Cilia ; ultrastructure ; Humans ; Maxillary Sinus ; ultrastructure ; Microscopy, Electron, Scanning ; Mucous Membrane ; ultrastructure

BACKGROUND: Inadequate hyperventilation may trigger cerebrovascular contraction and lead to lowered cerebral perfusion and oxygen supply-demand imbalance.OBJECTIVE: To investigate the influence of hyperventilation on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the cerebral arteries and veins in patients with serious traumatic brain injury.DESIGN: Case analysis.SETTING: Department of Anesthesiology, First Hospital Affiliated to Shantou University.PARTICIPANTS: Sixteen patients who received emergency operations in the First Hospital Affiliated to Shantou University between January and July 2002.METHODS: Patients with traumatic brain injury underwent operation under general anesthesia, and the PaCO2 was maintained at 30 mm Hg for 15 minutes by regulating the respiration rate, followed by decrease to 25 mm Hg, maintained for 15 minutes before restoration to 30 mm Hg for 15 minutes. The fractional concentration of inspired oxygen was adjusted to maintain blood PaO2 at around 100-150 mm Hg, and the blood sample was collected from the artery and internal jugular vein 15 minutes after adjustment of PaCO2 for blood gas analysis. The PaO2 was then increased to 200-250 mm Hg by increasing the fractional concentration of inspired oxygen, and the PaCO2 was adjusted from 30 to 25 and then back to 30 mm Hg in the described manner, and the oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins were measured.MAIN OUTCOME MEASURES: Influence of blood PaO2 and PaCO2 on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins.RESULTS: Sixteen patients met the diagnostic criteria and completed data collection. The arterial PaCO2 decreased from 30 to 25 mm Hg when arterial blood oxygen pressure increased from 100-150 to 200-250 mm Hg, which leads to obvious decrease of oxygen saturation in the internal jugular vein and obvious increased difference in oxygen content between the cerebral artery and vein. However the absolute value of oxygen saturation in the internal jugular vein was obviously higher at PaO2 of 200-250 mm Hg than that at PaO2 of 100-150 mm Hg, while the absolute value of cerebral arteriovenous difference of brain oxygen content was obviously lower. Compared to the basal level, the arteriovenous lactic acid difference was obviously increased at PaO2 of 100-150 mm Hg,PaCO2 of 30 and 25 mm Hg, and at PaO2 of 200-250 mm Hg and PaCO2 of 25 mm Hg.CONCLUSION: Relatively higher PaO2 (200-250 mm Hg) and mild hyperventilation (PaCO2 of 30 mm Hg) has no obvious effect on brain oxygen supply-demand balance.

Objective To explore the related factors of the relapse of schizophrenics in unwell developed economic areas.Methods To analyze 718 schizophrenics by single and multiple stepwise regression analyses to explore whether relapse of schizophrenia was related to those factors.Results 2.8％ experienced one time relapse, 14.2％ experienced two times relapse and 83％ three times. The rate of schizophrenic relapse was in turn correlated with treatment compliance, treatment intervention, marriage, clinical features, psychological stress,social support, the way of forming disease, medical expenses and condition of access to medical care. Conclusions More attention should be paid to the factors causing schizophrenic relapse and wider measures of prevention and treatment should be taken.

To date, three techniques of total spondelyctomy were used for spinal tumor, including piecemeal technique, eggshell technique and total en bloc spondelyctomy, and each has specific features and indications. Due to limitations of technique, piecemeal technique and eggshell technique are gradually replaced by total en bloc spondelyctomy in treatment of spinal tumor. Moreover, with technical development, application of total en bloc spondelyctomy in treatment of spinal tumor becomes more rigorous and standard. However, it is controversial about its indications and surgical approach. Postoperative spinal stability reconstruction is achieved through various methods according to different conditions.

