Table of Content

21 October 2013, Volume 34 Issue 5

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Differential changes of AMPA receptor GluR1 and GluR2 subunits synaptic targeting in the spinal cord dorsal horns in rats with incisional pain

SHI Rong, WANG Yun, GUO Ruijuan, WU Anshi, YUE Yun

2013, 34(5):  639-645.  doi:10.3969/j.issn.1006-7795.2013.05.001

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Objective To investigate the synaptic targeting changes of AMPA receptor GluR1 and GluR2 subunits in the spinal cord dorsal horns in rats with incisional pain.Methods Thirty-two adult male SD rats were randomly divided into four groups (n=8 in each): Group Ⅰ (control group), Group Ⅱ (3 h after incision), Group Ⅲ (1 d after incision), and Group Ⅳ (3 d after incision). The rats in Group Ⅱ-Ⅳ received right plantar incision and the cumulative pain scores (CPS) and paw withdrawal thresholds (PWT) were tested at 3 h, 1 d, and 3 d after incision, respectively. All rats were euthanized for harvesting L3-L6 spinal cord dorsal horns tissue ipsilateral to incision after pain behaviors were measured. Western blotting was used to test the expression of GluR1 and GluR2 in the crude synaptosomal membrane and total soluble fraction of spinal cord dorsal horns in each group (n=3). Western blotting was also used to test the Stargazin phosphorylation level (Ser240/241) in the spinal cord dorsal horns of each group (n=3). Results The CPSs peaked at 3 h after incision, and then was gradually decreased, but were a bit higher than those of in Group Ⅰ at 3d after incision. The PWTs in incisional groups were significantly lower than those of in Group Ⅰ. The expression of GluR1 in synaptosomal membrane was significantly increased in incisional groups as compared with Group Ⅰ and peaked in Group Ⅱ. In contrast, the expression of GluR1 in total solution of Group Ⅱ~Ⅳ has not significant changes compared to Group Ⅰ. The expression of GluR2 in synaptosomal membrane and total solution did not change among the groups. Compared with Group Ⅰ, Stargazin phosphorylation level of total solution in spinal cord dorsal horns in Group Ⅱ~Ⅳ has no significant differences. Conclusion Surgical injuries may induce the synaptic targeting of GluR1-containing subunit AMPA receptor into the synaptosomal membrane in the spinal cord dorsal horns, but not change the expression of GluR2-containing subunit AMPA receptor, which eventually increase GluR1/GluR2 ratio and Ca²⁺ permeable AMPA receptors in the synaptosomal membrane,and thus enhance the excitation of AMPA receptors in synaptosomal membrane which lead to the transduction of pain signals in spinal cord dorsal horns. Meanwhile, this experiment confirms, synaptic targeting of AMPA receptors assisted by Stargazin is not associated with the phosphorylation of Stargazin(Ser240/241).

Evaluation of upper airway during perioperative period in patients with obstructive sleep apnea hypopnea syndrome

