Table of Content

21 April 2013, Volume 34 Issue 2

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Magnolol pretreatment prevents sepsis-induced intestinal dysmotility by maintaining functional interstitial cells of Cajal

MIAO Bin, ZHANG Shuwen, WANG Hong, YANG Tiecheng, ZHOU Deshan, WANG Baoen

2013, 34(2):  163-170.  doi:10.3969/j.issn.1006-7795.2013.02.001

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Objective To investigate the mechanism by which magnolol treatment prevents sepsis-induced dysmotility in lipopolysaccharide(LPS)-treated mice. Methods Sepsis was induced by intravenous(tail vein) injection of LPS. Animals were divided into four groups: the magnolol-treated septic group, the mosapride-treated septic group,the placebo-treated septic group, and the control group. Intestinal transit and circular smooth muscle contraction were measured 12 h after LPS injection, and immunocytochemisty was performed to study the morphology of ICCs. NO content, superoxide dismutase(SOD) activity, and malondialdehyde(MDA) concentration were detected using commercial kits. Results Intestinal transit and muscular contractility were significantly lower in the LPS-treated group than in the control group. Immunocytochemical experiments showed that the total number of ICCs, and the total and average lengths of the ICC processes were significantly decreased in the LPS-treated group compared with those in the control group. In LPS-treated animals, magnolol pretreatment significantly accelerated intestinal transit, increased circular muscle contraction, and prevented ICC morphological changes. Magnolol pretreatment prevented the sepsis-induced increase in NO concentration, and MDA concentration, and decrease in SOD activity in LPS-treated animals. Conclusion Magnolol treatment prevented sepsis-induced intestinal dysmotility by regulating oxidative stress to maintain functional ICCs.

A prospective study on withholding and withdrawing of life support treatment in a Chinese intensive care unit

ZHANG Qi, JIANG Li, XI Xiuming

2013, 34(2):  171-176.  doi:10.3969/j.issn.1006-7795.2013.02.002

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Objective To investigate the withholding and withdrawing of life supporting treatment in intensive care unit. Methods We undertook a prospective observational study in one Chinese university-hospital intensive care unit(ICU) between Jun 2009 and May 2011. Data were collected from all patients for whom decisions to withhold or withdraw life-supporting treatments were made, the data included age, sex, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), and previous chronic diseases. All patients were followed up until death or discharge from the ICU, and the length of ICU stay were recorded. Patients for whom such decisions were made were classified by the type of decision: group A was withheld, group B was withdrawn, group C was only DNR during dying. Results Totally 86 patients whose life support was withheld or withdrawn during the ICU duration were enrolled. That was 7.2% of the total admissions in the same period. These patients aged (76.6±12.5) years and 50.0% were male; 68.6% decisions were made by family request; 53.5% patients were covered by medical insurance. Death or discharge occurred 41.0 h after decision of withholding or withdrawing. During the study, 69 patients died in ICU(30.9% of all the ICU death), ICU mortality was 80.2%. Compared to group A and C, group B had less surviving time and less medical expense. Conclusion The percentage of withholding or withdrawing of life-supporting treatment was not high in our ICU. The families were the major part who made the requests. Only One-third of the ICU deaths in our study were preceded by a decision to withhold or withdraw life-supporting treatment. Withdrawing life-support led to less medical expense.

Use of antibiotics in postoperative intracranial infection patients in neurosurgery

YUE Xiaoyan, SHI Guangzhi

2013, 34(2):  177-180.  doi:10.3969/j.issn.1006-7795.2013.02.003

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Objective To understand the situation of antibiotics use and intracranial infections in postoperative patients in neurosurgical department. Methods The data of the time of intracranial infection, bacteria detected in cerebrospinal fluid(CSF) culture and the use of the antibiotics were collected in patients who underwent neurosurgery from January 2009 to June 2011. Results Among 21 067 cases, positive results of CSF culture accounted for 1.2%(253 cases). The mean time from operation to intracranial infection occurrence was 7.2 days, the time to obtain culture result was 10.2 days. The most frequently isolated bacterium was coagulase negative staphylococcus(28.85%), followed by Staphylococcus aureus(14.62%). Antibiotics were empirically used in all CSF positive patients. Antibiotics were sensitive in 33.4% of empiric use cases and 82.9% of the cases in whom antibiotics were used against specific targets were sensitive. Conclusion The positive rate of CSF culture was low. The coagulase negative staphylococci and Staphylococcus aureus play important role in intracranial infection. Though antibiotics are used often, adequate use should be emphasized.

