Objective:To investigate the effects of rosuvastatin and lfuvastatin on patients with acute coronary syndrome (ACS) combing impaired glucose tolerance (IGT).
Methods: A total of 215 consecutive ACS patients combing IGT treated in our hospital from 2009-05 to 2011-05 were studied. The patients were randomly divided into 2 groups, Rosuvastatin group, the patients received rosuvastatin10mg/day, n=108 and Fluvastatin group, the patients received fluvastatin 40mg/day, n=107. The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) levels before and at 6, 12, 24 months after medication, fasting blood glucose (FBG), 2-hour postprandial glucose (2hPBG) and the number of new-onset of diabetes patients were compared between 2 groups.
Results: After treatment, the TC, LDL-C levels were decreased (6, 12, 24 months) and the HDL-C level (12, 24 months), 2hPBG (24 months) were increased in both groups. Compared with Fluvastatin group, Rosuvastatin group had decreased TC and LDL-C (6, 12, 24 months), and increased LDL-C (24 months). With 6, 12, 24 months treatment, the blood lipids reached the standard were more in Rosuvastatin group than those in Fluvastatin group as 35.3%vs 26.1%, 36.4% vs 22.0%, 43.1% vs 31.8% respectively, all P<0.05. With 12 and 24 months treatment, the new-onset diabetes patients in Rosuvastatin group were 11 and 18, in Fluvastatin group were 12 and 17. With 12, 24 months treatment, FBG, 2hPBG levels and the number of new-onset diabetes patients were similar between 2 groups, P>0.05.
Conclusion: Compared with lfuvastatin, the conventional dose of rosuvastatin could better reduce the blood lipids level in ACS patients combing IGT, the effects for preventing ACS patients from IGT to diabetes were similar for both drugs.

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Objective To explore the feasibility of evaluating the lung function by MSCT in emphysema.Methods The MSCT scan and pulmonary function tests(PFF)were respectively performed in 147 receptors within one week.They were randomly divided into 2 groups:group A(120 receptors), including normal,mild,moderate and severe abnormal pulmonary function based on the PFT,for comparing the correlation between pulmonary quantitative indexes of MSCT pulmonary function and PFT and settingup the primary grade criteria of abnormal pulmonary function in emphysema,group B(27 receptors)for evaluating the diagnostic accuracy in group A.The total lung was respectively scanned at the full inspiration and full expiration with MSCT.The pulmonary quantitative indexes of MSCT were measured with Siemens Pulmo pulmonary quantitative software.Results There was correlation between pulmonary quantitative indexes of MSCT and PFF.The Piex/in_(-910)showed best correlation with FEV_1%(r=-0.905,P

OBJECTIVETo compare the relation between the preoperative functional magnetic resonance imaging (fMRI) with blood oxygen level dependent (BOLD) technique and intraoperative motor evoked potential (MEP) monitoring for cortical mapping of primary motor cortex in patients with tumors near the central area. And to determine whether non-invasive preoperative fMRI can provide results equivalent to those achieved with the invasive neurosurgical "gold standard".

METHODSA prospective study of 16 patients with various pathological tumors of the central area was conducted. Preoperative fMRI scans using the BOLD contrast technique in each patient were performed. An activation scan was achieved by using a motor task paradigm, which consisted of simple flexion-extension finger movements and finger-to-thumb touching in a repeating pattern. The anatomical structure was delineated by the T(1)-weighted three-dimensional fast spoiled gradient recalled sequence (3D/FSPGR) immediately afterward. The BOLD images were overlaid on the T(1)-weighted 3D/FSPGR images, and then co-registered to the neuronavigation system. The fMRI activations were documented by using a neuronavigation system in sequence, and compared to standardized intraoperative MEP monitoring, which included direct cortical electrical stimulation (DCES) or transcranial cortical electrical stimulation (TCES) or their combination. The compound muscle action potentials of forearm flexor and hand muscle responses were recorded during either TCES or DCES. Two techniques were compared to determine the accuracy for cortical mapping of primary motor areas with fMRI.

RESULTSOverall, the intraoperative MEP monitoring showed good correlation with fMRI activation in 92.3% of cases. The coincidence rate, however, was 100.0% between TCES and fMRI, and 66.7% between DCES and fMRI respectively. There was no statistically difference between two cortical mapping techniques, chi-square test of paired comparison of enumeration data, P < 0.01.

CONCLUSIONBOLD fMRI was a high sensitive and reliable technique to locate the position of the primary motor areas and their spatial relation with adjacent tumor, especially for the presurgical planning in patients with central area brain tumor.

