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Objective:To evaluate the effects of dexamethasone and etomidate on cortisol secretion in elderly patients undergoing general anesthesia.Methods:One hundred and twenty-five elderly patients of either sex, aged 66-90 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergoing minor and medium elective surgeries under general anesthesia, were allocated into 4 groups using a random number table method: propofol and normal saline group (group PN, n=31), propofol and etomidate group (group PD, n=31), etomidate and normal saline group (group EN, n=33) and etomidate and dexamethasone group (group ED, n=30). In PN and EN groups, propofol (2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.In PD and ED groups, etomidate (0.2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.The serum cortisol concentrations were measured at 8: 00 after entering the operating room on the morning of operation (T 1), 1 h after the start of anesthesia (T 2), 2 h after the start of anesthesia (T 3), 8: 00 on the next day ofoperation (T 4) and 8: 00 on the 2nd day of operation (T 5). Blood glucose concentrations were measured at T 1-T 3, and the hypotension during the peri-anesthesia period, nausea and vomiting in post-anesthesia care unit, and nausea and vomiting scores were recorded at 24 h after operation. Results:A total of 122 patients completed the trial.Compared with PN group, the concentration of serum cortisol was significantly decreased at T 2-T 5, blood glucose concentrations were increased at T 2 and T 3 ( P<0.05), and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in PD group ( P>0.05), and the concentration of serum cortisol was significantly decreased at T 2-T 4, the incidence of hypotension was decreased ( P<0.05), and no significant change was found in the blood glucose concentrations, incidence of nausea and vomiting or nausea and vomiting scores in EN group ( P>0.05). Compared with ED group, the serum cortisol concentration was significantly increased at T 2 and T 3, the incidence of hypotension was increased, the incidence of nausea and vomiting and nausea and vomiting scores were decreased ( P<0.05), and no significant change was found in the blood glucose concentrations in PD group ( P>0.05), and the serum cortisol concentration was significantly decreased at T 2 and T 3 and increased at T 4 and T 5, the serum cortisol concentration was decreased at T 2 and T 3, and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in EN group ( P>0.05). Conclusions:Combination of etomidate and dexamethasone significantly enhances the duration and degree of inhibition of cortisol secretion in elderly patients than etomidate or dexamethasone alone.
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Objective:To explore the construction and application in kidney-transplant recipients of accelerated rehabilitation surgery scheme.Methods:From February 2017 to January 2018, 49 kidney-transplant recipients who received routine preoperative management in the First Affiliated Hospital of Wenzhou Medical University were selected as regular group, while another 49 kidney-transplant recipients who received accelerated rehabilitation surgery scheme in our hospital from February 2018 to June 2019 were selected as observation group.The incidences of complications such as postoperative bleeding, infection of incisional wound and urinary tract, pulmonary infection, rejection reaction and urine leakage between the two groups were compared.The early rehabilitation progress such as preserved time of dwelling catheter, leaving bed time and first defecation time between the two groups were compared.The postoperative hospitalization time, hospitalization expense and the rate of readmission within 30 days were compared.Results:The incidence of complications of the observation group was 4.08%(2/49), which was significantly lower than that of the regular group[22.45%(11/49)](χ 2=7.184, P=0.007). The preserved time of dwelling catheter[(2.51±1.12)d], leaving bed time[(1.96±1.08 )d] and the first defecation time[(2.56±1.16)d] of the observation group were significantly better than those of the regular group[(4.96±1.40)d, (4.82±1.36)d and (4.84±1.38)d]( t=9.663, 11.650, 8.943, all P=0.000). The postoperative hospitalization time[(19.53±2.38)d] and hospitalization expense[(35.7±3.2)thousand CNY] of the observation group were significantly lower than those of the regular group[(26.49±3.42)d and (49.8±8.2)thousand CNY]( t=11.812, 11.327, all P=0.000). The readmission rate within 30 days of the observation group[2.04%(1/49)] was significantly lower than that of the regular group[18.37%(9/49)], the difference was statistically significant(χ 2=7.127, P=0.008). Conclusion:The construction and effective application of accelerated rehabilitation surgery scheme in kidney-transplant recipients can reduce the incidence of complication in recipients after transplantation, accelerate their rehabilitation in early stage, shorten the hospitalization time, reduce the hospitalization expense and lower the readmission rate after 30 days.
