Effects of intravenous thrombolysis with a recombinant tissue plasminogen activator at different time windows on acute ischemic stroke in patients / 中国基层医药

Objective:To investigate the clinical efficacy of intravenous thrombolysis with a recombinant tissue plasminogen activator at different time windows on acute ischemic stroke in patients.Methods:A total of 172 patients with acute ischemic stroke who received treatment in Lishui Municipal Central Hospital from January 2019 to December 2021 were included in this study. They were divided into observation (onset to admission < 3 hours, n = 86) and control (onset to admission = 3-4.5 hours, n = 86) groups according to the time from onset to admission. Clinical efficacy, coagulation indexes, the National Institutes of Health Stroke Scale score, and the modified Rankin Scale score were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [89.54% (77/86) vs. 75.58% (65/86), χ2 = 4.89, P < 0.05]. After treatment, fibrinogen, low whole blood viscosity, and plasma viscosity in the observation group were (2.55 ± 0.62) g/L, (9.68 ± 1.37) mPa·s, (1.45 ± 0.17) mPa·s, respectively, which were significantly higher than (1.53 ± 0.58) g/L, (9.19 ± 1.46) mPa·s, (1.32 ± 0.15) mPa·s in the control group ( t = -11.14, -2.27, -5.32, all P < 0.05). Antithrombin III level in the observation group was significantly lower than that in the control group [(91.65 ± 7.23)% vs. (97.74 ± 6.82)%, t = 5.68, P < 0.05]. At 2 hours, 1 day, and 2 weeks after thrombolysis, the National Institutes of Health Stroke Scale scores in the observation group were (2.49 ± 0.31) points, (1.98 ± 0.24) points, (1.79 ± 0.05) points, which were significantly lower than (3.32 ± 1.08) points, (2.69 ± 0.35) points, (2.18 ± 0.21) points in the control group ( t = 6.85, 15.52, 16.75, all P < 0.001). After treatment, the modified Rankin Scale score in the observation group was significantly lower than that in the control group [(2.01 ± 0.79) points vs. (2.88 ± 0.64) points, t = 7.94, P < 0.001]. Conclusion:Intravenous thrombolysis with a recombinant tissue plasminogen activator within 4.5 hours after onset exhibits good therapeutic efficacy in patients with acute ischemic stroke. Earlier thrombolysis leads to better therapeutic efficacy and prognosis.

Efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss / 中国基层医药

Objective:To investigate the efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss. Methods:A total of 120 patients with sudden hearing loss who received treatment in the Department of Otolaryngology, Mingzhou Hospital between January 2017 and January 2020 were included in this study. They were divided into intratympanic injection group (intratympanic injection of prednisolone acetate, n = 60) and intravenous injection group (intravenous injection of prednisolone acetate, n = 60) according to route of drug administration. After 8 days of treatment, clinical efficacy was compared between the two groups. The hearing thresholds at 500 Hz and 1 000 Hz in both groups were detected using pure tone audiometry. The levels of procalcitonin and high-sensitivity C-reactive protein and adverse drug reactions were compared between the two groups. Results:After treatment, total response rate in the intratympanic injection group was significantly higher than that in the intravenous injection group (93.33% vs. 80.00%, χ2 = 4.61, P < 0.05). The hearing threshold at 500 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(38.69 ± 3.56) vs. (42.36 ± 4.36), t = 5.05, P < 0.001). The hearing threshold at 1 000 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(32.36 ± 3.36) vs. (40.15 ± 4.12), t = 11.35, P < 0.001). After treatment, procalcitonin level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(0.65 ± 0.12) μg/L vs. (0.98 ± 0.15) μg/L, t = 13.30, P < 0.001)]. High-sensitivity C-reactive protein level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(3.28 ± 0.36) mg/L vs. (5.26 ± 0.56) mg/L, t = 23.03, P < 0.001]. There was no significant difference in incidence of adverse reactions between intratympanic injection and intravenous injection groups (8.33% vs. 10.00%, χ2 = 0.10, P > 0.05). Conclusion:Compared with intravenous drip of prednisolone acetate, intratympanic injection of prednisolone acetate can improve the clinical symptoms of patients with sudden hearing loss and enhance clinical efficacy.

Práticas de medicações injetáveis: conduta referida de profissionais de enfermagem / Prácticas de medicaciones inyectables: conducta referida de los profesionales de enfermería / Injectable medications: self-reported practices of nursing professionals

RESUMO Objetivo: Identificar a conduta referida de profissionais da enfermagem, do estado de São Paulo, sobre Práticas de Medicações Injetáveis. Método: Estudo tipo survey que identificou a frequência referida sobre Práticas de Medicações Injetáveis mediante resposta de questionário eletrônico, validado, entre setembro e dezembro de 2017. Resultados: Considerando as 1.295 respostas computadas, foram identificadas inconformidades como compartilhamento de frascos multidoses para dois ou mais pacientes (10,8%), reutilização de insumos de uso único, como seringas para salinização de pacientes diferentes (1,2%) e reencape de agulhas após uso (4,9%). Foram referidas maior adesão ao uso de luvas para administração de injeções endovenosas (80,5%) e falta de treinamento para manipulação de dispositivos de segurança (13%). Dados correlacionais apontaram que, quanto maior a idade, melhor era a conduta referida na prática de injetáveis. Conclusão: Embora a maioria das condutas configure-se dentro das Boas Práticas de Medicações Injetáveis, há relatos de práticas de risco, como compartilhamento de insumos de uso único. O treinamento para uso de dispositivos de segurança ainda não é uma realidade para todos os profissionais, visto que muitos o referiram como raro.

