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Objective:To discuss the medication law in prescriptions of Professor Shao Nianfang in the treatment of kidney deficiency and bone marrow loss in senile dementia based on data mining.Methods:Medical cases of kidney deficiency and bone marrow loss in senile dementia in the Geriatric Hospital of Shandong University of Traditional Chinese Medicine from 1st Jan. 2014 to 31st Oct, 2019 were collected. Through hospital electronic medical records system prescription statistics, using ancient and modern medical case cloud platform (V1.2.4), medication frequency, property ans taste, efficacy analysis, correlation rule analysis, clustering analysis and complex network analysis were performed.Results:Totally 110 cases were included in medical cases, involving 238 kinds of Chinese materia medica. The top 10 Chinese materia medica with use frequency were Poria, Acori Tatarinowii Rhizoma, Corni Fructus, Dioscoreae Rhizoma, Rehmanniae Radix Praeparata, Alpiniae Oxyphyllae Fructus, Rehmanniae Radix, Astragali Radix, Chuanxiong Rhizoma, Atractylodis Macrocephalae Rhizoma; the properties were mainly mild, warm slight cold, and cold; the tastes were mainly sweet, bitter, pungent, and light; the meridians were mainly spleen, liver, lung and kidney meridians; the efficacy was clearing dampness and promoting diuresis, clearing heat and promoting blood circulation, calming mind, clearing heat and detoxification, reducing dampness and promote appetizing, tonifying spleen; the association analysis found 15 groups of drug combinations used more than 25 times, they were: Corni Fructus and Poria, Corni Fructus and Dioscoreae Rhizoma, Dioscoreae Rhizoma and Corni Fructus, Rehmanniae Radix Praeparata and Corni Fructus, Dioscoreae Rhizoma and Poria, Astragali Radix and Poria, Alismatis Rhizoma and Poria, Moutan Cortex and Poria, Rehmanniae Radix Praeparata and Poria, Rehmanniae Radix and Poria, Polygalae Radix and Acori Tatarinowii Rhizoma, Moutan Cortex and Corni Fructus, Moutan Cortex and Dioscoreae Rhizoma, Alismatis Rhizoma and Corni Fructus, Alismatis Rhizoma and Dioscoreae Rhizoma; clustering analysis identified four groups of new prescriptions, the first group: Poria, Rehmanniae Radix, Rehmanniae Radix Praeparata, Alismatis Rhizoma, Moutan Cortex, Corni Fructus, Dioscoreae Rhizoma; the second group: Acori Tatarinowii Rhizoma, Cistanches Herba, Morindae Officinalis Radix; the third group: Alpiniae Oxyphyllae Fructus, Chuanxiong Rhizoma, Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle; the fourth group: Atractylodis Macrocephalae Rhizoma, Codonopsis Radix, Astragali Radix, Angelicae Sinensis Radix; the results of complex network analysis showed that the core prescription was modified Liuwei Dihuang Pills. Conclusion:This study found that in view of kidney deficiency and bone marrow loss in senile dementia, Professor Shao pays attention to strengthening the healthy qi, and focuses on tonifying deficiency, taking into account the methods of clearing dampness, clearing heat, detoxification, removing blood stasis and restoring consciousness. The four new prescriptions found in the study can provide a reference for modified medication for syndrome differentiation.
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Objective To investigate the change of serum alkaline phosphatase (ALP) level in patients with acute cerebral infarction (ACI) and its clinical significance.Methods A total of 400 patients with ACI (ACI group) and 240 gender-and age-matched healthy controls during the same period were enrolled in this study.Serum ALP,total protein,alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and other indicators of liver function,serum creatinine (Cr),blood urea nitrogen (BUN) and other indexes of renal function were determined.ACI patients were divided into three subgroups according to the largest diameter of infarction slice on the diffusion weighted imaging (DWI):small area group (＜1.5cm),middle area group (1.5-4.0cm) and large area group (＞4.0cm).The degree of neurologic impairment at admission and the degree of nerve function recovery at discharge were assessed by National Institute of Health stroke scale (NHISS) and modified-Rankin Scale (mRS) in all patients.The relationship of serum ALP level with infarction area,NHISS score and mRS was analyzed.Results Serum ALP level was higher in ACI group than in control group [(80.1±24.4)U/L vs.(75.5±21.5)U/L,t=-2.471,P=0.014].Serum ALP level was elevated along with the increase of infarction areas in ACI group [(78.0 ± 23.3)U/L,(79.4±24.9) U/L vs.(87.7±26.0) U/L,F=4.374,P=0.013].The correlation analysis showed that serum ALP level was positively correlated with infarction area (r=0.118,P=0.019) and NHISS score (r=0.114,P=0.023),but no significant relationship was found with mRS (r=0.071,P=0.08).Multivariate regression analysis revealed that patients with high serum ALP level (＞86 U/L) had 1.691-fold higher risk for cerebral infarction than did those with low serum ALP level(＜67 U/L) (OR=1.691,95％CI:1.103～2.594) after adjusting for confounding variables including age,gender,hypertension,diabetic mellitus,heart disease (coronary heart disease and atrial fibrillation),et al.Receiver operating curves (ROC) analysis revealed that the area under the curve of serum ALP level for predicting ACI was 0.557 (95％CI:0.512～0.602,P=0.016),and its sensitivity and specificity were 43.1％ and 67.6 ％ respectively when serum ALP level was 81.5 U/L.Conclusions Serum ALP level is increased in ACI patients,which has positive correlations with cerebral infarction areas and NHISS scores.In the future,maybe,we could assess ACI by monitoring serum ALP levels or improve the prognosis of ACI patients by decreasing serum ALP levels in the future.
