Effects of Left Ventricular Assist and Aortic Graft Angle on Aortic Valve: A Hemodynamic Study / 医用生物力学

Objective To investigate the effect of left ventricular assist device (LVAD) and aortic graft angle on hemodynamics of aortic valve. Methods Three models of aorta and aortic valve with 45°, 60° and 90° anastomosis angles between LVAD and aorta were constructed, and an in vitro pulsating table was built for in vitro experiments. Using particle image velocimetry (PIV) system, three moments in the cardiac cycle ( T1 systolic peak, T rapid closure, T3 diastolic peak), were selected to study the hemodynamic state of aortic valve. Results Velocity vector, vorticity and viscous shear stress were used to evaluate the effect of LVAD anastomosis angle on hemodynamics of aortic valve. During the period of rapid valve closure, with the increase of graft angle, the blood flow velocity near the valve wall, the average vorticity and the maximum viscous shear stress all increased. Conclusions When the graft angle is lower, the impact velocity of blood on the valve is smaller, and the shear force on the valve decreases, so that the valve is in a better hemodynamic environment. This study provides references for the selection of anastomotic angles in clinical operations.

Anesthesia management of living small bowel transplantation / 中华麻醉学杂志

Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

Effect of ultrasound-guided serratus anterior plane block on postoperative pain in patients under-going breast prosthesis implantation / 临床麻醉学杂志

Objective To investigate the effect of ultrasound-guided serratus anterior plane (SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 25 each) : SAP block group (group N) and control group (group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375％ ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale (VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N (P ＜ 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.

Study on the Optimization of Family Doctor Team Based on Rational Drug Use in Primary Medical Institutions / 中国药房

OBJECTIVE： To provide reference for optimizing the structure of family doctor team and improving rational drug use in primary medical institutions of China. METHODS： Combined with relevant literatures and author’s work experience， the situation of rational drug use in primary medical institution and the development of family doctors team were reviewed. The problems existing in the rational drug use service provided by family doctor team were analyzed to put forward relevant suggestions. RESULTS & CONCLUSIONS： There are some problems in primary medical institutions， such as blind selection or abuse of antibiotics， high frequency of injection use. Provinces and municipalities that implement the family doctor model in China have gradually formed five kinds of family doctor contract service modes， such as “1+1+1” contract service mode， “basic package+personality package” contract service mode. The existing family doctors team have problems in the development of rational drug use services， such as lack of pharmaceutical service personnel， low business ability， limited pharmacy knowledge of team members， and insufficient participation of pharmacists. A reasonable family doctor team should pay attention to the cultivation of pharmacy service pharmacists， strengthen pharmacy professional knowledge training of medical staff， and build a corresponding “pharmaceutical joint” platform by means of the medical association platform if necessary so as to promote rational drug use in primary medical institutions.

Therapeutic effect of sequential local injection of heterogeneic lymphocytes and autologus lymphocytes on transplanted hepatocarcinoma in mice / 实用肿瘤学杂志

Objective The aim of this study was to investigate the anti-tumor effect on sequential injection of heterogeneic lymphocyte(HL)and autogeneic lymphocyte(AL). Methods The HL was prepared by using CC3HF1 mice as feeders. CB6F1 mice were used as recipients,and Hepa1-6 cells were inoculated into the recepients′groin subcutis. A cryoprecipitate was extracted from mouse plasma by freeze-thaw method to prepare fibrin Glue(FG);FG was combined with HL or AL to be FG-HL or FG-AL. The experimental treatment consisted of two stages. At first stage(15 d),FG-HL were injected on the surface of the tumor-bearing tissue of the recipients as the experimental group,and FG-phosphate buffer saline(FG-PBS)were injected on the surface of the tumor-bearing tissue of the rest recipients as the control group. The immunological factors such as tumor cell killing rate of the spleen lym-phocytes and numbers of lymphocytes,CD8 +T and NK in the two groups were detected,respectively. At later stage(10 d),a part of mice were randomly selected from the experimental and control groups,and the lymphocytes( AL) were used to form FG-AL,which were injected on the surface of tumor-bearing tissues in the rest of mice. Tumors in mice of the two groups were compared for tumor volume and tumor inhibition rate. Results The tumor cell killing rate of AL in the experimental group(26. 70 ± 7. 22) was signifi-cantly higher than that in the control group(5. 70 ± 2. 68)(P<0. 01). Numbers of mouse spleen lymphocytes,CD8 +T cells and NK cells were significantly higher than the corresponding values of the control group(P<0. 05). After the two-stage treatment,the aver-age tumor volume of the experimental group[(1.20 ±0.33)cm3]was significantly smaller than that of control group[(2.05 ±0.37) cm3](P<0. 01). The tumor inhibition rate in the experiment group was 41. 5% when compared to the control group. Conclusion Local injections of FG-HL followed by FG-AL can significantly inhibit the growth of transplanted tumor in mice;it is expected to become an anti-tumor biological therapy.

