Objective To investigate the effectivity of bispectral index(BIS)and auditory -evoked potentials index(AEP index)in monitoring the depth of desflurane anesthesia in the elderly. Methods Sixty patients(ASA gradeⅠ～Ⅱ)without obvious auditory and psychiatric dysfunction undergoing general anesthesia were enrolled in this study,and they were devided into the elderly group (n=30)and the non-elderly group(n=30)according to the age.After the endotracheal intubation,the lungs were ventilated with desflurane in oxygen.End-tidal concentrations of desflurane were maintained at 0.6,1.0 minimum alveolar concentrations(MAC)and 1.3 MAC for 20 minutes, respectively.The changes of BIS,AEP index,mean arterial blood pressure(MAP)and heart rate (HR)were recorded simultaneously.Results In the elderly and non-elderly groups,BIS were 94.14?6.5 and 94.5?4.6(P＞0.05),and AEP index at pre-anesthesia were 87.2?11.7 and 89.2?6.9(P＞0.05)respectively,which showed no statistic difference between two groups.BIS and AEP index decreased significantly in each time point at pre-anesthesia compared with those during anesthesia in two groups (P＜0.05).In the periods of increasing concentration of desflurane,BIS decreased gradually in two groups(P＞0.05),but BIS in the elderly group were higher than in the non-elderly group at the same end-tidal desflurane concentration(P＞0.05),and BIS negatively correlated with the end-tidal desflurane concentration in two groups.In the elderly group,AEP index decreased significantly at the concentration of 1.0 MAC and 1.3 MAC of desflurane compared with that of 0.6 MAC(P＜0.05),but there was no difference in AEP index with increasing end-tidal desflurane concentration from 1.0 MAC to 1.3 MAC(P＞0.05).At every concentration of desflurane,AEPindexintheelderlygroupwaslessthaninthenon-elderlygroup(P＜0.05).Conclusions BIS and AEP indexes correlate well with the end-tidal desflurane concentration,and are valuable for monitoring the depth of desflurane anesthesia in the elderly.AEP index can predict the difference in depth of anesthesia at the same end-tidal desflurane concentration between the elderly and the non-elderly.

Adult ; Anesthetics, Inhalation ; administration & dosage ; Desflurane ; Electroencephalography ; methods ; Female ; Humans ; Isoflurane ; administration & dosage ; analogs & derivatives ; Male ; Middle Aged ; Monitoring, Intraoperative ; Nitrous Oxide ; administration & dosage

Objective To investigate the role of clinical pharmacist in anti-infection therapy for patients with augmented renal clearance (ARC).Methods A case with multi-site severe infection after traffic accident was treated with anti-infection therapy.According to the characteristics of infection and pharmacokinetics,clinical pharmacist discussed the intervention by clinical pharmacist in terms of formulating anti-infection program and adjustment of individual dose.Results After consultation and evaluation by clinical pharmacist,the patient was diagnosed as ARC.According to pharmacokinetics characteristics reported by literature,vancomycin was adjusted to 1 g (once per 8 h).Based on detection result of pathogenic bacteria,meropenem was replaced by cefoperazone/sulbactam,and the dose was increased to 3 g (once per 6 h).And then,vancomycin concentration was detected again,and it reached ＞ 10 μg· mL-1;pathogenic bacteria culture result was negative.This patient obtained good therapeutic effect.Conclusion Clinical pharmacist could assist physician on anti-infection treatment and dose adjustment of ARC patient,and improve ARC patient's therapeutic effect.

Objective To explore the relating factors for cognitive dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods Totally 150 patients with acute exacerbation of COPD (AECOPD) and 150 gender and age-matched healthy subjects (controls) received the cognitive and depression function assessment.150 AECOPD cases were classified into two groups:COPD patients with or without cognitive dysfunction.Fasting blood uric acid (UA) was measured and compared between the two groups.Relating factors for cognition dysfunction were analyzed.Results The score of Montreal Cognitive Assessment (MoCA) was reduced in AECOPD patients as compared with controls [(19.01±3.58) vs.(26.58±1.42)scores,t=-3.48,P=0.032].The score of Hamilton depression (HAMD) scale was higher in AECOPD patients than in controls [(18.05 ± 4.50) vs.(9.98 ± 3.51) scores,t =4.63,P =0.028].The prevalence of cognitive impairment in the patients with AECOPD was 82 cases (54.7％).The serum UA level was lower in the AECOPD patients with cognitive impairment than in patients without cognitive impairment [(235±42) μmol/L (n=82) vs.(332±45) μmol/L (n=68),t=-6.65,P=0.003].In AECOPD patients,the cognitive function was correlated with education,length of hospital stay,serum UA level,COPD stages,disease duration and the depression level,but was not correlated with smoking and body mass index.Conclusions The cognitive impairment is highly prevalent in patients with AECOPD,which is associated with lower serum UA level,longer hospital stay and disease severity.

