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Objective:To evaluate the effect of gender factor on efficacy of remimazolam combined with alfentanil in the patients undergoing gastrointestinal endoscopy.Methods:Two hundred patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ, scheduled for elective gastrointestinal endoscopy, were divided into 2 groups ( n=100 each) according to gender: male group (group M) and female group (group F). Remimazolam 0.2-0.3 mg/kg and alfentanil 5-7 μg/kg were intravenously injected, remimazolam 0.5-0.7 mg·kg -1·h -1 was continuously infused during operation to maintain the modified observer′s assessment of alert/sedation score<3 points, and alfentanil 2 μg/kg was administered when necessary. The consumption of remimazolam and alfentanil, examination time, recovery time and time of post-anesthesia care unit stay were recorded. The satisfaction scores of examination physicians and patients were recorded. The occurrence of adverse reactions such as injection pain, intraoperative body movement, respiratory depression, hypotension, bradycardia and hiccups and postoperative dizziness, nausea, vomiting, fatigue, abdominal pain and abdominal distension were recorded. Results:There was no significant difference in the consumption of remimazolam and alfentanil, examination time, recovery time, satisfaction scores of examination physicians and patients between the two groups ( P>0.05). There was no significant difference in the incidence of respiratory depression, hypotension, bradycardia, injection pain, body movement, hiccups, abdominal pain, abdominal distension, and fatigue between the two groups ( P>0.05). Compared with group M, the time of post-anesthesia care unit stay was significantly prolonged, and the incidence of postoperative dizziness, nausea and vomiting was increased in group F ( P<0.05). Conclusions:Remimazolam combined with alfentanil provides better efficacy in male patients than in female patients undergoing gastrointestinal endoscopy.
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Objective:To investigate the clinical characteristics and pregnancy outcomes in pregnant women with left ventricular non-compaction (LVNC).Methods:The clinical data of seven pregnant women with LVNC from January 2011 to December 2021 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed, including age, gestational age of symptom first occured, LVNC history, clinical symptoms, New York Heart Association (NYHA) cardiac function class, echocardiography, blood brain natriuretic peptide (BNP), treatment and the maternal and fetal outcomes.Results:Five cases were diagnosed before pregnancy, of which there were three women with medication; one case diagnosed in the month of pregnancy; one case diagnosed at 36 weeks of gestation. NYHA cardiac function was grade Ⅰ in four cases and grade Ⅱ in three cases before or during the first trimester of pregnancy. Of the five pregnant women who underwent echocardiography, there were one case of left ventricular insufficiency, three cases of mild left ventricular dysfunction and one case of normal left ventricular function before or during the first trimester of pregnancy. Of the five pregnant women to the second and third trimester of pregnancy, there were one case of grade Ⅳ, one case of grade Ⅲ, two cases of grade Ⅱ-Ⅲ and one case of grade Ⅱ in NYHA class ; three cases of left ventricular insufficiency, two cases of normal left ventricular function by echocardiography four cases had cardiac symptoms at 15-24 weeks of gestation and were treated with medication. In four cases, blood BNP increased to 214-1 197 ng/L during pregnancy, and were 89-106 ng/L after termination of pregnancy. There were 4 cases with arrhythmia. Indications for termination of pregnancy: LVNC complicated with heart failure in two cases, LVNC complicated with decreased cardiac function and threatened preterm birth in one case, complicated with pregnancy at full term in two cases, LVNC complicated with severe pulmonary hypertension in one case, and left ventricular dysfunction in one case. Cesarean section in four cases in the third-trimester, in one case in the second-trimester, and forceps curettage in two cases were taken. Two full-term infants,two preterm infants were born without LVNC.Conclusions:Women diagnosed with LVNC and low left ventricular ejection fraction before pregnancy are more prone to decreased cardiac function during pregnancy. Carrying out pregnancy risk assessment and strengthening the multi-disciplinary team management of high risk factors in pregnancy are conducive to achieve good pregnancy outcomes.
