The effect of ultrasound monitoring of inferior vena cava collapse index guiding fluid replacement on circulation in elderly patients during induction of general anesthesia / 中国医师杂志

Objective:To investigate the effect of ultrasound monitoring of inferior vena cava collapse index (IVC-CI) guiding fluid replacement on circulation in elderly patients during induction of general anesthesia.Methods:A total of 71 elderly patients who underwent elective surgery under general anesthesia and tracheal intubation at Hunan Provincial People′s Hospital from April 2021 to September 2022 were randomly divided into control group (35 cases) and observation group (36 cases) using a random number table method. Before anesthesia, both groups of patients underwent IVC ultrasound examination and calculated the IVC-CI value. For patients with IVC-CI≥40%, the observation group was given 8 ml/kg of crystal solution before anesthesia induction, while the control group was not treated. The incidence of hypotension, the use of vasoactive drugs, and the total infusion volume from anesthesia induction to skin incision were recorded in two groups. Mean arterial blood pressure (MBP), heart rate (HR), oxygen saturation (SpO 2), cardiac index (CI), and cardiac volume variability (SVV) before anesthesia (T 0), 5 min after induction (T 1), 1 min after tracheal intubation (T 2), 5 min after tracheal intubation (T 3), 10 min after tracheal intubation (T 4), and 1 min before skin incision (T 5) were recorded and compared between the two groups. Results:The incidence of hypotension (27.8% vs 60.0%) and utilization rate of vasoactive drugs (25.0% vs 48.6%) in the observation group were lower than those in the control group, and the total infusion volume during anesthesia induction was higher than that in the control group, with statistical significance (all P<0.05). SVV, CI and MBP at T 1, T 3, T 4 and T 5 were significantly different from those at T 0 in the control group ( F=3.85, 14.66, 3.96, all P<0.05). SVV, CI and MBP at T 1, T 3, T 4 and T 5 in the observation group were significantly different from those at T 0 ( F=3.51, 13.20, 4.35, all P<0.05). There was no significant difference in SVV, CI, MBP, HR and SpO 2 between 2 groups (all P>0.05). Conclusions:For the elderly patients with preoperative IVC-CI≥40%, pre-filling with 8ml/kg crystal solution before anesthesia induction can significantly reduce the incidence of hypotension and the utilization rate of vasoactive drugs in the elderly patients during anesthesia induction.

Effect of esketamine on cardiac index in patients undergoing prone lumbar surgery under general anesthesia / 中国医师杂志

Objective:To observe the effect of esketamine on cardiac index in patients undergoing lumbar surgery in prone position under general anesthesia.Methods:Forty-five patients with prone lumbar surgery after general anesthesia in Hunan Provincial People′s Hospital from March to July 2021 were divided into observation group (24 cases, group A) and control group (21 cases, group B) according to random number table method. Group A received 0.5 mg/kg esketamine intravenously during induction, and 0.15 mg/(kg·h) esketamine intravenously for 2 h after prone position. Group B received the same amount of normal saline. Both groups were given sevoflurane and remifentanil during operation to maintain anesthesia, and sufentanil was given intermittently during operation. The mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic pressure (DBP), cardiac index (CI), and heart rate (HR) before induction (T 0), during endotracheal intubation (T 1), 5 minutes after intubation (T 2), 5 minutes after prone position (T 3), 10 minutes after prone position (T 4), 30 minutes after prone position (T 5), 45 minutes after prone position (T 6), 60 minutes after prone position (T 7), 90 minutes after prone position (T 8), and 120 minutes after prone position (T 9) were recorded; The total dosage of norepinephrine 2 hours after anesthesia to prone position and extubation time after operation were also recorded. The Visual Analogue Scale (VAS) was performed 15 minutes after extubation, 6 and 24 hours after operation. Results:There was no significant difference in CI between T 3-T 9 and T 2 in group A ( P>0.05); the CI of group B at T 3-T 7 was significantly lower than that at T 2 (all P<0.05); there was no significant difference in CI between T 8-T 9 and T 2 in group B (all P>0.05); There was no significant difference in CI between group A and group B at T 0-T 2 (all P>0.05). The CI of group A at T 3-T 9 was significantly higher than that of group B (all P<0.05); The dosage of norepinephrine in group A was significantly lower than that in group B ( P<0.05); There was no significant difference in HR, MAP, SBP and DBP between the two groups at different time points (all P>0.05); there was also no significant difference in extubation time and VAS scores at 15 minutes, 6 hours and 24 hours after extubation between the two groups (all P>0.05). Conclusions:Intraoperative application of esketamine can increase CI after prone position and reduce the amount of norepinephrine during lumbar surgery.

