Objective To investigate the relationship between the pattern of infarct distribution on diffusion-weight imaging (DWI) and progressive movement deficits (PMD) in patients with infarct in the perforator territory of the middle cerebral artery (MCA). Methods The patients with new infarction in the perforator territory of MCA were analyzed retrospectively. PMD was defined as an increase of at least 2 points on the motor item of the National Institutes of Health Stroke Scale (NIHSS) score persisting for at least 24 hours within 5 days of stroke onset. The demographic characteristics, risk factors, clinical presentation, and distribution characteristics of the infarcts in the PMD and non-PMD groups were compared. Results A total of 64 patients were enrol ed in the study, including 38 females and 26 males, aged 67. 5 ± 10. 8 years. There were 28 patients in the PMD group and 36 in the non-PMD group. The proportion of the infarcts located in the posterior paraventricular region (67. 8% vs. 25. 0%; χ2 =11. 5, P<0. 05) of the PMD group and the mean baseline NIHSS score (6. 9 ± 1. 8 vs. 4. 3 ± 1. 2; t=2. 42, P<0. 05) were significantly higher than those of the non-PMD group. Multiple logistic regression analysis showed that the posterior paraventricular type infarcts had significantly independently correlation with PMD (odds ratio 6. 31, 95% confidence interval 2. 20-18. 0; P<0. 001). Conclusions The posterior paraventricular type infarcts on DWI can be used as a neuroimaging marker for predicting PMD in patients with infarction in the perforator artery territory of MCA.

Pain is the most fearful symptom in cancer patients.The cancer patients suffered refractory pain with the progress of cancer.Not all cancer patients could obtain adequate pain relief by the mefhod of three-step pain relief ladder of WHO.With the reseach and recognition of the mechanisms,the pain can be effectively controlled by the right technique at the right time.It is summarized in this artical about the central and peripheral mechanism and the treatment progress of the terminal cancer pain.

[Objective]Postoperative analgesia with the use of parenteral opoids or epidural analgesia can be associated with troublesome side effects.Good perioperative analgesia facilitates rehabilitation,improves patient satisfaction,and may reduce the hospital stay.We investigated the analgesic effect of locally injected drugs around a total knee prosthesis.[Method]Thirty-eight patients undergoing total knee arthroplasty were randomized either to reveive a periarticuiar intraoperative injection containing bupicaine,morphine,epinephrine,hydrocordisone or to reveive no injection.We compared the PCA consumption at the some time point after tatal knee arthroplasty.Visual analog scores for pain,preoperation and postoperation,6 weeks after operation were collected.[Result]The patients who had received the injection used significantly less patient-controlled analgesia over the first 24 hours after the surgery.They had lower visual analog scores for pain 24 hours and 48 hours after operation.No cardiac or central nervous system toxicity was observed.[Conclusion]The perioperative analgesia protocol improved patient satisfaction,pain control and minimizes side effects after total kneearthroplasty.

Adult ; Echocardiography, Doppler, Color ; Female ; Humans ; Hypertension, Pulmonary ; etiology ; Pulmonary Veno-Occlusive Disease ; complications ; diagnosis ; Tomography, X-Ray Computed

Objective To observe the effect of mesenchymal stem cells ( MSC) in treating ischemic diabetic ulcers, and to explore its clinical perspectives. Methods Prepared electro-spinning biomaterials and cultured MSC to study effect of MSC composite biomaterials in vitro by scanning electron microscope,MTT array and influence of MSC conditioned medium on endothelial cells. The use of 5 to 8 week old male C57BL/6J mice were prepared into diabetic mice,femoral artery ligation in the proximal thigh,in dorsal skin full-thickness wounds caused by the diameter 5 mm. Then the effect of MSC composite biomaterials on ischemic diabetic ulcers was determined. Results This study found that the MSC grow well on electro-spinning biomaterials. Cells foot extension and connections between cells were observed by scanning electron microscope. Stimulated by high glucose,growth and proliferation of MSC has a stronger ability on biomaterials. MSC condi-tioned medium on biomaterials increased human umbilical vein endothelial cells proliferation ability. Conclusion MSC composite biomateri-als can effectively improve the treatment effect of MSC on ischemic diabetic ulcers. The study indicated stem cells composite biomaterials have great potential and application prospect in the treatment of ischemic diabetic ulcers healing.

