Objective To investigate the causes of and prevention for cerebral complications in perioperative period in patients with carotid stenosis. Methods The causes and treatment of cerebral complications among 133 cases of carotid stenosis during perioperative period from May 2004 to Jun 2009 were analysed retrospectively. Results Among 133 cases, 94 cases underwent carotid endarterectomy (CEA) and 39 cases had carotid artery stenting(CAS). Cerebral complications developed in 16 cases including 3 cases of more than two attacks. 5 cases suffered from tansient ischemia attacks (TIA)or cerebral ischemia before operation. 5 developed TIA or cerebral hyperperfusion syndrome (CHPS) among those undergoing CEA and 4 developed TIA or CHPS among CAS cases. During postoperative period, 8 cases developed TIA, CHPS,cerebral infarction or cerebral hemorrhage. Conclusions Prevention and treatment of cerebral complications is extremely important durning surgical therapy of carotid stenosis.

BACKGROUND: Spleen is correlated with mitochondrion. The "spleen governs movement and transformation of food and liquids" in traditional Chinese medicine refers to not only the digestion and absorption of food in gastrointestinal tract, but also the process of biological oxidation and energy production of mitochondrion.OBJECTIVE: To analyze the effects of Si-Jun-Zi decoction (SJZD), a typical prescription for invigorating spleen and replenishing qi, on repairing the mitochondrial damage of cells of liver, myocardium, gastric mucosa and skeletal muscle in rats with spleen asthenia.DESIGN: A randomized controlled observation.SETTINGS: Second Department of Internal Medicine, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine;Guangzhou University of Traditional Chinese Medicine.MATERIALS: The experiments were carried out in the internal medicine laboratory, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and the testing center of Guangzhou University of Traditional Chinese Medicine from June to December in 2004. Forty SD rats were provided by the animal center of Guangzhou University of Traditional Chinese Medicine. Xiao Cheng-Qi decoction consisted of officinal magnolia bark, immature bitter orange and rhubarb according to the ratio of 3:3:2; SJZD consisted of radix codonopsitis pilosulae, largehead atractylodes rhizome, India bread and liquorice root according to the ratio of 2:2:2:1, and it was provided by the Department of Pharmacy, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,and made into 100% decoction.METHODS: After raised for 1 week, the SD rats were divided randomlyinto 4 groups: normal control group, spleen asthenia group, natural convalescence group and SJZD-treated group, and the rats in the latter three groups were made into models of long-term spleen asthenia. Rats in the normal control group were fed with normal chow, intragastric administered with saline (3 mL), once every other day for 34 weeks. Rats in the spleen asthenia group were intragastricly administered with Xiao Cheng-Qi decoction (3 mL) and fed every other day for 34 weeks, the rats in the natural convalescence group were fed with normal chow for 8 weeks after being treated as those in the spleen asthenia group for 26 weeks, and those in the SJZD-treated group were treated as those in the spleen asthenia group for 26 weeks, and then intragastricly administered with SJZD (4 mL, once a day) and fed with normal chow for 8 weeks. At the end of the 34th week,the rats were decapitated under anesthesia, and the skeletal muscle, liver,gastric mucosa and myocardium were taken out rapidly. The protein amounts in mitochondrial suspension were detected with the biuret method,the content of mitochondria in I g tissue was calculated according to the tissue mass, and the mitochondrial ultrastructures were observed under transmission electron microscope.MAIN OUTCOME MEASURES: The contents and ultrastructures of mitochondria in skeletal muscle, liver, gastric mucosa and myocardium were observed.RESULTS: All the 40 rats were involved in the analysis of results without deletion. ① At the end of the 34th week, the mitochondrial contents of skeletal muscle, liver, myocardium and gastric mucosa were all significantly lower in the spleen asthenia group than in the normal control group (P＜ 0.01), and markedly higher in the natural convalescence group than in the spleen asthenia group (P ＜ 0.05-0.01). The mitochondrial contents of the tissues were the highest in the SJZD-treated group, which were significantly higher than those in the spleen asthenia group and natural convalescence group (P ＜ 0.05-0.01), as well as the normal control group (P＜ 0.01). ② Comparison of mitochondrial ultrastructures in skeletal muscle,liver, gastric mucosa and myocardium at the end of the 34th week: In the spleen asthenia group, the mitochondria of myocardial cells were seriously swollen, the compact substance of hepatocellular mitochondria were decreased or disappeared and the crest disrupted; the mitochondria of skeletal muscle were shrunk and decreased, mitochondrial membranes were disorganized and crest disappeared, mitochondrial membranes were disorganized and crest disappeared; For gastric parietal cell of spleen asthenia,the amount of mitochondria reduced, inner structure confused, mitochondrial crestae of gastric chief cell was broken. In the natural convalescence group, the changes of the mitochondrial morphology were slight. The mitochondrial morphology in the SJZD group was close to those in the normal control group.CONCLUSION: SJZD has the effects of increasing the contents of mitochondria in skeletal muscle, liver, myocardium and gastric mucosa and repairing the damaged structure of mitochondria because of spleen asthenia.

