RESUMEN
Objective To investigate the relationship of chronic sleep deprivation and high fat diet with laryn-gopharyngeal reflux (LPRD) .Methods A total of 16 rats were randomly divided into the experimental group and control group .Modified multiplatform water surface method and high fat diet (containing 35％ fat) were used in the experimental group rats .The rats in the control group had free sleep and normal feed .The upper gastrointestinal tract pH monitoring with double detectors was used to record the changes of pH in the both rats for 10 hours .The reflux index ,the times of re-flux with pH<4 and the longest duration of reflux were selected and converted into data of 24 hours .The three indexes of the experiment group were compared to those of the control group .Results There was no animal death during the model construction .The rats in the experimental group were irritable .There was no difference of rats weight in both groups before and after the experiment(P>0 .05) .The median of reflux index ,times of reflux with pH<4 and the longest duration of reflux of pharyngeal pH 2 detector in the rats of the experimental group were 21 .07 ,27 .25 and 61 .11 ,respectively .Those of the control group were 1 .25 ,0 .95 and 8 .44 ,respectively .Above three index of the experimental group increased obviously and the difference was statistically significant when compared to those of the control (P<0 .05) .It was suggested that LPRD might appear in the experimental group rats .The median of reflux index and the times of reflux with pH < 4 of esophageal pH1 detector in the rats of the experimental group were 15 .87 and 96 .67 ,displaying an increase when compared to those of the control group (26 .25 and 5 .6) .The differ-ences were statistically significant(P<0 .05);but the median of the longest duration of reflux in pH1 detector of the experimental group rats was 26 .25 ,failing to show statistical difference compared to that of the control group (5 .6) (P>0 .05) .Conclusion Chronic sleep deprivation and high fat diet may play an important role in the pathogenesis of LPRD .This animal model may be a new vector to study LPRD .
RESUMEN
Objective To evaluate the effect of TEG ( thromboelastography ) in the timing choose of CABG( coronary artery bypass grafting ) surgery for patients that receiving DAPT treatment .Methods This study is prospective analysis from November 2013 to May 2014 in Wuhan Asia Heart Hospital.The study cohort consisted of 1 201 patientswith acute coronary syndrome , theage range from 43 to 79 years (61.1 ±10 years) with 134 males and 79 females.and the patients undergo DAPT ( aspirin 100 mg/d, clopidogrel 75 mg/d) which were prepare to the coronary artery bypass grafting and then randomly divided into two groups according to the ratio of 1∶1.There were 101 patients, using perioperative TEG inspection , which conduct the choose of surgery timing according to the ADP-induced platelet-fibrin clot strength ( MAADP) after 24 h of the withdraw of DAPT.Distribute the patients into≥50 mm, 35-50 mm and <35 mm groups according to the MAADPresults, and theirCABG was complete within 1 day, 3-5 days and after 5 days respectively. The other 100 patientsacceptancoronary artery bypass grafting surgery and DAPT patients but without TEG examination as the control group , which were withdrawal the DAPT for 5 -7 days by routine before operation.The primary endpoint is 24 h chest tube drainage andkey secondary endpoint is the total number of transfused red blood cells .Recorded the mean intubation time , ICU stay times , Median length of hospital stayandrethoracotomyrates, 30-day mortality, and 30-day readmission rate at the same time.Using Fisher in the variables , t-test when two groups were compared , use ANCOVA for variable factor correction and Statistical analysis was performed using chi-square test in the calculate of results .Results The average chest drainage in TEG group and the control was 438.8 ml vs 487.8 ml(t=1.063,P=0.289),and the total amount of transfused red blood cell in both groups were 493.8 ml vs 551.6 ml(t=1.228,P=0.2227), there were no significant difference between the two groups .The total waiting time in the three categories of patients in TEG group is 294 days ( an average waiting time of 3.11 days per patient ) and was reduced 38%(3.1 days to 5 days)than the guidelines recommend.Conclusions Although the perioperative bleeding and red blood cell transfusion , the occurrence and postoperative adverse events were similar in two groups , but using thrombelastographto measure platelet function before CABG surgery can help to choose the timing of surgery and reduce the waiting time before surgery .