosis rate was detected by flow cytometry .Results: The growth inhibitory rates of SNU-1 cells were increased with the increasing of dose of salidroside B (10,50,100 μg/ml),and there were significant differ-enced.Apoptosis flow cytometry test results showed that SNU-1 cells apoptosis rate was increased with the increasing of dose of salidroside B(10,50,100 μg/ml).ROS levels was increased with the increase of the concentration of salidroside with significant differ -ence.The expression of salidroside B on Caspase-3,Bax and E-cadherin of SNU-1 cells were increased,Bcl-2,N-cadherin and MMP-9 of SNU-1 cells were decreased.Conclusion:The apoptosis of SNU-1 cells may be through Caspase-3 pathway,mitochondrial pathway apoptosis cascade and the level of ROS by salidroside B , and the reduce of metastasis ability may also through the destruction of adhesion between the cells and basement membrane and increased the stability of tumor cells by salidroside B .

Comparative study of running and badminton exercise on bone mineral density and related biochemistry marks in female university students / 国际检验医学杂志

Objective To investigate the differences of 10-week running and badminton exercise on bone mineral density(BMD) and related biochemistry markers in female university student.Methods Sixty healthy female university students were randomly divided into running(R) group,badminton(B) group and control group.Apart from basic physical education class,the R and B group participated in running and badminton exercise respectively(30-40 min per time,3 times per week,10 weeks).Before and after test,the BMD of lumbar vertebra and femurs,the serum level of estradiol(E2) and testosterone(T),the serum level of alkaline phosphatase(ALP)and tartrate resistant acid phosphatase(TRACP) were all detected.Results After test,there were no significant difference on BMD in all parameters of the three groups(P>0.05).After test,the serum level of E2 and TRACP in R group were significant higher than those in control group(t=-3.351,t=-0.854,P<0.05),the serum level of Ca was significant lower than that in control group(t=-1.852,P<0.05).Comparison between before test and after test,the serum level of E2 and P increased significantly in R group(P<0.05),while the serum level of TRACP decreased significantly(P<0.05),the serum level of P and Ca increased in the three groups(P<0.05),while no differences were seen in the other parameters.Conclusion The effects of running exercise on serum level of E2 and TRACP were higher than badminton exercise.

Excimer laser atherectomy combined with drug-eluting balloon angioplasty for the treatment of chronic ischemia of lower limbs: preliminary results in three patients / 介入放射学杂志

Objective To evaluated the safety and feasibility of excimer laser atherectomy (ELA) combined with drug-eluting balloon angioplasty in treating chronic ischemia of lower limbs.Methods ELA combined with paclitaxel-eluting balloon angioplasty was adopted to treat chronic ischemia of lower limbs caused by arteriosclerosis occlusive disease of lower extremity in three patients.All three patients had arteriosclerosis occlusive disease of superficial femoral artery;in two of them the disease was primary occlusive lesion and in another patient the disease was in-stent re-occlusion lesion after sten implantation.Results After the treatment,the blood flow in the diseased arteries was unobstructed,the blood supply of the lower limbs was obviously improved.No procedure-related complications occurred.Two weeks after the treatment,no recurrence of ischemic symptoms was observed,the blood flow in superficial femoral artery kept unobstructed.The patients recovered smoothly.Conclusion For the treatment of chronic ischemia of lower limbs,which are caused by the primary arteriosclerosis occlusive disease of lower extremity or by the in-stent re-occlusion lesion after sten implantation,ELA combined with paclitaxel-eluting balloon angioplasty is clinically safe and feasible,although its long-term effect needs to be clarified with more studies.

The Innovation of "Internet +" Chronic Disease Management System Construction Based on the Perspective of Supply-side Reform / 中国卫生经济

From the perspective of supply side,the traditional chronic disease management mode was used to innovate the construction of "Internet +" chronic disease management system,which integrated wearable measuring instrument,chronic patients,mobile health,chronic disease management system,professional and technical personnel,remote medical treatment and the government as a whole.Through the system construction,it helped patients with chronic diseases and the high-risk groups for prevention,treatment and prognosis,make the self management of patients,unified management of patients,improved their awareness and control of chronic diseases,helped the patients with chronic disease auxiliary management personnel management,promote the implementation of chronic disease prevention and control effectively.