RESUMEN Objetivo: Identificar la conducta de profesionales de enfermería del estado de São Paulo sobre Prácticas de Medicaciones Inyectables. Método: Se trata de un estudio tipo survey, el cual identificó la frecuencia de Prácticas de Medicaciones Inyectables mediante respuesta de un cuestionario electrónico, validado entre septiembre y diciembre de 2017. Resultados: Teniendo en cuenta las 1.295 respuestas computadas, se identificaron inconformidades como el uso de frascos de dosis múltiples para dos o más pacientes (10,8%), la reutilización de insumos de un solo uso, como jeringas para la salinización de diferentes pacientes (1,2%) y el reencapuchado de agujas después de su uso (4,9%). Sobresalió la adhesión al uso de guantes para las inyecciones intravenosas (80,5%) y la falta de capacitación sobre la manipulación de dispositivos de seguridad (13%). Los datos correlativos señalaron que, a mayor edad, mejor la conducta referida en la práctica de los inyectables. Conclusión: Aunque la mayoría de las conductas se configuran dentro de las Buenas Prácticas de Medicaciones Inyectables, se informa sobre la existencia de prácticas de riesgo, como el compartir insumos de un solo uso. La capacitación en el uso de dispositivos de seguridad aún no es una realidad para todos los profesionales y muchos han declarado que raramente se los entrena en esa área.

ABSTRACT Objective: To identify the self-reported injectable medications of nursing professionals in the state of São Paulo. Method: Survey study that assessed the self-reported frequency of injection medications through a validated electronic questionnaire, applied from September to December 2017. Results: The 1,295 computed responses showed non-compliances such as sharing multidose vials for two or more patients (10.8%), reusing single-use supplies, such as use of saline flush syringes for different patients (1.2%) and needle recapping after use (4.9%). Greater adherence to glove use for administration of intravenous injections (80.5%) and lack of training for handling safety devices (13%) were reported. Correlational data showed that, the older the age, the better the self-reported injecting practices. Conclusion: Although most practices are within Safe Injecting practices, there are reports of risky practices, such as sharing single-use supplies. Training for the use of safety devices is not yet a reality for all professionals, since many reported it as rare.

Risk factors and predictive model of hemorrhage transformation after thrombolysis in cerebral infarction / 中国医师杂志

Objective This study aims to explore the risk factors of hemorrhagic transformation (HT),and compare the predictive ability of different predictive models.Methods Retrospective analysis of clinical data of patients with intravenous thrombolysis in our hospital from June 2015 to June 2018.The risk factors were statistically analyzed.The results were fitted into a new predictive model named MODEL.The area under receiver operating characteristic (ROC) curve was used to compare the predictive ability of the MODEL and some traditional methods including the Multicenter Stroke Survey (MSS),and the Totaled Health Risks In Vascular Events Score (THRIVE),and the Glucose at presentation,Race,Age,Sex,systolic blood Pressure at presentation,Severity of stroke at presentation (GRASPS) to HT.Results The results of single factor analysis showed that there were significant differences in the history of hypertension,the history of atrial fibrillation,the systolic pressure before thrombolysis,the National Institute of Health Stroke Scale (NIHSS) score before thrombolysis,the level of plasma total cholesterol (TG),low density lipoprotein cholesterol (LDL-C),apolipoprotein B (Apo B),D dimer (DD),and the platelet distribution width and the sodium ion.Multivariate logistic regression analysis confirmed that the NIHSS score before thrombolysis,the level of plasma LDL-C and DD were independent risk factors for HT.The formation of a new predictive model was logi(p) =0.21 +0.99 × NIHSSscore-0.834 × LDL-C +0.002 × DD,which was defined as predictive mode of MODEL.The four predictive models all had predictive effects on HT.Z test results showed that,compared with the GRASPS,the MODEL and MSS showed a higher predictive power.Conclusions The NIHSS score before thrombolysis,and the level of plasma LDL-C,and DD were independent risk factors for HT after intravenous thrombolysis.MODEL and MSS had better predictive performance.