Adolescent ; Adult ; Brain Neoplasms ; pathology ; physiopathology ; surgery ; Child ; Evoked Potentials, Motor ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; Motor Cortex ; pathology ; physiology ; Neuronavigation ; Oximetry ; Prospective Studies ; Transcranial Magnetic Stimulation ; methods

OBJECTIVETo study the correlation between the lung pixel indexes of multi-slice spiral CT (MSCT) and pulmonary function test (PFT), and to explore the CT features of histograms of lung attenuation.

METHODSMSCT scan and pulmonary function test (PFT) were separately performed in 127 subjects within one week. The total lung was scanned with MSCT at full inspiration, full expiration, and normal respiration. The lung pixel indexes were measured by Pulmo pulmonary quantitative software. These indexes include PI(-910Huin), PI(-960HUEX), PI(-910Huin), PI(-960Huex), PI(-910(Hun), PI(-960Hun), PI(910Huex/in), and the histograms of lung attenuation.

RESULTSCorrelation existed between all the lung pixel indexes of MSCT and PFT. PI(-910Huex/in showed the best correlation with FEV1/FVC (r = 0.901, P < 0.01). Three distribution patterns were found in the histograms of lung attenuation of total lung, including double-peak distribution (n = 28), similar normal distribution (n = 81), and partial distribution (n = 18).

CONCLUSIONThe lung pixel indexes of MSCT have significant correlation with PFT and can be used to assess the pulmonary function.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Respiratory Function Tests ; Tomography, Spiral Computed

Objective To observe the influence of dexmedetomidine applied in combined acupuncture-medication anesthesia on vomiting after thyroidectomy. Method Seventy patients who were going to receive thyroidectomy were randomized into group A and B, with 35 cases in each group. Combined acupuncture-medication anesthesia [electroacupuncture at Hegu (LI4), Neiguan (PC6) and Futu (ST32) plus intravenous infusions of sufentanil citrate injection (0.3 mg/kg) 20 minutes before operation]was adopted in both groups. Group A was additionally intervened by constantvelocity micropump infusion of dexmedetomidine hydrochloride injection (0.5 mg/kg) within 10 minutes before operation and remaining 0.4 mg/kg/min during operation, while group B was intervened by infusion of normal saline 10 minutes before operation. The observer's assessment of awareness/sedation (OAA/S) scores at different time points[lying in bed for 5 minutes before operation (T0), before the beginning of the operation (T1), 30 minutes after operation (T2), 60 minutes after operation (T3) and at the end of operation (T4)] in the two groups were observed. The additional times and total dose of sufentanil during operation, the number of cases using esmolol and urapidil, and the number of vomiting cases occurred within 2 hours after operation and 2～24 hours after operation in the two groups were recorded.Result The additional times and total dose of sufentanil during operation in group A were significantly different from those in group B (P<0.01). The utilization rate of esmolol and urapidil were respectively 31.4％ and 14.3％ in group A versus 77.1％ and 65.7％ in group B, and the between-group differences were statistically significant (P<0.01). The incidence of vomiting within 2 hours after operation and 2～24 hours after operation were respectively 20.0％ and 17.1％in group A versus 54.3％ and 42.9％ in group B, and the between-group differences were statistically significant (P<0.01). The OAA/S scores at different time points (T1, T2, T3 and T4) in group A were significantly different from those in group B (P<0.01). Conclusion Dexmedetomidine applied in combined acupuncture-medication anesthesia can reduce the additional times and total dose of sufentanil during thyroidectomy, and it can reduce the incidence of postoperative vomiting as well.

Objective To establish a "patient-centered" integrated information platform for emergency interconnection. Methods Based on the existing software, hardware and network systems of the hospital, design ideas of the modularization, process and standardized were used to reshape the process of emergency diagnosis and treatment in department of emergency-critical care medicine of Huashan North Hospital,Fudan University, and develop integrated information platform for emergency interconnection, including triage, emergency physician workstation, electronic medical records, clinical pathways of key diseases, medical integration, electronic handover classes, imaging, testing, ultrasound, drug counseling and medication safety, performance appraisal and management systems of scientific research, etc. Results The information platform for emergency interconnection was successfully developed. The functional logic of each system was clear and concise. It had strong compatibility, stable performance and powerful processing capability. It could quickly query the target content and support free and fast switching of each window. At present, daily diagnosis and treatment of emergency patients were realized by informationization, which completely liberated the manual labor of medical staff, shortened the processing time of unit patient, and significantly improved efficiency of the work. At the peak of the patients' visit, the overall operation of the emergency department was stable, and all the work was carried out in an orderly manner. There was no delay of the diagnosis and treatment for critically ill patients in the emergency department. Emergency access to patients with key diseases was smooth, and waiting time was significantly shortened. Clinical decision-making of medical staff had been effectively regulated. The success rates of the patients with acute trauma or acute respiratory failure were significantly improved, the time of the critical treatment were significantly shortened in patients with emergency respiratory cardiac arrest or acute ST-segment elevation myocardial, and compliance rate of the door-to-balloon time met the requirements of the Emergency Room to Balloon Expansion Time (DTB) Alliance. Conclusion The integrated information platform for emergency interconnection ran through the whole process of emergency diagnosis and treatment, based on emergency clinical practice, which could meet the needs of daily work in emergency department and help improve the quality of emergency medical and department management.