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Objective@#To evaluate the effectiveness of eradication therapy based on Helicobacter pylori (Hp) susceptibility and CYP2C19 genotype in children with refractory Hp infection.@*Methods@#In this prospective observational cohort study, 156 children with Hp refractory to amoxicillin+clarithromycin+omeprazole triple regimen in Baoding Children′s Hospital from December 2017 to May 2018 were enrolled. Ninety-two of them underwent Hp culture and CYP2C19 detection. Seventy-five cases with positive Hp culture were defined as culture successful group and were treated according to Hp susceptibility and CYP2C19 genotype. Seventeen cases with negative Hp culture were defined as culture failed group and were treated only based on the results of CYP2C19 genotype. Sixty-four children who did not have Hp culture and CYP2C19 gene testing were defined as the empirical eradication therapy group and were treated with quadruple regimen (amoxicillin+metronidazole+omeprazole+bismuth). Bacterial resistance, CYP2C19 polymorphism and therapeutic effectiveness between the three groups were compared using chi-square test.@*Results@#Among the 75 positive Hp culture results, 72 (96%) were resistant to clarithromycin, 3 (4%) were resistant to metronidazole, 5 (7%) were resistant to levofloxacin, 5 (7%) were resistant to rifampicin, 1 (1%) was resistant to tetracycline, and none was resistant to amoxicillin and furazolidone. The CYP2C19 polymorphism in 92 patients showed that 43 (47%) were extensive metabolizer (EM), 9 (10%) were poor metabolizer (PM), and 40 (43%) were intermediate metabolizer (IM). In terms of the effectiveness, eradication rate in the culture successful group,culture failed group and empirical eradication therapy group were 99% (74/75), 88% (15/17) and 72% (46/64), respectively (χ2=21.325, P<0.05). The eradication rate in the culture successful group was significantly higher than that in empirical eradication therapy group (χ2=21.005, P<0.05), while there was no difference between empirical eradication therapy group and culture failed group (χ2=1.154, P=0.283).@*Conclusion@#Eradication regimen based on bacterial susceptibility and CYP2C19 genotype should be considered in children with refractory Hp infection.
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Objective To construct a rapid genetic DNA extraction method, with nano magnetic beads, self-designed reagents system and extracting process. Method Part I: DNA extraction from old blood cotton swab sample with self-designed DNA extraction kit, then quantiifed by UV spectrophotometer. The method was further optimized on the preliminary results. Part II: All kinds of difficult DNA sample were tested with optimized kit, to detect the applicability of the kit. Result By improving the experimental condition, the extraction effects of different DNA sample is good, meanwhile, the extraction cost is relatively low.
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Objective To evaluate the efficacy and safety of Radix Astragali(Huang Qi)for newborns with hypoxic ischemic encephalopathy(HIE). Methods We searched the Cochrane library,PubMed,Cochrane,EMBASE,CBM,CNKI,VIP and Wan?fang database,randomized controlled trial(RCT)evaluating the efficacy and safety of Huang Qi for newborns with HIE would be in?cluded and the methodological quality of RCT was evaluated according to the Cochrane Handbook for Systematic Reviews of Interven?tions version 5.1.0. Results Thirteen studies were included(1031 patients),11 RCT used open control as control,2 RCT used posi? tive control. There was no trial reported the death or disability at the end of 12 months follow-up period. Meta-analysis of one study showed Huang Qi group could not significantly reduced mortality rate of HIE compared with open control group〔RR=0.33,95%CI (0.04,3.07)〕. Meta analysis of 7 studies(n=597)showed that the efficacy rate of huang Qi group was significantly higher than that of open control group in treatment of HIE〔RR=1.22,95%CI(1.07,1.39),I2=48%〕. Meta-analysis of 3 trials(n=163)showed that there was significant difference in the improvement of NANA scale on the seventh day〔MD=5.37,95%CI(1.46,9.27),I2=89%〕be?tween Huang Qi group and open control group. Meta-analysis of 2 trials(n=111)showed that there was significant difference in the im?provement of NANA scale on the tenth day〔MD=2.03,95%CI(1.37,2.69),I2=0〕between Huang Qi group and open control group. No fatal side effects were reported. Conclusion Based on the current evidence,due to the limitation of quality of included studies and sample size,the routine use of Huang Qi for treatment of HIE in newborns is not recommended. The long-term efficacy and safety studies are required to confirm it.
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Objective To study the significance of level changes of serum hydrogen sulfide(H2 S) and interleukin-6(IL-6)in children with hand,foot and mouth disease(HFMD).Methods Nity-two cases with HFMD were enrolled and divided into severe HFMD group(48 cases)and common HFMD group(44 cases).Forty-six healthy children were enrolled as healthy control group.The serum H2 S and IL-6 were detected.Results Acute phase:compared to the healthy control group[H2 S(55.76 ±7.80)μmol /L,IL-6 (61.31 ±13.43)ng /L],the level of serum H2 S significantly reduced and the level of IL-6 significantly increased in severe HFMD group[H2 S(21.72 ±7.52)μmol /L;IL-6(131.33 ±17.82)ng /L]and common HFMD group[H2 S(31.86 ±8.41 )μmol /L;IL-6(95.48 ±15.07)ng /L](P ﹤0.01 ),and there was signifi-cantly difference between the severe HFMD group and common HFMD group(P ﹤0.01 ).Recovery phase:compared to the healthy control group,the serum H2 S level[(34.54 ±13.21 )μmol /L]was lower and IL-6 [(92.73 ±15.25)ng /L]was higher in severe HFMD group(P ﹤0.01 ).The serum H2 S level was negatively correlated with IL-6 in severe HFMD group and common HFMD group(r =-0.31 ,P ﹤0.01 ;r =-0.45, P ﹤0.01 ).Conclusion The serum H2 S and IL-6 participate in the pathological process of HFMD,and the level change can be used as one of indicators of early diagnosis.