Objective To analyze the clinical characteristics of severe retinopathy of prematurity (ROP) in extremely low birth weight infants (ELBWI),and to evaluate the management model of ROP screening of ELBWI and the clinical effects and treatment timing of photocoagulation with intravitreous injection of vascular endothelial growth factor inhibitor (Avastin).Methods Forty-five cases of ELBWI (birth weight ＜ 1000 g) survived finally in our neonatal intensive care unit from July 1,2004 to June 30,2011 were reviewed.ROP screening was regularly performed in 4 ～ 6 weeks postpartum with binocular indirect funduscope by ophthalmologists.Newborns with severe ROP were treated with laser photocoagulation in the fundus.Some newborns that developed aggressive posterior ROP(APROP) were treated with combined intravitreous injection of Avastin and photocoagulation.Results Thirteen of 45 cases (28.89％) had not developed to ROP finally.Six cases (13.33％) developed to stage 1 ～ 2 ROP and then spontaneous recovery during the follow-up period.Twenty-six newborns (57.78％) developed to severe aggressive posterior ROP (APROP) and need to be treated with photocoagulation.All 3 APROP infants (6.67％) were received intravitreous Avastin injection prior to photocoagulation.The visual acuity of all 45 patients (100％) in this study was preserved.Conclusion ELBWI have a higher morbidity of severe ROP.Timely screening and intervention are effective to prevent disease progression.Intravitreous Avastin injection prior to photocoagulation may be necessary to preserve the visual acuity of infants with APROP.Respiratory management is the key for post-operation care.

OBJECTIVEThe aim of the present study is to explore the effects of exhaustive exercise-induced oxidative stress on the antioxidant capacity and diformability of rat red blood cells.

METHODSRats were divided into three group (n = 10): sedentary control (C), exhaustive running exercise (ERE) and moderate running exercise (MRE) groups. Animals in the ERE group started treadmill running at a speed of 20 m/min speed with a 5% gradient, and reached a speed of 25 m/min with gradient 15% in 20 min. Running was continued until exhaustion. MRE group rats running at a speed of 20 m/min with a 5% gradient for 40 min. The levels of free thiol in erythrocyte membrane protein, lipidperoxidation levels and membrane protein components were analyzed. The red blood cell deformability of different groups was also observed.

RESULTSThe results showed that red blood cells were damaged by severe oxidative stress and the anti-oxidative capacity decreased significantly under exhaustive exercise conditions. Besides, lipid peroxidation and protein sulfhydryl cross-link based clustering of membrane were found after exhaustive exercise, and polymers high molecular weight (HMW) was formed. The elongation index (EI) was found to decline significantly in the ERE group compared with the C and MRE groups under shear stress (control group, 0.41 +/- 0.01 at 3 Pa and 0.571 +/- 0.008 at 30 Pa; ERE group, 0.314 +/- 0.013 at 3 Pa and 0.534 +/- 0.009 at 30 Pa; P < 0.05 and P < 0.01, respectively).

CONCLUSIONThese exercise-induced oxidative injure result in a significant decrease in deformability of rat erythrocytes, which in turn leads to dysfunction in the microcirculatory.

Animals ; Disease Models, Animal ; Erythrocyte Deformability ; Fatigue ; metabolism ; physiopathology ; Male ; Oxidative Stress ; Physical Conditioning, Animal ; Rats ; Rats, Sprague-Dawley

Objective The 4-and 16-hydroxylated metabolites of estrogens have been implicated in carcinogenesis,whereas its 2-hydroxylated metabolites have been shown to have antiangiogenic effects.We aimed to examine whether the polymorphisms of catechol-O-methyltransferase(COMT)involved in the estrogen metabolism are associated with endometrial cancer risk.Methods Polymerase chain reaction- restrictive fragment length polymorphism(PCR-RFLP)analysis was used to study the variant allele frequency distributions of COMT Val158Met genetic polymorphism in a population based case-control study with 132 endometrial cancer cases and 110 controls.Odds ratios(OR)and 95% confidence intervals(CI) were estimated by unconditional logistic regression after adjustment for known or suspected risk factors for endometrial cancer.Results The most frequent genotype was COMT~(Val/Val)(47.2%,52/110)in control group and COMT~(Mal/Met)(58.3%,77/132)in endometrial cancer group.The difference between the two groups was of statistical significance(P

