OBJECTIVETo evaluate the feasibility and efficacy of Narcotrend (NT) monitor in monitoring the depth of anesthesia in severely burned patients with target-controlled infusion (TCI) of remifentanil hydrochloride and propofol during perioperative period.

METHODSEighty patients with severe burn hospitalized from February to November 2011, to whom eschar excision was performed within one week after injury, were enrolled. They were classified into II to III grade according to the American Society of Anesthetists classification, and their total burn area ranged from 31% to 50%TBSA, or full-thickness burn area from 11% to 20% TBSA. Patients were divided into trial group (monitoring depth of anesthesia with routine method and NT monitor) and control group (monitoring depth of anesthesia with routine method) according to the random number table, with 40 cases in each group. All patients received TCI of remifentanil hydrochloride and propofol to induce and maintain anesthesia. During the operation, the anesthesia level of NT monitor used in the trial group was maintained from grade D1 to E0, while the fluctuation of mean arterial pressure (MAP) and heart rate of patients in control group was maintained around the basic values within a range of 20%, and on the basis of which, concentrations of two narcotics were adjusted. Concentrations of remifentanil hydrochloride and propofol during maintenance of anesthesia were recorded. The duration from drug withdrawal to waking from anesthesia (including the duration from drug withdrawal to eye opening by calling and the duration from drug withdrawal to orientation recovery) of patients was recorded. Values of MAP and heart rate at admission into the operation room, loss of consciousness, 2 min after intubation, before operation, 2, 15, and 30 min after the beginning of operation, and the end of operation were recorded. The prediction probability (P(k)) of NT stage (NTS) and NT index (NTI) in trial group, and that of MAP and heart rate in control group for two durations from drug withdrawal to waking form anesthesia were recorded. The administration of vasoactive drugs and intraoperative awareness of patients in two groups were recorded. Data were processed with t test, analysis of variance, and chi-square test, and the relationship between NTS, NTI, MAP, heart rate and their corresponding P(k) for the duration from drug withdrawal to orientation recovery was processed with Spearman correlation analysis.

RESULTSMaintained target effect-site concentration of remifentanil hydrochloride and target plasma concentration of propofol of patients were obviously lower in trial group [(2.62 ± 0.35) ng/mL, (3.84 ± 0.22) µg/mL] than in control group [(2.95 ± 0.21) ng/mL, (4.16 ± 0.31) µg/mL, with t values respectively -5.113 and -5.324, P values all below 0.01]. The duration from drug withdrawal to eye opening by calling and the duration from drug withdrawal to orientation recovery were obviously shorter in trial group [(10.2 ± 0.7) min, (11.1 ± 1.0) min] than in control group [(11.3 ± 1.0) min, (13.1 ± 0.7) min, with t values respectively -5.740 and -10.806, P values all below 0.01]. The MAP (except for 2 min after intubation) and the heart rate of patients in both groups were lower at the time points from loss of consciousness to the end of operation than at the time of entering operation room (with F values respectively 12.074, 36.425, P values all below 0.01 in trial group and F values respectively 21.776, 35.759, P values all below 0.01 in control group). The statistically significant difference between two groups in MAP level was only observed at the time of loss of consciousness (t = 3.985, P < 0.01). MAP level was close in two groups at other time points. Heart rates of patients in two groups were close during perioperative period. P(k) values of NTS and NTI for the duration from drug withdrawal to eye opening by calling (0.937 ± 0.025, 0.899 ± 0.049) were obviously higher than those of MAP and heart rate for this duration (0.579 ± 0.057, 0.536 ± 0.039, F = 900.337, P < 0.01). P(k) values of NTS and NTI for the duration from drug withdrawal to the orientation recovery (0.901 ± 0.031, 0.868 ± 0.046) were significantly higher than those of MAP and heart rate for this duration (0.532 ± 0.060, 0.483 ± 0.044, F = 890.895, P < 0.01). NTS, NTI, MAP, and heart rate were respectively negative, positive, positive and positive in correlation with their P(k) values for the duration from drug withdrawal to the orientation recovery (with r values from -0.734 to 0.682, P values all below 0.01). There was no statistically significant difference between two groups in administration of vasoactive drugs. No intraoperative awareness occurred.

CONCLUSIONSApplication of Narcotrend monitor in monitoring the depth of anesthesia in severely burned patients during perioperative period with TCI of remifentanil hydrochloride and propofol is beneficial to reducing dosage of narcotics and shortening duration of recovery from anesthesia, and it can accurately predict the level of consciousness of patients at the time of withdrawal of anesthesia.