Effect of tight glycemia control on the clinical outcome in critically brain-injured patients: a Meta-analysis

YIN Ningning, YUE Xiaoyan, CAI Yehua, ZHOU Jianxin

2013, 34(2):  181-186.  doi:10.3969/j.issn.1006-7795.2013.02.004

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Objective To evaluate the effect of tight glycemia control(TGC) on the clinical outcome in critically brain-injured patients. Methods All randomized controlled trials on the use of TGC in critically brain-injured patients were identified by computer and manual retrieval. Studies were enrolled if adult patients were randomized to receive TGC or conventional glycemia control(CGC). Extracted data included mortality, long-term neurological outcome and rate of hypoglycemia. Results Sixteen trials were enrolled in this meta-analysis, 9 were published in English and 7 in Chinese. Modified Jadad scores were more than or equal to 4 in 10 trials, in which only 1 trial was published in Chinese. There were no significant differences in hospital mortality or late mortality between TGC and CGC groups. The rate of hypoglycemia was higher in TGC group. The combined rate of good long-term neurological outcome was significantly higher in survived patients receiving TGC(odd ratio=1.37, 95% confidence interval: 1.05~1.80). Conclusion TGC was beneficial at improving long-term neurological outcome in critically brain-injured patients. The quality of randomized controlled trials published in Chinese should be further improved.

Biomarkers in predicting renal replacement therapy in acute septic kidney injury

JIANG Bo, JIANG Li, XI Xiuming

2013, 34(2):  187-190.  doi:10.3969/j.issn.1006-7795.2013.02.005

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Objective To evaluate whether the serum neutrophil gelatinase associated lipocalin(sNGAL), urinary neutrophil gelatinase lipocalin(uNGAL), urinary interleukin-18(uIL-18) or urinary kidney injury molecule-1(uKIM-1) can predict the need for renal replacement therapy(RRT)in patients with septic acute kidney injury(AKI). Methods A prospective observational study was conducted in patients with septic AKI whose expected ICU stay ≥24 h. AKI was defined by American Kidney Injury(AKIN) criteria during the 48 h after admission, while sNGAL, uNGAL, uIL-18 and uKIM-1 were determined at the enrollment. Test characteristics were calculated to assess the diagnostic performance of these biomarkers. Results Forty-five patients were studied, RRT was initiated in 12 patients with septic AKI in the first 7 days. Two groups were defined according to the need of RRT: RRT group(n=12) and non-RRT group(n=33). RRT group had higher median uNGAL level compared to non-RRT group(912.0 vs 218.0 ng/mL, P<0.001). The predicting performance for uNGAL was good(AUC 0.88), and that of sNGAL, uIL-18 and uKIM-1 was poor(AUC 0.68,0.69,0.67, respectively). Conclusion uNGAL might be a good biomarker for predicting the need of RRT in patients with septic AKI.

Automated mode in the weaning of mechanical ventilated patients: a systematic review

ZHU Bo, LI Zhiqiang, XI Xiuming

2013, 34(2):  191-200.  doi:10.3969/j.issn.1006-7795.2013.02.006

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Objective To investigate the effects of automated weaning mode on the total duration of mechanical ventilation, weaning duration, mortality, length of stay in the intensive care unit and hospital, and adverse events. Methods We searched PubMed, EMBASE, CINAHL, CENTRAL, SinoMed and ISI Web of knowledge, and reference list of articles. We included randomized and quasi-randomized controlled trials comparing automated with non-automated mode in the weaning from mechanical ventilation in critically ill adults. The quality of included studies was critically evaluated and quantitatively analyzed. Results Thirteen trials met the inclusion criteria. Compared with non-automated mode, the duration of mechanical ventilation and weaning in the weaning automated group was reduced significantly [MD=-63.98, 95%CI(-108.67, -19.29)] and [MD=0.84, 95%CI(-1.31, 2.99)], respectively in the mechanical ventilation <24 h subgroup. The re-intubation rate and requirement for protracted weaning over 14 days were significant in the mechanical ventilation <24 h subgroup. Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and adverse events when automated mode are used. As a result of significant heterogeneity among studies, our findings should be interpreted with caution.

Berlin definition of acute respiratory distress syndrome: what has been changed?

DU Bin

2013, 34(2):  201-203.  doi:10.3969/j.issn.1006-7795.2013.02.007

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Since the publication of American-European Consensus Conference(AECC) definition of acute respiratory distress syndrome(ARDS) in 1994, the limitations of the AECC definition were recognized. In 2012, the Berlin definition of ARDS was published, specifying the acute time frame, and creating illustrative vignettes to guide judgments about the primary cause of respiratory failure. However, the Berlin definition still classified the severity of oxygenation impairment by oxygenation index, which might be subject to the influence of inspired fraction of oxygen. In addition, there is no evidence that the reference set of chest radiographs helps to enhance inter-observer reliability. 【

