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Objective:To evaluate the relationship between postoperative delirium(POD) and preoperative frailty in elderly patients undergoing spinal surgery.Methods:Two hundred and twenty patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ-Ⅳ, undergoing elective posterior lumbar decompression, bone grafting and internal fixation under general anesthesia, were selected. Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale on 1 day before surgery. POD was assessed twice a day within 3 days by Confusion Assessment Method. Patients were divided into POD group and non-POD group according to whether POD occurred within 3 days after surgery. Multivariate logistic regression analysis was used to identify the risk factors for POD in elderly patients undergoing spinal surgery, and the value of preoperative frailty in predicting POD was analyzed using the receiver operating characteristic curve.Results:A total of 190 patients were finally enrolled, among which 55 patients presented with frailty before surgery, and the incidence was 29.0%. Forty-six patients developed POD, and the incidence was 24.2%. Multivariate logistic regression analysis showed that aging ( OR=1.15, 95% confidence interval [ CI] 1.03-1.29, P=0.017), preoperative frailty ( OR=2.35, 95% CI 1.24-4.43, P=0.009), increase in surgical segments ( OR=4.14, 95% CI 1.71-10.05, P=0.002) and increase in postoperative 24-h pain VAS score ( OR=1.38, 95% CI 1.07-1.78, P=0.013) were independent risk factors for POD in elderly patients undergoing spinal surgery. The area under receiver operating characteristic curve of preoperative frailty in predicting POD was 0.702 (95% CI 0.608-0.796, P<0.001). Conclusions:Preoperative frailty is an independent risk factor for POD in elderly patients undergoing spinal surgery. Preoperative frailty can predict the occurrence of POD in elderly patients undergoing spinal surgery to some extent.
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Objective:To evaluate the effect of esketamine on extremity ischemia-reperfusion-induced lung injury in elderly patients undergoing total knee replacement.Methods:Sixty elderly patients of both sexes, aged 65-80 yr, with body mass index <35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective unilateral total knee replacement under neuraxial anesthesia, were divided into 2 groups according to the random number table method: control group (C group) and esketamine group (S group), with 30 cases in each group. Esketamine 0.3 mg/kg was intravenously infused before tourniquet inflation in group S. Immediately after the end of operation, the two groups received adductor block with 0.5% ropivacaine 15 ml under ultrasound guidance. And then patient-controlled intravenous analgesia was performed, patient-controlled intravenous analgesia solution included sufentanil 1.5 μg/kg in 100 ml of normal saline in group C and sufentanil 1.5 μg/kg and esketamine 0.75 mg/kg in 100 ml of normal saline in group S. The background infusion rate was 1.5 ml/h, the patient-controlled analgesia dose was 1.5 ml, and the lockout interval was 15 min in the two groups. When the visual analogue scale score at rest≥ 4 points within 3 days after surgery, ketorolac tromethamine 30 mg was intravenously injected for rescue analgesia. Blood samples from the radial artery were collected for blood gas analysis at 30 min before tourniquet inflation(T 0), 30 min after tourniquet inflation(T 1), and 3 min, 30 min and 24 h (T 4) after tourniquet release (T 2-4), and PaO 2 and PaCO 2 were recorded. The alveola-arterial oxygen partial pressure difference, oxygenation index and respiratory index were calculated. Peripheral venous blood samples were collected at T 0, T 3 and T 4 for determination of serum endothelin-1 and malondialdehyde by enzyme-linked immunosorbent assay. The requirement for rescue analgesia and occurrence of dizziness, hallucinations and pulmonary complications within 3 days after surgery were recorded. Results:Compared with group C, alveola-arterial oxygen partial pressure difference was significantly decreased at T 1-3, respiratory index was decreased, oxygenation index was increased at T 2, 3, and serum endothelin-1 and malondialdehyde concentrations were decreased at T 3, 4, and the rate of postoperative rescue analgesia was decreased in group S( P<0.05). There was no significant difference in the incidence of postoperative dizziness, hallucinations, and pulmonary complications between the two groups ( P>0.05). Conclusions:Esketamine can reduce extremity ischemia-reperfusion-induced lung injury in elderly patients undergoing total knee replacement, and the mechanism may be related to regulating vascular endothelial function and reducing lipid peroxidation.