Objective To investigate the clinical features of renal tumor patients with yon Hip-pel-Lindau (VHL) disease. Methods Clinical data of 9 renal tumor cases with VHL disease were analyzed and reviewed. The renal tumor characteristics were compared with data of 46 sporadic renal cell cancer (SRCC) cases during the same period. Results In the 9 renal tumor cases with VHL dis-ease presented, significant statistical differences were found in the aspects of bilateralness (7 vs 0), ipsilateral multicentricity(5 vs 2)and cystic growth pattern(6 vs 1) compared with SRCC (P＜0.01). During the average follow-up period of 54 months, no significant difference was found in the median survival between VHL disease patients and SRCC patients(136 vs 42 months). However, a better tendency of VHL disease over SRCC was found in survival curve study. Conclusions VHL disease should be considered when renal tumors present bilateral, multicentric or with cystic growth pattern. Management should be individualized with close watchful waiting in combination with nephron sparing surgery. Nephrectomy should be avoided when possible.

Objeetive To investigate the outcome of microvascular reconstruction of the tongue with anterolateral thigh flaps in the treatment of middle-late stage tongue cancer patients. Methods From December 2003 to March 2007,nine patients underwent simultaneous reconstruction of the tongue and oral floor defects with anterolateral thigh flaps after resection of squamous cell carcinoma of tongue.The flaps ranged from 7 cm×10 cm to 10 cm×12 cm in size,and were adjusted to the defect of the tongue and oral floor.The vascular pedicle included descending branch of the lateral femoral circumflex artery and the accompanying veins.The outcome of reconstruction was evaluated by follow-up examinations,considering the contour and mobility of the reconstructed tongues,the swallowing function and the speech function.Results All of the donor sites were closed directly,with minimal donor-site morbidity. All patients recovered unevenffully from surgery,with no immediate postoperative complications:no flap necrosis,no wound infection or wound dehiscence.The transplanted flaps survived well.The average follow-up period was 18 months.During the follow-up period there was no tumor recurrence and the contour of the reconstructed tongues showed sufficient bulk.The patients demonstrated good mobility of the reconstructed tongue.The swallowing and speech function recovered satisfactory.Two months postoperatively the patients were able to ingest a solid or semisolid diet,and six months postoperatively the patients developed intelligibe language.Conclusion The anterolateral thigh flaps are suitable and reliable for the microsurgical reconstruction of the large defects caused by middle-late stage tongue cancer.

Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.

OBJECTIVEIn order to improve the irrigation for Panax notginseng growing seedlings, different mulching ways were carried out to investigate the effects of double mulching.

METHODField experiment was applied to study soil moisture, soil temperature and bulk density of different mulching ways while the germination rate and seedlings growth also were investigated.

RESULTCompared with the traditional single mulching with pine leaves or straw, double mulching using plastic film combined with pine leaves or straw could reduce 2/3 volumes of irrigation at the early seedling time Double mulching treatments didn't need to irrigate for 40 days from seeding to germination, and kept soil moisture and temperature steady at whole seedling time about 30% and 9.0-16.6 degrees C, respectively. The steady soil moisture and temperature benefited to resist late spring cold and germinate earlier while kept germination regularly, higher rate and seedlings quality. In contrast, single mulching using pine leaves or straw had poor soil moisture and temperature preserving, needed to irrigate every 12-day, meanwhile dropped the germination and booming time 14 days and 24-26 days, respectively, reduced germination rate about 11.3%-8.7%. However, single pine leaves mulching was better than straw mulching. In addition, though better effects of soil moisture and temperature preserving as well as earlier and higher rate of germination with single plastic films mulching had, some disadvantages had also been observed, such as daily soil temperature changed greatly, seedling bed soil hardened easily, more moss and weeds resulted difficulty in later management.

CONCLUSIONTo the purpose of saving water and labor as well as getting higher germination rate and seedlings quality, double mulching using plastic films combined pine leaves at the early time and single mulching removing plastic films at the later time is suggested to apply in the growing seedlings of P. notoginseng.

Agriculture ; methods ; China ; Drugs, Chinese Herbal ; analysis ; Fertilizers ; analysis ; Panax notoginseng ; chemistry ; growth & development ; Quality Control ; Seedlings ; chemistry ; growth & development ; Soil ; chemistry

Objective To study the influence of lactational dioxin exposure(2,3,7,8-tetrachlorodibenzo-p-dixon,TCDD)on development of alveolar bone in SD rat offspring.Methods The rats of TCDD exposure group and control group were sacrificed and the alveolar bone with molars of PD60 rats in the two groups were embedded in resin.The sections were observed by fluorescent microscope.The alveolar bone formation was evaluated by histological examination,tetracycline fluorescence marker and quantitative histomorphometry.The indices of quantitative histomorphometry were compaired.Resuits The trabecular structure of abeolar bone was looser in TCDD exposure group than in the control group.The tetracycline fluorescence markers were more disorganized in TCDD group.The indices of quantitative histomorphometry of alveolar bone between two groups showed significantly difierent. Conclusions Lactational 2,3,7,8-TCDD exposure decreased the quality and quantity of alveolar bone in SD rat offspring.It is suggested that dioxins exposure may interrupt the spatial configuration.

