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Objective:To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children.Methods:The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins type Ⅲ from January 2013 to December 2021 at Department of Orthopaedics, Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital. They were divided into a reduction failure group (35 cases) and a reduction success group (136 cases). Factors such as fracture height, age, body mass index, ulnar-radial offset direction, obvious axial rotation of the distal fracture fragment, combined ulnar nerve injury, and time from injury to operation were listed as risk factors. The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results:The average age of 171 children was (7.8±2.6) years. There were 151 cases of radial deviation and 20 cases of ulnar deviation, 120 high type fractures and 51 low type fractures, and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment. The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age, obvious rotation of the distal fracture fragment, and ulnar nerve injury ( P<0.05), but no significant differences in fracture height, body mass index, ulnar-radial offset direction, or time from injury to operation ( P>0.05). Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment ( OR=3.287, 95% CI: 1.136 to 9.513, P=0.028) and combined ulnar nerve injury ( OR=6.439, 95% CI: 2.262 to 18.327, P=0.001) were risk factors for failure in closed reduction. Conclusion:As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children, they should arouse more attention in the treatment of such fractures.
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【Objective】 To evaluate the efficacy and safety of different doses and frequencies of oral Sildenafil in the treatment of erectile dysfunction (ED). 【Methods】 The randomized,open clinical trial included 120 ED patients who met the inclusion and exclusion criteria. The patients were randomly divided into the following groups:on-schedule (25 mg/day),on-demand (50 mg,taken irregularly half an hour before each sexual life),new regular group (25 mg/day,50 mg more before each sexual life),regular group (100 mg/time,twice/week). All treatments lasted for 8 weeks. The follow-up indexes included the five-item International Index of Erectile Function (IIEF-5),Erection Hardness Scale (EHS) and Sexual Encounter Profile (SEP2/3). The adverse reactions were recorded. 【Results】 The IIEF-5 scores of the four groups were significantly higher than those after baseline treatment (P0.05). In terms of effective rate,at the 16th week,there were significant differences between the on-demand group (10.7%) and new regular group (62.1%),and between the on-demand group (10.7%) and regular group (50.0%) (P<0.001). In terms of EHS, the percentage of grade 4 patients in regular group was significant higher than that in the on-demand group at the 8th week and 16th week (all P<0.05). In terms of positive rate of SEP-3,there was a significant difference between the on-demand group and regular group (P=0.042) at the 16th week. In the course of treatment,there were transient adverse reactions such as headache,blurred vision,stuffy nose and back pain,which did not affect the treatment. 【Conclusion】 All of the four treatment methods of oral sildenafil showed good efficacy. Both regular group and new regular group maintained good clinical efficacy during the follow-up,which is better than that of the on-demand group. The new regular scheme can be used as a new,safe and effective treatment option.
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Objective:To investigate the effect of inferior vena cava variability (IVCV) combined with difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO 2) on guiding fluid resuscitation in septic shock. Methods:Patients with septic shock admitted to the department of critical care medicine of Jiangxi Provincial People's Hospital from January 1, 2018 to December 31, 2020 were enrolled, and they were divided into control group and observation group according to random number table method. Patients in both groups were given fluid resuscitation according to septic shock fluid resuscitation guidelines. The patients in the control group received fluid resuscitation strictly according to the early goal-directed therapy (EGDT) strategy. Resuscitation target: central venous pressure (CVP) 12-15 cmH 2O (1 cmH 2O≈0.098 kPa), mean arterial pressure (MAP) > 65 mmHg (1 mmHg≈0.133 kPa), mean urine volume (UO) > 0.5 mL·kg -1·h -1, central venous oxygen saturation (ScvO 2) > 0.70. In the observation group, the endpoint of resuscitation was evaluated by IVCV dynamically monitored by bedside ultrasound and Pcv-aCO 2. Resuscitation target: fixed filling of inferior vena cava with diameter > 2 cm, IVCV < 18%, and Pcv-aCO 2 < 6 mmHg. The changes in recovery indexes before and 6 hours and 24 hours of resuscitation of the two groups were recorded, and the 6-hour efficiency of fluid resuscitation, 6-hour lactate clearance rate (LCR) and 6-hour and 24-hour total volume of resuscitation