Clinical study of Arteriovenous needle used in rescuing patients with hemorrhagic shock / 中国基层医药

Objective To evaluate the clinical value of subclavian vein puncture with 16 G arteriovenous indwelling needle for emergency treatment of hemorrhagic shock,so as to provide a new approach for the rapid establishment of deep venous passage.Methods 80 patients with acute hemorrhagic shock were randomly divided into patients with arteriovenous indwelling needle group (catheter group) and conventional guide wire deep vein puncture group(routine puncture group),40 cases in each group.The two groups were treated with supraclavicular subclavian vein puncture.The operation time,success rate of the first puncture,puncture times and rehydration rate,incidence of complications were observed in the two groups.Results The operation time of indwelling needle group was (62 ±22)s,which was significantly shorter than (672 ± 178)s of the conventional puncture group,there was significant difference between the two groups (t =15.062,P =0.000).The first time success rate of puncture in the indwelling needle group was 70％ (28 cases),which in the conventional group was 80％ (32 cases),the difference was not statistically significant(x2 =1.067,P =0.439),all patients were in 3 attempts in successful puncture.The velocity of infusion of 500 mL hydroxyethyl starch in the indwelling needle group was (198 ± 51)s,which was better than (456 ± 86)s in the conventional puncture group,the difference between the two groups was statistically significant (t =9.318,P =0.000).The two groups had no deep vein puncture related complications.Conclusion Arteriovenous indwelling needle by supraclavicular subclavian vein puncture with conventional guide wire supraclavicular subclavian vein puncture catheter can be used for emergency treatment of hemorrhagic shock,but the indwelling needle group in the operation time and velocity is superior to conventional guide wire group,more suitable for the rescue of patients with acute hemorrhagic shock time is pressing,stay with stable circulation can be through the guide wire inserted catheter indwelling subclavian vein catheter.

Comparative study of recent adverse reactions caused by 131I-Metuximab treatment of advanced hepatic celluler cancer via two different routes / 中华核医学与分子影像杂志

Objective To compare the recent adverse reactions caused by 131I-Metuximab (licartin) treatment via two different routes and to assess the safety and advantages of peripheral intravenous bolus of licartin for the treatment of advanced HCC.Methods Clinical data of 54 patients (45 males,9 females,age 33-80 years) with advanced HCC treated with Licartin in Tianjin Medical University Cancer Institute and Hospital from October 2010 to March 2013 were collected and analyzed.The patients were divided into vein group (n=33) with Licartin injected through peripheral vein and artery group (n =21) with Licartin injected through hepatic artery.The results of blood routine examination,liver and kidney function and thyroid function between the two groups (1 week before treatment,4 and 12 weeks after treatment) were compared.The adverse reaction rate (ARR) and adverse reaction progression rate (ARPR) were also compared between the 2 groups.Ten days after Licartin treatment,all patients underwent gamma imaging to access the drug distribution in vivo.x2 test and two-sample t test were used to analyze data.Results There were no significant differences on age,gender and TNM staging between the vein group and the artery group (t =0.721,x2=0.561 and 4.769,all P＞0.05).The vein group showed temporary drug-related leucopenia (x2=7.041,P＜0.05) and increased level of serum total bilirubin (STB;x2 =10.297,P＜0.05) 4 weeks post-treatment.Twelve weeks later,the above parameters returned to baseline.In artery group,no influence on liver and kidney functions was observed,but the numbers of WBC and PLT decreased significantly (x2 =8.949 and 8.778,both P＜0.05) and returned to baseline 12 weeks post-treatment.The ARR in patients who had normal ALT levels before treatment between the two groups was significantly different(3.33％(1/30) vs 5/19,x2=5.718,P＜0.05).No significant difference was observed on ARR in patients with normal level of other parameters,and on ARPR in patients with abnormal preoperative parameters between the two groups (x2 =0.000-2.500,all P＞0.05).The drug's in vivo biodistribution and the thyroid function between the 2 groups showed no significant difference.Conclusion The peripheral intravenous bolus administration of Licartin is safe to treat patients with advanced HCC.

Transplantation of human umbilical cord derived-mesenchymal stem cells by different ways for the treatment of spinal cord injury / 中国组织工程研究

BACKGROUND:Currently, human umbilical cord derived-mesenchymal stem cel s are mainly for local transplantation, which has some shortcomings, such as large trauma, bleeding, complications, that limit its widespread application in clinical practice. OBJECTIVE:To investigate the feasibility of intravenous transplantation of human umbilical cord derived-mesenchymal stem cel s for repair of spinal cord injury. METHODS:Eighty Wistar rats with spinal cord hitting were divided into five groups:blank control group with no transplantation (n=10), DMEM local transplantation group (n=15), DMEM intravenous transplantation group (n=15), cel local transplantation group (n=20), cel intravenous transplantation group (n=20). The functional recovery of spinal cord injury was observed with Basso, Beattie and Bresnahan scores at regular time as wel as hematoxylin-eosin staining and immunohistochemistry staining. RESULTS AND CONCLUSION:During 1 day to 2 weeks after transplantation, there was no significant difference in the Basso, Beattie and Bresnahan scores between the five groups;within 4-12 weeks after transplantation, the Basso, Beattie and Bresnahan scores were significantly higher in the two cel transplantation groups than the other three groups, but there was no difference between these two cel transplantation groups (P>0.05). Histological observation showed that the number of voids and glial scars was less in the cel local transplantation group and cel intravenous transplantation group compared with the other three groups, and there was also no difference between the two cel transplantation groups. These results indicate that the intravenous transplantation of human umbilical cord derived-mesenchymal stem cel s is similar to the local transplantation in the repair of acute spinal cord injury, which is simple and avoids secondary injuries and various complications. It is recommended that this method provide a new approach for cel transplantation.