Self-face recognition of mania

JIA Hongxiao, YIN Mengya, ZHU Hong

2013, 34(2):  204-206.  doi:10.3969/j.issn.1006-7795.2013.02.008

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Objective To investigate self-abnormality in manic patients using the experimental psychological paradigm of self-face recognition(SFR). Methods Totally 32 manic patients who met the criteria of mania in DSM-Ⅳ and 32 healthy subjects matched in gender, age and education level were tested. The subjects were asked to recognize the face images presented on the computer, the data of the reaction times were recorded by the computer and were analyzed by Metlab and SPSS software. Results The manic patients showed slower responding time on recognizing pictures than the healthy controls. Healthy controls were faster in recognizing one’s own picture than strangers’ picture(P<0.05); the manic patients showed no significant difference in recognizing all kinds of pictures(P>0.05). Conclusion There was abnormality on self-face recognition in manic patients, compared to normal subjects.

Self-face recognition of depression

YIN Mengya, JIA Hongxiao, ZHU Hong, LIU Jia

2013, 34(2):  207-210.  doi:10.3969/j.issn.1006-7795.2013.02.009

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Objective To investigate self-abnormality of depression patients using the experimental psychology paradigm of self-face recognition(SFR). Methods We used the Photoshop, Murph image processing technology to prepare the face images of 16 patients with depression who met the criteria of the DSM-Ⅳ and 16 normal subjects with matched gender, age and education level. The subjects were asked to recognize the face images presented on a computer, the data of the response times recorded by the computer were analyzed by Metlab and SPSS software. Results In the self face images recognition, the patients with depression were slower than that of the healthy subjects(P<0.05). In the stranger images recognition, there were no statistically significant differences between depression patients and healthy subjects(P>0.05). And in the famous images recognition, the right hands of depression patients reacted slower than normal subjects(P<0.05), and left no statistical difference(P>0.05). Conclusion The result indicated that depression patients had self-abnormality.

Therapeutic effect of the decoction of clearing heat and relieving depression combine with fluoxetine in the treatment of treatment resistant depression

YUAN Haining, JIA Hongxiao, ZHU Hong, TIAN Jinzhou, SHI Jing

2013, 34(2):  211-213.  doi:10.3969/j.issn.1006-7795.2013.02.010

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Objective To observe the effect of the decoction of clearing heat and relieving depression combined with fluoxetine in the treatment of treatment-resistant depression. Methods Fifty-five cases of treatment-resistant depression were randomized into the control group or study group. The control group was treated with fluoxetine, while the study group was treated with fluoxetine combined with Chinese medicine. The scores of Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale(HAMA) were observed and compared. Results After treatment, the scores of HAMD in study group decreased significantly compared with baseline group at week 8 and week 12(P<0.05 and P<0.01). The scores of both HAMA in study group decreased significantly compared the control group at week 8 and week 12(P<0.05 or P<0.01). This decrease begins with the fourth week till the end of the study. Conclusion The therapy with the decoction of clearing heat and relieving depression could improve the effect of fluoxetine on treatment-resistant depression.

Progress in studies on processing and its neural mechanism for familiar face

LIU Shanshan, JIA Hongxiao, LIU Jia

2013, 34(2):  214-217.  doi:10.3969/j.issn.1006-7795.2013.02.011

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Research on familiar face processing has attracted more attentions. In the past decades, understanding of familiar face processing through a variety of cognitive neuroscience, neuropsychology, and relatively accurate survey of functional neuroimaging investigations has achieved considerable progresses. This article reviews the influencing factors, functional modes and involved neural basis of familiar face processing and the processing abnormalities in clinical manifestation.

Education and training of family medicine in Taiwan

LEE Mengchi

2013, 34(2):  218-223.  doi:10.3969/j.issn.1006-7795.2013.02.012

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Family Medicine was first adopted by both medical community and health authority of Taiwan in 1970s, and the Taiwan Association of Family Medicine was established in 1986. Since 2000, the projects of family physicians system as well as the integration of primary settings and hospitals have been on the way. In response to the demands of people in modern society, the Family Medicine education in Taiwan pays more attention to learners’ competence and professionalism to take care of patients and to solve their health problems. Problem or task-based learning, clinical skills training and examinations, education on behavior sciences and communication skills, and community rotations have been applied to trainees in order to provide a patient-centered and community-oriented holistic care. Family Medicine has been fully accepted as one of medical specialties based on its own academy and irreplaceable position in health care system. The characteristics of Family Medicine are not only its broader knowledge and skills, but also its unique philosophy and attitudes in taking care of patients and their families. It’s no doubt that the education and training of Family Medicine is the key factor for success.

