Comparison of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide and endothelin-1 / 中国医师进修杂志

Objective:To compare the effects of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide (NO) and endothelin-1 (ET-1).Methods:The clinical data of 80 patients with laparoscopic surgery in Guangrao People′s Hospital from March 2017 to March 2019 were retrospectively analyzed. Among them, 40 cases were given propofol intravenous anesthesia (propofol group), and 40 cases were given etomidate intravenous anesthesia (etomidate group). The anesthetic effect, plasma NO and ET-1 levels, hemodynamic indexes and adverse reactions (muscle spasm, nausea and vomiting, injection site pain, body movement and respiratory depression) were compared between the two groups.Results:The time of consciousness disappearance, tracheal intubation, eye opening, spontaneous breathing and speech response in etomidate group were significantly shorter than those in propofol group: (57.48 ± 2.63) s vs. (86.17 ± 7.41) s, (4.39 ± 2.56) min vs. (6.42 ± 2.58) min, (5.39 ± 2.56) min vs. (9.42 ± 2.58) min, (5.21 ± 1.99) min vs. (8.75 ± 2.54) min and (8.39 ± 2.56) min vs. (8.39 ± 2.56) min, and the differences were statistically significant ( P<0.05). The levels of NO and ET-1 in the etomidate group were significantly lower than those in the propofol group at 0.5, 1.0 and 1.5 h after pneumoperitoneum ( P< 0.05). The levels of systolic blood pressure, diastolic blood pressure and oxygen saturation (SpO 2) in the etomidate group were significantly higher than those in the propofol group: (78.42 ± 4.68) mmHg (1 mmHg = 0.133 kPa) vs. (74.11 ± 6.63) mmHg, (132.86 ± 8.71) mmHg vs. (111.24 ± 3.56) mmHg and 0.982 ± 0.032 vs. 0.953 ± 0.043, and the differences were statistically significant ( P<0.05). The incidence of adverse reactions in the etomidate group was significantly lower than that in the propofol group: 17.5% (7/40) vs. 47.5% (19/40), P<0.05. Conclusions:Compared with propofol intravenous anesthesia, etomidate intravenous anesthesia in laparoscopic surgery patients has more stable hemodynamics and better anesthetic effect. It can effectively inhibit the release of NO and ET-1, and has higher safety.

Analysis of a family with early onset familial Alzheimer′s disease caused by mutation of amyloid precursor protein gene p.V717I / 中华神经科杂志

Objective To analyze the clinical data of a family with early?onset familial Alzheimer′s disease and to analyze the mutation of the pathogenic gene in the family. Methods The clinical data of a proband who was clinically diagnosed as early?onset Alzheimer′s disease in the Department of Neurology, People′s Hospital of Zhengzhou University in October 2018 and her family members were collected. Moreover, whole exome sequencing was performed on blood sample from the proband, then its deleterious effects were assessed according to the Standards and guidelines for the interpretation of sequence variants, a joint consensus recommendation of the American College of Medical Genomics. Subsequently, the strong pathogenic mutation was validated by Sanger sequencing in the some members of the family and 50 sporadic Alzheimer′s disease and 50 normal individuals of the family. Apolipoprotein E (APOE) typing of 10 family members was all epsilon 3/epsilon 3. Results The proband in this family showed decreased memory, visual space disorder, verbal repetition, personality change and abnormal mental behavior. The mutation at codon 717 of exon 17 of the proband amyloid precursor protein gene was detected by gene detection. The mutation at codon 717 of exon 17 of the proband beta?amyloid precursor protein gene was also found in the other five members of the family. The mutation was not found in 50 sporadic Alzheimer′s disease patients and 50 normal individuals outside the family. The proband′s head magnetic resonance imaging (MRI) showed bilateral hippocampal atrophy on plain scan, especially on the left side. No obvious abnormality was found in the head magnetic resonance angiography. The head MRI of the proband′s sister showed brain atrophy and bilateral hippocampal atrophy. Conclusions The study identified the pathogenic mutation of the beta?amyloid precursor protein gene p. V717I in six patients of a family with early?onset familial Alzheimer′s disease, and the mutation showed a phenomenon of family segregation. This finding is of great significance to the study of early?onset Alzheimer′s disease in Chinese population.