Adolescent ; Adult ; Aged ; Anesthesia, Intravenous ; Burns ; surgery ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; instrumentation ; methods ; Piperidines ; Propofol ; Skin Transplantation ; methods ; Young Adult

With the core of "molecules and cells", the integrated curriculum group of School of Basic Medical Sciences, Lanzhou University, focuses on the transfer of life molecules, reorganizes teaching content, and integrates Medical Cell Biology, Biochemistry and Molecular Biology, and Medical Genetics to construct a new integrated course of Molecular Medicine. The curriculum group actively explores and practices the mode of medical integration through reconstruction of the curriculum system and optimization of the course content. On the basis of establishing the online course system, the group explores the diversified teaching methods and evaluation systems suitable for Molecular Medicine and discusses the problems in curriculum construction.

OBJECTIVETo investigate the characteristics and differences of propofol pharmacokinetics in shock phase and hypermetabolic phase in severe burn in rabbits.

METHODSTwenty New Zealand rabbits were assigned to burn group (n = 10) and sham injury group (n = 10) according to the random number table. Rabbits in burn group were inflicted with 30%TBSA full-thickness scald (named burn below), resuscitated instantly, and were intravenously injected with 5.1 mg/kg propofol 6 hours after injury. 1.5 mL blood was collected from left external jugular vein at 1, 3, 5, 10, 15, 20, 30, 45, 60, 90 minute(s) after injection respectively. Above procedure was performed again 1 week later. Rabbits in sham injury group were treated similarly as rabbits in burn group but were sham scalded. Propofol concentration in plasma was determined with high performance liquid chromatography. Data of propofol concentration-time were analyzed with 3P97 practical pharmacokinetics calculating program, and then the most fit compartment model was selected to calculate pharmacokinetic parameters.

RESULTSThe blood concentration-time curve of propofol fitted in with the two-compartment model in burn group, and three-compartment model in sham injury group. During shock phase, comparing with central compartment distribution volume [Vc, (3.1 + or - 1.5) L/kg], area under curve [AUC, (25 + or - 7) mg x min x L(-1)], elimination phase half life [t1/2beta, (113 + or - 93) min], clearance [CLs, (110 + or - 50) mL x kg(-1) x min(-1)] of rabbits in sham injury group, Vc[(8.8 + or - 4.2) L x kg(-1)] and AUC [(44 + or - 10) mg x min x L(-1)] increased significantly (with t value respectively 3.191 and 3.668, and P values both below 0.01); t1/2beta [(339 + or - 258) min] prolonged (t = 2.932, P < 0.05); CLs [(40 + or - 30) mL x kg(-1) x min(-1)] decreased (t = -3.013, P < 0.05) in burn group. During hypermetabolic phase, CLs [(180 + or - 40) mL x kg(-1) x min(-1)] of rabbits in burn group was significantly higher than that in sham injury group [(90 + or - 30) mL x kg(-1) x min(-1), t = -3.013, P < 0.05]. Comparing with those of rabbits in burn group during shock phase, Vc [(4.1 + or - 1.3) L/g] and AUC [(24 + or - 5) mg x min x L(-1)] decreased significantly (with t value respectively 2.979 and 3.766, and P value both below 0.01); distribution phase half time [t1/2alpha, shock phase (16.1 + or - 13.1) min and hypermetabolic phase (8.3 + or - 2.5) min] and t1/2beta [(55 + or - 19) min] shortened obviously (with t value respectively 9.065 and 8.795, and P values both below 0.01); CLs increased significantly (t = 4.238, P < 0.01) during hypermetabolic phase.

CONCLUSIONSThere are great differences in propofol pharmacokinetics between shock phase and hypermetabolic phase in severely burned rabbits. The change is characterized by increase in Vc and AUC, extension of t1/2alpha and t1/2beta, decrease in CLs during shock phase and obvious increase of CLs during hypermetabolic phase.

Animals ; Burns ; metabolism ; pathology ; Propofol ; pharmacokinetics ; Rabbits ; Shock ; metabolism

OBJECTIVETo evaluate the efficacy of tadalafil in the treatment of ED after transurethral resection of the prostate (TURP).

METHODSA total of 113 patients with ED after TURP received 3 months of tadalafil treatment and were followed up for 6 months. The IIEF-5 scores of the patients and the number of successful penile intromissions and sustained penile erections in the patients' sexual life diary were compared before and after the treatment.

