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Objective:To evaluate the effect of driving pressure-guided individualized positive end-expiratory pressure (PEEP) titration on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods:Fifty elderly patients, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index of 19-28 kg/m 2, undergoing elective robot-assisted radical prostatectomy under general anesthesia, were divided into 2 groups ( n=25 each) according to the random number table method: traditional lung-protective ventilation group (group C) and driving pressure-guided individualized PEEP group (group D). The method for setting PEEP was as follows: PEEP 5 cmH 2O was used throughout operation in group C. In group D, the optimal PEEP was titrated after intubation and mechanical ventilation and Trendelenburg position-pneumoperitoneum construction, the initial value was the lowest PEEP allowed by the anesthesia machine, the PEEP was increased by 1 cmH 2O (PEEP≤12 cmH 2O) every 4 min, the plateau pressure and PEEP were simultaneously recorded to calculate the driving pressure, and the corresponding PEEP was considered as the optimal PEEP for the individual when the driving pressure reached the minimum.Ultrasound examination was performed after catheterization of radial artery (T 0), after anesthesia induction (T 1), 4 min after developing optimal PEEP ventilation (T 2, 4 min after developing ventilation in group C), after restoration of body position (T 3), before extubation (T 4), and at 2 h after admission to postanesthesia care unit (T 5). Atelectatic aeration loss scores were recorded at T 0, T 1, T 4 and T 5.Bilateral optic nerve sheath diameter was measured at T 0-4.Arterial blood gas analysis was performed at T 0, T 2, T 3 and T 5, PaO 2 and PaCO 2 were recorded, and oxygenation index was calculated.The postoperative pulmonary complications within 3 days after operation were recorded. Results:Compared with group C, atelectasis aeration loss scores at T 4, 5 and PaCO 2 at T 2, 3 were significantly decreased, and PaO 2 and oxygenation index were increased at T 2, 3, 5 in group D ( P<0.05). There were no significant differences in the bilateral optic nerve sheath diameter and incidence of postoperative pulmonary complications between the two groups ( P>0.05). Conclusion:Driving pressure-guided individualized PEEP can increase intraoperative oxygenation and decrease the development of atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.
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Objective T o investigate the tim e-dependent expression of m etallothionein (M T ) 1A m R N A and M T 2A m R N A in contused skeletal m uscle of rats. Methods A total of 54 Sprague-D aw ley rats w ere used in this study. T he rats w ere divided into tw o parts:control group (n=6) and contusion groups (0.5, 1, 6, 12, 18, 24, 30, and 36 h after contusion, n=6). T otal R N A w as extracted from skeletal m uscle. T he expression levels of M T 1A m R N A and M T 2A m R N A w ere detected by SY B R G reen I real-tim e PC R . Results T he expression trends of the tw o potential m arker genes w ere related to w ound age. In ad-dition to 0.5 h, there w ere significant contrasts betw een the control group and contused group (P<0.05), about the expression levels of M T 1A m R N A and M T 2A m R N A in different phases. A s the extension of w ound age, the relative expression of M T 1A m R N A and M T 2A m R N A at 1 h, 6 h, 12 h and 18 h after contusion dem onstrated upgrade tendency until its expression levels in 18 h peak w ith 239.41±15.20 and 717.42 ±50.76, respectively. W hen tim e extends to 24 h after injury, the expression of above tw o m arks decreased, respectively. T he M T 1A m R N A and M T 2A m R N A expression levels increased at 30 h and then decreased. Conclusion D eterm ination of M T 1A m R N A and M T 2A m R N A levels by real-tim e PC R m ay be useful for the estim ation of w ound age.