Effects of isoflurane preconditioning on renal ischemia-reperfusion injury in rats / 中国医师杂志

Objective To investigate the effects of isoflurane preconditioning on renal ischemia reperfusion (I/R) injury in rats and the role of TNF-α plays in the mechanism.Methods Male SD rats were used in the study.The animals were randomly divided into 3 groups ( n =12 each):shame operation group; I/R group; Isoflurane preconditioning group (inhaled 1.5％ isoflurane (1 MAC) for 30 min followed by 10 min washout before I/R).At 2 h reperfusion,blood samples were obtained for urea nitrogen (BUN) concentration and creatinine (Cr) content.The level of TNF-α in renal tissues were determined by enzyme-linked immunosorbent assay (ELISA).Observe the pathological changes in H.E.staining slides under microscope.Results BUN concentration and Cr content and the level of TNF-α in I/R group and isoflurane preconditioning group were significantly higher than in shame operation group[ BUN:( 17.69 ±0.99)mmol/L vs (8.37 ±1.12)mmol/L,t =-23.55,P ＜0.01; ( 12.26 ± 1.11 ) mmol/L vs (8.37 ±1.12 )mmol/L,t =- 19.09,P ＜ 0.01 ;Cr:( 103.22 ± 13.42)μmol/L vs (71.48 ± 8.59) μ mol/L,t =-21.45,P ＜0.01;(86.51 ± 11.49) μmol/L vs (71.48 ±8.59) μmol/L,t =-9.87,P ＜0.01 ;TNF-α:(0.51 ±0.07)ng/ml vs (0.43 ±0.00)ng/ml,t =-5.79,P ＜0.01;(0.47 ±0.03)ng/ml vs (0.43 ±0.00)ng/ml,t =-8.86,P ＜0.01 ].BUN concentration and Cr content and the level of TNF-α in Isoflurane preconditioning group were significantly lower than in I/R group [ BUN:( 12.26 ± 1.1 1 ) mmol/L vs ( 17.69 ± 0.99 ) mmol/L,t =15.67,P ＜ 0.01 ; Cr:( 86.51 ± 11.49) μmol/L vs ( 103.22 ± 13.42 ) μ mol/L,t =6.68,P ＜0.01 ;TNF-α:(0.47 ±0.03) ng/ml vs (0.51 ±0.07) ng/ml,t =2.61,P ＜0.05].Therenal I/R injury which located around kidney tubules was increased in I/R group and isoflurane precondi-tioning group compared to shame operation group [ ( 17.26 ± 1.45 ) vs (0.00 ± 0.00 ),t =- 72.38,P ＜0.01;(12.69±1.83) vs (0.00 ±0.00),t =-39.53,P ＜0.01].The renal I/R injury which located around kidney tubules was decreased in isoflurane preconditioning group compared to I/R group [ ( 12.69 ±1.83) vs (17.26±1.45),t =19.87,P ＜0.01].Conclusions Preconditioning with 1.5％ isoflurane 30 min can protect kidney from I/R injury in rats by regulating the level of TNF-α in renal tissues.

Clinical analysis of 48 cases with pulmonary lymphangioleiomyomatosis:a report of three cases and review of domestic literatures published in the past ten years / 中华全科医师杂志