RESULTSThe IIEF-5 scores were 9.83 +/- 3.96 before the medication, 20.23 +/- 3.25 after it, and 17.28 +/- 3.03 at 6 months after drug withdrawal, with statistically significant differences between pre- and post-treatment (P < 0.05). The patients' success rates of penile intromission and sexual intercourse were increased from 44.8% and 7.5% before the medication to 81.7% and 63.2% after it.

CONCLUSIONTadalafil can be used as a first-line drug for the treatment of ED after TURP.

Aged ; Carbolines ; therapeutic use ; Erectile Dysfunction ; drug therapy ; etiology ; Humans ; Male ; Middle Aged ; Phosphodiesterase Inhibitors ; therapeutic use ; Tadalafil ; Transurethral Resection of Prostate ; adverse effects ; Treatment Outcome

OBJECTIVETesticular mixed nonseminomatous germ cell cancer (TMNGCC) is rarely reported. This study aimed to explore the clinical symptoms, pathological characteristics and treatment methods of TMNGCC.

METHODSWe analyzed the clinical data of 1 case of TMNGCC, observed its pathological characteristics under the light microscope by histology, cytochemistry, immunohistochemistry and immune marking, and investigated the clinical features of such tumors by reviewing the relevant literature.

RESULTSThe patient presented with a chief complaint of painless testicular swelling for 3 years. Histopathological examinations revealed a tumor of papillary, fissural or adenoid structure, with large polygonal or columnar cells with one or more irregular vesicular nuclei, the nuclear membrane clear, the cytoplasm eosinophilic or basophilic, and the interstitium infiltrated by a few lymphocytes. Here are the immunohistochemical results: CD117 -, CK8-18 + +, CD30 + +, CK + + +, vimentin -, PLAP +/-, P53 +, AFP + and EMA + +. The tumor was pathologically diagnosed as teratogenic embryonic testicular cancer, and treated by radical surgery, followed by adjuvant chemotherapy according to the treatment of TMNGCC. One-year follow-up found the patient to be alive.

CONCLUSIONTMNGCC is a rare malignant tumor, mostly with unobvious clinical symptoms. Its diagnosis primarily depends on physical examination, ultrasonography, CT, and measurement of serum tumor markers; its confirmation necessitates pathological examination, and its first-choice treatment is surgical resection.

Adult ; Humans ; Male ; Neoplasm Staging ; Seminoma ; pathology ; Testicular Neoplasms ; pathology

OBJECTIVETo investigate the method and result of arthroscopic trans-septal approach (ATS).

METHODSTen fresh cadaveric knees were prepared for anatomical study about the posterior septum, and 65 posterior compartment arthroscopy of the knees were performed to view the structure of the posterior septum. The initial diagnosis included: rheumatoid arthritis, pigmented villonodular synovitis, osteoarthritis, loose body or foreign body in the posterior compartment, posterior cruciate ligament (PCL) injury or avulsion fracture, posterior horn tear of meniscus, undiagnosed swollen knee with pain and effusion, osteochondritis dissecans, pyogenic arthritis, gout. From January 2002 to June 2005, 22 cases of ATS were applied. Anterolateral portal was initially created, followed by posterolateral portal under the viewing of arthroscopy which was located at the anterolateral portal. Anteromedial and posteromedial portals were also created using the same technique. Arthroscopy was then transferred to the posteromedial portal, and blade was introduced from the anteromedial portal to gradually remove the synovium covering PCL. Arthroscopy was relocated to the anteromedial portal, Wissinger rod was introduced from the posteromedial portal and pointed to the posterior septum adjacent to the posterior edge of the midportion of PCL. The Wissinger rod was pushed carefully to pierce through the posterior septum under the sight of arthroscopy which was located at the posterolateral portal. ATS was finally created.

RESULTSThe posterior septum was in the middle of posterior compartment of the knee, which was film screen-like at the sagittal plane and sandwich-like at the transverse plane. The synovium covered the posterior septum at arthroscopic inspection. Twenty-two cases of ATS were successfully created, amounting to 34% (22/65) of all cases at the same period which had received the arthroscopy of posterior compartments of the knees. Synovectomy of the posterior compartments of the knees was performed in 7 cases, loose body removal was in 6 cases, PCL reconstruction was in 4 cases, reduction and fixation of PCL avulsion fracture was in 2 cases. Chondroplasty, inflammatory synovectomy, and meniscectomy were performed accordingly in 6 osteoarthritis cases. No vascular or nervous injury was encountered. At an average of 20 months follow-up (range, 4 to 45 months), 9 cases still had mild knee pain or swelling, 2 cases had severe pain and were recommended for total knee replacement, the other 11 cases had no recurrence of knee pain or swelling.