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Objective To summarize and analyze the epidemiological and clinical characteristics of patients with subacute thyroiditis(SAT),so as to provide a basis for prevention and treatment.Methods The epidemiological and clinical data of 1 865 patients with SAT,who were treated in the Shandong Institute of Prevention and Control for Endemic Disease in 2015-2006,were collected.The SAT patients' sex,age,urban and rural areas,occupation and time of onset distributions,summary onset clinical manifestations,laboratory findings,treatment and outcome were analyzed retrospectively.Results The average age of the 1 865 patients with SAT was 42.16 years old,the youngest was 9 years old,and the oldest was 74 years old.Most of the patients were 21-50 years old,which was accounted for 62.36％ (1 163/1 865),and most of the patients were female,which was accounted for 83.70％ (1 561/1 865).Most of the patients lived in rural areas,which was accounted for 60.54％ (1 129/1 865).Most patients were onset in January,accounted for 20.48％ (382/1 865),and the least in July,accounted for 1.77％ (33/1865).For the clinical classification,the moderate type and the light type were the largest part with 1 716 cases,accounted for 92.01％,while the severe type was 149 cases,accounted for 7.99％.The clinical manifestations were as follows:the neck discomfort in 1 701 cases,accounted for 91.21％;neck pain,sore throat and palpitate in 1 439 cases,1 351 cases and 1 341 cases,accounted for 77.16％,72.44％ and 71.90％,respectively.Laboratory test results were as following:1 865 cases of thyroid 131I absorption rate reduced(100％);1 396 cases of thyroid nodules increased(74.85％);532 cases of FT3 and FT4 significantly increased,while TSH significandy decreased (28.53 ％);949 cases of FT3 and FT4 increased,while TSH decreased (50.88％);53 cases of FT3 and FT4 decreased,while TSH increased (2.84％);331 cases of FT3,FT4 and TSH in the normal range(17.75％).The thyroid 13I absorption rate significantly increased and thyroid nodules significantly reduced with treatment,the difference was statistically significant (t =-34.93,133.2,all P ＜ 0.001).1 813 patients were cured,while 52 cases arised hypothyroidism.Conclusion Majority of SAT patients are young women.The peak of the incidence of SAT lies in autumn and winter.The proportion of the moderate type is the highest.Early diagnosis and treatment is the key to improve the prognosis of patients with SAT.
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Astract:Objective To investigate the ultrastructural changes and HSP70 expression in liver of mice after microwave irradiation with lethal dose and to explore the application of these indexes as the basis of medical identification in microwave irradiation induced death. Methods The mice were divided into the control group and the irradiation group. Mice of the irradiation group were induced death by whole body exposure to 129 W/cm2 microwave irradiation for 30 minutes. The ultrastructure of liver was observed by transmission electron micro-scope;changes of the HSP70 mRNA and protein expression in liver were detected by reverse transcription polymerase chain reaction ( RT-PCR) and Western blotting respectively. Results Liver cytoplasm was observed dissolved with points and sheets and there were mitochondri-al crest and membrane solution in the irradiation group. And the HSP70 mRNA and protein expression level increases significantly compared with the control group with statistically significant difference (P<0. 01). Conclusion Death induced by microwave irradiation could lead to liver cytoplasm dissolution, mitochondria damage, mRNA and protein expression of HSP70 up-regulation, which may be used as important diagnostic indicators of microwave irradiation induced death.
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Objective To observe auditory brainstem response evoked at different electrode positions adopting electrode slices .Methods The ABRs of 12 normal guinea pigs (24 ears)were recorded by two methods using clicks as stimulation .Active electrode was positioned at the vertex while the ground electrode at the nose .The reference e‐lectrode was placed on bilateral pinnas or mastoids .Then observe waveforms ,response thresholds (RT) ,peak la‐tencies(PL) and inter-peak latencies (IPL)of ABR .Results No significant difference were observed in the RT ,Ⅰ ,Ⅱand Ⅲ PL ,Ⅰ - Ⅲ IPL of ABR between the two methods(P>0 .05) .When stimulation was decreasing and with the reference electrode slices placed at bilateral pinnas ,waveⅡpeak was stable and discernable of ABR record‐ings across twenty -four ears of guinea pigs .The amplitude decreased more slowly than any other waves ,and dis‐appeared at the last .While reference electrode slices were placed on bilateral mastoids ,the amplitude of wave Ⅲ de‐creased more slowly than any other waves except wave Ⅳ ,and disappeared at lost .Ⅱ - Ⅲ ,Ⅲ - Ⅳ IPL became shorter .These two positions both recorded amplitude higher and PL advanced for wave Ⅳ as the stimulation de‐creased by 20 to 40 dB nHL ,and Ⅲ - Ⅳ IPL became shorter .This phenomenon was more obvious when reference electrode was placed at mastoid .Conclusion Wave Ⅱwas more stable and discernible with reference electrode placed at the bilateral pinnas .Therefore wave Ⅱ recorded by this way can be a new method to record the ABR threshold of g uinea pig s .
