1.The influence of the sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients
Jie LYU ; Dan LIU ; Youzhong AN ; Yi FENG
Chinese Critical Care Medicine 2015;(10):845-849
ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.
2.Research progress of adenosine receptors in fibrosis diseases
Feng YANG ; He WANG ; Xiongwen LYU ; Jun LI
Chinese Pharmacological Bulletin 2015;(4):445-448
The fibrosis can occur in many kinds of organs,and its sustained progress may lead to organ structural damage and functional decline,and even the organ failure,which threatens the human health and the life seriously.Adenosine is an endogenous purine nucleoside that can be generated in various tissues of the body and regulate a multitude of body functions via the combina-tion with four different kinds of G protein-coupled receptors.Re-cent studies have found that adenosine receptors play an impor-tant role in regeneration tissue and fibrosis process.To under-stand the processes may be helpful to the treatment of fibrosis diseases.This review makes a summary on latest research pro-gress of adenosine receptors in fibrosis diseases.
3.Clinical application of the preemptive analgesia of Dezocine on patients with renal transplantation anesthesia
Feng LIU ; Xiuzhen LIU ; Henglin WANG ; Yidong LYU
Clinical Medicine of China 2014;30(11):1130-1133
Objective To investigate the effect of dezocine combined with fentanyl in patients undergoing kidney transplantation on the quality of anesthesia and recover consciousness,as well as explore the preemptive analgesia effect of dezocine in renal transplantation.Methods Eighty patients undergoing allogeneic renal transplantation were randomly divided into control group (Ⅰ) and dezocine group (Ⅱ) (40 cases for each group).Patients in two groups were induced with midazolam 0.05 mg/kg,propofol 1-2 mg/kg,fentanyl 3 μg/kg,and cis-atracurium 2.5 mg/kg intravenously,and then they were incubated and given mechanical ventilation.Anesthesia was maintained with intravenous and inhalational anesthesia.1%-2% sevoflurane had been inhaled until half an hour before the end of the surgery,while 1% propofol 3-5 mg/kg/h and remifentanil 0.1-0.2 μg/kg/min had been pumped intravenously till the end of the surgery.2μg/kg fentanyl was infused in control group,while in dezocine group 0.1 mg/kg dezocine was intravenously infused before skin incision.The concentration of sevoflurane and the pump speed ofremifentanil were adjusted according to the depth of anesthesia.Changes of mean arterial pressure (MAP),heart rate (HR) and the pulse oximetry (SPO2) before anesthesia (T0),before skin incision (T1),5 minutes after incision (T2),5 minutes before extubation (T3) and 10 minutes after extubation(T4) were recorded.Extubation time,nausea,vomiting and the incidence of adverse reactions during recovery period were also recorded.Before leaving the operating room,VAS scale was used to assess the pain situation of patients.Results There were no significant differences in terms of MAP,HR and SPO2 at each time point between two groups (P > 0.05).The VAS scores in fentanyl group was 1.76 ± 0.43,as same as that in dezocine group (1.84 ± 0.57,P =0.480 7).The incidence of adverse reactions including nausea,vomiting in fentanyl group and dezocine group were 22.5% and 2.5%,and the difference was significant (x2 =7.314 3,P =0.007).The extubationtime after surgery in diesoline group [(12.21 ± 2.16) min] was significantly shortened than that in fentanyl group [(15.15 ± 2.25) min],P =0.000).Conclusion Dezocine preemptive analgesia is used in renal transplant patients in advance,and it can partly replace the same effect of fentanyl analgesia intensity,significantly shorten the extubation time,reduce the occurrence of awakening period adverse events such as of nausea,vomiting and restlessness.It is safe for renal transplant patients.
4.Progress of TGR5 receptors in liver metabolism and immune
Baobing HAO ; Jianhua RAO ; Ling LYU ; Feng ZHANG
Chinese Journal of Hepatobiliary Surgery 2014;20(11):834-837
TGR5,expressing in many tissue cells,is a kind of bile acid membrane receptor and participates in a variety of metabolic and immune diseases.Activated TGR5 can keep the metabolism system in a steady state by mediating the metabolism of bile acid,lipid,and blood sugar,reducing insulin resistance and increasing the body's energy consumption; TGR5 could regulate the immune responses of mononuclear cell and Kupffer cell in the liver.For example,it can regulate the adaptive immune response by inhibiting the expression and release of inflammatory cytokines in Kupffer cells,and regulating the differentiation and maturation of dendritic cells.This review mainly focused on the function of TGR5 in liver metabolism and immune and further explored the related mechanism,as well as its clinical significance in related liver diseases.
