ObjectiveTo explore the value of three-dimensional speckle tracking (3DT-STI) technique for evaluating end-systolic three-dimensional longitudinal strain (3DLSe) of left ventricular myocardium in patients with left anterior descending coronary artery (LAD) lesions.MethodsSixty patients with pure LAD lesions diagnosed by coronary artery angiography (CAG) in Taizhou Hospital from June 2012 to December 2014 were enrolled, including 30 patients with acute anterior wall myocardial infarction (infarction group) and 30 patients without acute anterior wall myocardial infarction (non-infarction group). Sixty patients in the control group were enrolled in Department of cardiology in Taizhou Hospital in the same period. 3DLSe within LAD blood-supplied region, adjacent region and remote region were analyzed in all cases using 3DT-STI. The 3DLSe differences of 3 groups were compared by one-way analysis of variance, and the 3DLSe differences between two groups were compared by the LSD-t test. The inter-observer and intra-observer consistency of 3DLSe of left ventricular myocardium were analyzed by Bland-Altman drawing analysis method.Results3DLSe of all 7 segments within LAD blood-supplied region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically significant (infarction groupvs. control group:t values were 6.96, 7.41, 8.94, 8.23, 8.94, 12.09 and 15.99, respectively,P values were all less than 0.01; infarction groupvs. non-infarction group:t values were 5.30, 5.50, 4.66, 4.32, 4.66, 7.66 and 10.11, respectively, P values were all less than 0.01); 3DLSe of middle anterior segment, middle anterior septal segment, apical anterior segment, apical septal segment and apex of heart within LAD blood-supplied region were lower in non-infarction group than those of control group, and the differences were statistically signiifcant (t values were 3.56, 3.23, 3.02, 3.25 and 4.36, respectively,P values were all less than 0.01), but 3DLSe of basal anterior segment and basal anterior septal segment had no statistically significant difference. 3DLSe of basal inferior septal segment within LAD adjacent region had no statistically significant difference in all 3 groups. 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region were lower in infarction group than those of non-infarction group and control group, and the differences were statistically signiifcant (infarction groupvs. control group:t values were 4.15, 4.79, 4.58, 9.24 and 12.07, respectively,P values were all less than 0.01; infarction groupvs. non-infarction group:t values were 2.66, 3.59, 4.29, 7.74 and 10.33, respectively,P values were all less than 0.01); but 3DLSe of basal lateral segment, middle inferior septal segment, middle lateral segment, apical inferior segment and apical lateral segment within LAD adjacent region had no statistically significant difference between non-infarction group and control group. 3DLSe of all 4 segments within remote region had no statistically significant difference. Bland-Altman drawing analysis method showed the mean inter-observer and intra-observer difference of 3DLSe of left ventricular myocardium were-0.3% and-0.2%, the 95% conifdence interval (CI) were in the range of (-5.6%, 5.0%) and (-8.2%, 7.7%), respectively. It was demonstrated that 3DLSe of left ventricular myocardium had good inter-observer and intra-observer consistency.Conclusions3DLSe of left ventricular myocardium can detect the subtle changes in myocardial systolic function and is more sensitive than the conventional echocardiography. It can localization and analyze quantitatively the range of myocardial ischemia or infarction and has good consistency.

Objective To investigate the effects of target-controlled infusion (TCI)of dexme-detomidine on the median effective concentration of effect-site (Ce50 )of propofol at loss of conscious-ness (LOC)in patients.Methods Sixty-four patients,28 males and 36 females,aged 20-60 years, ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery,were randomly allocated to receive dexmedetomidine of 0 ng/ml (group P),dexmedetomidine of 0.4 ng/ml (group D1),dexmedetomi-dine of 0.6 ng/ml (group D2)and dexmedetomidine of 0.8 ng/ml (group D3)for 1 5 min before TCI of propofol,n =1 6 in each group.The propofol infusion was started to provide an effect-site concen-tration of 1.0 μg/ml,and increased by 0.2 μg/ml when propofol effect-site concentration and target concentration were equilibrium until LOC.Results The Ce50 (95%CI )at loss of consciousness in groups P,D1,D2 and D3 were 2.30 (2.24-2.36)μg/ml,1.92 (1.87-1.96 )μg/ml,1.60 (1.55-1.65)μg/ml and 1.41 (1.35-1.45 )μg/ml,respectively.There was a negative correlation between the effect-site concentration of propofol-induced LOC and target concentration of dexmedetomidine (r=-0.84,P <0.01).Compared with groups P,D1 and D2,the incidence of bradycardia was higher in group D3 (P <0.05).Conclusion The Ce50 of propofol-induced LOC gradually decreases with in-creasing target concentration of dexmedetomidine.Combining propofol with dexmedetomidine of 0.4 or 0.6 ng/ml that can reduce the Ce50 of propofol-induced LOC,which is suitable for induction of an-esthesia with a lower incidence of bradycardia.

