Objective To investigate the risk factors and their prevention and treatment approaches for occurring radial artery spasm (RAS) during the brain digital subtraction angiography (DSA) with transradial catheterization in patients with ischemic cerebrovascular disease.Methods The patients who underwent DSA of transradial approach because of ischemic cerebrovascular disease were enrolled.Their clinical data,surgical complications,and radial artery spasm were collected.The data of occurring RAS or not during DSA of transradial approach in patients were compared.Multivariate logistic regression analysis was used to analyze the risk factors for occurring RAS during DSA of transradial approach.Results A total of 100 patients with ischemic cerebrovascular disease who underwent DSA of transradial approach (74 ischemic stroke,26 transient ischemic attack) were enrolled,of which 21 (21％) had RAS.Of the 21 patients with RAS,4 suspended their operations and completed their DSA after spasm relief; another 17 were treated with intrathecal cocktail (heparin 2500 U,nitroglycerin 0.5 mg,verapamil 1.25 mg) and completed their DSA after spasm relief.There were significant differences in the proportions of radial artery diameter (1.89 ±0.28 mm vs.2.12 ± 0.17 mm; t =1.582,P =0.041),duration of operation (12.3 ± 3.1 min vs.9.8 ±2.7 min; t =1.264,P =0.038),and radial artery diameter ＞2 mm (9.52％ vs.65.82％ ;x2 =9.624,P =0.002),radial artery anatomy variation (23.81％ vs.0.27％; x2 =14.185,P＜ 0.001),and the first successful puncture (42.86％ vs.78.48 ％ ;x2 =5.335,P =0.021) in patients between RAS group and the non-RAS group.Multivariate logistic regression analysis showed that the radial artery anatomy variation (odds ratio [OR] 1.940,95 ％ confidence interval [CI] 1.372-2.241; P=0.023) was an independent risk factor for the occurrence of RAS.Radial artery diameter ＞2 mm (OR 0.752,95％ CI 0.352-0.847;P=0.043) and the first successful puncture (OR 0.843,95％ CI 0.367-0.941; P=0.045) were the independent protective factors for RAS.Conclusions RAS is a common complication of DSA of transradial approach.Repeated puncture,radial artery diameter,and radial artery anatomy variation are its most important influencing factors.

Objective To observe the expressions of CD26, Ki67 and epidermal growth factor receptor(EGFR) proteins in thyroid neoplasms, to explore their value in differential diagnosis between benign and malignant thyroid neoplasms and to search for molecular marker in well-differentiated thyroid carcinomas.Methods The expressions of CD26,Ki67and EGFR proteins were examined by immunohistochemistry in 50 differentiated thyroid carcinomas (TC) and 50 thyroid adenomas (TA) and their relationships were analyzed.Results The positive rate and expression intensity of CD26,Ki67and EGFR proteins in TC were significantly higher than those in TA, and especially higher in follicular TC than those in follicular TA.Conclusion The abnormal expressions of CD26, Ki67and EGFR proteins appear to be valuable in differential diagnosis and predicting prognosis of thyroid carcinomas, especially CD26 can be used as a diagnostic marker in well-differentiated carcinoma of follicular cell origin.

Objective:To have an experimental investigation on teaching reform of Orthopedics of TCM based on network resources.Method:Two comparison groups were set and observed when we were teaching the orthopedics students of 2003 grade.One was taught by traditional problem-based learning(PBL) method,the other was taught by PBL method based on network resources.Results:The creative thought and research ability of the students who had been taught by PBL method based on network resources were greatly improved.Conclusion:The teaching method based on network resources has so many advantages such as students being able to self-learn and research without time and space limit that it can be used more in medical students teaching.

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization (TDR) under acute myocardial ischemia in intact canine was investigated. Using the monophasic action potential (MAP) recording technique, MAPs of the epicardium (Epi), mid-myocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs. MAPD90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization (EAD) before autonomic nervous stimulation and during autonomic nervous stimulation were compared. It was found that 10 min after acute myocardial ischemia, TDR was increased from 55 +/- 8 ms to 86 +/- 15 ms during sympathetic stimulation (P < 0.01). The TDR (53 +/- 9 ms) during parasympathetic stimulation was not significantly different from that of the control (55 +/- 8 ms) (P > 0.05). The EAD was elicited in the Mid of 2 dogs (16%) 10 min after acute myocardial ischemia, but the EAD were elicited in the Mid of 7 dogs (58%) during sympathetic stimulation (P < 0.01). It was concluded that: (1) Sympathetic stimulation can increase the transmural dispersion of repolarization and induce early afterdepolarizations in the Mid under acute myocardial ischemia, which provide the opportunity for the ventricular arrhythmia developing; (2) Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.
Action Potentials/physiology ; Autonomic Nervous System/*physiopathology ; Electric Stimulation ; Heart Ventricles/innervation ; Heart Ventricles/*physiology ; Myocardial Ischemia/*physiopathology ; Neuromuscular Junction