5.Clinical psychological intervention on anxiety and depression in hemodialysis patients
Chengyan LYU ; Caiping ZHOU ; Haiyan YU ; Guangyu CHENG ; Suzhi FENG
Chinese Journal of Primary Medicine and Pharmacy 2014;(19):2910-2911
Objective To explore the effects of clinical psychological intervention on anxiety and depression in hemodialysis patients .Methods Hemodialysis patients were randomly divided into two groups:psychological inter-vention group and control group ,25 patients in each group .In intervention group ,besides routine clinical treatment and nursing measures ,we analyzed the clinical information of the patients ,consulted the relevant documents ,combined the evidence and clinical experience ,and finally conducted the psychological intervention .Self-Rating Anxiety Scale and Self-Rating Depression Scale of these patients were analyzed .Results Before the intervention , the SAS and SDS scores of intervention group and control group were (57.3 ±1.5) versus (56.9 ±1.6) and (55.3 ±2.3) versus (56.1 ±3.5),respectively.The t values were 0.912(P>0.05) and 0.955(P>0.05),respectively.After interven-tion,the score before and after the trial between these two groups were significantly different (P<0.05).The SAS and SDS scores of intervention group and control group were (16.4 ±0.9) versus (10.1 ±1.3) and (14.3 ±2.1) ver-sus (9.7 ±1.5),respectively.Conclusion Clinical psychological intervention can effectively relieve anxiety and depression in hemodialysis patients .
6.Neurotoxicity preventive effect of oxaliplatin with lipoic acid plus sodium potassium magnesium calcium and glucose injection
Ran LYU ; Yongjie LI ; Qingliang FENG ; Yu SUN
Chinese Journal of General Practitioners 2014;13(7):583-584
A total of 218 patients on chemotherapeutic regimens containing oxaliplatin were randomly divided into experimental (n =120) and control (n =98) groups.The experimental group received an intravenous infusion of lipoic acid plus sodium potassium magnesium calcium and glucose injection.The control group had only normal saline.Overall incidence of neurotoxicity and toxicity grade of peripheral nerve were observed after 4,8 and 12 cycles.Those with neurotoxic symptoms were followed up for 1 year.No significantly statistical difference existed in the incidence of peripheral neurotoxicity after 4,8 cycles (P >0.05).After 12 cycles,31 patients in the experimental group had an onset of neurotoxicity of grade3 (n=8,6.7%) &grade4 (n=0) versus21 cases of grade3 (n=21,21.4%) and grade4 (n=5,5.1%) in the control group.Statistically significant differences existed between grades 3 and 4 neurotoxicity (P <0.05).After 1 year of follow-up,the incidence of grade 1 of neurotoxicity was 2.5% (n =3) in the experimental group versus 23.7% (n =9) in the control group.And the inter-group difference was statistically significant (P < 0.05).Lipoic acid plus sodium potassium magnesium,calcium and glucose injection can effectively prevent the occurrences of acute and chronic peripheral neurotoxicity associated with oxaliplatin.
7.Genetic characteristics of E1 gene of six rubella virus strains isolated in Henan province from 2012 to 2013
Daxing FENG ; Yating MA ; Wanyu LYU ; Zhenying ZHANG
Chinese Journal of Microbiology and Immunology 2014;(7):517-520
Objective To investigate the genetic characteristics of E 1 gene of rubella virus strains isolated in Henan province for further investigation on rubella prevention and control .Methods RNA was extracted from rubella virus strains isolated from suspected measles cases in Henan during 2008 to 2012 .E1 gene of the isolates were amplified by RT-PCR and sequenced .The nucleotide ( nt ) and amino acid ( aa ) sequences of E1 gene of Henan isolates were aligned with the sequences of other reference strains downloaded from GenBank.Phylogenetic tree was constructed by using MEGA 6.0 software package.Results The pre-dominant genotype of rubella virus isolated in Henan was 1E genotype.No 1F genotype was detected.The 2B genotype emerged in 2013.The E1 gene of Henan isolates shared 87.8%-100% homologies in nucleo-tide sequences and 67.0%-100%in amino acids sequences .No variation was detected at hemagglutination inhibition and neutralization sites .A Leu to Phe mutation occurred at amino acid site 338 of 1E genotype in all isolates.Conclusion The results of this study demonstrated that genotype 1E was the predominant geno-type of rubella virus epidemic in Henan province .
8.Role of integrins in occurrence and development of breast cancer.
