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@#Objective To analyze the perioperative safety and the short-term prognosis of non-small cell lung cancer (NSCLC) patients with preoperative arrhythmia. Methods The clinical data of NSCLC patients treated in the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University from August 2020 to March 2021 were collected and observed. The patients were divided into an arrhythmia group and a control group according to whether there was arrhythmia in the 24 h ambulatory electrocardiogram examination report before operation. The incidence of intraoperative and postoperative cardiovascular events and short-term prognosis were compared between the two groups. Results A total of 466 patients were included in this study, including 338 patients in the arrhythmia group, 176 males and 162 females, with a median age of 68.0 (63.0, 72.0) years, and 128 patients in the control group, 59 males and 69 females, with a median age of 66.5 (60.0, 72.0) years. A total of 26 patients (7.7%) in the arrhythmia group were placed with temporary pacemakers before operation. There was no significant difference in the incidence of cardiovascular related events between the two groups [100 (29.6%) vs. 28 (21.9%), P=0.096]. The incidence of postoperative arrhythmia events in the arrhythmia group was higher than that in the control group [112 (33.1%) vs. 11 (8.6%), P<0.001]. The average postoperative ICU stay in the arrhythmia group was longer than that in the control group (1.1±0.7 d vs. 1.0±0.6 d, P=0.039). Conclusion Preoperative arrhythmia does not increase the risk of intraoperative cardiovascular events in NSCLC patients, but increases the incidence of postoperative arrhythmia events and prolongs ICU stay.
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Objective:To analyze the application of thinking visual guidance teaching model in anesthesia clinical practice teaching.Methods:Taking the implementation time (March 2019) of thinking visual guidance teaching model in our hospital as the limit, 56 interns who came to our hospital for anesthesia practice before the implementation were included as control group, and 61 interns enrolled after the implementation (from March 2019 to March 2020) were included in study group. The mastery status of professional skills (duration of anesthesia operation, success rate of one-time anesthesia puncture and success rate of one - time tracheal intubation), professional knowledge assessment results and professional attitude changes were compared between the two groups at 2 months and 6 months of training. Self-evaluation after 6 months of training was compared between the two groups. SPSS 18.0 was used for t test and chi-square test. Results:After 6 months of training, the mastery status of professional skills (duration of anesthesia operation, success rate of one-time anesthesia puncture, and success rate of one-time tracheal intubation) of the two groups of interns were significantly improved compared with those after 2 months of training, and the above indicators of study group were significantly better than those of control group (all P<0.05). After 6 months of training, the scores of assessment results of professional knowledge (basic knowledge, understanding and memory, case analysis, emergency handling) and professional attitude (behavior, language, initiative and adaptability) in the two groups of interns were significantly higher than those after 2 months of training, and the above indicators scores of study group were significantly higher than those of control group (all P<0.05). The scores of self-evaluation (learning efficiency, learning atmosphere, learning ability, self-confidence and satisfaction) of study group at 6 months of training were significantly higher than those of control group at the same period (all P<0.05). Conclusion:Thinking visual guidance teaching model can effectively improve the professional knowledge and operation skills of anesthesia clinical interns, and it has a good application effect.
