Objective To compare the effects of dexmedetomidine and fentanyl on the median effective concentration (EC50) of propofol required for inducing respiratory depression.Methods ASA physical status Ⅰ or Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,with body mass index of 22-28 kg/m2,scheduled for elective gynecological surgery under general anesthesia,were randomly divided into 3 groups:control group (group C),dexmedetomidine group (group D) and fentanyl group (group F).Dexmedetomidine 0.5 μg/kg and fentanyl 1.5 μg/kg in 10ml of normal saline were infused over 10 min in D and F groups,respectively,while the equal volume of normal saline was given in group C.Lidocaine was injected intravenously followed by target-controlled infusion of propofol.In C,D and F groups,the initial target concentration of propofol was 2.5,2.1 and 1.1 μg/ml,respectively,and the ratio between the two successive concentration gradients was 1.1.It was defined as positive when patients developed respiration depression.EC50 and 95％ confidence interval of propofol inducing respiratory depression were calculated.BIS values and OAA/S scores were recorded after admission to operating room (T0),after infusion of dexmedetomidine,fentanyl or normal saline,at 5 and 10 min after the start of propofol target-controlled infusion and after the target effect-site and plasma concentrations were balanced.Results EC50 (95％ confidence interval) of propofol required for inducing respiratory depression was 2.72 (2.55-2.91),2.15 (2.05-2.27)and 1.17(1.08-1.25) μg/ml in C,D and F groups,respectively.Compared with group C,the EC50 was significantly decreased in D and F groups and the BIS values and OAA/S scores were increased in group F (P ＜ 0.05),and no significant changes were found in the BIS values and OAA/S scores in group D (P ＞ 0.05).The EC50 was significantly decreased and the BIS values and OAA/S scores was increased in group F as compared with group D (P ＜ 0.05).When the BIS values reached 65 or OAA/S scores was 3,the effect-site concentration was significantly lower in D and F groups than in group C (P ＜ 0.05).In C,D and F groups,the percentage of patients who developed upper airway obstruction caused by glossocoma was 100％,60％ and 20％,respectively,and who developed decreased respiratory rate or apnea (RR≤ 8 bpm or respiratory arrest time≥ 15 s) was 0,40％ and 80％,respectively.Conclusion Although dexmedetomidine induces no respiratory depression,dexmedetomidine can enhance the potency of propofol required for inducing respiratory depression and the prtency is lower than that of small-dose fentanyl.

Objective To investigate the life satisfaction and its related factors in primary caregivers of breast cancer patients. Methods The Life Satisfactory Index A (LSIA) and self-administrated questionnaire were used. The life satisfaction between breast cancer patients'primary caregivers and breast benign patients' primary caregivers were compared. The factors of the life satisfaction in primary caregivers of breast cancer patients were analyzed. Results The life satisfaction was poorer in the breast cancer patients' primary caregivers than in the breast benign patients' primary caregivers (P<0.01). The life satisfaction in the breast cancer patients' primary caregivers was correlated with the stage of breast cancer, course of disease, primary caregivers' age and family monthly income (P<0.05). Conclusion The life satisfaction in breast cancer patients' primary caregivers is worse and is related with stage of breast cancer, course of disease, primary caregivers' age and family monthly income.

Model is a scientific thinking and operation method. It can provide guideline for resolving some nursing practice problems, and improve the quality of nursing service. Research on nursing model has received more and more attention. This paper analyzes the concept, classification, and development of the model, and describes its application in research on nursing model. According to background and research problem, researchers should analyze the characteristics of different methods of development and validation of model, and choose the approprate method. Thus, it can improve the scientificity and operability of results of nursing model.

OBJECTIVETo deepen the understanding of clinical manifestations and treatment of patients with positive lupus anticoagulant (LAC).

METHODSThe clinical data of 2 patients were analyzed and related literature were reviewed.

RESULTSCase 1, a 31-year-old female, diagnosed as lupus anticoagulant positive, secondary to undifferentiated connective tissue disease, was presented with menorrhagia and thrombocytopenia. Anti-nuclear antibody (ANA) was positive 1:1000 (homogeneous type) with anti-double stranded DNA positive, and dRVVT LA1/LA2 was 3.4. Coagulation function was alleviated after treatment with glucocorticoid and total glucosides of paeony. Case 2, a 59-year-old female was presented with gingival bleeding, hematuria with the level of F II:C 13%. dRVVT LA1/LA2 was 2.0. Anti-nuclear antibody (ANA) was positive 1:1000 (type of cytoplasmic granule), anti-double stranded DNA was positive. The patient was diagnosed as hypoprothrombinemia-lupus anticoagulant syndrome (LAHS) and acquired coagulation factor deficiency. The signs of hemorrhage were alleviated after treatment with methylprednisolone 40 mg/day and cyclophosphamide, while the level of F II:C was below normal.