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action potentials (MAPs) of the epicardium (Epi), midmyocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall in 12 open-chest dogs. MAPD90 and transmural dispersion of repolarization among three myocardial layers as well as the incidence of the EAD before autonomic nervous stimulation and during autonomic nervous stimulation were compared. The results showed that the MAPD90 of Epi, Mid and Endo before autonomic nervous stimulation were 278 +/- 11 ms, 316 +/- 16 ms and 270 +/- 12 ms respectively, the MAPD90 of Mid was significantly longer than that of Epi or Endo (P<0.01). MAPD90 of Epi, Mid and Endo were shortened by 19 +/- 4 ms, 45 +/- 6 ms, 18 +/- 3 ms respectively during sympathetic stimulation. Compared with that of the control, the transmural dispersion of repolarization during sympathetic stimulation was shortened from 44 +/- 4 ms to 15 +/- 3 ms (P<0.01), but early afterdepolarizations were elicited in the Mid of 5 dogs (41%) during sympathetic stimulation. Parasympathetic stimulation did not significantly affect the MAPD90 in the three layers. It is concluded that there is the transmural dispersion of ventricular repolarization in intact canine. Sympathetic stimulation can reduce transmural dispersion of repolarization, but it can produce early afterdepolarizations in the Mid. Parasympathetic stimulation does not significantly affect the transmural dispersion of ventricular repolarization.
Action Potentials/physiology ; Autonomic Nervous System/*physiology ; Electric Stimulation ; Electrocardiography ; Electrodes ; Endocardium/innervation ; Endocardium/physiology ; Heart Ventricles/innervation ; Heart Ventricles/*physiology ; Myocardium/cytology ; Neuromuscular Junction ; Pericardium/innervation ; Pericardium/physiology

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization (TDR) under acute myocardial ischemia in intact canine was investigated. Using the monophasic action potential (MAP) recording technique, MAPs of the epicardium (Epi), mid-myocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs. MAPD90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization (EAD) before autonomic nervous stimulation and during autonomic nervous stimulation were compared. It was found that 10 min after acute myocardial ischemia, TDR was increased from 55 +/- 8 ms to 86 +/- 15 ms during sympathetic stimulation (P < 0.01). The TDR (53 +/- 9 ms) during parasympathetic stimulation was not significantly different from that of the control (55 +/- 8 ms) (P > 0.05). The EAD was elicited in the Mid of 2 dogs (16%) 10 min after acute myocardial ischemia, but the EAD were elicited in the Mid of 7 dogs (58%) during sympathetic stimulation (P < 0.01). It was concluded that: (1) Sympathetic stimulation can increase the transmural dispersion of repolarization and induce early afterdepolarizations in the Mid under acute myocardial ischemia, which provide the opportunity for the ventricular arrhythmia developing; (2) Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.
Action Potentials ; physiology ; Animals ; Autonomic Nervous System ; physiopathology ; Dogs ; Electric Stimulation ; Female ; Heart Ventricles ; innervation ; Male ; Myocardial Ischemia ; physiopathology ; Neuromuscular Junction ; Ventricular Function

