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OBJECTIVE To systematically evaluate the efficacy and safety of midazolam and dexmedetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， Embase， Web of Science， Cochrane Library， Clinical trials. gov， China Journal Full Text Database， Chinese Science and Technology Journal Database， Wanfang database and China Biomedical Literature Database， the data on the efficacy and safety of midazolam and dexmetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation were collected from the establishment of the database to March 31， 2023. After extracting data from clinical studies that met the inclusion criteria， the meta-analysis was conducted by using the RevMan 5.3 statistical software. RESULTS A total of 31 literature were included， with a total of 2 765 patients. Results of meta-analysis showed that the mechanical ventilation time [MD＝14.13， 95%CI （13.75， 14.52）， P＜0.000 01] and the length of hospitalization in the intensive care unit [MD＝0.92， 95%CI （0.54， 1.30）， P＜0.000 01] of patients in the midazolam group was longer than dexmedetomidine/ propofol group. The incidence of bradycardia in midazolam group was lower dexmedetomidine/propofol group [OR＝0.60， 95%CI （0.41， 0.90）， P＝0.01]， but there was no statistically significant difference in the incidence of hypotension between the two groups [OR＝0.69， 95%CI （0.47， 1.01）， P＝0.06]. The incidence of delirium [OR＝3.88， 95%CI （2.74， 5.49）， P＜0.000 01]， ventilator- associated pneumonia [OR＝2.32， 95%CI （1.19， 4.51）， P＝0.01]， and respiratory depression [OR＝5.70， 95%CI （3.09， 10.52）， P＜0.000 01] in midazolam group were higher than dexmedetomidine/propofol group. CONCLUSIONS Compared with dexmedetomidine/propofol， midazolam increases patients’ mechanical ventilation time and the length of hospitalization in the intensive care unit in terms of efficacy， and increases the risk of delirium and pulmonary complications in terms of safety， but has a smaller cardiovascular impact.
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Upper arm central venous access port refers to the port implanted through the peripheral vein of the upper arm by surgeon and peripherally inserted central catheter nurse cooperation. It can provide a new way for patients requiring long-term infusion therapy but it has not been widely used in China. This article introduces the targeted patients, operation process, maintenance and use, daily life notes, common complications and advantages of arm port, to provide reference for the wide application of arm port.
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Objective To explore the effect of preventive management path of breast cancer related lymphedema based on risk reduction program on breast cancer patients underwent axillary lymph nodes dissection (ALND). Methods This study used convenient sampling method to recruit 60 patients underwent ALND. Patients were randomly divided into the control group (n=31) and the intervention group (n=29). All patients received general care while patients of the intervention group also received the Risk Reduction Program. Lymphedema symptom experience was investigated by Breast Cancer and Lymphedema Symptom Experience Index 1 month, 3 months, 6 months, 12 months after surgery. Results Twelve months after surgery, the intervention group had 4.00(8.00)lymphedema related symptoms while the controll group had 9.00(7.00), the difference was significant (Z=-2.023, P=0.043). The score of lymphedema related symptom distress in the intervention group was 3.00(7.00)while it was 7.00(17.00)in the control group, the difference was significant (Z=-2.159, P=0.031). The scores of functional dimension and sexual dimension in the intervention group were 0(2.00)and 0(0), and in the control group were 3.00(5.00)and 0(1.00), the differences were significant (Z=-2.315,-2.334, P=0.021, 0.020). No significant differences of lymphedema rate existed between groups (P>0.05). Conclusion The preventive management path of breast cancer related lymphedema based on risk reduction program can decrease the number of lymphedema symptoms and release lymphedema symptom distress.
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@#The aim of this paper was to study the species and sources of related substances in montelukast sodium granules based on HPLC-MS/MS. The related substances of the already marketed montelukast sodium granules(Singulair, 4 mg)were firstly separated and identified by HPLC-MS/MS method, and their chemical structures and sources were confirmed according to the pulished synthesis process and degradation studies. The results revealed that there were 7 related substances, whose chemical structures and sources were confirmed based on the MS/MS technique and the related literature. Impurity 7, montelukast quinoline ring oxynitride, had not been reported. This study systematically analyzed the related substances in the commercical product, which provides useful information for the development and quality control of the product.
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Objective To explore the feasibility and safety of radiofrequency ablation for difficult access liver cancer under percutaneous local anesthesia combined with contrast-enhanced ultrasonography.Methods 45 patients(62 lesions) in the experimental group were treated by percutaneous,local anesthesia combined with contrast-enhanced ultrasound and in some cases with artificial ascites assisted by radiofrequency ablation vs control group of 40 patients (54 lesions) receiving radiofrequency ablation guided by CT or ultrasound through laparoscopy or open surgery.The complications,and postoperative residual and recurrence rates were compared between the two groups.Results Of the all patients,4 cases suffered from severe complications.The pain scores and the blood loss were less significant in the experimental group.There was no significant difference in tumor residual rate between the two groups when evaluated on one month after the procedures,and in the recurrence rate after three and six months.Conclusion Radiofrequency ablation for difficult liver cancer by percutaneous local anesthesia combined with contrastenhanced ultrasonography is less traumatic and less of complications compared to traditional method with a similar tumor residual rate and recurrence rate.
