Volume 93  ·   Issue 35  ·  2013

Dexmedetomidine is a highly selective alpha₂Adrenergic receptor agonists with central anti-sympathetic and anti-anxiety effects that produce a sedative effect similar to natural sleep; At the same time, it has certain analgesic and diuretic effects, has no obvious inhibition on respiration, and may have certain protective properties on the function of heart, kidney and brain. It can be used for sedation of patients treated with ventilator by endotracheal intubation, perioperative anesthesia combined with medication and sedation during invasive examination or treatment.

To explore whether or not small bowel feeding can reduce the incidence of hospital acquired pneumonia (HAP).

The databases of Pubmed, Embase and Web of Science were searched to identify the relevant randomized controlled trials (RCT) from January 1992 to September 2012.Meta analysis was performed to analyze the effects of gastric versus small bowel feeding on HAP.

Ten RCTs including 830 patients were retrieved and 6 of which examined the effect of ventilator-associated pneumonia (VAP).In total, the incidence of HAP was 15% (62/407) in bowel feeding group versus 23% (97/423) in gastric feeding group.As compared with gastric feeding,small bowel feeding appeared to significantly reduce the incidence of HAP[RR 0.67,95% CI (0.51-0.89), P=0.005; I²=0%)], but did not reduce the mortality[RR 1.08, 95% CI (0.84-1.40), P=0.54; I²=0%] and the duration of ICU stay[weighted mean difference in 0.04 days, 95% CI (-2.83-2.91), P=0.98; I²=96%].Subgroup analysis indicated that small bowel nutrition reduced the incidence of VAP[RR 0.64,95% CI (0.46- 0.90),P=0.01; I²=9%)], but did not reduce the incidence HAP of non-VAP[RR 0.74, 95% CI (0.45-1.21), P=0.23; I²=0%)].

Compared with gastric feeding, small bowel feeding can reduce the incidence of HAP, especially VAP, but can not reduce the mortality.

To explore the variations of left ventricular-arterial coupling and elucidate its mechanisms in septic shock.

Septic shock rabbits were established by an intravenous injection of endotoxin.A total of 12 rabbits were divided randomly into sham operation group (S,n=6) and endotoxin injection group (E, n=6).Ultrasonic echocardiography and hemodynamic monitoring were conducted at 0 h (30-min post-operation), 2 h (1-hour after endotoxin or saline injection) and 4 h (3-hour after endotoxin or saline injection) and the relative hemodynamic indices were recorded.

(1) In E group, end-systolic elastance (Ees) at 2 h was lower than that at 0 h (75.72±5.16 vs 90.77±7.17 mm Hg/ml) and Ees at 4 h was lower than that at 2 h (58.45±3.63 vs 75.72±5.16 mm Hg/ml,P<0.05). (2) In E group, left ventricular diastolic volume (LVDV) at 2 h and 4 h were both lower than that at 0 h (3.26±0.21 vs 3.58±0.25 ml, 3.27±0.19 vs 3.58±0.25 ml).And left ventricular end diastolic compliance (Ced) at 4 h were lower than that at 0 h and 2 h (0.61±0.05 vs 0.74±0.07 ml/mm Hg, 0.61±0.05 vs 0.75±0.08 ml/mm Hg, P<0.05). (3) In E group, Ea at 2 h and 4 h was lower than that at 0 h (41.35±2.87 vs 50.46±3.22 mm Hg/ml, 40.13±2.68 vs 50.46±3.22 mm Hg/ml,P<0.05). (4) In E group, Ea/Ees at 4 h was higher than that at 0 h and 4 h (0.70±0.07 vs 0.57±0.06,0.70±0.07 vs 0.56±0.05,P<0.05).And Ea/Ees at 2 h had no significant difference with that at 0 h (0.56±0.05 vs 0.57±0.06, P<0.05).

During compensatory stage of septic shock, left ventricular-arterial coupling shows no significant variation.However, during decompensatory stage of septic shock, there is significant left ventricular-arterial decoupling.The main reason for decoupling lies in that the decrease of left myocardial contractility is more significant than that of left ventricular afterload.And ventricular diastolic dysfunction may also participate.

To explore the effects of vascular paralysis upon prognosis and tissue perfusion in septic shock patients.