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Objective:To investigate the efficacy and safety of dienogest (DNG) alone and gonadotropin-releasing hormone agonist (GnRH-a) combined with DNG sequential treatment to adenomyosis.Methods:The clinical data of 110 patients with adenomyosis attending the First Affiliated Hospital of Nanjing Medical University from December 2019 to March 2022 were retrospectively analyzed, including 40 patients treated with DNG (2 mg/day) alone (DNG group) and 70 patients treated with sequential DNG (2 mg/day) after 3-6 injections of GnRH-a (GnRH-a+DNG group). The clinical data before and after treatment were compared between the two groups.Results:(1) The dysmenorrhea visual analogue scale (VAS) scores, cancer antigen 125 (CA 125) and cancer antigen 19-9 (CA 19-9) levels at different time periods after treatment were significantly lower than before treatment in both groups (median before treatment: DNG group 70.0 mm, 68.55 kU/L, 22.45 kU/L respectively, GnRH-a+DNG group 80.0 mm, 151.50 kU/L, 20.44 kU/L respectively; all P<0.001). (2) The hemoglobin (Hb) levels of patients in both groups at different time periods after treatment were significantly higher than those before treatment (median: DNG group 102.00 g/L, GnRH-a+DNG group 94.00 g/L; all P<0.001). (3) Treatment with DNG alone did not have a significant effect on uterine volume in patients of DNG group ( P>0.05), and uterine volume decreased significantly in the 15th-24th months of GnRH-a+DNG group compared with that before treatment (median: 167.76 vs 227.77 cm 3; P<0.05). (4) There were no significant differences in hepatic and renal function and coagulation indexes between the two groups before and after treatment (all P>0.05), and no significant abnormal lesions were observed in breast tissue during the follow-up period. (5) The incidence of amenorrhea of GnRH-a+DNG group was higher than that of DNG group, and the incidences of irregular spotting bleeding and breakthrough hemorrhage were lower than those in DNG group. Conclusions:Whether DNG is used alone or in combination with GnRH-a in sequence, it could significantly relieve dysmenorrhea symptoms, improve the level of Hb, reduce the levels of CA 125 and CA 19-9 in patients with adenomyosis, with no adverse effects on coagulation and hepatic or renal function. GnRH-a sequential DNG therapy is superior to DNG alone in improving uterine bleeding patterns and controlling the growth of uterine volume in patients with adenomyosis.
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Objective:To explore the application effect of CDIO (Conceire, Design, Implement, Operate) teaching mode in the training of PICC nurse trainees.Methods:A total of 80 PICC nurses trained in Xinjiang Uygur Autonomous Region People ′s Hospital from March to August 2021 were divided into the control group (40 patients) and the intervention group (40 patients) according to the baseline comparison principle. The control group participated in the first training using the traditional teaching mode, and the intervention group participated in the second training using the CDIO teaching mode. The scores of core competence and teaching satisfaction of PICC specialist nurses in the two groups were compared at the 8th week after training, and the theoretical and operational scores of the two groups were compared at the 4th and 8th week after training. Results:After training, the scores of professional theoretical knowledge, professional operation skills and related abilities in the core competence of PICC specialist nurses in the intervention group were (27.76 ± 2.07), (40.42 ± 4.12) and (11.42 ± 1.86), respectively. The control group was (22.21 ± 3.71), (34.84 ± 6.86) and (10.15 ± 2.10) points, respectively, and the differences between the two groups were statistically significant ( t=-8.25, -4.42, -2.85, all P<0.01). After 4 and 8 weeks of training, the theoretical scores of the intervention group were (82.00 ± 7.51), (86.25 ± 3.53) points, and the operational scores of PICC laying and maintenance were (93.68 ± 3.25), (91.13 ± 4.75) points, respectively. The control group was (76.48 ± 9.38), (83.28 ± 4.05), (91.48 ± 3.72), (88.58 ± 6.28) points, respectively, and the differences between the two groups were statistically significant ( t values were -3.50 - -2.05, all P<0.05). In the teaching satisfaction of the intervention group, the teaching level, teaching method and teaching effect were 97.5% (39/40), 95.0% (38/40), 100.0% (40/40), while that of control group were 77.5% (31/40), 80.0% (32/40), 85.0% (34/40). There were statistically significant differences between the two groups ( χ2=7.31, 4.11, 4.51, all P<0.05). Conclusions:CDIO teaching mode is superior to traditional teaching mode. It can improve students′ core competence and achievement of theoretical and operational knowledge, and improve teaching satisfaction. It is worth promoting.