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Objective To investigate the clinical significance of serum procalcitonin(PCT)and B-type natri-uretic peptide(BNP)before and after fluid resuscitation in patients with septic shock.Methods A total of 62 patients with septic shock were selected from January to December in 2015.The patients with arterial blood gas,24 hours of cumulative resuscitation fluid and the time of resuscitation were monitored and recorded.PCT and BNP levels were detected.Results The resuscitation fluid was(7 899.31 ± 1 337.64)mL and the time of resuscitation was(19.07 ± 5.64)h in the treatment of body fluid resuscitation in 62 patients.There were sig-nificant differences in pH,Na+,Cl-,PCT and BNP values before and after treatment,the differences were sta-tistical significant(P<0.05).There was a negative correlation between serum PCT and 24% cumulative ser-um(r= -0.956,P<0.05).Conclusion The levels of serum BNP and PCT in patients with septic shock were closely related to the disease,and can be used to monitor the therapeutic efficacy in patients with septic shock.
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Objective To evaluate the value of CEUS in dynamicly assessing the blood perfusion of hepatic alveolar echinococcosis (HAE) in rats.Methods The experimentally induced secondary HAE in totally 70 rats were studied at different time periods (gth week,28th week,and 50th week) with CEUS,and compared to pathology results.Results At the 9th week,55 HAE lesions (55/70,78.57％) presented hyperechoic and the rest of 15 HAE lesions (15/70,21.43％)presented mixed echogenicity.The single or multiple vesicular structures were found as pathological feature.At later stages (28th week and 50th week),the size of lesions increased compared to 9th week with more solid structures and the calcifications found in HAE lesions.Microscopically,the fibrous tissues surrounding the lesions gradually thickened and the microvascular accumulation were visible around the lesions.The HAE lesions at the 9th week showed the ring enhancement and central septa enhancement in CEUS.The HAE lesions at the 28th week and 50th week showed combinations of no enhancement,ring enhancement,and central septa enhancement in CEUS.The ratio of edge enhancement to maximum diameter of lesions decreased with the progression (P=0.02).Conclusion The ultrasonographic features in HAE lesions become more complicated with increasing calcifications and enlarged necrosis areas with the progression.The CEUS can reveal the dynamics of blood perfusion of HAE lesions at different stages.
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Objective To establish the pyrogen removing effect of activated carbon in the technics of traditional Chinese medicine (TCM) injections. Methods The content of bacterial endotoxin concentration was detected by kinetic turdimetric assay to evaluate the effect of removing pyrogen before and after using activated carbon in concentrated solution of TCM injection. Results The activated carbon adsorption rate of Shuanghuanglian concentrated solution≥70%and the activated carbon adsorption rate of Danshen concentrated solution>95%. Conclusion Pyrogen manufacturing process is scientific and rational by adding activated carbon adsorption in powder injection of TCM. The bacterial endotoxin of large doses can't be removed fully by activated carbon adsorption.
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Objective:This study aims to evaluate the consistency between contrast-enhanced ultrasound (CEUS) and enhanced computed tomography (CT) in determining the effect of radiofrequency ablation (RFA) on hepatocellular carcinoma. Methods: RFA procedures guided by either ultrasound or CT were performed on 35 patients with 68 lesions. Enhanced CT and CEUS were regularly conducted after the procedures to evaluate the effect of RFA. The full ablation, residual, and recurrence rates of tumors, as well as the di-agnostic accuracies and kappa values of CEUS and enhanced CT, were determined. Results:The full ablation and residual rates of tumors for the 68 lesions diagnosed by CEUS were 84%and 16%, respectively;whereas those for the lesions diagnosed by enhanced CT were 90%and 10%, respectively. No significant difference was found between the obtained rates using the two diagnostic methods (χ2=0.576 3, P=0.447 8). Moreover, the two methods exhibited high consistency (K=0.882 9, Sk=0.120 4). Of the 68 lesions, 13 recurred within 24 months. The recurrence rate evaluated by CEUS was 19%(13/68). No significant difference was found between the detection rates of CEUS (92%, 12/13 lesions) and enhanced CT (100%, 13/13 lesions) in diagnosing recurrent lesions (P>0.05). Enhanced CT could be used as the gold standard for evaluating tumor residual and recurrence rates after RFA. The overall diagnostic accuracy of CEUS reached 92%(63/68 lesions). Conclusion:CEUS and enhanced CT exhibit high accuracy and consistency in evaluating the effect of RFA on hepatocellular carcinoma. CEUS can provide a reliable diagnostic proof for tumor patients after undergoing RFA procedure.
