Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..

Objective To investigate the effect of esmolol pretreatment on propofol injection pain..Methods Ninety patients undergoing breast cancer surgery under general anesthesia were ran-domly assigned into three groups (n=30 each).Group E were pretreated with 5 mg/ml(total 2 ml)es-molol group L with 20 mg/ml (total 2 ml)lidocaine and group N with 2 ml normal saline.After one minute,each group was administrated propofol intravenouly.The pain and hemodynamic data were re-corded.Results Compared with group N,propofol injection pain degree decreased obviously in groups E and L (P <0.05).propofol injection pain occurred in 25 (83.3%)in group N,was signifi-cantly higher than that of 12 (40.0%)in group E and 14 (46.7%)in group L (P <0.05),propofol injection pain had no significant difference between groups E and L.Compared with T1 ,SBP,DBP decreased in groups E and L at T2 ,SBP decreased in group N at T2 significantly (P <0.05).Com-pared with T2 ,DBP was significantly higher at T3 in group E (P <0.05).Conclusion Pretreatment with low dose esmolol was effective in attenuating pain during propofol injection.

Objective To investigate the effect of hypercapnia on cerebral oxygen metabolism under propofol anesthesia during one-lung ventilation (OLV) in patients.Methods Forty ASA physical status [or Ⅱ patients,aged 53-63 yr,scheduled for elective lobectomy performed via video-assisted thoracoscope,were enrolled in the study.Anesthesia was induced with iv injection of midazolam,fentanyl and vecuronium and target-controlled infusion of propofol and maintained with target-controlled infusion of propofol and intermittent iv boluses of fentanyl and vecuronium.BIS value was maintained at 40-60 during surgery.At 15 min of OLV,hypercapnia was performed and PaCO2 was maintained at 50-55 mm Hg lasting for 15 min,and then respiratory rate was adjusted to maintain PaCO2 at 40-45 mm Hg.Immediately before OLV (T0),at 15 min of OLV and hypercapnia (T1,2),and at 15 min after the end of hypercapnia (T3),arterial and jugular bulb venous blood samples were obtained for determination of arterial partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2),jugular bulb venous oxygen partial pressure (PjO2) and hemoglobin saturation (SjO2).The arterial to venous oxygen content difference (Da-jO2) and cerebral extraction rate of oxygen (CERO2) were calculated.Results SaO2 and PaO2 at T1-3,SjO2 and PjO2 at T1 and T3 and Da-jO2 at T2 were significantly lower and CERO2 at T1 and T3 was higher than those at T0 (P ＜ 0.05).SjO2 and PjO2 were significantly increased and Da-jO2 and CERO2 were significantly decreased at T2(P ＜0.05) and no significant changes were found in the parameters of cerebral oxygen metabolism at T3 as compared with those at T1 (P ＞ 0.05).Conclusion Hypercapnia can improve cerebral oxygen metabolism under propofol anesthesia during OLV in patients.

Acute Disease ; Chemical and Drug Induced Liver Injury ; etiology ; Humans ; Male ; Middle Aged ; Toluidines ; poisoning ; Young Adult

Adolescent ; Adult ; Allyl Compounds ; poisoning ; Chronic Disease ; Female ; Humans ; Occupational Diseases ; diagnosis ; therapy ; Poisoning ; diagnosis ; therapy

As a member of nuclear receptor superfamily, farnesoid X receptor (FXR) has been shown to regulate numerous metabolic pathways, which include playing an important role in bile acid metabolism, maintaining lipid and glucose homeostasis when FXR is activated. With the prevalence of the glucose and lipids disorder, FXR attracts increasing attention. It may be a potential target for the treatment of type 2 diabetes mellitus and lipid disorders.
Bile Acids and Salts ; Diabetes Mellitus, Type 2 ; Glucose ; metabolism ; Homeostasis ; Humans ; Lipid Metabolism ; Receptors, Cytoplasmic and Nuclear ; metabolism

OBJECTIVETo investigate the type and corresponding operation methods of ulnar lateral mass in distal radial fractures.

METHODSFrom January 2004 to September 2010,32 cases of distal radial fractures with ulnar lateral mass were treated by surgical incision and relocate ulnar lateral mass,including 23 males and 9 females with an average age of (34 +/- 9) years old ranging from 28 to 65 years old. According to the classification of Melone-Doi, 2 cases with type I, 24 cases of type II, 6 cases with type III. The operative appoach involved palm-radial, palm-ulnar, radial-dorsal. Among them, 28 patients with closed fractures were fixed with plate, 4 cases (including 2 cases of open fractures) were fixed by Kirschner pin and braces.

RESULTSThirty-two patients were followed up for 8 to 18 months with an average of 12 months. All fractures were healing without complications. According to modified Gartland-Werley scoring system (GWSS), the total score was 1.12 +/- 0.45, the remain deformity was 0, subjective evaluation was 0.50 +/- 0.30, objective evaluation was 0.30 +/- 0.21, complications was 0.40 +/- 0.09; the result was excellent in 21 cases, good in 11 cases.

CONCLUSIONThe location of ulnar lateral mass in distal radial fractures is one of the important prognostic factors in wrist function and surgical treatment is an effective method of fixing ulnar lateral mass in distal radial fractures.

Adult ; Aged ; Bone Nails ; Bone Plates ; External Fixators ; Female ; Fracture Fixation ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Treatment Outcome ; Ulna Fractures ; surgery

Objective To study the methods of three dimensional reconstruction of digitized virtual breast invasive ductal carcionma and sterical characteristic of tumor growth.Methods The specimens were sliced into 0.2 mm continuous sections on transversal plane with the computerized miller,and photographs were taken with digital camera.3DDOCTOR software was used to make three dimensional block diagram and the thin sectional and three dimentional characteristics of breast invasive ductal carcionma were observed.Results Every structure of breast in thin section was clear.Stereo image of breast solid could be shown satisfactorily.Every shape of stereo image and the structure of breast could be shown by revolving the three dimensional image in different direction,beneficial to us in understanding the dimensional growth pattern of tumor.Conclusion The sliced image of breast invasive ductal carcionma database was exact.The image of three dimentional reconstruction was clear,which could reflect the structural feature and growth pattern of breast carcinoma in the breast exactly and be conducive to the evaluation of tumor margin in breast conservation therapy.

Objective To summerize the clinical experience of 23 cases of carotid cavernous fistula(CCF) and discuss the treatment strategy. Methods Retrospectively analyzed 23 patients(11 males and 12 females) of CCF,including 14 patients with Barrow type A,1 with type B,1 with type C and 7 with type D. Results Vascular approach for embolization was undertaken in 20 cases by transarterial access and 2 via venous route while 1 case was given up. Among them,9 cases obtained complete occlusion by simple balloon embolization and 5 were treated by direct occlusion of internal carotid artery. Another 5 cases used NBCA glue for the occlusion,1 case was embolized by gelatin-sponge particulates combined with compression of carotid artery,2 cases were treated by coil embolization of cavernous sinus and 1 case was only managed by carotid compression maneuver. We achieved satisfactory clinical results with 21 patients cured and 2 patients improved. Conclusion Complexity and refractory are the characteristic of CCF,and endovascular treatment should be the major choice of treatment. (J Intervent Radiol,2006,15: 323-326)