Objective To compare the effect of conventional and hyperoxia management strategy during deep hypothermia in patients with DeBake type 1 aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement.Methods 32 adult patients undergoing total aortic arch replacement were randomly allocated to one of two groups(n=16 each):conventional(C)and hyperoxia group(H).The patients had no history of cerebral vascular disease.Left radial artery and dorsal artery of left foot were cannulated for monitoring of blood pressure of upper and lower limbs.Right internal jugular vein was cannulated for CVP monitoring and administration of drug and fluid.Anesthesia was induced with etomidate 10-15 mg,fentanyl 5-10 ?g?kg~(-1) and pancuronium 0.1 mg?kg~(-1) and maintained with fentanyl(total amount was＜20 ?g?kg~(-1)),isoflurane and pancuronium after tracheal intubation.Intermittent i.v.boluses of diazepam,sodium thiopental or propofol were given during cardiopulmonary bypass(CPB).Another catheter was inserted into right internal jugular vein eephalad until resistance was met.The tip of the catheter was at the level of mastoid process.The hyperoxia management involved the following steps:FiO_2 was gradually reduced with decreasing body temperature(T_0)from 70%(36～ 37℃)to 60%-40%(35.9-34℃),38%-30%(32-26℃),30%(26-24℃)and finally to 21%.When nasopharyngeal T_0 was reduced to 22℃ or 5-10 min before selective cerebral peffusion(SCP),FiO_2 was raised to 60%-100% to maintain PjvO_2＞20 mm Hg or SjvO_2＞60%.FiO_2 was maintained at 60%-100% during SCP until T_0 was rewarmed to 22℃,then reduced to 30%.FiO_2 was then gradually increased to 40%(when T_0 reached 28℃),to 50%-70% (34-37℃)and finally to 80%(T_0＞37℃).Blood samples were taken from jugular venous bulb and arterial port of oxygenator for determination of PjvO_2,SjvO_2 and PaO_2 before skin incision (T_1),at 15 min of CPB(T_2),10 min of SCP(T_3),5 min after descending aorta unclamping(T_4),5 min after left subclavian artery unclamping(T_5),5 min after left common carotid artery unclamping(T_6),anonymous artery unclamping(T_7),when nasopharyngeal To returned to 35℉(T_8)and 10 min after CPB was terminated(T_9).The awakening time and the duration of ICU stay(days)were recorded.Pre- and postoperative neurological examination and brain CT scan were performed.Results All patients survived the operation and were discharged from hospital.No new brain infarction occurred.Transient neurologic dysfunction occurred in 2 patients in group H and 3 patients in group C.There was a positive linear relationship between PaO_2 and PjvO_2 during deep hypothermia in group H (r=0.541,P＜0.01).The PjvO_2 and SjvO_2 were significantly higher in group H than in group C.The awakening time and the ICU stay were significantly shorter in group H than in group C.Conclusion The hyperoxia management strategy can provide clinical prognosis than the conventional management strategy during deep hypothermia for total aortic arch replacement by supplying more dissolved oxygen.

Doctor WANG Zhi-zhong in the Southern Song Dynasty proposed the acupoint view of "location of disease", which explained the connotation of acupoints from the angle of clinic. Its meaning included two levels, one level meant pathological change on the body surface, that was the location of acupuncture diagnosis-treatment, and the other one indicated that the body surface which was the reflecting point of pathological change on the distal area or inside the body was the location of acupuncture diagnosis-treatment. The specific connotations of clinical acupoints were: location of pathogenic factors or reflection of pathogenic factors, regularity between acupoints un- der disease and specific organ, morphological differences and positioning variability after acupoints under disease, and acupoints examination, diagnosis and treatment.
Acupuncture Points ; Acupuncture Therapy ; history ; China ; History, Ancient ; Humans ; Medicine in Literature ; Meridians

OBJECTIVETo observe the analgesic effect of Zhitong Capsule (ZTC) and study its mechanism in adjuvant arthritis (AA) rats.