AIM:To research the absorption mechanism of aesculin across Caco-2 monolayer model.METHODS:The Caco-2 cell monolayers drug transport model was assigned to study the double transport mechanism of aesculin to explore the absorption of aesculin according as time and drug concentration determined through HPLC and the P_ app was calcalated.RESULTS:In the Caco-2 monolayer model,the transport of aesculin form Apical to Basolateral was similar to the transport form basolateral to apical.CONCLUSION:The main mechanism of the aesculin intestinal absorption in the Caco-2 monolayer model is passive transference.

0.05).Conclusion When given concomitantly as a Cocktail,theophylline,chlorzoxazone and dapsone have no pharmacokinetic interaction,which could be used together to evaluate CYP1A2,CYP2E1 and CYP3A4 activity.

INTRODUCTIONWe report a series of operated tetralogy of Fallot (TOF) patients focusing on complications and outcomes.

MATERIALS AND METHODSData from TOF patients seen at our centre's adult congenital heart disease clinic was analysed.

RESULTSThere were 21 patients: the mean age was 32.2 +/- 12.4 years; the age at first operation was 9.0 +/- 7.9 years; the mean postoperative follow-up duration was 23.5 +/- 12.1 years; and the current New York Heart Association (NYHA) status: I, 82%; II, 4%; III, 14%. Fourteen patients had complete operative notes. All these patients underwent total TOF correction; 2 had staged aortopulmonary shunt with total correction at a mean of 3.2 years later, pulmonary artery patch augmentation in 8 patients and pulmonary valvotomy in 8 patients. Three patients required pulmonary valve homograft replacement for severe pulmonary regurgitation (PR) at 13, 28 and 36 years after the initial corrective operation.

CURRENT INVESTIGATIONSRBBB on ECG (91%), QRS duration 137 +/- 29 ms. Echocardiography showed dilated right ventricular end-diastolic (RVED) diameters (3.2 +/- 0.8 cm); severe PR (67%), residual right ventricular outflow tract obstruction (RVOTO) (42%) and VSD patch leakage (9%). Cardiac magnetic resonance (CMR) (8 patients) showed dilated RVED volumes 252.6 +/- 93.8 mL, indexed RV volume 165.7 +/- 34.8 mL; RV systolic function was preserved in most patients with a RV ejection fraction of 49.5 +/- 5.7%. One patient had atrial tachycardia and another had frequent non-sustained ventricular tachycardia that required radiofrequency ablation.

CONCLUSIONPatients with TOF who had full corrective surgery during childhood are now surviving into adulthood. Many challenges arising from complications in the postoperative period remain. It is imperative that adult TOF patients should have regular followup to monitor development and subsequent management of these complications.

Adult ; Echocardiography ; Female ; Humans ; Male ; Outcome Assessment (Health Care) ; methods ; Postoperative Complications ; epidemiology ; physiopathology ; Singapore ; epidemiology ; Tetralogy of Fallot ; surgery

