OBJECTIVETo explore the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) combined with infusion of propofol in anodynia bronchoscopy.

METHODSNinety patients who received selective bronchoscopy were randomized into a group of compound TEAS with infusion of propofol (group A), a group of compound fentanyl with propofol (group B) and a group of simple propofol (group C). In group A, the plaster electrode stimulation was applied at bilateral Hegu (LI 4), Laogong (PC 8), Neiguan (PC 6) and Waiguan (TE 5). The anesthesia was induced after 20 min of stimulation till the end of examination. In group B and group C, the electric stimulation was not adopted. In group B, before anesthesia, fentanyl 1 microg/kg was injected intravenously. Afterwards, the intravenous infusion of propofol was used in the the three groups for anesthesia. The mean arterial pressure (MAP), heart rate (HR), saturation of pulse oximetry (SpO2) and respiratory rate (RR) were recorded at different time points. The induced dosage and total dosage of propofol, examination time, the awakening time and adverse reactions were observed in the patients of each group.

RESULTSThe difference in examination time was not significant among the three groups (P > 0.05). The postoperative awakening time in group A was earlier than that in group B and group C [(220.3 +/- 110.5) s vs (285.6 +/- 109.4) s, (290.1 +/- 105.1) s, both P < 0.05]. The total dosage of propofol in group C was larger than those in group A and group B [(288.5 +/- 26.7) mg vs (225.1 +/- 30.2) mg, (230.4 +/- 29.3) mg, both P < 0.05]. The induced dosage in group C was larger than those in group A and group B [(193.7 +/- 42.3) mg vs (152.3 +/- 36.1) mg, (155.4 +/- 40.5) mg, both P < 0.05]. Every life physical sign in group A during examination was more stable as compared with that in group B and group C. The incidence of hypotension and bradycardia in group A were lower than those in group C [3.3% (1/30) vs 26.7% (8/30), 0% (0/30) vs 20.0% (6/30), both P < 0.05]. The adverse incidence of oxygen supply in group A was lower than that in group B [6.7% (2/30) vs 33.3% (10/30), P < 0.05]. Intraoperative awareness and improper memory did not happen in postoperative investigation.

CONCLUSIONIn the transcutaneous electrical acupoint stimulation combined with infusion of propofol in anodynia bronchoscopy, the physical sign of patient is stable with less adverse reactions. This method reduces anesthetic dosage and shortens the postoperative awakening time, which can be effectively applied in bronchoscopy.

Acupuncture Analgesia ; Acupuncture Points ; Adult ; Analgesia ; Anesthetics, Intravenous ; administration & dosage ; Bronchoscopy ; Female ; Humans ; Male ; Middle Aged ; Pain Management ; Propofol ; administration & dosage ; Transcutaneous Electric Nerve Stimulation

Objective To explore the clinical effects of correction the midface depression.Methods From Aug.2010 to Aug.2015,185 cases of midface depression (aged from 18 to 61 years)were corrected by using structural fat grafting technique,the site and volume were placed as follows,tear trough 1ml,lid cheek groove 2 ml,midcheek groove 0.5 ml,anteriorcheek 4-8 ml,nasolabial fold 1-2 ml,nasal alar base 1-2 ml,evator labii superioris 1-2 ml,zygomaticus major 1-2 ml,buccinator 1-3 ml,and upper lip 3-5 ml.Results 185 cases were followed from 3 months to 3 years and the results were evaluated by visual analogue scales;156 cases of midface depression were corrected after the first structural fat grafting,the midface changed from concave to convex,and acquired prominent malar became more attractive;satisfaction of visual analogue scales were more than 80 ％;only 12 cases needed a second grafting.Conclusions The midface concavity can be corrected effectively by using structural fat grafting technique,the results are satisfied and the technique is safe,simple and effective.