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Objective To investigate the applicability of Stroop color-word test in Chinese eldly patients with sub-jective cognitive impairment. Methods 36 patients with subjective cognitive impairment and 35 normal elders,all accepted general information questionaire( including age,gender,education,ect) ,Chinese version Stroop color-word test,background neuropsychological tests(MMSE,ADL,GDS,ect). Analysis of indicators included: the number of errors,average response,Stroop interference effects ( SIE)-Time difference of the Color inconsistencies and consist-ent with the meaning of words. At last we analyse relationship between CWT results and age,education,et al. Re-sults There were no significant differences in neuropsychological tests. Compared with normal subjects,subjective cognitive impairment subjects spent more time and made more errors in doing this task. They made statistical signifi-cance. The linear regression analysis between reaction time, the number of errors and overall cognitive function ( MMSE) , age, memory ( digit span, delayed recall) showed:the numbers of errors and the average response time had significant positive correlation with age. SIE of SCI was significantly longer than the normal control, the differ-ence was significant (P<0. 05). And it had no significant correlation with age, overall cognitive function and mem-ory and other related inspection. Conclusion Stroop color-word test has a certain sensitivity in recognition of sub-jective cognitive impairment elders.
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Objective To investigate the effect of dexmedetomidine on excitatory aminoacid (EAA)and inhibition of amino acid(IAA)in cerebro-spinal fluid(CSF)of patients undergoing in-tracranial tumor surgery,and to explore the cerebral protective mechanism of dexmedetomidine in neurosurgery.Methods Sixty patients aged 18-64 years old,ASA Ⅰ or Ⅱ,weighing 50-90 kg un-dergoing elective intracranial tumor surgery were randomly divided into dexmedetomidine group (group D)and control group(group C).Dexmedetomidine 1 μg/kg was infused before anesthesia in-duction for more than 10 minutes and pumped continously with 0.2-0.7 μg·kg-1·h-1 in group D, while in group C midazolam 0.03-0.05 mg/kg was injected followed by intermittent administration of 0.03-0.05 mg/kg.BIS value was maintained between 40-50.MAP and HR was recorded at the time points before induction(T0 ),dura mater incision(T1 ),tumor resection(T2 ),at the end of the surgery (T3 ).And we collected CSF at T0 ,T3 ,6 hours after the surgery(T4 ),12 hours after the surgery (T5 ),24 hours after the surgery(T6 ),then the concentrations of EAA and IAA were determined with high-performance liquid chromatography (HPLC)at T0 ,T3 ,T4 ,T5 and T6 .Results The MAP and HR in group D at T1-T3 were much lower than that in T0 and in group C(P <0.05).Compared with T0 ,the Glu and Asp in CSF significantly increased in group C at T3-T6 and were much higher than those in group D (P < 0.05 ),GABA was significantly decreased and much lower than group D(P <0.05).Compared with T0 ,the Glu and Asp in group D at T3-T5 were increased and GABA was decreased, but without statistic significance. At T6 , the values recovered to the level at T0 . Conclusion Dexmedetomidine can be used to maintain hemodynamic stability in intracranial tumor surgery,and may play a role in cerebral protection through inhibiting expression of Glu and Asp (EAA).
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Objective To compare the clinical effect of remifentanil and dexmedetomidine on controlled hypotension during endoscopic sinus surgery. Methods Forty patients undergoing endoscopic sinus surgery were randomly divided into group R and group D, 20 in each group. All patients received controlled hypotension when the surgeons began to sterilize the nasal cavity for the purpose of maintaining the MAP at 60 ~ 70 mmHg. Group R received remifentanil 1μg/kg over 1 minute, followed by 0.2 to 0.4μg/kg per minute infusion during maintenance, whereas group D received dexmedetomidine 1μg/kg over 10 minutes, followed by 0.2 to 0.7μg/kg per hour during maintenance. At the moment of pre-induction(T0), incision(T1), 30 min(T2) and 60 min(T3) after incision and 10 min(T4) after end of controlled hypotension, MAP and HR were measured. Quality of the surgical field, blood loss and extubation time were recorded. Sedation and postoperative pain were assessed on arrival at the PACU. Results The goals for the MAP level were achieved and the surgical field quality was ideal in both groups. The MAP and HR values at T1~ T3 were significantly lower than those at T0 in both groups (P 0.05). No significant difference was founded between the groups in the Fromme operative field score and blood loss (P > 0.05). The extubation time was significantly shorter in group R than in group D(P<0.05). The sedation score in the PACU was significantly lower in group R than in group D(P<0.05), while there were no significant differences in postoperative pain between the groups(P<0.05). Conclusion Both remifentanil and dexmedetomidine are safe agents for controlled hypotension and are effective in providing satisfactory surgical fields during endoscopic sinus surgery. However , remifentanil is advantageous in time for extubation and complete consciousness from anesthesia and therefore it may have the advantage of fast track anesthesia.