were also recorded; at the same time, the duration of mechanical ventilation, length of intensive care unit (ICU) stay, 28-day mortality and the incidence of acute renal failure and acute pulmonary edema between the two groups were compared. Results:A total of 80 patients were enrolled in the analysis, with 40 in the control group and 40 in the observation group. The MAP, CVP and ScvO 2 at 6 hours and 24 hours of resuscitation in the two groups were significantly higher than those before resuscitation, while Pcv-aCO 2 and blood lactic acid (Lac) were significantly decreased, and UO was increased gradually with the extension of resuscitation time, indicating that both resuscitation endpoint evaluation schemes could alleviate the shock state of patients. Compared with before resuscitation, IVCV at 6 hours and 24 hours of resuscitation in the observation group were decreased significantly [(17.54±4.52)%, (18.32±3.64)% vs. (27.49±10.56)%, both P < 0.05]. Compared with the control group, MAP and ScvO 2 at 6 hours of resuscitation in the observation group were significantly increased [MAP (mmHg): 69.09±4.64 vs. 66.37±4.32, ScvO 2: 0.666±0.033 vs. 0.645±0.035, both P < 0.05], 24-hour MAP was increased significantly (mmHg: 75.16±3.28 vs. 70.12±2.18, P < 0.05), but CVP was relatively lowered (cmH 2O: 9.25±1.49 vs. 10.25±1.05, P < 0.05), indicating that the fluid resuscitation efficiency was higher in the observation group. Compared with the control group, 6-hour LCR in the observation group was significantly increased [(55.64±6.23)% vs. (52.45±4.52)%, P < 0.05], 6-hour and 24-hour total volume of resuscitation was significantly decreased (mL: 2 860.73±658.32 vs. 3 568.54±856.43, 4 768.65±1 085.65 vs. 5 385.34±1 354.83, both P < 0.05), the duration of mechanical ventilation was significantly shortened (days: 6.78±3.45 vs. 8.45±2.85, P < 0.05), while the incidence of acute pulmonary edema was significantly decreased [2.5% (1/40) vs. 20.0% (8/40), P < 0.05]. There was no significant difference in the length of ICU stay, 28-day mortality or incidence of acute renal failure between the two groups. Conclusions:Dynamic monitoring of IVCV and Pcv-aCO 2 can effectively guide the early fluid resuscitation of patients with septic shock, and compared with EGDT, it can significantly shorten the duration of mechanical ventilation, reduce the amount of fluid resuscitation, and reduce the incidence of acute pulmonary edema. Combined with its non-invasive characteristics, it has certain clinical advantages.
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Objective:To investigate the characteristics and reliability of a novel sub-classification of Wilkins type III lateral-flexion supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 92 children with supracondylar fracture of the humerus admitted to Provincial Children′s Hospital of Anhui Medical University from January 2013 to August 2021, including 38 males and 54 females, aged 2-13 years [(8.5±2.4)years]. Lateral-flexion Wilkins type III supracondylar humeral fractures were classified into two subtypes according to the fracture features: type IIIA ( n=14), complete fracture with the distal fragment displaced anteriorly and laterally, with no obvious anterior or posterior inclination (<10°) or rotation; type IIIB ( n=78), complete fracture with the distal fragment displaced anteriorly and laterally, with significant anterior or posterior inclination (>10°) or rotation. The incidence and risk ratio of ulnar nerve injury and open reduction were compared between the two subtypes of the fracture. The weighted Kappa method was used to test the inter- and intra-observer agreement of the two new subtypes. Results:Of all, 15 children had ulnar nerve injury, among which 1(6.7%) was type IIIA and 14(93.3%) were type IIIB; while other 77 children had no ulnar nerve injury. The risk of ulnar nerve injury in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=2.84, 95% CI 0.34- 25.56, P>0.05). The open reduction was performed in 11(73.3%) out of the 15 children with ulnar nerve injury, but in 18(23.4%) out of the 77 children with no ulnar nerve injury. The risk of open reduction in children with ulnar nerve injury was 9-fold higher than that in children without ulnar nerve injury ( OR=9.01, 95% CI 2.28- 33.17, P<0.01). Open reduction was performed in 29 children, among which 2(6.9%) were type IIIA and 27(93.1%) were type IIIB. The risk of open reduction in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=3.17, 95% CI 0.66-15.24, P>0.05). The intra-observer Kappa value was 0.49±0.09(95% CI 0.31-0.66), indicating a moderate agreement. The inter-observer Kappa value was 0.80±0.06(95% CI 0.68-0.91), indicating a strong or very strong agreement. Conclusions:Wilkins type IIIB lateral-flexion supracondylar fracture of the humerus in children is more likely to be accompanied by ulnar nerve injury and to be opt to open reduction in comparion with type IIIA. The new subtyping has reliable inter-observer and intra-observer consistency, and is able to facilitate the prediction of surgical plans.