Objective To study clinical effect of oral montelukast therapy in the treatment of 35 children with cough variant asthma.Methods 35 children with cough variant asthma were divided into the control group (17 cases)and observation group(18 patients).The control group was given oral procaterol hydrochloride,patients in the observation group were given oral montelukast sodium on the basis of taking procaterol hydrochloride.Results The total effective rate of the observation group (94.44%) was significantly higher than the control group (64.71%),the difference between the two groups was statistically significant (χ2 =4.832,P <0.05).In the two groups before and after treatment the maximum peak expiratory flow rate change had no statistically significant difference (P >0.05).After treatment,the FEV of the observation group (12.81 ±0.34)L was higher than that of the control group(2.32 ±0.45 )L,the difference between the two groups was statistically significant(χ2 =3.648, P <0.05).The FVC of the observation group (3.44 ±0.21)L was higher than the control group (2.98 ±0.15)L, the difference between the two groups was statistically significant (χ2 =7.417,P <0.05).The FEV1 /FVC of the observation group (68.31 ±6.44)was higher than that of the control group (58.46 ±6.49),the difference between the two groups was statistically significant (χ2 =4.505,P <0.05).The cough relief time of the observation group (4.45 ±1.32)d was lower than the control group (6.33 ±2.46)d,the difference between the two groups was statistically significant (χ2 =3.151,P <0.05).The cough symptoms disappear time of the observation group (7.63 ±1.96)d was shorter than the control group (10.61 ±1.84)d,the difference between the two groups was statistically significant (χ2 =4.639,P <0.05).In the two groups before and after treatment the liver and kidney function and blood,urine routine had no significant changes.No adverse reaction occurred during the treatment.Conclusion Steiner conven-tional therapy combined with montelukast in the treatment of children with cough variant asthma can rapidly relieve symptoms of cough,significantly improve lung function,reduce the recurrence rate,no adverse reactions,and signifi-cantly improve clinical efficacy,it is worthy of clinical application.

Objective To compare the efficacy and safety of recombinant insulin lispro and insulin lispro in the treatment of type 2 diabetes mellitus(T2DM ) .Methods Forty‐eight T2DM patients with poor blood glucose control were randomly assigned to the recombinant insulin lispro group (observation group ,n=32) and insulin lispro group (control group ,n=16) according to the ratio of 2∶1 .On the basis of injection of the recombinant insulin glargine once daily before sleep ,the two groups were given the re‐combinant insulin lispro injection or insulin lispro injection once before each meal .The period of treatment was 16 weeks .The levels of HbA1c ,2 h postprandial blood glucose(2hPG) and fasting plasma glucose(FPG) before and after treatment were measured and compared between the two groups .The adverse events were evaluated at the end of treatment .Results Forty‐four cases finished the study ,28 cases in the observation group and 16 cases in the control group .The levels of HbA1c ,FPG and 2hPG after 16‐week treatment in the two groups were decreased significantly (P<0 .05) .The decrease amplitudes of HbA1c in the observation group and the control group were (1 .55 ± 1 .50)% and(1 .06 ± 1 .30)% respectively ,which of FPG were (2 .07 ± 5 .01)mmol/L and (1 .09 ± 3 .18)mmol/L respectively ,and which of 2hPG declined (3 .28 ± 5 .71)mmol/L and(3 .60 ± 5 .89)mmol/L respectively . With HbA1c as the main evaluation index and 0 .40 as the non‐inferiority critical value ,non‐inferiority was found in the recombi‐nant insulin lispro injection as compared with the insulin lispro injection (P<0 .05) .The standard‐reaching rate of HbA1c less than 6 .50% in observation group was 14 .29% ,and which of HbA1c less than 7 .00% was 28 .57% ;in control group ,these two stand‐ard‐reaching rates were 18 .75% and 43 .75% respectively ,and there were no statistically significant differences between two groups (P>0 .05) .Conclusion The recombinant insulin lispro injection has non‐inferiority effects in the aspect of effectiveness compared with the lispro insulin injection ,moreover they have the same safety .