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Objective:To explore the risk factors of early infection patients after heart transplantation(HT)and provide references for preventing and treating early infection.Methods:From April 2018 to May 2021, clinical data were retrospectively reviewed for 95 HT recipients treated at Zhengzhou Seventh People's Hospital.They were divided into two groups of infected(n=34)and uninfected(n=61). Gender, age, disease type, preoperative IABP implantation, postoperative intra-aortic balloon pump(IABP)implantation, postoperative extracorporeal membrane oxygenation(ECMO)implantation, preoperative mechanical ventilation, preoperative leukocyte, preoperative lymphocyte, preoperative serum C-reactive protein(CRP), operative approach, APACHEⅡscore, NYHA grade, hemoglobin, cardiopulmonary bypass time, donor heart cold ischemia time, postoperative thoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative urinary tube indwelling time, postoperative acute rejection, postoperative ventilator assisted treatment time and postoperative ICU time.The risk factors of early infection were analyzed by univariate and multivariate Logistic regression analysis.Results:There were 34 cases of early infection after HT and 8 cases died.In infection group, preoperative hemoglobin(female <110 g/L or male <120 g/L), ECMO post-operation, 24-48 h post-operation, APACHE post-operation(>6), postoperative intrathoracic drainage tube indwelling time(≥7 d), postoperative gastric tube indwelling time(≥4 d), postoperative urinary tube indwelling time(≥5 d), postoperative acute rejection(positive), postoperative ventilator assisted treatment time(≥2 d)and postoperative ICU time(≥10 d)were 18 cases(52.94%), 8(23.53%), 30(88.24%), 22(64.71%), 18(52.94%), 20(58.82%), 4(11.76%), 21(61.76%)and 19(55.88%); uninfected group: 16 cases(26.23%), 3(4.92%), 32(52.46%), 24(39.34%), 15(24.59%), 31(34.43%), 1(1.64%), 21(34.43%)and 4(6.56%). Significant inter-group differences existed( χ2=6.778, 5.68, 12.326, 5.623, 7.740, 5.297, 4.489, 6.615, 28.947, P<0.05). Multivariate Logistic regression analysis indicated that 24-48h post-operation, APACHEⅡ score >6(β=1.024, Wald χ2=7.653, OR=2.141, OR95% CI=1.323~4.215), ECMO post-operation(β=1.783, Wald χ2=6.186, OR=5.949, OR95% CI =1.459~24.25), postoperative intrathoracic drainage tube indwelling time ≥7 d(β=0.712, Wald χ2=5.745, OR=1.054, OR95% CI=1.183~6.753), postoperative gastric tube indwelling time(β=0.832, Wald χ2=6.756, OR=1.132, OR95% CI=1.416~8.406), postoperative ventilator assisted treatment time(β=0.745, Wald χ2=6.563, OR=1.212, OR95% CI=1.289~7.346)and postoperative ICU time=1.28(β=1.325, Wald χ2=9.752, OR=2.435, OR95% CI=1.426~6.354)were independent risk factor for early infection after HT( P<0.05). Conclusions:Early infection after HT remains higher.It is significantly correlated with 24-48 h post-operation APACHE II score, ECMO post-operation, postoperative intrathoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative ventilator assisted treatment time and postoperative ICU time.Targeted interventions should be adopted for lowering the incidence of early infection after HT.
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Objective:To explore the differences in intravascular ultrasound results in elderly coronary heart disease(CHD)patients with different uric acid levels.Methods:A total of 145 elderly patients diagnosed with CHD in our hospital from December 2017 to May 2020 were included as study subjects.Uric acid levels were measured and intravascular ultrasound examination was conducted in all patients.They were divided into different groups based on uric acid levels: Group A(uric acid≤199 μmol/L), Group B(uric acid 200~399 μmol/L)and Group C(uric acid≥400 μmol/L). Data from intravascular ultrasound-derived indexes were analyzed and compared between the three groups.Results:There was no significant difference in the degree of left main stenosis between Group A and Group B, but it was less severe in both groups than in Group C( F=5.625, P=0.039). Plaque fibrous cap thickness showed no significant difference between Group B and Group C, but it was smaller than in Group A( F=7.825, P=0.020). Group C had the largest plaque area and maximum thickness among the three groups, followed by Group B[(11.12±1.73)mm 2 and(1.76±0.24)mm]and Group A[(8.29±3.14)mm 2 and(1.38±0.09)mm]( F=6.384 and 6.827, P=0.028 and 0.015). Conclusions:Elevated uric acid levels in elderly CHD patients can increase the area and thickness of plaques, and reduce plaque fibrous cap thickness, leading to an increased risk of formation of unstable plaques, which can be life-threatening for these patients.Thus, monitoring and managing uric acid levels should be stressed in elderly CHD patients.
