Objective:To evaluate the effects of early administration of dexmedetomidine on benzodiazepine ( BZD) requirements of intensive care unit ( ICU) patients with alcohol withdrawal syndrome ( AWS) .Methods:Totally 60 adult patients with severe AWS were chosen and randomly divided into groups A and group B with 30 patients in each .The patients in group A received benzodiazepine simultaneously with early administration of dexmedetomidine , and those in group B received only benzodiazepine .After the first admin-istration of dexmedetomidine , the 24-h cumulative BZD requirement , stay length in ICU and hospital , condition of mechanical ventila-tion and incidence of hypotension and bradycardia were recorded .Results:The 24-h cumulative BZD requirement in group A was obvi-ously lower than that in group B [(8.6 ±1.2) mg vs (25.6 ±4.9) mg, P<0.05].The number of patients with mechanical ventila-tion in the two groups was similar, while the duration of intubation in group A was less than that in group B [(24.9 3.1) h vs (48.8 6.9) h, P<0.05].Additionally, group A had higher incidence of bradycardia when compared with group B (57% vs 13%, P<0.05).Conclusion:As the adjuvant treatment for alcohol withdrawal syndrome , early administration of dexmedetomidine can notably decrease the benzodiazepine requirement of ICU patients .

ObjectiveTo explore the correlation of gastrointestinal symptom of severe cases and abdominal compartment syndrome (ACS),improve monitor technique. MethodsUsing descriptive study to do classified description according to the distribution of 384 severe cases' gastrointestinal symptom and using regressive analysis to analyze the dangerous factors of 46 cases who suffered ACS. Results①The rate of gastrointestinal symptom of 46 cases with ACS:one case with nausea and vomiting occupied 2.2％ ,45 cases with abdominal distension and pain occupied 97.8％ ,45 cases with bowel sound occupied 97.8％,2 cases with diarrhea occupied 4.3％,45 cases with constipation occupied 97.8％. ②Aceording to the single factor logistic regressive analysis shows statistical significant symptoms relating to ACS as follows:abdominal distension and pain,bowel sound decline and constipation,etc. With multi-factors unconditional progressively logistic regressive analysis shows:the first dangerous factor of ACS is abdominal distension and pain(OR=259.106),then is bowel sound decline. CondusionThe correlation exists between the gastrointestinal symptoms and ACS. The clinical nurses should pay attention to the monitor of gastrointestinal function so that the incidence of ACS can be reduced through promoting monitor skills.

Atheroselerosis and thrombangiitis obliterans are the chief factors of chronic lower extremity ischemia. Usually we utilize intervcntional treatment which includs balloon dilatation and stent implantation or surgical revascularization for the patients who have good target vessels, but those methods are not suitable for the patients who have small target vessels. The transplantation of bone marrow stem cells is the new tech-nology for chronic lower extremity isehemia, which utilize the capacity of stem cells that have multiple differ-entiation activity and high self renewal potentiality. It can direetionally differentiated into endothelial cells. It has a good perspective in chronic lower extremity isehemia.

Ischemic disease of lower extremity is a severe disease threatening human health.In the 21st century the stem cells transplantation is one of the most advanced technologies and has applied quickly to clinical therapy.The stem cells possess the potential differentiation capability and can differentiate into all kinds of tissue cells.We transplant stem cells from peripheral blood or bone marrow to isehemie appendicular muscle or obsructed vessal in order to make them differentiate into newborn blood capillary,improve and re-cover blood flow of lower limb and achieve the aim of treating lower limb ischemia.

Objective To evaluate the effects of dexmedetomidine on postoperative cognitive function in the aged patients undergoing carotid endarterectomy.Methods Forty patients,aged 65-80 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective carotid endarterectomy,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group DEX).Anesthesia was induced with midazolam,etomidate,fentanyl and rocuronium.The patients were tracheally intubated.In group DEX,a loading dose of dexmedetomidine 0.03 μg· kg-1 ·min-1 was infused intravenously for 10 min starting from the time point before induction,and dexmedetomidine 0.30μg· kg-1 ·min-1 was infused until 30 min before the end of operation starting from the end of intubation.The equal volume of normal saline was given instead of dexmedetomidine in group C.At 1 day before operation (To) and 6 and 24 h after operation (T1.2),venous blood samples were collected for determination of serum brain-derived neurotrophic factor (BDNF) concentrations.The cognitive function of the patients was assessed using Mini-Mental State Examination (MMSE) at To,T2,and 48 h,72 h,7days and 1 month after operation (T3-6).Results Compared with the baseline value at T0,the serum BDNFconcentrations were significantly increased at T1 in the two groups,MMSE scores were decreased at T2,3 in groupC,and MMSE scores were decreased,and the serum BDNF concentrations were increased at T2 in group DEX.Compared with group C,the MMSE scores were significantly increased at T3.4,the serum BDNF concentrations were increased at T2,and no significant change was found in MMSE scores at T5.6 in group DEX.Conclusion Dexmedetomidine is helpful in improving postoperative cognitive function and in promoting the recovery of postoperative cognitive function,and the mechanism may be related to enhanced production of endogenous BDNF in the aged patients undergoing carotid endarterectomy.