Objective To compare the low-intensity focused ultrasound (LIFU) and high-intensity focused ultrasound (HIFU) in treating pain due to chronic soft tissue injury.Methods Ninety-three patients with pain due to chronic soft tissue injury, aged 18-80 yr, with body mass index of 18-31 kg/m2,course of the disease 3 months-10 yr, and pain intensity of 4-8 in a numeric rating scale, were randomly divided into 2 groups using a random number table: low intensity group (group LI, n =49) and high intensity group (group HI, n =44).In group LI, the patients received LIFU with the minimum ultrasonic intensity causing senses (acid, hemp, swelling, pain) , and the treatment was continued for 10 min.In group HI, the patients received HIFU with the focused uhrasound intensity that could not be tolerated by the patients, the treatment was continued for 1 min each time and then suspended for 1 min, and the total time for treatment was 10 min.The patients received the treatment once a day, and the course of treatment was 5 days in both groups.When numeric rating scale score ＞ 4 during the treatment, parecoxib sodium 40 mg was injected intramuscularly as rescue analgesic.Both the therapeutic index and improvement in movement were used to evaluate the therapeutic effect, and the quality of life and depression were assessed and scored.The treatment-related adverse events were also recorded.Results The total effective rate was 98％ and 84％ in LI and HI groups, respectively.Compared with group HI, the total effective rate was significantly increased, the quality of life score was increased, and no significant change was found in depression score in group LI.No patients used parecoxib sodium or developed treatment-related adverse events in group LI.One patient (2％) required parecoxib sodium, the incidence of skin burns, nerve damage and abnormal pain was 4％, 2％ and 2％, respectively, and no patients developed tissue swelling in group HI.Conclusion LIFU has higher therapeutic effect than HIFU in treating pain due to soft tissue injury, and the safety is good.

Objective To observe the pain behavior of rats with Oxaliplatin‐induced peripheral neuropathy(OXIPN)and cal‐citonin gene related peptide(CGRP)expression.Methods Twenty Wistar rats were randomly divided into 2 groups :normal con‐trol group and model group.Oxaliplatin(20 mg/kg)was injected intraperitoneally to the rats in the model group.Mechanical pain threshold and cold allodynia were detected before and 6 ,24 ,72 h and 7 days after modeling ,respectively.Western blot and im‐munohistochemical method were employed to measure the expression of CGRP in dorsal spinal root ganglion of control group and model group.Results The mechanical pain threshold of modal group rats decreased 6 h after injection of Oxaliplatin as compared with the normal group[(11.6 ± 2.2)g vs. (13.9 ± 3.7)g] ,and decreased with prolongation of time ,reduced to the lowest at 72 h[(3.9 ± 1.4)g]and maintained to day 7 ,and the same trend was found in cold chemical allodynia test.CGRP ex‐pression of dorsal root ganglion increased significantly in the model group rats ,and there was a significant positive correlation between the expression of CGRP and the degree of mechanical pain threshold.Conclusion CGRP plays an important role in Ox‐aliplatin‐induced central sensitization of rats with peripheral neuropathy.

Objective To assess the diagnostic value of susceptibility weighted imaging in intracranial capillary telangiectasia. Methods Clinical and imaging data of 1 3 cases with pathologically proved intracranial telangiectasia were collected.All 1 3 patients were examined with conventional MRI and SWI scanning,five patients were checked with MRA while other six cases were examined by CT scanner,and the results were compared.Results All 13 patients had multiple lesions and a total of 176 lesions were detected by SWI,exhibiting hypointense with possiblely punctate hyperintense in the center .Fifty-two lesions were detected by T1 weighted imaging;105 lesions were detected by T2 weighted imaging;112 lesions were detected by fluid attenuated inversion recovery;69 lesions were detected by diffusion weighted imaging;6 9 lesions were detected by apparent diffusion coefficient.Six cases underwent CT scanning, and one showed multiple low density while the remaining five cases did not find any abnormalities.No cerebral vascular malformation was found in five cases scanned by MRA.The lesions showed round or oval shape,ranging from 3 mm to 17mm in diameter.Among them,98 lesions were located in the pons,39 in cerebellum,23 in cortex,10 in basal ganglia,6 in thalamus.Conclusion SWI is the sensitive sequence to detect intracranial capillary telangiectasia.SWI could be used as the preferred imaging method for intracranial capillary telangiectasia.