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Objective:To assess plasma microfibrillar associated protein 5(MFAP5) level in patients with polycystic ovary syndrome(PCOS), and to explore its relationship with glucose and lipid metabolism as well as sex hormones.Methods:Fifty PCOS patients and 65 healthy female subjects were selected as PCOS group and control group, respectively. Clinical data and plasma MFAP5 levels between the two groups were compared.Results:The plasma MFAP5 level in PCOS group was significantly higher than that in control group( P<0.01), and the plasma MFAP5 level in PCOS overweight subgroup was higher than that in control subgroup( P<0.01). No difference was observed in plasma MFAP5 level between the two non-overweight subgroups( P>0.05). Correlation analysis showed that plasma MFAP5 level was positively correlated with waist circumference, low density lipoprotein-cholesterol, fasting insulin, homoeostasis model assessment of insulin resistance index(HOMA-IR), HbA 1C, testosterone, LH/FSH ratio, and leukocyte( P<0.05 or P<0.01). There was no significant correlation of MFAP5 with body weight, body mass index(BMI), hip circumference, waist hip ratio, high density lipoprotein-cholesterol(HDL-C), triglyceride, total cholesterol, and blood glucose( P>0.05). In PCOS group, plasma MFAP5 level was positively correlated with body weight, BMI, waist circumference, hip circumference, total cholesterol, and leukocyte( P<0.05 or P<0.01). There was no significant correlation of MFAP5 with waist hip ratio, HDL-C, triglyceride, blood glucose, fasting insulin, HOMA-IR, leukocyte, and sex hormones( P>0.05). Multivariate logistic regression analysis showed that MFAP5 was an independent risk factor for PCOS( P<0.05). Conclusion:Plasma MFAP5 level is increased in PCOS patients and is closely related to BMI, waist circumference, hip circumference, and total cholesterol. Plasma MFAP5 is an independent risk factor for PCOS, which may be involved in the pathogenesis of PCOS.
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Objective:To explore the different coagulation state in patients with adenomyosis and its clinical significance.Methods:Clinical data of the patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. (1) Differential coagulation state between 25 healthy women and 25 patients with adenomyosis were compared during menstrual and non-menstrual periods. (2) The coagulation indexes of 145 patients with adenomyosis (observation group 1) and 129 patients with cervical intraepithelial neoplasia grade Ⅲ (control group 1) who underwent hysterectomy in non-menstrual period were compared. (3) The coagulation indexes of 154 patients with adenomyosis (observation group 2) and 147 women without myometrial lesions (control group 2) who underwent endometrial curettage during uterine bleeding period were compared. (4) Correlations of coagulation index with cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9) and uterine volume in patients with adenomyosis were analyzed. Results:(1) The coagulation state of each health women during the menstrual and non-menstrual period showed no significant differences (all P>0.05). For the 25 patients with adenomyosis, fibrinogen [FIB; 2.61 g/L(2.50-3.10 g/L)] and D-dimer [0.60 mg/L (0.40-1.00 mg/L)] in the menstrual period were significantly higher than those in the non-menstrual period [2.25 g/L (1.90-2.70 g/L) and 0.27 mg/L (0.20-0.40 mg/L), respectively; both P<0.01], while thrombin time [TT; 16.70 s (16.10-17.40 s)] in the menstrual period was significantly lower than that in the non-menstrual period [17.95 s (17.20-18.40 s); P<0.01]. (2) In the non-bleeding period, D-dimer [0.26 mg/L (0.20-0.40 mg/L)] and platelet count [257.0×10 9/L (212.0×10 9/L-308.5×10 9/L)] of observation group 1 were significantly higher than those of control group 1 (all P<0.01). Besides, FIB ( r=0.237, P=0.004) and D-dimer ( r=0.373, P<0.001) were positively correlated with CA 125, while prothrombin time (PT; r=-0.208, P=0.012) and internationalized normalized ratio of plasma prothrombin time (PT-INR; r=-0.201, P=0.015) were negatively correlated with CA 19-9. (3) In the bleeding period, PT [10.70 s (10.10-11.20 s)] and PT-INR [0.93 (0.90-1.00)] of observation group 2 were significantly lower than those of control group 2 (all P<0.01), while D-dimer [0.41 mg/L (0.20-0.80 mg/L)] was significantly higher than that in the control group 2 ( P<0.001). Furthermore, FIB ( r=0.252, P=0.038) and D-dimer ( r=0.321, P=0.008) were positively correlated with uterine volume, while activated partial thromboplastin time (APTT; r=-0.190, P=0.018) and TT ( r=-0.304, P=0.012) were negatively correlated with uterine volume. (4) During non-menstrual period and uterine bleeding period, APTT and TT in patients of observation group 1 and 2 combined with anemia were significantly lower than those of non-anemia patients (all P<0.05). Conclusion:Patients with adenomyosis have a tendency to hypercoagulability in both the uterine bleeding and non-bleeding periods, which may be related to enlarged uterine volume, increased serum CA 125 and anemia.