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Objective:To describe the characteristics and management of right-sided infective endocarditis (RSIE) during pregnancy.Methods:The clinical manifestation, blood culture, echocardiography, diagnosis, treatment, and maternal and infant outcomes of seven patients with RSIE during pregnancy from Capital Medical University Affiliated Beijing Anzhen Hospital from January 2009 to March 2020 were retrospectively collected and described.Results:The incidence of RSIE during pregnancy was 0.27‰ (7/25 832). All patients had a history of congenital heart disease, with a mean age of (26.0±2.7) years and a mean gestational age at onset of (28.7±6.6) weeks. Cardiac murmur, fever, dyspnea, cough, expectoration, and pulmonary rales were the common symptoms. Seven cases were complicated by anemia, seven with hypoproteinemia, six with hypoxemia, five with pulmonary hypertension, and five with positive blood culture. Echocardiography indicated that vegetations were mainly attached to the pulmonary valves (four cases), followed by the tricuspid valves (three cases) and the right ventricular outflow tract (three cases). Four patients were diagnosed with septic pulmonary embolism by chest X-ray. All patients were treated with intravenous antibiotics. Cesarean section was performed on five cases in the third trimester and one in the second trimester due to intrauterine death. The other case underwent vaginal delivery in the third trimester. Cardiac surgery was conducted during the hospitalization in four cases and not in the other three. The mean length of stay was 26 days (12-76 days). Six cases were cured, and one died after discharge. Among the six neonates, one had asphyxia and was died after withdrawal of treatment. The remaining five infants survived and developed well during the follow-up of 5 years (3-10 years).Conclusions:Pregnancy complicated by RSIE is a rare and critical condition, requiring early diagnosis to make optimal treatment strategies, reducing maternal and infant fatality.
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Objective:To investigate the clinical phenotype of a child with Jansen-de Vries syndrome, to clarify its genetic diagnosis and genetic characteristics, and to improve the understanding of this disease.Methods:Clinical data from a child with Jansen-de Vries syndrome diagnosed in the Children′s Affiliated Hospital of Zhengzhou University in October 2019 were collected, using core family-complete exon genomics detection (Trio-WES) and chromosome copy number variation (CNV) analysis techniques for genetic testing for the child and her parents, generation Sanger sequencing for family member verification for possible pathogenic mutations, and clinical and molecular genetic analysis. The relevant reports of PPM1D gene mutation in patients with mental retardation were reviewed.Results:The proband was a 11-month-old girl, presenting with mental retardation, lagging speech and motor development, autistic behavior, gastrointestinal dysfunction, and short stature, low flat nose bridge, low ear, short finger syndrome.Trio-WES results of the core family of the child suggested that PPM1D was a new transcoding heterozygous mutation, PPM1D (NM-003620): c.1216delA (p.Thr406Profs *3), and the karyotype and CNV analysis of the chromosome were normal. Literature retrieval showed currently a total of 18 cases were reported PPM1D gene mutation of mental disorders, described in the online human Mendel database for developmental disorder associated with gastrointestinal dysfunction and pain threshold increases, the age distribution in the seven months to 21 years of age, clinical manifestation of mental retardation, increased pain threshold, abnormal behavior, feeding difficulties, visual impairment, short finger syndrome, a group of syndromes associated with short stature, fever or vomiting, and congenital deformities. Conclusions:Jansen-de Vries syndrome clinically presents mainly with overall retardation (mental retardation/backward delayed motor development, language development, low muscle tone), abnormal behavior (lonely sample behavior, autism), craniofacial malformations (broad forehead, low ear nose bridge, thin upper lip), short finger syndrome (short feet, pinky stubby), gastrointestinal dysfunction (milk overflow, feeding difficulties, constipation). The child was diagnosed as a newly transcoding heterozygous mutation of the PPM1D gene. The current treatment is mainly rehabilitation training, and growth hormone replacement therapy can be given to part of the short height disease. The PPM1D gene [PPM1D(NM-003620): c.1216delA(p.Thr406Profs *3)] is the genetic cause of the child.
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Objective:To compare the efficacy of mivacurium versus cisatracurium in patients undergoing painless fiberoptic bronchoscopy.Methods:A total of 100 patients of both sexes, aged 18-64 yr, of American Society of Anesthesiology physical status I or Ⅱ, scheduled for elective fiberoptic bronchoscopy were divided into 2 groups ( n=50 each) using a random number table method: mivacurium group (M group) and cisatracurium group (C group). Mivacurium 0.15 mg/kg was injected intravenously in group M, and cisatracurium 0.1 mg/kg was injected intravenously in group C. The onset time of neuromuscular block (ThD95), the duration of neuromuscular block (TOFR25), recovery index (RI), recovery time of autonomous respiration, extubation time and time of discharge from postanesthesia care unit (PACU) were recorded.The occurrence of intraoperative and postoperative adverse reactions and complications were recorded.The mean arterial pressure (MAP), heart rate (HR) and SpO 2 at restlessness at 10 min after entering the operating room (T 1), at loss of consciousness (T 2), when laryngeal mask airway was inserted (T 3), at the end of surgery (T 4), when laryngel mask airway was removed (T 5), and when the patients left the operating room (T 6). Results:Compared with group C, TOFR25, RI, recovery time of autonomous respiration, extubation time and time of discharge from PACU were significantly shortened, the total incidence of adverse reactions was decreased ( P<0.05), and no significant change was found in ThD95 in group M ( P>0.05). There was no significant difference in MAP, HR and SpO 2 at each time point between the 2 groups ( P>0.05). Conclusion:Mivacurium provides better efficacy than cisatracurium when used for painless fiberoptic bronchoscopy.
