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Objective:To investigate the application value of ultrasound guided transversus abdominis plane block (TAP) combined with sevoflurane inhalation general anesthesia in patients with coronary heart disease undergoing laparoscopic cholecystectomy.Methods:A total of 90 patients with coronary heart disease who received laparoscopic cholecystectomy in the Third Hospital of Changsha from April 2021 to December 2021 were selected. The patients were randomly divided into observation group (47 cases) and control group (43 cases). The observation group was given ultrasound guided TAP combined with sevoflurane inhalation general anesthesia; The control group was given conventional general anesthesia. The heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO 2) of the two groups were observed before anesthesia (T 1), at the time of skin resection (T 2), at the time of gallbladder separation (T 3) and at the time of skin suture (T 4). The recovery time, operation time, anesthesia time and postoperative Visual Analogue Scale(VAS) score at 2, 6, 12 and 24 h were recorded. The levels of serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), myocardial troponin (cTnI), superoxide dismutase (SOD) and malondialdehyde (MDA) before and after operation were detected, and the incidence of adverse cardiovascular events in the two groups were observed. Results:The MAP and HR in T 2, T 3 and T 4 were higher than those in T 1 in the control group (all P<0.05); The MAP and HR at T 2, T 3 and T 4 in the observation group were significantly lower than those in the control group (all P<0.05); There was no significant difference in operation time and anesthesia time between the observation group and the control group (all P>0.05); The recovery time of observation group was significantly earlier than that of control group ( P<0.05). The CK, CK-MB and cTnI in the observation group were significantly lower than those in the control group at 24 h after surgery (all P<0.05). There was no significant difference in SOD and MDA between the observation group and the control group at 24 h after surgery (all P<0.05). The VAS score of the observation group were lower than those of the control group at 2 h, 6h, 12 h and 24 h after surgery (all P<0.05). There was no significant difference in the incidence of postoperative adverse cardiovascular events between the two groups ( P>0.05). Conclusions:TAP combined with sevoflurane inhalation general anesthesia has good application value in laparoscopic cholecystectomy in elderly patients, which can improve the anesthesia effect and the quality of recovery, and significantly reduce the myocardial injury of patients.
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Objective To observe the efficacy and safety of recombinant tissue type plasminogen activa-tor (rt-PA)for the treatment of the patients with wake-up ischemic stroke (WUS)under the guidance of multimode CT. Methods Eighteen patients with WUS (a thrombolytic group)suitable for intravenous thrombolysis after multimode CT imaging screen at the Department of Neurology,Shiyan Hospital of Integrated Traditional and Western Medicine,Hubei Province from October 2012 to October 2014 were enrolled retrospectively. Twenty patients with WUS (a control group)who underwent multimode CT imaging screen were suitable for intravenous thrombolysis,but because of exceeding time window or rejecting thrombolysis and other reasons without having intravenous thrombolysis from February 2012 to February 2014 were enrolled retrospectively. The control group was treated with conventional therapy and the thrombolytic group was treated with rt-PA (0. 9 mg/kg)intravenous thrombolytic therapy. The indicators including fibrinogen (Fib),coagulation function (prothrombin time [PT ]),activated partial thromboplastin time (APTT ), platelet (PLT ),high-sensitivity C-reactive protein (hs-CRP ),National Institute of Health Stroke Scale (NIHSS )scores,and activities of daily living scores (Barthel index)at before treatment and 24 h,7 and 14 days after treatment were observed respectively. The adverse events and complications were documented and compared with the control group. Results There were no significant differences in Fib,PT,APTT, PLT,hs-CRP,NIHSS score and Barthel index before treatment between the thrombolytic group and the con-trol group (all P>0. 05);at day 7 and 14 after treatment in the thrombolytic group,compared with before treatment,Fib (14 d after treatment),PLT,and hs-CRP were decreased,PT and APTT were prolonged,the NIHSS scores were decreased,and Barthel indexes were increased. There were significant differences (all P<0. 05). At day 14 after treatment,there were significant differences in Fib,PT,APTT,hs-CRP,NIHSS scores,and Barthel indexes (Fib:3. 25 ± 0. 38 g/L vs. 3. 55 ± 0. 28 g/L;PT:15. 7 ± 3. 2 s vs. 12. 9 ± 2. 5 s;APTT:42. 7 ± 3. 5 s vs. 38. 7 ± 2. 6 s;PLT:[189 ± 26]× 109/L vs. [201 ± 23]× 109/L;hs-CRP:5. 7 ± 0. 6 mg/L vs. 11. 3 ± 2. 2 mg/L;NIHSS scores:5. 6 ± 2. 4 vs. 9. 2 ± 4. 5;and Barthel indexes:68 ± 15 vs. 47 ± 5)between the two groups (all P <0. 05). Except 1 patient occurred symptomatic intracerebral hemorrhage after thrombolysis,no other serious complications were observed in the thrombolytic group. One patient in the control group had stress gastric ulcer and bleeding,no symptomatic intracerebral hemorrhage occurred. Conclusion Multimode CT guidance can be used as a reliable imaging evidence for patients with WUS expanding intravenous thrombolytic time window. Under the multimode CT guidance, using rt-PA for intravenous thrombolytic therapy has a certain efficacy.