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Objective:To explore the effect of ICE regimen (ifosfamide, carboplatin, VP16) combined with methotrexate on the clinical efficacy and expression of miR-451a and miR-15a in patients with diffuse large B cell lymphoma (DLBCL).Methods:A total of 56 patients with DLBCL in the Third Hospital of Changsha from March 2013 to may 2018 were prospectively selected and randomly divided into observation group and control group, 28 cases in each group. The control group was treated with ICE regimen, and the observation group was treated with ICE regimen combined with methotrexate. The tumor control rate, toxic and side effects, the expression of miR-451a and miR-15a, immune function (CD3 +, CD4 +, CD8 +, CD4 +/CD8 +), serum tumor markers [β 2 microglobulin (β 2-MG), carbohydrate antigen 125 (CA125), and lactate dehydrogenase (LDH)] levels were compared before and after treatment between the two groups, follow-up for 6 to 12 months was used to calculate the survival rate of the two groups. Results:The tumor control rate in the observation group (92.86%) was higher than that in the control group (71.43%) ( P<0.05); After treatment, the miR-15a decreased and miR-451a increased in the two groups, and the miR-15a in the observation group was lower than that in the control group, while miR-451a was higher than that in the control group ( P<0.05); After treatment, the CD3 +, CD4 +, CD4 +/CD8 + of the two groups were lower than before treatment, and CD8 + was higher than before treatment ( P<0.05), but there was no significant difference between the two groups ( P>0.05); After treatment, the serum CA125, LDH, and β 2-MG in the two groups were lower than before treatment, and the above indexes in the observation group were lower than those in the control group ( P<0.05); There was no significant difference between the two groups in the incidence of side effects and the survival rates of 6, 9 and 12 months after treatment ( P>0.05). Conclusions:ICE regimen combined with methotrexate in the treatment of DLBCL can further improve the therapeutic effect and reduce the serum tumor marker levels by regulating the expression of miR-451a and miR-15a, with less toxic side effects and less immune damage, and high safety.
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Objective:To investigate the changes of plasma prothrombin fragment 1+ 2 (F 1+2), tissue factor positive microparticle (TF+ MP) and thrombin antithrombin complex (TAT) level before and after the treatment of low molecular weight heparin combined with reteplase in patients with malignant tumor and lower extremity venous thrombosis. Methods:From July 2016 to October 2019, 64 patients with malignant tumors and lower extremity venous thrombosis in the Third Hospital of Changsha were selected, they were divided into observation group ( n=32) and control group ( n=32) by simple randomization. The control group was treated with low molecular heparin, and the observation group was treated with low molecular heparin combined with reteplase. The efficacy, clinical symptom improvement time, incidence of adverse reactions, difference in lower limb circumference, blood flow velocity, activated partial thromboplastin time (APTT), prothrombin time (PT), plasma F 1+2, TF+ MP, TAT level before and after treatment were compared between the two groups; the correlations of plasma F 1+2, TF+ MP, and TAT level with clinical symptom improvement time, peripheral diameter difference of lower extremity, blood flow velocity, APTT, and PT were analyzed. Results:The total effective rate of the observation group (87.50%) was higher than that of the control group (65.63%) ( P<0.05); The improvement time of clinical symptoms in the observation group was shorter than that in the control group ( P<0.05); After treatment, the peripheral limb diameter difference of the observation group was lower than that of the control group, and the blood flow velocity was higher than that of the control group ( P<0.05); The APTT and PT in the observation group were higher than those in the control group after treatment ( P<0.05); The plasma F 1+2, TF+ MP, and TAT level in the observation group were lower than those in the control group after treatment ( P<0.05); The levels of plasma F 1+2, TF+ MP, and TAT were positively correlated with symptom improvement time and lower limb circumference difference, and negatively correlated with blood flow velocity, APTT, and PT ( P<0.05); There was no significant difference in the incidence of adverse reactions (18.75%) between the observation group and the control group (12.50%) during the treatment period ( P>0.05). Conclusions:Plasma F 1+2, TF+ MP, and TAT expression in patients with malignant tumors and venous thrombosis of the lower extremity can be used as biological indicators to evaluate the patient's condition and treatment effect. Low molecular weight heparin combined with reteplase can significantly reduce the plasma F 1+2, TF+ MP and TAT level, promote the improvement of symptoms, effectively reduce the peripheral diameter difference of lower extremity, improve blood flow velocity and coagulation function, and has a significant effect.
