Evaluation of cilazapril in vasovagal syncope treatment

Objective: to evaluate cilazapril in vasovagal syncope treatment. Method: eighty-six cases of VVS patients found positive in TTT tilt were medicated with 2.5 mg cilazapril daily for three months and followed up by TTT. Results: seven cases quit due to cough or unexplained reason; 79 VVS patients had no more fainting spells; 75.95% of TTT results of patients changed to negative after 3 months therapy. The before and after cilazapril treatment average blood pressures (taken in lying position) were 121/73 mm Hg (1 mm Hg=0.133kPa) and 120/76 mm Hg respectively (P>0.05); and mean heart rates were 68.63±12.37/min and 70.13±13.15/min respectively with no significant changes (P>0.05). Conclusion: Cilazapril was effective in treatment of VVS; did not affect normal blood pressure and heart rate; was safe; and had little side effect.     

Video-assisted thoracoscopic surgery （VATS） for bilateral primary spontaneous pneumothorax

Objective:To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25-96 min) and (120.6±28.7) min (range 84-166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.     

Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.     

Conditioned cardiac and behavioral response topography to an olfactory CS dissociates with age

Conditioned cardiac and behavioral responses to an olfactory stimulus (CS) paired with electric shock (US) were studied in 16-, 23-, and 75-day-old rats. Heart rate and behavior were recorded during a single 15-trial training session in which a 10-sec olfactory stimulus (amyl acetate) was either paired or explicitly unpaired with the US. In the preweanling rats, the conditioned cardiac response consisted of anincrease in heart rate (tachycardia) and a slight increase in investigatory behaviors. In contrast, the conditioned cardiac response in the adult rats consisted of adecrease in heart rate (bradycardia) and a striking increase in behavioral immobility (freezing). The 23-day-old rats showed a dichotomous pattern of responding; some showed preweanling-like conditioned responses and some showed adultlike responses. Developmental changes in neural organization and degree of learning are discussed as possible determinants of the transition from infant to adult modes of responding.     

Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients

INTRODUCTION In the arsenal of cardiac functional parameters,cardiac output(CO),cardiac index(CI),and strokevolume(SV)are potentially important determinantsof hemodynamics,the measurement of which relieson complicated and sometimes invasive techniques.In the case of congestive heart failure,non-invasivemethods to provide accurate measures of these pa-rameters during exercise stress testing would addsignificant objectiveness to the test result.This couldbe of considerable importance for …     

硝普钠与拉贝洛尔对高血压急症患者血液流变学影响的对比观察

目的：观察硝普钠与拉贝洛尔对高血压急症患者血液流变学的影响。方法：高血压急症56例,随机分为硝普钠组与拉贝洛尔组。28例采用硝普钠治疗,其它28例给予拉贝洛尔。两组均静脉持续用药6小时。每例于治疗开始和结束时分别进行血液流变学检测。结果：降压总有效率硝普组为100％（28／28）,拉贝洛尔组92．9％（26／28）,两组差异无统计学意义（P〉0．05）,但硝普钠组起效快于拉贝洛尔组。患者经硝普钠治疗后,血液流变学显示低切变率下全血粘度、高切变率下全血粘度、血浆比粘度、红细胞取集指数及血小板聚集率均显著下降（P〈0．01或P〈0．05）,与拉贝洛尔组比较,差异有显著性（P〈0．05）。拉贝洛尔组血液流变学各指标值虽有下降,但未达到统计学显著性程度（P〉0．05）。与药物有关的不良反应,硝普钠组明显低于拉贝洛尔组（3．6％,vs 21．4％,P〈0．05％）。结论：硝普钠治疗高血压急症疗效确切、起效快、不良反应少,且该药有改善血液流变性作用,优于拉贝洛尔。     

Low‐intensity pulsed ultrasound ameliorates angiotensin II-induced cardiac fibrosis by alleviating inflammation via a caveolin-1-dependent pathway