A total of 73 septic shock patients consecutively admitted into our department from January 2010 to July 2011 were retrospectively studied.Their hemodynamic data, arterial lactate concentration and APACHEⅡ (acute physiology and chronic health evaluationⅡ) score at the beginning of cardiac output monitoring (0 h),as well as the outcome of Day 28 postdiagnosis were recorded.Stroke volume index (SVI) and cardiac index (CI) were obtained through transpulmonary thermodilution technique by pulse induced continuous cardiac output (PiCCO) system.

(1) APACHEⅡscore at 0 h was higher in non-survivors than those in survivors ((14.6±5.6) vs (20.4±4.8), P<0.01).Stroke systemic vascular resistance index (SSVRI),pulse pressure/stroke volume index (PP/SVI),effective arterial elastance index (EaI),24 h lactate clearance rate (24 rLac), 72 h lactate clearance rate (72 rLac) and 7 d lactate clearance rate (7 rLac) in nonsurvivors were all lower than those in survivors (P<0.05); (2) SVRI,SSVRI,PP/SVI and EaI were all correlated significantly with 24 rLac, 72 rLac and 7 rLac[(212.7±52.6) vs (185.4±50.5),PP/SVI: (2.8±0.7) vs (2.5±0.6), EaI: (5.0±1.2) vs (4.3±1.1), 24/72/7 rLac: (18.4±46.4) vs (21.5±49.7), (19.9±49.6) vs (-21.5±46.3), (35.5±45.8) vs (-59.5±64.5), P<0.00].

Vascular paralysis is correlated with prognosis and tissue perfusion in septic shock patients.And SSVRI,PP/SVI and EaI are more significant.

To explore some related problems in surgical treatment of ruptured anterior circulation intracranial aneurysms in elders.

The clinical data of 38 elderly patients with ruptured anterior circulation intracranial aneurysms were analyzed retrospectively.Such related problems as indication, timing and complications of operation were discussed through their Modified Rankin scales at discharge and half a year later.

Their Hunt-Hess grades wereⅠ (n=6),Ⅱ (n=17),Ⅲ (n=5),Ⅳ (n=6) andⅤ (n=4) respectively.Among them,33 cases were complicated preoperatively with other vital diseases while another 5 previously healthy (Ⅲ,n=3;Ⅱ,n=1;Ⅳ, n=1).And their modified Rankin scales of discharge and half-a-year follow-up were 0 (n=12 vs 12), 1 (n=10 vs 10), 2 (n=4 vs 4), 3 (n=3 vs 1), 4 (n=3 vs 3), 5 (n=4 vs 3) and 6 (n=2 vs 3) respectively.All scales of 5 cases of previously healthy patients were 0- 2.

Operation is vital for rescuing patient life and achieving excellent outcomes.Age is not a risk factor for intracranial aneurysms of elders.Early and aggressive operation is recommended for those without contraindications.Physical status is more important than age in decision-making.

To evaluate the roles of rebiopsy for clinically diagnosed metastatic lesion in detecting the changes of hormonal receptors and second malignancy.

The metastatic lesions were rebiopsied by core needle aspiration or incision in 42 patients with a clinical diagnosis of metastatic breast cancer by computed tomography or ultrasound.

None of major complications occurred.Thirty-one metastases were proved pathologically.The discrepancies between primary breast cancer and metastatic lesions of estrogen receptor (ER), progesterone receptor (PR), HER-2 statuses were 22.6%, 25.8% and 9.7% respectively.And 7 second malignancies were found (16.7%, 5 primary lung and 2 primary pancreas cancers).Four patients showed no relapse through rebiopsy.

The rebiopsy of clinically diagnosed metastatic breast cancer may find the discrepancies of ER, PR, HER-2 statuses and second malignancy so as to change the therapeutic strategies of patients.

To explore the influencing factors of reproduction status in women undergoing laparoscopic myomectomy (LM).

A total of 278 LM patients were recruited.We retrospectively reviewed the reproduction status of 87 pregnant cases after LM.The correlations of their pregnancy outcomes and such clinical profiles as age, operative techniques, biological characteristics of fibroids (number, type, size and location) were analyzed.No uterine rupture occurred during the gestation period.

None of them switched to open surgery due to laparoscopic difficulties.However, one patient had a laparoscopic suture for secondary bleeding of uterine incision.At 3 months post-operation, sonography showed no heterogeneous echo,effusion and hematoma in uterine incision.Incision through uterine cavity occurred intraoperatively in 8 cases, but no intrauterine adhesion was found on hysteroscopy 3 months later.And 87 women became pregnant and the postoperative fertilization time was from 2 months to 5 years.Age influenced the postoperative pregnancy rate.Other factors such as location, number and size of fibroid had no impact on fertility.