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Objective:To investigate the protective effect and mechanism of celastrol in acute lung injury (ALI) of septic rats.Methods:According to random number table, 24 male Sprague-Dawley (SD) rats were divided into control group (Con group), Sham operation group (Sham group), sepsis-induced ALI group by cecal ligation and perforation (CLP group) and celastrol intervention group (CLP+celastrol group, 2 mg/kg intraperitoneal administration 1 hour before surgery), 6 rats in each group. The abdominal aortic blood of the rats was collected for blood gas analysis 24 hours after the surgery, and then the rats were sacrificed and the lung tissues were taken to calculate the lung wet/dry weight ratio (W/D). The pathological characteristics of lung tissues were observed under light microscope and calculated the lung injury score. The protein levels of Toll-like receptor 4 (TLR4), interleukins (IL-6, IL-10), and nuclear factor-κB (NF-κB) of cytoplasm and nucleus in lung tissues were detected by enzyme linked immunosorbent assay (ELISA).Results:The partial arterial oxygen pressure (PaO 2), lung W/D ratio, lung injury score and the protein levels of inflammatory factor in lung tissues had no differences between Con group and Sham group. Compared with the Con group, PaO 2 in the CLP group was significantly decreased [mmHg (1 mmHg = 0.133 kPa): 60.33±2.01 vs. 109.20±2.99], the lung W/D ratio and lung injury score were significantly increased (lung W/D ratio: 4.44±0.05 vs. 3.27±0.04, lung injury score: 10.67±0.42 vs. 0.50±0.22), and the protein levels of TLR4, IL-6, IL-10 and the nucleus NF-κB in the lung tissues were significantly increased [TLR4 (pg/L): 21.87±0.66 vs. 3.27±0.09, IL-6 (ng/L): 861.10±8.28 vs. 120.30±3.91, IL-10 (ng/L): 212.40±2.57 vs. 41.73±1.02, nuclear NF-κB (ng/L): 707.70±16.82 vs. 403.30±7.46], but the protein level of cytoplasm NF-κB was significantly decreased (ng/L: 213.70±8.67 vs. 408.30±8.71), with statistically significant differences (all P < 0.05). Compared with the CLP group, PaO 2 in CLP+celastrol group was significantly increased (mmHg: 76.83±3.21 vs. 60.33±2.01), the lung W/D ratio and lung injury score were significantly decreased (lung W/D ratio: 3.82±0.03 vs. 4.44±0.05, lung injury score: 5.00±0.37 vs. 10.67±0.42), and the protein levels of TLR4, IL-6, IL-10 and nucleus NF-κB in the lung tissue were significantly decreased [TLR4 (pg/L): 7.57±0.21 vs. 21.87±0.66, IL-6 (ng/L): 380.90±6.55 vs. 861.10±8.28, nuclear NF-κB (ng/L): 533.80±9.42 vs. 707.70±16.82], and the protein level of cytoplasm NF-κB was significantly increased (ng/L: 342.70±14.96 vs. 213.70±8.67), with statistically significant differences (all P < 0.05), while the protein level of IL-10 in lung tissues had no significant difference (ng/L: 210.50±3.16 vs. 212.40±2.57, P > 0.05). Conclusion:Celastrol may regulate the expression and release of inflammatory factors by inhibiting the TLR4/NF-κB pathway, thereby alleviating the ALI induced by sepsis in rats.
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Objective To explore the feasibility of extracorporeal membrane oxygenation (ECMO) in protecting the donor liver in donation after citizen's death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin (TB), alanine transaminase (ALT) and aspartate transaminase (AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen (PaO2) were remarkably increased (all P < 0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen's death are significantly improved after ECMO, and the liver function of the recipients also recover well.