LIN Na, LI Yanru, LI Tianzuo, ZHANG Bingxi, YE Jingying

2013, 34(5):  646-650.  doi:10.3969/j.issn.1006-7795.2013.05.002

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Objective Obstructive sleep apnea hypopnea syndrome (OSAHS) is a severe respiratory sleep disorder, with repeated episodes of nocturnal apnea and hypoxemia as the main clinical features. This study aimed to observe the characteristics of upper airway collapse under general anesthesia with muscle relaxation to provide evidences for better perioperative airway management.MethodsThirty male cases, who met the diagnostic criteria by polysomnography (PSG) for OSAHS, and received elective uvulopalatopharyngoplasty. Vecuronium (0.08 mg/kg) was given to achieve complete muscle relaxation after the nasal endotracheal intubation was achieved with slow induction. The image workstation with fiberscope was used to observe the pharynx cavity and record images. The cavity pressure, which represents the passive collapse of the airway and can just open the soft palate pharyngeal cavity, was analyzed. The correlation of the graphics and data with sleep monitoring indicators were analyzed.Results All patients were successfully operated on with no accidents and perioperative complications. The body mass index (BMI) was (28.39±3.99) kg/m². The apnea hypopnea index (AHI) was (52.3±23.8) times/h. The supine AHI (AHIs) was (68.9±23.6) times/h. The minimum nocturnal pulse oxygen saturation was (72.5±9.3)%. With full muscle relaxation, in 1 case (3.3%) the upper airway was completely collapsed at the flat of hard palate. The flat of soft palate and uvula completely collapsed in all patients (100%). The tongue pharynx plane collapsed in 23 patients (76.7%). The median critical opening pressure of post soft palate was 8.3 (5.9, 11.5) cm H₂O (1 cm H₂O=0.098 kPa). It was positively correlated with AHI (r= 0.377,P= 0.040). Conclusion The abnormalities of the airway passive collapse in OSAHS patients increase. The perioperative risk of serious respiratory tract obstruction is high. Retropalatal and retroglossal airway are the most collapsible segments. If the airway completely collapses and the positive ventilation is not improved with oropharyngeal airway, the use of nasopharyngeal airways should be considered. The individualized airway assessment can improve the perioperative security for OSAHS patients. The critical opening pressure was positively correlated with AHI, especially with AHIs. Therefore the critical opening pressure can be estimated to guide clinical practice.

Effects of calibration in patients in awakened or sedated status on postoperative muscle relaxant monitoring value

YIN Cheng, XUE Jixiu, YE Xin, MA Yanhui, YAN Yanhong

2013, 34(5):  651-654.  doi:10.3969/j.issn.1006-7795.2013.05.003

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Objective To observe the effects of calibration in patients in awakened or sedated status for single twitch stimulation (T₁) and train-of-four (TOF) (T₄/T₁) on postoperative T₁ and TOF value. Methods Forty patients at ASAⅠor Ⅲ level, were divided into two groups at random: The awakened group (group A) and the sedation group (group S). In the group A, calibrated T₁ and TOF in the case of patients without given any sedative, and in the sedation group, calibrated when patients were given etomidate to make BIS in 40-60. Two groups of patients were not given muscle relaxants. The maximum values of T₁ and TOF were observed while the BIS value of two groups of patients with postoperative awake returned to preoperative levels. Results The postoperative T₁ maximum value of patients in the group S was obviously higher than it in the group A(P=0.005), there was no statistically significant difference between two groups of postoperative TOF in maximum value comparison(P=0.191).Conclusion In the observation of muscle relaxant monitoring, patients in awakened status underwent the T1 and TOF calibration, which caused a small effect on postoperative T₁ value, has more clinical significance.

Impact of intrathecal labor analgesia on duration and interval of uterine contraction

LI Qiuhong, XU Mingjun

2013, 34(5):  655-659.  doi:10.3969/j.issn.1006-7795.2013.05.004

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Objective To investigate the impact of intrathecal labor analgesia on duration and interval of uterine contraction.MethodsIn this prospective study,60 parturients from Beijing Obstetrics and Gynecology Hospital who would like to have labor analgesia were randomized into two groups, one into spinal-epidural anesthesia group (group C) and the other into epidural anesthesia group (group E). The visual analogue scores (VAS) of pre-and post analgesia, rates of oxytocin use, the duration and interval time of uterus contraction were observed and recorded.Results 1) Compared to no analgesia, VAS scores were significantly reduced after analgesia in both groups. In this study,it was found that the onset of analgesia in the group C was significantly shorter than the group E (P<0.01). 2) The oxytocin usage increased after analgesia in each group (P<0.05). Oxytocin usage was similar after analgesia (P>0.05) in both groups. 3) After labor analgesia, duration of uterine contraction was shortened and interval of uterine contraction was extended within a short time. Duration of uterine contraction was shortened in the group C 5-30 min after analgesia (P< 0.05), duration of uterine contraction was shortened in the group E 10-30 min after analgesia (P<0.05). Interval of uterine contraction was extended in group C 15-30 min after analgesia (P<0.05). There was no significant difference after labor analgesia in group E in the interval of uterine contraction (P>0.05). Conclusion Combined spinal-epidural anesthesia and epidural anesthesia in labor analgesia can provide a good analgesic effect, but labor analgesia have a certain influence on uterine contraction. Duration of uterine contraction was shortened and interval of uterine contraction was extended within a short time, understanding of uterine contraction characteristics, and effective treatment contribute to the success of labor analgesia.