The effects of a single IV lidocaine bolus dose on the minimal alveolar concentration of sevoflurane / 天津医药

Objective To evaluate the effects of a single IV lidocaine bolus dose on the minimal alveolar concentration (MAC)of sevoflurane. Methods Patients (n=90), aged 25-65 years whose Anesthesiologists (ASA) classification wasⅠorⅡand underwent elective surgery on trunk under general anesthesia, were randomly divided into 3 groups with 30 cases in each group:high-dose lidocaine group (group H), low-dose lidocaine group (group L) and control group (group C). They were induced by sevoflurane inhalation, and ventilated by LMA (laryngeal mask airway). After a 15 minutes equilibration period with the above sevoflurane concentration , the medication to be studied (2%lidocaine 1.5 mg/kg for group H , 2%lidocaine 0.75 mg/kg for group L, 0.9%saline 5mL for group C) was administered for 3 minutes before the skin incision. The response to skin incision (movement versus no movement) was recorded in the first minute after skin incision. The MAC for sevoflu?rane was determined using the Dixon′s up and down method. Values of mean arterial pressure (MAP), heart rate (HR), and BIS were recorded at 1 minute and 5 minutes after being monitored (average values were noted as T0), immediately before the administration of medication (T1), immediately before the skin incision (T2) and 1 minute after the skin incision(T3). Results MAC in group H (2.00%± 0.17%) was lower than that in group C (2.22%± 0.18%) by approximately 0.22%,and which was lower than that of group L ( 2.21%± 0.14%) by approximately 0.21%(F=7.054,P<0.05). No significant differ?ence in the MAC of sevoflurane was noted between group L and group C. The values of HR, MAP and BIS all decreased at T 2 and increased at T3 in all 3 groups (all P<0.05). No significant difference in HR, MAP or BIS was observed between T0 and T1 in all three groups. The values of HR and BIS were lower in group H than those in group C and group L at T2 and T3. The values of MAP were lower in group L and group H than those in group C at T2 and T3. The value of MAP were lower in group H than that in group L at T2(all P<0.05). Conclusion A singleⅣ1.5 mg/kg lidocaine decreases MAC of sevoflurane, but the decreased amplitude (11%) does not reach expectation.

Tracking Intravenous Adipose-Derived Mesenchymal Stem Cells in a Model of Elastase-Induced Emphysema / 결핵및호흡기질환

BACKGROUND: Mesenchymal stem cells (MSCs) obtained from bone marrow or adipose tissue can successfully repair emphysematous animal lungs, which is a characteristic of chronic obstructive pulmonary disease. Here, we describe the cellular distribution of MSCs that were intravenously injected into mice with elastase-induced emphysema. The distributions were also compared to the distributions in control mice without emphysema. METHODS: We used fluorescence optical imaging with quantum dots (QDs) to track intravenously injected MSCs. In addition, we used a human Alu sequence-based real-time polymerase chain reaction method to assess the lungs, liver, kidney, and spleen in mice with elastase-induced emphysema and control mice at 1, 4, 24, 72, and 168 hours after MSCs injection. RESULTS: The injected MSCs were detected with QD fluorescence at 1- and 4-hour postinjection, and the human Alu sequence was detected at 1-, 4- and 24-hour postinjection in control mice (lungs only). Injected MSCs remained more in mice with elastase-induced emphysema at 1, 4, and 24 hours after MSCs injection than the control lungs without emphysema. CONCLUSION: In conclusion, our results show that injected MSCs were observed at 1 and 4 hours post injection and more MSCs remain in lungs with emphysema.

Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes / Frequência de medo de agulhas e impacto de uma abordagem educacional multidisciplinar em gestantes com diabetes

PURPOSE: To evaluate the frequency of fear of needles and the impact of a multidisciplinary educational program in women with pre-gestational and gestational diabetes taking insulin during pregnancy. METHODS: The short Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), composed by two subscales that access fear of self injection (FSI) and fear of self testing (FST), was administered twice during pregnancy to 65 pregnant women with pre-gestational and gestational diabetes: at the first endocrine consult and within the last two weeks of pregnancy or postpartum. An organized multidisciplinary program provided diabetes education during pregnancy. Statistical analysis was carried out by Wilcoxon and McNemar tests and Spearman correlation. A p<0.05 was considered to be significant. RESULTS: Data from the short D-FISQ questionnaire shows that 43.1% of pregnant women were afraid of needles in the first evaluation. There was a significant reduction in scores for FSI and FST subscales between the first and second assessments (first FSI 38.5% compared with second 12.7%, p=0.001; first FST 27.7% compared with second FST 14.3%, p=0.012). CONCLUSIONS: The fear of needles is common in pregnant women on insulin therapy and an organized multidisciplinary educational diabetes program applied during pregnancy reduces scores of such fear.