Analysis of a family with early onset familial Alzheimer′s disease caused by mutation of amyloid precursor protein gene p.V717I / 中华神经科杂志

Objective@#To analyze the clinical data of a family with early-onset familial Alzheimer′s disease and to analyze the mutation of the pathogenic gene in the family.@*Methods@#The clinical data of a proband who was clinically diagnosed as early-onset Alzheimer′s disease in the Department of Neurology, People′s Hospital of Zhengzhou University in October 2018 and her family members were collected. Moreover, whole exome sequencing was performed on blood sample from the proband, then its deleterious effects were assessed according to the Standards and guidelines for the interpretation of sequence variants, a joint consensus recommendation of the American College of Medical Genomics. Subsequently, the strong pathogenic mutation was validated by Sanger sequencing in the some members of the family and 50 sporadic Alzheimer′s disease and 50 normal individuals of the family. Apolipoprotein E (APOE) typing of 10 family members was all epsilon 3/epsilon 3.@*Results@#The proband in this family showed decreased memory, visual space disorder, verbal repetition, personality change and abnormal mental behavior. The mutation at codon 717 of exon 17 of the proband amyloid precursor protein gene was detected by gene detection. The mutation at codon 717 of exon 17 of the proband beta-amyloid precursor protein gene was also found in the other five members of the family. The mutation was not found in 50 sporadic Alzheimer′s disease patients and 50 normal individuals outside the family. The proband′s head magnetic resonance imaging (MRI) showed bilateral hippocampal atrophy on plain scan, especially on the left side. No obvious abnormality was found in the head magnetic resonance angiography. The head MRI of the proband′s sister showed brain atrophy and bilateral hippocampal atrophy.@*Conclusions@#The study identified the pathogenic mutation of the beta-amyloid precursor protein gene p.V717I in six patients of a family with early-onset familial Alzheimer′s disease, and the mutation showed a phenomenon of family segregation. This finding is of great significance to the study of early-onset Alzheimer′s disease in Chinese population.

Fatal familial insomnia preliminarily diagnosed as frontotemporal dementia: a case report and literature review / 中华神经科杂志

Objective To explore the clinical,imaging,genetic features in a case of fatal familial insomnia (FFI),and review related literatures.Methods A case of middle-aged woman diagnosed as frontotemporal dementia based on the preliminary manifestation of abnormal mental behavior was reported.The clinical features,imaging characteristics,electroencephalogram and polysomnogram of the patient were analyzed,and the blood samples from the patient and some of her familial members were collected for the sequencing of prion protein gene (PRNP).Results This patient was a middle-aged woman,whose clinical manifestations were abnormal mental behavior,rapid progressive dementia and intractable insomnia,abnormal night sleep behavior and laryngeal stridor.Brain MRI indicated frontotemporal lobe atrophy.Non-sleep disturbance was observed in polysomnography.The cerebrospinal fluid was negative for 14-3-3 protein.The results of PRNP sequencing revealed that the mutation of gene D178N/129M was detected.Conclusions Detection of PRNP plays an important role in the diagnosis of FFI.Patients suspected of FFI in clinic should be detected for genetic testing.Whether the frontotemporal lobe atrophy was caused by FFI or concurrent with FFI remains to be further verified.