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Objective:To evaluate the efficacy of remimazolam-alfentanil-mivacurium for fiberoptic bronchoscopy.Methods:A total of 100 patients of both sexes, aged 18-64 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective fiberoptic bronchoscopy, were divided into 2 groups ( n=50 each) using a random number table method: remimazolam-alfentanil-mivacurium group (group R) and propofol-alfentanil-mivacurium group (group P). Oxygen was inhaled by mask, and alfentanil 10 μg/kg was slowly injected intravenously in advance.One minute later, remimazolam 0.2 mg/kg was injected intravenously in group R, propofol 1.5-2.0 mg/kg was injected in group P until loss of consciousness, and mivacurium 0.14 mg/kg was then injected intravenously in 2 groups.When the bispectral index value was 40-60, mechanical ventilation was performed after laryngeal mask was placed by the same anesthesiologist.During the maintenance of anesthesia, remimazolam 1 mg·kg -1·h -1 was infused intravenously in group R, propofol 4-6 mg ·kg -1·h -1 was infused intravenously in group P, and mivacurium was intermittently injected in both groups to maintain muscle relaxation.Before induction (T 0), when the laryngeal mask was placed (T 1), immediately when fiber bronchoscope reached juga (T 2), at 10 min after the surgery (T 3), at the end of the surgery (T 4) and when patients regained consciousness (T 5), blood pressure (BP), (HR), pulse oxygen saturation (SpO 2), breathing at the end of the CO 2 partial pressure (P ETCO 2), BIS values and Modified Observer's Assessment/Alertness and Sedation (MOAA/S) score were recorded.The time from beginning of anesthesia to beginning of examination, total examination time, the time from the end of administration to laryngal mask airway removal, the time to recovery of spontaneous breathing and the time from emergence to discharge from postanesthesia care unit (PACU) were recorded.The occurrence of intraoperative and postoperative adverse reactions was recorded. Results:There was no significant difference in SpO 2, P ETCO 2, BIS values and MOAA/S score at each time pint and the time from beginning of anesthesia to beginning of examination, the time to recovery of spontaneous breathing and the time from emergence time to discharge from PACU between the 2 groups ( P>0.05). Compared with group P, systolic blood pressure and diastolic blood pressure were significantly increased at T 1, T 3 and T 4, the time from the end of administration to laryngal mask airway removal was prolonged, the incidence of intraoperative hypotension, postoperative cough and total adverse reactions were decreased in group R ( P<0.05). Conclusion:Remimazolam-alfentanil-mivacurium produces better efficacy than propofol-alfentanil-mivacurium for fiberoptic bronchoscopy.
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Objective:To analyze the clinical data of pregnant women complicated with cardiovascular disease in our center in the past 10 years, and to explore the trend of incidence, clinical diagnosis, and treatment of the disease.Methods:Clinical data of pregnant women with cardiovascular disease who delivered in Beijing Anzhen Hospital, Capital Medical University from 2010 to 2019 were collected and analyzed retrospectively. According to the time of the establishment of multidisciplinary team (MDT) in the center, the pregnant women were divided into the first 5-year group (2010-2014) and the second 5-year group (2015-2019). The general data, the composition of pregnancy complicated with cardiovascular disease and the changes of maternal and infant outcomes of the two groups were analyzed.Results:(1) During 2010-2019, there were 2 267 cases of pregnancy complicated with cardiovascular disease (836 cases in the first 5-year group and 1 431 cases in the second 5-year group), with a total incidence of 10.2% (2 267/22 334). Among all kinds of cardiovascular diseases, arrhythmia (41.0%, 930/2 267) and congenital heart disease (38.2%, 865/2 267) were more common. (2) There were 212 cases (25.4%, 212/836) and 426 cases (29.8%, 426/1 431) classified as Ⅲ or Ⅳ by modified WHO cardiovascular risk classification in the first 5-year group and the second 5-year group, respectively, and the difference was statistically significant ( χ2 =5.076, P=0.024). Among all kinds of cardiovascular diseases, there were 111 cases (13.3%, 111/836) and 159 cases (11.1%, 159/1 431) with valvular disease in the first 5-year group and the second 5-year group, respectively. The change of the component ratio was -16.5% (the difference was significant when the absolute value of change>10%), showing a significant decreasing trend. Aortic disease was found in 16 cases (1.9%, 16/836) and 56 cases (3.9%, 56/1 431), respectively, with a significant upward trend of 105.3%. (3) The mortality rate of pregnant women with cardiovascular disease was 1.0% (22/2 267), and 1.2% (10/836) and 0.8% (12/1 431) in the first 5-year grouop and the second 5-year group, respectively. There was no significant difference between the two groups ( χ2=0.702, P=0.402). ICU occupancy rates in the first 5-year group and the second 5-year group were 25.6% (214/836) and 20.7% (296/1 431), respectively, and the difference between the two groups was statistically significant ( χ2=7.306, P=0.007). There were no significant differences in cesarean section rate, mortality rate and incidence of adverse events between the two groups of pregnant women, and there were no significant differences in birth weight, preterm birth rate, mortality rate and asphyxia rate between the two groups of newborns (all P>0.05). Conclusions:Pregnancy complicated with cardiovascular disease is a common cause of adverse obstetric outcomes. There are various types of specific cardiovascular diseases, and the prognosis varies greatly. In recent years, the disease composition ratio has changed, and the severity and complexity of diseases have increased. Hierarchical management, MDT and individual management could improve the treatment level and reduce adverse outcomes.