ObjectiveCardiac hypertrophy and fibrosis are major pathological manifestations observed in left ventricular remodeling induced by angiotensin II (AngII). Low-intensity pulsed ultrasound (LIPUS) has been reported to ameliorate cardiac dysfunction and myocardial fibrosis in myocardial infarction (MI) through mechano-transduction and its downstream pathways. In this study, we aimed to investigate whether LIPUS could exert a protective effect by ameliorating AngII-induced cardiac hypertrophy and fibrosis and if so, to further elucidate the underlying molecular mechanisms.MethodsWe used AngII to mimic animal and cell culture models of cardiac hypertrophy and fibrosis. LIPUS irradiation was applied in vivo for 20 min every 2 d from one week before mini-pump implantation to four weeks after mini-pump implantation, and in vitro for 20 min on each of two occasions 6 h apart. Cardiac hypertrophy and fibrosis levels were then evaluated by echocardiographic, histopathological, and molecular biological methods.ResultsOur results showed that LIPUS could ameliorate left ventricular remodeling in vivo and cardiac fibrosis in vitro by reducing AngII-induced release of inflammatory cytokines, but the protective effects on cardiac hypertrophy were limited in vitro. Given that LIPUS increased the expression of caveolin-1 in response to mechanical stimulation, we inhibited caveolin-1 activity with pyrazolopyrimidine 2 (pp2) in vivo and in vitro. LIPUS-induced downregulation of inflammation was reversed and the anti-fibrotic effects of LIPUS were absent.ConclusionsThese results indicated that LIPUS could ameliorate AngII-induced cardiac fibrosis by alleviating inflammation via a caveolin-1-dependent pathway, providing new insights for the development of novel therapeutic apparatus in clinical practice.     

一次性使用持续注入器持续输注氯普鲁卡因在硬膜外麻醉中的临床应用

①目的:探讨一次性使用持续注入器输注氯普鲁卡因在硬膜外麻醉中的效果,以积累临床经验,指导临床工作.②方法:选取90例硬膜外麻醉的患者,随机分为两组,观察组(45例)应用一次性使用持续注入器持续输注氯普鲁卡因,对照组(45例)应用一次性使用持续注入器持续输注利多卡因.③结果:实验组在麻醉起效时间、痛觉消失时间及运动阻滞时间明显短于对照组,实验组低血压的发生率明显高于对照组.④结论:氯普鲁卡因用于硬膜外麻醉,麻醉效果较好,适合持续输注,但要警惕低血压的发生.     

Creation of reversed phase high-performance liquid chromatographic technique to assay platelet-activating factor

Objective: To establish a new assay for platelet-activating factor (PAF), to compare it with bio-assay; and to discuss its significance in some elderly people diseases such as cerebral infarction and coronary heart disease. Methods: To measure PAF levels in 100 controls, 23 elderly patients with cerebral infarction and 65 cases with coronary heart disease by reversed phase high-performance liquid chromatographic technique (rHPLC). Results: rHPLC is more convenient, sensitive, specific, and less confusing, compared with bio-assay. The level of plasma PAF in patients with cerebral infarction was higher than that in the controls (P<0.01), and in patients with coronary heart disease. Conclusion: Detection of PAF with rHPLC is more reliable and more accurate. The new assay has important significance in PAF research.     

Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI), who were treated with emergency percutaneous coronary intervention (PCI). Methods: 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate (eGFR) was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01). CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032, odds ratio (OR) 4.159, 95% confidence interval (CI) 1.127-15.346). Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.     