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Objective:To investigate the effects of turning head to the opposite insertion side on catheter heterotopia and degree of comfort among PICC catheter patients.Methods:The inpatients with PICC catheter in Hepatological Surgery of Changzhi People′s Hospital from January 2018 to December 2019 were collected as research object, patients from January to December 2018 was assignment to the control group, patients from January to December 2018 was assignment to the experimental group, with 174 cases in each group. They were catheterized with turning head to the opposite insertion side and turning head to the PICC insertion side, respectively. The incidence of catheter heterotopia, complications as well as degree of comfort during the placement of PICC were compared between the two groups.Results:The successful cases of one-time delivery tube and occurred catheter heterotopia were 97.1% (169/174) and 1.2% (2/174) in the experimental group, the index mentioned above were 91.4% (159/174) and 7.5% (13/174) in the control group, the differences between the two groups were statistically significant ( χ2=5.30, 8.43, both P<0.05). The results from survival curve analysis demonstrated that the occurred of catheter-related venous thrombosis and catheter-related bloodstream infections were significantly lower in the experimental group compared to the control group ( χ2=15.23, 8.76, both P<0.05). The score of comfort during the placement of PICC was (15.00 ± 2.19) in the experimental group, which was significantly lower than (16.86 ± 1.88) points in the control group ( t=8.49, P<0.05). Conclusions:Adopting turning head to the opposite insertion side method can improve the success rate of one-time delivery tube, reduce the incidence of catheter heterotopia and reduce the discomfort of patients during PICC catheterization.
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Objective:To investigate immune effects of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on mouse models of cutaneous squamous cell carcinoma (cSCC) .Methods:Ultraviolet-induced SKH-1 hairless mouse models of cSCC were established, and 40 tumor-bearing mice were randomly and equally divided into several groups: control group receiving no treatment, and 7 treatment groups treated with ALA-PDT for 1, 3, 6, 12 and 24 hours, as well as 3 and 7 days respectively. After treatment, these mice were sacrificed at different time points, and skin tissues measuring 5 mm 3 in size were resected. Immunohistochemical study and flow cytometry were performed to detect local infiltration of immune cells in cSCC tissues at different time points, including neutrophils, macrophages, T cells, B cells, natural killer cells and dendritic cells. Statistical analysis was done by the two-sample t test using SPSS 16.0 software. Results:The number and proportion of local neutrophils and macrophages showed the most significant increase in mouse cSCC tumors 1 hour after ALA-PDT compared with those before treatment (immunohistochemical results [number of cells per 400 × field]: 61.22 ± 6.65 vs. 22.56 ± 4.13, 59.67 ± 4.30 vs. 21.89 ± 3.26, respectively, both P < 0.05; flow cytometry results: 35.64% ± 15.33% vs. 5.46% ± 2.44%, 12.15% ± 4.86% vs. 1.98% ± 1.49%, respectively, both P < 0.05) . Both immunohistochemical study and flow cytometry showed that the expression of T cells, B cells, natural killer cells and dendritic cells significantly increased in cSCC tissues 6 hours after treatment (all P < 0.05) . After reaching the peak, the number and proportion of the above-mentioned cells decreased in cSCC tissues, but were still higher than those before treatment, and the increase continued until the end of this study, that is, day 7 after treatment. Conclusion:ALA-PDT may exert anti-tumor effects by recruiting immune cells, especially neutrophils and macrophages.
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Photodynamic therapy (PDT) is the first-line treatment of some intractable skin diseases, such as actinic keratosis, condyloma acuminatum and moderate to severe acne vulgaris. In clinical practice, radiation parameters and light sources are important for the efficacy of PDT. This review focuses on the selection of radiation parameters and light sources for PDT in terms of the wavelength and type of light sources and dose of radiation, and summarizes research progress in new light sources for PDT.
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Tumor microenvironment is one of the key factors affecting the prognosis of malignant tumors, and tertiary lymphoid structures are a new target for enhancing anti-tumor immunity in the local microenvironment. There are lymphocyte aggregates similar to tertiary lymphoid structures in the skin, suggesting the possibility of their existence in many skin diseases. Previous studies have confirmed the existence of tertiary lymphoid structures in malignant melanoma and their associations with a better prognosis of patients. This review summarizes the progress in skin-associated lymphoid tissues, tertiary lymphoid structures and function in malignant melanoma, and the role of tertiary lymphoid structures in the evaluation of prognosis of patients.
