The paper is to report the study of pharmacokinetics of transdermal administered nicotine in the brain of freely moving rat by using microdialysis with stable labeled isotope as internal standard. The pharmacokinetic behavior of nicotine in Sprague Dawley rat brain was investigated after intranasal administration (3.75 mg). Brain fluid samples were collected by intracerebral microdialysis with DL-nicotine as internal standard. Concentrations of nicotine and DL-nicotine in the sample were measured by HPLC-MS/MS. Main pharmacokinetic parameters were calculated and analyzed by Das 2.0 pharmacokinetic software. The recovery of nicotine and the delivery of DL-nicotine were the same. The fate of absorption and distribution was two compartment model and the values of t1/2alpha was 170.31 min, t1/2beta was 263.30 min and the AUC(0-infinity) was 2.75 x 10(5) microg x L(-1) min separately. DL-nicotine can be used to calibrate the recovery of nicotine, and the new method of stable isotope microdialysis can be used to study the pharmacokinetics of freely moving rat. It will make sense for the treatment of addiction of tobacco and provide a new thought for the research of pharmacokinetics-pharmacodynamic combination.

This article analyzes the current characteristic of cardiology teaching.In light of advantages of network education,it discusses the prospect of network-based education and some problems.

Objective To explore the method and points for attention in laparoscopic cholecystectomy(LC) of porcelain gallbladder.Methods Twenty-eight cases of porcelain gallbladder, especially 17 LC cases, from January 1980 to January 2005 were analyzed retrospectively.Results Of 28 cases(0.44%) of porcelain gallbladder in 6328 cholecystectomy patients,calcification of gallbladder occurred in 92.86% patients diagnosed by B ultrasonography 17 LC patients were cured. Two cases with gallbladder carcinoma no implantion or metastases happened.Conclusion B ultrasonography before operation and improving of the operative mode and skill in LC are the keys to get the successful results.

Objective To develop training program of evidence implementation(EI) based on PARIHS model and to evaluate the effectiveness on clinical nurses for evidence-based nursing knowledge,attitudes and ability,and to understand the evaluation of participants about the methodological training.Methods A quasi-experiment design was conducted.A 6-month comprehensive evidence implementation training program was developed including methodological lecture,group discussion,EI case analysis,EI project development and implementation,and was carried out among 44 clinical nurses from 11 tertiary hospitals in Shanghai.The participants' EBN knowledge,attitudes and ability were measured by EBN knowledge,attitudes and ability questionnaire at 3 months and 6 months after training.Results Participants' EBN knowledge and ability were significantly improved at 3 months and 6 months after training(P＜0.05),and participants' EBN attitude had no significant difference before and after training (P＞0.05).The level of training satisfaction among participants was higher than 80.0％,and participants had finished 22 evidence implementation programs.Conclusion Evidence implementation training based on PARIHS can enhance clinical nurses' EBN knowledge and ability.Participants' EBN attitude hasn't been significantly improved.Participants have high satisfaction towards methodological training.

Objective To investigate the training needs of evidence implementation of clinical nurses and its influencing factors.Methods A total of 645 clinical nurses were investigated on training needs of evidence implementation by field and web survey with self-designed questionnaire about training needs of evidence implementation.Results The demand rates on training needs (17 entries) of evidence implementation in nurses were higher than 90.0%. The training methods and assessment methods of evidence implementation were diversified. There were statistically significant differences in some of the demand rates among different educational background, duties, research experiences (with or without), and attending time of evidence-based nursing training (t=26.990, 10.020, 8.719, 14.600;P<0.05).Conclusions The evidence implementation training should be carried out according to different educational background, duties, research experiences and the length of evidence-based nursing training of nurses. Besides, the training methods and assessment methods should be diversified.