Creation of reversed phase high-performance liquid chromatographic technique to assay platelet-activating factor

INTRODUCTION Platelet activating factor (PAF), a kind of pho-spholipids compound, synthesized and secretedmainly by neutrophilic granulocyte, platelet, is ahighly potent chemical mediator in inflammationand allergic reactions and induces microvascularleakage in several tissues (Chung, 1997). PAFs arefew in vivo, have short half life (only about 30seconds) and rapidly convert to lyso-PAF that hasno bio-activity and is both the metabolite and pre-cursor of PAF (Rao, 1998). Lyso-P…     

MGB probe assay for rapid detection of mtDNA11778 mutation in the Chinese LHON patients by real-time PCR

Objective:Leber's hereditary optic neuropathY (LHON)is a maternally inherited degeneration of the optic nerve caused by point mutations of mitochondrial DNA(mtDNA).Many unsolved questions regarding the penetrance and pathophysiological mechanism of LHON demand efficient and reliable mutation testing.This study aims to develop a minor groove binder(MGB) probe assay for rapid detection of mtDNA11778 mutation and heteroplasmy in Chinese LHON patients by real-time polymerase chain reaction(PCR).Methods:Forty-eight patients suspected of having LHON and their maternal relatives underwent a molecular genetic evaluation,with 20 normal individuals as a control group at the same time.A real-time PCR involving two MGB probes was used to detect the mtDNA 11778 mutation and heteroplasmy.A linear standard curve was obtained by pUCmLHONG and pUCmLHONA clones.Results:All 48 LHON patients and their matemal relatives were positive for mtDNA 11778 mutation in our assay,27 heteroplasmic and 21 homoplasmic.Eighteen cases did not show an occurrence of the disease,while 9 developed the disease among the 27 heteroplasmic mutation cases.Eleven did not show an occurrence of the disease,while 10 cases developed the disease among 21 homoplasmic mutation cases.There was a significant difierence in the incidence between the heteroplasmic and the homoplasmic mutation types.The time needed for running a real-time PCR assay was only 80 min.Conclusion:This real-time PCR assay is a rapid,reliable method for mtDNA mutation detection as well as heteroplasmy quantification.Detecting this ratio is very important for predicting phenotypic expression of unaffected carriers.     

Administration of fentanyl via a slow intravenous fluid line compared with rapid bolus alleviates fentanyl-induced cough during general anesthesia induction

Objective

Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia.

Methods

A total number of 1200 patients, aged 18–64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025.

Results

Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%–11.4% vs. 55.9%, 95% CI: 51.8%–60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05).

Conclusions

The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.

     

先天性巨大房缺的外科治疗

目的:探讨巨大房缺手术治疗特殊性,提高巨大房缺的手术安全性和治疗效果。方法:通过对23例巨大房缺的手术治疗(其中常规体外循环下纠治17例、不停跳下纠治6例,补片修补17例、直接修补6例),对其术前诊断、病情和并发畸形的估计、手术方法和经验教训等进行总结分析。结果:22例手术顺利,治愈出院.仅1例围术期死亡;但发现术前心脏彩超对房缺的大小、分型、合并畸形的诊断等有一定的局限性,易于误诊、漏诊。结论:巨大房间隔缺损外科治疗疗效确实,安全性高,但应提高对其常常合并肺静脉异位引流的认识,以免造成手术困难、甚至发生危险。     

Comparison of low-molecular-weight-heparin and unfractionated heparin for acute PTE

INTRODUCTION Acute pulmonary thromboembolism(PTE)is serious pulmonary vascular disease with high mortality.The challenge is to make a correct diagnosiand give appropriate treatment(Nicolaides et al.2001).Effective treatment will decrease morbidityand mortality.This study compares the efficacy,adverse effects and costs of low-molecular-weightheparin(LMWH)and unfractionated heparin(UH).MATERIALS AND METHODS Materialss a or-sis al.,ity ad-ht-).All patients diagnosed as non-massiv…     