OBJETIVO: Avaliar a frequência do medo de agulhas e o impacto de um programa educacional multidisciplinar em mulheres com diabetes pré-gestacional e gestacional em uso de insulinas durante a gravidez. MÉTODOS: O questionário Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ) resumido, composto por duas subescalas que acessam o medo de injeções (FSI) e o medo da automonitoração (FST), foi administrado duas vezes durante a gestação de 65 mulheres com diabetes pré-gestacional e gestacional: na primeira consulta endocrinológica e dentro das últimas duas semanas de gestação ou pós-parto. Durante a gravidez, as gestantes foram submetidas a um programa multidisciplinar sistematizado para prover educação em diabetes. A análise estatística foi realizada por meio dos testes de Wilcoxon e McNemar e a correlação de Spearman. Valor p<0,05 foi considerado como significativo. RESULTADOS: A aplicação do questionário D-FISQ resumido indicou que 43,1% das gestantes apresentavam medo de agulhas na primeira avaliação. Houve significativa redução nos escores das subescalas FSI e FST entre a primeira e segunda avaliação (primeiro FSI 38,5% comparado com o segundo 12,7%, p=0,001; primeiro FST 27,7% comparado com segundo FST 14,3%, p=0,012). CONCLUSÃO: O medo de agulhas é frequente em gestantes em uso de terapia com insulina, e um organizado programa multidisciplinar educacional em diabetes aplicado durante a gestação reduz os escores do medo.

Effects of different methods of administration on clinical pharmacodynamics of cisatracurium during liver transplantation / 中华麻醉学杂志

Objective To evaluate the effects of different methods of administration on clinical pharmacodynamics of cisatracurium during liver transplantation.Methods Twenty-four ASA physical status Ⅲ patients of both sexes,aged 18-63 yr,weighing 60-88 kg,with body mass index of 20-30 kg/m2,scheduled for elective liver transplantation,were randomly divided into 2 groups (n =12 each):continuous infusion group (group C) and intermittent bolus injection group (group Ⅰ).The total intravenous anesthesia was used during surgery.When T1 recovered to 10％ of control height after induction of anesthesia,continuous infusion of cisatracurium was started with an initial rate of 1.5 μg· kg-1 · min-1,and the infusion rate was manually adjusted to maintain T1 at about 10％ in group C,and intermittent iv boluses of cisatracurium 0.03 mg/kg were given to maintain T1 ≤ 10％ in group Ⅰ.The use of muscle relaxants was stopped immediately after peritoneum closure.The consumption of cisatracurium per minute,time for T1 to recover from 10％ to 25％,recovery index and time for recovery of spontaneous breathing after surgery were recorded.Results Compared with group Ⅰ,the consumption of cisatracurium per minute was significantly reduced and the time for recovery of spontaneous breathing after surgery was shortened (P ＜ 0.05),and no significant changes were found in the time for T1 to recover from 10％ to 25％ and recovery index in group C (P ＞ 0.05).Conclusion Compared with intermittent bolus injection,continuous infusion of cisatracurium during liver transplantation is helpful in improving the clinical potency of the muscle relaxant and in reducing the occurrence of complications during anesthesia recovery period.

The serum sFas level changes of intravenous immunoglobulin treatment of incomplete Kawasaki disease / 中国医师杂志

Objective To observe the changing levels of serum sFas before and after intravenous i mmunoglobulin (IVIG) treatment of incomplete Kawasaki disease (IKD),to explore the roles of sFas in the pathogenesis of IKD and IVIG treatment mechanism.Methods Thirty eight cases of IKD children were selected as experimental group and 20 examples of the same age of children as the control group.The IKD children were treated by IVIG in combination with aspirin (ASP) ; and blood test was performed before treatment,3 days after treatment,and 14 days after treatment,respectively.Dual-resistant sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum sFas,plasma Fibrinogen (PT-D),d-dimer (D-D),and c-reactive protein (CRP).Results The levels of serum sFas,PT-D,D-D,and CRP were significantly higher than the control group for IKD children before treatment[(0.55 ± 0.14)ng/L vs (0.24 ±0.04) ng/L,(552.3 ± 147.2) mg/dl vs (277.3 ±82.5)mg/dl,(649.0 ±201.6) μg/L vs (315.4 ±91.8)μg/L,and(72.2 ±28.7)mg/L vs (7.2 ±2.9)mg/L; t' =12.41,9.11,8.64,13.82;All P ＜ 0.05] ;3 days after treatment,compared with those before treatment and control group,the sFas level of IKD children at the third day after treatment was significantly decreased compared to that before treatment and control groups,respectively [(0.43 ± 0.09) ng/L vs (0.55 ± 0.14) ng/L,(0.24 ± 0.04) ng/L,F =47.624,All P ＜0.05] ;For the level of sFas at the 14th day after treatment,no statistical significance was found between IKD children and the control group[(0.24 ±0.05) ng/L vs (0.24 ±0.04) ng/L,t =0.596,P ＞ 0.05].Conclusions The abnormally increased serum sFas level before IVIG treatment suggests that dysfunction of apoptosis be involved in the pathogenesis of the IKD.Intravenous immunoglobulin treatment may be involved in the apoptosis process.

Hand contracture due to extravasation injury from peripheral intravenous therapy in children / 中华骨科杂志

Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.

Anafilaxia com convulsões após angiografia com fluoresceína em paciente ambulatorial / Anaphylaxis with convulsions following intravenous fluorescein angiography at an outpatient clinic

A fluoresceína endovenosa é associada a pequenos efeitos adversos durante a angiografia da retina, a maioria deles sem gravidade e não relacionada a mecanismos imunológicos. Entretanto, em raras ocasiões, pode ocorrer reação anafilactoide; fatalidades envolvendo o uso de fluoresceína têm sido descritas. Complicações graves após injeção endovenosa de fluoresceína requerem ação imediata da equipe envolvida, assim como treinamento regular para padronizar o tratamento.

Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.

Comparison of acute Mycobacterium tuberculosis infection mouse models established by different infection routes / 中华传染病杂志

ObjectiveTo compare three types of acute Mycobacterium tuberculosis infection mouse models established through different infection routes and to set up the theoretical basis for further developing,selecting and applying these animal model in the tuberculosis-related research.MethodsStandard strain of Tubercle bacillus H37Rv was diluted to 1 × 106 colony forming unit (cfu)/mL.The mice were infected with the bacteria through different routes including intravenous injection,intranasal administration and inhalation of bacteria aerosol.Six weeks after the infection,the mice were euthaniz ed and necropsied. The lung tissues were collected and gross changes were observed.The colony counting was performed and the lung tissues were assessed by HE staining,acid fast staining.The e xpression level of tumor necrosis factor (TNF)-α per unit area in lung tissue was detected by immunohistochemistry. The data were analyzed by t test. Results The amounts of Mycobacterium tuberculosis in lung tissues of mice in inhalation group,intranasal administration group and intravenous injection group were (6.290±0.028),(6.150±0.021) and (6.120±0.008) lg cfu/mL,respectively; while no Mycobacterium tuberculosis was detected in control group. The difference between infection group and control group was statistically significant (t =3.762,P＜0.01),while there were no significant differences among infection groups with different infection routes (P＞0.05).According to the results of gross observations and histological assessment,the pathological changes were observed and red tubercle bacillus was detected by acid-fast staining in the lung tissues of all the mice in infection group.The results of immunohistochemistry showed that the expression levels of TNF-α per unit area were as follows:intravenous injection group (0.049 × 106 )＜intranasal administration group(0.759×106) ＜ inhalationgroup(1.042×106), whichwere statistically different (t =2.504,P＜ 0.05).ConclusionInhalation of bacteria aerosol may be the most efficient method to establish tuberculosis infection mouse model compared to intravenous injection and intranasal administration.

Estudo de toxicidade retiniana após injeções intravítreas seriadas de infliximabe em olhos de coelhos / A safety study of retinal toxicity after serial intravitreal injections of infliximab in rabbits eyes

OBJETIVO: Determinar os níveis de toxicidade de duas e três aplicações intravítreas de infliximabe na retina de coelhos albinos, por meio de exames clínicos oftalmológicos, eletrorretinográficos e histológicos. MÉTODOS: Foram utilizados doze coelhos albinos divididos em dois grupos. No primeiro grupo de 10 coelhos, cada olho recebeu duas (n=10 olhos) ou três injeções (n=10 olhos) intravítreas de 2 mg de infliximabe dissolvidos em 0,06 ml de solução salina, em intervalos mensais. Um segundo grupo de dois coelhos, que serviu como grupo controle (n=4 olhos), foram submetidos a duas e três aplicações intravítreas de BSS. Noventa dias após, os coelhos foram novamente submetidos a exame oftalmológico (biomicroscopia, oftalmoscopia e tonometria), eletrorretinográfico e, após enucleados, a exame histológico. RESULTADOS: O exame biomicroscópico e oftalmoscópico não revelou anormalidades retinianas nos olhos injetados com infliximabe e no grupo controle. Alteração histológica notada foi a presença de raros linfócitos e eosinófilos no vítreo posterior em quatro e em seis olhos submetidos a duas e três aplicações de infliximabe sem significado clínico. A única alteração clinicamente significante foi uma reação inflamatória severa com presença de exsudatos vítreos na interface vítreo retiniana e discreto edema de células ganglionares nos dois olhos de um único coelho, sem alterações no vítreo posterior. Os exames eletrorretinográficos mostraram amplitudes em média 12-13 por cento menores daquelas obtidas antes do tratamento, contudo não houve nenhuma diferença estatisticamente significante quando comparamos as amplitudes e a latencia entre os achados electrorretinográficos pré e pós-tratamento. CONCLUSÃO: Duas e três aplicações intravítreas de infliximabe em olhos de coelhos em intervalos mensais, na dosagem de 2 mg, não provocam alterações significantes após um seguimento de noventa dias, quer no exame histológico, na eletrorretinografia e na avaliação clínica oftalmológica. Conclui-se que doses seriadas de infliximabe por via intravítrea é um procedimento seguro. Estudos clínicos em humanos devem ser realizados para melhor avaliação da segurança do seu uso no tratamento de determinadas doenças que acometem a retina e a coroide.