For achieving a high conception rate and guaranteeing the safety of pregnant women, a clinician should select reasonable surgical approaches, perform accurate anatomical restoration, apply strict hemostasis and choose a right time of conception.

To explore the significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery.

For 22 patients with pituitary adenomas over a period of 2 years at Peking Union Medical College Hospital, resection of pseudocapsule was applied for complete tumor removal.Pituitary function test and radiological imaging were performed at preoperation, 3 months post-operation and at subsequent 6- 12 months intervals postoperatively.

All pituitary adenomas were totally removed under microscope.The symptoms of headache, disorder of sight and visual field disappeared postoperatively in nonfunctional pituitary adenomas.The GH levels of 2/5 growth hormone secreting adenoma patients were 4.2 and 7.7μg/L while it was under 1 μg/L for another 3.The postoperative level of prolactin was 4.3μg/L in prolactin secreting adenoma.The level of adrenocorticotropic hormore decreased under 5 ng/L except one was 15.7 ng/ L.Leakage of cerebrospinal fluid occurred intraoperatively in 3 patients and postoperatively in 1.No leakage was found after repair.Diabetes insipidus occurred in one patient and was controlled with Minirin.Pseudocapsule was confirmed by pathological examination.Special staining revealed reticulum fibers in pseudocapsule.

Resection of pseudocapsule may achieve a higher remission rate without deteriorating pituitary function.

To explore the effects of different antihypertensive strategies on blood pressure and urinary albumin excretion in patients with hypertension and microalbuminuria.

For this multi-center, randomized, positively controlled clinical trial, a total of 531 patients with mild-to-moderate essential hypertension and microalbuminuria were enrolled.They were divided randomly into calcium channel blocker (CCB), angiotensinⅡreceptor antagonist (ARB) and CCB+ARB groups.The whole treatment period was 6 months.

According to ANOVA analysis, the post-therapeutic urinary albumin level decreased 20.6, 27.6 and 30.9 mg/L in CCB, ARB and CCB+ ARB groups respectively (P=0.067).And the extents of urinary albumin reduction were 31.1 and 6.6 mg/L in patients with controlled and uncontrolled blood pressure respectively (P<0.001).

Effective antihypertensive therapy is a key for decreasing urinary albumin excretion in hypertensive patients.As compared with calcium antagonists, ARB-containing regimens appear to be better in reducing urinary albumin.

To examine the automatic processing of facial expression and explore the pathogenesis in generalized anxiety disorder (GAD) patients.

Fifteen GAD patients and 15 gender-, age- and education-matched healthy volunteers were recruited from First Affiliated Hospital, Dalian Medical University.The expression-related mismatch negativity (MMN) was recorded to explore the automatic processing mechanism into emotional faces with task-irrelevant emotional faces as effective media.

The MMNs elicited by emotional faces were significiantly lower in GAD participants than those in healthy participants[MMN1:case group (-0.30±0.09) μV, control group (-0.68±0.13) μV, P=0.0003; MMN2: case group (-0.22±0.13) μV, control group (-0.72±0.13) μV, P=0.011] (Ps<0.05) analyzing.For the effect of expression, it was found that the MMNs elicited by negative expression were lower in GAD participants than those in healthy participants mainly in right hemisphere while positive expression mainly in left hemisphere[MMN1:case group (-0.45±0.15) μV,control group (-0.99±0.15) μV,P=0.017; MMN2:case group (0.23±0.22) μV, control group (-1.23±0.22) μV,P=0.003; (MMN1:case group (-0.12±0.14) μV, control group (-0.65±0.14) μV,P=0.015; MMN2:case group (0.14±0.18) μV, control group (-0.42±0.18) μV,P=0.039].

There is an impairment of automatic processing of emotional faces.

To explore the influencing factors of research ability of resident anesthesiologists to improve research training programs.

A questionnaire was conducted in 123 residents and graduate students.And the data were collected and analyzed.

The proportion of residents publishing papers over the last three years and research skills were much less than that of master degree candidates (P<0.05).Senior residents were superior to juniors (7/7; 0/46) (P<0.05).For residents (esp.juniors), a lack of time, research-related classes and mentor guidance were the major influencing factors of research capability.

