Efficacy and safety of intraoperative radiotherapy for pancreatic cancer: a meta-analysis / 中华放射肿瘤学杂志

Objective:To compare and analyze the efficacy and safety of intraoperative radiotherapy (IORT) combined with conventional therapy (surgery combined with radiochemotherapy) and conventional therapy alone for pancreatic cancer.Methods:Literature review was conducted from PubMed, Cochrane Library, Web of Science, Embase, Chongqing VIP, CNKI, Wanfang Data and China Biomedical Literature Service System (SinoMed). The literatures that met the inclusion criteria were screened and the data were extracted. Meta-analysis was carried out by RevMan 5.4 software.Results:A total of 11 studies consisting of 813 patients were included. According to the combined results, compared with conventional therapy, IORT combined with conventional therapy could improve the overall survival rate of pancreatic cancer ( HR=0.66, 95% CI=0.54-0.81, Z=4.03, P<0.001), and did not increase the treatment-related side effects ( OR=1.00, 95% CI=0.69-1.46, Z=0.01, P=0.99), but failed to bring benefit to the local control rate ( HR=0.56, 95% CI=0.31-1.01, Z=1.93, P=0.05). Conclusions:The overall survival rate in the IORT combined with conventional therapy group is significantly better than that in the conventional therapy group. No significant difference is found in the treatment-related adverse reactions between two groups. IORT combined with conventional therapy is worthy of clinical application.

Effect of deep learning image reconstruction algorithm on CT image quality and detectability of hypovascular hepatic metastases at low radiation dose levels / 中华放射学杂志

Objective:To investigate the efficiency of deep learning image reconstruction (DLIR) algorithm in the image quality and detection of hypovascular hepatic metastases under low radiation doses in comparison with adaptive statistical iterative construction-V (ASiR-V).Methods:Fifty-six patients with suspected hypovascular hepatic metastases who needed abdominal enhanced CT scans were collected prospectively in the First Affiliated Hospital of Zhengzhou University from January to April 2021. The patients received conventional radiation dose with tube current-time products of 400 mA CT scans in the first venous phase, low-dose CT scans in the second venous phase, which were set as tube current-time products of 280 mA for group A (19 cases), 200 mA for group B (19 cases) and 120 mA for group C (18 case), respectively. The images of first venous phase and 3 groups of second venous phase were both reconstructed with ASiR-V60% and high-DLIR (DLIR-H). Quantitative parameters [image noise, liver and portal vein signal to noise ratio (SNR), contrast to noise ratio (CNR)] and qualitative parameters (overall image quality, lesion conspicuity, diagnostic confidence) were compared between ASiR-V60% and DLIR-H images, and the effective radiation dose (ED) and the lesion detectability of each group was recorded. The paired t test was used to compare quantitative parameters, whereas the Wilcoxon signed-rank test of paired data was used to compare qualitative parameters. Results:In the second venous phase, ED was (5.56±0.35) mSv in group A, (3.88±0.23) mSv in group B, and (2.42±0.23) mSv in group C, with a decrease of 30%, 50% and 70% compared with the first venous phase, respectively. Moreover, with the decrease of radiation dose, the noise gradually increased, and the CNR lesions, SNR liver and SNR portal vein all gradually decreased. DLIR-H images had statistically better quantitative scores than ASiR-V60% images when the same radiation dose was applied (all P<0.001). Furthermore, the qualitative parameters of each group decreased with the decrease of radiation dose. Under the same radiation dose, the overall image quality, lesion conspicuity and diagnostic confidence of DLIR-H were higher than those of ASiR-V60% (all P<0.001). All lesions [100% (84/84)] were detected by ASIR-V60% and DLIR-H in group A, 92.0% (75/81) in group B, and 88.0% (79/89) in group C. Conclusions:Compared with ASiR-V60%, DLIR-H could reduce image noise, improve overall image quality and lesion conspicuity of hypovascular hepatic metastases as well as increase diagnostic confidence under different radiation doses.