Sildenafil inhibits hypoxia-induced voltage-dependent potassium channels downregulation in human pulmonary artery smooth muscle cells

MAO Ting, WANG Yuexiu, LIU Jie, LI Jing, WANG Jun

2013, 34(2):  224-231.  doi:10.3969/j.issn.1006-7795.2013.02.013

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Objective To investigate the effect of sildenafil on hypoxia-induced voltage-dependent potassium channels(Kv) downregulation in human pulmonary artery smooth muscle cells(PASMCs). Methods Patch clamp techniques were applied to record K⁺ currents from human PASMCs cultured with SMBM(2% FBS) in normoxia or hypoxia(3% O₂) in the absence or presence of sildenafil(100 nM) for 72 h. Furthermore, the effect of sildenafil on the Kv channel subfamily was examined via the special anti-Kv1.5 antibody dialysis. Real-time PCR and Western blotting techniques were performed to detect the gene transcription and protein expression of Kv1.5 channel in human PASMCs. Results Hypoxia obviously inhibited whole-cell K⁺ currents in PASMCs; sildenafil significantly restored hypoxia-decreased K⁺ currents; Kv1.5 channel is the target of the modulation of sildenafil on Kv in hypoxic PASMCs; sildenafil partially restored hypoxia-inhibited mRNA and protein expression of Kv1.5 channel in PASMCs. Conclusion Sildenafil inhibits hypoxia-induced voltage-dependent potassium channels downregulation in human PASMCs.

Change of NHERF family protein and CAL protein in Parkinson’s rats gastrointestinal tissue

SHI Xiaocui, FENG Xiaoyan, SONG Ran, YANG Longyan, HE Junqi

2013, 34(2):  232-238.  doi:10.3969/j.issn.1006-7795.2013.02.014

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Objective To study the expression of NHERF family protein and CAL protein in the digestive system of Parkinson’s disease, and investigate the mechanism of the dysfunction of digestive system in Parkinson’s disease. Methods Substantia nigra dopaminergic neurons of the SD rats were damaged by injecting 6-hydroxydopamine(6-OHDA) in the brain substantia nigra. Western blotting analysis for the expression of NHERF family protein and CAL protein in the gastry, duodenum and colon of the control and 6-OHDA treated rats were performed. Results The Western blotting results showed that the protein level of PDZK1 and CAL in the gastric corpus was enhanced in 6-OHDA treated rats, the protein level of NHERF1, NHERF2 and PDZK1 in the duodenum was increased in 6-OHDA treated rats, the protein level of NHERF1, PDZK1 and CAL in the colon was enhanced in 6-OHDA treated rats. Conclusion The upregulation of NHERF family protein and CAL protein may contribute to the dysfunction of digestive system in 6-OHDA treated rats. These results provide a strong evidence for further studying the mechanisms of digestive system dysfunction in Parkinson’s disease.

Therapeutic effect of citalopram on depressive model rats and the relative mechanism

YAO Yao, YANG Jian, PEI Yu, WANG Yong, MA Xin, WANG Xiaomin, Wang Xuan

2013, 34(2):  239-244.  doi:10.3969/j.issn.1006-7795.2013.02.015

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Objective To explore the protective effect of citalopram on depressive model rats and the relative mechanism through continuous intraperitoneal injection of citalopram. Methods Establishing chronic unpredictable stress rat model. It consisted of a variety of stressors applied randomly every day for 4 weeks, The type of stressor included restraint, forced swim, food or water deprivation, tail pinch and so on. Successful model rats were subjected to continuous intraperitoneal injection with different doses of citalopram for 3 weeks, followed by behavioral tests. Sacrificing the rats immediately after the last behavioral test, the content of brain-derived neurotrophic factor(BDNF) in the hippocampus and serum was detected by ELISA and Western Blotting. Results After chronic unpredictable stress for 4 weeks, the model rats displayed lower weight gain, decreased sucrose preference, and reduced locomotor activity. Intraperitoneal injection with 10 mg·kg^-1·d^-1 citalopram for 3 weeks could significantly increase the sucrose preference and the movement distance of model rats. Intraperitoneal injection with 10 mg·kg^-1·d^-1 citalopram for 3 weeks could significantly increased the content of BDNF in the serum and the hippocampus of model rats. Conclusion Rats subjected to chronic unpredictable stress for 4 weeks displayed apparent depressive symptoms. Intraperitoneal injection with 10 mg·kg^-1·d^-1 citalopram for 3 weeks could improve the depressive behavior of model rats, the underlying mechanism may relate to increased BDNF content in the hippocampus.

