Objective To investigate the effects of combined general and epidural anesthesia on intestinal barrier function in patients with obstructive jaundice after surgery.Methods Forty patients with obstructive jaundice,male 1 5 cases,female 25 cases,aged 26-65 years,of ASA Ⅰ-Ⅲ,with TBIL >100 μmol/L were randomly divided into two groups (n =20):the general intravenous anes-thesia group (group GA)and the combined general and epidural anesthesia group (group GE).Pa-tients of group GA with oxygen mask rapid intubate induction of endotracheal after general anesthesia. Patients of group GE take left side line of T8~9 or T9 ~1 0 segmental epidural puncture and insert cathe-ter,after changing the hypothesis to be 2% lidocaine 5 ml for test quantity,confirm without anesthe-sia complications and other abnormalities after general anesthesia 5 minutes later.Peripheral venous blood was sampled when entering the operating room (T1 ),and at the end of operation (T2 ),24 hours after operation(T3 )and 48 hours after operation (T4 ).The concentration of D-lactate (D-LA) was measured using ELISA method.Also polymerase chain reaction (PCR)was performed for quali-tative detection of Escherichia coli specific beta galactosidase gene BG.Results Compared with T1 , Plasma D-LA level in two groups at T2-T4 were increased gradually and it was significantly higher in group GA than in group GE at T2-T4 with significant difference (P <0.05).The Escherichia coli DNA test was negative at T1 ,the positive rate of Escherichia coli DNA gradually increased,and it was significantly higher in group GA than in group GE at T4 with significant difference(P <0.05).Conclusion Compared with the general intravenous anesthesia, general anesthesia combined with epidural anesthesia may relieve the intestinal barrier injury in patients with obstructive jaundice after surgery.

Objective To study whether closed reduction and interlocking intramedullary nailing will worsen the injured radial nerve associated with the fracture of humeral shaft.Methods Of the 353 patients with fracture of humeral shaft who received operation from January 2002 to January 2005,63 ones were complicated with preoperative injury to their radial nerve.A retrospective analysis was done of their physical examination records, operative records,X-ray films and results of the treatment.Eleven cases were treated with closed reduction and interlocking intramedullary nailing,and 52 cases with open reduction and internal fixation of plates and screws fol- lowed by exploration to the radial nerve.Chisquare test of PEMS 3.1 system was adopted to analyze the clinical data. Results The radial nerve was embedded by the fracture ends in nine cases(17.3%)of the 52 cases,and con- tused in the other 43 ones.In the 63 cases,The injured nerves recovered spontaneously 2 to 12 weeks postoperatively except in twn cases.All the eases got bony union 3 to 4 months after operation.Closed reduction and interlocking intramedullary nailing has hardly more harmful effects on the injured radial nerve assoeiated with the fracture of humeral shaft than open reduction and internal fixation of plates and screws followed by neural exploration.Con- clusion Closed reduction and interlocking intramedullary nailing is fit for the freatment of fractures of humeral shaft with radial nerve injury.

Diabetic keratopathy (DK) is a common ocular complication of diabetes.Long-term hyperglycemia impairs many structures of the cornea, leading to corneal opacity and visual dysfunction.A large number of researches focus on the epithelium and nerve abnormities in DK, but the pathogenesis is not completely elucidated.Dendritic cells (DCs) are specialized antigen-presenting cells, linking innate and adaptive immunity, participating in the occurrence and development of diabetes and its complications.To date, there are many myths in relationship between DCs and DK to be solved, and there are a few researches that investigate the relation between DCs and the occurrence and development of diabetes.In this article, the pathogenesis and pathogenic changes of DK, the types and functions of different DCs, the relationship between DCs and chronic inflammation and delayed healing of corneal epithelium in DK, as well as the role of DCs in corneal neuropathy were reviewed in order to provide some references for further investigations about the pathogenesis and treatment of DK.

Objective To comparatively study the difference between thromboelastography (TEG)and light transmission ag-gregometry (LTA)in monitoring clopidogrel effect in patients with acute coronary syndrome.Methods 68 patients with a-cute coronary syndrome,who were in hospital from February to December 2013,were enrolled in this study.They received TEG and LTA to determine platelet aggregation.Results Clopidogrel effect was (47.84±26.04)% and (45.64±20.92)%respectively by TEG and LTA.There were negative correlation between LTAADP and TEGADP(r=-0.752,P<0.001),pos-itive correlation between LTAADP and MAADP(r=0.789,P<0.001),negative correlation between TEGADP and MAADP(r=-0.820,P<0.001).Conclusion There was a good correlation between the two methods.TEG can be used to evaluate thera-peutic effect of Clopidogrel effect.

Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Hepatitis B ; epidemiology ; immunology ; prevention & control ; Humans ; Infant ; Infant, Newborn ; Male

Objective To investigate the effects of extracorporeal membrane oxygenation (ECMO) in severe cardiopaths with crisis. Methods Fourteen cases of severe eardiopaths with crisis were treated by ECMO with V A- ECMO technique, whose pump was centrifugal pump and whose tubes was spread byheparin. The cases included 8 fulminating myocarditis (FM) cases with ventricular arrhythmias or/and acute heart failure or/and cardiac shock and 6 acute myocardial infarction cases with pump failure or cardiac shock,in whom 10 cases with cardiorespiratory resuscitation. Haemodynamics and blood gas analysis, and so on were measured before and after treatment. Results The support time of ECMO was 3-106 h, mean (32.4±27.6) h. After ECMO mean arterial blood pressure (MAP), left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDd), partial pressure of arterial oxygen, saturation of blood oxygen improved (P < 0.05 or < 0.01 ), negative value of base excess decreased significantly( P < 0.01 ). MAP had notchanged before and after stopping ECMO [ (80.02±10.20) wan Hg (1 mm Hg = 0.133 kPa) vs (76.34±9.15) mm Hg] (P > 0.05), however, LVEF and LVEDd improved continually (P <0.05). Conclusion ECMO can provide oxygen supply and stable circulation volume for severe cardiopaths with crisis to recover cardiorespiratory function or save valuable time to treat primary disease.

To understand the impact of salvianolate injection treatment of liver and kidney function using different from the hospital information system nationwide 18 large three hospitals (hospital information system, HIS) to extract using salvianolate age 18-80 years-old patient, a total of 10 470 cases, depending on the treatment used to have two times before and after treatment 7 d aspartate aminotransferase (AST), alanine aminotransferase patients (ALT), serum creatinine (Cr) and blood urea nitrogen (BUN) measurement indicators grouped according salvianolate continuous use different treatment patients were divided into two groups, continuous medication time > 14 d were defined as the observation group, ≤ 14 d were defined as the control group, continuous medication longer than 31 d were not included in the analysis. Each index number of the observation group and the control group were: ALT (268/1 465), AST (270/1 585), Cr (278/1 582), BUN (278/1 611). After using propensity score methods to balance two groups of covariates, based on unweighted logistic regression logistic regression propensity score weighting combined with propensity score weighting to adjust for covariates logistic regression of liver and kidney function in the two groups were analyzed. The results showed: three logistic regression analysis showed no likelihood of ALT, AST, Cr targets two groups of patients with abnormal statistically significant difference, continuous medication time > 14 d may increase the risk of abnormal BUN indicators, comprehensive analysis still can not explain use different treatment of patients salvianolate cause liver and kidney toxicity damage, still large prospective randomized controlled trials further study.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase ; metabolism ; Aspartate Aminotransferases ; metabolism ; Blood Urea Nitrogen ; Creatinine ; blood ; Female ; Humans ; Injections ; Liver ; drug effects ; metabolism ; Male ; Middle Aged ; Plant Extracts ; administration & dosage ; adverse effects ; therapeutic use ; Prospective Studies ; Young Adult

