Efficacy comparison between Milrinone and Papaverine on the spasm of internal mammary artery during off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To compare the efficacy of Milrinone and Papaverine in relieving the spasm of internal mammary artery (LIMA) during off-pump coronary artery bypass grafting (OPCABG).Methods:Between April 2018 to December 2018, 200 patients who suffered obvious angina pectoris and three-vessel disease documented by coronary angiography, undergoing OPCABG at Beijing Anzhen Hospital, Capital Medical University were recruited in this study, including 103 males and 97 females, aged 46-74 years, with an average of (59.12±0.49) years old. For all patients, the LIMA was anastomosed to left anterior descending artery(LAD). According to different methods relieving LIMA spasm, all patients randomly divided into 4 groups (n=50): Papaverine surface infiltration group (group Ⅰ), Papaverine injection group (group Ⅱ), Milrinone surface infiltration group (group Ⅲ) and Milrinone injection group (group Ⅳ). The blood flow (ml/min) of the free LIMA, the blood flow of the LIMA-LAD after bypass, anastomotic time of obtuse marginal artery, the use of vasoactive drugs, the outcomes of perioperative period and 1 year after operation were compared in the four groups.Results:There was no significant difference between group Ⅲ and group Ⅰ in the blood flow of free LIMA and LIMA-LAD[(45.50±1.43)ml/min vs. (47.42±1.61)ml/min、(28.60±0.89)ml/min vs. (28.40±0.96)ml/min, all P>0.05]. The blood flow of free LIMA and the LIMA-LAD in group Ⅱ were significantly higher than those in group Ⅰ[(60.36±1.28)ml/min vs. (47.42±1.61)ml/min, (42.40±1.25)ml/min vs. (28.40±0.96)ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅲ[(70.86±2.00) ml/min vs. (45.50±1.43) ml/min, (59.46±1.25) ml/min vs. (28.60±0.89) ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅱ[(70.86±2.00) ml/min vs. (60.36±1.28) ml/min, (59.46±1.25) ml/min vs. (42.40±1.25)ml/min, all P<0.05]. The anastomotic time of obtuse marginal artery[(7.14±0.72)min vs. (8.30±0.93)min, (8.10±0.89)min, (8.14±0.90)min, P<0.05], the dopamine dose[(3.76±0.40)μg·kg -1·min -1 vs. (5.02±0.52)μg·kg -1·min -1, (4.84±0.48)μg·kg -1·min -1, (4.90±0.49)μg·kg -1·min -1,P<0.05] and the esmolol usage (32% vs. 60%, 58%, 58%, P<0.05) during the operation in group Ⅳ were significantly reduced compared with the other three groups. The V3 ST depression on the postoperative first day[(0.34±0.18)mv vs. (0.71±0.22)mv, (0.68±0.20)mv, (0.69±0.22) mv, P<0.05], and the TNI on the postoperative third day[(0.24±0.08)ng/ml vs. (0.56±0.15)ng/ml, (0.54±0.11)ng/ml, (0.53±0.12) ng/ml, P<0.05] were significantly lower in group Ⅳ than those in the other three groups. However, there was no significant difference about the first-year patency of LIMA-LAD among four groups. Conclusion:For relieving spasm of LIMA, the Milrinone injection was better than that of Papaverine, which could shorten the anastomotic time of obtuse marginal artery, maintain intraoperative hemodynamics stability, reduce myocardial damage during OPCABG.