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Objective To investigate the early diagnosis of myocardial injury after neonatal asphyxia based on the clinical manifestations of myocardial injury, electrocardiogram (ECG), cardiac enzymes and tissue Doppler echocardiography. Methods From January 1, 2013 to June 30, 2014, 101 cases of neonatal asphyxia in the neonatal intensive care unit of the First Hospital of Tsinghua University, with gestational age> 37 weeks and birth weight > 2 500 g, were enrolled. Apgar scores were used to diagnose neonatal asphyxia. Myocardial damage after neonatal asphyxia was diagnosed according to the hypoxia history, clinical presentation, ECG and cardiac enzymes. According to the umbilical arterial blood gas analysis, severe asphyxia was divided into two groups:the severe asphyxia with severe acidosis group and the severe asphyxia without acidosis group. The incidence of myocardial damage, clinical manifestations associated with myocardial damage, ECG and myocardial enzymes [creatine kinase isoenzyme MB (CK-MB) and cardiac troponin T (TnT); control group involved 50 cases for the same period of admission with newborn jaundice] and echocardiography (control group involved 30 cases for the same period with normal term delivery) were compared among the three groups [mild asphyxia (n=72), severe asphyxia with severe acidosis (n=18) and severe asphyxia without severe acidosis (n=11)]. One-way ANOVA, the LSD test, Kruskal-Wallis test for independent samples, Chi–square test and Fisher's exact test were used for statistical analysis. Results (1) The incidence of myocardial damage after asphyxia was 34.6%(35/101). It was higher in the severe asphyxia group than in the mild asphyxia group [62.1%(18/29) vs 23.6% (17/72), χ2=7.549, P=0.006]; and it was higher in the severe asphyxia with severe acidosis group than in the severe asphyxia without severe acidosis group (14/18 vs 4/11, Fisher's exact test, P=0.048). (2) Clinical manifestations: The proportion of bradycardia was greater in the severe asphyxia with severe acidosis group (13/14) than in the severe asphyxia without severe acidosis group (1/4) and the mild asphyxia group (7/17);the differences were statistically significant (Fisher's exact test, P=0.019 and 0.007). (3) ECG: Eighteen cases (51.4%, 18/35) showed ECG abnormalities. (4) Cardiac enzymes:CK-MB 48 h after birth in the severe asphyxia with severe acidosis group, severe asphyxia without severe acidosis group, mild asphyxia group and the control group were 78.72 (34.63-122.01), 31.71 (21.33-37.12), 23.11 (14.61-36.02) and 11.82 (8.64-18.93) μg/L, respectively. CK-MB in the severe asphyxia with severe acidosis group was higher than in the severe asphyxia without severe acidosis group, mild asphyxia group and the control group (H=48.425, 90.040 and 96.045, respectively, all P<0.01). After treatment for 5-7 days, there was no statistically significant difference in these four groups (H=7.165, P=0.416). TnT 48 h after birth in the four groups was 0.19 (0.12-0.39), 0.11 (0.06-0.34), 0.07 (0.05-0.13) and 0.06 (0.04-0.08) μg/L, respectively. TnT in the severe asphyxia with severe acidosis group was higher than in the other three groups (H=45.753, 44.665 and 61.215, respectively, all P < 0.01). Despite the reduced TnT level after treatment for 5-7 days, TnT in the severe asphyxia with severe acidosis group was higher than that in the other three groups (H=17.520, 21.122 and 43.286, respectively, all P<0.01). (5) Echocardiography:Twenty cases (57.1%, 20/35) showed abnormalities. The values of mitral systolic peak velocity and late diastolic peak velocity in the severe asphyxia with severe acidosis group were lower than those in the control group found by tissue Doppler echocardiography [(3.4±0.3) vs (4.8±0.3) cm/s, (4.1±0.2) vs (6.0±1.1) cm/s, respectively, t=3.293 and 2.542, both P < 0.05]. Conclusions Myocardial damage can occur after neonatal asphyxia. Cord blood pH value should be combined to determine the severity of asphyxia. Myocardial damage is more serious in the severe asphyxia with severe acidosis group. Clinical manifestations should be taken seriously, and laboratory examinations should be improved for early diagnosis and treatment.
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Objective To investigate serum DJ-1 expression and its significance in ovarian cancer. Methods The expression levels of DJ-1 protein were detected by double antibody sandwich method in 52 cases of ovarian tumors (9 cases of benign ovarian tumors, 5 cases of borderline ovarian tumors and 38 cases of ovarian cancer,ovarian tumor group and 20 non-ovarian tumors (control group). Results The expression of DJ-1 protein was lower in the control group than that in ovarian tumor group (P0.05). Conclusion DJ-1 might be used as a serum marker in the diagnosis of ovarian cancer. It might be involved in the pathogenesis of ovarian cancer,and could predit the development and prognosis of ovarian cancer.