CONCLUSIONSymptoms of patients with positive LAC are variable. The diagnosis relies on history of disease and laboratory test. Currently, there is no standardized treatment. Cases of LAHS should be thoroughly investigated for any known causes and related disorder.

Adult ; Blood Coagulation ; Cyclophosphamide ; therapeutic use ; Female ; Glucocorticoids ; therapeutic use ; Hematologic Tests ; Hemorrhage ; Humans ; Hypoprothrombinemias ; diagnosis ; Lupus Coagulation Inhibitor ; blood ; Methylprednisolone ; therapeutic use ; Middle Aged

OBJECTIVETo explore the clinical value of immature platelet fraction (IPF), absolute immature platelet fraction (A- IPF) and thrombelastograph (TEG) on assessment of bleeding risk of immune thrombocytopenia (ITP).

METHODStwo hundred and seventy- one patients with ITP were assessed based on ITP-BAT bleeding grading system. IPF, A-IPF were determined in 271 patients ,TEG in 125 patients. The correlations between bleeding grades and IPF, A-IPF, variables of TEG in subgroups were analyzed by statistical method. The predictive value of IPF, A-IPF, and variables of TEG on bleeding risk of ITP patients was evaluated.

RESULTSThere were no significant differences in bleeding degree in all patients with different gender and disease stage (P>0.05). Mild bleeding rate in children was higher than that in adult (P<0.05). PLT inversely correlated with bleeding grade for the entire cohort (P<0.001). In all subjects, PLT< 30 × 10⁹/L and pediatric cohorts with PLT< 30 × 10⁹/L, PLT were negatively correlated with IPF (P<0.05), positive correlated with A-IPF (P<0.001) and the maximum amplitude (MA (P<0.05). Bleeding grades were significantly correlated with IPF, A-IPF, MA in all subjects and patients with PLT< 30 × 10⁹/L (P<0.001). IPF, A-IPF and MA did not correlate with bleeding grades in children with PLT< 30 × 10⁹/L (P>0.05). ROC curve analysis revealed IPF, A-IPF and MA had better predictive value (AUC 0.745, 0.744, 0.813, P<0.001). Multivariate analysis showed that IPF and MA were independence factors for predicting bleeding risk in ITP patients and comprehensive predictive value was higher (AUC 0.846, P<0.001) than single variable.

CONCLUSIONIPF, A-IPF and MA could accurately evaluate bleeding risk in ITP patients. It may be considered as reference index of the treatment and observation index of curative effect.

Adult ; Blood Platelets ; Child ; Hemorrhage ; etiology ; physiopathology ; Humans ; Multivariate Analysis ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; complications ; physiopathology ; ROC Curve

OBJECTIVETo analyze clinical and molecular characteristics of low-risk essential thrombocythemia (ET) in a large cohort of Chinese patients and to explore risk factors for major thrombosis and treatment strategies.

METHODSMedical records of patients with an initial diagnosis of ET from March 1982 to May 2012 in our hospital were retrospectively analyzed.

RESULTSA total of 604 low-risk ET patients were enrolled with a median follow-up of 49 months (range:0-338). 43(7.1%) patients experienced major thrombotic events. Cox proportional hazards regression revealed JAK2 V617F mutation (HR=2.279; P=0.035) and cardiovascular risk factors (CVF) (HR=2.541; P=0.006) to be risk factors for total thrombotic events, while only CVF (HR=2.633; P=0.008) was risk factor for arterial thrombosis. None of the evaluated factors was related to venous thrombosis. Patients with both JAK2 V617F mutation and CVF had a worse thrombosis- free survival than those with only one risk factor (P<0.05). In patients with JAK2 V617F or CVF alone, antiplatelet treatment (P=0.016) significantly decreased the risk of thrombosis, while those with both JAK2 V617F and CVF could benefit from cytoreductive agents (P=0.018).

CONCLUSIONChinese low-risk ET patients have a lower risk of thrombosis than Caucasian low-risk ET patients. JAK2 V617F mutation and CVF are the most significant risk factors for thrombosis. Existence of both risk factors further increases the thrombotic risk. Treatment strategies on low-risk ET patients should be made based on presence or absence of risk factors.

Asian Continental Ancestry Group ; Humans ; Janus Kinase 2 ; Mutation ; Retrospective Studies ; Risk Factors ; Thrombocytopenia ; complications ; Thrombosis ; genetics