Construction of training course for peer lecturer of AIDS prevention driven by empirical value on Moso Teach / 中华医学教育探索杂志

To improve the AIDS's knowledge level and intervention ability of peer lecturers in college, from the accumulation idea and activity type of experience value on Moso Teach, the author carried out systematic resource construction around the course design principles and objectives, at the same time one quantitative scoring system including learning degree and sharing degree was constructed. Through voluntary enrollment and selection among the students, the first group of peer lecturer training on AIDS prevention were set up, and 28 students were collected to experience the "mixed" application of the course. After the evaluation, it was found that there were positive functions in promoting the ability of AIDS prevention in the peer lecturer training course based on experience value of Moso Teach as the driving force and quantification. According to the problems exposed in the construction, the author put forward improvement strategies from the aspects of scoring system, off-line activities and resource optimization.

Prevalence of eating behavior problems among preschool children in rural Hunan and its determinants / 中国学校卫生

Objective@#To understand the prevalence of eating behavior problems among preschool children in rural Hunan, and to explore its determinants, so as to provide a reference for solving their eating behavior problems.@*Methods@#A multistage stratified cluster sampling method was used to randomly select 3 288 preschool children aged 3-6 years and their caregivers from 24 kindergartens between August and November 2019. Eating behavior problems questionnaire survey and peripheral blood hemoglobin detection were conducted among the preschool children, and unconditional Logistic regression model was used to analyze the determinants.@*Results@#The total prevalence of eating behavior problems among preschool children in rural Hunan was 66.8%(2 195/3 288), and the three most common eating behavior problems were poor appetite(40.1%, 1 317/3 288), picky eating(43.6%, 1 434/3 288), poor eating habits(44.4%, 1 460/3 288), respectively. The risk factors for general eating behavior problems included left-behind children, caregiver occupation as professional and technical staffs, average daily static activity time≥3 hours, anemia, and second-hand smoke exposure, and older age and daily moderate/high intensity activities were protective factors. In the analysis of the three most common eating behavior problems: The risk factors for poor appetite included left-behind children, anemia, and second-hand smoke exposure, and daily moderate/high intensity activities was protective factors. The risk factors for picky eating included left-behind children, caregiver occupation as professional and technical staffs, high family income, average daily static activity time≥3 hours, and daily moderate/high intensity activities was protective factors. The risk factors for poor eating habits included left-behind children, caregiver occupation as professional and technical staffs, average daily static activity time≥3 hours, and older age and daily moderate/high intensity activities was protective factors.@*Conclusion@#The prevalence of eating behavior problems among preschool children in rural Hunan was high, which is influenced by age, left-behind, caregivers occupation, family income, activities, anemia, and second-hand smoke exposure.

Characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy after weaning from invasive ventilation in patients of surgical intensive care unit / 中华危重病急救医学

Objective To investigate the characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy (HFNC) after weaning from invasive ventilation. Methods The patients who received sequential HFNC after weaning from invasive ventilation admitted to surgical intensive care unit (ICU) of Peking University People's Hospital from June 1st 2016 to May 31st 2018 were retrospectively analyzed. Clinical variables, respiratory therapy parameters, respiratory variables, cardiac variables and outcomes were reviewed and analyzed. Treatment characteristics of HFNC after weaning was analyzed. Patients were divided into HFNC success group and HFNC failure group according to the failure of HFNC, and the differences between the two groups were compared. The independent risk factors of HFNC treatment failure were analyzed by Logistic regression analysis. The value of predictive treatment failure of risk factors and regression models were analyzed by receiver operating characteristic (ROC) curve. Results A total of 99 patients were included, 61 men, and the median age was 67.0 (57.0, 76.0) years old. The medianinitial HFNC flow was 50 (50, 60) L/min, and inspired oxygen concentration (FiO2) was 0.50 (0.40, 0.60). Eighteen patients experienced HFNC failure (18.2%). Compared with the HFNC success group, the sequential organ failure assessment (SOFA) score in the HFNC failure group was higher [4 (3, 5) vs. 2 (1, 3), P < 0.01], B type natriuretic peptide (BNP) before HFNC therapy were significant higher [ng/L: 647.2 (399.2, 1 331.3) vs. 127.2 (55.2, 369.5), P < 0.01], and respiratory frequency (RR) and heart rate (HR) were significant faster, mean arterial pressure (MAP) was significant higher, oxygen index (PaO2/FiO2) was significant lower after 30 minutes HFNC treatment [RR (times/min): 26 (22, 28) vs. 19 (17, 21), HR (bpm): 105 (97, 107) vs. 85 (77, 90), MAP (mmHg, 1 mmHg = 0.133 kPa): 104.3 (101.7, 110.7) vs. 92.3 (88.3, 97.7), PaO2/FiO2 (mmHg): 207.3 (185.8, 402.8) vs. 320.2 (226.2, 361.5), all P < 0.05]. It was shown by multiple Logistic regression analysis that the SOFA score [odds ratio (OR) = 2.818, P = 0.022, β = 1.036], BNP before HFNC treatment (OR = 1.002, P = 0.033, β = 0.002) and HR after HFNC treatment 30 minutes (OR = 1.140, P = 0.032, β = 0.131) were independent risk factors for HFNC treatment failure. It was shown by ROC curve that the area under the ROC curve (AUC) for the prediction of HFNC failure was 0.840, 0.859, 0.860 and 0.962 for SOFA, BNP before HFNC treatment, HR after HFNC treatment 30 minutes, and regression model, all had good forecast values (all P < 0.01). Conclusions HFNC is one of the commonly used oxygen therapy methods in the ICU, but not all patients who are treated as a sequential therapy after invasive mechanical ventilation weaning can benefit from it. SOFA score, BNP before HFNC treatment and HR after 30 minutes HFNC treatment were independent risk factors of HFNC failure. Each independent risk factor and regression model can predict the success of HFNC treatment.