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A three-dimensional finite element model of premaxillary bone and anterior teeth was established with ANSYS 13.0. The anterior teeth were fixed with strong stainless labial archwire and lingual frame. In the horizontal loading experiments, a horizontal retraction force of 1.5 N was applied bilaterally to the segment through hooks at the same height between 7 and 21 mm from the incisal edge of central incisor; in vertical loading experiments, a vertical intrusion force of 1.5 N was applied at the midline of lingual frame with distance between 4 and 16 mm from the incisal edge of central incisor. After loading, solution was done and displacement and maximum principle stress were calculated. After horizontal loading, lingual displacement and stress in periodontal membrane (PDM) was most homogeneous when the traction force was 14 mm from the edge of central incisor; after vertical loading, intrusive displacement and stress in PDM were most homogeneous when the traction force was 12 mm from the incisal edge of central incisor. The results of this study suggested that the location of center of resistance (CRe) of six maxillary anterior teeth is about 14 mm gingivally and 12 mm lingually to incisal edge of central incisor. The location can provide evidence for theoretical and clinical study in orthodontics.
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Humanos , Modelos Dentários , Análise do Estresse Dentário , Análise de Elementos Finitos , Incisivo , Maxila , Ligamento Periodontal , LínguaRESUMO
Objective To explore the expression of Her-2 and the effect on the initiation,development,invasion and metastasis of pancreatic carcinoma.Methods A total of 225 patients with pancreatic carcinomafrom January 2000 to December 2007 were analyzed retrospectively.Paraffin sections of surgical specimens from all the patients who underwent standard resection were examined by SP immunohistochemical method staining.The expression of Her-2 in patients with pancreatic carcinoma and the association between Her-2 and other clinical and pathological parameters were examined.Results Her-2 was positive in 87 of all the 225 patients(38.67%).The differentiation of tumors;size of tumors;lymph node metastasis and other organs metastasis were significantly related to Her-2.The surrival time of the Her-2-positive patients[(19.33±8.15)/nonths]Was significantly shorter than that of the Her-2-negative patients [(36.23±15.44)months]in the univariate analysis(P<0.01).At multivariate COX proportional hagards model analysis,the positivity of Her-2 applied to be an independent prognostic factor,which was also influenced by size of tumors;lymph node metastasis and other organs metastasis.Conclusion It suggests the incidence of Her-2 play an important role in evaluation of the prognosis of pancreatic carcinoma,and it could serve as an independent predictor of prognosis of pancreatic carcinoma.
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Objective To establish the plane strain model of brain tissues on mid-sagittal plane and discuss the relation between the brain tissue deformation and brain injury. Methods By referring to the computerized tomography pictures of the human body and using plane strain and finite element method (FEM), we applied plane strain hypothesis to establish a model for calculation of the brain tissue deformation caused by rotational inertia loading during vehicle crash accident. Results At the 12th ms, the shear strain field adjacent to parietal lobe reached 0.148 and the maximum positive shear stress located at white material of the cerebellum was up to 8 088.0 Pa. At the 28th ms, the maximum shear stress located at the cerebellum reached 900.9 Pa. Great shear strain existed in the cerebrospinal fluid region all the time and shear stress with large absolute value presented on the boundary of white matter and gray matter. Conclusions Under rotational inertia loading, the shear strain (stress) in brain tissues can lead to diffuse axonal injury. The uneven strain (stress) may cause serious avulsion damage in brain tissues.
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Objective There is still controversy over the effect of hyperglycemia on the tolerance of heart to ischemia/reperfusion(I/R)injury in patients with diabetes mellitus. The aim of this study was to evaluate the effect of hyperglycemia on I/R-induced ventricular arrythmia in isolated diabetic rat hearts. Methods Twenty-four healthy male SD rats weighing 210-250g were randomly divided into two groups: control group(C, n=10) and diabetes mellitus group(DM, n=14). Diabetes mellitus was induced by intraperitoneal injection of streptozotocin 60 mg?kg~(-1). Blood glucose was measured 72h later and every week thereafter. Diabetes mellitus was defined as persistent hyperglycemia(blood glucose≥16.7 mmol/L after meal). The diabeticrats received no insulin. The rats were anesthetized with pentobarbital 60mg?kg~(-1). The hearts were immediately removed and perfused with oxygenated(95% O_2, 5% CO_2)Krebs-Henseleit buffer(KHB)in a Langendorff apparatus at a constant perfusion pressure of 80 mm Hg. The 14 diabetic rats were further divided randomly into 2 subgroups: (1)DM+KHB (n=7) and (2) DM+GLU(n=7) in which glucose 3.6 g was added to KHB 1000ml. After 20 min equilibration all hearts were subjected to 30 min global ischemia followed by 40 min reperfusion. Epicardial electrocardiogram was monitored. The incidence of ventricular tachycardia(VT) and ventricular fibrillation(VF) and their duration were measured. The severity of arrhythmia was quantified by arrythmia score(AS). Coronary outflow was collected for determination of creatine kinase(CK) release. Results The incidence of ischemia-induced arrythmia was significantly lowered in diabetic hearts. The incidence of VT was 14.3% and VF 28.6% in DM+KHB subgroup as compared to 60%(VT) and 100%(VF) in the control group. The CK release was significantly lower in diabetes group(DM) than in control group(C); furthermore the CK release in DM=KHB subgroup was lower than that in DM=GLU subgroup. Conclusion Diabetic rat hearts are less susceptible to I/R induced arrythmia. Hyperglycemic perfusion reduces to some extent the increased tolerance to I/R injury in diabetic rat hearts as shown by increased CK release in DM+GLU subgroup but hyperglycemic perfusion has anti-arrhythmic action as shown by 0% incidence of VT and VF in DM+GLU subgroup.