Objective To observe the analgesic effects of patient-controlled intravenous analgesia (PCIA) and continuous infusion of morphine into epidural space(CIEA) after suprapubic transvesical prostatectomy. Methods Seventy-five patients undergoing suprapubic transvesical prostatectomy were randomly assigned to PCIA group,CIEA group and control group. In PCIA group, 2 0mg/h morphine as a recommended dose would be injected intravenously by the patient through a self-controlled analgesic delivery system in which another 1 mg morphine could be injected whenever patient felt pain until the pain relieved. The lockout time was 20 minutes. In CIEA group, 0 08 mg/h morphine was injected into epidural space. 50～75mg of pethidine was injected whenever the control group patients felt pain. VAS(vision simulate score), frequency and duration of bladder spasm, discontinuance time of bladder irrigation and BP were observed. Results The CIEA and PCIA group were superior to the control group with characteristics of stable analgesic effect, shorter duration and lower frequency of bladder spasm and shorter time of bladder irrigation(P0 05); but the PCIA group had longer gastrointestinal function recovery time(P

Objective To approach the dynamic change in the membrane protein on platelet microparticles of patient with anti-platelet therapy, and look for a new test which are helpful to supervise the anti-platelet therapy. Method We collected blood samples from the patient with myocardial infarction ( n =9) treated with ticlopidine (250 mg?2 in the first and second day, 250 mg/day from the third to sixth day)in different time (before treatment, and 4 d, 5 d, 6 d, 9 d, 10 d after treatment), and examine the percent of PAC-1 + PMP or CD62p + PMP in the samples by activating platelet with 20 ?mol ADP. Result By activating platelet with 20 ?mol ADP, the percent of CD62p + PMP at different time (before treatment, and 4 d, 5 d, 6 d, 9 d, 10 d after treatment) were 84.3%?3.6%, 81.4%?3.4%, 70.3%?2.7%, 70.6%?3.2%, 83.5%?2.8%, 85.4%?2.1%,as of PAC-1 + PMP were 85.3%?3.5%, 82.5%?2.2%, 72.3%?3.5%, 72.4%?3.3%, 85.4?3.4%, 86.0%?3.8%. The percent of CD62p + PMP and PAC-1 + PMP in 5 d obviously increase ( P

AIM: To determine the effect of exogenous phosphocreatine (PCr) at different concentrations on transient outward potassium (Ito) current in rat ischemic ventricular mid-myocardial (M) cells and to explore the antiarrhythmia mechanism in the treatment of ischemic heart disease. METHODS: M cells were isolated enzymatically from left ventricular mid-myocardium of rats. Peak Ito current was recorded by patch-clamp technique in the whole-cell configuration when M cells were superfused with normal Tyrode solution,simple ischemic solution,and simulated ischemic solution containing PCr at concentrations of 5,10,20 and 30 mmol/L for 10 min. RESULTS: Peak Ito current density of M cells superfused with simple simulated ischemic solution was significantly reduced by (76.1±6.3)% (P<0.05) compared with M cells superfused with Tyrode solution. Ischemic solution containing 5,10,20 and 30 mmol/L PCr reduced peak Ito current density by (57.1±9.6)% (P<0.05),(40.3±10.3)% (P<0.05),(34.3±9.6)% (P<0.05) and (32.1±10.6)% (P<0.05),respectively. There was statistical difference among ischemic solution without PCr and containing PCr at concentrations of 5 and 10 mmol/L groups (P<0.05). No statistical difference among groups of 10,20 and 30 mmol/L PCr was observed (P>0.05). CONCLUSION: PCr reverses the inhibition of Ito current under ischemic condition in M cells,which may be the mechanism responsible for arrhythmia prevention in ischemic heart disease. PCr at concentrations of 0～10 mmol/L exerts significant dose-effect relationship.

AIM: To make a comparison between 64-multidetector computed tomography (64-MDCT) and coronary angiography (CAG) for assessing the clinical significance of coronary lesions and the coincidence rate of these two methods. METHODS: From May 2005 to July 2006, totally 85 patients, who were suspected or diagnosed as coronary atherosclerotic heart disease, were performed with both 64-MDCT and CAG in the General Hospital of Chinese PLA. They included 64 males and 21 females, aged 41-83 years, with a mean of 61 years. Informed consents were obtained from all the patients. Coronary artery stenosis was detected with the stenosis rate of diameter method and area method, which was calculated by 64-MDCT and analysis software for vessels. Coronary luminal diameter was evaluated as normal, mild stenosis (25%-49%), mild-moderate stenosis (50%-74%), moderate-severe stenosis (75%-94%), severe stenosis (95%-99%), and occlusion (100%). RESULTS: The 64-MDCT images were evaluated for the existence of occlusions or significant stenosis (≥50% lumen reduction) in native coronary arteries. Its coincidence rate with CAG was 89% in left coronary artery main stem, 93% in left anterior descending coronary artery, 68% in left circumflex coronary artery, and 48% in right coronary artery. CONCLUSION: The 64-MDCT has a high diagnostic accuracy in detecting coronary artery stenosis, and is identical with CAG in the assessment of left coronary artery main stem and left anterior descending coronary artery. Thus it is potential for the clinical application on the evaluation of coronary artery stenosis, qualitative and quantitative detection of coronary atherosclerotic plaque.