Thevalueofmonochromaticenergyimagingderivedfrom RevolutionCTindetectingcoronary plaqueswithdifferentconcentrationofcontrastagent:aphantomexperiment / 实用放射学杂志

Objective Toexplorethevalueofmonochromaticenergyimaginggeneratedfrom RevolutionCTindetectingcoronary plaquesindifferentconcentrationsofcontrastagent.Methods Sixtesttubesnumbered3,4,5,6,8and9inthephantom wereselectedand filledupwithdifferentconcentrationsofiodinesolutions(20,10,5,2.5,0,13mgI/mL,respectively),fishbonesimulatingcalcified plaqueandstreakyporksimulatinglipid/fibrousplaque.EachtubeunderwentspectralCTscan(studygroup,70keV monochromatic energyimaging)and120kVpCTscan (controlgroup)respectivelyinRevolutionCT.Theabilityofplaquedetectionwasevaluated subjectively,andfurtheranalysis was madeontheimages withascoregreaterthanorequaltothreepoints.One-way ANOVA and Bonferroni m ethod w ere used to co m pare the C T values and C N R in different tubes in the intra-group co m parison ,w hile paired t test and M ann-W hitney U testwereusedfortheinter-groupcomparison.Results TheoverallimagequalityofNo.4,5and9testtubes inbothgroupsmettheclinicaldiagnosticlevel.Intheintra-groupcomparison,No.5testtubeshowedhigherCNRofcalcifiedplaque andNo.9testtubeshowedhigherCNRoflipidplaqueandfibrousplaquethantheothers(t=4.105-29.214,allP<0.001).Whilein theinter-groupcomparison,thestudygroupshowedsimilarCNRofcalcifiedplaqueinNo.9testtube(t=-1.576,P=0.130)tothecontrol group,andhigherCNRintheothersthanthecontrolgroup(Z=-4.074--3.815,t=-14.782--3.520,allP<0.05).Conclusion Comparedwith120kVpCTimages,monochromaticenergyimagingat70keVfrom RevolutionCTshowedbetteroverallimagequality andcoulddisplaycoronaryplaquesbetterwiththecontrastagent concentrationfrom5mgI/mLto13mgI/mL.