CONCLUSIONSATS has no blind area under arthroscopic vision and facilitate trans-septal operation. It is a safe and effective method to treat the diseases of the posterior compartment of the knee. The direction of inside to outside to create ATS is comparatively reliable, and PCL could be identified as an interior landmark during the passage of Wissinger rod through posterior septum to create ATS.

Adult ; Arthroscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; surgery ; Knee Injuries ; surgery ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Posterior Cruciate Ligament ; pathology ; Reproducibility of Results ; Treatment Outcome

OBJECTIVETo study the circulating vaccine-derived poliovirus (cVDPVs) that occurred in Zhenfeng county, Guizhou province in 2004 and to discover wild-poliovirus, vaccine-derived poliovirus (VDPVs) and other vaccine-associated poliovirus which could cause clinical poliomyelitis.

METHODSField epidemiological studies at the epidemic area and collecting acute flaccid paralysis (AFP) case and contact stool specimen for virus identification and nucleotide sequencing. Analysis on data related to annual reports on stool specimens surveillance which involved AFP case and contacts in the resent years in Zhenfeng county.

RESULTSType-I VDPVs had been isolated from 2 AFP cases and 3 contact stool specimen in Wanlan village of Zhenfeng. After the first cVDPVs case was identified, there were 3 cases identified of having other vaccine-associated poliovirus of type-I or type-II in the 5 case of AFP that met the criteria of clinical poliomyelitis. The result of virological surveillance on polio showed that the EV isolation rate (55.1%) of Zhenfeng county was higher than the rate from the whole province of the same year (23.2%). The poliovirus (PV) isolation rate (36.8%) was obviously higher in 2004 than in the previous years. In the 16 PVs strains, the type-I accounted for 43.8% which was significantly higher than the average level (18.3%) from the whole province.

CONCLUSIONSData indicated that the type-I VDPVs had been circulating (cVDPVs) in Zhenfeng county in Guizhou province. Clinical poliomyelitis was caused by non-VDPVs. The increased PV infection and the decreasing rate of vaccination in the general population were responsible for the epidemic of type-I cVDPVs at this time. Monitoring and evaluation on the rate of routine immunization program and prediction of the trend of epidemic should be strenthened.

Adolescent ; Animals ; Cell Line ; Child, Preschool ; China ; epidemiology ; Disease Outbreaks ; Feces ; virology ; Humans ; Infant ; Infant, Newborn ; Male ; Paraplegia ; epidemiology ; etiology ; virology ; Poliomyelitis ; prevention & control ; Poliovirus ; immunology ; physiology ; Poliovirus Vaccines ; immunology ; Vaccination ; statistics & numerical data

Objective:To compare the clinical effect of percutaneous sacroiliac screw fixation assisted by O-arm navigation or C-arm X-ray fluoroscopy in the treatment of sacroiliac joint complex injury.Methods:A retrospective case-control study was conducted on 32 patients with sacroiliac joint complex injury admitted to Second Affiliated Hospital of Army Medical University from July 2016 to January 2019.There were 21 males and 11 females, aged from 20 to 59 years (mean, 41.3 years). According to Tile classification, there were 7 patients with type B1 fracturs, 13 with type B2, 5 with type B3, 5 with type C1, and 2 with type C1. Group A ( n=17) had percutaneous sacroiliac screw fixation assisted by O-arm navigation, while Group B ( n=15) had percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy. Time of single screw placement, time of intraoperative fluoroscopy, intraoperative bleeding volume and bone union time were measured. Reduction quality was evaluated by Matta standard score. Majeed function score was assessed 6 months at the latest follow-up. Complications were also observed. Results:All patients were followed up for 6-37 months (mean, 18.6 months). The time of sacroiliac joint screw placement [(27.3±5.1)minutes] and time of intraoperative fluoroscopy [(43.3±3.2)s] in Group A were significantly less than those in Group B [(52.3±5.9)minutes, (64.6±5.4)s] ( P<0.05). There were no significant differences between Group A and Group B in intraoperative bleeding [(17.8±2.6)ml vs. (20.7±3.1)ml] and bone union time [(13.4±1.4)weeks vs. (14.1±1.9)weeks] ( P>0.05). According to the reduction quality evaluated by Matta standard score, the good and excellent rate was 88% (15/17) in Group A and 87% (13/15) in Group B ( P>0.05). The good and excellent rate of the Majeed function score was 94% (16/17) in Group A and 87% (13/15) in Group B at the latest follow-up ( P>0.05). One patient in Group B demonstrated one screw slightly penetrating the anterior cortex of vertebral body. No neurovascular injury, wound infection, or screw loosening occurred. Conclusion:For sacroiliac joint complex injury, percutaneous sacroiliac screw fixation assisted by O-arm navigation has advantages in the duration of screw placement and intraoperative fluoroscopy over percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy.

