Effects of dexmedetomidine sedation on cerebral blood flow and cerebral oxygen metabolism in patients with acute craniocerebral injury / 中国基层医药

Objective:To observe the sedative effect of dexmedetomidine(DEX) on patients with acute craniocerebral injury(ACI), and to explore its influences on cerebral blood flow(CBF) and cerebral oxygen metabolism.Methods:A total of 68 ACI patients were randomly divided into control group( n=34) and observation group( n=34) according the random digital table method.The patients in both two groups were transferred to intensive care unit(ICU) for routine comprehensive treatment after surgery.On this basis, the observation group was given intravenous injection of 0.5 μg·kg -1·h -1 DEX for 3d.The changes of mean arterial pressure(MAP), heart rate(HR), respiration rate(RR), blood oxygen saturation(SpO 2), scores of Ramsay and Glasgow Coma Scale(GCS), CBF, jugular bulb venous oxygen saturation(SjvO 2), arteriovenous oxygen content difference(AVDO 2) and cerebral oxygen extraction rate(CERO 2) were compared between the two groups. Results:At 24h and 72h after being transferred to ICU, MAP[(89.05±10.91)mmHg, (90.24±9.40)mmHg], HR[(82.42±9.51)times/min, (81.18±8.26)times/min] and RR[(27.03±5.20)times/min, (26.38±4.75)times/min] in the observation group were significantly lower than those in the control group[(109.49±10.41)mmHg, (103.63±11.68)mmHg, (109.52±8.37)times/min, (104.46±9.16)times/min, (32.76±5.71)times/min, (29.59±4.40)times/min]( t=7.904, 5.208, 12.473, 11.006, 4.326, 2.891, all P<0.05). There was no statistically significant difference in SpO 2 between the two groups( P>0.05). At 72h, the Ramsay score in the observation group was lower than that in the control group[(2.72±0.35)points vs.(3.42±0.40)points], while the GCS score was higher than that in control group[(11.92±1.81)points vs.(10.14±2.28)points], and there were statistically significant differences between the two groups( t=7.679, 3.565, all P<0.05). At 72h, the CBF, AVDO 2 and CERO 2 were lower than those at 0h in the observation group( t=2.406, 4.908, 6.291, all P<0.05), which were significantly lower than those in the control group( t=2.087, 5.493, 6.423, all P<0.05). At 72h, the SjvO 2 was higher than that at 0h in the observation group[(61.27±4.70)% vs.(51.44±3.48)%]( t=9.801, P<0.05), which was significantly higher than that in the control group[(53.32±3.64)%]( t=7.798, P<0.05). Conclusion:DEX can improve postoperative sedation effect of ACI patients, stabilize vital signs, reduce cerebral oxygen consumption and improve cerebral oxygen metabolism disorders.

Clinical study on microcirculation resistance index for predicting major adverse cardiac events after PCI operation in patients with ST segment elevation myocardial infarction / 重庆医学

Objective To investigate the clinical value of the index of microcirculation resistance(IMR) in the prediction of major adverse cardiac events after PCI in the patients with ST segment elevation myocardial infarction.Methods Forty-eight inpa tients with acute ST segment elevation myocardial infarction(STEMI) in the cardiology department CCU of our hospital from December 2013 to June 2015 were selected,including 38 males and 10 females,and divided into 3 groups according to the measured IMR value after PCI operation:the group A,IMR≤25(n=18);group B,IMR 25 ～ 32 (n =16);group C,IMR≥32 (n =14).Serum NT-ProBNP was collected,and the data in cardiac color ultrasound after PCI and at postoperative 1 year:left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD),and major adverse cardiac events within 1 years after PCI were also collected.Results The serum of concentrations NT-ProBNP were compared among the three groups[(2 734.83 ± 1 009.40) vs.(4 929.68±611.52) vs.(7 480.64±2 082.78)],and the difference among 3 groups was statistically significant (F=35.449,P=0.000).The difference of LVEF among the three groups had statistal significance[(54.00-±-5.99) vs.(52.31 ± 4.35)vs.(49.29 ±4.68),F=3.376,P=0.043)],and there was no statistical difference among the three groups in LVEDD(P＞0.05).The difference of LVEF at postoperative 1 year among 3 groups had statistical significance[(57.28 ± 5.21)vs.(54.43 ±3.69)vs.(46.43±5.33),F=16.744,P=0.000],and the difference of LVEDD (48.94±1.95)vs.(50.63±2.68)vs.(52.14±2.69) among 3 groups was statistically significant(F=6.875,P=0.002).The differences in the major adverse cardiac events,cases of cardiac death and cases of heart failure after postoperative 1 year among 3 groups were statistically significant(x2 value=6.707,P=0.035;x2 value=6.084,P=0.048);the occurrence of again ACS,again PCI and malignant arrhythmia had no statistical difference among 3 groups(P＞0.05).Conclusion Measurement of IMR after PCI in the patients with STEMI can effectively predict the heart function and the risk of major adverse cardiac events within 1 year.

Effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats.</p><p><b>METHODS</b>Fifty male SD rats were randomly divided into 5 groups, including a control group, a myocardial fibrosis model (established by injections of isopropyl adrenaline for 10 days) group, and 3 edaravone groups with edaravone treatment at low, medium, or high doses for 14 days. After the treatments, the rats were examined for the degree of myocardial fibrosis, left ventricular mass index (LVMI), collagen volume fraction (CVF), and myocardial contents of collagen I (Col I), collage III (Col III), hydroxyproline (Hyp), superoxide dismutase (SOD), malondialdehyde (MDA), and nitric oxide (NO); The expression of transforming growth factor-β1 (TGF-β1) in the myocardial tissues was examined by immunofluorescence assay and Western blotting.</p><p><b>RESULTS</b>Compared with the control rats, the rat models of myocardial fibrosis showed significantly increased CVF and LVMI (P=0.000), which were lowered by edaravone treatments in a dose-dependent manner (P<0.05). The myocardial contents of Col I, Col III and Hyp also increased in the model group (P=0.000) and were lowered dose-dependently by edaravone; the contents of MDA was higher (P=0.000) and SOD and NO were lower in the model group (P=0.000), and edaravone treatments obviously increased SOD and NO contents (P<0.05). The model rats showed significantly increased myocardial expression of TGF-β1 (P=0.000), which was markedly lowered by edaravone treatments (P=0.000). The myocardial content of MDA was positively correlated while SOD and NO were negatively with LVMI, CVF, Col I, Col III and Hyp; TGF-β1 was positively correlated with LVMI, CVF, Col I, Col III, Hyp and MDA but negatively with SOD and NO.</p><p><b>CONCLUSION</b>Edaravone can relieve oxidative stress and inhibit TGF-β1 activation to ameliorate myocardial fibrosis in rats.</p>

Application of low doses of digital subtraction angiography three-dimensional reconstruction in joint fracture of the trauma / 国际外科学杂志

ObjectiveTo compare X-ray,spiral CT and low does digital subtr,action angiongraphy technology of three dimensional reconstruction in 30 cases of the applications in the joint fractures,to study the application value of the digital subtraction angiography three- dimensional reconstruction in joint fracture.MethodsA retrospective analysis was made on 30 cases with joint fracture in Guangdong Provincial Guangzhou Development District Hospital,who were confirmed by the X-ray and spiral CT three-dimensional reconstruction and digital subtraction angiography three-dimensional reconstruction and the demonstrations three-dimensional reconstruction,spiral CT three-dimensional reconstruction and X-ray were compared.ResultsAll 30 cases fractures showed clear line,line of walk line,of the number of fracture,source and separation shift condition.Digital subtraction angiography could be clearly shows 30 cases in spiral CT could clearly show in 20 cases,10 cases not clearly show in,while X-ray clearly show in 10 cases,not show in 20 cases.Spiral CT showed clearly joint capsule and soft tissue.The SPSS 11.0 statistical soft package was used.Spearman correlation analysis,the single factor analysis of variance and the independent t test and the chi-square test were employed for data analysis,P ＜ 0.05 was considered statistical significance.Conclusions Digital subtraction angiography three-dimensional reconstruction can more clearly display fracture line,fracture pieces,walk line,source and separation shift condition compared with spiral CT and Xray essaminations,which is helpful for treatment options and prognosis estimation.

Information dissymmetry and progress reconstruction of hospital library / 中华医学科研管理杂志

Information Dissymmetry is a common phenomenon in this economical market.None of us can master all information about anything.The relative difference of the information's occupancy leads to a sharp distinction of the bargainer' status currently.During the service of our hospital library,Information Dissymmetry seriously restricts the development of our library and makes many readers dissatisfied.The author analyzed the problem in progress of service to the reader and finally put forward the countermeasure of this progress reconstruction in the hospital library.