Comparative analysis of two kinds of virtual unenhanced technique of spectral CT and routine plain CT in thorax / 中国医学影像技术

Objective: To investigate image quality of virtual unenhanced images (VUE) and material suppressed iodine images (MSI) compared with true unenhanced images (TUE), and to explore the application value of virtual unenhanced technique in chest CT scanning. Methods: Forty patients underwent conventional unenhanced CT and contrast-enhanced CT with spectral imaging mode, and dual-phase enhanced scanning with GSI Assist mode was performed. VUE based on initial data and MSI based on contrast-enhanced images during arterial phase (AP) and venous phase (VP) were generated, respectively. CT values and standard (SD), CNR of thoracic aorta, pulmonary artery, erector spinae muscle and fat and qualitative visual parameters (image quality as graded on a 5-point scale) were compared. Statistical analysis was performed with One-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H tests. Results: CT value of pulmonary artery and thoracic aorta in AP-MSI were significantly different with those in TUE (both P0.05). Compared with TUE, qualitative visual parameters had no difference with VP-VUE (all P>0.005), which were lower in AP-VUE, AP-MSI and VP-MSI (all P<0.005). The radiation dose reduced by 19.29% with VUE compared with TUE. Conclusion: Using VUE could acquire better image quality than MSI with reducing radiation dose. VP-VUE has similar image quality to TUE, which has potential to replace TUE.

Clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit / 中华危重病急救医学

Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.

Abdominal CT with low radiation dose in obese patients: application of wide-detector helical CT combined with adaptive statistical iterative reconstruction-V (ASIR-V) / 中华放射医学与防护杂志

Objective To investigate the value of wide-detector helical CT combined with adaptive statistical iterative reconstruction-V (ASIR-V) in the low radiation dose CT examination of upper abdomen in obese patients.Methods In the first phantom experiment part,the optimal percentage of pre-and post-ASIR-V of abdominal scanning (120 kVp,NI =10 HU) were explored.The second human experiment was performed based on the phantom study,and our institutional review board approved this prospective study,each participant provided written informed consent.87 obese patients (body mass index,BMI ≥30 kg/m2) underwent contrast-enhanced abdominal CT scan were randomly divided into two scan protocols [protocol A:n =43,120 kVp,detector coverage of 80 mm,40％ pre-ASIR-V (group A1)and combined with 60％ post-ASIR-V (group A2) respectively;protocol B,n =44,120 kVp,detector coverage of 40 mm,40％ ASIR (group B)].Quantitative parameters [image noise and contrast-to-noise ratio (CNR)] and qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared.Weighted effective dose (E) were assessed.Results The optimal percentage of pre-and post-ASIR-V of abdominal scanning were 40％ and 60％,respectively.The effective radiation dose in protocol A [(4.55 ± 0.95) mSv] was decreased for 53％ as compared with protocol B [(9.58 ± 2.04) mSv](t =-14.773,P ＜ 0.001).During the arterial phase and portal venous phase,except for the CNRs of liver,Group A2 showed higher CNRs (q =2.160-3.209,P ＜ 0.05),lower image noise(q =-4.212--3.202,P＜0.05),and higher overall image quality scores(Z =-5.155--2.561,P ＜0.05) as compared with group A1 and group B.Group A1 showed similar CNRs,similar image noise(P ＞ 0.05),and lower overall image quality scores (Z =-3.298--3.030,P ＜ 0.05) than group B.The overall image quality scores in group A were all greater than 3 point and met the clinical diagnostic level.Conclusions Compared with stand-detector helical CT in obese patients,the wide-detector helical CT combined with 40％ pre-ASIR-V could reduce the radiation dose by 53％,and improve overall image quality by combining post-ASIR-V technique.

Optimized combination of pre-and post-adaptive statistical iterative reconstruction-V in low dose abdominal CT scanning / 中国医学影像技术