Objective To evaluate the initial experience of intracoronary stenting in patients with acute myocardial infarction (AMI) in our hospital.Methods Ballon-expansion stents were deployed in 18 patients (male: 15, female 3, aged between 38-72 years old) with AMI after emergency PTCA. The major indications for intracoronary stenting in our present study include: 1) acute reocclusion or high risk of reocclusion due to intimal dissection; 2) severe residual stenosis (≥50% diameter stenosis) after repeat balloon dilation; and 3) obvious elastic recoil failed to response to repeat intracoronary nitroglycerin infusion. The dilating pressure for stent implantation was 12-18 atm with a dilating time of 10-30 sec. Patients were heparized during catheter maneuvers and were medicated with Ticlopidine (250 mg, twice daily) for 3 months and aspirin (250 mg, once daily) after stenting.Results 1) Coronary angiography (CAG) showed that all patients (n=18) had a single-vessel total occlusion (left anterior decending 9, right coronary artery 8, and left circuflex 1) before emergency PTCA and was successfully restored to TIMI 3 grade blood flow after intracoronary stenting (13 with Nir stent, 1 with Jonson and Jonson stent, and 4 with Cordis stent). 2) Minor residual intracoronary thrombosis was presented in 5 of 18 patients after PTCA, and it was totally disppeared after stenting; 3) One patient with inferior infarction developed Ⅲ degree atrioventricular blockade (AVB) and temporary pacemaker was introduced. This patient died of cardiac tamponade 6 h after stenting due to right ventricular perforation by electrode. No cardiac death, recurrent angina and reinfarction occurred during the 4-16 months follow-up peroid in the other 17 patients; 4) No angiographically restenois was found in all the 3 patients who had a secondary conronary angiography 4 weeks after stenting. 5) Left ventricular ejection fraction (LVEF) determined with Doppler echocardiography 4 weeks after stenting tended to be improved but failed to reach significant difference as compared to the basal LVEF (43.27%±8.43% vs 40.58%±7.23%, P>0.05, n=17) measured within 24 h after the onset of chest pain.Conclusions These results suggest that intracoronary stenting is a highly effective strategy in prevention or treatment of acute reocclusion after emergency PTCA in AMI. Minor residual intracoronary thrombosis after balloon dilation was not a contraindication for stent implantation.

OBJECTIVETransesophageal echocardiography was performed during closed-chest cardiopulmonary resuscitation (CPR) in in-hospital cardiac arrest to further explore the hemodynamic mechanism of CPR.

METHODSCPR attempts were performed according to advanced cardiovascular life support guidelines in 6 cases of in-hospital cardiac arrest. Multi-plane transesophageal echocardiography was carried out within 15 min of initiation of CPR. Throughout CPR, the motion of the mitral, tricuspid and aortic valves, the changes in the left ventricular cavity size and the thoracic aortic diameter were observed. Trans-mitral and trans-aortic Doppler files of blood flow were also documented.

RESULTSA closure of the mitral and tricuspid valves with simultaneous opening of the aortic valve occurred exclusively during chest compression, resulting in forward blood flow in the pulmonary and systemic circulation. Peak forward aortic flow at a velocity of 58.8 +/- 11.6 cm/s was recorded during the compression phase. Whereas, a closure of the aortic valve and rapid opening of the atrioventricular valves associated with ventricular filling during relaxation of chest compression was noted in all 6 patients. Peak forward mitral flow at a velocity of 60.6 +/- 20.0 cm/s was recorded during the release phase. Mitral regurgitation during the chest compression period was detected in 5 patients, reflecting a positive ventricular-to-atrial pressure gradient. A reduction in the left ventricular chamber and an increase in the thoracic aortic diameter during the compression phase was found in all patients, indicating that direct cardiac compression contributed to forward blood flow.

CONCLUSIONThese observations favor the cardiac pump theory as the predominant hemodynamic mechanism of forward blood flow during CPR in human beings.

Aged ; Aged, 80 and over ; Cardiopulmonary Resuscitation ; Echocardiography, Transesophageal ; Female ; Heart Arrest ; diagnostic imaging ; physiopathology ; therapy ; Hemodynamics ; Humans ; Male ; Middle Aged