PURPOSE: To determine retinal and choroid toxicity levels of two and three infliximab intravitreous injections in albino rabbits by means of electroretinographic, histological and ophthalmological clinical tests. METHODS: 12 albino rabbits were used in the study. Each eye was given two (n=10 eyes) or three (n=10 eyes) serial intravitreous 2 mg infliximab injections dissolved in 0.06 ml of saline, at monthly intervals. A separate group of rabbits (n=4 eyes) served as a control group. Ninety days after the study had begun, the rabbits underwent clinical and electroretinographic tests, and after being enucleated, the eyes were examined for histological changes. RESULTS: Slit-lamp biomicroscopy and fundoscopic examination did not reveal any significant retinal abnormalities in the eyes injected with infliximab and control eyes or in pre- and post-treated eyes. The histological change that was noted was the presence of rare lymphocytes and eosinophils in the posterior vitreous of some of the rabbits subjected to two or three injections, but it was not considered clinically significant. A severe inflammatory reaction with vitreous exudates and ganglion cell edema in a single rabbit was clinically significant. The electroretinographic tests showed amplitudes that were on the average 12-13 percent smaller than those obtained before the treatment, however, there were no statistically significant differences when comparing the amplitude or the implicit time between pre- and post-treatment electroretinographic findings. CONCLUSION: Two and three intravitreous 2 mg infliximab injections in rabbits at monthly intervals did not cause any changes after a 90-day follow-up, according to histological and electroretinographic tests and after clinical evaluation. Differently from prior studies that have investigated potential retinotoxicity effects after single administrations, this study investigated the possibility of retinotoxicity after multiple injections. Clinical studies in humans should be conducted to better evaluate the safety of this drug in the treatment of certain diseases affecting the retina and the choroid.

Comparison of neuromuscular blocking effects of rocuronium given by different methods of administration during liver transplantation / 中华麻醉学杂志

Objective To compare the neuromuscular blocking effects of rocuronium given by intermittent bolus injection, continuous infusion and target-controlled infusion during liver transplantation. Methods Thirty-six patients with hepatic failure of both sexes aged 21-63 yr weighing 48-80 kg undergoing liver transplantation were studied. The donor livers were obtained from living donors. The patients were divided into 3 groups according to the mode of rocuronium administration ( n = 12 each): group Ⅰ intermittent bolus injection (group Ⅳ); group Ⅱ continuous infusion (group CI) and group Ⅲ target-controlled infusion (group TCI). Neuromuscular block was assessed by TOF stimulation of ulnar nerve (TOF-Watch SX). Anesthesia was induced with midazolam 5 mg,fentanyl 4-6 μg/kg and propofol 1.0-1.5 mg/kg, and rocuronium was administered using different modes of administration. A bolus of rocuronium 0.6 mg/kg was given during induction and supplemental rocuronium 0.15 mg/kg was given when T1 was returned to 25% in preanhepatic stage and T4/T1 (TOFR) returned to 25% in anhepatic and neohepatic stages in group Ⅳ. TCI at an initial target effect-site concentration of 3 μg/ml was started during induction, the concentration was adjusted to maintain T1 at 5%-10% , TCI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then TCI at a target effect-site concentration of 0.1 μg/ml was started again and the concentration was adjusted to maintain T1 at 5%-10% in group TCI. A bolus of rocuronium 0.6 mg/kg was given during induction, the initial infusion rate was set at 30 μg· kg-1 ·min-1 and then adjusted to maintain T1 at 5%-10% in preanhepatic stage, CI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then it was started again at 1 μg· kg-1 · min-1 in preanhepatic stage and the infusion rate was adjusted to maintain T1 at 5%-10% in group CI. Tracheal intubation was performed when the maximal effect was achieved. The administration was stopped after suture of the peritoneum. The onset time, the maximal depression of T1 , intubation condition, recovery time and the total amount of rocuronium consumed were recorded.Results There was no significant difference in onset time, the maximal depression of T1, intubation condition,ecovery time and the total amount of rocuronium consumed among the 3 groups ( P ＞ 0.05). Conclusion There is no significant difference in the onset and recovery when neuromuscular blocade was induced by rocuronium via Ⅳ, CI and TCI, but neuromuscular blockade induced by rocuronium via TCI and CI is more stable than that induced by rocuronium via Ⅳ during liver transplantation.

Comparison of efficacy of nitroglycerine administered by local application and intravenous injection for uterine relaxation in patients undergoing caesarean section / 中华麻醉学杂志

Objective To compare the efficacy of nitroglycerine administered by local application and intravenous injection for uterine relaxation in patients undergoing caesarean section. Methods Sixty ASA Ⅰ patients, aged 25-35 yr, weighing 60-90 kg, undergoing caesarean section, were randomly allocated into 3 groups ( n = 20 each): control group (group C), intravenous injection group (group I) and local application group (group L). Combined spinal-epidural block was used in the patients. After isolation of uterus, nitroglycerine 0.2 mg was injected intravenously in group Ⅰ and was injected into uterine muscle in group L. The delivery time, blood loss during operation and MAP at the time of uterus incision and 3, 5, 10, 15 and 20 min after uterus incision were recorded. Results Compared with group C, MAP at the time of uterus incision was significantly decreased and the delivery time was significantly shortened in group Ⅰ and L, and the blood loss during operation was significantly increased in group Ⅰ while decreased in group L ( P ＜ 0.05). MAP at the time of uterus incision and 3, 5, and 10 min after uterus incision was significantly increased, the delivery time was significantly shortened, and the blood loss during operation was significantly decreased in group L compared with group Ⅰ ( P ＜ 0.05). Conclusion Local application of nitroglycerine exerts better efficacy than intravenous injection for uterine relaxation in patients undergoing caesarean section.