Objective? To investigate the status of self-management of discharged patients after radioactive 125I seeds implantation and analyze the possible influencing factors,so as to provide reference for postoperative continuous nursing guidance. Methods? From March to April 2018, convenient cluster sampling was used to select out of hospital tumor patients who met the inclusion criteria after 125I seed implantation in the Department of Radiation Oncology of Peking University Third Hospital within half a year. The self-designed Radiation Protection Knowledge and Self-management Behavior Evaluation Questionnaire was used to collect data through telephone follow-up and medical record review. In the self-designed part of the questionnaire, 2 particle group doctors and 2 deputy directors and 1 associate professor was invited to evaluate the content validity of the questionnaire. The total number of questionnaires was 72 and 72 valid questionnaires were collected. SPSS 21.0 statistical software was used for data entry and analysis. Results? After 125I seed implantation, the patients′ knowledge score of radiation protection outside hospital was (3.33±1.22) with a full score of 5; the self-management score of radiation protection was (27.40±9.47) with a full score of 44; the total self-management score of patients with lead-free clothing was higher than that of patients with lead-free clothing (t=5.51,P＜0.001); the self-management level of radiation protection of medical insurance patients was higher than that of self paid patients (t=2.15,P＜0.05); family economic pressure was the influencing factor of self-management of radiation protection (F=-4.41,P＜0.05); the knowledge of radiation protection was positively correlated with self-management behavior of radiation protection (r=0.544,P＜ 0.001). Multivariate linear regression analysis showed that, the family economic incorne, the total score of radiation protection knowledge, and whether they have their own lead clothing were the main influencing factor of discharged patients with cancer after 125I seeds implantation (P＜0.05). Conclusions? The knowledge of radiation protection outside the hospital and the ability of self-management of radiation protection of the patients after 125I seed implantation are medium level. The important factors influencing the self-management of radiation protection of the patients after seed implantation are whether they have their own lead clothing, family economic income, and the cognitive level of radiation protection. In order to achieve better self-management level of radiation protection, medical staff should educate patients about the hazards and protection of radiation, improve patients′ awareness of radiation protection, and encourage patients to buy lead clothing.

OBJECTIVETo assess the value of compound anesthesia of transcutaneous electrical point stimulation and Remifentanil and the efficacy of this method on postoperative acute pain.

METHODSSixty cases with vertebral lamina internal fixation decompression operation were selected and randomly divided into 2 groups, an observation group and a control group, 30 cases in each group. The patients in the observation group received compound anesthesia of transcutaneous electrical point stimulation at Hegu (LI 4), Laogong (PC 8), Neiguan (PC 6) and Waiguan (TE 5) 30 min before anesthesia induction with HANS stimulator and then Remifentanil anesthesia. During the operation, the stimulation was lasted for 30 min and ceased for 30 min until the end of operation. The patients in the control group received simple Remifentanil anesthesia. The dosage of the narcotic, changes of both blood pressure and heart rate during operation, before and after extubation and the pain degree, etc. were investigated in the two groups.

RESULTS(1) The dosage of Isoflurane, (0.52 +/- 0.33)vol%, in the observation group was significantly lower than (1.12 +/- 0.18) vol% in the control group (P < 0.01). (2) Both blood pressure and heart rate during operation, before and after extubation in the observation group were lower than those before operation (P < 0.01), and both the blood pressure and heart rate during operation in the control group were lower than those before operation (P < 0.01). The blood pressure after extubation in the observation group was significantly lower than that of the control group (P < 0.01), and the heart rate before and after extubation in the observation group was significantly lower than that of the control group (P < 0.01). (3) The time of extubation and palinesthesia in the observation group were significantly shorter than those in the control group (P < 0.01). (4) In the observation group, the VAS scores after palinesthesia in 26 cases were < 4, and in 4 cases were > or = 5, while in the control group, the scores in 4 cases were < 4 and in 20 cases > or = 5, with a significant difference between the two groups (P < 0.01).

CONCLUSIONCompound anesthesia of transcutaneous electrical point stimulation and Remifentanil can reduce the dosage of narcotics, shorten the time of palinesthesia and effectively prevent and treat acute pain after Remifentanil anesthesia.

Acupuncture Analgesia ; Adult ; Anesthesia Recovery Period ; Anesthetics, Intravenous ; administration & dosage ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; prevention & control ; therapy ; Piperidines ; administration & dosage ; Spine ; surgery