Objective To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. Methods A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05). Conclusion For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
目的 探讨层流手术室动态空气菌落数超标的高危因素。 方法 回顾分析2010年3月－2011年11月168台次特别洁净层流手术室动态空气样品细菌培养结果的资料，依据层流手术室动态环境下空气样品是否超过10个菌落形成单位（CFU）/m3将168例空气样品细菌培养的资料分别命名为超标组和正常组。超标组有56台次，正常组有112台次。将超标组与正常组就有关手术持续的时间、参与手术的医务人员数量、参观人数、手术过程中开门的次数、是否为污染手术、手术及麻醉设备是否在手术过程中有搬动、是否为接台手术、患者术前1 d是否更衣洗澡以及麻醉方式等因素进行分析比较。 结果 层流手术室动态空气菌落数超标与参观手术的人数、术中开门次数、手术类型、术中有无设备搬动及患者术前1 d是否进行更衣洗澡等因素有关（P＜0.05），而与手术持续时间、参加手术的人员数量、是否接台手术及麻醉方式等无关（P＞0.05）。 结论 参观手术的人数＞3人、术中开门次数＞10次、手术类型为污染手术、术中有设备搬动及患者术前1 d未进行沐浴更衣是层流手术室动态空气菌落数超标的高危因素。
目的 总结反复黏膜感染的IgA肾病的临床病理特点。 方法 采用单中心流行病学调查及回顾性研究，收集2006年1月－2009年12月253例经肾活检确诊为IgA肾病的住院患者的临床病理资料，对114例反复黏膜感染的IgA肾病患者（A组）及139例偶发或从未发生黏膜感染的IgA肾病患者（B组）的临床病理指标进行比较。 结果 A组患者年龄较B组小（t=2.913，P=0.004），临床表现无明显症状者比例较B组多，临床分型以反复发作肉眼血尿型为多，病理分级较B组轻（Z=?2.042，P=0.041），IgA+IgM+C3沉积率高（P＜0.001）；B组IgA+IgG+C3沉积率高（P＜0.001），纤维连接蛋白沉积率高（P＜0.001）。 结论 反复黏膜感染的IgA肾病组患者年龄小，反复发作肉眼血尿型多，临床表现及病理分级较轻；两组FN沉积及免疫球蛋白沉积的主要类型不同，提示两组发病机制可能有所不同。
ObjectivesTo systematically review the safety of traditional Chinese medicine injection based on clinical centralized monitoring studies that have been carried out and listed so far, to understand basic situation of adverse reactions and explore the risk factors of traditional Chinese medicine injections and to provide evidence for clinical rational use of drugs and optimizing centralized monitoring methods. MethodsCFDA, CNKI, VIP, WanFang Data, Sinomed, PubMed and The Cochrane Library databases were electronically searched to collect studies on safety monitoring of listed traditional Chinese medicine injections from inception to February, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using Excel software. ResultsA total of 14 studies involving 14 varieties of injections, 296 200 cases were included. The highest incidence rate of adverse reactions was found in the XueBiJing injection (2.54%). The related factors of ADR extraction were age, sex, drug combined usage, time from administration, allergic history, administration days, indication, dose and distribution of the tube. ConclusionsThe safety of traditional Chinese medicine injection is generally high. Middle and old age is an important factor in the occurrence of ADR. The incidence of ADR is relatively high in the first 6 days of drug use, and the incidence of ADR is more likely to be caused by irrational use of drugs in clinic, and the history of allergy may be related to the occurrence of ADR. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo investigate the negative emotions of patients before cardiac surgery in West China Hospital in order to analyze the related factors.MethodsThe Huaxi emotional-distress index (HEI), a screening tool for mood disorders developed by the Mental Health Center of West China Hospital, was used for preoperative psychological evaluation of 1 968 adult patients hospitalized in cardiac surgery from March 2016 to July 2014. There were 835 males and 1 133 females at age of 49±13 years.Results Fifty-one patients (2.6%) had negative emotions, among whom 6 patients were screened for suicide risk. After intervention, none of them had serious consequences caused by adverse emotions, such as automatic discharge from hospital, avoidance of surgery and suicide.ConclusionThis study found that most of the cardiac surgery patients in West China Hospital have good psychological status before surgery, and a few suffered from negative emotions. “Huaxi emotional-distress index” is simple, effective and worth promoting.