Objective To observe the impact of adaptive statistical iterative reconstruction-V (ASiR-V) on image quality and radiation dose in abdominal CT imaging,and to optimize combination of pre-and post ASiR-V percentage.Methods Totally 160 patients underwent plain and contrast-enhanced abdominal CT were randomly divided into study group or control group (each n=80).In study group,plain images were reconstructed with 20％ pre ASiR-V combined with 20％,40％,60％ and 80％ post-ASiR-V,the arterial phase images were reconstructed with 40％ pre-ASiR V combined with 40％,60％ and 80％ post-ASiR-V,while the venous phase images with 60％ pre-ASiR-V combined with 60％ and 80％ post-ASiR-V,and the delayed phase images with 80％ pre-ASiR-V combined 80％ post-ASiR-V.In control group,images were reconstructed with filtered back projection (FBP) and 0 pre-ASiR-V combined post-ASiR-V (20％ in plain,40％ in arterial phase,60％ in venous phase and 80％ in delayed phase imaing).The objective parameters (image noise [SD] and CNR) and image quality scores were analyzed and compared.Results CT dose index,dose length product and effective dose of each phase in study group were lower than those in control group (all P＜0.001).In study group,with the increasing of post-ASiR-V percentage,SD values gradually decreased (P＜0.01),and CNR gradually increased or did not change.With the increasing of post-ASiR-V (20％-60％),image quality scores increased,and image quality of 80 ％ post-ASiR-V was low.In study group,image quality of 20％ pre-ASiR-V combined 40％ or 60％ post-ASiR-V was similar to 20％ post-ASiR-V image in control group in plain,and that of 40％ pre-ASiR-V combined 60％ post-ASiR-V was similar to 40％ post-ASiR-V image in control group in arterial phase (all P＞0.05),while image quality scores of other combinations of pre-and post-ASiR-V percentages were lower than those in control group.Conclusion ASiR-V can improve abdominal CT image quality,and 40％ pre-ASiR-V combined 60％ post-ASiR V is recommended.

Cervical pregnancy treated by uterine artery chemoembolization combined with dilatation and curettage / 实用放射学杂志

Objective To evaluate the efficacy and safety of uterine artery chemoembolization(UACE)in conjunction with dilata-tion and curettage in the treatment of cervical pregnancy.Methods UACE was performed in 7 patients with cervical pregnancy,after bilateral uterine artery perfusion of methotrexate,using gelatin sponge for embolization.Dilatation and curettage was carried out within 1 week after the procedure.Results The symptom of vaginal bleeding was effectively controlled after UACE,then dilatation and curettage performed in 6 within 1 week,the blood loss during curettage procedure was 10-30 mL(mean 21 mL).The serumβ-HCG decreased to normal range within 1 week in 1 and 3 weeks in 6 after intervention,average 1 6.4 ± 6.9 days.No serious com-plications occurred and follow up did not show symptoms of premature ovarian failure.Conclusion UACE combined with dilatation and curettage significantly improve the efficacy and safety of the treatment of cervical pregnancy,and avoid serious incident,such as massive hemorrhage and unnecessary resection,the clinical application is safe and effective.

Effects of sevoflurane pretreatment on inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

Objective To investigate the effects of sevoflurane pretreatment on the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) and the mechanism of myocardial protection.Methods Twenty NYHA class Ⅱ or Ⅲ patients of both sexes,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n=10 each): sevoflurane group (group S) and control group (group C).The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam0.03-0.06 mg/kg,fentanyl 5-10μg/kg and pipecuronium 0.04-0.08 mg/kg.Sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly adjusted to 1.0％ and maintained at this level for 30 min in group S.Blood samples were taken from the central vein before skin incision,immediately after aortic clamping,immediately after aortic unclamping and at 30 min after aortic unclamping,at 2,6,12 and 24 h (T1-8) after operation for determination of the concentrations of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL) and interleukin-8 (IL-8),intercellular adhesion molecule-1 (ICAM-1),cardiac troponin I (cTnI) and activity of creatine kinase MB (CK-MB).The requirement for cardiovascular drugs was recorded after release of aortic cross clamp.Results Compared with group C,the plasma concentrations of TNF-α,IL-6 and IL-8 were significantly decreased at T3-8,the plasma concentrations of ICAM-1 and cTnl were significantly decreased at T4-8,the activity of plasma CK-MB was significantly decreased at T8,and the requirement for cardiovascular drugs was significantly reduced after release of aortic cross clamp in group S (P ＜0.05).Conclusion Sevoflurane pretreatment can inhibit the inflammatory response and provide myocardial protection to some extent in patients undergoing cardiac valve replacement with CPB.