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Objective:To investigate clinical manifestations and dermoscopic characteristics of lichen planus-like keratosis (LPLK) .Methods:Clinical data were collected from 21 patients with LPLK who visited Shanghai Skin Disease Hospital and underwent both dermoscopic and histopathological examinations from January 2017 to September 2019, and clinical and dermoscopic features were retrospectively analyzed.Results:These patients were aged 64.69 ± 13.29 years, and the ratio of males to females was 1∶2. Skin lesions were located on the face of 18 cases and legs of 3 cases, and were red/violaceous in color in 7 cases, reddish-brown in 5, brown/gray in 8, and brown/reddish in 1. There were 3 types of skin lesions, including plaque-like type in 10 cases, flat pigmented patch type in 6, and flat erythema-like type in 5. As dermoscopy showed, 12 cases were non-pigmented LPLK, and 9 were pigmented LPLK. Pigment granules were found in 13 lesions, and there was no significant difference in the prevalence of pigment granules between pigmented and non-pigmented LPLK ( P=0.07) ; pigment granules were often diffusely distributed (9/13) , and the diffuse distribution pattern was common paticularly in pigmented LPLK (8/9) ; locally distributed pigment granules were found in 4 cases of non-pigmented LPLK. Coarse pigment granules were seen in 10 cases (10/13) , including 8 of pigmented LPLK and 2 of non-pigmented LPLK, and the prevalence rate of coarse pigment granules significantly differed between the pigmented LPLK and non-pigmented LPLK groups ( P=0.002) . Moreover, special distribution patterns of pigment granules included the annular granular pattern (8/13) and peppered pattern (7/13) , and no significant difference was observed in the prevalence of the 2 special distribution patterns between the pigmented LPLK and non-pigmented LPLK groups (both P > 0.05) . Scales were seen in 13 cases (13/21) , and vascular structures in 7 (7/21) , and there was no significant difference in the prevalence of the 2 structures between the pigmented and non-pigmented LPLK groups ( P=0.67, 0.16, respectively) . Conclusions:LPLK mostly occurs on the face, and manifests as solitary red, reddish-brown or brownish-gray plaques or patches, whose surfaces may be covered with scales. The characteristic dermoscopic feature of LPLK is the presence of pigment granules, which are coarse, often diffusely distributed, and commonly observed in pigmented LPLK.
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Objective:To evaluate the effect of general anesthesia guided by electroencephalography (EEG) monitoring on postoperative delirium (POD) in elderly patients with non-acute fragile brain function.Methods:Sixty patients of both sexes with non-acute fragile brain function, aged 65-85 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index of 18-30 kg/m 2, undergoing hip replacement, were divided into 2 groups ( n=30 each) by a random number table method: conventional general anesthesia group (group C) and general anesthesia guided by EEG monitoring group (group E). Anesthesia was maintained by intravenous infusion of propofol 50-150 μg·kg -1·min -1 and remifentanil 0.05-0.30 μg·kg -1·min -1 and intermittent intravenous boluses of rocuronium.In group E, the dose of anesthetic was reduced when the EEG burst-suppression ratio≥10% for more than 1 min or anesthesia index (AI) <40.If the situation mentioned above still existed after 1 min, the dose of anesthetic was continued to be reduced or norepinephrine was injected intravenously.In group C, the amount of intraoperative anesthesia was adjusted according to the changes in hemodynamics.Norepinephrine 4-10 μg or dopamine 1 mg was given intravenously in the light of the patients′ heart rates when intraoperative hypotension occurred.At 10 min after anesthesia induction, immediately after skin incision, immediately at the end of surgery and at 1 h after surgery, blood samples were obtained from the artery and jugular venous bulb for blood gas analysis and for calculation of jugular bulb blood oxygen content (CjvO 2), artery-jugular bulb blood oxygen content difference (Ca-jvO 2), cerebral oxygen uptake rate (CERO 2) and jugular-arterial blood lactate concentration difference (Djv-aLac). The emergence time, amounts of intraoperative anesthetics, use of noradrenaline, cumulative time of EEG burst inhibition and duration of AI<40 were recorded.The development of POD was assessed within 5 days after surgery by the confusion assessment method for the intensive care unit and the duration was recorded. Results:Compared with group C, recovery time, cumulative time of EEG burst inhibition and duration of AI<40 were significantly shortened, the intraoperative consumption of propofol and remifentanil was decreased, the requirement for intraoperative noradrenaline was increased, CjvO 2 was increased, Ca-jvO 2 and CERO 2 were decreased immediately at the end of surgery and at 1 h after surgery, the incidence of POD within 5 days after surgery was decreased, and POD duration was shortened in group E ( P<0.05). Conclusion:General anesthesia guided by EEG monitoring can reduce the development of POD in elderly patients with non-acute fragile brain function.