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Objective? ? To? evaluate? the? protective? effect? and? curative? effect? of? early? treatment? with?extracorporeal?membrane?oxygenation?(ECMO)?in?severe?patients?with?acute?respiratory?distress?syndrome?(ARDS)?caused?by?acute?phosgene?poisoning.? Methods? The?course?of?treatment?of?4?cases?of?ARDS?caused?by?acute?phosgene?poisoning?admitted?to?intensive?care?unit?(ICU)?of?Jiangxi?Provincial?People's?Hospital?in?April?2018?was?retrospectively?analyzed.?The?treatment?parameters?in?patients?before?and?after?the?ECMO?treatment?at?1,?3,?7?days?were?collected,?including?pH?of?the?arterial?blood,?arterial?partial?pressure?of?carbon?dioxide?(PaCO2),?arterial?partial?pressure?of?oxygen?(PaO2),?blood?lactic?acid?(Lac)?and?systemic?vascular?resistance?index?(SVRI),?cardiac?index?(CI),?extravascular?lung?water?index?(ELWI),?plateau?pressure?(Pplat),?positive?end-expiratory?pressure?(PEEP),?driving?pressure?(ΔP),?and?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHE?Ⅱ),?the?length?of?ICU?stay,?the?treatment?duration?of?ECMO?and?the?duration?of?mechanical?ventilation.? Results? After?admitted?in?hospital,?the?4?patients?were?all?put?on?tracheal?intubation?and?ventilator,?but?the?ventilator?support?conditions?were?high,?the?oxygenation?and?internal?environment?were?unstable.?Therefore,?ECMO?therapy?was?performed?on?the?next?day?after?admission.?Oxygenation?was?improved?obviously?after?treatment,?ventilator?support?conditions?could?be?obviously?reduced,?including?3-6?mL/kg?of?the?small?tidal?volume,?8-10?cmH2O?(1?cmH2O?=?0.098?kPa)?of?the?PEEP,?0.30?of?the?inhaled?oxygen?concentration?(FiO2),?and?other?lung?protection?rest?strategies.?The?parameters?were?improved?obviously?after?the?ECMO?treatment?compared?with?before,?from?the?1st?day?after?the?ECMO?treatment,?PaO2,?SVRI?rose?obviously,?Lac,?ELWI,?Pplat,?PEEP,?ΔP,?APACHEⅡ?were?significantly?decreased?[PaO2??(mmHg,?1?mmHg?=?0.133?kPa):?85.5±10.7?vs.?54.2±4.5,?SVRI?(kPa·s·L-1·m-2):?153.6±9.4?vs.?118.0±12.6,?Lac?(mmol/L):?2.15±0.19?vs.?4.93±0.96,?ELWI?(mL/kg):?17.73±2.99?vs.?20.45±4.13,?Pplat?(cmH2O):?19.25±2.21?vs.?35.75±2.22,?PEEP?(cmH2O):?9.0±1.2?vs.?13.5±1.7,?ΔP?(cmH2O):?10.25±1.26?vs.?22.25±3.86,?APACHEⅡ:?17.25±2.22?vs.?26.50±2.08,?all?P?﹤0.05];?pH?and?CI?were?significantly?increased?after?3?days?treatment,?and?PaCO2?was?significantly?decreased?[pH:?7.43±0.05?vs.?7.21±0.13,?CI?(mL·s-1·m-2):?? 64.35±3.17?vs.?59.51±3.17,?PaCO2?(mmHg):?42.0±2.2?vs.?55.0±8.5,?all?P?<?0.05].?All?the?4?patients?were?treated?successfully?and?discharged?after?improvement.?The?length?of?ICU?stay?was?8-27?days,?with?an?average?(13.5±9.0)?days;?the?treatment?duration?of?ECMO?was?6-12?days,?with?an?average?(8.0±2.7)?days;?the?duration?of?mechanical?ventilation?was?6-20?days,?with?an?average?(10.75±6.19)?days.? Conclusion? Early?treatment?with?ECMO?can?significantly?improve?the?oxygenation?of?severe?ARDS?caused?by?acute?phosgene?poisoning,?eliminate?excessive?CO2?in?the?body,?reduce?ventilator-associated?lung?injury,?and?improve?the?prognosis.
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Objective: To analyze the application and significance of three-dimensional (3D) printing in the surgical simulation and plan-ning for pelvic malignant tumors before the actual surgery, surgical resection, and postoperative resection effect analysis. Methods: A retrospective analysis was performed for 20 cases of primary pelvic malignant tumors in 11 male and 9 female patients with a mean age of 39.1 years (range, 14-60 years) who were admitted to Xinjiang University of Medical Science and Technology between January 2014 and January 2018. The tumors included osteosarcoma in 7 patients, chondrosarcoma in 12, and Ewing's sarcoma in one. Accord-ing to the Enneking pelvic classification, 10 cases involved the pelvicⅡarea; 6, the pelvicⅢarea; 6, the pelvicⅠandⅡareas; and 8, the pelvic I andⅣareas. According to whether or not a 3D-printed osteotomy guide plate was used, the cases were divided into a 3D-printed guide plate group and a conventional group, with 10 cases in each group. Operation time, blood loss volume, function score, and linear distance deviation were compared between the two groups. Results: The operation was completed successfully with com-plete excision in 20 patients. The operation time in the 3D-printed guide plate group (4.4～1.4 h) was not statistically significantly dif-ferent from that in the control group (4.5～1.4 h; P=0.83). No significant difference in intraoperative blood loss volume was found be-tween the 3D-printed guide plate (1,980～1,158 mL) and control (2,785～1,784 mL; P=0.16) groups. The postoperative Musculoskele-tal Tumor Society score (20.4～0.98) in the 3D-printed guide plate group showed no significant difference from that in the convention-al group (20.2～1.29; P=0.78). The mean linear difference between the 3D-printed guide plate group (3.8～1.9 cm) and the conven-tional group (8.7～1.0) was statistically significant (P=0.001). Conclusions: The 3D-printed group was not significantly different from the conventional group in terms of operation time, blood loss volume, and function score but had better surgical resection accuracy than the conventional group.