Investigation and analysis on the current situation and demand of intracavity electrocardiographic positioning technique training for PICC specialist nurses in Shandong Province / 中国实用护理杂志

Objective:To understand the current situation and demand of intracavity electrocardiographic positioning technique training for PICC specialist nurses in Shandong Province, and provide a reference for further improving and improving the training of PICC specialist nurses.Methods:From July 7-23, 2019, a total of 903 PICC specialist nurses in Shandong Province were selected by the convenience sampling method. The nurses were investigated by the self-made general information questionnaire of PICC specialist nurses in Shandong Province and the training demand questionnaire of intracavity electrocardiographic positioning technique.Results:40.75% (368/903) PICC specialist nurses had participated in intracavity electrocardiographic positioning technique training; 84.27% (761/903) PICC specialist nurses thought it necessary to conduct intracavity electrocardiographic positioning technique training. PICC specialist nurses had various training on intracavity electrocardiographic positioning technique, the average content requirements were all above 4.67 points. The highest score of theoretical training content was the judgment of the relationship between catheter tip position and electrocardiogram P wave (4.80 ± 0.47), and the highest score of operation training content was the intracavitary electrocardiography guided PICC catheterization (4.74 ± 0.55). 94.24%(851/903) PICC specialist nurses hoped to achieve the goal of improving clinical nursing practice ability through intracavity electrocardiographic positioning technique training. Intravenous therapy specialist academic conference was the main hoped training form(76.85%, 694/903). Multiple regression analysis showed that the number of years of catheterization, job position and understanding of the technology were the influencing factors of PICC specialist nurses′ training needs for intracavity electrocardiographic positioning technique ( t = -3.73,3.12, -3.63, all P<0.05). Conclusions:The training rate of intracavity electrocardiographic positioning technique was low, but PICC specialist nurses had higher training requirements for intracavity electrocardiographic positioning technique. Managers should pay attention to the training of intracavity electrocardiographic positioning technique, and develop targeted training programs to further improve the clinical practice capabilities of the PICC specialist nursing team.

Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer

PURPOSE: The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. MATERIALS AND METHODS: The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0–50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. RESULTS: The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. CONCLUSION: Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

The analysis of risk factor and the establishment of pre-operation warming score system for infection after intracavity lithotripsy in upper urinary tract calculi / 中华泌尿外科杂志

Objective To discuss the risk factor of infection after intracavity lithotripsy in upper urinary tract calculi,and establish a pre-operation warming score system.Methods From Jan.2013 to May 2016,412 upper urinary calculi patients who underwent intracavity lithotripsy were analyzed to evaluate the associated risk factors before operation and infection after operationg by non-conditional logistic regression analysis.The pre-operation warming score system was established by giving those risk factor 1-4 point based on OR value.The best threshold was then determined by ROC curve.Results Diabetes mellitus,infection history,renal calculus and uretero-pelvic junction calculus,stone burden,the degree of hydronephrosis and the gender of female were high-risk factors contributed to infection after intracavity lithotripsy,which were given 3,3,3,2,2,2point respectively based on their OR value(8.660,7.046,3.723,2.675,2.256,1.891),and the patients who got high socre were more likely to suffered infection.The sensitivity and specificity of the wanning score system for infection after intracavity lithotripsy were 74.3％ and 84.0％ respectively when its truncation point was 7.5 point(total score was 15 piont).Conclusions Patients who got more than 7.5 point according to the wanning score system were high risk groups of infection after intracavity lithotripsy.

A applicational analysis about the effect of Marine Injection on combined therapy of benign tracheobronchial stenosis / 中国基层医药