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OBJECTIVE@#To explore the characteristics of mutations of four common pathogenic genes (GJB2, SLC26A4, GJB3 and 12S rRNA) among patients with nonsyndromic hearing loss (NSHL) from eastern Shandong.@*METHODS@#Peripheral blood samples of 420 NSHL patients were collected, and a hereditary-deafness-gene microarray was used to detect GJB2 c.235delC, c.299-300delAT, c.35delG and c.176del16 mutations, GJB3 c.538C>T mutation, SLC26A4 c.2168A>G and c.IVS7-2A>G mutations, and 12S rRNA c.1555A>C and c.1494C>T mutations. For patients carrying single heterozygous mutations, the coding regions of the above genes were analyzed with Sanger sequencing.@*RESULTS@#The results of the microarray assay and Sanger sequencing showed that 84 patients (20.00%) carried GJB2 mutations, with c.235delC (16.43%) and c.299-300delAT (7.86%) being most common. Seventy-five patients (17.86%) carried SLC26A4 mutations, for which c.IVS7-2A>G accounted for 15.71%. In addition, 5.95% of patients carried 12S rRNA mutations. Only one patient was found to carried GJB3 mutation (c.538C>T).@*CONCLUSION@#Common pathogenic mutations for NSHL in eastern Shandong included GJB2 c.235delC and SLC26A4 c.IVS7-2A>G. Of note, 5.95% of patients were due to 12S rRNA m.1555A>G mutation, which gave a frequency greater than other regions of China.
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Humans , China , Connexin 26 , Connexins , DNA Mutational Analysis , DNA, Mitochondrial , Deafness , Genes, rRNA , Hearing Loss , Mutation , RNA, Ribosomal , Sulfate TransportersABSTRACT
Objective To evaluate the role of poly( ADP-ribose) polymerase-1 ( PARP-1) in lung ischemia-reperfusion ( I/R ) injury in rats and the relationship with autophagy. Methods Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-240 g, were divided into 3 groups (n=8 each) using a random number table method: sham operation group (S group), lung I/R group ( I/R group) and lung I/R plus PARP-1 inhibitor PJ34 group ( I/R+PJ34 group) . The chest was only opened without clamping the left hilum of lung in group S. Lung I/R injury model was established by clam-ping the left hilum of lung for 45 min followed by 120 min reperfusion in I/R and I/R+PJ34 groups. PJ3410 mg/kg was intraperitoneally injected at 30 min before ischemia in group I/R+PJ34, while the equal volume of normal saline was injected in S and I/R groups. The rats were sacrificed at the end of reperfusion, and lungs were removed for microscopic examination of the pathological changes ( with a light microscope) which were scored and for determination of wet to dry weight ratio ( W/D ratio) , cell apoptosis ( by TUNEL) , ex-pression of PARP-1 activity markers ( PAR) , Bcl-2, Bax, microtubule-associated protein 1 light chain 3Ⅰ ( LC3-Ⅰ) , LC3-Ⅱ and Beclin-1 ( using Western blot ) . The apoptosis index, Bcl-2/Bax ratio and LC3-Ⅱ/LC3-Ⅰ ratio were calculated. Results Compared with S group, the W/D ratio, pathological scores, apoptosis index and LC3-Ⅱ/LC3-Ⅰ ratio were significantly increased, the expression of PAR and Beclin-1 was up-regulated, and Bcl-2/Bax ratio was decreased in I/R and I/R+PJ34 groups (P＜0. 05). Compared with I/R group, the W/D ratio, pathological scores, apoptosis index, and LC3-Ⅱ/LC3-Ⅰratio were significantly decreased, the expression of PAR and Beclin-1 was down-regulated, and Bcl-2/Bax ratio was increased in I/R+PJ34 group ( P＜0. 05) . Conclusion PARP-1 activation is involved in lung I/R inju-ry in rats, and the mechanism may be related to increasing autophagy and inducing cell apoptosis.