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Objective To explore the association between hearing loss and dysfunction of the vestibular end-organ in older individuals. To evaluate the common risk factors for hearing loss and otolith dysfunction. Meth-ods A total of 120 elderly patients without any vestibular symptoms were recruited in this study. They were divid-ed into two groups:a study group(patients with presbycusis)and a control group(patients without presbycusis). Audiological status was measured with pure tone audiometry and the saccular function was tested with cervical ves-tibular evoked myogenic potential(cVEMP). The results of cVEMP were calculated and compared between the two groups. Results Comparing to the control group,mean P1 and N1 latencies were significantly prolonged(t =4.67,4.59,P < 0.05)and the amplitudes were signi cantly reduced(t = 6.72,P < 0.05)in the study group. A sig-nificant correlation between hearing loss at high frequencies and reduced cVEMP amplitudes(r = -0.41,P < 0.05) were observed in the study group. Noise exposure was significantly associated with cVEMP amplitude(β = -0.52, P < 0.05). Conclusions Presbycusis may be accompanied by the hypofunction of saccular function without any vestibular symptoms,and the high frequency hearing threshold is closely related to the saccular function. Noise ex-posure appears to be related to both cochlear and saccular dysfunction.
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Objective To explore nurse students' perceptions of the power dynamics in the teacher-student relationship during their clinical practice. Methods Semi-structured interviews were conducted on 15 nurse students using phenomenological methodology. Data were analyzed by Colaizzi′s sphenomenological procedure. Results Three core themes that emerged from the qualitative data:meanings of power; the desired power dynamics; enhancing the clinical learning experience. Conclusions The dominant theme in the participants' discourse is that teachers should possess more power than students in order to prevent students from causing harm to patients.The consensus is that the teacher's power in supervising students'clinical practice is necessary for the benefit of patient safety.
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Objective To investigate the clinical effect of using ambroxol hydrochloride and dexamethasone by nasal spray inhalation after endoscopic sinus surgery in treating chronic sinusitis.Methods One hundred and forty patients with chronic sinusitis receiving endoscopic sinus surgery in our hospital from January 2014 to December 2014 were selected as the research subjects.After surgery,the control group was given dexamethasone nasal spray inhalation,while the observation group was given ambroxol hydrochloride and dexamethasone by nasal spray inhalation.The curative efficacy,the score of visual analogue scale(VAS) was adopted to evaluate the subjective symptoms severity and the nasal endoscopy and CT examination results were evaluated by the Lund-Kennedy score.The serum levels of IL-5 and IL-12 were detected in the two groups.Results All cases were successful completed surgery and no severe adverse reactions appeared after surgery.The observation group had a total effective rate of 97.1 ％,which was signif icantly higher than 88.6 ％ in the control group,the difference was statistically significant(P＜0.05).In the aspects of sinusitis related symptoms after operation,compared with the control group,the VAS scores of nasal discharge,nasal obstruction,cheek pain,headache and hyposmia in the observation group were significantly decreased,the difference was statistically significant(P＜0.05).In the postoperative re-examination process,the score of assessment of nasal endoscopic score and paranasal sinuses CT score in the observation group were significantly decreased,the difference was statistically significant(P＜0.05).In the serological indicator determination,serum levels of IL-5 and IL-12 after treatment in the observation group were significantly lower than those in the control group,the difference was statistically significant(P＜0.05).Conclusion Using ambroxol hydrochloride combined with dexamethasone by nasal spray inhalation after endoscopic sinus surgery has good efficacy in treating chronic sinusitis,can decrease serum levels of IL-5 and IL-12.