Clinical characteristics of four patients with primary intraspinal lymphoma / 中华神经科杂志

Objective To analyze clinical characteristics of four cases with primary intraspinal lymphoma to achieve early diagnosis of the disease.Methods Clinical data including the clinical presentation,imaging features and pathological characteristics of four patients diagnosed as primary intraspinal lymphoma confirmed surgically and pathologically from February 2014 to February 2017 in Henan Provincial People's Hospital were analyzed retrospectively,and literatures were reviewed.Results The major clinical manifestations of the primary intraspinal lymphoma were as following:persistent or intermittent waist (back) pain,accompanied with both lower limb weakness,dysfunction of motion,loss or disappearance of sensation,incontinence,followed by an acute progressive neurological function deterioration.The imaging showed a single fusiform shape or irregular lump.The T1 WI signal was equal or slightly lower,and T2WI showed equal or slightly higher signal,and the general signal uniform;The lump showed mild or moderate homogeneous enhancement.The group of four cases were B cell non-Hodgkin lymphoma confirmed by pathological biopsy.Conclusions The clinical and imaging features of primary intraspinal lymphoma are lack of specificity and are easy to be misdiaguosed.The diagnosis is mainly based on pathological biopsy.

Positions of the implanted stimulating electrodes for artificial facial nerve for inducing contraction of the orbicularis oris muscle in rabbit with peripheral facial paralysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the optimal positions of the implanted stimulating eletrodes for artificial facial nerve (AFN) for inducing contraction of the orbicularis oris muscle (OOM) in rabbit with peripheral facial paralysis.@*Methods@#According to the four microelectrodes of the AFN stimulating side, four modes of the implanted positions were divided. In line with different modes, the electrodes were implanted into the affected OOM of the rabbits with unilateral peripheral facial paralysis. AFN output electric stimulation to induce contraction of the affected OOM with uniform stimulating frequency and pulse length in vitro. Then compared the stimulus threshold amplitude and the peak amplitude separately among different modes by SAS 9.3 version statistical software.@*Results@#The differences of the stimulus threshold amplitude and the peak amplitude had no statistically significant separately between the first mode and the second mode (P>0.05), but there were statistically significant differences between the third mode and the fourth mode (P<0.05). Both kinds of the amplitudes were approximated between the first mode and the second mode respectively, and higher than those in the third mode or the fourth mode. Furthermore, both kinds of the amplitudes in the fourth mode were higher than those in the third mode.@*Conclusions@#The microelectrodes of the AFN stimulating lateral are implanted into the upper lip with a public microelectrode and an output microelectrode, into the lower lip with an output microelectrode, and into the way, which is located to the angle 40° to 45° about the line joining between the midpoint of the ipsilateral auricle root and the corner of the mouth with an output microelectrode. This is the third positional mode which requires lowest effective stimulus current intensity. Thus the mode is suitable as the optimal placement programme.

Comparison of Work Mode and Effect Analysis in ICU Area of Our Hospital before and after the Applica-tion of Automated Drug Dispensing System / 中国药房

OBJECTIVE:To promote standard management of drugs in ICU area. METHODS:The change of work mode in ICU area of our hospital was analyzed and compared after the application of automated drug dispensing system(ADDS)as well as the change of related indicators 3 months before and after the application of ADDS;the effect of ADDS was evaluated. RESULTS& CONCLUSIONS:After the application of ADDS,the management of base drugs changed from open management to intelligent, closed-off and authority management;drug storage and cost management became more scientific,and staff allocation became more optimal. Under the condition of zero difference in the number of medical orders,initial medication time shortened from 170 min to 131 min (P<0.05),time of daily drug preparation and drug repercussion shortened from (81.20 ± 3.56)min to (30.04 ± 7.55) min,and (9.18 ± 2.79)min to (6.47 ± 4.66) min (P<0.05). The application of ADDS can improve work efficiency,standardize drug management,promote medical safety,and provide reference for initiating a new mode of drug management in wards.