In the early 1990's, emergency percutaneous transluminal coronary angioplasty (PTCA) has been proven to be the best strategy for acute myocardial infarction (AMI). It has not only resulted in a higher vascular recanalization, but has also further reduced mortality and morbidity, and has greatly improved life quality of patients with AMI.Objective To investigate the effect of emergency PTCA in AMI.Methods Emergency PTCA was performed in 52 AMI patients (male: 43, female: 9) from October 1993 to December 1997 in our hospital. The patients were aged between 31-89 years (±s, 53.7±8.2). Among them, 25 had anterior infarction, 27 inferior infarction. Angiographically infarct-related vessels were left anterior descending artery (LAD) in 27 cases, right coronary artery (RCA) in 22, and left circumflex artery (LCx) in 3. The mean time from the onset of chest pain was 6.12±5.13 h (2-12 h). Primary PTCA (balloon angioplasty without previous thrombolytic therapy) was performed in 34 cases, and rescue PTCA (balloon angioplasty after previous thrombolytic therapy that had failed to restore blood flow) in 15 cases, and immediate PTCA ( balloon angioplasty after previous successful thrombolysis but with severe residual stenosis and reoccurring angina pectoris) in 3 cases. Only the infarct-related vessels was dilated during emergency PTCA which is similarto conventional balloon angioplasty. All patients were given aspirin of 250 mg/d and were heparinized during the first 3-5 days after PTCA. Ticlopidine (250 mg, twice daily) was also given for 3 months if patients had experienced intracoronary stenting.Results Emergency PTCA was successfully performed in 48 of 52 patients (33/34 in primary PTCA, 12/15 in rescue PTCA, and 3/3 in immediate PTCA) which accounts for the initial success rate of 92%. Intracoronary stents were implanted in 18 of the 48 patients due to the presence of different vessel complications. PTCA was failed in 4 patients (3 occurred in rescue PTCA, 1 occurred in primary PTCA). Among the patients, one died of acute pulmonary edema during the rescue PTCA procedure, one had acute reocclusion after rescue PTCA and died of acute pump failure within 24 h. Guiding wire failed to put through lesions in the other 2 patients. Mass intracoronary thrombosis was present in 5 of 34 patients after primary PTCA despite the restoration of TIMI 3 grade blood flow in the distal segment. The residual thrombosis disappeared after urokinase (500 000-1 500 000 IU) was infused into the culprit coronary.Conclusions Clinical studies have suggested that emergency PTCA is more effective in early reperfusion than that of thrombolysis in AMI. Though emergency PTCA is highly effective, but the initial success rate is lower than that of conventional PTCA with a higher complication and mortality. Thus it should be only steadily introduced into AMI.

ObjectiveTo understand the usage of antibiotics in outpatients in a county of Zhejiang Province from 2015 to 2020， so as to provide a basis for further standardizing the clinical application of antibiotics in this region. MethodsOutpatient records and prescription records of 146 public medical institutions from 2015 to 2020 were extracted from the electronic medical record data sharing platform system of medical institutions in a county of Zhejiang Province. The utilization rates and the number of types of antibiotics used in outpatient patients were described. According to the drug anatomy， therapeutic and chemical classification system （ATC）， clinical application classification and dosage form， the use status of different types of antibiotics was observed. The annual percentage change （APC） was used to analyze the time trend of antibiotic use. Among the antibiotic prescriptions in each year， the proportions of prescriptions aimed for different use reasons and patients were compared to analyze the changes in the structures of antibiotic prescriptions. ResultsDuring 2015‒2020， a total of 2 861 438 prescriptions were issued in146 primary public medical institutions in this county， including 314 642 prescriptions for antibiotics， and the overall utilization rate of antibiotics was 11%. The utilization rate of antibiotics showed a decreased trend across the years （from 14.23% in 2015 to 7.59% in 2020，APC=-11.51%， 95%CI=-0.01%‒-21.7%， t=-12.05， P<0.001） and an obvious seasonal variation character （higher in winter and spring， lower in summer and autumn）. Cefoxitin sodium for injection was the most used antibiotic in 2015， and cefuroxime was the most used antibiotic from 2015 to 2020， respectively. The utilization rates of cephalosporins （APC=-11.06%， 95%CI=0‒-20.89%， t=-22.233， P<0.001）， quinolones （APC=-9.74%， 95%CI=0‒-18.53%， t=-7.652， P=0.002）， macrolides （APC=-17.52%， 95%CI=0‒-17.52%， t=-3.626， P=0.022） and lincoamides （APC=-49.01%， 95%CI=0‒-74%， t=-3.35， P=0.029） showed a decreasing trend across the years. There were differences in the distribution of drug use reasons （χ²=9 458.427， P<0.001）， as well as the age （χ²=5 421.709， P<0.001） and sex （χ²=245.322， P<0.001） of patients. During the observation period， 50.69% of antibiotic prescriptions were used to treat respiratory diseases， with the highest proportion of 57.67% in 2015 and the lowest proportion of 34.93% in 2020. 58.37% of patients were aged 50‒70 years， with a decreasing proportion of patients under 50 years （17.83% in 2015， 6.64% in 2020） and an increasing proportion of patients over 70 years （24.1% in 2015， 38.41% in 2020）. ConclusionThe utilization rate of antibiotics used in outpatients from primary public medical institutions in a county of Zhejiang Province shows a decreasing trend across the years， but higher than that of secondary and above hospitals in China， and also higher than that of primary medical institutions in economically-developed areas. The management and monitoring of the clinical use of antibiotics in the county should be actively strengthened.