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Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.
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@#In the context of the global pandemic of COVID-19, with the epidemic epicenter located in the Wuhan City, China, patients with severe mental illness have also been deeply affected by the epidemic. In this paper, two patients with schizophrenia who recovered from COVID-19 were reported. Because of the long-term positive results of the SARS-CoV-2 serum antibody IgM test, they had to undergo medical isolation and social restrictions for a long time. After the situation was effectively identified by the medical staff and they were eliminated as a potential virus carrier and released from the medical isolation center. Since psychiatrists often lack systematic knowledge of infectious diseases, the authors hope that this paper can provide a reference to avoid unnecessary wastage of medical resources and prevent placing serious mental burden on such patients in the future.
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Objective To compare the diagnostic value of DWI and ultrasound elastography(UE) in staging hepatic fibrosis in patients with chronic viral hepatitis B(CHB). Methods Fifteen healthy volunteers (control group) and 69 patients with CHB (disease duration more than 1 year) (patient group) were prospectively recruited. All of the subjects underwent DWI and UE experiments twice with the interval of less than 3 days. Liver ADC and shear wave velocity(SWV) values were obtained for subsequent analysis. Sixty?nine patients who had biopsy were grouped according to their pathological grading of fibrosis, from S0 to S4. One?way ANOVA was used to compare the ADC and SWV values between the five different fibrosis groups and control group. Spearman correlation analysis was used to analyze the correlations between the ADC and SWV values and those staging factors. Finally, receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of ADC and SWV values in discriminating different stages of hepatic fibrosis. Results Based on the pathological results, the 69 patients were reclassified to five subgroups with 11, 13, 12, 15 and 18 patients in the S0, S1, S2, S3 and S4 groups respectively. ADC values were(1.39±0.09)×10-3,(1.39±0.08)×10-3,(1.38±0.10)×10-3,(1.20±0.06)×10-3,(1.12±0.07)×10-3 and(1.01±0.07)×10-3mm2/s for the control group and stages S0 to S4 respectively.SWV values were(1.17±0.07),(1.16±0.08),(1.23±0.10),(1.48±0.14),(1.85±0.14)and(1.97±0.12)m/s for stages S0 to S4 and the control group respectively. Statistically significant differences were observed among them (P<0.01). Both ADC (r=-0.894,P<0.01) and SWV (r=0.904,P<0.01) values were highly correlated with the stages of liver fibrosis. The area under ROC(AUC) for predicting fibrosis stages (≥S1, ≥S2, ≥S3 and S4) with ADC values was 0.893, 0.991, 0.966 and 0.952 respectively. Accordingly, the AUC for SWV values were 0.937, 0.993, 0.994 and 0.914. Conclusions The two imaging methods of DWI and UE showed good and similar diagnostic performance in discriminating the different stages of hepatic fibrosis.
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Objective To explore drug abuse prevention measures by surveying the changes before and after methadone maintenance treatment(MMT). Methods The baseline survey data were obtained from patients who participated in the MTT program for the first time at Wuhan First Health Clinic of Mental Health Center Affiliated to Tongji Medical College between March 2006 and December 2013,and the general conditions of these patients were analyzed. Results There were 1 186 drug abusers, with a male and low education(junior high school and below)dominance. After the initiation of the MMT program,the number of addicted people was highest in 2008,and then gradually decreased after 2009.MMT program achieved obvious social benefits.The proportion of injectable drug use alone was decreased and the rates of oral drug use and snorting were increased over time.Fixed salary and temporary salary were obviously increased in drug abusers after 2009. Daily drug cost was decreased over time. The proportion of community/ media propaganda through which people got to know MMT remained low. Conclusion The community support and educational propaganda should be strengthened at the same time when MMT is carried out.