Effects of sevoflurane pretreatment on myocardial injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

Objective To investigate the effects of sevoflurane pretreatment on the myocardial injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty NYHA class Ⅱ or Ⅲ patients,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n =10 each):sevoflurane group (group S) and control group (group C).The patients were premeditated with intramuscular morphine and scopolamine.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.Anesthesia was maintained with intermittent iv boluses of midazolam,fentanyl and pipecuronium and in addition sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly increased to 1.0％ and maintained at the level for 5 min in group S.Blood samples were taken from the central vein before skin incision (T1),immediately after aortic clamping (T2 ),at 0 and 30 min after aortic unclamping (T3-4),and at 2,6,12 and 24 h after operation (T5-8) for determination of the concentration of serum cardiac troponin Ⅰ (cTnI) and activities of creatine kinase (CK) and creatine kinase isoenzyme-MB (CK-MB).Myocardial specimens were taken from right auricle before aortic clamping and at 10 min after aortic unclamping for electron microscopic examination.Results The concentration of serum cTnI and activities of CK and CK-MB were significantly increased at T4-8 in both groups ( P ＜ 0.05).The serum cTnI concentration at T4-8 and the activities of CK and CK-MB at T8 were significantly lower in group S than in group C ( P ＜0.05).Different degrees of mitochondrial swelling were observed after aortic unclamping in both groups,but the changes were milder in group S than in group C.Conclusion Sevoflurane pretreatment can attenuate the myocardial injury in patients undergoing cardiac valve replacement with CPB.

Monitoring and evaluating of cerebral state index in the induction of anesthesia with targetcontrolled infusion with propofol and remifentanil / 中国医师进修杂志

ObjectiveTo evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in the induction of anesthesia with target-controlled infusion (TCI) with propofol and remifentanil patients.Methods Forty-four ASA Ⅰ or Ⅱ patients undergoing elective surgery were anesthetized with TCI with propofol and remifentanil.Anesthesia was induced with TCI with remifentanil and propofol.The target effect-site concentration of remifentanil was 4 ng/ml.The initial effect-site concentration of propofol was 1.5 μ g/ml and was increased by0.5 μ g/ml every 4 min,till 1 min after the level of observer’s assessment of alertness sedation (OAA/S) score was 0 score.Electric tetanic stimulation was given when the level of OAA/S score was 1 score.The CSI,mean arterial pressure (MAP),heart rate (HR),OAA/S score and the effect-site concentration of propofol were recorded.ResultsCSI values declined with the decrease of OAA/S score,CSI was 91 ±5,77 ±7,70 ±7,62 ±6,49 ± 12,36 ± 10 at OAA/S score with 5,4,3,2,1score.CSI values were statistically different between 0 score and 1 score,1 score and 2 scores,3 scores and 4 scores,4 scores and 5 scores of OAA/S score(P ＜0.05).The differences of MAP,HR had no statistical significance between two scores of OAA/S score (P ＞0.05).The Spearman rank correlation coefficients between CSI,MAP,HR and OAA/S score were 0.899,0.342,0.125,respectively.The prediction probabilities to differentiate different OAA/S score for CSI,MAP,and HR were 0.89 ± 0.05,0.62 ± 0.08,0.53 ±:0.11,respectively.There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination was 0.812,P ＜ 0.01 ).ConclusionDuring the induction of patients with TCI with propofol and remifentanil,the CSI is accurate as an indicator of awakening and different levels of consciousness after anesthesia,and can reliably predict the anesthesia depth.

Pretreatment with butorphanol to prevent injection pain of rocuronium bromide / 中国医师进修杂志

Objective To evaluate the effect of pretreatment with butorphanol to prevent injection pain of rocuronium bromide.Methods One hundred and fifty ASA Ⅰ-Ⅱ grade patients,undergoing elective surgery were divided into 3 groups by random digits table with 50 cases each.Butorphanol group received butorphanol 2 mg,fentanyl group received fentanyl 100 μg,and control group received 0.9％sodium chloride when general anesthesia induced.Anesthesia was induced with propofol 2 mg/kg and the test drug was injected over 30 s,120 s after the test drug injection,1％ rocuronium bromide 0.6 mg/kg was injected.Nausea,vomiting,apnea and bucking were recorded after drugs injection.Results The rates of rocuronium bromide injection pain in fentanyl group[10％(5/50)]and butorphanol group[8％(4/50)]were significant lower than that in control group[82％(41/50)](P ＜ 0.01).None of the patients discovered nausea,vomiting,apnea and bucking in 3 groups.Conclusion Pretreatment with 2 mg butorphanol reduced the incidence of rocuronium bromide injection pain,furthermore,there is no untoward reaction such as nausea,vomiting,apnea and bucking.