Objective To observe the changes of arm equilibrium pressure (Parm) in different occlusion time,the reference range of Parm in hemodynamic stable patients,and to explore the relationship between Parm and systemic hemodynamic parameters.Methods Mechanically ventilated postoperative abdominal surgery patients who admitted to ICU with stable hemodynamic status were enrolled.After hemodynamic data were recorded,arm stop-flow maneuvers were performed to measure Parm.At 10,20,30,40,50,60 seconds after occlusion,arterial pressure were measured twice within 5 minutes and recorded as the average value.Results Thirty patients were included.The Parm decreased gradually with the prolongation of the occlusion time.The value was not stable within 60 s,but the reducing extent was not obvious after 40s.The 95％ reference range of Parm 30 S was 23-44 mmHg(1 mmHg =0.133 kPa) and Parm 60 S was 19--35 mmHg.Parm at 30 s and 60 s were positively correlated with systolic arterial pressure,diastolic arterial pressure,mean arterial pressure,central venous pressure (all P ＜ 0.001),but not heart rate and pulse pressure.Linear regression analysis showed that Parm at 10 s,20 s,30 s only had linear correlation with diastolic arterial pressure (10 s,β =0.504,P =0.001;20 s,β =0.297,P =0.005;30 s,β =0.231,P =0.015),and Parm at 40 s,50 s,60 s were linear correlation with diastolic arterial pressure (40 s,β =0.220,P =0.004;50 s,β =0.210,P =0.004;60 s,β =0.213,P =0.004) and central venous pressure (40 s,β =0.516,P =0.018;50 s,β =0.513,P =0.01;60 s,β =0.472,P =0.023).Conclusion In mechanically ventilated postoperative abdominal surgery patients with stable hemodynamic status,Parm decreases when occlusion time is prolonged,which is not stable within 60 s occlusion.Arterial blood pressure and central venous pressure are positively correlated with Parm.

Objective:To explore the pharmaceutical care model for the patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) caused by inhalation of chemical agents to ensure the safety, rationality and effectiveness of drugs. Methods:According to the characteristics of drug therapy for the patients with ALI/ARDS caused by inhalation of chemical agents, the pharma-ceutical care was carried out and the suggestions on the medication were given. Results:Through the pharmaceutical care, the safety, reasonability and effectiveness were improved. And the incidence of adverse drug reactions was decreased. Conclusion: Cooperating with clinical physician, clinical pharmacists can perform active pharmaceutical service and optimize dosage regimen, which is beneficial to the safety, reasonability and effectiveness of drug therapy for the patients.

Objective To observe the roles of nuclear factor-κB (NF-κB) and hypoxia-inducible factor-1 o (HIF-1 α) in hippocampal neurodegeneration of status epilepticus (SE) rats, and explore whether HIF-1α activation is regulated by NF-κB.Methods A total of 110 male Sprague-Dawley rats were randomly divided into seven groups : (1) Control group treated with saline (control, n =15), (2) sham group implanted cannula into lateral ventricle and treated with saline (sham, n =15), (3) SE group treated with pilocarpine (SE, n =20), (4) NF-κB activity inhibitor pyrrolidine dithiocarbamate (PDTC) group treated only with PDTC (PDTC, n =15), (5) SE + PDTC group treated with pilocarpine plus PDTC (SE + PDTC, n =15), (6) SE + HIF-1o siRNA group implanted cannula into lateral ventricle and treated with pilocarpine plus HIF-1 α siRNA (SE + HIF-1α siRNA, n =15), (7) SE + control siRNA group implanted cannula into lateral ventricle and treated pilocarpine plus control siRNA (n =15).SE was induced by injecting lithium chloride and pilocarpine.The seizure of rats was observed.The protein expressions of NF-κB and HIF-1 α in hippocampus of rats were examined by Western blotting.The degenerating neurons in hippocampus were detected by Fluoro-Jade C (FJC) staining.Results Twenty-four hours after termination of SE, the nuclear protein expressions of NF-κB and HIF-1α in hippocampus of rats were increased in SE group (0.57 × 0.06, 0.47 ± 0.07) compared with those in control group (0.23 ± 0.03, 0.20 ± 0.03;P ＜0.05);and compared with SE group PDTC significantly decreased the nuclear protein expressions of NF-κB and HIF-1 α in SE + PDTC group (0.23 ± 0.03, 0.14 ± 0.03;P ＜ 0.05);in SE + PDTC group the numbers of FJC positive cells in CA1 area (28.33 ±5.03) were decreased compared with that in SE group (76.67 ± 13.32);HIF-1 o siRNA injected into lateral ventricle of rats significantly decreased the expression of HIF-1α in hippocampus (0.22 ±0.03) and the number of FJC positive cell in CA1 area (27.34 ±7.02) in SE + HIF-1α siRNA group compared with those in SE group (0.39 ±0.06, 76.67 ± 13.32;P ＜0.05).Conclusions These data suggest that SE can result in activation of NF-κB/HIF-1o pathway in brain.Inhibition of the pathway can attenuate hippocampal neurodegeneration caused by SE, which has the brain protective effect.