Objective To observe the clinical effect of dynamic blood glucose monitoring combined with intensive insulin therapy in critically ill patients with hyperglycemia in intensive care unit (ICU).Methods A total of 135 cases of critically ill patients with severe hyperglycemia were randomly divided into control group (n =67) and treatment group (n =68).Control group was given fingertip blood glucose monitoring,3 times a day combined with syringe pump continuous intravenous 2-4 U · h-1 insulin.Treatment group was given dynamic blood glucose monitoring (every 6 h on blood glucose changes recorded) combined with insulin intensive treatment (when patients' initial blood glucose ＞ 12.1 mmol · L-1,the patients were intravenous infusion 4 U · h-1 insulin,if the blood glucose did not decline,the appropriate increase in 1.5-2.0 U · h-1 insulin).Two groups were treated continuously for 2 weeks.The fasting blood glucose (FBG),ICU hospitalization time,mean mechanical ventilation time,mortality and hypoglycemia were observed in two groups.Results After 3,5,7 d treatment,the FBG in treatment group were (6.34 ± 1.48),(5.73 ± 1.23),(5.24 ± 0.86) mmol· L-1,had significant difference with those in control group,which were (8.76 ±2.36),(8.46 ±2.19),(7.59 ±2.19) mmol · L-1(P ＜0.05).The ICU hospitalization time,mean mechanical ventilation time in treatment group were (8.63 ±5.72),(6.25 ±4.61) d,had no significant difference with those in control group,which were (9.78 ±6.34) and (6.75 ±4.78) d (P ＞0.05).There were 7 cases (10.29％) of mortality in treatment group and 11 cases (16.41％) in control group,with no significant difference (P ＞ 0.05).There were 6 cases (8.82％) of hypoglycemia in treatment group and 14 cases (20.89％) in control group,with no significant difference (P ＜ 0.05).Conclusion In the intensive care unit,hyperglycemia patients with dynamic blood glucose monitoring combined with insulin intensive treatment can more accurately grasp hyperglycemia critically ill patients' blood glucose changes,and then more scientific development of insulin use,can quickly reduce the patients' blood glucose and reduce the incidence of hypoglycemia,has a very good clinical efficacy.

OBJECTIVE To explore the effect of Tuoli Xiaodusan(MDX)on ischemia-reperfusion injury of rat skin flaps and its potential mechanism.METHODS Rats were randomly divided into sham operation group(Sham group),Model group,MDX high-dose group(MDX-H group)and MDX low-dose group(MDX-L group),with 10 rats in each group.After the rat back skin flap model was successfully constructed,the drug was administered by gavage immediately,once a day for 14 consecutive days.The changes of rat skin flaps in each group after surgery were observed,and the survival rate of rat skin flaps in each group was measured on the 14th day after surgery;the histopathological changes of rat skin flaps were observed by HE staining;the protein expression of p-p65 and p-IκBα in the rat skin flap tissue was detected by Western blot;ELISA method was used to detect the expression of TNF-α,IL-1β,and IL-6 cytokines;Ki67 and CD31 immunohistochemical staining were used to observe epidermal basal layer cell prolifera-tion and vascular regeneration.RESULTS Compared with Model group,MDX-H group and MDX-L group had a small amount of e-dema and inflammatory fluid exudation after surgery,and the scab removal time was advanced;the ischemic necrosis of the skin flap was significantly improved,the area of skin flap necrosis was significantly decreased,and the survival rate of rat skin flaps was signifi-cantly increased(P<0.01).In addition,MDX could significantly improve the pathological morphology of ischemia-reperfusion injury in rat back skin flaps,reduce the expression of p-p65 and p-IκBα proteins(P<0.001),and decrease the levels of TNF-α,IL-1β,IL-6 inflammatory factor levels(P<0.05,P<0.01,P<0.001,P<0.000 1).The differences in Ki67 and CD31 also suggested that treatment with MDX accelerate re-epithelialization and blood vessel formation after ischemic flap injury.CONCLUSION MDX plays a role in improving ischemia-reperfusion injury of skin flaps by regulating the NF-κB signaling pathway and accelerating epithelializa-tion and angiogenesis.