Objective:To investigate the value of bedside transthoracic echocardiography(TTE) in volume reactivity assessment of children with septic shock.Methods:A total of 41 children aged from 1 to 5 years with septic shock requiring mechanical ventilation admitted to PICU from January 2017 to June 2020 were prospectively included.Under the condition of complete mechanical ventilation, full sedation and analgesia, and no spontaneous breathing(tidal volume 8 to 10 mL/kg), volume expansion was given to children.Hemodynamic indexs such as cardiac index(CI), stroke volume index(SVI) and stroke volume variability(SVV) were measured before and after volume expansion by noninvasive cardiac output monitoring(NICOM) and TTE.Moreover, aortic flow velocity time integral variable degrees(ΔVTI), inferior vena cava variability(ΔIVC) and inferior vena cava dilation index(dIVC) were also measured by TTE.Patients were considered to be responsive to volume expansion if SVI NICOMincreased≥15%.Based on the responsiveness of volume expansion, all the patients were divided into response group and non-response group.The value of SVV TTE, ΔVTI, ΔIVC, dIVC, ΔCVP and SVV NICOMin predicting volume responsiveness were analysed. Results:(1) There were 23 cases in response group and 18 cases in non-response group.Before volume expansion, there were no statistically significant differences in general hemodynamic indexes HR, MAP, CVP, EF, CI NICOM, and CI TTEbetween two groups( P>0.05). (2) In response group, HR, MAP, CI, SVI and CVP were all improved after volume expansion( P<0.001). In non-response group, only CVP was significantly increased after volume expansion, while other indexes were not improved( P>0.05). (3)Before the volume expansion, SVV TTE, ΔVTI, ΔIVC, and dIVC in response group were higher than those in non-response group( P<0.001). After volume expansion, these indicators were significantly reduced in response group.In non-response group, only ΔIVC significantly reduced after volume expansion.(4) The receiver-operating characteristic curve analysis showed that the area under the curve of SVV TTEand ΔVTI was 0.971, with 12.04% as the threshold, the sensitivity was 0.957 and the specificity was 0.944. The area under the curve of ΔIVC was 0.981, with 25.98% as the threshold, the sensitivity was 0.870 and the specificity was 1.000.The area under the curve of dIVC was 0.980, with 29.86% as the threshold, the sensitivity was 0.870 and the specificity was 1.000. The area under the curve of ΔCVP was 0.778, with 2.5 cmH 2O(1 cmH 2O=0.098 kPa) as the threshold, the sensitivity was 0.913 and the specificity was 0.556. The area under the curve of SVV NICOMwas 0.874, with 12.50% as the threshold, the sensitivity was 0.869 and the specificity was 0.778. Conclusion:The dynamic indexes SVV, ΔVTI, ΔIVC and dIVC monitored by TTE have good accuracy in evaluating children′s volume responsiveness, among which the accuracy of ΔIVC and dIVC is relatively the highest; the value of ΔCVP in predicting volume responsiveness is limited.

Human leukocyte antigen (HLA) is an important immunogenetic system. It plays a key role in immunoresponsiveness and hematopoietic stem cell and organ transplantation. The development of modern medicine and tissue typing promotes the combination of molecular biology techniques with HLA typing, and improves the accuracy and practicability of HLA typing. In this review, recent advances were concisely introduced in research of HLA typing on the application of restriction fragment length polymorphism (RFLP), sequence specific oligonucleotide probe (SSOP), single strand conformational polymorphism (SSCP), sequence specific primer (SSP), flow cytometry, gene chip, sequencing based typing, virtual DNA analysis and so on.
DNA ; analysis ; genetics ; Flow Cytometry ; methods ; HLA Antigens ; genetics ; Histocompatibility Testing ; methods ; Humans ; Polymerase Chain Reaction ; methods ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single-Stranded Conformational

Objective To develop a clinical laboratory vehicle with advantages in mobility,deployment,automation and informatization to meet the requirements of disaster relief.Methods Ford transit V348 ambulance was used as the base,which was equipped with routine blood analyzer,routine urine analyzer,biochemical analyzer and etc.The same instruments,agents and procedures were adopted as those in the clinical laboratory department of rear hospital,and LIS,air cleaning system and necessary auxiliary units were also involved in the modification.Results The clinical laboratory vehicle increased the working efficiency while decreased the errors.Conclusion The vehicle fulfills mobile medical support for military operations other than war such as disaster relief,and thus is worthy promoting practically.

Objective To explore the safty and feasibility of transrectal ultrasound guided transperineal seminal vesicle biopsy in the evaluation of clinical staging of prostate cancer.Methods Retrospectively study 57 suspected prostate cancer patients with seminal abnormality during 2010.7-2015.1,age ranged from 50 to 78 years,average 65 ±7 years,serum total prostate specific antigen (tPSA) 3.2-131.1 μg/L, average (23.7 ± 11.3) μg/L.Twenty-two cases had palpable prostate nodules through rectal examination.All the 57 patients underwent ultrasound and template guided transperineal prostate and seminal vesicle puncture biopsies.Results Forty-four cases out of 57 found prostate cancer cells in biopsies, and 32 cases had seminal vesicle invasion (positive group) while the other 12 were negative.Twenty cases had been performed prostatectomy in the positive group and their post-operative pathological examination all showed prostate cancer with seminal vesicle invasion.Eleven cases in the negative group had been performed prostatectomy ,and 2 cases showed seminal vesicle invasion.The clinical stages of all cases in the positive group were considered as T3b both pre-operatively and post-operatively.In the negative group however, 11 cases were considered as T2 stage pre-operatively,while 2 cases were increased to T3b stage post-operatively.The sensitivity of puncturing seminal vesicle was 91％ (20/22) ,specificity was 100.0％ (9/9).Positive predictive value was 100.0％ (20/20),while negative predictive value was 82％ (9/11).All the 57 cases did not present fever after puncture biopsies, while 23 cases presented hematuria (40％) ,20 cases presented hemospermia (35％) and 1 case presented urinary retention (2％).Conclusions Transrectal ultrasound-guided transperinealseminal vesicle puncture is safe and reliable, it helps to improve the accuracy of pre-operative staging.