Equity Study on Utilization of Traditional Chinese Medicine Service:Based on the Background of Three Basic Medical Insurance / 中国医学伦理学

Objective: To compare the differences and caused of patients' utilization of Traditional Chinese Medicine service under three basic medical insurance systems.Methods: Using self-developed questionnaire,random sample survey was conducted among the basic medical insurance outpatients in five hospitals in Nanjing and Lanzhou.The survey content included the basic information of the patients,the utilization of Traditional Chinese Medicine outpatient clinics,the utilization of Traditional Chinese Medicine service items,and the suggestions for the Traditional Chinese Medicine service.Results:①The utilization rate of the Traditional Chinese Medicine out-patient clinics in new rural cooperative medical system patients was much lower than that in urban basic medical in-surance patients.②The utilization rate of Traditional Chinese Medicine service projects in patients under basic medical insurance for urban employees was higher than those under medical insurance for urban residents and new rural cooperative medical system patients.In all Traditional Chinese Medicine service projects,the utilization rate of cupping project was the highest(48.3％).③ The gap between urban and rural areas made the utilization rate of Traditional Chinese Medicine service projects different among patients participating in basic medical insurances.④ The most expected suggestion of patients was the improvement of the efficacy of Traditional Chinese Medicine(68.5％),followed by the improvement of medical insurance-related reimbursement ratio(65.2％)and the in-crease of reimbursement items(64.3％).Conclusion: The government should increase the financial input in new rural cooperative medical system and improve the basic medical insurance system.Traditional Chinese Medicine medical institutions should improve the quality of services in order to achieve the fairness in the provision of health services.

Pig pancreas islets transplanted in an artificial cyst under capsule of liver for diabetic mellitus in rats / 中华器官移植杂志

Objective To develop a new method of immune isolation for transplanting pig islets to rat to observe the effects on diabetic rats.Method Diabetes of rat was induced by streptozotocin.Pancreas of pig was digested with type V collagenase.The pig islets were purified by density gradient centrifugation.Insulin stimulation index of the purified pig islets was evaluated.Liver of the 18 diabetic rats and 6 normal rats was exposed by operation.Capsule at one edge of the liver lobe was cut apart and separated from liver parenchyma on both sides of the lobe.An artificial cyst was constructed by a cellulose ester (CE) dialysis bag with a ball of hollow fibers in the bag,and each end of the bag was closed by a thread.Each end of the bag was stuffed into the subcapsule of each side of the liver lobe.The thread at each end of the bag was passed through a hole of the capsule at other edge of the lobe and linked to each other around the lobe to hold the artificial cyst on the liver parenchyma.Middle part of the cyst (with the ball of hollow fibers in) was put between the cuts of capsule and under the skin.The collagen solution (pH 7.4) with pig islets (4000 IEQ) was injected into the subcapsule artificial cyst of 12 diabetic rats as experiment group.The collagen solution without pig islets was injected into the subcapsule artificial cyst of 6 diabetic rats and 6 normal rats as diabetes control group and normal control group respectively.The cut was sutured.The collagen solution became a collagen gel in the artificial cysts.At 8th week of the initial transplantation,the solution with pig islets (2000 IEQ) was injected percutaneously again into the subcapsule artificial cyst of each rat of the experiment group.Rats of the three groups were raised as usual,and the levels of fasting blood glucose were measured regularly.Result The insulin stimulation index of the purified pig islets was 2.2 ± 0.2.At 1st to 8th week of the initial transplantation,the levels of fasting blood glucose in the experiment group at every time point were lower significantly than those in the diabetes control group (P＜0.01).At 13th week of the initial transplantation,there was no significant fibroplasia around the subcasule artificial cysts in the rats by visual observation.Conclusion CE dialysis bag in the liver capsule at 13th week did not show significant stimulation to the surrounding tissues.Pig islets isolated in the subcapsule artificial cyst of rats might live normally and perform hypoglycemic action.Pig islets could be percutaneously injected into the subcapsule artificial cyst.