OBJECTIVES: This study was designed to investigate the effect of antipsychotic drugs (chlorpromazine, haloperidol and clozapine) on the cerebral hemodynamics including the changes in regional cerebral blood flow(rCBF) and the pill arteriolar diameter of male Sprague-Dawley rats. METHODS: The changes in rCBF were determined by laser-Doppler flowmetry, and the changes in diameter of pill arteriole were measured through a closed cranial window. RESULTS: Clozapine(0.1~10 microgram/kg, i.v. or 0.03~3 micrometer caused an increase in rCBF in association with a vasodilation of pill arteriole in a dose-dependent miner, whereas chlorpromazine and haloperidol(5~500 microgram/kg, i.v., or respectively) were without effect on rCBF. Clozapine-induced increases in rCBF were significantly blocked by topical pretrfatment with NMDA receptor blockers(MgCl(2), MK-801, ketamine and D(-)-2-amino-5-phosphonopentanoic acid). Constitutive nitric oxide synthase inhibitors (N(G)-nitro-L-arginine, 7-nitroindazole and diphenyleneiodonium) markedly inhibited the clozapine-induced increases in rCBF. However, aminoguanidine, an inducible nitric oxide synthase inhibitor did not affect the clozapine-induced increases in rCBF. Inhibitors of soluble guanylyl cyclase(methylene blue and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one) significantly attenuated the clozapine-induced increases in rCBF. CONCLUSION: These results suggest that typical antipsychotic drugs are without effect on rCBF, but atypical antipsychotir drug clozapine exerts an increase in rCBF with pial arteriolar dilation via mediation of NMDA receptor stimulation, and thereby, leading to activation of neuronal and endothelial nitric oxide synthases and increase in cyclic GMP formation.
Animals ; Antipsychotic Agents* ; Arterioles ; Chlorpromazine ; Clozapine ; Cyclic GMP ; Dizocilpine Maleate ; Haloperidol ; Hemodynamics* ; Humans ; Ketamine ; Laser-Doppler Flowmetry ; Male ; N-Methylaspartate ; Negotiating ; Neurons ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Rats* ; Rats, Sprague-Dawley ; Vasodilation

Objective To evaluate the therapeutic effects and complications of modified facial mask for non-invasive ventilation (NIV) in elderly patients with respiratory failure.Methods A total of 132 elderly patients(107 males and 25 female,aged 78.5±8.6 years) treated with NIV from February 2008 to May 2011 were randomized into two groups:modified facial mask(group A,n=68,56 males and 12 females,aged 78.8±22.2 years) and control facial mask(group B,n=64,64 males and 13 females,aged 76.6±20.4 years).Duration of NIV,time in RICU(respiratory intensive care unit),length of hospital stay,risk for hospital acquired pneumonia (HAP),risk for invasive ventilation,cure rates,in-hospital mortality,NIV failure rate and cost were compared between the two groups.The complications of NIV,such as oropharyngeal dryness,skin damage of face and nose,abdominal bloating,gas leakage from mask were also compared between the two groups.Results Compared with group B,duration of NIV(12.2±2.3 d vs.18.4±3.6d),time in RICU(7.3±3.2d vs.14.6t5.4d),length of in hospital stay(16.6±4.2d vs.28.2±6.2)d,and cost(2.23±0.12 ten thousand yuan vs.4.23± 0.24 ten thousand yua) in group A were significantly decreased(t=9.72,14.91,13.08,10.81 respectively,all P＜0.05).The risk for invasive ventilation [2.9％ (2 cases) vs.43.8％(28 cases)],NIV failure rate [5.9％ (4 cases) vs.12.5％ (28 cases)] were also decreased in group A compared with group B(x2 =31.26,25.74,both P＜0.05).Compared with group B,The complications of NIV such as skin damage of face and nose[4.4％ (3 cases) vs.37.5％ (24 cases)],abdominal bloating [2.9％ (2 cases) vs.28.1％ (18 cases)],gas leakage from mask [8.8 ％ (6 cases)vs.50％(32 cases)] in group A were significantly decreased(x2 =31.26,25.74,all P＜0.05).Conclusions Modified facial mask for NIV is effective in the treatment of elderly patients with respiratory failure.The complications and in-hospital mortality are reduced with the application of modified facial mask for NIV and it is highly tolerated by patients.Modified facial mask for NIV is the first choice in the treatment in elderly patients with respiratory failure.