METHODSForty-eight male Sprague-Dawley rats were randomly divided into six groups with 8 rats in each group. On the first day, except to those in the normal group that were treated with normal saline, the same amount of Freund's complete adjuvant (FCA) was given through intradermal injection into the right hind paw to all the rats in the other groups. From the 17th day of the modeling on, the rats in groups of ZTC were administered daily through gastrogavage with a dose of 1000, 500, 250 mg/kg respectively, while equal volume of normal saline was given to those in the normal group and model group, and an equal volume of aspirin (ASA) solution was given to rats in the ASA group through gastrogavage for 10 days, once per day, and on the 27th day, the analgesic effect of ZTC was measured with heat withdraw method. The activities and contents of superoxide dismutase (SOD) and lipid peroxides (LPO) in serum were observed by spectrophotometry, and the level of beta-endorphin (beta-EP) in hypothalamus were determined by the assay of immunohistochemistry.

RESULTSZTC showed significant effects on enhancing the pain threshold and at the same time it increased the activities of SOD and reduced the contents of LPO in serum. ZTC could also increase the level of beta-EP in hypothalamus.

CONCLUSIONZTC has analgesic effect and its mechanism is probably related with its effect in inhibiting the level of oxygen free radicals in serum and increasing the level of beta-EP of hypothalamus in rats.

Analgesia ; methods ; Animals ; Arthritis, Experimental ; metabolism ; physiopathology ; therapy ; Hypothalamus ; metabolism ; Lipid Peroxides ; blood ; Male ; Medicine, Chinese Traditional ; Pain ; physiopathology ; Pain Threshold ; drug effects ; Phytotherapy ; Plant Preparations ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; blood ; Tissue Distribution ; beta-Endorphin ; metabolism

COVID-19 not only affects the physical health of Chinese people, but also their psychological health. This article mainly summarizedthe causes, clinical manifestations and preventive measures of COVID-19 impact on psychology of Chinese people, and presentedtwo representative cases at the same time.

BACKGROUNDThe infection risk of natural orifice transluminal endoscopic surgery (NOTES) is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load during transgastric and transvaginal procedures with antiseptic or controlling perioperative preparation.

METHODSForty-five female pigs were randomly assigned to five equal groups: the transgastric (TG) control group (group A), the TG middle volume gastric lavage group (group B), the TG high volume lavage group (group C), the transvaginal (TV) control group (group D) and the TV study group (group E). The study groups received gastric or vaginal lavage and abdominal antimicrobial irrigation, while the control groups received neither. All animals were administered intravenous antibiotics, underwent NOTES peritoneoscopy and transumbilical laparoscopic cholecystectomy under NOTES view with sterile instruments. The viscerotomy was closed by laparoscopic suture. The animals were observed until necropsy was performed 14 days postoperatively. Quantitative bacteriologic cultures were taken from the gastric or vaginal aspirate before and after lavage; peritoneal fluid was collected before and after peritoneal irrigation and at necropsy.

RESULTSThe surgical procedures were completed for all the pigs and all of them survived. The mean operative time of the TG group and the TV group was (81 ± 27) minutes and (66 ± 12) minutes, respectively. All animals survived for 14 days. At necropsy, significantly more peritoneal infections were noted in group A than in group D (5:9 vs. 0:9; P < 0.05). No gross evidence of intra-peritoneal infection was found in groups B, C, D and E. Bacteriological evidence was seen in all pigs in group A, 7 pigs in group B, 6 pigs in group D, and none in groups C and E.

CONCLUSIONSWithout gastric or vaginal lavage and antibiotic peritoneal irrigation, the TG procedure has a higher infection rate than the TV access. After antiseptic preparation, the bacterial load significantly decreased in the TG group, which seems as safe as the sterile TV approach.

Animals ; Female ; Natural Orifice Endoscopic Surgery ; methods ; Stomach ; surgery ; Swine ; Vagina ; surgery