Objective To investigate the distribution and drug resistance of pathogen caused community-onset bloodstream infection (COBSI) in patients of affiliated hospital of university,and to provide evidence for the clinical therapy.Methods The clinical data of patients with COBSI in emergency department admitted to Huashan North Hospital Affiliated to Fudan University from January 2014 to December 2017 were collected,and the distribution and drug resistance of pathogen were retrospectively analyzed.The patients were divided into community-acquired bloodstream infection (CABSI) group and health care-associated bloodstream infection (HCABSI) group according to clinical diagnosis.The source of patients,past health status,blood culture isolation of pathogens,drug sensitivity test results were recorded,and the trend of drug resistance of main pathogens to common antibiotics from 2014 to 2017 were analyzed.Results A total of 258 pathogens were isolated from patients,including 186 Gram-negative pathogens (G-pathogens,72.09％) and 72 Gram-positive pathogens (G+ pathogens,27.91％),while the fungal strain was not isolated.The two most frequently isolated G-pathogens causing CABSI were Escherichia coli (80 isolates,65.57％) and Klebsiella pneumonia (24 isolates,19.67％),including extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli (37 isolates) and Klebsiella pneumonia (3 isolates),the average detection rates were 46.25％ and 12.50％ respectively.The two most frequently isolated G+ pathogens were Streptococcus (32 isolates,57.14％) and Staphylococcus (15 isolates,26.79％),but methicillin-resistant Staphylococcus aureus (MRSA) had not been isolated.The two most frequently isolated G-pathogens causing HCABSI were Escherichia coli (45 isolates,70.32％) and Klebsiella pneumonia (7 isolates,10.94％),including ESBLs-producing Escherichia coli (20 isolates) and Klebsiella pneumonia (1 isolate),the average detection rate was 44.44％ and 14.29％,respectively.The most frequently isolated G+ pathogens were Staphylococcus (10 isolates,62.50％),Streptococcus (3 isolates,18.75％) and Enterococcus faecium (3 isolates,18.75％),including MRSA (3 isolates).ESBLs-positive Escherichia coli and Klebsiella pneumoniae were almost completely resistant to cefazolin and highly resistant to ampicillin,ampicillin sodium and sulbactam sodium,ceftriaxone and furadantin,with the drug resistance rates of higher than 50％,and the drug resistance rate was significantly higher than that of corresponding ESBLs-producing negative pathogens.Escherichia coli were completely sensitive to piperacillin tazobactam,imipenem,and ertapenem,but Klebsiella pneumoniae had some resistance to piperacillin tazobactam and imipenem.Methicillinresistant coagulase-negative Staphylococci (MRCNS) were highly resistant to common antibiotics,while Streptococcus strains and MRSA had low resistance rates,and all pathogens were completely sensitive to linezolid and vancomycin.The average annual resistance rate of Escherichia coli to common antibiotics in CABSI group was increased,but the difference was significant only for ciprofloxacin (from 2014 to 2017,they were 37.5％,28.6％,52.6％,65.2％,respectively,Z =5.076,P =0.024).The average annual resistance rate of Klebsiella pneumonia to cefazolin and ciprofloxacin in CABSI group and that of Escherichia coli to ceftriaxone in HCABSI group showed an increasing trend without significant differences.Conclusions Escherichia coli and Klebsiella pneumoniae were the main pathogens of emergency COBSI,ESBLs-producing Escherichia coli were more common,and the average annual drug resistance rate to common clinical antibiotics was increasing.The drug resistance of ESBLs-producing Escherichia coli and Klebsiella pneumoniae was more serious than that of ESBLs-producing negative pathogens,so antibiotics should be used rationally.

Emergency Service, Hospital ; Intensive Care Units ; Outcome Assessment, Health Care

Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Humans ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; Tomography, X-Ray Computed