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Background and purpose: Preemptive analgesia is one of the strategies to treat postoperative pain by preventing the establishment of central sensitization. This study was designed to explore whether the method of flurbiprofen axetil injection combined with bilateral cervical plexus nerve block in thyroid carcinoma surgery as multimodal preemptive analgesia can serve as a better analgesia. Methods: Sixty patients with thyroid carcinoma were randomly divided into three groups. Patients in Group A were treated with flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia. Patients in Group B were anesthetized with bilateral cervical plexus nerve block. General anesthesia alone was used in patients of Group C. The onset time of nerve block, operation time, extubation time and dosage of fentanyl were recorded. The VAS (visual analogue scale) was used to evaluate the pain level, the side effects of drugs were also analyzed. Results: The onset time of nerve block in Group A, Group B were (7.47±1.04) min and (8.75±1.36) min, repectively (P<0.05). The dosage of fentanyl n Group A, B and C were (0.36±0.04) mg, (0.40±0.06) mg and (0.45±0.07) mg, respectively (Group A vs Group B P<0.05; Group A vs Group C, P<0.01).VAS scores of patients in Group C were higher than both Group A and B at 4,8 h after operation. Moreover, patients in Group B got higher VAS scores than that of Group A at 8 h. The side effects of both Group A and B were much less serious than that of Group C. Conclusion: Flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia during thyroid carcinoma surgery can supply better analgesia and opioid-sparing effects, with less side effects.
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Objective To investigate the effect of gabapentin on high voltage active calcium currents in the injured dorsal root ganglion (DRG) neurons in a rat model of neuropathic pain.Methods Pathogen-free male SD rats aged 4-6 weeks were used in this study. The animals were anesthetized with intraperitoneal pentobarbital soclium 50 mg/kg. L_5 spinal nerve was ligated between DRG and sciatic nerve and cut distal to the ligature. The animals were decapitated on the 14th postoperative day. L_5 DRG was isolated and the neurons in the ganglion were enzymatically dissociated. The high voltage active calcium current was recorded using whole-cell patch-clamp technique.Results Gabapentin inhibited the peak calcium current in the injured DEG neurons. Peak calcium current was decreased by gabapentin 100 μmol/L and both activation and steady-state inactivation curve shifted to more hyperpolarized potentials. Conclusion Gabapentin can inhibit high voltage active in the injured DRG neurons in a rat model of neuropathic pain. The alteration in the inactivation of the electrophysiological properties may be involved in the mechanism.
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Objective To investigate the changes in high voltage-activated (HVA) calcium current in dorsal root ganglion (DRG) neurons isolated from rats with neuropathic pain. Methods Pathogen-free male SD rats aged 4-6 weeks weighing 180-220 g were used in this study. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg. Neuropathic pain was induced by ligation of L5 spinal nerve between DRG and sciatic nerve. The nerve was transected distal to the ligature. The animals which showed positive signs of neuropathic pain were decapitated on the 14th postoperative day. L5 and L4 DRGs were isolated and the neurons in the ganglia were enzymatically dissociated (group L5 and L4). The control group received no surgery (group C). The HVA Ca2+ current was recorded using whole-cell patch clamp technique. Results Peak calcium current density was significantly lower in group L5 and L4 than in group C, and was significantly lower in group L5 than in group L4 . Halfactivation value (Va 1/2) was also significantly lower in group L5 than in group C and L4 (P ＜ 0.05). The relative contribution of N-type to the total HVA Ca2+ current was significantly greater in group L5 than in group C and L4(P ＜ 0.05). There was no significant difference in the steady-state inactivation curves among the 3 groups. Conclusion In rats with neuropathic pain, the HVA Ca2+ current in the injured DRG neurons may play a key role in the induction of neuropathic pain.
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Objective In order to choose a suitable method in detecting MRS,the detection rate,sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test,cefoxitin disk diffusion test and PCR for mecA gene are evaluated.Methods MRSA and MRCNS are detected by the four methods metioned above in 175 staphylococci,then comparing the postive detection rate by Chi-square test and calculating sensitivity and specificity of the other three methods based on PCR for meeA gene as a gold standard.Results The detection rate of four methods have no difference in detecting MRSA,but the detection rate of Vitek-32 auto microbacteria indentity system and oxacillin agar dilution test is better than that of PCR for mecA gene in detecting MRCNS.Sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test and cefoxitin disk diffusion test in detecting MRSA are 100%、96.3%、96.3% and 88.2%、100%、100% respectively,the sensitivity of detecting MRCNS are all 100%,the specificity of detecting MRCNS are 50%、46.1% and 65.4% respectively.Conclusions Both mecA gene and the determination for MIC of Oxacillin should be considered in final decision for MRS,Furthermore.the MRS mediated by mecA gene and the MRS mediated by non-mecA gene should be treated differentially.