Sufficient time, research-related knowledge and mentor instructions may improve the research ability.

To explore the clinical characteristics, diagnostic strategies and surgical techniques of hemangioblastoma (HB) in medulla oblongata.

The clinical and radiological characteristics, therapeutic processes and outcomes of 12 HB cases treated at our department from 2002 to 2012 were studied by retrospective analysis.

Headache, somatic numbness and limb muscle weakness were the major symptoms of oblongata HB.Magnetic resonance imaging before surgery revealed a total of 12 single tumors.Among these tumors, upper (n=1), middle (n=7) and lower (n=4) parts of medulla oblongata were involved.The locations were surface (n=9) and intramedullary (n=3).Three tumors had cyst.Digital subtraction angiography (DSA) was performed on 5 cases and it revealed that the main blood supply arteries of tumors were branches of posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA).One case underwent pre-surgical embolism during angiography.Eleven tumors were totally resected and 1 was fulgurized.Symptoms improved (n=8) and worsened (n=2).And two patients died.All survivors were followed up for 3 months to 10 years and had a McCormick functional grading ofⅠ-Ⅱ.One case relapsed 7 year later.

For Cystic HB, small or medium sized substantial HBin middle and lower part of oblongata, surgical removal is often safe and symptoms may be lessened.It can be used as a first-line treatment.For large (≥3 cm) substantial HB or HB in upper part of oblongata, serious postoperative complications such as respiratory failure, neurogenic pulmonary edema or acute obstructive hydrocephalus may occur.Thus surgical resection should be prudently considered and possible consequences thoroughly discussed with the patients.

To explore the attitudes and confidence of general practitioners (GPs) in handling dementia and its related problems.

A questionnaire survey was conducted among 287 GPs from 73 hospitals in Shanghai on September 25, 2012.It included basic practicing information and their attitudes and confidencein handling dementia and its related problems.

Among all participants, 78.4% of them responded that they encountered few demented patients during their clinical practices and only 24.7% of them had attended some dementia-related knowledge training courses.Senior GPs were less enthusiastic than junior GPs in handling dementia and its related problems as they were more likely to think that dementia should be diagnosed by a specialist (87.1% vs 74.8%,OR=2.28, 95% CI:1.14-4.57), less likely to actively refer patients (22.0% vs 10.1%,OR=2.52, 95% CI:1.24-5.14) and more likely to form an opinion that GPs had a very limited role in the care of demented patients (9.7% vs 0.7%, OR=15.59, 95% CI:1.96-123.81).

Most Shanghai GPs lack trainings about dementia and its related knowledge and their attitudes toward the care of dementia are pessimistic.Thus it is necessary to provide them more training to enhance their confidence and enthusiasm in the care of dementia.

To explore the effects of reconstructing method (narrow gastric tube (NGT) versus whole stomach (WS) ) on health-related quality of life (HRQL).

From 2007 to 2008, 104 patients underwent esophagectomy for cancer in our hospital.To assess HRQL, a questionnaire in reference to the EORTC-QLQ-C30 and the QLQ-OES18 was administered at 3 weeks, 6 months, 1 year, 2 year and 3 years after surgery.They were divided into NGT (n=52) and WS (n=52) groups.To assess HRQL, a questionnaire in references to EORTC-QLQ-C30 and QLQOES18 was administered at 3 weeks, 6 months, 1 year, 2 year and 3 years post-operation.Their clinical data were collected prospectively and follow-up was performed regularly.

The patients in the NGT group reported significantly (P<0.05) better average scores of HRQL at both 6 months and 1 year.However, no significant difference in average scores of HRQL was found at 3 years.Patients in the NGT group reported significantly (P<0.05) better scores of reflux at 3 weeks, 6 months and 1 year.Nausea was the only item with significant difference on HRQL at 2 years and 3 years.No significant difference existed between two groups with regards to cumulative survival rate at 3 years.

No significant difference existed between two groups with regards to cumulative survival rate at 3 years.The patients with gastric tube reconstruction after oncologic esophagectomy present better HRQL.Further studies are warranted to perform survival analysis beyond 3 year postoperation.

To explore the topical hemostatic effects of batroxobin (BX) and electric cauterization (EC) on capillary hemorrhage of rabbit with a removal of carotid arterial adventitia.