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Objective To compare the clinical therapeutic effect of percutaneous nephrolithotomy (PCNL) and flexible ureteroscope lithotripsy (FUL) for unilateral lower-calyceal calculi with the diameter of 10-20 mm. Methods The clinical data of 65 patients with unilateral lower-calyceal calculi with the diameter of 10-20 mm were retrospectively analyzed. Thirty cases were treated with PCNL (PCNL group), and 35 cases were treated with FUL (FUL group). The operative time, success rate of lithotomy, haemoglobin decrease after operation, postoperative hospital stay, hospitalization expenses and complication were compared between 2 groups. Results Treatment was completed successfully in the patients of 2 groups, without ureteral perforation, avulsion and other serious complications intraoperatively and postoperatively. There were no statistical differences in success rate of lithotripsy, incidence of high fever after operation and postoperative analgesia rate between 2 groups (P>0.05). The operative time and hospitalization expenses in FUL group were significantly higher than those in PCNL group:(95.27 ± 22.69) min vs. (62.25 ± 20.73) min and (17 242 ± 2 679) yuan vs. (14 205 ± 1 654) yuan, and the haemoglobin decrease after operation and postoperative hospital stay time were significantly lower than those in PCNL group:(0.67 ± 0.33) g/L vs. (7.98 ± 4.33) g/L and (3.75 ± 0.78) d vs. (6.54 ± 1.68) d, and there were statistical differences (P<0.05). Conclusions For the treatment of lower-calyceal calculi with the diameter of 10-20 mm, the success rates of lithotripsy of PCNL and FUL are similar. FUL has less trauma, with shorter postoperative hospital stay time, but the cost is relatively high.
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Objective To compare health related quality of life (HRQOL) between modified and traditional cutaneous ureterostomy, and explore the reasons for these differences, in order to provide the basis of HRQOL for the choice of cutaneous ureterostomy. Methods A total of 53 patients underwent cutaneous ureterostomy were selected, and the patients were divided into traditional cutaneous ureterostomy group (traditional group, 21 cases) and modified cutaneous ureterostomy group (modified group, 32 cases) according to the surgery method. The patients were evaluated by functional assessment of cancer therapy-bladder (FACT-BL), and the HRQOL was compared between 2 groups. Results There were no statistical differences in HRQOL score at 1, 3, 6 and 9 months after surgery between 2 groups (P>0.05). The HRQOL score at 12 months after surgery was significantly higher in modified group than that in traditional group:(141.5 ± 10.4) scores vs. (123.1 ± 5.2) scores, and there was statistical difference (P0.05). But the scores of functional status and bladder cancer special scale (BSS), total score of FACT-BL in modified group were significantly higher than those in traditional group:(26.0 ± 2.5) scores vs. (23.8 ± 3.5) scores, (46.7 ± 6.2) scores vs. (34.8 ± 5.5) scores, (143.9 ± 15.7) scores vs. (117.5 ± 8.1) scores, and there were statistical differences (P<0.01). Conclusions The HRQOL at 12 months after surgery in modified cutaneous ureterostomy is better than that in traditional cutaneous ureterostomy. Therefore, if the patient's physical condition permits, priority should be given to modified cutaneous ureterostomy to reduce the complications and improve the quality of life.
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Objective To observe the efifcacy of rosuvastatin in patients with unstable angina and its impact on the levels of lipids, high sensitive C-reactive protein (hs-CRP), homocysteine(Hcy) and troponin I (cTnI). Method 384 patients with unstable angina, from January 2010 to December 2012, were randomly divided into observation group and control group, each group had 192 cases, the control group received simvastatin, the observation group were gave rosuvastatin. The efficacy, and the levels of lipids, hs-CRP, Hcy and cTnI were observed after treatment. Results The total effective rate was 92.19%in observation group which was signiifcantly better than 81.25%in control group (χ2=9.044, P<0.01). Before treatment, the levels of TG , TC, LDL-C, HDL-C, Hcy, hs-CRP and cTnI showed no signiifcant difference, after treatment the levels of TG , TC and LDL-C, Hcy, hs-CRP and cTnI were signiifcantly lower than those before treatment (P<0.01), while, the levels of HDL-C signiifcantly increased than those before treatment (P<0.01), the reducing or increasing levels in observation group were more signiifcant compared with the control group (P<0.01). Conclusion Rosuvastatin treatment in unstable angina not only can reduce plasma lipid, but also reduce their inflammation, and stabilize the arterial plaque for unstable angina, it play an important role in development and prognosis.