Objective To preliminaryly explore the effect and adverse reaction of Marine Injection combined therapy through local spray in benign tracheobronchial stenosis.Methods 19 cases of bronchial tuberculosis were collected in our department.By assessing cough,shortness of breath and other symptoms,chest high -resolution CT (HRCT)of three -dimensional reconstruction,and length were observed by ultrafine bronchial stenosis.According to the pathogeny and types of stenosis,combined multiple intervention were sequentially adopted,and then Marine Injec-tion was sprayed through one -off endoscopic spray tube.All the subjects were divided into the two groups,the higher concentration Marine injection (1 200 mg/mL)group was chosen with the condition of serious inflammation,edema, ulcer and necrosis,obvious local granulation tissue hyperplasia,severe scar stenosis,and the length of stenosis greater than 2 cm or the sectional area of stenosis less than 50% of the normal sectional area,otherwise the low concentration (600 mg/mL)group was chosen.The subjects were reexamined by clinical symptoms,high -resolution CT (HRCT) of three -dimensional reconstruction,and ultrafine bronchoscopy a week after the surgery to dynamically observe the local changes.Depending on the situation,the injection was sprayed once a week,adding up to 2 -4 times.Follow -up visit lasted for 3 months,cough,expectoration or hemoptysis,and dyspnea were observed.Results 11 cases were effective fully,17 cases were effective substantially,7 cases were ineffective,the total effective rate was 80% (28 /35).The overall complication rate was 42.8% (15 /35),no deaths occurred.No complications related to local spra-ying of Marine were seen.Conclusion Local spray of Marine Injection may have preferable effect that inhibits scar formationand prevention airway restenosis.It is worth further study with a high security,precise clinic effect,easy oper-ation and etc.

Application of intracavity double pipe suction in the repair of duodenal rupture / 中华消化外科杂志

Objective To investigate the effects of intracavity double pipe suction in the duodenal rupture repair.Methods The clinical data of 56 patients with duodenal rupture repair who were admitted to Fuzhou General Hospital from January 2003 to January 2014 were retrospectively analyzed.Thirty-one patients and 25 patients received the simple drainage (simple drainage group) and intracavity double pipe suction (intracavity double pipe suction group) for duodenal rupture repair.Quantitative data were presented by $ ± s,repeated measures analysis of variance and the t-test were used to evaluate quantitative data,respectively.Count data were analyzed using Chi-square test or Fisher's exact test.Results Volume of drainage of patients in the intracavity double pipe suction group at day 1,2,3,4,5,6,7 were (220 ± 54) mL,(284 ± 65) mL,(368 ± 35) mL,(413 ± 41) mL,(454 ± 62) mL,(714 ± 96) mL and (852 ± 121) mL,compared with (102 ± 30) mL,(124 ± 29)mL,(186 ±26)mL,(110 ±21)mL,(167 ±31)mL,(193 ±35)mL and (182 ±44)mL in the simple drainage group,with a significant difference between the 2 groups (F =65.214,P ＜ 0.05).The volumes of drainage of the 2 patterns were compared at postoperative day 1 to 7,with a significant difference (t =9.532,11.624,13.421,15.257,14.147,18.311,20.135,P ＜0.05).The incidence of duodenal fistula,intraperitoneal infection and wound infection in the simple drainage group were 29.0％ (9/31),41.9％ (13/31) and 51.6％ (16/31),compared with 4.0％ (1/25),12.0％ (3/25) and 16.0％ (4/25) in the intracavity double pipe suction group,showing a significant difference between the 2 groups (x2 =4.460,6.077,7.645,P ＜ 0.05).The incidence of pancreatic fistula and pulmonary infection in the sample drainage group and intracavity double pipe suction group were 16.1％ (5/31) and 29.0％ (9/31),8.0％ (2/25) and 12.0％ (3/25),with no significant difference between the 2 groups (x2 =0.836,2.385,P ＞ 0.05).The duration of hospital stay and hospital expenses in the simple drainage group and the intracavity double pipe suction group were (30 ± 14) days and(12 ± 6) x 104 yuan,(21 ± 7) days and (7 ± 5) x 104 yuan,respectively,with significant difference between the 2 groups (t =3.161,2.913,P ＜ 0.05).Conclusion The intracavity double pipe suction for duodenal rupture repair is simple and effective for significantly improving the prognosis of patients and reducing the duration of hospital stay and hospital expenses.