Analysis of coronary artery bypass grafting in 1650 male patients undergoing coronary artery bypass grafting

JIN Mu, LI Shuwen, CHENG Weiping, LU Jiakai

2013, 34(5):  660-665.  doi:10.3969/j.issn.1006-7795.2013.05.005

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Objective Coronary artery bypass grafting (CABG) is generally considered the principal therapy for patients with coronary heart disease, which consisted of on-pump CABG (ONCABG) or off-pump CABG (OPCABG). To compare the earlier clinical results between heart-beating on-pump and off-pump CABG in 1 650 male patients.Methods The perioperative data of 1 650 male patients who underwent CABG were investigated based on the perioperative CABG database from 2007 to 2009. The earlier clinical results between heart-beating on-pump and off-pump CABG were compared. The risk factors of postoperative in-hospital mortality and CRRT were also identified by multiple logistic regressions.Results The duration of CABG and total operation of OPCABG group were less than those of ONCABG group(P<0.01).There were more cases of grafts >3 (20.9% vs 13.3%)(P<0.01)and less cases of CRRT(1.33% vs 3.98%)and IABP(3.23% vs 6.63%)in OPCABG group. There was no significant difference in in-hospital mortality between two groups. Multivariate analysis demonstrated that preoperative ejection fraction (EF) less than 40% (P=0.000,OR=8.321), more than 70 years (P=0.003,OR=4.870) and postoperative CRRT (P=0.000,OR=45.500) were the independent risk factors of postoperative in-hospital mortality; preoperative hypertension (P=0.049,OR=2.665), preoperative renal dysfunction(P=0.045,OR=3.598) were the independent risk factors, while the usage rate of continuous renal replacement therapy (CRRT) was reduced by two thirds in male patients undergoing off-pump coronary artery bypass grafting. Conclusion OPCABG was a better alternative to heart-beating ONCABG for patients with age>70 years and/or preoperative poor renal function and/or cardiac dysfunction.

Fifty percent effective dosage of 0.5% ropivacaine for ultrasound guided subgluteal sciatic nerve blocking in elderly patients undergoing ankylosis arthrolysis of knee joint

LAN Fei, WANG Tianlong

2013, 34(5):  666-668.  doi:10.3969/j.issn.1006-7795.2013.05.006

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Objective To determine the 50% effective dosage of 0.5% ropivacaine for ultrasound guided subgluteal sciatic nerve blocking in elderly patients undergoing ankylosis arthrolysis of knee joint. Methods Twenty-one ASA Ⅰ-Ⅲ elderly patients of both sexes, aged 65-79 year weighing 60-90 kg were recruited to receive ultrasound guided sciatic nerve blocking by means of subgluteal approach for ankylosis arthrolysis of knee joint. The volume of 0.5% ropivacaine was injected in each patient was based on modified Dixon's up-and-down method. The initial volume was 20 mL and each time the volume increased/decreased by 2 mL. The 50% effective dose and 95% confidence interval (95% CI) of 0.5% ropivacaine were calculated by using Probit Regression method. Results The median effective dosage of 0.5% ropivacaine for elderly patients undergoing ankylosis arthrolysis of knee joint by using of ultrasound guided sciatic nerve block with subgluteal approach is 14.5 mL (95% confidence interval 12.5-15.6 mL).Conclusion The 50% effective dosage of 0.5% ropivacaine for ultrasound guided subgluteal sciatic nerve block in elderly patients undergoing ankylosis arthrolysis of knee joint was 14.5 mL.

