Objective To investigate the learning curve of minimally invasive direct coronary artery bypass ( MIDCAB) via left anterior small thoracotomy. Methods We retrospectively reviewed results of a consecutive series of 80 patients underwent MIDCAB via left anterior small thoracotomy performed by a single surgeon.The patients were divided into 4 groups ( group A, B, C, D, n=20 in each group) according to the sequence of the operation.The left internal mammary artery ( LIMA) harvesting time, anastomosis time, total operative time, the drainage volume of the first day postoperation, mechanical ventilation time, hospital stays postoperation, in-hospital morbidity and mortality were compared.The learning curve was assessed by means of regression analysis with logarithmic curve fitting. Results The basic clinical characters were similar in all groups before the operation.The operations were accomplished successfully in all the 80 cases.No intraoperative conversion to sternotomy, death, or perioperative myocardial infarction happened.The LIMA-harvesting time in the group B, C, and D was significantly shorter than that in the group A [(53.7 ±19.2) min, (50.2 ±17.7) min, and (43.2 ±10.3) min vs.(77.0 ±30.0) min, P =0.001, 0.000, and 0.000].There was no difference between group B and C, B and D, C and D in the LIMA-harvesting time (P>0.05).The total operative time in the group B, C, and D was significantly shorter than in the group A [ (128.7 ±21.7) min, (129.0 ±33.3) min, and (112.2 ±14.5) min vs. (165.2 ±41.8) min, all P=0.000], without difference between the group B and C, B and D, C and D (P>0.05).The learning curve models were obtained: LIMA-harvesting time ( min) =113.77 -16.869 × ln ( operation number); total operative time (min)=220.281 -25.276 ×ln (operation number). Conclusion MIDCAB via left anterior small thoracotomy is safe and effective, with a learning curve of approximately 20 cases.

Objective To compare the graft function of 2 methods of kidney harvesting,the modified method of combined liver and kidney procurement and rapid en bloc kidney procurement. Methods The clinical data of 220 cadaveric renal transplantation recipients were collected(12 months follow-up),174 cases from en bloc kidney procurement and 46 from combined liver and kidney procurement.The average harvesting time,the incidence of renal vein injury,1 year kidney survival and incidence of acute rejection were compared between the two methods.Results In average harvesting time and incidence of renal vein injury,the en bloc kidney procurement were better than the method of combined liver and kidney procurement.However,the method of combined liver and kidney procurement was better than the en bloc kidney procurement in 1 year kidney survival,1 year incidence of acute rejection and average warm ischemia time.There was no difference in 1 year survival of patients and 24 h,1 week and 1 year graft function after transplantation. Conclusion Although the method of combined liver and kidney procurement is better than the en bloc kidney procurement in 1 year kidney survival and 1 year incidence of acute rejection,there is no difference between the 2 methods in 1 year survival of patients and graft function after transplantation.

Air ; analysis ; Air Pollutants, Occupational ; analysis ; Formates ; analysis ; Gas Chromatography-Mass Spectrometry ; methods ; Humans ; Occupational Exposure ; analysis ; Workplace

ObjectiveTo evaluate the efficacy of preoperative oral pregabalin for attenuating postoperative pain after laparoscopic cholecystectomy.MethodsIn this prospective,randomized controlled double-blind study,sixty ASA Ⅰ or Ⅱ patients aged 19-72 yr weighing 46-86 kg undergoing laparoscopic cholecystectomy were randomly divided into 2 groups ( n =30 each):control group (group C) received placebo,and pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery.Anesthesia was induced with propofol,fentanyl and rocuronium and maintained with sevoflurane inhalation and intermittent iv boluses of fentanyl and rocuronium.The patients were intubated and mechanically ventilated.BIS value was maintained at 40-50 during operation.Static and dynamic VAS score,Ramsay score and consumption of morphine were recorded at 6,12,and 24 h after surgery.Side-effects including nausea,vomiting,headache and dizziness were also recorded.ResultsStatic and dynamic VAS scores and morphine consumption were significantly lower during the first 24 h after surgery while Ramsay scores were higher at 6 h after operation in group P than in group C.There was no significant difference in the incidence of side-effects between the 2 groups.No over-sedation occurred in group P.ConclusionPreoperative oral pregabalin 150 mg is safe and effective in reducing postoperative pain after laparoscopic cholecystectomy.