Combined inhibition of Stat3 and HIF-1α for enhancement of radio- and chemo-sensitivity in laryngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the influence of signal transducer and activator of transcription 3 (Stat3) and hypoxia-inducible factor-lα (HIF-1α) on the resistance effect of laryngeal squamous cell carcinoma to radiation therapy and chemotherapy under the hypoxia circumstances.@*METHOD@#Western blot was used to test the expression of p-Stat3 and HIF-1α in the Hep-2 cells under the hypoxia conditions. MTT assay was used to test the proliferation of Hep-2 cells after radiation therapy and chemotherapy; the Hep-2 cells were suppressed expression of Stat3 and/or HIF-1α.@*RESULT@#(1) AG490 induced significant proliferation inhibition on Hep-2 cells and Hep-2HIF-1α-/- cells in vitro underthe hypoxia environments (P < 0.05); (2) Suppressing expression of Stat3 reduced the expression of HIF-1α protein (P < 0.05); (3) Combined inhibition of Stat3 and HIF-1α enhanced radio- and chemo-sensitivity in laryngeal squamous carcinoma cells under hypoxia.@*CONCLUSION@#Combined inhibition of Stat3 and HIF-1α can further enhance radio- and chemo-sensitivity in laryngeal squamous carcinoma cells under hypixia compare than inhibiting Stat3 or HIF-1α alone. Effectively blocking of HIF-1α pathway and suppressing the expression of Stat3, would be an effective method to enhance radio- and chemo-sensitivity in laryngeal squamous carcinoma cells, which provides a new thought to reduce the resistance to treatment.

The correlation of CT perfusion imaging with microvessel density and vascular endothelial growth factor in hepatic alveolar echinococcosis / 中华放射学杂志

Objective To explore the correlation of CT perfusion imaging with microvessel density (MVD) and vascular endothelial growth factor (VEGF) in hepatic alveolar echinococcosis (HAE).Methods Multi-slice spiral CT perfusion imaging was performed in 27 patients with HAE.Time-density curves(TDC) of the HAE peripheral area was drawn from the region of interest (ROI) with perfusion functional software.CT perfusion parameters including blood flow ( BF ),blood volume ( BV ),mean transit time(MTT) and permeability surface area product (PS) were calculated.MVD and VEGF expression of pathological specimens were examined by immunohistochemical staining with anti-CD34,anti-VEGF monoclonal antibody.The CT perfusion parameters,MVD and VEGF were compared in different types of TDC with t test.The correlation of CT perfusion parameters with MVD and VEGF were analyzed with Spearman test.Results In this group,21 cases which TDC lower than that of the liver were classified as type Ⅰ,the others 6 cases TDC higher than the liver were of type Ⅱ TDC.TDC perfusion parameters of the two types were as follows,BF:( 111.7 + 27.6),( 158.9 + 39.5 ) ml · 100 g- 1 · min - 1,BV:( 15.1 + 6.2),(26.8+8.4) ml/100 g,MTT:(7.0+4.4),(7.7+3.1) s,PS:(51.7 +17.3),(51.0+20.5) ml·100 g-1 · min-1.The significant differences of BF,BV and MVD[ (20.5 +5.4)/HP,(37.2 ±7.5)/HP,respectively ] were found between two types ( t =- 7.897,- 18.783,- 5.223,P ＜ 0.05,respectively).There were no significant differences in MTT,PS and VEGF expression(2.1 ± 1.0,3.2 ± 1.0,respectively)between two types of TDC(P ＞0.05).The correlation was found between the MVD and BF and BV in the type Ⅱ TDC group( r =0.789 and 0.878,respectively) and no correlation was found between MVD and each CT perfusion parameters in the type Ⅰ TDC group ( P ＞ 0.05 ).There was no correlation between the VEGF expression and CT perfusion parameters in two types of TDC ( P ＞ 0.05 ).Conclusion CT perfusion imaging with different type of TDC reflected different situation of angiogenesis in HAE peripheral area,which could be a potential technique to illustrate the microcirculation of this disease.