Interventional bronchoscopy via laryngeal mask airway [LMA] under general anesthesia in children using adult flexible bronchoscope

Objective: To evaluate the safety and effectiveness using adult flexible bronchoscopy via laryngeal mask airway [LMA] under general anesthesia in children aged 2 - 5 years

Design: Retrospective study

Setting: Yuhuangding Hospital, Yantai, China

Subjects: The procedures of bronchoscopy were performed with an adult flexible bronchoscope via LMA under general anaesthesia. Indications and complications were analyzed, retrospectively

Intervention[s]: Expanding the wide use of pediatric flexible bronchoscopy to diagnostic and interventional bronchoscopy

Main outcome measure[s]: Performed using SPSS17.0

Results: The indications for bronchoscopy included tracheal mucous plugs removal in 108 cases with pneumonia, tracheobronchial foreign bodies removal in 82 cases, endobronchial biopsy in 66 cases, bronchoscopic cryosurgery in 23 cases with tracheal granulation tissue formation after long-term endotracheal intubation, balloon dilatation in 11 cases with lobar bronchial stenosis and bronchoscopic management in 12 cases with traumatic tracheobronchial injuries. Complications were reported for 193 cases, with an overall complication rate of 63.9%. The incidence rate was highest in children aged 2 - 3 years, and decreased with age. Hypoxia and post bronchoscopy cough were the most complication in all patients. Acute hypoxia during bronchoscopy happened in 5 [1.6%] cases and was relieved quickly by intermittent withdrawal of the bronchoscope. Most post bronchoscopy cough without respiratory distress or hypoxia could be seen in 188 [62.3%] cases and resolved within four hours after inhalation of budesonide

Conclusion: An adult flexible bronchoscope via LMA could be safely and effectively used for interventional bronchoscopy in 2 - 5 years old children with different kinds of the proximal airway diseases

Endovascular therapy for complex subclavian artery occlusive diseases / 介入放射学杂志

Objective To discuss the key points of endovascular therapy for complex subclavian artery occlusive diseases. Methods During the period from January 2012 to December 2013, a total of 92 patients with complex subclavian artery occlusive disease were admitted to Xuanwu Hospital of Capital Medical University, Beijing, China. The clinical data were retrospectively analyzed. The features of the lesions, the success rate of endovascular therapy, the use of combined approaches, the relief of symptoms after treatment, etc. were evaluated. Results The complex subclavian artery occlusive diseases could be divided into three types. Type Ⅰ: long segment of the left subclavian artery was occluded; type Ⅱ: ostial stenosis or occlusion of the right subclavian artery; and type Ⅲ: subclavian artery stenosis or occlusion was associated with the ostial disorder of the vertebral artery, or the opening of vertebral artery was affected by the subclavian artery stenosis or occlusion. The technical success rate was 82.6%. Combination use of femoral artery and brachial artery approach was employed in 27.2% of patients, which had improved the technical success rate. After the treatment the symptom improvement rate was 81.6%. Conclusion Upper limb artery approach can improve the re-canalization rate of left subclavian artery with long segment occlusion, and can ensure the accurate positioning of stent at the site of right subclavian artery opening. During the procedure of endovascular intervention for subclavian artery occlusion disease, attention should be paid to the protection of the vertebral artery.

Application of bronchofiberscopy laryngeal mask coupled with foreign body forceps in the removal of children airway foreign bodies / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the value of bronchofiberscopy laryngeal mask airway coupled with foreign body forceps in the removal of children airway foreign bodies.</p><p><b>METHODS</b>Bronchofiberscopy laryngeal mask airway and its mating foreign body forceps were designed. Ninety-two children with airway foreign bodies were hospitalized from Jan. 2011 to Oct. 2013 underwent removal surgeries through bronchofiberscopy via laryngeal mask airway coupled with the mating foreign body forceps under fast induction general anesthesia. The fluctuation of the patients' blood pressure (BP), heart rate (HR), saturation of pulse oxygen (SpO2) and pressure of end-tidal carbon dioxide (PetCO2) were recorded. SPSS 13.0 software was used to analyze the data.</p><p><b>RESULTS</b>All the operations were successful, and the haemodynamics indexes of the patients were stable with good ventilation. No side effect and complications were found. Compared with the basic value before anesthesia, there was no statistically significant difference in pulse blood pressure PetCO2 between immediately after laryngeal mask, laryngeal mask after 3 minutes, bronchoscope into the glottis instantly, immediately after laryngeal mask. SpO2 increased after laryngeal mask (F = 3.04, P < 0.05).</p><p><b>CONCLUSION</b>Bronchofiberscopy laryngeal mask airway coupled with foreign body forceps applied in the removal surgery of children airway foreign body is safe, effective and with less complication.</p>

Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Totally laparoscopic aortic surgery is still in its infancy in China. One of the factors preventing adoption of this technique is its steep learning curve. The objective of this study was to evaluate the feasibility and safety of laparoscopic surgery for aortoiliac occlusive disease (AIOD).</p><p><b>METHODS</b>From November 2008 to November 2012, 12 patients were treated for severe AIOD with a totally laparoscopic bypass surgery at our university hospital. The demographic data, operative data, postoperative recovery data, morbidity and mortality were analyzed and compared with those of conventional open approach.</p><p><b>RESULTS</b>Twelve totally laparoscopic aortic surgery procedures, including two iliofemoral bypasses (IFB), three unilateral aortofemoral bypasses (UAFB), and seven aortobifemoral bypasses (ABFB), were performed. Conversion to open procedures was required in three patients. The mean operation time was 518 (range, 325-840) minutes, mean blood loss was 962 (range, 400-2500) ml, and mean aortic anastomosis time was 75 (range, 40-150) minutes. Compared with conventional open approach for aortofemoral bypasses performed concomitantly during this period, laparoscopic patients required fewer narcotics and a shorter in-hospital stay and earlier recovery. Postoperative complications developed in four patients, including a single patient with transient left hydronephrosis, ischemic colonic fistula and pneumonia, residual aortic stenosis proximal to the anastomotic site, and asymptomatic partial left renal infarction. All patients recovered and were discharged on postoperative Days 7-14 except one patient that died of respiratory failure on Day 46. All grafts were patent with follow-up imaging performed by Duplex examination, with a mean follow-up time of 10.7 (range, 2-61) months.</p><p><b>CONCLUSION</b>Totally laparoscopic bypass surgery is a feasible and safe procedure for AIOD, but attention needs to be paid to improve laparoscopic skills of vascular surgery in order to minimize morbidity during the learning curve of this advanced procedure.</p>

Percutaneous transluminal renal angioplasty with stent is effective for blood pressure control and renal function improvement in atherosclerotic renal artery stenosis patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable debate. The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients, especially as it relates to blood pressure control and renal function improvement.</p><p><b>METHODS</b>A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital. We compared blood pressure, number of oral antihypertensive medications, and renal function changes pre and post-procedure at 24 months follow-up.</p><p><b>RESULTS</b>A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed. At 24 months follow-up, both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P < 0.05). Overall, the estimated glomerular filtration rate did not change significantly (P > 0.05); however, a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P < 0.05).</p><p><b>CONCLUSION</b>Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients, providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.</p>

Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>METHODS</b>From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>RESULTS</b>There were 39 741 patients screened, 14 526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% (1826) had in-hospital medical complications. The most common complication was pneumonia (1373; 11.9% of patients), followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR = 6.946; 95%CI 5.181 to 9.314), at 3 months (adjusted OR = 3.843; 95%CI 3.221 to 4.584), 6 months (adjusted OR = 3.492; 95%CI 2.970 to 4.106), and 12 months (adjusted OR = 3.511; 95%CI 3.021 to 4.080). Having multiple complications strongly increased the death risk of patients.</p><p><b>CONCLUSION</b>Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.</p>