Anesthesia depth and postoperative long-term mortality

YUE Yun

2013, 34(5):  669-672.  doi:10.3969/j.issn.1006-7795.2013.05.007

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Recently postoperative mortality has been associated with cumulative anesthetic duration of low bispectral index (BIS). It was suggested that cumulative deep hypnotic time (cumulative duration of low BIS) was an independent predictor of 1 year mortality after major noncardiac surgery in 2005. Reports confirmed that the mortality-hypnosis association was all derived from secondary analyses of data collected prospectively for other purposes, which were to evaluate the effect of BIS monitoring on the incidence of intraoperative awareness. In these substudies, it was found that cumulative time at BIS less than 45 was associated with an increased risk of death for up to 2 year after surgery. It was also found that the absence of low BIS values was associated with improved survival and reduced morbidity (myocardial infarction and stroke). The substudy of the B-Unaware Trial added the evidence confirming the association between cumulative duration of low BIS and postoperative mortality. In this investigation, 17.8% of patients died in the first 3 year after cardiac surgery, with the risk of death increased by 29% for every cumulative hour for which the BIS was less than 45 during surgery. These three studies along with another report on the ICU patients who experienced burst suppression had a significantly higher 6-month mortality rate compared with patients who did not have burst suppression when sedated (59% vs 33%). Recognizing that the hypnosis-mortality association exists warrants further studies on the association.

Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis

CHEN Mingkai, HE Qianyu, DING Baijing, LIU Yunyan

2013, 34(5):  673-678.  doi:10.3969/j.issn.1006-7795.2013.05.008

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Objective To evaluate the efficacy of endoscopic variceal ligation (EVL) and sclerotherapy (EVS) for obliteration of esophageal varices among patients who survived an episode of first variceal hemorrhage. Methods The related literature was identified from Pubmed, Medline, Embase, CNKI, the library of Cochrane, and Wanfang database. RevMan 5.1 Software provided by the Library of Cochrane was used for Meta-analysis. Results A total of 7 randomized controlled trials were included. It was shown that the rehemorrhage rate of EVL was significantly lower than that of EVS (OR=0.54,95% CI:0.38－0.76,Z = 3.56,P = 0.000 4); Meanwhile, there was no significant difference in mortality between EVL and EVS (OR=0.79,95% CI:0.55－1.14,Z =1.27,P = 0.21). Compared with EVS, EVL could significantly reduce the complications of treatment (OR=0.22,95% CI:0.13－0.38,Z = 5.51,P=0.000 01); there was no significant difference in obliteration of varices between EVL and EVS (OR=1.46,95% CI:0.98－2.18,Z =1.88, P =0.06). Little publication bias was found with funnel plot analysis. Conclusion EVL is better than EVS in the prevention of rehemorrhagia of esophageal varices and it is the first choice for secondary prophylaxis.

Clinical value of acetic acid and methylene blue chromoendoscopy in the diagnosis of gastric intestinal metaplasia

LI Peng, WANG Yongjun, SUN Mingjiong, ZHANG Nana, ZHANG Shutian, WANG Fengyun, TANG Xudong