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Objective To investigate the effects of sand therapy temperature on bone reconstruction and numerical study on the heat transfer.Methods CT scan imaging was performed respectively for four times(before and after OA model was set up,and after the first and second weeks during the sand therapy).Import the scan data to MIMICS software,and the changes of femoral bone mass layer were analyzed.After combining the muscle,femur,bone marrow and meshing,the established three-dimensional model of the STL format was introduced into the COMSOL software for heat transfer simulation and effect of stress on bone remodeling induced by temperature field.Results Changes of four CT scan data were analyzed.The soft bone volume was reduced,while the dense and hard bone volume were increased.Numerical simulation on the heat transfer showed the temperature distribution of the thigh and the femur.Conclusions The thermal stress produced by sand therapy temperature exert promoting effect on the femur bone remodeling.
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plus stented elephant trunk implantation (Bentall+Sun′s surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ②5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery;2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26 ± 10) weeks. (3)Maternal and fetal outcomes:20 patients survived after treatment (83%,20/24) and 4 patients died (17%,4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant;3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4 ± 1.7) years. So far the infants′ development was good.Conclusions Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.
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Objective To investigate the clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of the gestation. Methods Nine cases of pregnant women diagnosed as infective endocarditis with vegetations in Beijing Anzhen Hospital, Capital Medical University from January 2001 to October 2015 were enrolled in retrospective analysis. Consultations were held by doctors from department of obstetrics, anesthesiology, cardiology, cardial surgery and extracorporeal circulation to decide the individualized treatment plan for the 9 cases of pregnant women after admissions. Clinical treatments including general treatment, anti-infection treatment, cardiac surgery, and termination of pregnancy surgery were completed through collaboration among related departments. The clinical characters, therapeutic regimens, maternal and neonatal outcomes of the 9 cases were analyzed. Results (1)Clinical characters: the ages of the 9 cases of pregnant women were from 25 to 36 years old. The onset gestational ages were from 19 to 36 weeks. Clinical symptoms: fever, cough, sputum and progressive anemia were the main symptoms. Patients had cyanosis of lips, could not lie on the back or even be orthopnea, when heart failure happened. Heart murmur was audible and splenomegaly was touched in physical examination. Blood cultures were positive. Basic heart disease types: 7 cases of congenital heart diseases included 2 cases of aortic insufficiency, 1 case of mitral insufficiency, 1 case of patent ductus arteriosus, 1 case of right ventricular outflow tract stenosis and 2 cases of ventricular septal defect.Two cases of rheumatic heart diseases included 1 case of mitral stenosis, 1 case of mitral stenosis after artificial disc changed and jammed. According to endocardial vegetations attached position there were 3 cases of mitral valve vegetations, 2 cases of pulmonary valve vegetations, 3 cases of aortic vegetations and 1 case of right ventricular outflow tract neoplasm. Preoperative heart function classification:1 case of levelⅡ, 3 cases of levelⅢ, 5 cases of levelⅣ.(2)Treatments:general treatment included oxygen uptake, rest in bed, cardiac strengthen and diuretic therapy, etc. Combined and adequate antibiotics were applied in anti-infection treatment according to drug sensitive test. Nine cases of pregnant women were all performed surgical treatment of heart diseases and removal of the endocardial vegetations. Caesarean sections were performed for 2 cases in second trimester and for 7 cases in last trimester. Cardiac surgery and caesarean section were operated in 6 cases at the same time among 22-34 weeks of pregnancy. Cardiac surgery were respectively operated in 2 cases 11 days and 32 days after the caesarean section at 33, 37 weeks of pregnancy. While Cardiac surgery was operated (at 26 weeks of pregnancy) before the caesarean section (at 37 weeks of pregnancy) in another 1 case. (3) Maternal and neonatal outcomes:7 cases of pregnant women were rescued successfully, while 2 cases of pregnant women were death. Postoperative heart function classification: 1 case of level Ⅰ, 2 cases of levelⅡ, 4 cases of levelⅢand 2 cases of levelⅥ. Neonatal survivals were 6 cases including 2case of full-term infants, 4 cases of preterm infants. Stillbirth or neonatal death were 3 cases, which included 2 cases performed caesarean section in second trimester and 1 case of very low weight infant who was given up treatment by family because of severe asphyxia. Followed up periods were from 1 to 7 years with an average time of (2.0 ± 1.6) years. Infants and young children grew and developed well during the period of follow up. Conclusions The risk is extremely high of pregnancy with infective endocarditis with vegetations. But there is still a way to save the maternal and neonatal life by using a multidisciplinary collaboration formulation and implementation of individualized treatment plan and selecting the appropriate time for heart surgery and the termination of pregnancy.