Analysis of the psychological status in relation to employment among undergraduates of the Capital Medical University

DU Lianlian, CHEN Yanwei, WU Wei

2013, 34(2):  245-250.  doi:10.3969/j.issn.1006-7795.2013.02.016

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Objective To improve students' psychological health related to job hunting through an investigation into the psychological status of undergraduates in Capital Medical University. Methods We compiled a questionnaire, the importance of the survey to the respondents, applied the anonymous method, and asked them to fill the forms. The sampling method we took was stratified cluster sampling, in selected six classes from six schools to investigate the psychological status of students, then we analyzed the data by using T test and nonparametric test methods. Results The survey showed that, 38.5% respondents suffered severe psychological pressure, which has negative influence on students' normal life. Students in different schools with different basic psychological status and different goals had different levels of pressure. Conclusion Undergraduates in this university have severe psychological pressure and some of them are bothered by job hunting.

Expression of Toll-like receptor 11~13 in mast cells

LI Yan, LI Bo, YAO Xiujuan, LV Zhe, AN Yunqing, WANG Wei, HUANG Kewu, SUN Ying

2013, 34(2):  251-257.  doi:10.3969/j.issn.1006-7795.2013.02.017

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Objective To identify whether murine mast cells express Toll-like receptors 11-13(TLR11-13). Methods Reverse transcription polymerase chain reaction(RT-PCR), flow cytometry and immunofluorescent staining were used to detect the expression of TLR11-13 in murine bone marrow-derived mast cell(BMMC) and mast cell line MC/9 at the levels of mRNA and protein. Results Both BMMC and MC/9 expressed TLR11-13 at both mRNA and protein levels. Conclusion The expression of TLR11-13 by mast cells has provided clues to future investigating biological functions of these TLRs in mast cells.

Interleukin 1 receptor accessory protein contributes to children and adult low grade gliomas

XING Shushan, HU Wanning, ZHAO Xiqing, LIU Wenqing, GONG Jian

2013, 34(2):  258-263.  doi:10.3969/j.issn.1006-7795.2013.02.018

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Objective To analyze the expression of interleukin 1 receptor accessory protein(IL-1RAP) in children and adult low grade gliomas(LGG) and correlation between the level of this markers and low grade gliomas recurrence. Methods The samples of LGG were collected and divided into two groups(adult group and children group).Gene expression profiles in adult group and children group were compared by microarray. The expression of changed gene was indentified by immunohistochemistry(IHC), Western blot and quantitative real-time PCR(qRT-PCR) in 20 cases of LGG(10 children, 10 adult). Results We identified that IL-1RAP was consistently up-regulated in children group LGG with the adult group LGG by cDNA array, and the level of IL-1RAP in children group was significantly higher than that of adult group detected by RT-PCR, Western blot and IHC(Chi-Square=12.439, P<0.05). Conclusion IL-1RAP may be the potential biomarkers to evaluate the inclination of invasion and recurrence in children and adult low grade gliomas. And the dysregulation of IL-1RAP may be critical for malignant astrocytoma formation, and thus a possible novel universal target for therapeutic intervention.

Comparison of clinical effects of total lumbar disc replacement for different indications

WANG Yu, KONG Chao, LU Shibao, HAI Yong, WANG Qingyi, ZANG Lei, MENG Xianglong

2013, 34(2):  264-269.  doi:10.3969/j.issn.1006-7795.2013.02.019

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Objective To retrospectively compare the clinical effects of total disc replacement for different indications. Methods From December 1999 to December 2006, 65 patients suffered from degenerative disc diseases were treated with Charite SB Ⅲ disc replacement. The patients were subdivided into 3 groups according to their diagnosis: 1 nine patients with discogenic low back pain; 2 thirty-five patients with degenerative disc disease(DDD), accompanying soft disc herniation(nucleus pulposus prolapse, NPP); 3 four patients with recurrence of NPP after disctomy. All patients were evaluated by VAS Score(0-100 pts) and ODI Score(%) pre-operatively and 1, 3, 6, 12, 24 months after surgery and at the final follow-up. Radiographic parameters as range of motion(ROM) of the index level were evaluated by A-P and dynamic X-Ray. Statistical calculations were conducted with the above data. Results Comparing results in each group: during the follow-ups, in the three groups significant differences were found in VAS Score and ODI Score compared with those before surgery; during the follow-ups, the ROM in three groups were well maintained and showed no significant difference with that before surgery. Compared results among groups: pre-operative VAS Score and ODI Score of patients with DDD accompanying NPP were higher than those of other two groups. At the final follow-up, there was no significant difference of VAS Score and ODI Score among three groups, but patients with DDD accompanying NPP had a better remission rate. During the follow-ups, the ROM in three groups were well maintained and showed no significant difference with that before surgery. At the final follow-up, there are no significant differences among the different groups. But patients with DDD accompanying NPP achieved better remission rate than the other two groups(P<0.05). There was no significant difference among the three groups pre-operatively and during the follow-ups. Conclusion Discogenic low back pain, DDD accompanying NPP and recurrence of NPP after disctomy are good indications for TDR. For patients with DDD accompanying NPP, TDR is an excellent choice.