2013, 34(5):  679-683.  doi:10.3969/j.issn.1006-7795.2013.05.009

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Objective To evaluate the clinical value of acetic acid and methylene blue chromoendoscopy in the diagnosis of gastric intestinal metaplasia.Methods Cases from endoscopy center of Friendship Hospital, Capital Medical University, and Beijing Xiyuan Hospital, China Academy of Traditional Chinese Medicine, suspected chronic atrophic gastritis and/or intestinal metaplasia under white light endoscopy, were randomized into acetate acid group or endoscopic and methylene blue group respectively with 0.2% methylene blue solution or 1:4 Shanghai white vinegar spraying on gastric mucosa, then the suspected area was biopsied for pathological evaluation. Results Totally 146 cases with suspected chronic atrophic gastritis and/or intestinal metaplasia under white light endoscopy, were randomized into acetate acid group (76 cases) or methylene blue group (70 cases). After 0.2% methylene blue spraying, gastric intestinal metaplasia presented with blue coloring, and clearly demarcated with surrounding mucosa, while after acetic acid spraying, gastric intestinal metaplasia presented with blue coloring became more evidently whitening, and clearly demarcated with surrounding mucosa. After staining with acetic acid, the sensitivity and specificity in the diagnosis of gastric intestinal metaplasia were 84.6% (55/65) and 90.9% (10/11) respectively, which were 82.8% (48/58) and 100% (12/12) for methylene blue, both consistent with pathological diagnosis. The diagnosing rate of gastric intestinal metaplasia with acetate acid and methylene blue staining were 73.7% (56/76) and 68.6% (48/70), the difference was not statistically significant (P>0.05). The diagnostic sensitivity of gastric intestinal metaplasia with acetate acid and methylene blue staining were 84.6% and 82.8% (P=0.769). The diagnostic specificity of gastric intestinal metaplasia with acetate acid and methylene blue staining were 90.9% and 100% (P=0.009). Conclusion Acetic acid and methylene blue staining both contribute to the diagnosis of gastric intestinal metaplasia. Acetic acid had higher specificity than methylene blue staining for the diagnosis of gastric intestinal metaplasia.

Analysis on risk factors of colorectal polyps

LI Yanping, LI Ji, GAI Xiaorong, WU Jun, LI Wenbin, WU Dong, YAO Fang, LI Jingnan

2013, 34(5):  684-688.  doi:10.3969/j.issn.1006-7795.2013.05.010

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Objective To investigate the risk factors that may be associated with colorectal polyps. Methods Patients who underwent complete colonoscopy at Peking Union Medical College Hospital endoscopy center between June 1, 2012 and May 31, 2013 were enrolled into this study. These patients were divided into polyps group and normal control group. Each case undertook the same questionnaire about their general situation and endoscopic polyps performance. The data were statistically analyzed by using SAS 9.2. Results Totally 106 colorectal polyps patients were enrolled into the polyps group and 383 normal persons were enrolled into control group. Multivariate logistic regression analyses were performed. Age (OR=1.343, 95%CI:1.063-1.697), family history of cancer (OR=3.013,95%CI:1.675-5.419) and high proportion of red meat intake (OR=1.650, 95%CI: 1.085-2.509) were independent risk factors for colorectal polyps. Adenomatous polyps was easier to be detected in male than in female (P<0.05) and the proportion of patients with adenomatous polyps increased with age (P<0.05). Conclusion Age, family history of cancer and high proportion of red meat intake are independent risk factors for colorectal polyps, while high proportion of fresh fruits and vegetables intake are protective factors. Elderly male patients may have increase risk to occur adenomatous polyps. Risk factors questionnaire is useful in screening for colorectal tumors.

Comparative analysis of short-term outcomes of laparoscopic and open surgery for rectal cancer

QIU Feng, WANG Jin

2013, 34(5):  689-692.  doi:10.3969/j.issn.1006-7795.2013.05.011

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Objective To conduct a comparative analysis of short-term outcomes of laparoscopic and open surgery for rectal cancer. Methods Retrospective analysis was performed on 138 cases who underwent rectal cancer surgery in Beijing Friendship Hospital from January 2009 to March 2012. The cases were divided into laparoscopic surgery group (n=82) and open surgery group (n=56). The short-term outcomes, including radical therapeutic effect of surgery, intraoperative details, postoperative recovery and postoperative complications were compared between the two groups.Results The blood loss of laparoscopic group and open surgery group were (103.0±93.1)mL and (158.0±130.1)mL. The postoperative analgesia number was 18 (22.0%) and 29 (51.8%), flatus time was (2.4±0.6) days and (2.8±0.9) days, defecation time was (3.3±1.0) days and (3.7±1.3) days, the postoperative feeding time was (3.8±1.3) days and (4.6±2.0) days, hospital stay was (19.6±7.1) days and (22.0±9.1) days, postoperative complication rates were 14 (17.1%) and 21 (37.5%). The differences mentioned above were statistically significant (P<0.05), and there were no significant differences in the rest of the compared indicators. Conclusion The laparoscopic rectal cancer surgery can achieve the similar radical therapeutic effect as the open surgery. Besides that it has the advantages of shorter hospital stay, less blood loss, less postoperative pain, faster recovery of gastrointestinal function and fewer complications.