BACKGROUND: The occurrence and severity of acute high-altitude disease(AHAD) are determined by the speed entering the highland, the altitude of highland and seasons. The association between obesity and AHAD has not been fully investigated.OBJECTIVE: To investigate the association between obesity and acute high-altitude in people exposed rapidly to the highland.DESIGN: Comparative observation.SETTING: Department of Cardiology, General Hospital of Chinese PLA and Department of Cardiology, Tibetan General Hospital of Chinese PLA.PARTICIPANTS: The experiment was conducted at the Department of Cardiology, General Hospital of Tibetan Military Area Command of Chinese PLA in August 2006. Totally 82 Henan subjects aged 28-45 years were selected from the male workers constructing the Qinghai-Tibet Railway and their managers with acute high-altitude exposure. They had never been to the highland before, and all agreed to the detection.METHODS: ①Every subject completed the AHAD self-report questionnaire at sea level and 12 hours and 24 hours after ascending high-altitude. The items in the questionnaire included symptoms of headache, gastrointestinal symptoms,fatigue or weakness, dizziness, and insomnia. Each symptom was graded from 0-3 with 0 as no symptoms, 1 as mild symptoms, 2 as moderate symptoms, and 3 as severe symptoms and a total score of 15. A score of 4 or more could by identified as AHAD. ②The height and body mass were measured to calculate the body mass (BMI). Those with BMI≥28 kg/m2 served as the obesity group [n =39, mean age (35±8) years], and those with BMI of 18.5-23.9 kg/m2 as the normal body mass group [n =43, mean age (35±8) years]. ③Arterial blood was taken to evaluate arterial oxygen saturation (SO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide pressure (PaCO2) at baseline and 24 hours after ascending high-altitude. ④The measurement data was compared by t test.MAIN OUTCOME MEASURES: BMI, vital capacity of lungs, SO2, PaO2 and PaCO2 levels of obese and normal people.RESULTS: Totally 39 obese people and 43 normal people were involved in the result analysis. ①AHAD score: No symptom was reported at sea level in all participants (scored 0), but the AHAD scores in the obesity group were significantly higher than those in normal group 12-hour and 24-hour after ascending high-altitude. ②Blood gas analysis:At sea level, there were no statistical differences in the levels of SO2, PaO2, and PaCO2 between two groups (P ＞ 0.05).But 24 hours after ascending high-altitude, SO2 and PaO2 of the obesity group were much lower than in the normal group (P＜ 0.01), and PaCO2 was significantly higher than in the normal group (P＜ 0.01).CONCLUSION: Obese men are more vulnerable to high-altitude hypoxia than people with normal body mass. Obesity is an important risk factor for the development of acute high-altitude disease.

OBJECTIVETo investigate the impact of cardiac resynchronization therapy (CRT) on left ventricular systolic function evaluated by velocity vector imaging (VVI) in refractory heart failure patients and the predictive value of VVI on CRT responses.

METHODSThis study included 38 patients with medically refractory heart failure (HF) patients underwent CRT in our department from May 2007 to April 2011. Left ventricular long axis dyssynchrony indexes including time to peak of systolic velocity (Ts max-min), standard deviation of the time to peak of systolic velocity (Ts-SD) before and at 3-6 months post CRT. CRT response was defined as 15% decrease in left ventricular end-systolic volume. ROC curve and the area under the curve (AUC) were calculated.

RESULTSTwenty-four patients were defined as responder. No significant difference was observed between responders and non-responders in medical therapy. When using Ts max-min to predict response, the AUC of ROC curves was 0.76 ± 0.07. The sensitivity and specifity was 70.8% and 77.8% respectively with Ts max-min ≥ 124.0 ms. When using Ts-SD to predict response, the AUC of ROC curves was 0.82 ± 0.07. The sensitivity and specifity was 79.2% and 71.2% respectively with Ts-SD ≥ 40.5.

CONCLUSIONTs-SD is a useful index to predict CRT response in refractory HF patients.

Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019 to December 2021 were enrolled in this study.They were divided into elderly group(≥60 years old,99 cases)and non-elderly group(＜60 years old,95 cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA2DS2-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P＜0.05,P＜0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3％vs 8.4％,P=0.001).Postoperative complications in the elderly group in-cluded 1 case of pericardial effusion and 2 cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7％vs 69.5％,P=0.763)or recurrence rate during blanking period(21.2％vs 21.1％,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95％CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95％CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1 year after ablation.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
Humans ; Carcinoma, Adenoid Cystic/pathology* ; Neoplasm Recurrence, Local ; Neck/pathology* ; Oropharynx/pathology* ; Diagnostic Errors