Feng LYU ; Xiaojing GUO ; Li FU
Chinese Journal of Pathology 2015;44(4):294-296
Breast Neoplasms
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etiology
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Female
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Humans
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Integrins
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physiology
9.Application of 3.0T magnetic resonance diffusion weighted imaging in evaluating the effect of advanced gastric cancerˊs neoadjuvant chemotherapy
Zengxin LU ; Zhenhua ZHAO ; Aijing SUN ; Feng TAO ; Jieqing LYU
Cancer Research and Clinic 2015;(7):453-457
Objective To evaluate the clinical value of 3.0T magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) on evaluation effect of neoadjuvant chemotherapy in advanced gastric cancer. Methods 3.0 T MRI DWI examination was performed in 42 cases of advanced gastric cancer diagnosed by gastroscopy and pathology, including 32 patients were examined with DWI both before and after chemotherapy. Lymph nodes of gastric cancer lesions and display ability of stomach were measured, and the area of the apparent diffusion coefficient (ADC) values in normal stomach and tumors were compared. ADC values were compared in the same patients before and after neoadjuvant chemotherapy and analyzed along with postoperative pathological examinations. Results In a total of 40 patients who received 74 DWI examinations, ADC values in tumor and lymph nodes were significantly higher than those in normal tissue. The ADC value in tumors was (1.348 ±0.278) ×10-3 mm2/s, and in 12 cases of stomach lymph node enlargement was (1.329±0.188) ×10-3 mm2/s. However, the average ADC value of normal stomach was (2.081± 0.189) ×10-3 mm2/s with significantly lower DWI than that of the former (P< 0.001). After chemotherapy, the ADC value in tumors was increased, which was (1.572 ±0.261) ×10-3 mm2/s (P< 0.001). After neoadjuvant chemotherapy, 16 patients received gastric cancer radical prostatectomy, and postoperative pathological TRG ratings of tumor were decreased with different extent. Tumor cell density (TCD) before treatment with an average of 4.45 ×10-5 / px2, which was downgraduated to 2.48 ×10-5 / px2 after chemotherapy and surgery. Negatively correlation between TCD values and ADC values were observed. Conclusion MRI DWI examination can effectively detect advanced stomach cancer and the associated lymph node enlargement. Comparison of tumor morphology and ADC values in advanced gastric cancer before and after neoadjuvant chemotherapy has clinical value in prognosis.
10.A comparative study of new gastric cancer screening scoring system and new ABC method for screening gastric cancer and precancerous lesions
Xiaoteng WANG ; Zizhong JI ; Feng HAN ; Bin LYU
Chinese Journal of Internal Medicine 2021;60(3):227-232
Objective:To compare the value of new gastric cancer screening scoring system and serum pepsinogen (PG) combined with gastrin-17 (G-17) (new ABC method) in screening gastric cancer and precancerous lesions.Methods:A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019. There were 275 males and 301 females with an age of 40-72 (52±10) years. According to the new ABC method and the new gastric cancer screening scoring system, the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test, PG Ⅰ/PG Ⅱ(PGR) and G-17 before endoscopy. The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated. Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis. Results:A total of 576 patients were enrolled. According to the new ABC method, 382 patients were classified into low-risk group, 170 patients into middle-risk group and 24 patients into high-risk group, respectively. In the new ABC method, 1 case of gastric cancer (0.3%) was detected in low-risk group, 8 cases (4.7%) in middle-risk group and 3 cases (12.5%) in high-risk group. As for atrophic gastritis, 89 cases (23.3%) was detected in low-risk group, 94 cases (55.3%) in middle-risk group and 18 cases (75.0%) in high-risk group. According to the new gastric cancer screening scoring system, 336 patients were classified into low-risk group, 205 patients into middle-risk group and 35 patients into high-risk group, respectively. One case of gastric cancer (0.3%) was detected in low-risk group, 6 cases (2.9%) in middle-risk group and 5 cases (14.3%) in high-risk group. As for atrophic gastritis, 41 cases (12.2%) were detected in low-risk group, 134 cases (65.4%) in middle-risk group and 26 cases (74.3%) in high-risk group. In this two methods, the prevalence of gastric cancer increased according to the disease stage ( χ2 =22.509, P<0.01; χ2=24.156, P<0.01); in terms of atrophic gastritis, the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method ( χ2=14.844, P<0.01), but higher in the middle-risk group ( χ2=3.955, P=0.047). Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods ( P<0.01). Conclusions:Both methods are suitable for screening gastric cancer and precancerous lesions, and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.