Therapeutic effect of inhaled aerosolized versus intravenous milrinone on oleic acid-induced acute lung injury in rats / 中华麻醉学杂志

Objective To compare the therapeutic effect of inhaled aerosolized and intravenous milrinone,a phosphodiesterase-3 inhibitor in rats with oleic acid-induced acute lung injury (ALI) .Methods Forty male SD rats weighing 300-350 g were randomly divided into 4 groups (n=10 each) : group Ⅰ normal control: group Ⅱ ALI; group Ⅲ milfinone inhalation and group Ⅳ intravenous milrinone.The animals were anesthetized with intraperitoneal 2% pentobarbital 40 mg/kg,tracheostomized and mechanically ventilated (FiO2 30%,VT 10 ml/kg,RR 80 bpm,I:E=1:2).The chest was opened and the heart was exposed.Pulmonary artery was catheterized via fight ventricle.MAP,CVP,airway pressure and pulmonary artery pressure (PAP) were monitored.ALI was induced with 10% oleic acid 2 ml/kg administered through fight external jugular vein in group Ⅱ,Ⅲ and Ⅳ.In control group 0.1% BSA solution 2 ml/kg was administered iv instead of oleic acid.In group Ⅲ at 30 min after oleic acid administration aerosolized milrinone 1 mg/ml was inhaled 4 times at 60 min interval.Each time milrinone was inhaled for 10 min.In group Ⅳ at 30 min after oleic acid administration a bolus of 10 μg/kg milrinone was given iv followed by 10 min milrinone infusion at 1 μ·kg-1·min-1.The same procedure was repeated 4 times at 60 min interval.MAP and PAP were recorded and blood samples were taken from carotid artery and pulmonary artery for blood gas analysis at the 1st,2nd,3rd and 4th treatment.PaO2/FiO2 and Qs/Qt were calculated.The animals were sacrificed by exsanguination after the 4th treatment.The lungs were removed.The left lung was lavaged.Neutrophil count and protein content in broncho-alveolar lavage fluid (BALF) were determined.W/D lung weight ratio and lung myeloperoxidase (MPO) activity were measured.The uhrastructure of the lung was examined with electron microscope.Results The MAP was significantly lower after oleic acid adminstration in group Ⅳ than in other 3 groups.PaO2/FiO2 was significantly decreased and Qs/Qt increased by iv oleic acid in group Ⅱ ,Ⅲ and Ⅳ.PAP was significantly increased after iv oleic acid in group Ⅱ ,Ⅲ and Ⅳ but was significantly lower in group Ⅲ and Ⅳ than in group Ⅱ .The neutrophil count and total protein content in BALF,W/D ratio and lung MPO activity were significantly increased in group Ⅱ ,Ⅲ and Ⅳ as compared with control group(Ⅰ) and were significantly higher in group Ⅳ than in group Ⅲ.The lung damage induced by oleic acid was less serious in group Ⅲ and Ⅳ than in group Ⅱ .Conclusion Inhaled aerosoLized milrinone has better therapeutic effect than intravenous milrinone in rats with oleic acid-induced ALI and is safer.

Comparison of efficacy and toxicity profile between intraperitoneal and intravenous topotecan in human ovarian cancer xenografts / 北京大学学报(医学版)

Objective:To compare the therapeutic and toxic profile of topotecan given intraperitoneally with intravenously in human ovarian cancer xenografted into athymic nude mice.Methods: Eighty female Balb-c/nu-nu mice were randomized assigned into eight groups (n=10). Xeneografts resulted from intramesentery injection of cultured human ovarian cancer cells SKOV3 in athymic mice. Onset of intraperitoneal treatment with either topotecan or cisplatin (7.5 mg/kg) was on day 7. Animals scheduled for topotecan i.p. received intraperitoneal application of topotecan (1.5 mg/kg×2, 3.0 mg/kg×2, 6.0 mg/kg×2 or 10.0 mg/kg×1). Animals scheduled for topotecan i.v. received intravenous administration of topotecan (6.0 mg/kg×2 or 10.0 mg/kg×1). Two weeks after drug application animals were killed. Tumor growth inhibition were assessed and compared with untreated mice and cisplatin intraperitoneally administered mice. Acute toxicity was determined by loss of body weight. Cell cycle division and apoptosis after drug administration was determined by flow cytometric analysis.Results: In a panel of ten tumour xenografts, intraperitoneal topotecan was significantly more effective than intravenous administration. The toxicity profile suggested a better tolerability in terms of weight loss after intraperitoneal administration than cisplatin control. Topotecan 10.0 mg/kg i.p. per day (1 day) schedule was an optimal treatment for ovarian cancer and well tolerated by mice with no signs of acute toxicity. Topotecan and cisplatin induce cells G0-G1 arrest and apparent apoptosis. No significant difference among mice treated with topotecan intraperitoneally or intravenously or cisplatin was observed in term of apoptosis and cell cycle perturbation.Conclusion:The results may have implications for the future design of clinical studies on intraperitoneal application of topotecan. It suggests that apoptosis and cell cycle perturbation play an limited role in the mechanism of topotecan administration.