Effect of tagalsin on p53 and Bcl-2 expression in hepatoma H(22) tumor-bearing mice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the effect and mechanism of tagalsin on hepatoma cells.</p><p><b>METHODS</b>The animal models were established by transplanting H(22) mouse hepatoma cells to mouse liver, and ten days later the mice were randomly divided into five groups: blank group, carmofur positive group and tagalsin groups, including low-dose, middle-dose and high-dose groups. Then medicine or oil was given to the mice by gastric gavage in consecutive 5 days with a 2-days interval as a course of treatment, two courses in all. All mice were killed at 24 hours after medication, and the survival period, ascites conditions, aggressive conditions intra- or extra-liver, weight changes, tumor volume and spleen index of the tumor-bearing mice were observed. Pathological changes of the tumors were examined. Apoptotic factors p53 and Bcl-2 protien and mRNA were detected by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>tagalsin inhibited the hepatoma growth effectively without influencing spleen index to some extent. The tumor inhibition rate of tagalsin low, middle and high dose groups were 17.9%, 63.1% and 71.8%, respectively. Immunohistochemical results showed that the p53 and Bcl-2 protein positive cell counts of the positive control and experimental groups were significantly lower than those of the blank group (P < 0.01). RT-PCR results showed that the p53 mRNA expression was significantly enhanced and Bcl-2 mRNA expression was decreased in the positive control groups and tagalsin treatment groups, especially in the high dose group, compared with those of the blank group (P < 0.05).</p><p><b>CONCLUSIONS</b>tagalsin can inhibit the growth of mouse hepatoma cells significantly. The mechanism of its anti-tumor effect may work via up-regulating the wild type p53 gene expression and down-regulating Bcl-2 gene expression and thus regulating tumor cell apoptosis.</p>

Effects of parecoxib on morphine dosage in postoperative patient-controlled analgesia following thoracoscope-assisted thoracotomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of parecoxib on morphine dosage in patient-controlled analgesia (PCA) following thoracoscope-assisted thoracotomy.</p><p><b>METHODS</b>A consecutive series of 100 patients undergoing thoracoscope-assisted thoracotomy were randomized into 5 groups and received PCA with morphine doses at 0, 5, 10, 15, and 20 mg given in 200 ml saline (groups P(1), P(2), P(3), P(4), and P(5), respectively). Parecoxib (40 mg) was given in all the patients immediately before the operation, and the mixture (4-5 ml) of lidocaine and ropivacaine was administered into the 3 intercostal spaces upper and lower to the incision before chest closure. PCA was administered for each patient. The visual analogue scale (VAS) at rest and coughing and the respiratory functional parameters were recorded at 1, 2, 4, 8, 12, 24, 36, and 48 h after the start of PCA, and the actual and effective button-pressing times (D(1)/D(2)) in PCA were also recorded.</p><p><b>RESULTS</b>No patients showed signs of respiratory inhibition within 24 h after the operation, and the resting VAS was comparable between the groups within the initial 6 postoperative hours. At 8 to 24 h postoperatively, the VAS scores at rest and coughing were significantly higher in P(1) group than in the other groups (P<0.05), and no significant differences were found between the groups at 36 to 48 h. D(1)/D(2) in groups P(1) and P(2) were significantly different from those in the other 3 groups at 4-24 h, but no such difference was found between groups P(3), P(4), and P(5).</p><p><b>CONCLUSION</b>The application of parecoxib may reduce the dosage of morphine in PCA following thoracoscope-assisted thoracotomy and results in good analgesic effect without affecting the patients respiratory function and sputum elimination.</p>

Radiofrequency treatment on respiratory symptoms due to gastroesophageal reflux disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Diagnosis and treatment for respiratory symptoms (RSs) of gastroesophageal reflux disease (GERD) is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency (RF) treatment on RSs of GERD in a preliminary 12-month follow-up observation.</p><p><b>METHODS</b>From April 2006 to October 2008, 505 GERD patients with mainly respiratory presentations such as wheezing, chronic cough or hoarseness, were treated by endoscopic RF. A questionnaire was completed before and after treatment, using a six-point scale ranging from 0 to 5 to assess symptom severity and frequency. The symptom score was the sum of frequency and severity.</p><p><b>RESULTS</b>Symptom scores were significantly improved at the end of the follow-up period. The mean heartburn score decreased from 5.31 to 1.79. The mean regurgitation score decreased from 5.02 to 1.64; mean cough score decreased from 6.77 to 2.85; mean wheezing score decreased from 7.83 to 3.07; and mean hoarseness score decreased from 5.13 to 1.81 (P < 0.01). No major complications or deaths occurred. Minor complications included temporary post-procedural retrosternal unease or pain (n = 106; 21.0%), mild fever (n = 86; 17.0%), transient nausea/vomiting (n = 97; 19.2%), and transient dysphagia (n = 42; 9.3%). Thirty-five (6.9%) patients had recurrence of symptoms. Endoscopic RF treatment was repeated in six patients, and laparoscopic fundoplication was performed in seven.</p><p><b>CONCLUSION</b>Endoscopic RF is an effective and safe means to treat RSs in patients with GERD.</p>