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This paper summarize the perioperative nursing of 11 patients with vaginal reconstruction using autologous buccal micro-mucosa. The preoperatively psychological nursing,meticulous specialist care and oral care,as well as postoperatively diet instruction,oral care,vaginal care,and serf-care instruction before discharge are the key points to reduce postoperative compli-cations and increase the success rate of surgery.
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Objective To explore the possibility of united test of CA72-4, CA19-9 in gastric juice in diagnosis of gastric carcinoma.Methods The gastric juices were respectively obtained by liquid collector made by ourselves through gastreecope in study group(30 cases of gastric cancer) and control groups(32 cases of gastratrophia,30 cases of gastric ulcer,and 30 cases of chronic superficial gastritis).The gastric juice content of CA72-4, CA19-9 were determined synchronously with ES-300 auto-enzymoimmuno-analyzer.Results The gastric juice contents of CA72-4,CA19-9 were (83.54±143.70) U/ml and (47.05±29.64) U/ml, and the positive rates were 76.66% and 43.33% in study group,respectively,and all higher than those of control groups(P <0.01 ).The level of CA72-4 was high in two of 32 patients with gastratrophia,and one was diagnosed as gastric carcinoma after nine months follow-up.Conclusion The combined detection of CA72-4 and CA19-9 provide main evidence for the diagnosis of gastric cancer and diagnostric significance of advanced gastric cancer.
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@#ObjectiveTo explore the related factors influencing effect of community-based rehabilitation (CBR) on activities of daily living (ADL) in stroke patients in.Methods202 stroke patients were randomly divided into the CBR group (n=103) and control group (n=99). The patients of the CBR group treated with rehabilitation and following-up including risk factors controlled with drug, rehabilitation, health education and mental treatment, those of the control group only treated by following-up. Before and five months after treatment, patients of two groups were assessed with Barthel Index (BI), clinical never function limitation score, cognitive item of Functional Comprehensive Assessment (FCA). Multielement regression analysis was applied, the ADL score of last assessment was taken as dependent variable, group information, location, smoking, sex, age, course of diseases, education, drinking, sleeping, the first scores of FCA and BI were taken as independent variable.ResultsThe improvement of ADL of stroke patients was related with group information, drinking, course of diseases, the first scores of FCA, BI, and etc.ConclusionEarly CBR can significantly improve the ADL of the stroke patients. Cognitive deficit also has influence on ADL.
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Objective To compare the characteristics between two kinds of 40Hz auditory evoked potentials and provide suitable index for clinical auditory test of low-frequency. Methods The potentials including 40Hz auditory event related potential of middle latency response(40Hz AERP-MLR) and 40Hz auditory event related potential of early latency response(40Hz AERP-ELR) from window and vertex were recorded in guinea pigs. Results The common characteristics of the potentials were good frequency response,easy identification and lower responsive thresholds.Amplitude of 40Hz AERP-ELR was higher and threshold was lower than 40Hz AERP-MLR,especially 0.5kHz tone burst,which was (14.15?6.06)dBnHL.In vertex,the threshold of 40Hz AERP-MLR was (43.50?9.65)dBnHL,which was higher than that in round window(P
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Objective To investigate the effects of methylmercury on outward potassium currents in isolated outer hair cells of guinea pig cochlea.Methods The whole-cell patch clamp technique was used.Calcium sensitive outword potassium currents were recorded when the concentrations of mercurial were 1/1000 LD_(50),1/100 LD_(50) and 1/10 LD_(50).Results After methylmercury poisoning,amplitudes of the outword potassium currents I_(K(Ca)) were(1.48?0.28),(1.36?0.16) and(1.22?0.13)nA.Compared with control group,the amplitudes in three methylmercury poisoning groups were decreased by 8%,16% and 25%(P