Simultaneous determination of five psychoactive drugs in overdosed patients serum by high performance liquid chromatography

GUO Wei, ZHAO Ye, GUO Guixin, ZHANG Jun, SUN Chuan, RONG Zhang, DUAN Xiaoxia, LI Wenbiao, ZHAI Yimin

2013, 34(2):  270-274.  doi:10.3969/j.issn.1006-7795.2013.02.020

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Objective A high performance liquid chromatography(HPLC) method with ultraviolet(UV) detection(230 nm) was developed and validated for the quantification of 5 drugs, Risperidone, clozapine, reboxetine, 9-hydroxy Risperidone and norclozapine, in human serum. Methods Following a one-step liquid-liquid extraction with diethyl ether, the analyte and internal standard(paroxetine) were separated using an isocratic mobile phase consisted of acetonitrile: methanol: butylamine: acetic acid: deionized water=20: 2.9: 1.1: 1: 34.3 on a reverse phase Inertsil C₁₈-3 column. Five drugs and IS were separated well under the chromatographic condition. The calibration curve was verified over the range of 100~1 600 μg/L and limit of detection(LOD) was 25 μg/L(S/N=10). Results The imprecision of within and between batches were 3.1%~15.6% and 5.7%~18.4%, respectively. The accuracy of within and between batches were 0.1%~8.7% and 0.3%~13.3%. Commonly used psychotropic drugs did not interfere with the drugs and internal standard. Conclusion This method was found to be rapid, simple, accurate, sensitive and more suitable for rapid qualitative and quantitative determination of drugs in the serum of overdosed patients.

Meta-analysis of the effectiveness of UACE and systematic MTX in the treatment of CSP

HE Xin, CHEN Wei, ZHANG Zhenyu, WANG Shuzhen, ZHAI Yan, LI Jinfeng, SANG Cuiqin

2013, 34(2):  275-281.  doi:10.3969/j.issn.1006-7795.2013.02.021

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Objective The objective of the study was to evaluate the efficacy and safety of uterine artery chemoembolization(UACE) vs systemic methotrexate(MTX) for pregnancy within a cesarean scar(CSP). Methods A database was constructed for the articles on relevant clinical trials on UACE treated with CSP, which were searched from PubMed, EMBASE, Cochrane Library, China Biological Medicine Database, CNKI,VIP, WanFang, and through contact with experts in the field from January 1995 to March 2012. The Revman 5.0 software was used for Meta-analysis according to Cochrane system evaluation method. Results Nineteen studies involving 913 patients were included. Meta-analysis showed that there were significant differences in success rate, bleeding volumes during uterine curettage, recovered β-hCG to normal values, hospitalization time, and severe adverse effects(P<0.05); there were no significant differences in mild side effects and hospitalization costs(P>0.05). Conclusion Compared with systematic MTX, UACE followed by suction curettage for CSP appeared to have more advantages and may be a priority option. But the study is limited to the original quality, quantity as well as the differences between the treatment programs of the study, the above conclusion only for clinicians to reference. Nevertheless, more multicenter, large-scale randomized controlled trials(RCTs) are still needed to get more high-quality evidence that to update this system.

A study on the infection-endurance ability of the novel complex mesh combined by polypropylene and acellular tissue matrix

WANG Minggang, SUN Wenbing, YANG Shuo, TIAN Maolin, CHEN Jie, SHEN Yingmo

2013, 34(2):  282-286.  doi:10.3969/j.issn.1006-7795.2013.02.022

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Objective To explore the infection-endurance ability of the novel complex mesh combined by polypropylene(PP) and acellular tissue matrix(ACTM) in contaminative condition. Methods A total of 60 New Zealand white rabbits were randomized divided into two groups(n=30), the experiment group animals were treated with the novel complex mesh of PP and ACTM(IPOM method) and the control group animals were treated with the traditional complex mesh of PP and expanded polytetrafluoroethy-lene(e-PTFE )(IPOM method) respectively. Meanwhile, the mesh was contaminated with the rabbit intestinal juice in each group before the incision was closed. The infected state of the mesh was observed and specimens for pathological examination were collected during the first month after the operation. Results Only one case of the experiment group and 8 cases of control group appeared infected. It was prone to find fibroblasts proliferation and neovascularization by pathological examination in experiment group. Significant difference was found between the two groups. Through bacterial culture we found Escherichia coli in the infected mesh. Conclusion Compared with the traditional complex mesh of PP and e-PTFE, the novel complex mesh of PP and ACTM had powerful endurance in intestinal juice contaminative condition. The mechanism might be involved in the fibroblast proliferation and neovascularization.