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Objective To evaluate the efficacy of patient-controlled infraclavicular brachial plexus block for analgesia after elbow arthrolysis.Methods Eighty patients with elbow stiffness of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective elbow arthrolysis, were equally and randomly assigned to receive either the infraclavicular (Ⅰ group) or axillary (A group) brachial plexus block.All catheters were placed using ultrasound visualization preoperatively.When patients complained of pain in the recovery room after regaining consciousness, 0.2％ ropivacaine was injected via the catheter, 15 min later patient-controlled infraclavicular brachial plexus block was performed with 0.2％ ropivacaine (400 ml), and an electronic pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml/h.The patients underwent rehabilitation exercise everyday for 3 consecutive days starting from 24 h after operation.The catheter insertion time, successful block, and occurrence of moderate or severe pain (numeric rating scale [NRS] score ＞ 4) and greater inserting resistance (inserting resistance score＞ 1) during insertion, and the occurrence of paresthesia and vascular damage during insertion were recorded.NRS score was recorded at 24, 48 and 72 h after operation during rehabilitation exercise.The elbow articular range of motion was recorded at 72 h after operation, and the improvement in articular range of motion was calculated.The satisfaction with the improvement in articular range of motion (improvement ≥ 80％) and occurrence of complete improvement in articular range of motion (improvement=100％) were recorded.Catheter-related adverse reactions (such as oozing from the insertion site, obstruction, prolapse) and local anesthetics-related adverse reactions (nausea and vomiting, central nervous system toxicity) were recorded.Results The success rate of blockade was 100％ during insertion in both groups.Compared with group A, the catheter insertion time was significantly shortened, the incidence of moderate or severe pain and greater inserting resistance during insertion was decreased, the incidence of paresthesia and vascular damage during insertion was decreased, NRS score at 24 h after operation durig rehabilitation exercise was decreased, the incidence of complete improvement was increased (P＜0.05), and no significant change was found in the improvement in articular range of motion and satisfaction with the improvement in group I (P＞0.05).Conclusion Patient-controlled infraclavicular brachial plexus block can be safely and effectively used for analgesia after elbow arthrolysis, and it provides better efficacy than patient-controlled axillary brachial plexus block.
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<p><b>OBJECTIVE</b>To study the reactive changes of normal nasal mucosa in rabbit under photodynamic therapy (PDT) and to make a preliminary research for the treatment of allergic rhinitis (AR) with PDT.</p><p><b>METHODS</b>Twenty-four New Zealand rabbits were divided into 2 groups, an experimental group and a control group with 12 rabbits in each group. PDT was applied to the experimental group, while the control group was given no treatment. The nasal mucosa was sampled separately from the same position of the rabbits from the 2 groups on 1st, 3rd, 7th, 14th, 21st, 28th day. Histomorphological changes of the sampled nasal mucosa were observed under light microscope and transmission electron microscope (TEM). The damage of three tachykinins: substance P (SP), neurokinin A (NKA) and neurokinin B (NKB) of nerve fibers was observed after immunohistochemical staining.</p><p><b>RESULTS</b>Compared with the control group, the nasal mucosa tissues from the experimental group had serious inflammatory reaction with basal layer damaged on the 1st and 3rd day after PDT application, the epithelial cells of nasal mucosa were arranged in disorder, and part of cilium shortened and became abnormal or even disappeared, each organelles damaged obviously; on the 7th, 14th, 21st day, it could be seen that ciliated cell, columnar cell and goblet cell started regeneration, basal cell and lamina propria glands proliferated, and the glands appeared secretion phenomenon; on the 28th day, ciliated columnar epithelium took back the nasal mucosas with small amount of microvilli, and mucous granules were found in the column cells. Nasal immunohistochemical staining of the experimental group from various stages showed that three kinds of neuropeptides were not expressed.</p><p><b>CONCLUSIONS</b>Normal rabbit nasal mucosas will be temporarily damaged after PDT application, the damaged nasal mucosa begin to recover in one week, and return to normal in about four weeks. Most structure and functions have recovered at the fourth week except some nerve endings.</p>
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Animals , Rabbits , Cilia , Inflammation , Nasal Mucosa , Neuropeptides , Photochemotherapy , Substance PABSTRACT
