Nursing of sedation and analgesia using low-dose fentanyl with midazolam during thrombectomy for anterior-circulation acute ischemic stroke / 中国实用护理杂志

Objective To investigate the nursing of sedation and analgesia using low-dose fentanyl with midazolam during intra-arterial treatment with mechanical thrombectomy by means of stent for patients with anterior-circulation acute ischemic stroke.Methods All of 61 patients who underwent intra-arterial treatment with anterior-circulation acute ischemic stroke were retrospectively collected.They were divided into two groups according to the different program of individual conscious sedation:the control group(30 cases)used midazolam for intravenous maintain sedation,experimental group(31 cases)added the low-dose fentanyl on the basis of the control group.The thrombectomy was performed by the same group of interventional radiologists,while the effect of sedative,vital signs,respiratory curve and SpO2(blood oxygen saturation),assessment of Ramsay's sedation score,restlessness and other sedation adverse reactions were respectively observed in both groups.Nursing intervention was performed aiming at different states of patients during operation.Results All 61 patients were implemented with good medical care with no intracranial hemorrhage or intraoperative death.In the control group,there were 4 patients with Ramsay 1 point of sedation,resulted motion artifacts in digital subtraction angiography images in 3 of them,1 patient with slight reduction of SpO2,and vomiting in 4 patients.1 patient with decreased mean arterial pressure.In the experimental group,there was no Ramsay 1 point of sedative patient.The SpO2 was decreased in 5 patients.Respiratory inhibition occurred in 3 patients and the mean arterial pressure decreased slightly in the other 3 patients.Conclusions Application of low-dose fentanyl and midazolam is safe and reliable in patients who underwent intra-arterial treatment with anterior-circulation acute ischemic stroke.While closely observation to the changes of breath frequency curve and SpO2 in operation are very essential to actively prevent the occurrence of respiratory depression.

Clinical features of intracranial giant lymph node hyperplasia / 肿瘤

Objective: To investigate the clinical features of intracranial Castleman's disease, and to improve the understanding of the disease. Methods: The clinical features of one case of intracranial mixed type Castleman's disease, who was diagnosed in Department of Neurosurgery, Zhujiang Hospital, Southern Medical University in February 9, 2017, were retrospectively analyzed, and the relevant literatures about intracranial Castleman's disease were reviewed. The PubMed, Embase, Ovid, Cochrane, Wanfang Database and China Journal Full-text Database were searched using the keywords including "Castleman", "Intracranial"and "Central nervous system" for related literatures published between January 1, 1980 and January 31, 2017. Results: A 32-year old female was admitted because of headache for one month. CT examination showed an irregular and well-defined hyperdense lesion in the right temporo-parietal area with surrounding extensive edema and this mass was markedly contrast enhanced. Laboratory examination revealed anemia and hyperimmunoglobulinemia. The mass was removed completely by surgical resection. Postoperative pathology examination revealed mixed type Castleman's disease in the right temporo-parietal area. MRI was performed 3 months after the surgery. No residual tumor and recurrence were demonstrated. Seventeen related case reports were retrieved and 20 cases of intracranial Castleman's disease were reported. Among total 21 cases, there were 7 males and 14 females, ranging from 8 to 82 years old, and the median age was 47 years old. The mass arised from the dura matter or leptomeninges, and the most common sites of origin were located at the cerebral convexity and the parafalcine. The most common clinical features were seizures and headache. Radiographically, the previously reported cases presented as a homogeneously enhanced extra-axial well-defined mass with a marked peritumoral edema. Conclusion: Intracranial Castleman's disease is a rare clinical condition. The diagnosis can be made in combination with clinical findings and the laboratory examination.

Expression and clinical significance of bone morphogenetic protein 3 in hi-lar cholangiocarcinoma tissues / 中国病理生理杂志

[ ABSTRACT ] AIM: To investigate the expression and clinical significance of bone morphogenetic protein 3 (BMP3) in hilar cholangiocarcinoma tissues.METHODS: Thirty cases of hilar cholangiocarcinoma specimens were col-lected.The expression of BMP3 at mRNA and protein levels in the tumor tissues and paracancerous tissues was detected by real-time PCR and Western blot.The hilar cholangiocarcinoma paraffin-embedded specimens (n=103) were collected. The protein expression of BMP3 was determined by immunohistochemical method, and the relationship of BMP3 protein ex-pression with clinical pathological characteristics was evaluated.RESULTS:In the 30 patients with hilar cholangiocarcino-ma, the expressions of BMP3 protein and mRNA in 22 cases of tumor tissues were significantly decreased compared with the adjacent normal tissues.The results of immunohistochemistry showed that 87 cases were negative and 16 cases were weakly positive in all 103 cases of hilar cholangiocarcinoma.The expression of BMP3 protein was associated with the tumor TNM staging, lymph node metastasis and tumor differentiation (P<0.05).CONCLUSION:BMP3 gene might be inhibited in human hilar cholangiocarcinoma.The down-regulation of BMP3 gene might be associated with the carcinogenesis and devel-opment of hilar cholangiocarcinoma.

Clinical efficacy of captopril combined with amlodipine in hypertension patients of the influence of high noise / 中国医师进修杂志

Objective To observed the clinical efficacy of captopril combined with amlodipine in hypertension patients of the influence of high noise.Methods A total of 150 hypertension patients who worked in ＞ 110 dB noise were divided into treatment group 1 (75 cases) and treatment group 2 (75 cases) by random digits table.Patients simply took enalapril in treatment group 1,patients took enalapril combined with amlodipine in treatment group 2.Selected 75 cases common hypertension patients were control group,they took enalapril combined with amlodipine.A year later,compared with three groups of plasma renin activity (PRA) and clinical efficacy.Results The PRA and efficient rate had no significant difference among three groups in half ayear (P ＞0.05).A year later,the PRA and efficient rate in treatment group 2 and treatment group 1 had obvious difference [(1.89 ± 0.37) ng/ (ml· h) vs.(2.40 ± 0.38) ng/ (ml· h),90.67 ％ (68/75) vs.72.00 ％ (54/75)] (P ＜ 0.05 or ＜ 0.01).But compared with control group no significant difference (P ＞0.05).Conclusion The clinical efficacy of captopril combined with amlodipine in hypertension patients is more apparent.