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Objective To observe the epidemic trends of Keshan disease (KD) from 1967 to 2012 in Chuxiong City,in order to provide a scientific basis for prevention and control of the disease.Methods The data below was collected and analyzed with epidemiological method.KD cases reported through registration and the death case reported were collected in Chuxiong City from 1960 to 2012,also the reported monitoring results of KD and the adult KD screening results of dilated cardiac patients and mountain patients in 2012 were collected,then epidemic trends of KD was analysed comprehensively.Results There were 1 569 cases of KD registered from 1967 to 2012.There were 566 death cases of KD.The total prevalence rate of KD was 7.7％ (226/2 953) by monitoring children KD at the diseased areas of KD and the potential KD patients accounted for 97.3％ (220/226) from 1990 to 1994.The total prevalence rate of KD was 0.6％ (44/7 174) by surveillance at KD diseased areas from 2005-2012 and the potential KD patients accounted for 70.5％ (31/44),there were 7 children cases of KD under 15 years who accounted for 15.9％ from 2005 to 2012.Totally 313 551 children were given sodium selenium for supplying selenium from 1976 to 2008.Totally 151 cases of KD were found by screening from the patients with dilated cardiac patients since 1988 and they were all chronic KD patients.There were 112 cases of KD in 2012 and there were 6 children cases of KD under 15 years,which accounted for 5.4％.Chuxiong City Keshan disease epidemic presented from subacute Keshan disease to Keshan disease,to latent Keshan disease a slow transition;age from children (＜6 years) to children (＜15 years) to adult-oriented features.Conclusions The incidence and prevalence rate of KD has reached the basic control standards,but children KD is coexisting with adults KD.The pathogenic factors have not been eliminated,disease monitoring and health promotion should be carried out.
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Objective To explore effective ways of vocabulary learning through investigation of medical college students . Methods Vocabulary learning of 200 medical college students from grade 2010 (high-score group and low-score group)were investigated by self-made scales. Exploratory factor analyses were conducted by PASW Statistics software. Vocabulary learning of two groups was compared by independent-samples t test. Results There were statistical significances in factors of‘attitude’ (P=0.000),‘methods and strategies’(P=0.000),‘vocabulary depth’(P=0.010)between higher-score and lower-score students and there was no statistical significance was in ‘importance of vocabulary’ (P=0.099)between two groups. Conclusions Attitude,methods and strategies as well as vocabulary depth play a central role in vocabulary learning.
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OBJECTIVE@#To assess the effect of celecoxib in combination with adriamycin(ADM) on cell proliferation and apoptosis.@*METHODS@#Cell lines were treated with celecoxib,and cell proliferation was examined by the method of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) at different time. The cellular apoptotic rate was analyzed by flow cytometry. RT-PCR was applied to distinguish the level of caspase-9 mRNA expression. Immunohistochemistry was used to detect the caspase-9 protein expression in Raji cells.@*RESULTS@#Celecoxib inhibited the proliferation and increased the apoptosis of Raji cell lines in a dose-dependent and time-dependent manner within 20-100 μmol/L. Compared with the celecoxib alone, the proliferation of Raji cell lines incubated with celecoxib and adriamycin was decreased. Caspase-9 mRNA and protein expression in Raji cells were significantly enhanced after the treatment of celecoxib (P<0.05).@*CONCLUSION@#Celecoxib can inhibit the proliferation of Raji cells in a dose-dependent and time-dependent manner. Celecoxib may lead to the apoptosis of Raji cells by up-regulating activities of caspase-9. Adriamycin could intensify the effect.
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Humans , Apoptosis , Burkitt Lymphoma , Pathology , Caspase 9 , Genetics , Metabolism , Celecoxib , Cell Line, Tumor , Cell Proliferation , Dose-Response Relationship, Drug , Doxorubicin , Pharmacology , Drug Synergism , Pyrazoles , Pharmacology , RNA, Messenger , Genetics , Metabolism , Sulfonamides , PharmacologyABSTRACT
Objective To investigate the effects of biatrial infusion on pulmonary artery pressure (PAP)after cardiopulmonary bypass (CPB) in patients undergoing mitral valve replacement.Methods Twenty NYHA Ⅱ or Ⅲ patients aged 22-53 yr weighing 34-57 kg undergoing mitral valve replacement complicated by pulmonary hypertension (mean pulmonary artery pressure (MPAP) ＞ 50 mm Hg) were randomly divided into 2 groups ( n = 10 each): infusion via right atrium group (group R) and infusion via both atria group (group B). After induction of anesthesia, a three cavity floating Swan-Ganz catheter was placed via right internal jugular vein to monitor CVP,PAP, pulmonary capillary wedge pressure (PCWP) and CO. The patients received infusion of prostaglandin E1 30-150 ng· kg- 1 · min - 1 and phenylephrine 0.2-0.6 μg· kg- 1 · min- 1 via central veins in group R and infusion of prostaglandin E1 30-150 ng·kg-1 ·min-1 via central veins and phenylephrine 0.2-0.6 μg·kg-1 ·min-1 via left atrium in group B. MAP, HR, MPAP, PCWP, CVP and CO were recorded 5 min before administration (T0), and 5,10, 30 and 60 min after administration (T1-4). Pulmonary vascular resistance index (PVRI), systemic vascular resistance index (SVRI) and CI were also calculated. Results D:\1111111111\MDB\zhmzxzz98201008.mdbCompared with the value at T0, MAP, MPAP, PCWP and PVRI were significantly decreased, while CI was increased at T1-4 in group R, and MAP, CI and SVRI were significantly increased, while HR, MPAP, PCWP, CVP and PVRI decreased at T1-4 in group B ( P ＜ 0.05).MAP, CI and SVRI were significantly higher, while HR, MPAP, PCWP, PVRI and CVP lower in group B than in group R ( P ＜ 0.05). Conclusion Biatrial infusion can effectively reduce PAP and pulmonary vascular resistance after CPB in patients undergoing mitral valve replacement.