Progress in digestive system endoscopy

HAO Xiaowen, LI Peng, ZHANG Shutian

2013, 34(5):  693-697.  doi:10.3969/j.issn.1006-7795.2013.05.012

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Nowadays with the rapid development of new technologies,digestive system endoscopy has been proven to be an effective device for treatment, rather than just a diagnostic tool. Such development plays a revolutionary role in diagnosis and treatment for digestive diseases. The invention of new endoscopic techniques, such as chromoendoscopy、magnifying endoscopy,fluorescence endoscopy, enables us to have further understanding of digestive diseases. The wide application of endoscopic interventions has provided safer, less invasive and cost-effective treatment. In this paper, we review the recent advances of endoscopic diagnosis and therapy for digestive diseases.

Protein kinase Cγ play roles in hypoxic preconditioning-induced neuroprotection and determination of its interacting proteins in penumbra of mice with ischemic stroke

HAN Song, ZHANG Nan, YIN Yanling, ZHAO Li, LUO Yanlin, LI Junfa

2013, 34(5):  698-703.  doi:10.3969/j.issn.1006-7795.2013.05.013

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Objective To validate the role of conventional protein kinase C (cPKC)γ in hypoxic precondition (HPC)- induced neuroprotection against brain ischemic injury, and determine cPKCγ -specific signaling proteins in penumbra of mice following ischemic stroke by using cPKCγ inhibitor and HPC mouse model.Methods Healthy adult male BALB/c mice were randomly divided into five groups, including normoxic sham, normoxic ischemia (I), ischemia following DMSO treatment (DMSO+I), ischemia post HPC (HPC+I), and ischemia after cPKCγ inhibitor Go6983 and HPC pretreatments. Using HPC and middle cerebral artery occlusion (MCAO)-induced ischemic stroke mouse models, the cPKCγ membrane translocation (activation) levels, cerebral infraction volum and cPKCγ -interacting proteins in ischemic penumbra were determined by Western blot, TTC staining, cPKCγ immunoprecipitation, two-dimensional electrophoresis (2-DE) and mass spectrometry (MS), respectively. Results Compared with MCAO-induced ischemia (I) group, cPKCγ membrane translocation (activation) levels was increased significantly in ischemic core and penumbra of HPC+I group, but cPKCγ inhibitor Go6983 pretreatment could inhibit the increases of cPKCγ membrane translocation in ischemic core, penumbra and contralateral cortex of HPC+Go6983+I mice (P<0.05, n=6 per group). cPKCγ inhibitor Go6983 abolished HPC-induced reduction in infarction size of mice with ischemic stroke (P<0.05, n=6 per group). In addition, Go6983 could inhibit the interaction between cPKCγ and partial interacting proteins in ischemic penumbra of HPC+I mice, including superoxide dismutase [Cu-Zn], DJ-1, UMP-CMP kinase, adenylate kinase isoenzyme 1, ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1), interleukin-16 and heat shock protein 70 (HSP70). Conclusion cPKCγ participates HPC-induced neuroprotection though regulating its interaction with partial interacting proteins in ischemic penumbra of mice following ischemic stroke.