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BACKGROUND:On the basis of modern design method and numerical simulation, studies can explore the action mechanisms of sand therapy in Uyghur medicine. OBJECTIVE:To explore a kind of non-homogeneous and isotropic biological bone finite element modeling method based on CT value, and to study the influence of sand therapy in Uyghur medicine on the mechanical properties of rabbits’ femur. METHODS:Eight adult New Zealand white rabbits were used to establish osteoarthritis models of right posterior femur with papain. These rabbits were divided into sand therapy group and control group. In the sand therapy group, after treatment with sand therapy in Uyghur medicine, rabbit femoral models were scanned with CT. The fault image data were imported into MIMICS software. 3D model of femur was generated. The meshing was done. The material properties were given. Three-point bending in the Ansys was simulated and solved.Simultaneously, the isolated three point bending tests were performed in al rabbit models. The corresponding deflection and the maximum stress values were obtained. Finaly, the results obtained from the three-dimensional finite element modeling method were compared with the results obtained from the experiments. RESULTS AND CONCLUSION:(1) The deflection and the maximum stress obtained by the three-point bending simulation analysis with the three-dimensional finite element model of the rabbits’ femur were wel correlated with the data obtained from the experiments. (2) These results indicate that the finite element modeling method is consistent with the structural and material properties of bone, which can be used to analyze the stress and deformation ofbones.
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Objective To evaluate the clinical characteristics of aortic dissection in pregnant patients with Marfan syndrome and the maternal and fetal outcomes in cardiovascular surgery. Methods Seven pregnant women with Marfan syndrome with aortic dissection were identified, who were treated in Beijing Anzhen Hospital Affiliated to Capital Medical University between January 2012 and September 2014. Patient charts were reviewed for cardiovascular surgery, occurrence of complications, clinical features and the maternal and fetal outcomes. Results (1)Among 7 patients, 4 cases were diagnosed as type A aortic dissection and 3 were cases diagnosed as type B aortic dissection. The diagnosis mainly depends on CT angiography. New York Heart Association(NYHA)classify into 5 of levelⅡ, 1 of levelⅢ, 1 of leveIⅣ. Except for 1 patient with cardiac tamponade lead to heart failure, the remaining 6 cases had no complications.(2)Three patients underwent heart surgery with cardiopulmonary bypass in second trimester and two patients underwent heart surgery in third trimester. Two patients terminated pregnancy before heart surgery(one of whom underwent artificial abortion,one of whom underwent cesarean section in second trimester).(3)The methods of cardiovascular surgeries were as follow:3 of Bentall+Sun′, 1 of Bentall+Sun′+right coronary artery bypass grafting, 1 of Bentall, 1 of the whole chest aorta replacement surgery, and 1 of femoral artery catheter chest aorta with membrane mesh stent implantation. The diameter of aortic roots measured during operation were 5 cm in 2 cases, 7 cm in 2 cases and 10 cm in 2 cases respectively. Among the 7 cases, 3 were conducted cesarean sections during cardiovascular surgery,1 was terminated pregnancy due to intrauterine fetal death after cardiovascular surgery, and 1 was conducted cesarean section due to severe early-onset preeclampsia at 30 weeks of pregnancy after cardiovascular surgery. (4)Among the 7 cases, 3 were conducted cesarean sections during cardiovascular surgery, the order of which was implemented cesarean section under general anesthesia firstly and then operated cardiovascular surgery with cardiopulmonary bypass and heparinization. Two were conducted cardiovascular surgery after termination of pregnancy by early artificial abortion operation or hysterotomy. 1 was conducted Bentall surgery at 18 weeks of pregnancy, after that the patient was receiving warfarin until the fetal brain hemorrhage was examined by ultrasound at 31 weeks of pregnancy;the patient was conducted cesarean section due to intrauterine fetal death. 1 was conducted heart surgery at 24 weeks of pregnancy and continue the pregnancy to 30 weeks, was conducted cesarean section due to severe early-onset preeclampsia at 30 weeks of pregnancy.(5)Among 7 patients, three patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. Two patients terminated pregnancy after heart surgery. Two patients terminated pregnancy before heart surgery. Six patients were alive and one patient died of multiple organ failure.(6)3 cases of newborn with birth body mass between 1 080 to 1 490 g.1 case of birth died after 14 d. 2 cases for newborns were alive without exception. Conclusion Aortic dissection poses serious risk for pregnant women with Marfan syndrome and the fetus, and the mortality rates for both the mother and the fetus are high. Early diagnosis and appropriate treatment should be based on maternal and fetal conditions (such as aortic dissection, gestational age). When fetus is mature, cardiovascular surgery should be carried out with cesarean section. A multi-disciplinary team between obstetric and cardiovascular surgery is crucial to the outcome of these critical patients.