Objective:To observe the effects of continuous light exposure on skeletal muscle fiber type transformation and lipid metabolism, and to explore its internal relationship.Methods:Mice were randomly divided into normal light group and 24-hour continuous light group by random number table. The serum and skeletal muscle lipid content and urine 6-sulfatoxymelatonin(6-SML)level were detected by ELISA. The expression of circadian clock and lipid metabolism related genes mRNA were observed by realtime PCR. The muscle fiber type and lipid deposition were evaluated by tissue immunofluorescence as well as oil red O staining.Results:Compared with the normal light group, the level of 6-SML in urine at night decreased( P<0.05), and the expression level and rhythm of brain and muscle ARNT-like protein 1(Bmal1), circadian locomotor output cycles protein kaput(Clock), and period 2(Per2)mRNA in the skeletal muscle changed in continuous light group. In addition, the body weight, blood lipid, free fatty acid, and triglyceride contents of skeletal muscle in continuous light group increased significantly( P<0.05 or P<0.01), the expression of carnitine palmitoyltransferase 1b (Cpt1b)mRNA, the key enzyme of fatty acid oxidation, decreased significantly( P<0.05), while the expression of stearoyl-CoA desaturase(Scd1)mRNA, a lipid synthesis related gene, increased significantly( P<0.01). Further immunofluorescence analysis showed that the proportion of slow muscle fibers decreased and that of fast muscle fibers increased in continuous light group(both P<0.05). Conclusion:The process of ectopic deposition of lipid in skeletal muscle in mice induced by continuous light exposure may be related to the remodeling of skeletal muscle fibers.

An in vitro model was built for researching the effects of strain on vascular smooth muscle cells (VSMCs). The cultured VSMCs was stretched by four-support-bending-beam system, then the project area of cells was measured by computer-image-processing, the adhesion force was measured by micropipette-aspirating system, the α-actin of VSMCs was distinguished by immunocytochemistry and the dynamic of VSMCs was determined by FCM. The results show that: (1) The adhesion force of VSMCs is positively related to time. The adhesion force of unit area is indistinct after stretched for four hour. (2) The amount of α-actin increases with stretching time. (3) The proliferation of VSMCs is a little inhibited by stretched 24 h. These results suggest that the VSMCs in vitro could adjust their behavious to adapt the tension.

OBJECTIVETo observe the therapeutic effect of Wenshen Huatan Recipe (WHR) on patients with early or middle stage chronic renal insufficiency (CRI) and investigate the clinical validity of applying sputum and blood stasis theory in treating CRI.

METHODSSixty CRI patients were selected and randomly assigned to the treated group (n = 32) and the control group (n = 28), all received conventional and symptomatic treatment, but those in the treated group were given WHR additionally. Two months were taken as one treatment course and the study lasted for 3 treatment courses. Total effective rate was assessed at the end of the 2nd and 6th month, changes of clinical symptom scores of TCM, and levels of blood urea nitrogen (BUN) and serum creatinine (SCr) in the two groups were observed as well.

RESULTSThe total effective rate of the 2nd and 6th month was 68.8% and 75.0% respectively in the treated group and 42.9% and 35.7% in the control group respectively, the difference between the two groups was significant (P < 0.05). Symptoms were improving along with the increasing medication time, and the improvement between the two groups was significant (P<0.01). Levels of SCr and BUN were significantly lowered in the treated group after 2-month and 6-month treatment (P < 0.05, P < 0.01).

CONCLUSIONWHR can significantly improve the clinical effect of treatment on CRI during early-middle stage, suggesting that CRI could be treated based on sputum and blood stasis theory with definite clinical efficacy.

Adult ; Aged ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Renal Insufficiency, Chronic ; diagnosis ; drug therapy ; Treatment Outcome

BACKGROUND: This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. METHODS: Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn't meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO2, PtcCO2) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student's t test was applied. Otherwise, Wilcoxon's rank-sum test was used. Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method. RESULTS: Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO2/FiO2) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO2 and PCO2 decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). CONCLUSION: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.