Study of factors influencing dose distribution of brachytherapy in cervical cancer / 西安交通大学学报·英文版

Objective: To study the factors which influence the dose distribution of brachytherapy in cervical cancer. Methods: Ninety-five patients with cervical cancer II - III b received fundamental radiation therapy including brachytherapy in our department from Aug. 2004 to Nov. 2005. The deviation of isodose curve of brachytherapy was based on A-B reference system, and the deviation of dose was defined by measuring in a practical standard body model. Results: The factors influencing isodose offset significantly were parametrial infiltrating degree, and anatomy factor of cervical cancer and operating skill. The degree of isodose offset could not be lowered with the increased frequency of brachytherapy. Conclusion: Making simulation in cervical brachytherapy is necessary not only for the identification of the deviation of isodose curve but also for adjusting the dose distribution and revising the plan of radiotherapy.

Study of factors influencing dose distribution of brachytherapy in cervical cancer / 药物分析学报

Objective To study the factors which influence the dose distribution of brachytherapy in cervical cancer. Methods Ninety-five patients with cervical cancer Ⅱ - Ⅲ b received fundamental radiation therapy including brachytherapy in our department from Aug. 2004 to Nov. 2005. The deviation of isodose curve of brachytherapy was based on A-B reference system, and the deviation of dose was defined by measuring in a practical standard body model. Results The factors influencing isodose offset significantly were parametrial infiltrating degree, and anatomy factor of cervical cancer and operating skill. The degree of isodose offset could not be lowered with the increased frequency of brachytherapy. Conclusion Making simulation in cervical brachythecapy is necessary not only for the identification of the deviation of isodose curve but also for adjusting the dose distribution and revising the plan of radiotherapy.

Multi-purpose Horizontal Transit Table for influential factors in dose distribution of brachytherapy in moderately advanced and advanced uterine cervical cancer / 中华放射肿瘤学杂志

Objective The factors influencing the dose distribution of intracavitary brachytherapy for moderately advanced and advanced uterine cervical cancer was studied.Methods Ninty-five patients with cervical cancerⅡ～Ⅲb who received radical radiation therapy in our department from Aug,2004 to Nov,2005,were treated with after-loading brachytherapy using,first,the self-designed“Mutipurpose Hori- zontal Transit Table”(MPHTT) for locating and treatment before the intracavitaray brachytherapy proper. The deviation of isodose curve based on A-B reference system,and the dose of deviation was defined by measuring in a practical standard phantom.Results There were significant influence on the deviation of i- sodose curve in pathology and para-metrial infiltration of cervical cancer and operating skill,but negative to clinical stage.The degree of deviation of isodose curve could not be lowered with the increase in sessions of intracavitary brachytherapy.Conclusions It is necessary to perform the locating,by use of mphtt,before the proper brachytherapy for patients with cervical cancer,not only for the identification of the deviation of i- sodose curve,but also to provide the evidence for revising the plan for dose adjustment of conformal radiation therapy in the pelvic cavity.

Clinical study of low-molecular weight heparin on the prevention of acute closure after percutaneous intracavitary coronary angioplasty / 中国综合临床

Objective To evaluate the safety and efficacy of low-molecular weight heparin on the prevention of acute closure after percutaneous intracavitary coronary angioplasty.Methods 73 patients were randomly assigned to LMWH and SH groups.All patients underwent SPECT or CAG.Myocardial ischemia and hemorrhage complication were analyzed.Results In Group LMWH,no case of hemorrhage complication occurred,and in 3 cases angina occurred within 24h after the operation,which was proved by CAG to be acute closure of target vessel (the incidence rate 8.6%) .In Group SH,gum and subcutaneous hemorrhage occurred to 2 cases within 7h after the operation,hematuria occurred to 2 cases within 12h and one case died from cerebral hemorrhage,which was confirmed by CT (the total hemorrhage incidence 13.2%).Another 4 cases in Group SH suffered from re-occurrence of angina,which was confirmed by CAG to be acute closure of target vessel (10.5%).There was significant difference in hemorrhage complication between the two groups (P0.05)。Conclusion The results suggest that LMWH is safe and effective in the prevention of acute closure after native vessel coronary angioplasty.