<p><b>BACKGROUND</b>There are several methods for postoperative analgesia for knee surgery. The commonly utilized method is multimodal analgesia based on continuous femoral nerve block. The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.</p><p><b>METHODS</b>Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group. Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group. Operations were performed under combined spinal and epidural anesthesia. After the operations, 0.2% ropivacaine was given at a speed of 5 ml/h through catheters in all patients. Visual analogue scale (VAS) pain scores at rest and while moving were noted at 4, 24, and 48 hours after the operation, and quadriceps strength was also assessed at these time-points. Secondary parameters such as doses of complementary analgesics and side effects were also recorded.</p><p><b>RESULTS</b>There were no significant differences between the groups in VAS pain scores at rest or while moving, at 4, 24, or 48 hours after the operation (P > 0.05). At these time-points, mean quadriceps strengths in the adductor group were 3.0 (2.75-3.0), 3.0 (3.0-4.0), and 4.0 (3.0-4.0), respectively, all of which were significantly stronger than the corresponding means in the femoral group, which were 2.0 (2.0-3.0), 2.0 (2.0-3.0), and 3.0 (2.0-4.0), respectively (P < 0.05). There were no significant differences between the groups in doses of complementary analgesics or side effects (P > 0.05). X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.</p><p><b>CONCLUSIONS</b>Continuous adductor canal block with 0.2% ropivacaine could be used effectively for analgesia after total knee replacement. Compared with continuous femoral nerve block, this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.</p>
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Aged , Female , Humans , Male , Middle Aged , Amides , Therapeutic Uses , Analgesia , Methods , Arthroplasty, Replacement, Knee , Methods , Femoral Nerve , Nerve Block , Methods , Ultrasonography , MethodsABSTRACT
Objective To investigate the effects of femoral nerve block combined with celecoxib on postoperative analgesia in elderly patients with hip fracture. Methods Two hundreds ASA -Ⅲ patients aged 65-89 yrweighing 35-90 kg undergoing hip fracture surgery were randomly divided into 4 groups ( n = 50 each):control group (group Ⅰ ), femoral nerve block group ( group Ⅱ ), celecoxib group (group Ⅲ ) and femoral nerve block +celecoxib group (group Ⅳ ). Operations were performed under combined spinal-epidural anesthesia. Groups Ⅲand Ⅳ were given oral celecoxib 400 mg at 1 h before operation, and 200 mg at 1 and 2 days after operation twice a day. Groups Ⅰ and Ⅲ received iv injection of sufentanil 0.06 μg/kg before the patients were placed in the position, while in groups Ⅱ and Ⅳ femoral nerve block was performed using a nerve stimulation with 20 ml of 0.5%ropivacaine and 10 min later the patients were placed in the position. All the patients received postoperative patient-controlled intravenous analgesia with sufentanil to maintain visual analogue scale score ≤ 3. The condition of satisfactory analgesia and sufentanil consumption within 24, 48 and 72 h were recorded. The coagulation function was measured on the day of admission to the hospital, at 1 day before operation and at 4 days after operation. Cardiac troponin Ⅰ (cTnI) concentrations were measured before operation, at the end of operation and at 1 day after operation. Postoperative complications was observed and recorded. Results Compared with group Ⅰ , the consumption of sufentanil was significantly reduced during each period in group Ⅳ ( P ＜ 0.01 ). Compared with group Ⅱ , the consumption of sufentanil was significantly reduced within 48 and 72 h after operation (P ＜ 0.05), while no significant change was found within 24 h after operation in group Ⅳ ( P ＞ 0.05). Compared with group Ⅲ , the consumption of sufentanil was significantly reduced within 24 h after operation ( P ＜ 0.05 ), while no significant change was found within 48 and 72 h in group Ⅳ ( P ＞ 0.05). The level of satisfactory analgesia was significantly higher in group Ⅳ than in the other three groups, and in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜ 0.05). The 4 groups were comparable with respect to the increased rate of cTnI concentrations at the end of operation and after operation, and perioperative blood coagulation. No postoperative complications were found in the 4 groups. Conclusion Femoral nerve block combined with celecoxib can reduce postoperative opioid consumption and enhance postoperative analgesia in elderly patients with hip fracture.
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Objective To study the effects of enriched environment on the capacity of learning and memory and expression of brain derived neurotrophie factor(BDNF) expression of CA1 hippocampus in Wistar rats. Methods 20 male Wistar rats were raised from weaning(21 days old) to young adulthoed(50 -60 days old) in either an enriched or normal environment. The ability of learning and memory was measured with the Morris water maze test,and the expression of BDNF of CA1 hippocampus neuron was detected by immunohistochemistry. Results During Morris water maze test, the mean latency in enriched environment group was significantly shorter than that in the normal control group(24.37±5.45)s Vs (31.28±5.39)s;the time taken to cross the target in enriched environment group was significantly more than that in the normal control group(3.38±0.79)Vs (2.21± 0.49);the swimming distance of platform quadrant increased in the enriched environment group, and the decreased gray intensity of BDNF expression in CA1 hippoeampus was found in the enriched environment group. Conclusions Enriched environment can improve the capacity of learning and memory of the rats, which were realized may be through BDNF pathway.