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Objective To find the spectacular indexes in the diagnosis of acute rejection of renal transplantation with color Doppler ultrasonography. Methods Forty-two patients with renal rejection were confirmed with percutaneous needle biopsy and 115 patients with stable renal function were confirmed with following-up (>1 year) and clinical examination. The length, width, thickness, cortex thickness and resistive index (RI) of two groups were analyzed statistically. Then the specificity, sensitivity, misdiagnosis rate, false negative rate and consistency rate of renal volume, pyramid swelling, echo weakening, RI＜0.7, RI≥0.7 and RI≥0.8 were calculated. Results The length, width and thickness were statistically different in two groups (P＜0.05). In patients with renal rejection, the marginal blood vessels in renal cortex decreased, and the blood velocity reduced obviously in the diastolic phase and RI increased obviously (P＜0.05). The sensitivity of the above indexes were 55.30%, 55.20%, 42.10%, 57.90%, 31.60%, respectively, while the specificity were 71.30%, 87.10%, 25.70%, 74.20% and 98.20%, respectively. Conclusion Enlargement of renal volume, swelling of renal pyramids, echo weakening and RI increasing are specific indexes for diagnosis of acute rejection of renal transplantation.
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Objective To investigate microRNA expression profiles of colonic cancer without lymph node metastasis and identify the specific microRNAs associated with carcinogenesis of colon.Methods Cancerous and para-cancerous tissues (5 cm from cancer tissues of the colon) confirmed without lymph node metastasis were collected from 3 patients. The microRNAs were extracted and isolated by mirVana RNA kit. Hybridizations were made by applying the microRNAs to Agilent microRNA microarray. Data analysis was done by software of Feacture Extraction. The discovered microRNAs were confirmed by real time PCR assay. Results Twelve out of 14 microRNAs associated with colonic cancer were up-regulated in colonic tissues. They were miR-106b, miR-135b,miR-18a,miR-18b,miR-196b, miR-19a, miR-224, miR-335, miR-424, miR-20a' , miR-301b and miR-374a. The rest two of miR-378 and miR 378* were down-regulated. Two up-regulated microRNAs (miR-18a and miR-135b) were detected in 3 pairs of cancerous and para-cancerous tissues. The expression level of miR-18a and miR-135b were accordant with the results of real time PCR.Conclusions microRNA.such as miR-106b,miR-135b.miR-18a.miR-18b,miR-196b,ect,were differentially expressed between cancerous and para-cancerous tissues.Many of these target genes are supposed to participate in the process of multiple tunmorgenesis.These microRNAs play an important role in the carcinogenesis of colon.
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Aim To study the effect of rosiglitazone(RGZ)on expression and excretion of connective tissue growth factor(CTGF) in renal tissue and urinary of diabetic nephropathy rats.Methods Three groups of rats were studied:normal control group(n=8),STZ-induced diabetic model group(n=8),diabetes RGZ-treatment group(n=8).Urinary CTGF was measured at the 1 st,4 th,6 th and 8 th week,as well as the expressions of CTGF protein(by histochemical staining)at the 8 th week by ELISA.Results The urinary excretion rates of CTGF at 4 th、6 th、8 th weeks and the expressions of CTGF protein in renal cortex at 8th weeks significantly increased in STZ-induced model group compared with those in normal group(P
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AimTo establish the model of adriamycin- induced nephritic syndrome in rats and its pathological change wasobserved. MethodsThe model of nephritic syndrome in rats was established by intravenous injection of adriamycin in the dose of 5mg · kg-1 and 3 mg · kg-1 respectively at the first day and 15 th day. The amount of urine protein was measured at the 1、2、3、4、6、8 and 12 th week and the serum biochemical pa rameters of TG, TCH, BUN, Cr, TP and ALB were detected at the 6 th and 12 th week. Results The urine protein and the serum biochemic parameters were increased significantly, except the TP and ALB, which were decreased. Pathological changes at the sixth week was similar to minimal changes in glomerulonephritis, and at the 12 th week, sclerosis of glomeruli of kidney could be found. ConclusionAfter first injection,the changes of kidney were like those inminimal change glomerulonephritis of human being. But after the second injection. The kidney had the changes of focal segmental glomeralosclerosis.
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Objective To compare the main pharmacodynamic actions between Siji Sanhuang Capsules (SSC) and Siji Sanhuang Pills (SSP). Methods Antipyretic, anti-inflammatory and antibacterial effects of SSC and its effect on the intestinal movement in normal mice and constipation mice were observed. Results SSC could relieve fever in rats induced by the fresh beer yeast and 2,4-dinitrophenol, significantly inhibit the auricular swelling induced by xylol and the increased capillary permeability caused by histamine in mice, and promote the intestinal movement in normal mice and constipation mice. In-vitro antibacterial experiments showed that SSC had an obvious bacteriostatic effect on Staphylococcus aureus,typhoid bacillus, Bacillus coli, Shigella flexneri, pseudomonas aeruginosa and Bacillus proteus. The effects were in a dose-dependent manner and the effects of SSC were stronger than those of SSP. Conclusion SSC exerts a Strong antipyretic, anti-bacterial, anti-inflammatory and carthartic effect.