The comparison of coronary arteries imaging features between Uygur and Han populations in Xinjiang with 64-slice spiral CT / 中华放射学杂志

Objective To analyze the imaging findings of coronary angiography using 64-slice row CT and investigate the difference of coronary artery's morphological characteristics between Uygur and Han populations.Methods A retrospective study was made to coronary CT angiographic images of 88 Uygur cases matched with 88 Han cases.The data were analyzed with X~2 test and paired Wilcoxon test.Results The coronary CT angiographic findings were different between Uygur population and Han population in the following aspects: there were 62, 18, and 8 cases with the left coronary artery originating from intra-sinus, para-sinus and extra-sinus location respectively in Uygur population, while there were 73, 14, and 8 cases in Han population respectively (t=8319, P<0.05).And there were 78,7, and 3 cases with the right coronary artery originating from intra-sinus, para-sinus and extra-sinus location respectively in Uygur population, while there were 82, 1 and 1 case respectively in Han population (t=6936, P<0.05).The incidence of the sharp marginal branch were 52 (52.09%) and 67 (76.13%) in the two populations respectively (X~2=5.8381, P<0.05).The cases with various malformations of coronary arteries were 16 and 6 cases in the two populations respectively(X~2 =5.1948,P<0.05).The cases with LCA variations were 28 and 49 cases in the two populations respectively(t =2692,P<0.05) and the number with RCA variations were 33 and 27 cases in the two populations respectively(2 =968,P<0.05).Conclusions There are lots of differences of the coronary artery morphology between the Uygur and Han populations.Firstly, these differences may be related to different patterns in coronary angiography.Secondly, these differences may be related to differences between Uygur and Han populations in the incidence and severity of coronary heart disease.

Clinical analysis of the diagnosis of laryngeal tuberculosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical characteristic and diagnosis of modern laryngeal tuberculosis.@*METHOD@#A retrospective research among 33 patients of laryngeal tuberculosis, with definitive pathological result, had been done in the laryngeal-endoscope room in our department.@*RESULT@#The main symptoms of laryngeal tuberculosis are hoarseness and sore throat. Most of the patients did not accompany with pulmonary tuberculosis (TB) (63.6%). Few of them accompany with low-grade fever, night sweat and malnutrition (24.2%). There are three types in the laryngeal-endoscope vision: edema type, hyperplasia type and ulcer exudation type. The positive rates of PPD and phlegm bacteria examination are respectively 87.9% and 68.4%. There can be seen in the pathological slides the interstitial phagocytes and giant cell reaction. Granuloma consisting of epithelioid cell and Langhans' cells is coexistent with necrotic tissue. Cheese necrosis is the typical characteristic of the disease.@*CONCLUSION@#Severe local symptoms of laryngeal with slightly general symptoms are the clinical characteristics of modern laryngeal tuberculosis. The diagnosis of it depends mainly on the process of the disease, laryngeal-endoscope examination and PPD examination combined with phlegm bacteria examination. And the final diagnosis is based on the pathological biopsy and tubercular bacillus culturing.

Clinical therapeutic effects of staging tympanoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinic characteristic and curative effect of staging tympanoplasty for chronic suppurative otitis media and cholesteatoma otitis media.@*METHOD@#Curative effects of 132 patients cured by staging tympanoplasty and 325 patients cured by no staging tympanoplasty were retrospectively analyzed. Curative effects include ABG value (the reduced value of air-bone conduct gaps after operation), recrudescence of cholesteatoma, tympanic membrane reperforation and wet ear after operation.@*RESULT@#In staging tympanoplasty group, ABG is 28.4 dB, rate of tympanic membrane reperforation is 1.5%, recrudescence of cholesteatoma is 0% and rate of wet ear after operation is 0%. In no staging tympanoplasty group, ABG is 21.3 dB, rate of tympanic membrane reperforation is 2.2%, recrudescence of cholesteatoma is 4.0% and rate of wet ear after operation is 1.2%.@*CONCLUSION@#The ABG, the rate of recrudescence of cholesteatoma in staging tympanoplasty group is much better than that in no staging tympanoplasty group. Tympanic membrane reperforation and wet ear after operation rate have no significant difference in statistic between two groups. We can conclude that staging operations will maintain and improve hearing level more effectively compare to no staging operation.