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Objective:To summarize the diagnosis and treatment process of abdominal involvement in 229 children with IgA vasculitis and to provide reference for clinic treatment.Methods:A total of 229 pediatric patients, diagnosed as IgA vasculitis with abdominal involvement admitted to the Department of Pediatric Nephrology of Shengjing Hospital, China Medical University from January 1st 2018 to December 31st 2019, were retrospectively analyzed in the study and were divided into three groups according to Numerical Rating Scale to compare indexes in different degrees of abdominal pain.Results:The duration of hospitalization was related with degree of abdominal pain, as the more severe the abdominal pain was, the longer the hospitalization time was( P<0.001). The incidence of bloody stool were also proportionate to the degree of abdominal pain( P<0.001). With the aggravation of abdominal pain, the proportion of intestinal wall edema increased, as the highest proportion was severe group( P<0.001). The proportion of renal involvement in severe group was significantly higher than that in non-severe group( P<0.001). Twenty cases of intestinal wall edema with decreasing of albumin were treated by intravenous hormone therapy after albumin infusion as the results of no intestinal complications occurred.Compared with the mild and moderate groups, the white blood cells of the severe group were higher( P<0.001)and the albumin was lower( P<0.05). It was no significant difference in hemoglobin, serum amylase and serum lipase among three groups.The mean value of CRP had no difference among three groups and was higher than that of normal.Interleukin(IL)-6 in severe group was higher than that in other two groups( P<0.05), but there was no significant difference in IL-2, IL-4, IL-10, IL-17 and tumor necrosis factor.In terms of treatment, 40 cases were treated with immunoglobulin and four cases with hemoperfusion.The average duration of intravenous glucocorticoid application was related to the degree of abdominal pain among three groups.The longest duration was severe group(16.00±6.91)d and the shortest one was mild group(6.71±3.75)d. Conclusion:Pediatric patients diagnosed as IgA vasculitis with severe abdominal pain whose part of inflammatory indexes increased and albumin decreased obviously should complete imaging examinations to evaluate the extent of intestinal wall edema.If diagnosed as hypoalbuminemia and intestinal wall edema distinctly, hormone therapy should be given after albumin infusion to prevent severe complications such as intestinal perforation.For pediatric patients of IgA vasculitis with severe abdominal symptoms, on the basis of hormone therapy, immunoglobulin and hemoperfusion could be used to quickly remove abnormal immune substances to slow down the disease.
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Objective:To explore the application effect of intelligent network-management system in the management of electronic controlled analgesic pump.Methods:A total of 70 medical staff were selected in Department of Anesthesiology from Peking University People′s Hospital from June to August 2018 and March to June 2019. Self controlled design was adopted. The data of 70 doctors and nurses were collected by comparing the development of electronic controlled analgesia pump before and after the two management modes in analgesia pump management of time-consuming and care satisfaction results.Results:Before the application of intelligent management system in the electronic controlled analgesia pump , the average access time of the analgesia pump was (3.725±0.332) min, and the satisfaction rate was 64.29% (45/70); after the application of the intelligent management system, the average access time of the analgesic pump was (1.901±0.237) min, and the satisfaction rate of the nurses was 97.14% (68/70). The difference before and after the application was statistically significant ( t value was 46.197, χ2 value was 8.425, P<0.05). Conclusions:Application of intelligent management system in the process of electronic controlled analgesia pump can effectively shorten the average access time of the analgesia pump, increase satisfaction rate, improve the work efficiency of clinical medical staff, and realize the network management of anesthesia analgesia pump.