Objective To study the quick triage assessment system for emergency nurse, establish evaluation model and method, select indicators and contents, guide triage nurses to be accurate, fast, convenient and practical, and also to optimize the use of emergency medical resources. Methods Screening the target population to conduct the research, collecting main indicators and features covered with main symptom and characteristics of severe critical emergency patients, selecting manifestation form of triage assessment system. Results The selected indicators and contents were demonstrated by a table-based form, and the quick triage assessment form for emergency nurse was established to instruct triage work. Conclusions This established quick triage assessment form is simple, intuitive and can improve the quality of emergency triage work. It possesses feasibility, practicality and achieves the optimal medical services with the limited emergency medical resources, which shows both social and economic effect.

OBJECTIVE: To observe the changes of volt-ampere characteristics of Yuan-Primary acupoints in women before, during and after menstruation, and to find out the relationships between Qi-blood in human body and volt-ampere characteristics of acupoints, so as to develop a new method for quantitative analysis on changes of Qi-blood. METHODS: A high-sensitive detection system of volt-ampere characteristics of acupoint was applied to detecting the volt-ampere characteristics of Taiyuan (LU 9), Daling (PC 7) and Shenmen (HT 7) in healthy women before, during and after menstruation. RESULTS: The resistances on LU 9, PC 7 and HT 7 with some certain scan currents were quite different among the women before, during and after menstruation. For such changes, PC 7 was of the most obvious change, LU 9 was of the less and HT 7 was of the least. The total ratio of the scanning spots with significantly increasing changes of resistances on these three acupoints along with the menstrual process was 70.6%. CONCLUSION: The volt-ampere characteristics of acupoints vary with the menstrual process, which is of the acupoint specificity. The resistances on the acupoints increase with the menstrual process, and such results may be due to the blood loss during menstruation. The volt-ampere characteristics can be used as a quantitative index to study on the change of Qi and blood.

Objective To evaluate the effect of using serf-designed facial support in prone position for patients after vitrectomy and silicone oil tamponade. Methods 100 patients with vitrectomy and sili-cone oil tamponade were randomly divided into the experimental group and the control group with 50 pa-tients in each group. The self-designed facial support in prone position was used in the experimental group, while the routing nursing measure was used in the control group. The ocular adverse effect and re-lapse rate were compared between the two groups. Results The incidence rate of corneal edema, in-creased intraocular pressure and retinal redetachment in the experimental group was higher than those in the control group, the time of keeping position in the experimental group was longer than that in the con-trol group. Conclusions Self-designed facial support in prone position can decrease discomfort and pain caused by compulsive position, reduce the incidence of complications, improve retinal attachment and increase the successful rate for the patients with vitrectomy and silicone oil tamponade.

Objective To investigate the factors that induce constipation in bedridden patients undergoing replantation of severed finger and find countermeasures. Methods A retrospective investigation was carried out in 92 patients undergoing replantation of severed finger, their constipation and factors influencing constipation were recorded. Results 61 patients suffered from constipation in total 92 cases,the rate being 66.30%. 76 patients reduced food intake, and 59 cases presented constipation (the rate being 77.63%). Factors influencing constipation included being unaccustomed to defecate in bed (the rate that present with constipation being 87.09%),reluctant to trouble others(75.47%), side effects of drugs(55.56%) and lack of dietary knowledge (71.87%), decreasing food intake was closely bound up with constipation. Conclusions Proper psychological counseling, strengthening of health propaganda, comfortable facility for defecation, improved family support and oral food intake can significantly reduce the proportion of constipation and increase comfort degree of patients.

Background and purpose: High-dose chemotherapy followed by autologous stem cell transplantation (auto-HSCT) is considered as the ifrst line treatment for patients with relapse/refractory lymphoma after conventional chemotherapy. However, most of these patients still relapse the second time. The purpose of this study was to analyze the efifcacy of the consolidation chemotherapy after autologous stem cell transplantation (HSCT) refractory/relapse lymphoma in high risk. Methods:A total of 38 patients with relapsed/refractory lymphoma including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were included, who were underwent auto-HSCT in our transplan-tation department from Jan. 2010 to Dec. 2013. In treatment group, 19 patients received 2 courses of consolidation che-motherapy after auto-HSCT every 2 to 3 months, with the regimen of mini-BEAM or modiifed mini-CBV. Another 19 patients had no chemotherapy after auto-HSCT as control group. Results:The median follow-up duration was 17.2 and 7.5 months in the treatment and control group respectively. The follow-up data demonstrated prolonged progression-free survival (PFS) in the treatment group than the control group [24.7 months vs 7.8 months, P=0.029 under intend-to-treat analysis ITT;24.7 months vs 5.2 months, P=0.01 under per protocol analysis(pp)]. There is also a trend of improved overall survival (OS) in the treatment group (P=0.055, ITT). Conclusion:Consolidation chemotherapy after auto-HSCT for refractory/relapsed lymphoma patients delay the relapse and tend to improve the overall relapse rate.