Effect of microwave irradiation on expression of heat shock proteins family in primary cultured rat hippocampal neurons / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the effects of microwave irradiation on the expression and regulation of heat shock proteins (HSPs) in primary cultured rat hippocampal neurons.</p><p><b>METHODS</b>Neurons were exposed to 90 mW/cm(2) microwave irradiation for 10 minutes. Western blot was used to determine the expression of HSP27, HSP70, HSP90 and heat shock factor 1 (HSF1) at 0, 3, 6, 12 and 24 hour respectively. Real-time RT-PCR was used to determine the mRNA expression of HSF1. DNA-binding activity of HSF1 was measured by electrophoretic mobility shift assay (EMSA).</p><p><b>RESULTS</b>The protein expression of HSP27 was significantly increased by 22%, 36%, 18% at 3, 6, 12 h, respectively (P < 0.05). The protein expression of HSP70 was significantly increased by 23%, 32%, 26% at 3, 6, 12 h, respectively (P < 0.05, P < 0.01). The protein expression of HSP90 was significantly increased by 27%, 33% at 6, 12 h, respectively (P < 0.05, P < 0.01). The DNA-binding activity of HSF1 was stimulated, however, no significant change of the expression of HSF1 was observed on both the mRNA and protein levels.</p><p><b>CONCLUSION</b>The transcriptional activity of HSF1 is activated by microwave irradiation, which promotes the expression of HSPs. Heat shock response which contributes to establish a cytoprotective state is induced by microwave irradiation in primary cultured rat hippocampal neurons.</p>

Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.</p><p><b>METHODS</b>Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.</p><p><b>RESULTS</b>We achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.</p><p><b>CONCLUSIONS</b>Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.</p>

Preliminary evaluation of clinical effects of below-knee arterial bypass on diabetic lower limb ischemia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate medium-long term patency of below-knee bypass on patients who suffered from diabetic lower limb ischemia.</p><p><b>METHODS</b>Clinical and follow-up data of 51 patients was retrospectively analyzed who underwent 56 below-knee bypass because of diabetes from November 2001 to December 2006. There were 35 male and 16 female with an average age of 68 years. They endured 26 months ischemic time lag in average, and had suffered from diabetes for 11 years. All of the patients were performed bypass to below-knee (posterior tibial, anterior tibial or peroneal) arteries. Kaplan-meier method was applied. The subgroups of different operative methods and different out-flow vessels were compared by Log-rank tests.</p><p><b>RESULTS</b>An average follow-up time of 23 months was achieved, and lost-follow-up rate was 15%. The total 1- and 5-year primary patent rates were 68% and 54% respectively, secondary patent rate were 70% and 60% respectively, limb salvage rates were 69% and 65%, survival rates were 82% and 60%. One year (3 years) of patent rate(s) of operative method subgroups of femoral-popliteal-infrageniculate bypass with composite grafts, femoral/popliteal-infrageniculate bypass with artificial grafts and femoral/popliteal-infrageniculate bypass with autologous veins were 70% (50%), 33% (33%) and 70% (70%) respectively. One year (4 years) of patent rate(s) of out-flow vessel subgroups of posterior tibial artery, anterior tibial artery and peroneal artery were 65% (60%), 80% (53%) and 77% (66%) respectively. However, both subgroups did not show any statistic differences by log-rank tests.</p><p><b>CONCLUSIONS</b>Partial or whole autologous veins as bypass grafts should be chosen when infrageniculate bypass is considered in diabetic patients. Considerable patent rates are acceptable no matter what kinds of out-flow vessels are chosen.</p>