Application of new cleaning process in instruments cleaning by automatic spray cleaning machine / 中国实用护理杂志

Objective To establish an effective cleaning process for automatic spray cleaning machine in case of without water purification system and to reduce the formation of scale on the surface of machine and instruments with increased cleaning degree.Methods Descale process was added to the previons concrete cleaning process.The clean effect Was compared with previous concrete process.The blocking of the pipeline was observed.Results The clean degree by new cleaning process reached 97.23%,which was,better than that of the previous process.The problem of blocking of the pipeline was also solved.Conclusions Addition of descale process when using automatic spray cleaning machine in case of without water purification system could guarantee the clean quality of instruments.

Clinical Pharmacists' Participating in the Management of Clinical Application on Antibacterial Drugs / 中国药房

OBJECTIVE:To provide reference for improving the rational use of antibacterial drugs in hospital.METHODS:Various measures were taken by clinical pharmacists to interfere with the clinical application of antibacterial drugs.RESULTS & CONCLUSIONS:Rational use and standard management of antibacterial drugs in hospital can be achieved by taking a series measures such as enhancing clinical pharmacists' own quality,pharmacists' participating in clinical medication management at the right moment,strengthening cooperation among different departments and bringing pharmacist' specialty advantages into full play.

Some experiences of the on-line application of an out-patient medical workstation / 医学研究生学报

We have developed an out-patient/emergency information system with the collaboration of Haitai Information Technology Co,Lth,and the out-patient medical workstaion have been put into full application.As our main experiences,we think that the on-line application of the workstation should be implemented step-by-step,in coordination with related departments,and with efficient safeguarding.

Feasibility studies on eliminating tumor cells from blood with a leucocyte depletion filter / 解放军医学杂志

Objective To explore and evaluate the efficiency of the leucocyte depletion filter on eliminating tumor cells from blood, and its influence on the morphology and function of red blood cells. Methods Blood from operation field was collected, filtered, centrifuged and washed. Intestinal cancer cells (LOVO) and gastric cancer cells (SGC) were cultured in vitro and mixed with the collected blood. Blood contaminated with known number of tumor cells was then centrifuged and washed with cell retriever, and then the mixture was filtered with leucocyte depletion filter. The amount of residual tumor cells in filtered blood was counted after trypan blue staining before and after culturing. Unwashed and unfiltered blood containing tumor cells were used as control and were also cultured. The morphology and Na+-K+-ATPase activity of treated red blood cells was assessed. Results Tumor cells were detectable after only being washed with cell retriever and grew well after culturing for two weeks. No tumor cells were found after both washed with cell retriever and filtered with leucocyte depletion filter, and no tumor cell grew two weeks after culturing. No change was found in morphology and Na+-K+-ATPase activity of red blood cells after being washed and filtered. Conclusion Cell retriever is not able to eliminate tumor cells from blood completely. Further filtration with leucocyte depletion filter is capable of completely eliminating the residual tumor cells in blood. The morphology and Na+-K+-ATPase of red blood cells do not change after being washed with cell retriever and being filtered with leucocyte depletion filter.

Inhibitory effects of oral propofol on nociceptive stimuli in mice / 解放军医学杂志

Objective To investigate whether oral propofol has any inhibitory effects and dose-response relationship on the pain inducing tissue injury in mice. Methods The effect of propofol on pain was observed in formalin test and acetic acid writhing test in mice. Formalin was injected subcutaneously into the plantar surface of one hind paw. Spontaneous nocuous responses were immediately scored by counting the number of flinches of the injected hindpaw at every 5-minute interval during a 60-minute period. The number of writhing caused by intraperitoneal injection of 0.6% acetic acid was also observed in mice. Results Oral propofol in a dose of 100mg/kg did not significantly inhibit nocuous stimulation. With higher doses, propofol inhibited both the phases 1 and 2 of persistent spontaneous pain induced by subcutaneous formalin injection. Orally taken propofol also inhibited the number of writhing after intraperitoneal acetic acid injection in a dose dependent manner. Conclusion Oral propofol is effective in inhibiting pain induced by formalin and acetic acid.