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Objective:To investigate the regulatory effects of endogenous nitric oxide (NO) on the activity of superoxide dismutase-1 (SOD1) and apoptosis of human umbilical vein endothelial cells (HUVECs).Methods:HUVECs were taken as the research object.The endothelial NO synthase (eNOS) short hairpin RNA(shRNA) lentivirus was employed to transfect HUVECs to knock down eNOS.HUVECs were divided in 4 groups: the scramble group, the eNOS shRNA group, the eNOS shRNA + sodium nitroprusside(SNP) group and the eNOS shRNA+ SNP+ tris (2-carboxyethyl) phosphine hydrochloride (TCEP) group.The protein expressions of eNOS and SOD1 dimer/monomer in cells were detected by western blot.The activity of SOD was detected by the enzyme-linked immunosorbent assay.The NO content in cells was detected with NO fluorescence probe.The level of superoxide anion in HUVECs was detected with dihydropyridine (DHE). The terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) assay was adopted to detect the apoptosis of HUVECs in situ.Results:Compared with the scramble group, the endogenous NO content (2.690±0.420 vs.15.029±2.193, P<0.01), eNOS protein expression (1.000±0.778 vs.3.141±0.199, P<0.01), SOD1 dimer/monomer ratio (4.6±1.0 vs.7.6±2.0, P<0.05) and SOD activity [(0.432±0.254) Carmen′s unit/10 4 cell vs.(1.000±0.116) Carmen′s unit/10 4 cell, P<0.01] were significantly decreased, while the level of intracellular superoxide anion (11.180±1.560 vs.6.146±1.007, P<0.01) and HUVECs apoptosis [75.0 (55.0, 100.0)% vs.0 (0, 0)%, P<0.01] were significantly increased in the eNOS shRNA group.Compared with the eNOS shRNA group, the content of endogenous NO (16.705±0.116 vs.2.690±0.420, P<0.01), the ratio of SOD1 dimer/monomer (7.3±2.0 vs.4.6±1.0, P<0.05) and the activity of SOD [(0.737±0.060) Carmen′s unit/10 4 cell vs.(0.432±0.254) Carmen′s unit/10 4 cell, P<0.05] were significantly increased, while the level of superoxide anion (6.897±1.648 vs.11.180±1.560, P<0.01) and the HUVECs apoptosis [0 (0, 0)% vs.75.0 (55.0, 100.0)%, P<0.01] were significantly decreased in the eNOS shRNA+ SNP group.Compared with the eNOS shRNA + SNP group, the ratio of SOD1 dimer/monomer (4.4±0.9 vs.7.3±2.0, P<0.05) and the activity of SOD [(0.214±0.084) Carmen′s unit/10 4 cell vs.(0.737±0.060) Carmen′s unit/10 4 cell, P<0.01] were significantly decreased, while the level of superoxide anion (10.917±1.552 vs.6.897±1.640, P<0.01) and the apoptosis level of HUVECs[63.6 (55.0, 90.0)% vs.0 (0, 0)%, P<0.01] were significantly increased in the eNOS shRNA+ SNP+ TCEP group.However, there was no significant difference in the NO content (16.112±0.926 vs.16.705±0.116, P>0.05). Conclusions:Endogenous NO could effectively antagonize the apoptosis of endothelial cells by increasing the cysteine-dependent SOD1 dimer/monomer ratio, enhancing SOD activity and inhibiting the accumulation of reactive oxygen species.
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Objective To prepare an ultra-porous hydrogel capable of controlled release and investigate the drug loading, releasing, administration route and efficacy with insulin as a model drug. Methods The polymer interpenetrating network method was used to prepare ultra-porous hydrogels (SPH-IPN). Insulin was selected as a model drug to study the drug loading and efficacy. Fourier transform infrared spectroscopy and nuclear magnetic resonance carbon spectroscopy were used to investigate the structure of the gel. The swelling ratio and porosity were measured to evaluate the gel performance. Results The drug loading capacity of insulin ultra-porous hydrogel was 3.19%. The insulin-loaded freeze-dried gel exhibited good hypoglycemic effect on diabetic rats in 1−24 hours from the experimental results on rats with subcutaneous implantation. Conclusion The subcutaneously embedded lyophilized insulin ultra-porous hydrogel provided good controlled release efficacy. It maintained stable blood glucose levels within 24 hours.