Objective To evaluate the internal fixation effect, degradation, and biocompatibility of polylactic-co-glycolic acid/hydroxyapatite (PLGA/HA) absorbable cannulated screws in treatment of lateral femoral condyle fracture of canine so as to provide the theory basis for their further improvement and clinical application. Methods Sixteen adult male Beagles (weighing, 9-12 kg) were selected to prepare the models of bilateral lateral femoral condyle fracture; left fracture was fixed with PLGA/HA absorbable cannulated screws as experimental group and right fracture with metal screws as control group. At 2, 4, 8, and 12 weeks after operation, general observation was done and X-ray films were taken for observing fracture healing; bone mineral density was measured; the histological examination was performed; and the degradation property of absorbable cannulated screws was detected. Results All animals survived to the end of the experiment. General observations showed that no fracture displacement occurred and fracture healed at 12 weeks in 2 groups; no breakage, displacement, or loosening of screws was observed in experimental group. X-ray films results showed that the absorbable cannulated screws could not be found out by X-ray in experimental group, but metal screws could be found out in control group; fracture healed with time in 2 groups. The bone mineral density reached the peak at 8 weeks in 2 groups, and no significant difference was found between 2 groups and among different time points in the same group (P gt; 0.05). Histological examination showed that 2 groups had similar fracture healing process at different time points; no obvious inflammatory reaction was found around absorbable cannulated screws in experimental group. The degradation results of absorbable cannulated screws showed that the intrinsic viscosity and molecular weight distribution obviously decreased at 2 weeks; the number average molecular weight and the weight average molecular weight markedly decreased at 4 weeks; and the maximum shear force did not decrease obviously at 8 weeks, and then decreased significantly. Significant differences were found in all indexes among different time points in the same group (P lt; 0.05). Conclusion PLGA/HA absorbable cannulated screws and metal screws show similar fracture healing process for fixing lateral femoral condyle fracture of canine, and the absorbable canulated screws have good biocompatibility. The maximum shear force of PLGA/HA absorbable cannulated screw has no obvious decrease during 8 weeks after operation, so it can ensure full healing of fracture.
Objective To investigate the effects of ovarian tissue cryopreservation by needle immersed vitrification (NIV) method and subsequently orthotopic transplantation on ovarian function reconstruction in chemotherapy-induced ovary damage rat model. Methods A total of 52 matured virginal female Wistar rats at age of 8-9 weeks housed in specific-pathogen-free facilities, weighing 250-300 g. Vaginal smears were obtained daily, 50 rats having at least 2 consecutive normal estrous cycles were included in the experiment. Ten rats were selected as donors randomly, and NIV method was used for cryopreserving ovarian tissues. The remaining 40 rats were divided into 3 groups according to different treatments: cyclophosphamide group (C group, n=14), cyclophosphamide/transplantation group (C/T group, n=12), and control group (NS group, n=14). In C group and C/T group, the rats received peritoneal injection of cyclophosphamide every day for 21 days to establish the chemotherapy-induced ovary damage models; and then the frozen-thawed ovarian tissues orthotopically transplanted into the left ovarian bursae in C/ T group. The rats received peritoneal injections of 0.9% saline solution every day for 21 days in NS group. Estrous cycle recovery time, ovary weight, morphology change of ovarian tissues, and follicle count were compared among 3 groups. Results One rat died at 2 days after transplantation in C/T group; the other rats survived to the completion of the experiment. At 4 weeks after the end of injection, no significant difference in body weight was found among 3 groups (P gt; 0.05). The rats of NS group had regular estrous cycle, but cyclic changes in vaginal smears were observed in C group and C/T group during cyclophosphamide treatment. The median estrous cycle recovery was 9 days (95%CI: 7.9-10.1 days) in C group, and was 6 days (95%CI: 4.9-7.1 days) in C/ T group, showing significant difference (χ2=6.571, P=0.010). The ovarian weight showed an obvious downtrend in C group at 4 weeks after cyclophosphamide treatment, and an upward trend was observed in C/T group. The ovarian grafts survived and grew well in C/T group. Primordium follicles and primary follicles in C/T group and NS group were significantly more than those in C group (P lt; 0.05), but no significant difference was found between NS group and C/T group (P gt; 0.05). There was no significant difference in secondary follicles and antral follicles among the 3 groups (P gt; 0.05). Conclusion The method of ovarian tissue cryopreservation by NIV and subsequently orthotopic transplantation can significantly shorten the estrous cycle recovery time in chemotherapy-induced ovary damage rat model. Ovarian grafts grow well, follicle count is similar to normal level. So it has the potential ability of ovarian endocrine and fertility reconstruction after chemotherapy.