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OBJECTIVE@#To determine the effect of arsenic trioxide combined with adriamycin(ADM) on the proliferation and apoptosis of human lymphoma cells.@*METHODS@#Raji cells were divided into an experimental group and a control group, and the experimental group was further divided into 1 micromol/L As(2)O(3) group,2 micromol/L As(2)O(3) group, ADM group,1 micromol/L As(2)O(3) and ADM group,2 micromol/L As(2)O(3) and ADM group. Human lymphoma cells Raji were treated with As(2)O(3) combined with ADM. Wright-Giemsa dying assay was used to observe the apoptosis morphology of lymphoma cells. The proliferation of the cells treated with As(2)O(3) and adriamycin was detected by the method of 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide(MTT). Flow cytometry(FCM) was used to detect the apoptosis rate of lymphoma and the fluorescene density in the lymphocytes. Effect of arsenic trioxide and adriamycin on the mutant p53 expression in Raji cells was detected by semi-quantitive RT-PCR.@*RESULTS@#Evident apoptotic morphological changes of Raji cells were observed 24 hours after treatment with As(2)O(3) or ADM. Compared with As(2)O(3) or ADM alone, As(2)O(3) combined with ADM could increase the inhibition ratio significantly (P0.05).@*CONCLUSION@#As(2)O(3) and ADM alone or combined can inhibit the proliferation, induce cell apoptosis, and downregulate the expression of mutant p53 in vitro. As(2)O(3) combined with ADM has synergistic anti-lymphoma cell effect in vitro. As(2)O(3) has no significant effect on the concentration of ADM on the Raji cells, but can enhance the chemosensitivity of Raji cells, and its mechanism may be that it can downregulate the expression of mutant p53.
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Humans , Antineoplastic Agents , Pharmacology , Apoptosis , Arsenic Trioxide , Arsenicals , Pharmacology , Cell Line, Tumor , Cell Proliferation , Doxorubicin , Pharmacology , Drug Synergism , Lymphoma , Pathology , Oxides , PharmacologyABSTRACT
Sixty barrows (Duroc × Labdrace × Yorkshine) were randomly assigned to two groups by weight of 33 kg,each of which was replicated three times with ten pigs. Half of the pigs were fed with diets containing 10 mg/kg lead and 0.5% particulate montmorillonite,the other half pigs were fed only with diets supplemented 10 mg/kg lead as control groups for 100 days.The results showed that the addition of particulate montmorillonite to the diet significantly decreased lead concentration in tissues such as blood,brain,liver,bone,kidney and hair and enhanced the erythropoiesis as measured by increasing numbers of RBC,hemoglobin and hematocrit values ,and elevated ALA-D activity in liver. The damage of lead to the liver was evident in the increases in hepatic concentration of malondialdehyde (+ 17.08% );decreases in the antioxidant enzymes catalase(-85.73 % ),superoxide dismutase ( - 52.17% ) and glutathione peroxidase ( - 47.56% ). Concomitant use of particulate montmorillonite in the diets completely ameliorated the lead-induced oxidative damage. It indicated that particulate montmorillonite is possessed of the potential therapeutic activity against lead poison.
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Objective To search the surgical methods of esophageal carcinoma complicated with cicatricial pyloric obstruction .Methods 18 cases were treated with resection. Among the resections,16 cases underwent resection of esophageal carcinoma esophago-gastrostomy above aortic arch in chest plus gastro-jejunum anastomosis ;2 cases treatment with resection of esophageal carcinoma plus esophago-gastretomy above aortic arch in chest combined with pyloroplasty.Results Of 18 cases ,cure rate was 100%.No severe complications were occurred in the procedure. Conclusion Surgical operation is safe , applicable and effective in treatment of esophageal carcinoma complicated with cicatricial pyloric obstruction.