Objective To improve the understanding and diagnosis of pulmonary lymphangioleiomyomatosis (PLAM) by the comprehensive review of domestic literatures in the past ten years.Methods Three new cases with PLAM were reported and integraed with other 45 cases reported domestically in the past ten years for analysis of their clinical features.Results The newly reported three cases of PLAM were all women at child-bearing age, with initial symptom of dyspnea after activity. Two of them complicated with extra-pulmonary PLAM. All the three cases were free of chylous effusion. Forty-seven of 48 cases with PLAM were pathologically diagnozed, with ages of onset of 5~69 (mean?s of 34?10) years. Their clinical manifestations were mainly respiratory, including dyspnoea (95.8%), haemoptysis (52.1%), pneumothorax (45.8%), chylous effusion (33.3%),cough (31.3%) and chest pain (12.5%). Abnormal manifestations in abdomen, including renal mass, retroperitoneal mass and retroperitoneal lymphadenopathy, were detected in 16 cases. Thirty-nine cases had their high-resolution CT (HRCT) examined and appearance of multiple cysts distributed throughout the bilateral lung fields could be discerned in 38 of them. Obstructive ventilation disturbance could be observed in 23 of 30 cases with the data or conclusions on pulmonary function tests, and mixed ventilation disturbance in seven cases. Respiratory failure was complicated in 17 of 28 cases with the data of arterial blood gas analyses.Conclusions HRCT had confirmative value for diagnosis of PLAM. In practice, HRCT, as well as other routine abdominal and pelvic imaging examinations, should be performed in time for child-bearing-age women with progressive dyspnoea, haemoptysis, or spontaneous pneumothorax, to detect if they complicate with PLAM.

Highly cellular leiomyoma of uterus: a comparative morphologic and immunohistochemical study of endometrial stromal tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the morphological characteristics and immunophenotype of highly cellular leiomyoma (HCL) of uterus, compared with that of uterine endometrial stromal tumors (EST).</p><p><b>METHODS</b>HE and immuno-stained sections EnVision method from 20 cases of HCL, 21 cases of EST and 1 case of stromomyoma were reviewed. Monoclonal antibodies against h-caldesmon, calponin, CD10, desmin and smooth muscle actin (SMA) were used for immunohistochemistry studies.</p><p><b>RESULTS</b>On microscopic examination, HCL were densely cellular and composed of cells that ranged from spindle-shaped to round with scanty cytoplasm. A focal fascicular pattern was present in all cases. Blood vessels with large, thick muscular walls were a conspicuous feature of the majority of tumors. Cleft-like spaces were present in 9 tumors and 15 cases exhibited irregular focal extensions into the adjacent myometrium. ESTs were composed of cells that resembled endometrial stromal cells of proliferative endometrium. These cases included a significant component of delicate blood vessels similar to spiral arterioles. All 20 low grade endometrial stromal sarcoma cases had infiltrative growth to adjacent myometrium. Immunoreactivities of HCL for h-caldesmon, calponin, CD10, Desmin and SMA were 80.0% (16/20), 100% (20/20), 0 (0/20), 95.0% (19/20) and 100% (20/20), respectively, whereas the positive rates of EST were 4.7% (1/21), 23.8% (5/21), 66.7% (14/21), 23.8% (5/21) and 19.0% (4/21), respectively (P = 0.001).</p><p><b>CONCLUSIONS</b>Highly cellular leiomyomas have distinct morphologic features. H-caldesmon, calponin, CD10, desmin and SMA are helpful in the differential diagnosis of HCL and EST.</p>

Investigation of Relationship Between Helicobacter Pylori Infection and Reflux Esophagitis / 中国医师杂志

Objective To investigate the relationship between helicobacter pylori (H. pylori) infection and reflux esophagitis (RE). Methods H.Pylori infection rates of RE in patients with simple chronic gastritis(CG),which was confirmed by gastrospcope combined with pathological diagnosis were researched.The relationship between HP infection and RE classifications using gastroscope and pathology was explored.Results ⑴H.pylori infection was found in 29(27.1%) in 107 cases of RE and 43(40.2%) in 107 cases of simple CG patients respectively,HP infection positive in RE patients less than that of simple CG patients.RE of class Ⅰ,Ⅱand Ⅲ using gastroscopy classification were 62.1%, 10.3% and 27.6% in H. Pylori-positive cases respectively, while they were 56.4%, 6.4% and 37.2% respectively in H. Pylori-negative ones. However, mild, moderate and severe RE identified by pathohistology were 72.4%, 13.8% and 13.8% in H.Pylori-positive cases respectively, and they were 57.7%, 17.9% and 24.4% respectively in H.Pylori-negative ones.Conclusions All above results suggested that H.Pylori possibly has prevention role in some extent to pathogenesis of RE. RE more commonly was seen in H.Pylori-negative cases.RE could inhibit the H.Pylori survive,So that,the RE was occurred frequently in H.Pylori-negative patients.The inflammatory extent of RE is not serious in H.Pylori-positive patients.