Feasibility of disposcope guided orotracheal intubation

MAO Wenhong, GAO Xue

2013, 34(2):  287-291.  doi:10.3969/j.issn.1006-7795.2013.02.023

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Objective To compare the effectiveness of disposcope and shikani guided tracheal intubation, and evaluate the feasibility of disposcope guided tracheal intubation under general anesthesia. Methods Totally sixty patients under general anesthesia were enrolled in this prospective study. The patients were randomly allocated to Group D(disposcope) or Group S(shikani). After anesthesia induction, tracheal intubation were performed under the guidance from disposcope or shikani. The number and duration and success rate of tracheal intubation were recorded. Noninvasive blood pressure and heart rate were recorded during tracheal intubation. Adverse events were recorded 24 hours after tracheal intubation. Results The rate of successful tracheal intubation with disposcope was 97% and comparable with shikani(100%). The number of attempts and the time to succeed were not significantly different between groups. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. The incidence and severity of sore throat and hoarseness were similar between the two groups. Conclusion Disposcope guided orotracheal intubation is safe and effective in patients under general anesthesia.

Activity of α motor neuron of spinal cord modulated by botulinum toxin A

GAO Baoqin, TIAN Zhaoxia, LIANG Yun, ZHANG Shaodong, YU Yazhen, WANG Yajie, DENG Yaxian, TIAN Yaping, YANG Weili, WANG Guifen

2013, 34(2):  292-297.  doi:10.3969/j.issn.1006-7795.2013.02.024

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Objective To study the modulating effect of botulinum toxin A(BTX-A) on the α motor neurons in spinal cord anterior horn. Methods Forty Wistar rats were randomly divided into four groups: group A, group B, group C, and group D. All rats in each group were anesthetized with 10% chloraldurat (0.3 mL/kg). Dorsal root ganglion(DRG) of L₄, L₅, L₆ on the left were exposed following partial laminectomy under the condition of sterility. In Group A and group B, 7 U/kg, 4 U/kg of BTX-A was injected into DRG respectively. In Group C, DRG was injected with the same volume of physiological saline. Group D is the control group. Spinal reflex function and neuroethology were evaluated before and 1, 3, 7, 14 days after BTX-A administration. Results H reflex latency and amplitude of the left hind limb of the rats were longer(P<0.05) and lower(P<0.01) than that of before BTX-A injection in group A. There was also no significant difference of H reflex latency and amplitude in goup B, C, and D when compared before and after BTX-A injection. H reflex latency and amplitude at different time points after BTX-A injection in group A were longer and lower than those of group B, C and D(P<0.05, P<0.01) on 7 days and 14 days after BTX-A injection. There was no significant difference of H reflex latency and amplitude at different time points after BTX-A injection between goup B and C, goup B and D, group C and D(P>0.05). The degree of modified Rivlin loxotic plate test at different time points is lower when compared after and before BTX-A injection in group A(P<0.05). The degree of modified Rivlin loxotic plate test in group A is lower than that of group B, C and D at different time points after BTX-A injection(P<0.05). There was no significant difference of modified Rivlin loxotic plate test degree between group B and C, group B and D,or group C and D(P>0.05) at different time points after BTX-A injection. Conclusion DRG injection of botulinum toxin type A may fundamentally block circuit of spinal and lower excitability of the α motor neurons in spinal cord anterior horn.

Influencing factors of anxiety and depression in patients with unstable angina

CHEN Liying, LIU Wenxian, WEI Jinling

2013, 34(2):  298-301.  doi:10.3969/j.issn.1006-7795.2013.02.025

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Objective To investigate prevalence and influential factors of anxiety and depression in patients with unstable angina(UA). Methods Data of 204 patients with UA who were admitted in our hospital from January of 2011 to January of 2012 were collected. All the subjects were assessed with Hospital Anxiety and Depression Scale. Comparative analysis of influencing factors such as age, gender, educational level, type of health insurance, etc. was conducted. Results Of all the subjects, 67 cases(32.8%) were identified as anxiety, 46(22.5%) as depression. Patients of UA with anxiety were more frequently seen in femal, with history of hypertension. Patients of UA with depression were more frequently seen in female, lower education level, those whose medical reimbursement covered ≤40% of medical expenses and with history of diabetes. Multivariate logistic regression analysis showed lower education level and with history of diabetes were the major risk factors on depression. Conclusion Patients with UA had high prevalence of anxiety and depression disorders. More attention should be paid to this phenomenon.