Objective:To discuss the treatment options for patients with azoospermia factor (AZF)c microdeletion on Y chromosome.Methods:One hundred and eighty three patients,who were diagnosed as AZFc microdeletion on Y chromosome in Peking University Third Hospital,were recruited in our stu-dy.In order to get better treatment option for this kind of patients,we retrospectively analyzed their clinic data including the treatment process and pregnancy outcome and found out the characteristics of their se-men.Results:Among the 183 patients,sperms can be found in ejaculated semen in 105 patients (57.4%,105 /183).One hundred and three patients (98.1%,103 /105)were diagnosed as severe or extremely severe oligospermia.Regular medication was given to 98 patients,6 patients (6.1%,6 /98) of which got natural pregnancy.The other 99 patients who have sperms in their semen received intracyto-plasmic sperm injection (ICSI),68 patients (68.7%,68 /99)of which got pregnancy.Seventy eight patients were diagnosed as azoospermia among all the 183 patients.Forty nine patients received testicular sperm aspiration (TESA),and 21 patients choose to receive micro-TESE directly.Among the 49 patients with TESA,sperms were retrieved in 17 patients (34.7%,17 /49),and sperms were not retrieved in 32 patients (65.3%,32 /49),of which 12 patients (37.5%,12 /32)gave up treatment and 20 patients (62.5%,20 /32)choose micro-TESE.Among the 41 patients who choose to receive micro-TESE,ope-ration has been done on 19 patients,of which 11 patients (57.9%,11 /19)got sperms.Among the 11 patients,TESA has been done on 6 patients before micro-TESE,of which 4 patients (66.6%,4 /6)got sperms.ICSI has already been done on 7 azoospermia AZFc microdeletion patients who underwent micro-TESE,of which 4 patients (57.1%,4 /7)get pregnancy.Conclusion:AZFc microdeletion patients who had sperms were always diagnosed as severe or extremely severe oligospermia.ICSI was their first choice instead of drug therapy.For AZFc microdeletion patients who were diagnosed as azoospermia, TESA was one of their choices,however,the success rate is not high.Micro-TESE is still possible to get sperms even after the failure of TESA.Therefore,we may choose micro-TESE instead of TESA in some azoospermia patients in order to reduce surgical trauma on patients.

BACKGROUNDErectile dysfunction (ED) is a common impairment among older men, and the prevalence rates increase sharply after age of 60 years. Most studies have focused on the prevalence rate or dangerous factors. The aim of this study was to investigate the basic epidemiologic data about ED patients with different ED courses. The purpose of this research was to understand the therapeutic effect of phosphodiesterase type 5 inhibitor (PDE5-I) and see how and why the ED course impact the progress of ED and the therapeutic effect of PDE5-I treatment.

METHODSFrom June 2008 to June 2009, 4252 questionnaires (Quality of Erection Questionnaire, QEQ) were gathered from 46 centers by urology or andrology doctors all around China. Patients with ED (age ≥ 20 years) filled in first half of the questionnaires when they came for the first time, and then completed the second half 4 weeks after PDE5-I therapy.

RESULTSED courses of most patients were less than 5 years (< 5 years, 74.0%; 5 - 10 years 20.8%; > 10 years, 5.2%). As ED course increasing, the incidence of the risk factors of ED, such as smoking, drinking, hypertension, diabetes, heart disease and hyperlipidemia also increase (P ≤ 0.01). PDE5-I was effective in improving the quality of sexual activities (P ≤ 0.01). Administration of PDE5-I improves satisfaction, enjoyment and frequency of sexual activities. The longer the ED course, the worse the therapeutic effect (< 5 years, 96.1%; 5 - 10 years, 94.9%; > 10 years, 89.0%) (P ≤ 0.01).

CONCLUSIONSThe ED course greatly affected the therapeutic effect of PDE5-1, the patients with ED should consult doctor at early stage of the disease. Administration of PDE5-I effectively improves the penile erection and the quality of sexual life of the patients hence should be considered as first-line medicine in the treatment of ED.

Adult ; Erectile Dysfunction ; drug therapy ; epidemiology ; physiopathology ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Surveys and Questionnaires

AIMTo evaluate the relaxant effect of verapamil on human corpus cavernosum in vitro and to assess the drug's potential as a treatment for erectile dysfunction (ED).

METHODSPreparations of the human corpus cavernosum were obtained from recently deceased young men who had had normal erectile function. The isometric tension and detailed curves were recorded when contractions induced by 10 micromol/L phenylephrine were reduced by different doses of verapamil or the vehicle control (sterile water). The tension of human corpus cavernosum preparations are described as a percentage of their top tension before adding verapamil or the vehicle. ANOVA and least significant difference tests were used for statistical analysis.

RESULTSDoses of 1 micromol/L, 10 micromol/L and 100 micromol/L verapamil resulted in relaxation of (35.28+/-7.96)%, (55.91+/-6.41)%, (85.68+/-4.16)% after 30 min, respectively. The vehicle control at the same time point produced relaxation of (-0.06+/-10.57)% (P<0.05).

CONCLUSIONVerapamil is significantly effective in relaxing normal human corpus cavernous smooth muscle induced by phenylephrine in vitro and the relaxant effect depends on the concentration of verapamil.

Adult ; Humans ; In Vitro Techniques ; Male ; Muscle Relaxation ; drug effects ; Muscle, Smooth, Vascular ; drug effects ; physiology ; Penis ; drug effects ; physiology ; Verapamil ; pharmacology