The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action potentials (MAPs) of the epicardium (Epi), midmyocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall in 12 open-chest dogs. MAPD90 and transmural dispersion of repolarization among three myocardial layers as well as the incidence of the EAD before autonomic nervous stimulation and during autonomic nervous stimulation were compared. The results showed that the MAPD90 of Epi, Mid and Endo before autonomic nervous stimulation were 278 +/- 11 ms, 316 +/- 16 ms and 270 +/- 12 ms respectively, the MAPD90 of Mid was significantly longer than that of Epi or Endo (P<0.01). MAPD90 of Epi, Mid and Endo were shortened by 19 +/- 4 ms, 45 +/- 6 ms, 18 +/- 3 ms respectively during sympathetic stimulation. Compared with that of the control, the transmural dispersion of repolarization during sympathetic stimulation was shortened from 44 +/- 4 ms to 15 +/- 3 ms (P<0.01), but early afterdepolarizations were elicited in the Mid of 5 dogs (41%) during sympathetic stimulation. Parasympathetic stimulation did not significantly affect the MAPD90 in the three layers. It is concluded that there is the transmural dispersion of ventricular repolarization in intact canine. Sympathetic stimulation can reduce transmural dispersion of repolarization, but it can produce early afterdepolarizations in the Mid. Parasympathetic stimulation does not significantly affect the transmural dispersion of ventricular repolarization.
Action Potentials ; physiology ; Animals ; Autonomic Nervous System ; physiology ; Dogs ; Electric Stimulation ; Electrocardiography ; Electrodes ; Endocardium ; innervation ; physiology ; Heart Ventricles ; innervation ; Myocardium ; cytology ; Neuromuscular Junction ; Pericardium ; innervation ; physiology ; Ventricular Function

Objective:To monitor the susceptibility of common used antimicrobial agents against nosocomial Gram-negative bacilli in 2018 across China.Methods:Prospective collection of Gram-negative bacilli from 13 teaching hospitals nationwide from January to December 2018. The minimal inhibitory concentration (MICs) of antibiotics such as meropenem was determined by agar dilution methods and broth microdilution methods. Interpretation of results using the Clinical and Laboratory Standards Institute(CLSI) 2019 M100S (29th Edition) standard. Data were analyzed by using WHONET-5.6 software.Results:A total of 1 214 non-repetitive Gram-negative bacilli were collected, accounting for 96.7% (1 174/1 214) of blood and sterile body fluid samples. The activity of antimicrobial agents against 871 strains of Enterobacteriaceae was as follows in descending order of susceptible rate: amikacin (93.2%, 812/871), meropenem (92.0%, 801/871), ertapenem (88.9%, 774/871), imipenem (88.4%, 770/871), piperacillin-tazobactam (84.0%, 732/871), cefoperazone-sulbactam (83.1%, 724/871), cefepime (71.4%, 622/871), minocyline (68.9%, 600/871), ceftazidime (66.9%, 583/871), levofloxacin (54.4%, 474/871).The resistance rates of Escherichia coli to the third generation cephalosporins were 61.5% (155/252) (ceftriaxone) and 60.7% (153/252) (cefotaxime), respectively. The resistance rates of Klebsiella pneumoniae to the third generation cephalosporins were 56.6% (126/222) (ceftriaxone) and 57.9% (129/222) (cefotaxime), respectively. The incidence of extended-spectrum β lactamase (ESBLs) positive E. coli and K. pneumoniae was 50.2% (127/252) and 18.2% (40/222), respectively. Over 95% of all the ESBLs positive strains were susceptible to imipenem and meropenem. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was 2.8% (7/252) and 20.4% (45/222), respectively. For Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii, the most susceptible agent were tigecycline (96.3%-100%), followed by amikacin (94.9%-97.1%), meropenem (89.8%-96.6%)and imipenem (89.8%-94.9%).The susceptibility of Proteus mirabilis, Morganella morganii and Serratia marcescens to meropenem and amikacin was over 90%.A total of 67 strains of carbapenems resistant enterobacteriaceae(CRE) were detected. Modified carbapenem inactivation method showed, 45 strains were serine carbapenemase and 20 were metalloenzymes. The susceptibility of Pseudomonas aeruginosa to meropenem and imipenem were 73.2% (112/153) and 66.0% (101/153), respectively. Acinobacter baumannii has the highest sensitivity to colistin (100%, 163/163), followed by tigecycline (87.1%, 142/163).Compared with other sources of infection, specimens of bloodstream infections were less resistant to Klebsiella pneumoniae (17.6%, 27/153 vs 21.7%, 15/69) and Acinetobacter baumannii (68.3%, 71/104 vs 71.2%, 42/59). Escherichia coli (2.5%,4/198 vs 0%,0/54) and Pseudomonas aeruginosa (37%, 33/89 vs 18.8%, 12/64) have a high proportion of carbapenem resistance. Conclusions:Carbapenems still maintain high antibacterial activity against Enterobacteriaceae bacteria, especially strains producing only ESBLs. Carbapenem-resistant Klebsiella pneumoniae should be given sufficient attention. Carbapenemase is the most important drug resistance mechanism of carbapenem-resistant Enterobacteriaceae in China.