视可尼喉镜在有门齿状况老年患者气管插管中的应用

目的：比较SOS与直接喉镜在合并有门齿状况的老年患者气管插管中的安全性与成功率。方法：选择全麻插管下行择期手术的老年患者80例,其中门齿松动者27例,门齿残缺者32例,门齿孤立牙者21例,随机均分为SOS组（S组）和直接喉镜组（Z组）。记录并对比两组插管次数、插管时间和插管并发症情况。结果：S组患者均能一次性快速经口气管插管成功（100%）,明显高于Z组（45%）,而且Z组12例（25%）患者3次插管不成功改用SOS一次插管成功。S组没有一例患者因插管操作不当造成门齿损伤或脱落,而Z组有4例直接导致门齿脱落,9例导致门齿松动。S组插管时间为21（9~58）s,明显短于Z组的44（15~65）s（P〈0.05）。结论：SOS对于门齿有松动、残缺、甚至孤立牙的老年患者,插管成功率高,用时短,插管并发症少,是一种安全有效的插管方法。     

Estrogen receptor expression in adrenocortical carcinoma

Objective: Adrenocortical carcinoma (ACC) is a rare but highly malignant tumor, and its diagnosis is mostly delayed and prognosis is poor. We report estrogen receptor (ER) expression in this tumor and our clinical experiences with 17 ACC cases. Methods: The data of the 17 patients (9 females and 8 males, age range from 16 to 69 years, mean age of 42.6 years) with ACC were reviewed, and symptoms, diagnostic procedures, treatment, and results of follow-up were evaluated. Immunohistochemistry was used to detect ER expression in tumor samples from the 17 patients. Results: At the time of diagnosis, 4 tumors were classified as Stage Ⅰ, 4 as Stage Ⅱ, 3 as Stage Ⅲ, and 6 as Stage Ⅳ. Eight patients demonstrated positive nuclear immunostaining of ER. The prognosis of patients with ER positive was significantly better (P<0.05) than that of patients with ER negative, with 1- and 5-year survival rates at 86% and 60% for ER-positive patients, and 38% and 0% for ER-negative patients, respectively. Conclusion: ER-positivity may be one of the factors associated with a worse prognosis of ACC.     

无痛结肠镜检查的效果观察

目的:探讨异丙酚、芬太尼联合静脉麻醉辅助结肠镜检查的效果。方法:将420例患者随机分为两组,自愿接受异丙酚、芬太尼静脉麻醉后行结肠镜检查者220例,未经静脉麻醉接受结肠镜检查者200例,比较两组患者完成结肠镜检查成功率,观察有无腹部疼痛和恶心、呕吐等副反应情况。结果:麻醉组检查成功率100%,均未诉腹部疼痛,恶心者占1.36%;未麻醉组检查成功率为95.5%,主诉腹部疼痛者占98.5%,主诉恶心、呕吐者占24.5%。检查效果有显著性差异,p均小于0.05。结论:异丙酚、芬太尼联合静脉麻醉用于结肠镜检查,能使患者安全、轻松地完成镜检,并减轻患者痛苦。     

Aorta-to-right atrium fistula, an unusual complication of endocarditis

Infective endocarditis (IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious compli-cation of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis, vegetation, perforation of noncoronary sinus, and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardi-ography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis, aggressive antibacterial therapy, and surgical treatment may improve the prognosis.     

川崎病合并支原体感染14例诊治体会

目的探讨小儿川崎病合并支原体感染的临床特征及诊治体会。方法对临床诊断为川崎病合并支原体感染的患儿进行回顾性分析。结果 14例患儿均有发热;球结合膜充血13例,皮疹8例,口腔粘膜改变14例,手足硬性水肿、指（趾）脱皮14例,颈部淋巴结肿大12例,卡痕、肛周粘膜潮红5例。白细胞增高、血C R P增高9例,心脏彩超示冠状动脉病变（C AL）2例。所有患儿均用阿奇霉素序贯治疗,并早期大剂量人血丙种球蛋白（IVIG）及阿司匹林、潘生丁治疗,13例治愈,1例呈IVIG不反应,再次予以IVIG后痊愈。结论肺炎支原体可能参与川崎病的发病。