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Objective:To investigate the expression and clinical significance of long non-coding RNA (LncRNA) CRNDE in cer-vical cancer. Methods:Specimens of cervical cancer tissues and matched non-tumor para-neoplastic tissues were collected from 87 pa-tients who underwent surgery in the Kaiping Central Hospital, China. Quantitative real-time PCR was used to examine the expression of LncRNA CRNDE, and its correlation with clinicopathological features was analyzed. Results:LncRNA CRNDE expression was sig-nificantly up-regulated in cervical cancer tissues than in adjacent non-tumor tissues (P<0.05). Increased LncRNA CRNDE expression was significantly correlated with FIGO stage, lymph node metastasis, and depth of cervical invasion (P<0.05). Moreover, a higher ex-pression of LncRNA CRNDE demonstrated significantly poorer overall survival in cervical cancer patients than in those with lower Ln-cRNA CRNDE expression (P<0.05). Multivariate analyses suggested that LncRNA CRNDE expression served as an independent pre-dictor for overall survival. Conclusion:Our findings posit that LncRNA CRNDE may be a potential prognostic marker and therapeutic target for cervical cancer.
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Objective To study the impact of severe idiopathic pulmonary arterial hypertension (IPAH) on pregnancy outcome and to investigate the effect of multidisciplinary approach during pregnancy on the pregnancy outcome in pregnant woman with severe IPAH.Methods Between March 2007 and November 2013,10 pregnant women with severe IPAH undergoing treatment in Beijing Anzhen Hospital were studied retrospectively.Hemodynamic measurements,medical therapy,manner of delivery,anesthetic administration,multidisciplinary management and outcomes were assessed.Results All 10 cases were first diagnosed at the mean of (24 ± 3) weeks during the pregnancy.The systolic pulmonary artery pressure (sPAP) estimated by transthoracic echocardiography was (95.6 ± 1.3) mmHg (1 mmHg =0.133 kPa).Seven cases of class Ⅲ and 3 cases of class Ⅳ were recorded by World Health Organization functional class.One patient underwent pregnancy termination at gestational age of 21 weeks with no maternal death or complications,nine patients continued pregnancy and all the patients underwent cesarean section.The mean pregnancy length was (31 ± 5) weeks.Nine had cesarean deliveries during continuous epidural anesthesia,and one during general anesthesia.There were three maternal deaths in hospital (5,2,3 days postpartum),and seven patients were alive,and the average hospitalization days was (8 ± 4) days.One fetus lost with cesarean section.Two were term delivery,and seven cases were premature delivery.The average weight is (1 948 ± 731) g and nine were alive and no malformation.Conclusions Because of maternal mortality in patients with severe IPAH remains prohibitively high,patients should continue to be counseled to avoid pregnancy.Women with severe IPAH who become pregnancy should be followed by multidisciplinary approach,and cesarean deliveries during continuous epidural anesthesia are a relatively safe way for pregnancy termination in patients with severe IPAH.
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Objective To evaluate PBL teaching results in medical virology experiment course. Methods Medical students of class 2011 were randomized assigned into PBL group (n=45, 20 five-academic-year students and 25 seven-academic year students) and control group (n=63, 38 five-academic-year students and 25 seven-academic year students). Teaching effectiveness was evaluated by scores of experiment, medical virology examination and final examination. PBL group was surveyed with questionnaire. SPSS statistical software was used and t test was employed to do analysis. Results Scores in medical virology examination were higher in seven-academic-year students in PBL group than in control group and there was no difference in other two examination scores between the two groups. Survey showed that interest motivation, case analysis, experiment design and knowledge grasp-ing in PBL group were highly satisfied. However, evidence-based and generalization ability among seven-academic-year students as well as autonomous learning ability and ability to deduce material among five-academic-year students were not completed satisfied. Conclusions PBL with public health events in medical virology experiment course can develop students' intrinsic motivation, knowledge grasping and public health awareness. However, PBL methods should be adjusted to suit different academic students.