Objective To evaluate the sedative interaction between dexmedetomidine and propofol.Methods Sixty-four American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index of 19.0-25.0 kg/m2,scheduled for elective surgery under general anesthesia,were allocated into 4 groups (n =16 each) using a random number table:different target concentrations of dexmedetomidine groups (D1-4 groups).Dexmedetomidine was administered by target-controlled infusion (TCI) with the Markku model.The target plasma concentrations of dexmedetomidine were 0,0.4,0.6 and 0.8 ng/ml in D1-4 groups,respectively.At 15 min of dexmedetomidine TCI,propofol was given by TCI with Schnider model,and the initial target effect-site concentration was set at 1.0 μg/ml.After the target effect-site and plasma concentrations were balanced,the target effect-site concentration of propofol was gradually increased in increments of 0.2 μg/ml until loss of consciousness (Observer's Assessment of Alertness/Sedation Scale score was 1).The model of pharmacodynamic interaction was used to analyze the sedative interaction between the two drugs.Results There was no statistically significant difference in residual sums of squares fitted by using the model of pharmacodynamic interaction between the target effect-site concentration of propofol and target plasma concentration of dexmedetomidine at loss of consciousness (P＞0.05).The linear dimensionless parameter of pharmacodynamic interaction was 0.The median effective effect-site concentration of propofol was 2.38 μg/ml at loss of consciousness,and the median effective plasma concentration of dexmedetomidine was 2.03 ng/ml at loss of consciousness.Conclusion Dexmedetomidine and propofol interact additively in terms of sedation.

Objective To evaluate the efficacy of closed-loop coadministration of propofol and remifentanil guided by Narcotrend index (NI) in laparoscopic cholecystectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic cholecystectomy,were randomized into 2 groups (n =30 each):program regulation group (group P) and artificial regulation group (group A).After the initial target effect-site concentration of propofol was selected,the target effect-site concentration of remifentanil was determined according to the formula.In group A,the target effect-site concentrations of propofol (2-4 μg/ml) and remifentanil (3-4 ng/ml) were adjusted artificially according to anesthesiologists' experience every 5 min to maintain NI value at 26-46.Induction time,anesthesia induction and mean maintenance doses and the initial,highest and lowest target concentrations of propofol and remifentanil,mean NI value,percentage of time with NI between 26 and 46,emergence time,and development of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value and intraoperative awareness were recorded.Results No intraoperative awareness was found in the two groups.Compared with group A,the induction time was significantly shortened,the induction dose and initial target concentration of remifentanil were increased,the mean maintenance dose and lowest target concentration of propofol and remifentanil were decreased,the percentage of time with NI between 26 and 46 was increased,and the emergence time was shortened (P＜0.05 or 0.01),and no significant change was found in the induction dose and initial target concentration of propofol,the highest target concentrations of propofol and remifentanil,mean NI value,or incidence of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value in group P (P＞ 0.05).Conclusion For laparoscopic cholecystectomy,NI-guided closed-loop coadministration of propofol and remifentanil produces safe and effective anesthesia,and the efficacy of precise administration is superior to that of artificially regulated target-controlled infusion.

OBJECTIVETo explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.

METHODSFrom August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.

RESULTSAll operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).

CONCLUSIONSPercutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; surgery ; Spondylosis ; surgery ; Treatment Outcome

OBJECTIVE: To investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation. METHODS: A survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital. RESULTS: As of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet. CONCLUSIONS The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.
Humans ; Intensive Care Units ; Critical Care ; Surveys and Questionnaires ; Tertiary Care Centers ; China