Aged, 80 and over ; Amyloid beta-Peptides ; metabolism ; Brain ; pathology ; Cerebral Amyloid Angiopathy ; complications ; metabolism ; pathology ; Cerebral Hemorrhage ; etiology ; pathology ; Consciousness Disorders ; etiology ; pathology ; Humans ; Male

Objective To investigate the role of extracellular signal-regulated kinase1/2 (ERK1/2) in the central amygdala on fentanyl-induced hyperalgesia in rats.Methods Thirty-two male SpragueDawley rats, weighing 60-100 g, were randomly divided into 4 groups (n =8 each) using a random number table: control group (group C), fentanyl-induced hyperalgesia group (group H), U0124 group (group U1) , and U0126 group (group U2).A catheter was implanted in the central amygdale.In group C, normal saline was injected subcutaneously, and 6.5 h later dimethyl sulfoxide (DMSO) was injected via the catheter.In group H, fentanyl was injected subcutaneously to induce hyperalgesia, and 6.5 h later DMSO was injected via the catheter.In group U1, hyperalgesia was induced, and 6.5 h later ERK1 inhibitor U0124 1.5 nmol was injected via the catheter.In group U2, hyperalgesia was induced, and 6.5 h later ERK1/2 inhibitor U0126 1.5 nmol was injected via the catheter.Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal threshold (TWT) were measured before fentanyl injection, at 6.5 h after injection, and at 30 min after DMSO or U0124/U0126 administration via the catheter (T0-2).After the last measurement of pain threshold, the rats were sacrificed, and the amygdala tissues were sampled for detection of the expression of phosphorylated ERK1/2 (p-ERK1/2) by Western blot in groups C and H.Results Compared with group C, the MWT and TWT were significantly decreased at T1,2in H and U1 groups, and at T1in group U2 (P＜0.05) , the expression of p-ERK2 was up-regulated (P＜0.05) , and no significant change was found in the expression of p-ERK1 in group H (P＞0.05).Compared with group H,the MWT and TWT were significantly increased at T2 in group U2 (P＜0.05) , and no significant change was found in MWT, TWT in group U1 (P＞0.05).Conclusion ERK2 activation in the central amygdala is involved in the development of fentanyl-induced hyperalgesia in rats.

Thoracic endovascular aortic repair (TEVAR) has been increasingly used in the treatment of Stanford type B dissection.The incidence of new entry after thoracic endovascular aortic repair has been gradually increased report including at the proximal end and at the distal end of the endograft.New entry is difficult to handle following thoracic endovascular aortic repair for aortic dissection,and associates with a high substantial mortality.It need pay more attention to prevention and treatment on new entry after thoracic endovascular aortic repair.We summary and analyze the possible causes,prevention and management of new entry after thoracic endovascular aortic repair for aortic dissection.This article review and conclusion the progress on stent graft induced new entry after thoracic endovascular aortic repair.

Objective To investigate the characteristics and clinical value of dynamic electrocardiogram in the treatment of patients with congestive heart failure and atrial arrhythmia.Methods A total of 226 congestive heart failure patients were taken into this research.124 congestive heart failure and atrial arrhythmia patients were divided into OSG group,102 congestive heart failure patients were divided into CTG group.24 -hour Holter monitoring was examined in both groups with ATA including AFR,AFL,ATC and PAC by dynamic electrocardiogram made in Mei Gaoyi medical equipment company.Results The ATA was (824.6 ±108.2)times(compared with the control group, t =9.054,P =0.019)in 124cases of the OSG group,including ATC (80.4 ±25.8)cases (compared with the control group,P =0.021,t =8.934).duration time (25.4 ±9.7)s,AFL (26.8 ±7.1 )cases(compared with the control group,P =0.014,t =9.162).duration time (13.5 ±5.8)s,AFR (97.5 ±51.3)times (compared with the control group,t =9.314,P =0.009).duration time (70.1 ±18.5)s,PAC (41.9 ±14.3)cases (compared with the control group,t =8.796,P =0.026).duration time (34.8 ±11.2)s.The ATA was (102.6 ±59.3)times in 102cases of the CTG group,including ATC (69.5 ±19.4)cases,duration time(5.7 ±1.3)s,AFL(8.5 ±2.6)cases,duration time (2.6 ±0.9)s,AFR (27.6 ±12.5)times,duration time,PAC(24.8 ±10.4)cases,duration time(19.6 ±7.9)s, which was significantly different with the CTG group(t =8.796,P <0.05).Conclusion CHF patients are probable to be complicated with ATA.The DCG examination in CHF patients is conducive to improve the effect of treatment and limit chances of sudden death,which is worthy of promotion.

Objective: To investigate the effect of administrative HDL-C (high density lipoprotein cholesterol) level on adverse cardiovascular events after discharge in elder patients with ST-segment elevation myocardial infarction (STEMI).
Methods: A total of 325 STEMI patients treated in our hospital from 2010-04 to 2012-07 were retrospectively studied. According to administrative HDL-C level, the patients were divided into 2 groups as High HDL-C group, n=139 and Low HDL-C group, n=186. The basic and clinical conditions, in-hospital treatment, death and the medication, adverse cardiovascular events during 6 and 12 months follow-up period were compared between 2 groups.
Results: The patients with in-hospital reperfusion therapy was higher in Low HDL-C group, and Low HDL-C group had the higher ratio of emergent PCI treatment, all P<0.05. During follow-up period, High HDL-C group had less patients with β-receptor blocker treatment, less non- fatal MI, adverse cardiovascular events and re-hospitalization, all P<0.05. Cox regression analysis showed that low HDL-C level (HR=0.558, P=0.024) and diabetes mellitus (HR=1.528, P=0.040) were the risk factors of adverse cardiovascular events, while emergent PCI (HR=0.47, P=0.001) was the protective factor in STEMI patients after discharge.
Conclusion: The lower administrative HDL-C level in elder patients with STEMI had the higher risk of adverse cardiovascular events after discharge.