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Objective To evaluate the changes in the expression of Toll-like receptor 4 (TLR4) mRNA and its down-stream cytokines IL-1β and TNF-α mRNA in spinal cord in a rat model of incisional pain.Methods Fifty-eight male Sprague-Dawley rats,weighing 180-220 g,were used in this study.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the hindpaw in isoflurane-anesthetized rats.Mechanical paw withdrawal threshold to yon Frey filament stimulation (MWT) on the operated and non-operated sides was measured before operation and at 0.5,1,2,6 and 12 h and 1,2,3,5 and 7 days after operation.Six rats were chosen and sacrificed before operation and at 2 and 8 h and 1,2,3,5 and 7 days after operation.Their lumbar segments (L4-6) of the spinal cord were removed for determination of the expression of TLR4,IL-1β and TNF-α mRNA by real-time PCR.Results Compared with the baseline value before operation,MWT on the operated side was significantly decreased at 0.5 h-5 days after operation,and the expression of TLR4,IL-1β and TNFα mRNA was up-regulated at 2 and 8 h and 1,2 and 3 days after operation (P ＜ 0.05),and no significant change was found in MWT on the non-operated side (P ＞ 0.05).MWT on the operated side was lowest at 2 h after operation and then gradually increased,the expression of TLR4 mRNA peaked on 1 day after operation,and the expression of IL-1 and TNF-α mRNA peaked at 8 h after operation (P ＜ 0.05).The TLR4 mRNA expression was negatively correlated with MWT on the operative side (r =-0.484,P ＜ 0.05),and IL-1 mRNA and TNF-α mRNA expression was positively correlated with TLR4 mRNA (r =0.294 and 0.540,respectively,P ＜ 0.05).Conclusion The expression of TLR4 mRNA and its down-stream cytokines IL-1β and TNF-α(mRNA in spinal cord is up-regulated,this change is involved in the maintenace of incisional pain,but it does not play an important role.
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Objective To investigate the therapeutic outcome and its influencing factors after laparoscopic conservative surgery in treatment of tubal pregnancy. Methods From January 2003 to December 2008, 226 cases with tubal pregnancy were treated by laparoscopic conservative surgery. The tubal pateacy was evaluated in 152 cases given by hysterosalpingography (HSG) and 6 cases given by second laparoscopic exploration at 3-6 months after surgery. In their first laparoscopic surgeries, 209 got successful treatment and 19 underwent fail treatment. At 3-6 months after surgery, 89 cases with tubal patency among 207 cases with successful treatment were enrolled in group A. Nineteen cases who were failed in their first laparoscopic conservative surgery and treated by salpingectomy and 63 cases with tubal obstruction were enrolled in group B. The rate of tubal patency was calculated on patients with characteristics of gestational sac less or more than 5 era, the level serum human chorionic gonadotropin (hCG) less than 2000 IU/L,2000 IU/L to 5000 IU/L, and more than 5000 IU/L Results There was no significant difference in age,parity, amenorrhea, location of tubal pregnancy, rupture, pelvic adhesion between group A and group B.Two hundred and seven cases (91.6%, 207/226) were successfully treated at initial laparescopy. One hundred and fifty-two cases got follow up and 55 cases lost follow up at 3 to 6 months after surgery. There was statistical difference in preoperative hCG value which median were 980 (55-12 000) IU/L in group A,3150 (570-40 000) IU/L in group B(P<0.01); the diameter of tubal gestational sac were (3.4±1.3)cm in group A and (5.0±1.7) cm in group B(P<0.01); respectively, the volume of peritoneal bleeding were 200 (0-1500) ml and 300 (0-1600) ml, the rate of live tubal embryo was 2% (2/89) in group A and 11% (9/82) in group B, which all reached statistical difference (P<0. 05). Among 171 cases in both group A and 8, the rate of tubal patency were 65% (67/103) in 103 cases with maximal diameter of tubal gestational sac less than 5 cm and 32% (22/68) in 68 cases with maximal diameter of tubal gestational sac more than 5 cm, which reached statistical difference (P < 0.01). The rate were 72% (73/102) in patients with serum level of hCG less than 2000 IU/L, 29% (12/42)in patients with 2000 IU/L to 5000 IU/L and 15% (4/27)in patients with more than 5000 IU/L, which also showed statistical difference (P <0.05). It was observed that preoperative serum hCG level (OR=0.277, P<0.01), the maximal diameter of gestational sac (OR=0.577, P<0.01) and the volume of peritoneal bleeding (OR=0.999, P < 0.05) were significant factors influencing successful laparoscopy treatment by logistical regression analysis.Conclusion In order to preserve fertility, laparoscopic conservative surgery was a safe and feasible approach in treatment of tubal pregnancy. Preoperative serum hCG levels, size of tube gestational sac were significant factors influencing successful laparoscopic surgery.
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Cannabinoids have been used in clinic for many years.However,their effective mechanisms,especially the role of the endogenous cannabinoid system in the regulation of intestinal motility are still poorly understood.In this article,we introduced that the compositions of the Cannabinoid family members,including their receptors,analogues,and antagonists,and the effects of them on the gastrointestinal movement.We provide the useful update information for the further clinic and experiment study on the cannabinoid family and the endocannabinoid system.