objecfive To know and compare the intelligence level of children born in different time periods in regions with iodine deficiency disorders(IDD)in Liaoning province.Methods All 7-14 year-old children from ten schools were chosen as the subjects respectively from six villages in each of the six counties and in regions with iodine deficiency,who were respectively born at the initialization of iodinated salt supplying period(1978-1980);non-iodinated salt supplying period(1981-1990);recovery of supplied iodized salt period(1991-1995);universal iodized salt period(1996-2000),respectively.Intelligence quotient(IQ)was measured by Combined Ravens Test in China(CRT-C)and Combined Ravens Test-the Rural,in China,2nd edition(CRT-RC2).Results IQ of children during the non-iodized salt period(91.9±14.3)was significantly lower than the initial supply of iodized salt period(95.8±14.6,q=8.60,P<0.01),recovery of supplied iodized salt period(99.7±14.7)was significantly higher than the initial supply of iodized salt period, non-iodized salt sales period(q = 9.53, 18.13, all P < 0.01 ),universal salt iodization( 104.3 ± 14.9) was significantly higher than the initial supply of iodized salt period, non-iodized salt sales period, recovery of supplied salt iodization(q = 20.00,28.00,10.46, all P < 0.01). Children's rate of mental retardation (IQ≤69) was higher in non-iodinated salt supplying period (6.7%, 88/1314 ) than the initial supply of iodized salt (4.4%, 21/471, χ2 = 3.85, P < 0.05), recovery of supplied iodized salt period(3.3%,48/1470) was significantly lower than non-iodinzed salt supplying period (χ2 = 15.37, P < 0.01), universal salt iodization period(2.7%, 36/1344) was lower than the initial supply of iodized salt period(χ2 = 4.41, P < 0.05) and non-iodinzed salt supplying period(χ2 = 26.34, P < 0.01 ). The IQ and intelligent retarded rates in children born during the initial years of iodinated salt supplying period were not different. The IQ of the children during ten years of non-iodized salt supplying period fluctuated in a "∪" curve, while the intelligent retardation rates in a "∩" curve.The children born during the period of recovery supplied iodized salt increased their IQ and lowered the retardation rates year after year. The IQ of the children in universal iodized salt period kept on increasing while intelligent retarded rates reduced to the lowest level. Conclusions The intelligence level of children born in regions with IDD during non-iodized salt supplying period is remarkably lower than that of the beginning years of iodinated salt supplying period. The intelligence level of children born after universal iodized salt period is remarkably higher than that of the initial iodinated salt supplying period and recovery of supplied iodized salt period, respectively.

OBJECTIVETo investigate the clinicopathologic features of the brain tissue diagnosed as ulegyria from modified anatomic hemispherectomy for refractory epilepsy.

METHODSThe clinical and pathologic findings were reviewed in 39 patients who underwent modified anatomic hemispherectomy and diagnosed as ulegyria in the Epilepsy Center of Tsinghua University Yuquan Hospital from 2007 to 2011.

RESULTSAll patients including 30 males and 9 females had medically intractable seizures, and the mean age of seizure onset and disease duration were 4.0 years and 7.3 years respectively. Significant history included febrile seizure in 14 patients (35.9%), cerebral hemorrhage in 8 patients (20.5%), fetal distress and surgical trauma each in 6 patients (15.4%), vascular malformation and cerebral hemorrhage in 1 patient (2.6%), and unclear history in 4 patients (10.2%). Histologically, all cases were characterized by cortical destruction, with neuronal loss and gliosis. All cases were accompanied by varying degree of cortical dysplasia, which were diagnosed as focal cortical dysplasia IIId. Hippocampus sclerosis was identified in 2 cases. Seizure outcome after surgery revealed 37 patients (94.9%) had an Engel grade I, two patients (5.1%) had an Engel grade II.

CONCLUSIONSFebrile seizure, cerebral hemorrhage, fetal distress and surgical trauma in childhood can lead to refractory epilepsy. Histopathological change in the brain is ulegyria accompanied by focal cortical dysplasia IIId. Modified anatomic hemispherectomy is an effective therapy to treat those patients with extensive changes of one hemisphere.

Adolescent ; Adult ; CD3 Complex ; metabolism ; Cerebral Cortex ; abnormalities ; pathology ; surgery ; Child ; Child, Preschool ; Epilepsy ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Hemispherectomy ; methods ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Malformations of Cortical Development ; metabolism ; pathology ; surgery ; Retrospective Studies ; Young Adult

Animals ; Female ; Ginsenosides ; pharmacology ; therapeutic use ; Hepatocytes ; drug effects ; metabolism ; ultrastructure ; Liver Cirrhosis, Experimental ; drug therapy ; metabolism ; Male ; Phytotherapy ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley ; Tissue Inhibitor of Metalloproteinase-1 ; metabolism

BACKGROUNDA multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.

METHODSAdult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.

RESULTSChanges of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.

CONCLUSIONSThe domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.

Adolescent ; Adult ; Aged ; Dialysis Solutions ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; methods ; Young Adult

BACKGROUNDData on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.

METHODSThe survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.

RESULTSThe analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).

CONCLUSIONSThe prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.

Adult ; Aged ; Awareness ; Female ; Humans ; Hypertension ; complications ; epidemiology ; therapy ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; complications