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BACKGROUND: Research shows that the auditory brainstem response (ABR) wave amplitude of tinnitus patients often act as big Ⅲ small Ⅴ.Tinnitus masking is a therapy of tinnitus, then how dose the ABR change in the process of tinnitus masking?OBJECTIVE: To observe the changing characteristics of ABR in patients with tinnitus as well as the changing rules of ABR after tinnitus masking.DESIGN: Case-control and self-control.SETTING: Department of Otorhinolaryngology, First Hospital of Jilin University.PARTICIPANTS: Continuous tinnitus group: 63 cases (68 ears) were selected from the Clinic of First Hospital of Jilin University from March 1999to October 2001. Control group: 10 cases (20 ears) of normal hearing youth (20-23 years old). All subjects received the examination and treatment voluntarily.METHODS: The ABR was firstly detected in tinnitus patients (foreheadmastoid conducting method was adopted), and examination of tinnitus as well as tinnitus masking test (masking for 5 minutes) were respectively conducted, immediately after that, the ABR was detected to do control-observation with the control group.MAIN OUTCOME MEASURES: ①The characteristics of ABR in patients with tinnitus. ②Effects of tinnitus masking on the amplitude wave of ABR, which was divided into positive group in residual inhibition test and negative group in residual inhibition test for analyzing.RESULTS: A total of 83 subjects were involved in the analysis of results.①The amplitude wave of ABR in youth of normal hearing were small Ⅲ big Ⅴ, whereas that in 22 ears (32.4％) out of 63 subjects (68 ears) were big Ⅲ smallⅤ, in which 17 ears were of patients positive residual inhibition test, and 5 were of negative.②After tinnitus masking therapy, 10 ears out of 17 ears of patients positive in residual inhibition test turned from big Ⅲ small Ⅴ to small Ⅲ big Ⅴ, and the wave amplitude of Ⅲ wasre duced in 3 ears, while the ABR in 2 ears out of 5 ears of negative patients turned to small Ⅲ bigⅤ, and there were no changes in other 3 ears.CONCLUSION: Tinnitus masking therapy can convert the abnormal ABR wave amplitude in patients with tinnitus to normal, which will be taken as the objective index in judging whether it is positive in residual inhibition test.
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Objective:To establish a podocyte cell injury model induced by puromycin aminonucleoside(PAN),an in vitro model for studying the role of podocytes,especial the slit diaphragm molecules in proteinuria at the cellular and molecular levels.Methods:MPC5 were treated for 24 and 48 hours by 15,45 and 75 mg/L PAN,respectively.The podocyte molecular behavior during podocyte injury was evaluated:the apoptotic podocyte cells were revealed with FITC-Annexin V and Propidium Iodide(PI) assay and the proliferative podocyte cells detected with MTT assay after PAN treatment.The distribution of Nephrin and Podocin was revealed with indirect-immnofluorescent staining under confocal microscope.The distribution of F-actin was revealed with direct-immnofluorescent staining under microscope.Results:The percentage of apoptotic podocyte cells was increased in a dose-and time-dependent manner after PAN treatment.In PAN-treated group,the apoptosis was obviously increased at hour 48,the PAN-45 treated group was 33.48%?14.55% and PAN-75 treated group 38.01%?12.13% vs the control group 6.38%?0.50%(P
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OBJECTIVE:To discuss the clinical significance of the expression of P- glycoprotein(P-gp),the multidrug resistance gene - 1(MDR - 1) expression product in the malignant lymphoma of nasalcavity and pharynx nasalis.METHODS: The expression of P - gp in the malignancy lymphoma of nasalcavity and pharynx nasalis of 37 cases was detected by S - P Immunohistochemical staining,and its correlations with patents' first visit,return visit,original sites,pathological type, immunohistochemical typing and prognosis were analyzed.RESULTS:Positive P- gp expression appeared in 87.5%(7/8) of the patients for return visit vs.34.5%(10/29) for first visit and 70.0%(7/10) with malignant lymphoma at pharynx nasalis vs.37.0%(10/27) with malignant lymphoma at nasal cavity,all showing significant differences.There were also significant differences in drug resistance between the patients with positive P- gp expression and those with negative P- gp expression (88.2%(15/17) vs.10.0%(2/20)).CONCLUSION:Positive P-gp expression serves as scientific basis for clinicians in predicating drug resistance and selecting drugs and establishing schemes.
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Objective To explore the prevalence of mild cognitive impairment (MCI) among elderly veterans. Methods 2 674 veterans ( aged 60 years and over) from 26 military sanatorium in Shijiazhuang city were studied. The Mini-Mental State Examination, Global Deterioration Scale, Activity of Daily Living, Hachinski Ischemic Scale and Hamilton Depression Scale were served as screening tools. Results The prevalence of total MCI was 8 08% in elderly people. The standardized prevalence of MCI was 6 87% in male and 10 38% in female (P