Musical therapy for children receiving venous transfusion in outpatient department

DUAN Jianhua, ZHANG Jingwen, ZHANG Qianli

2013, 34(2):  302-304.  doi:10.3969/j.issn.1006-7795.2013.02.026

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Objective To share the experience of musical therapy for children who receive venous transfusion in outpatient department. Methods Behavior scales and parents questionnaire were developed to obtain data before and after musical therapy for children receiving venous transfusion. Results Musical therapy could significantly reduce fearful language expression and tonic limb action. Conclusion Musical therapy was effective in reducing anxiety and distress.

Application of cervical anesthesia in induced abortion of community primary hospitals

CHAO Xiaoping, LIU Xiaohong

2013, 34(2):  305-307.  doi:10.3969/j.issn.1006-7795.2013.02.027

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Objective To investigate the analgesic effect of misoprostol plus lidocaine injection cervical local anesthesia in induced abortion. Methods A retrospective analysis was used. A hundred and eight-four patients with 6~10 week gestation, during January 2010 to June 2012, were enrolled into two groups. The combined group, 92 patients, was given 400 μg misoprostol orally for one hour preoperative, followed by lidocaine cervical injection intraoperative. The control group, 92 patients, was used traditional abortion method. The difference of postoperative analgesic effect, operative time, amount of bleeding and Incidence Abortion Syndrome between the two groups were observed. Results The total analgesic effective rate of the combined group and the control group were 92.4% and 33.7%, respectively. The difference was statistically significant between the two groups(P<0.05). The incidence rate of Incidence Abortion Syndrome was higher significantly in combined group compared with that in the control group(P<0.01); however, the operation time and the amount of bleeding had no significant difference between the two groups, respectively(P>0.05). Conclusion The method of cervical misoprostol combined with lidocaine injection for abortion analgesic had significant effect. It might be suitable for Community Hospitals without special monitoring equipments.

Clinical study of the isolated persistent left superior vena cava

LI Xiaoyu, YUAN Yuan, ZHANG Ping

2013, 34(2):  308-314.  doi:10.3969/j.issn.1006-7795.2013.02.028

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Objective A systematic analysis on the clinical features, natural history, diagnosis and treatment experience of isolated persistent left superior vena cava(PLSVC) was done. Methods Collected the symptoms succession and nearly 21 years of examination and detection data of one 78-year old case with isolated PLSVC, then did a comparative analysis. Results The case was without positive symptoms until 57-year-old, which was sinus bradycardia. Dual-chamber pacemaker was implanted due to the sick sinus syndrome 11 years ago, before implantation, examinations showed leukocytes, and reduction of platelets, PLSVC was found during the surgery. Seven years ago, the performances of abdominal venous congestion were visualized, and 5 years ago, he was presented to clinics due to severe tricuspid regurgitation and right ventricular dysfunction. Three months ago, his chest enhanced CT+ 3D cardiovascular reconstruction cleared the abnormalities of isolated PLSVC. Conclusion The delayed occurrence of isolated PLSVC symptoms motivates misdiagnosis of this malformation, whose first manifestation is often kinds of arrhythmias. Tricuspid systolic murmur could be found quite early. Echocardiography is the preferred screening method, cardiac catheterization or enhanced CT+3D cardiovascular reconstruction could manifested it. The treatments of cardiac arrhythmias include pacemaker implantation and coronary sinus target ablation. Some patients required early surgical treatment, at advanced stage, heart transplantation may be considered.

Lipodystrophic syndromes

ZHAO Xiangfu, ZHUANG Xiaoming

2013, 34(2):  315-323.  doi:10.3969/j.issn.1006-7795.2013.02.029

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The lipodystrophic syndromes are a heterogeneous group of congenital or acquired disorders characterized by either complete or partial lack of adipose tissue,which may occur in conjunction with pathological accumulation of fat in other distinct regions of the body. Patients with lipodystrophy suffer from numerous metabolic complications, such as severe insulin resistance, impaired glucose tolerance, diabetes mellitus, severe hyperlipidemia, progressive liver disease, and increased metabolic rate, serum leptin concentration can be low, indicating the importance of adipose tissue as an active endocrine organ. Not only does the total amount but also the appropriate distribution of fat deposits contribute to the metabolic state. Recent genetic and molecular research has improved our understanding of the mechanisms underlying lipodystrophy. Circulating levels of hormones secreted by adipose tissue, such as leptin and adiponectin, are greatly reduced in distinct subsets of patients with lipodystrophy, rationalizing the use of such hormones or agents that increase their circulating levels, such as peroxisome proliferator-activated receptor gamma(PPARγ) agonists, in a subset of patients with lipodystrophy. Other novel therapeutic approaches, including the use of growth hormone(GH) and GH-releasing factors, are also being studied as potential additions to the therapeutic armamentarium. Insights from recent research efforts and clinical trials could potentially revolutionize the treatment of this difficult-to-treat condition.