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This study attempts to develop a reference substance for the live bacteria count of Streptococcicosis live vaccines in order to evaluate the validity of live bacterial count in inspection and testing. We prepared a batch of live Streptococcus suis reference substance for live bacterial count, tested their physical property, purity, vacuum degree, remaining moisture, and determined their homogeneity, thermal stability and transportation stability. Moreover, we organized collaborative calibration to assign count values to the reference substance and determine the shelf life of the reference substance in 12 months. The results showed that the physical property, the purity, the remaining moisture and the vacuum degree of the reference substance were all in compliance with the requirements of the Chinese Veterinary Pharmacopoeia. The homogeneity test showed that the coefficient of variation of the count of the reference substance was less than 10%, indicating a good homogeneity. Transportation stability test showed that the reference substance remained active after 72 h transportation in summer and winter with the package of styrofoam boxes and ice packs. Thermal stability test showed that the reference substance could be stored for up to 3 months at -20 °C, or up to 21 days at 4 °C. According to the collaborative calibration, the reference vaccine was assigned a count value range of (8.5-12.1)×107 CFU/ampoule. The shelf life test showed that the reference substance was stable for 12 months when stored at -70 °C. The reference substance could provide a reference for the live bacterial count of Streptococcicosis live vaccines. Moreover, it could also be used as a reference to evaluate the quality of corresponding agar media.
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Bacterial Load , Reference Standards , Vaccines, AttenuatedABSTRACT
Photoacoustic imaging is a kind of non-invasive technology without ionizing radiation that can be used to image optical absorbers in tumor tissues according to the principle of "light in and sound out". It has the advantages of high contrast of optical imaging as well as high penetrability of acoustic imaging. However, current researches on photoacoustic imaging are still limited in the laboratory. This technology can be used for detection of cutaneous melanoma in situ and non-melanoma skin cancer, sentinel lymph node imaging, detection and eradication of circulating tumor cells by combining real-time laser ablation technique, and versatile imaging and treatment with the aid of exogenous imaging agents. This review summarizes preclinical experiments about photoacoustic imaging technology in skin tumors, with a view to promoting its clinical application at an early date.
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Objective:To compare the anesthesia methods for patients undergoing orthopaedic surgery between the epidemic period of COVID-19 in 2020 and the same period in 2019.Methods:A retrospective study was conducted of the patients who had undergone orthopedic surgery at The Trauma Emergency Center, The Third Hospital of Hebei Medical University in the epidemic period of COVID-19 from 20 January through 1 March in 2020 and from 4 February through 14 March in 2019 (the same lunar period). Their anesthesia methods were analyzed.The patients in the 2 periods were divided into a group of ≥65 years old and a group of <65 years old.The anesthesia methods and anesthetic operation time were compared between the total cohorts and 2 age groups in the 2 periods.Results:A total of 285 orthopedic operations were completed in the epidemic period in 2020, a decrease by 63.7% than the 784 operations in the same period in 2019; the proportion of elderly fracture patients ≥65 years old in 2020 [29.5%(84/285)] was significantly higher than that [18.1%(142/784)] in 2019. The proportion of non-airway management anesthesia in the epidemic period in 2020 [56.5% (161/285)] was significantly higher than that in the same period in 2019 [38.3%(300/784)]; there was a significant difference in the proportion of non-airway management anesthesia for elderly patients ≥65 years old between the 2 periods [41.6%(59/142) versus 71.4%(60/84)] ( P<0.05). The proportions of intraspinal anesthesia[36.5% (104/285)] and intravenous/+peripheral nerve block anesthesia[4.9%(14/285)] in 2020 were significantly higher than those in 2019 [25.5%(200/784) and 0.3%(2/784)] ( P<0.05); the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [27.7%(79/285)] was significantly lower than that in 2019 [48.9% (383/784)] ( P<0.05). In the group of ≥65 years old, the proportions of intraspinal anesthesia [48.8% (41/84)] and intravenous/+peripheral nerve block anesthesia [10.7%(9/84)]in 2020 were significantly higher than those in 2019 [29.6%(42/142) and 0] ( P<0.05), but the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [21.4% (18/84)] was significantly lower than that in 2019 [47.9%(68/142)] ( P<0.05). Compared with the operation time for intraspinal anesthesia (6.2 min ± 0.4 min) and for intubation/+block anesthesia (7.4 min ± 0.4 min) in 2019, the operation time in 2020 (12.6 min ± 0.4 min and 13.2 min ± 0.3 min, respectively) was significantly increased ( P< 0.05). Conclusions:The anesthesia methods for patients undergoing orthopaedic surgery in the epidemic period in 2020 were featured by non-airway management like peripheral nerve block anesthesia, intraspinal anesthesia, and laryngeal mask/+peripheral nerve block anesthesia because they might have helped to reduce the postoperative complications in respiratory system.The anesthetic operation time in the epidemic period in 2020 was increased than in the same period in 2019.
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Although the epidemic outbreak of Corona Virus Disease 2019(COVID-19) restricted free coming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in particular, sought medical attention. In this special situation, it was crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.