Objective To evaluate the efficacy of pleth variability index (PVI) in guiding volume therapy in the patients undergoing thoracoscopic surgery.Methods Forty patients of both sexes, aged 18-64 yr, with body mass index＜35 kg/m2 , of American Society of Anesthesiologists physical status I or Ⅱ ,scheduled for elective thoracoscopic lobectomy, were randomized into 2 groups (n =20 each) : control group (group C) and PVI group.During induction of anesthesia, multiple electrolyte solution was infused rapidly as a bolus of 250 ml, followed by a 2-8 ml · kg-1 · h-1 infusion.In group C, 6％ hydroxyethyl starch 130/0.4 and sodium chloride injection 50 ml and metaraminol 0.5 mg were administered to maintain mean arterial pressure ≥ 65 mmHg.In group PVI, 6％ hydroxyethyl starch 130/0.4 and sodium chloride injection 50 ml and metaraminol 0.5 mg were administered to maintain PVI ≤ 13％ and mean arterial pressure ≥ 65 mmHg.Immediately after the beginning of one-lung ventilation (T1) , immediately after the termination of one-lung ventilation (T2) and at 1 h after surgery (T3) , arterial oxygen saturation were recorded, and arterial blood samples were collected for blood gas analysis, and for determination of lactic acid concentrations.The blood creatinine concentrations were measured at 24 h before and after surgery.The fulid balance was recorded.Results The amount of colloid solution infused, total volume of fluid infused and lactic acid concentrations at T3were significantly lower in group C than in group PVI.There were no significant differences in the amount of crystralloid solution infused, urine volume, blood loss, arterial oxygen saturation at each time point, and blood creatinine concentrations at 24 h before and after surgery between the two groups.Conclusion PVI-guided volume therapy can not only maintain adequate blood volume and tissue perfusion, but also reduce the amount of fluid infused, and is helpful in mitigating lung water overload when used for the patients undergoing thoracoscopic surgery.

Objective To investigate the hemodynamic effects of enhanced external counterpulsation(EECP)on cerebral arteries with different stenoses.Methods Zero-dimensional/three-dimensional multiscale hemodynamic models of cerebral arteries with different stenoses were constructed.Numerical simulations of the EECP hemodynamics were performed under different counterpulsation modes to quantify several hemodynamic indicators of the cerebral arteries.Among them,the mean time-averaged wall shear stress(TAWSS)downstream of the stenosis was in the range of 4-7 Pa,a low percentage of TAWSS risk area,and high narrow branch flow were considered to inhibit the development of atherosclerosis and create a good hemodynamic environment.Results For cerebral arteries with 50%,60%,70%,and 80%stenosis,the hemodynamic environment was optimal in counterpulsation mode when the moment of cuff deflation was 0.5,0.6,0.7,and 0.7 s within the cardiac cycle.Conclusions For 50%stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.5 s should be selected.For 60%stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.6 s should be selected.For 70%or 80%stenotic cerebral arteries,the counterpulsation mode with a deflation moment of 0.7 s should be selected.As stenosis of the cerebral arteries increases,the pressure duration should be prolonged.This study provides a theoretical reference for the EECP treatment strategy for patients with ischemic stroke with different stenoses.

Objective:To summarize the characteristics and nursing experience of patients of transthyretin amyloid polyneuropathy.Methods:A retrospective study was performed in 9 patients with transthyretin amyloid polyneuropathy from different area in china from February 2018 to October 2021 in the Second Affiliated Hospital Zhejiang University School of Medical, summarized nursing points:used list to popularize disease knowledge, improved the nursing skills of rare diseases; did a good job in the safety nursing of sensory motor disorders to prevent pressure sores, scalds, fall, thrombosis and other complications, paid attention to the nursing of autonomic nerve dysfunction, prevented postural hypotension. Observe and prevent heart failure, manage diarrhea and constipation, and applied the guide to personalized urinary tract management;provided genetic counseling services, personalized continuing care and psychological care.Results:During hospitalization, the clinical symptoms of 9 patients were improved to varying degrees, after 3 months of telephone follow-up after discharge, 9 patients had no adverse events such as pressure ulcer and fall.Conclusions:By improving specialized skills, predictive risk management and symptom care, the symptoms of postural hypotension, urinary retention, constipation, diarrhea and other symptoms of transthyretin amyloid polyneuropathy patients can be prevented and improved, and adverse events such as falls and pressure sores can be avoided.

Objective:To evaluate the role of high frequency ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint.Methods:From May 2015 to may 2021, 41 patients with acute closed volar plate injury confirmed by Department of Hand and Foot Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were examined by high frequency ultrasonography. The sonographic features were analyzed and classified.Results:High frequency ultrasonography could not only clearly show the thickness, shape and echo of volar plate, but also the degree of injury and avulsion fracture of volar plate, according to which the closed volar plate injury could be divided into three types: A, B and C. Type A(13 cases): Avulsion fracture of the middle phalangeal base was found with volar plate rupture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and avulsion fracture was found at the distal end of the volar plate. Type B(11 cases): Complete rupture of the volar plate attachment of the middle phalangeal base was found without avulsion fracture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and the end of the volar plate contracted and thickened. Type C(17 cases): Tear of the volar plate was found, the sonogram showed enlarging volar plates, heterogeneous internal echo, and liquid dark area was visible in some cases. The average thickness of the three types of closed volar plate injury of the proximal interphalangeal joint measured by ultrasound was (0.33±0.05)cm, and the average thickness of the volar plate at the same position of the corresponding finger on the opposite side was (0.22±0.03)cm. There was significant difference between the two groups ( t=7.864, P=0.006). Conclusions:High frequency ultrasonography is the preferred imaging examination method for the diagnosis of closed volar plate injury in proximal interphalangeal joint, which has an important guiding significance for the selection of clinical treatment.

Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.

Objective:Biobank construction plays an irreplaceable role in the research of accurate prevention and treatment of diseases. Shared biobank network based on a large crowd queue is the way of the future. This subject is one of the key contents of national precision medicine "The Breast Cancer Cohort Study in Chinese Women: (BCCS-CW)" , aiming to solve the bottleneck of insufficient standardization and sharing.Methods:The establishment of "entity library-information library-extension library" , the widely Shared network of biobank of breast cancer specific disease cohort, and the establishment of strict standard setting and quality control standard to construct the standardized biobank.Results:This biobank provides a shared biobank resource for breast cancer risk assessment, prediction and early warning, early screening, classification, individualized treatment, efficacy and safety prediction and monitoring and other accurate prevention and treatment programs and clinical decision-making system research.Conclusion:The data of this biological sample bank is refined and complete, and the sample size of cases is sufficient, which can meet the research needs of medical big data, genomics, metabonomics, epigenetics and other fields.

Objective:To investigate the diagnostic value of ultrasonography in Poland′s syndrome.Methods:From February 2016 to December 2020, the ultrasonographic images of 15 patients with Poland′s syndrome diagnosed by Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed, and the ultrasonographic features were summarized.Results:High-frequency ultrasound could clearly show the anatomical structures of each layer of the chest wall of the patients with Poland′s syndrome. The sonogram of Poland′s syndrome mainly showed the absence of all or part of the pectoralis major on the affected side, some of which were combined with the absence of pectoralis minor. The difference between the thickness of the affected chest wall and the healthy side was statistically significant ( P<0.01). Among the 15 cases of Poland′s syndrome, 11 cases had brachydactyly or syndactyly. Ultrasound showed that the bifurcation position of the common palmar digital artery of the middle finger was lower than that of the healthy side. Conclusions:The ultrasonography is an effective imaging method for diagnosis of Poland′s syndrome.

Objective To compare the contents of alkaloid in Aconiti Kusnezoffii Radix with different degrees of processing and their effects on electrocardiogram and vagus nerve action potential in SD rats;To establish a toxicity evaluation method for Aconiti Kusnezoffii Radix and its processed products.Methods HPLC was used to determine the contents of six alkaloid components,including benzoyl neoaconitine,benzoyl aconitine,benzoyl subeaconitine,neoaconitine,subeaconitine and aconitine in Aconiti Kusnezoffii Radix and Aconiti Kusnezoffii Radix Cocta of soaking and boiled for 30 minutes,boiled for 4 h without soaking,soaking and boiled for 4 h,and soaking and boiled for 8 h.SD rats were subjected to sublingual drainage with Aconiti Kusnezoffii Radix and four types of processed products.The vagus nerve action potential and electrocardiogram of rats before and after administration were recorded,and the correlation analysis between alkaloid content and vagus nerve action potential and heart rate was conducted.Results The contents of alkaloid of the four processed products showed that the content of diester alkaloids was soaking and boiled for 30 min>boiled for 4 h without soaking>soaking and boiled for 4 h>soaking and boiled for 8 h;monoester alkaloid content:boiled for 4 h without soaking>soaking and boiled for 30 min>soaking and boiled for 4 h>soaking and boiled for 8 h.After the administration of each sample,compared with the basal discharge,the vagus nerve discharge of rats with different processed products was changed by sublingual administration,heart rate increased,the degree of arrhythmia increased,and it varied with the degree of processing;the results of correlation analysis showed that there was a significant correlation between the nerve discharge area and the contents of diester alkaloids and total alkaloids.Conclusion The action potential of the vagus nerve and electrocardiogram of rats after sublingual drainage administration can reflect the degree of numbness in the tongue,which can provide reference for the study of tongue sensation of Aconiti Kusnezoffii Radix.

Adult ; Humans ; Male ; Multiple Myeloma ; pathology ; Neoplasm Invasiveness

Objective:Breast cancer has been the first cancer among women with the incidence increasing gradually. In September 2016, the Breast Cancer Cohort Study in Chinese Women (BCCS-CW) was initiated, aiming to establish a standardized and sharable breast cancer-specific cohort by integrating the existing cohort resource and improving the quality of follow-up. The BCCS-CW may provide a research basis and platform for the precision prevention and treatment of breast cancer in etiology identification, prevention, early diagnosis, treatment, and prognosis prediction.Methods:We conducted a population-based perspective cohort by questionnaire interview, anthropometry, biological specimens, breast ultrasound and mammography. The cohort was followed by using regional health surveillance and ad hoc survey.Results:Finally, BCCS-CW included 112 118 women, in which 55 419 women completed the standardized investigation and blood specimens were collected from 54 304 women. The mean age of participants was 51.7 years old, 62.7% were overweight or obese, and 48.9% were menopausal.Conclusion:The BCCS-CW will provide population-based cohort resource and research platform for the precise prevention and treatment of breast cancer in Chinese women.