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[ ABSTRACT] AIM:To observe the inhibitory effect of madecassoside on the LPS-stimulated microglia and to inves-tigate its possible mechanism.METHODS:Microglia cells of neonatal Sprague-Dawley ( SD) rats were cultured, isolated and purified.Microglia cells were activated with lipopolysaccharide ( LPS) .The inhibitory effect of madecassoside on micro-glia was measured by MTT assay.Tumor necrosis factor alpha (TNF-α), interleukin 1β(IL-1β) were detected by ELISA. Cell cycle and apoptotic rate were evaluated by flow cytometry.The expression of TLR4 was detected by Western blotting. The expression of NF-κB was detected by RT-PCR.RESULTS: LPS induced the proliferation of microglia and release in-flammatory cytokines significantly.Compared with LPS group, madecassoside inhibited the proliferation of microglia induced by LPS in a dose dependent manner.The IC50 value of madecassoside was 10.97 nmol/L to microglia after incubation for 48 h.Madecassoside also decreased the levels of TNF-αand IL-6, increased the ratios of microglia at the G2 phase and the ap-optotic rate, decreased the expression of TLR4 and NF-κB significantly (P<0.05).CONCLUSION:Madecassoside has in-hibitory effects on the proliferation of LPS-stimulated microglia, by which the mechanism may be related to inhibition of the expression of TLR4 and NF-κB, change of cell cycle distribution and induction of microglia apoptosis.
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Objective:To analyze the protective effects of adoptively transferring different patrilineal lymphocytes and their Exosomes ( Exo) on fetation of mice with pregnancy loss comparatively.Methods: The peripheral blood mononuclear cells ( PBMC) from healthy men and the splenocytes from BALB/c and DBA/2 male mice were induced in vitro ,and their Exo were isolated through sucrose gradient ultra-centrifugation combined with ultrafiltration.The mice of CBA/J (♀) mated with BALB/c (♂) were enrolled as control group of normal pregnancy ,and the CBA/J (♀) mated with DBA/2 (♂) as URSA of pregnancy loss experimental animal model.The mice in URSA group were randomly divided into each group with treatment through adoptively transferring , which were injected intravenously or subcutaneously with splenocytes or splenocytes -derived Exo from mated DBA/2,unmated DBA/2 or unrelated BALB/c,also PBMC-derived Exo from men,respectively.And then,the placenta volumes,rates of fetal absorption and pregnancy loss were calculated to observe the fetation of embryos.Results:Compared with the group of normal pregnancy ,the placenta volumes from URSA group decreased greatly ,and rates of fetal absorption and pregnancy loss elevated greatly ( all P0.05 ).After transferring the Exo derived from either male mice or healthy men,the level of decreased fetal absorption rates were more than that in cellular-therapy groups ( all P<0.05 ).After transferring the Exo derived from men ,the level of decreased pregnancy loss rates were more than that in cellular -therapy groups and mice splenocytes-derived Exo group ( all P<0.05 ).Conclusion:Adoptively transferring patrilineal T lymphocytes and their Exo can greatly improve the fetation.Exo should become a non-cellular bio-remedy,which is expected to replace traditional immunotherapy of adoptively transferring lymphocytes.
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Objective To characterize angular dependency of MatfiXX and develop a method for its calibration in order to verify treatment plan with original gantry angles.Methods Absolute dose calibration was carried with thimble ionization chamber on the linear accelerator.so as to make sure 1 MU=1 cGy at the depth of maximum dose(dmax).A MatriXX was put into a Mutlicube phantom,and the ionization chamber matrix was calibrated with absolute dose.In order to determine a correction factor CF as a function of gantry angle θ.open beam fields of 10 cm×10 cm size were irradiated for gantry angles θ=0°-180°(every 5°)and every 1°for lateral angles θ in the range of 85°-95°.CF was defined as the ratio of the dose measured with ionization chamber and the dose from MatriXX.Results Relatively large discrepancies in response to posterior VS.anterior fields for MatriXX detectors(up to 10%)were found during the experiment and relatively large variability of response as a function of gantry angle.The pass rate of treatment plan in lateral beams was lower than that of other beams.The isodose distribution of corrected MatriXX matched well with the outcome from the treatment planning system. Conclusions The angular dose dependency of MatriXX must be considered when it is used to verify the treatment plan with original gantry angles.