Objective The bone marrow mesenchymal stem cells (BMSCs) have the capacity to differentiate into insul in-producing cells (IPCs) in vitro. However, low differentiation efficiency and poor maturity are the main obstacles. To investigate the feasibil ity of BMSCs differentiation into IPCs in diabetic pancreatic microenvironment of pigs. Methods BMSCs were isolated and purified from the bone marrow of a 4-week-old male pig. Fifteen female pigs (aged 8 to 10 weeks, weighing 8 to 10 kg) were randomly divided into 3 groups: normal control group (group A, n=5), diabetic control group (group B, n=5), and BMSCs transplanted group (group C, n=5). The pigs of groups B and C were treated by auris vein injections of styeptozocin and alloxan for 3 days to induce diabetes mell itus (DM) model, whose blood glucose level 2 days all greater than 17 mmol/L was successful DM model. A total of 1.1 mL of the 3rd passage BMSCs labeled with enhanced green fluorescent protein (EGFP), with cell density of 5 × 107/ mL, were injected into subcapsular pancreas of group C at multi ple points, normal saline at the same dosage into those of groups A and B. After 30 days of monitoring blood glucose, the histological analysis of islet number and size were done; the immunofluorescence staining was used to detect the protein expression of insul in in the new-formed islets. The EGFP+ cells were collected from the sections using laser-capture microdissection; RT-PCR was used to detect insulin mRNA and pancreatic and duodenal homeobox factor 1 (PDX1) mRNA expressions from EGFP+ cells, and the insul in and sexdetermining region of the Y chromosome (SRY) genes were detected by fluorescence in situ hybridization (FISH). Results The blood glucose level decreased significantly in group C when compared with that in group B from 18 days and gradually decreased with time (P lt; 0.05). The histological observation showed that the number of islets was increased significantly in group C when compared with that in group B (10.9 ± 2.2 vs. 4.6 ± 1.4, P lt; 0.05), and there was no significant difference when compared with that in group A (10.9 ± 2.2 vs.12.6 ± 2.6, P gt; 0.05). The size of new-formed islets in group C was significantly smaller than that in group A [(47.2 ± 19.6) μm vs. (119.6 ± 27.7) μm, P lt; 0.05]. The immunofluorescence staining showed that new-formed islets of group C expressed insulin protein. RT-PCR showed that the microdissected EGFP+ cells of group C expressed insulin mRNA and PDX-1 mRNA. FISH showed that the new-formed islet cells of group C contained SRY gene in Y chromosome and insulin double positive cells. Conclusion BMSCs can differentiate into IPCs in diabetic pancreatic microenvironment of pigs.
Objective To assess the efficacy and safety of okra capsule for IgA nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of okra capsule for IgA nephropathy were collected from CENTRAL, MEDLINE, EMbase, PubMed, WanFang Data, CNKI and CBM. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross-checked then. Then RevMan 5.07 software was used for meta-analysis. Results Five RCTs were included. The results of meta-analyses showed that: compared with the control group, okra capsule was more effective in decreasing urinary protein (P≥0.05), but had no significant difference in improving renal function, reducing urine red blood cells and blood lipid (Plt;0.05). No research reported the adverse effects of okra capsule. Conclusion Current evidence reveals that okra capsule can reduce urinary protein and improving therapeutic effect for IgA nephropathy. However, further studies are needed to test its safety. Because of the small sample size and low methodological quality of the included studies, these results require more high-quality RCTs for further verification.
目的 探讨抗核抗体（ANA）在IgA肾病中的阳性率及其对临床的意义。 方法 回顾性分析2007年1月－2009年12月间进行ANA检测的115例IgA肾病患者及59例非IgA肾病慢性肾炎患者的临床资料。统计分析ANA阳性与阴性的临床指标。 结果 IgA肾病患者中有12例（10.4%）存在ANA阳性，与非IgA肾病慢性肾炎中的阳性率比较差异无统计学意义（P＞0.05），ANA阳性的IgA肾病血浆IgG水平较高，病理改变较轻。 结论 IgA肾病ANA阳性的机体免疫有增强，肾功、尿蛋白及病理损害较轻，其对IgA肾病预后的影响仍需进一步研究。