A total of 27 New Zealand rabbits were randomly divided into control, BX and EC groups.Each group received BX (2 kU/L), EC (power=40 W) and saline for topical hemostasis after a removal of carotid arterial adventitia and blunt dissection.The animals were euthanized by 0, 14 and 28 d post-operation.The specimens of adventitia removal section were divided into three parts for histology (hematoxylin and eosin, MASSON & transmission electron microscope), immunohistochemistry (IHC) [monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) ] and reverse transcriptionpolymerase chain reaction (RT-PCR).

At Day 28 post-operation, the remodeling index, stenotic rate and collagen fiber density of BX and EC groups were (0.753±0.0739) and (0.618±0.0989), (0.298±0.030)% and (0.363±0.039)%, (15.4±3.5)% and (23.4±5.1)% respectively.There was statistically significant difference between two groups (P<0.05) while no difference existed between hemocoagulase and control groups.The results of electron microscopy showed that the atrial fibroblasts of EC group increased markedly versus BX group.As demonstrated by RT-PCR and IHC, the expressions of MCP-1, TGF-β1 and VEGF in BX group were lower than those in EC group (P<0.05) while no difference versus the control group.

As a safe and effective topical hemostatic method, BX can effectively decrease inflammation response and reduce vascular remodeling and narrowing in rabbits with a removal of carotid arterial adventitia.And its effect mimic closely natural conditions.

To develop a magnetic nanoparticles based magnetic resonance (MR) probe targeting CD40 mutant in the imaging of breast cancer cells in vitro.

For preparing an immunologically competent probe, monoclonal antibody was conjugated with ultrasmall superparamagnetic iron oxide (USPIO) particles basing on chemical cross-linking method.Its bioactivity was analyzed with flow cytometry, confocal microscopy and Prussian blue staining.The probe′s cell MR imaging in vitro was conducted on breast cancer cells (M231) high expressing CD40 mutant.The signal data from different groups were collected and analyzed with one-way variance and least significant difference-t test.

The molecular probe carrying nanoparticles and CD40 mutant antibody was constructed and separated successfully.The probe had similar magnetic property compared with original USPIO particles.It could recognize CD40 mutant on breast cancer cells (M231) with high specificity.MR cell imaging in vitro shows that T₂ and T₂^* obviously shortened after probe binding with M231 cells and T₂ weighted imaging become darker than control groups,the time of T₂ is 5H6-USPIO (51.66±5.31), 5C11-USPIO (92.89±4.72), USPIO (64.56±3.85) ms.The T₂ and T₂^* relaxation time of experiment group was shorter than control groups with statistical significance (P<0.01).

MR molecular probe targeting CD40 mutant may bind with breast cancer cells (M231) to provide further in vivo animal MR imaging.And CD40 mutant is expected to provide a new target for MR molecular imaging of breast cancer.

To explore the effects of curcumin on the expression of high mobility group box1 (HMGB1), cell viability and morphology in a cellular model of Alzheimer′s disease (AD).

Cultured PC12 cells in logarithmic growth phase were divided into 5 groups: normal cell group (A, non-treatment), model control group (B, 20μmol/L Aβ25-35), curcumin treatment group (C, 20μmol/L Aβ25-35+ 1μmol/L Cur), Aβ25-35+ r H MG1 (D, 20μmol/L Aβ25-35+ 500 ng/ml HMGB1) and solvent control group (E, 20μmol/L Aβ25-35+ 1μl/ml DMSO).Cell viability was examined by methyl thiazolyl tetrazolium (MTT).And the cellular expression and distribution of HMGB1 were detected by immunofluorescence and Western blot 24 hours later.

Compared with group A, the levels of cell viability in groups B, D and E significantly declined (0.76±0.06, 0.63±0.02, 0.75±0.03 vs 1.22±0.06, P<0.05) while the expression of HMGB1 increased (1.19±0.14, 1.12±0.16, 1.16±0.09 vs 0.85±0.04,P<0.05).Compared with group B, cell viability in group C significantly increased by 33% (1.01±0.05, P<0.05) while the expression of HMGB1 declined by 31% (0.78±0.03, P<0.05).A larger amount of extracellular HMGB1 was released in group B compared with group A.And the extracellular release of HMGB1 declined less in group C versus group B.

Curcumin may reduce Aβ25-35-induced cytotoxicity through a downregulated expression of HMGB1 and an inhibition of extracellular release of HMGB1 in PC12 cell.