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Objective The clinical benefits of carbohydrate intake 2-3 h before surgery in patients with digestive tract malignant tumor without diabetes mellitus have been confirmed by foreign experts,the"High level evidence" for perioperative nutrition support were also written in China"Guidelines for perioperative nutritional support in adults".However,there are few hospitals in China that prefer preoperative glucose pretreatment,taking into account the differences between domestic and foreign data.In this paper,the clinical randomly controlled experimental data about the effect of preoperative glucose pretreatment on the prognosis of patients with malignant tumor of digestive tract was analyzed by Meta analysis,in order to evaluate the efficacy and safety of preoperative glucose pretreatment in Chinese patients,and to achieve the clinical significance.Methods Retrieving the database from establishment to March 2017,the related literatures about preoperative glucose pretreatment and prognosis of patients with digestive tract malignant tumor were collected.Revman5.3 software was used to perform Meta analysis of 10 randomized controlled trials(606 patients)who met the inclusion criteria.Results Compared with the traditional fasting and non drinking group,the preoperative subjective discomfort of the preoperative group was significantly reduced(SMD = -1.29,95%CI = -2.00--0.59,P = 0.000 3), postoperative insulin resistance was significantly reduced(SMD=-1.92,95%CI=-2.68--1.16,P<0.01), postoperative blood glucose concentration,insulin concentration increased,and no vomiting and aspiration occur in any patient as shown by the literature.Conclusion In the patients with malignant tumor of digestive tract, perioperative nutrition support and pretreatment show significant clinical benefits,preoperative subjective comfort improves,the risk of aspiration does not increase significantly,postoperative insulin resistance decreases.It is proved that preoperative carbohydrate pretreatment is effective and safe in the operation of domestic digestive tract cancer.
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Histone methyltransferase SMYD3 (SET and MYND domain containing3) plays an important role in tumor epigenetics. Its high expressionin many cancer cells can promote the development and progressionof tumor by regulating several cellular biological functions such asproliferation, apoptosis, invasion and metastasis. Previous studieshave indicated that SMYD3 mainly modulate the methylation of lysineH3K4 to regulate the expression of certain genes. Recent researcheshave shown that SMYD3 can also interact with other histones andcytoplasmic proteins to regulate the expression of tumor-relatedgenes, thereby to promote the development of tumor. This reviewaims to introduce the structure, upstream regulatory pathwayand synergistic molecules of SMYD3, as well as to summarize itsregulation mechanisms, expression and inhibitors in tumor.
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Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation.Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan.2010 to Jan.2015 were considered as the objects,who was randomly divided into group A and group B.34 cases in group A were treated with Dexmedetomidine for sedation,and the other 34 cases in group B were treated with Midazolam for sedation.The Heart rate (HR),mean arterial pressure (MAP) and BIS value on the before anesthesia (T1),immediately before intubation (T2),immediately after intubation (T3),PaCO2 in before and after intubation,and the adverse reactions were compared between the two groups.Results There was no difference in HR,MAP and BIS at time of T1 between the two groups (P＞0.05).The HR,MAP and BIS were lower in group A than in group B at time of T2 and T3 (P＜0.01).The PaCO2 had no difference between the two groups at before and after intubation (P＞ 0.05).The rate of adverse effects had no difference between the two groups (x2 =1.308,P =0.253).Conclusions Compared with Midazolam,Dexmedetomidine can stable HR,MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation,which is worthy of clinical application.
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Objective To investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.Methods Twenty ASA Ⅰ or Ⅱ patients,aged 20-64 years,with body mass index (BMI) of 20-30 kg/m2,scheduled for elective orthopedic operation were enrolled in this study.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium,and maintained with sevoflurane,fentanyl and cisatracurium.Then the patients received endotracheal intubation and mechanical ventilation.Heart rate (HR),mean arterial blood pressure (MAP),central venous pressure (CVP),arterial pressure-based cardiac output (APCO),SW,systemic vascular resistance (SVR) and cardiac index (Cl) were recorded 5 minutes after endotracheal intubation.Blood was taken from the central vein at a rate of 30-50 ml/min and the volume was 5％ of the whole blood volume,and then haemodynamic parameters mentioned above were recorded after the haemodynamics were kept stable for 5 minutes.Blood was taken again with the method mentioned above and the haemodynamic parameters were recorded.Then 6％ hydroxyethyl starch (HES) 130/0.4 was infused at 50-70 ml/min via the right internal jugular vein,and the volume was equal to 5％ of the whole blood volume,and then haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 minutes.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the changes in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.Results Significant changes were found in SW,APCO and Cl after each change in blood volume (P ＜ 0.05 or 0.01),while no significant changes were found in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV (r =-0.875,P ＜ 0.01).Conclusion There is high correlation between SVV and blood volume during hypovolemia.And SVV can reflect the changes in blood volume accurately and can be used for volume therapy during hypovolemia.
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Objective To observe the effect of mouse nerve growth factor (mNGF) on treating herpes zoster.Methods The 64 patients with herpes zoster were divided into treatment group and control group by random digits table with 32 cases each.The control group received only routine treatment,the treatment group based on routine treatment combined with mNGF 30 μ g,both groups were treated 14 days.Pain changes of two groups were observed in once every 5 days,a total of 1 month.Results The times of pain to lessen and the pain to vanish of treatment group were (4.36 ± 2.01) and (12.29 ± 1.98) d,those of control group were (7.23 ±3.57) and (20.36 ±2.24) d,there were significant differences (t =5.21 and 8.37,P ＜0.01).The effective rate of treatment group was significantly higher than that of control group [96.9％(31/32) vs.71.9％(23/32),P＜0.05].Conclusion mNGF combined with routine treatment can significantly shorten the course of nerve injury and improve the prognosis with few adverse reactions.
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ObjectiveTo investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.MethodsTwenty ASA Ⅰ or Ⅱ patients,aged 20-64 yr,with body mass index 20-30 kg/m2,scheduled for elective orthopedic operation,were studied.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium and maintained with sevoflurane,fentanyl and cisatracurium.The patients were tracheal intubated and mechanically ventilated.HR,MAP,CVP,arterial pressure-based cardiac output (APCO),SVV,systemic vascular resistance (SVR) and cardiac index (CI) were recorded 5 min after tracheal intubation.Blood was taken from central vein at a rate of 30-50 ml/min,the volume was 5％ of the whole blood volume and the haemodynamic parameters mentioned above were recorded after the haemodynamics was kept stable for 5 min.Blood was taken again as the method mentioned above and the haemodynamic parameters were recorded.6％ HES 130/0.4 was then infused at 50-70 ml/min via right internal jugular vein,the volume was equal to 5 ％ of the whole blood volume and the haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 min.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the change in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.ResultsThere was significant change in SVV,APCO and CI after each change in blood volume ( P ＜ 0.05 or 0.01),while there was not always significant change in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV ( r =- 0.875,P ＜ 0.01 ).ConclusionThere is high correlation between SVV and blood volume during hypovolemia and SVV can reflect the change in blood volume accurately and be used for volume therapy during hypovolemia.
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This article analyzed current negative influence on medical students caused by network and the authors put forward 6 pieces of measures to enhance network moral education of medical students,such as establishing and consummating network moral and ethic norm system,strengthening character teaching to medical students by network,promoting construction of resources of network moral education,heightening managing quality of moral educators in high education,cultivating healthy campus network culture atmosphere,and building good online surroundings for medical students by joint of blocking up and dredging.