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<p><b>OBJECTIVE</b>To evaluate the biomechanical effects of intracellular changes on the voltage-gated sodium channels (VGSCs) on trigeminal ganglion neuron (TRGN).</p><p><b>METHODS</b>TRGN cells were acutely isolated from the neonatal SD rats. The voltage-dependent currents of the VGSCs on these neurons were elicited and analyzed by whole-cell patch-clamp recordings and the intracellular anisotonicity stimuli was established by adjusting the content of pipette solution. The effects of hypo-(260 mOsm) and hypertonic (350 mOsm) osmolarity on the activation and inactivation kinetics of VGSCs on TRGN were evaluated, compared with the normal intracellular environment.</p><p><b>RESULTS</b>The results demonstrated that intracellular hypotonic stimuli could influence both the activation and inactivation characteristics of VGSCs currents, including the membrane potential at half inactivation (V0.5) of the G-V and inactivation curves had obvious statistics significance (P<0.05) between hypotonicity (260mOsm) and isotonicity (306mOsm). However, only inactivation properties changed under intracellular hypertonic effects, including inactivation rate and k value.</p><p><b>CONCLUSION</b>It suggests that the kinetics of VGSCs on TRGN can be modulated both by intracellular hypo- and hypertonic with different characteristics.</p>
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Animals , Rats , Cells, Cultured , Membrane Potentials , Neurons , Osmolar Concentration , Patch-Clamp Techniques , Rats, Sprague-Dawley , Sodium Channels , Trigeminal GanglionABSTRACT
Objective To assess the feasibility of nuclear matrix protein 22(NMP22)and urinary bladder cancer,antigen (UBC) for the early diagnosis of bladder transitional cell carcinoma and its influencing factors.Methotis 105 subjects,including 60 patients of bladder cancer,25 patients of urological benign disease and 20 normal (healthy)individuals were enrolled in this study.Urine NMP22 and UBC wag assessed by enzyme-linked immunosorbent assay(ELISA).Urine NMP22 and UBC as well as exfoliocytology were conducted for the purpose to compare the sensitivity,specificity,positive and negative predictive value of these three ways.Results The sensitivity of NMP22(88.3%)and UBC(86.7%)were significantly better than exfolioeytology(40.0%,P<0.01).The specificity of NMP22,UBC and exfoliocytology were 80.0%,84.0%and 92.0%,respectively, the positive predictive values were 91.4%,92.9%and 92.3%,and the negative predictive values were 74.1%.72.4%and 38.9%.Conclusions NMP22 and UBC are sensitive,specific,simple,feasible and noninvasive diagnostic markers for the early detection of urinary bladder transitional cell cancer.
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Objective To evaluate the reconstruction of bladder using a segmental sinus-body of stomach on the basis of a clinical study.Methods We retrospectively reviewed the medical records,laboratory evaluations,imaging examinations,cystoscopy,urodynamic studies of 30 patients(17 men and 13 women;mean age,55 years;age range,21-69 years) who underwent the reconstruction of bladder using a segmental sinus-body of stomach.Of the 30 patients,24 had primary bladder cancer and 6 had tuberculous contracture of the bladder.Results After operation,the new gastric bladder worked well in keeping and emptying urine.All patients micturated through the urethra.The bladder capacity was 280-580 ml(mean,385 ml).The maximum urethral pressure was 20-60 cm H_2O(mean,49 cm H_2O).The filling bladder pressure was 5-15 cm H_2O(mean,12 cm H_2O).The maximum bladder pressure was 35-65 cm H_2O(mean,55 cm H_2O),and it was 28-60 cm H_2O(mean,46 cm H_2O) during urination.Qmax and post-void residual urine were 10-28 ml/s(mean,18 ml/s) and 5-85 ml(mean,20 ml),respectively.Follow-up ranged from 9 months to 24 years(mean,8.2 years).There were no disturbance of water and electrolyte metabolism,no vesicoureteral reflux,no uracratia,and no damage to renal function.Complications included perineal and vesical pain in 4 cases,enuresis in 5 cases,which gradually remitted 3-6 months after surgery,and bladder stone formation in 1 case,who underwent surgery again.At 3.5 years after surgery bladder tumor relapsed in 1 case,who then underwent transurethral resection of bladder tumor. Conclusions Our data show that the substitution of a segmental sinus-body of stomach for urinary bladder worth popularizing because of low complication rate and approximately normal urologic indexes.