Effects of flavonoid-rich diet intervention on body oxidative damage related biomarkers in the health subjects with different GST genotype

YUAN Linhong, MA Weiwei, LI Nan, JI Jian, FENG Jinfang, XIAO Rong

2013, 34(5):  704-709.  doi:10.3969/j.issn.1006-7795.2013.05.014

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Objective To study the response of body oxidative damage related biomarkers to flavonoid-rich diet intervention in healthy subjects with different GST genotypes. Methods Totally 26 healthy adults (21~23 years old) with the GSTT1-/GSTM1 -or GSTT1+/GSTM1 + genotype were enrolled to participate in the flavonoid-rich diet intervention. The venous blood and urine samples were collected at the baseline, 1 and 2 weeks after the dietary intervention. Experimental kits were used for detecting the plasma MDA, GSH levels, and erythrocyte SOD, GST and GSH-Px enzyme activities. ELISA Kit was applied to detect the urinary 8-OH-dG level. Results No significant differences of plasma MDA, GSH levels and erythrocyte SOD, GST and GSH-Px activities were found at the baseline between GSTT1/GSTM1 genotype groups. After dietary intervention for 1 week, the plasma MDA level in GSTM1+/GSTT1+ group had a significant decrease than the baseline and that in GSTM1-/GSTT1- group, while, after intervention for 2 weeks, the MDA level in GSTT1-/GSTM1- group began to decrease to lower than that in the baseline. Two weeks of flavonoid-rich food intervention had no effects on the plasma GSH level and erythrocyte SOD enzyme activity, but increase in GSH-Px activity was found in both groups. Significant increase in GSH-Px activities were detected in GSTM1+/GSTT1+ and GSTM1-/GSTT1- groups. The response of erythrocyte GST activity was GST genotype dependent. Dietary intervention significantly increased erythrocyte GST activity in the GSTM1+/GSTT1+ group; however, no influence was detected in GSTM1-/GSTT1 -group. The content of urinary 8-OH-dG presented a decrease trend after dietary intervention for 2 weeks, however, no statistical significance was found. Conclusion Oxidative damage related biomarkers of the subjects with different GSTT1/GSTM1 genotypes had different responses to the flavonoid-rich diet.

Effect of different sampling ways and different hematology analyzer on hematological parameters in SPF wistar rat

HE Peiheng, HU Zijing, JIANG Xueyun, TIAN Mi, GAO Lifang

2013, 34(5):  710-714.  doi:10.3969/j.issn.1006-7795.2013.05.015

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Objective To summarize the effects of different blood collection methods and hematology analyzers on hematology results. Methods Eight-week old SFP Wistar rats were used in this study and results were analyzed by SPSS. Results ①The white blood cell (WBC) and platelet (PLT) results in Wistar rat blood sample by angular vein approach and abdominal aortic approach showed significant difference (P<0.05); ②The abdominal aortic approach and abdominal venous approach gave analogical results in all parameters (P>0.05); ③ADVIA 2120 and XE-2100 gave different PLT values (P<0.05)Conclusion Different blood collection ways and analyzers have effect on hematology evaluation, especially in WBC and PLT count.

Determination of glucosamine in human plasma by LC-MS/MS

LI Pengfei, WANG Shumin, ZHANG Xi, AN Zhuoling, LIU Lihong

2013, 34(5):  715-719.  doi:10.3969/j.issn.1006-7795.2013.05.016

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Objective To develop a LC-MS/MS method for the determination of glucosamine in human plasma. MethodsGlucosamine was extracted with dichloromethane from the supernatant after protein precipitation with 5% sulfosalicylic acid and separated by gradient elution on an Agilent TC-C₁₈ column using acetonitrile -0.01% ammonia water as mobile phase. Detection was carried out by multiple reaction monitoring (MRM) on a 3200QTRAP LC-MS/MS system. Results The assay was linear over the range 20.0~2 000.0 ng/mL with a lower limit of quantitation of 20.0 ng/mL. The intra-and inter-day precision were less than 15%. The relative deviation was in the range -0.30%~1.69%. The recovery of glucosamine was in the range of 93.59%~106.27%.Conclusion The method is a rapid, sensitive, selective and reliable one for the determination of glucosamine in human plasma. The assay could be applied to a pharmacokinetic study in healthy volunteers.

Study on micronucleus frequency in human lymphocyte exposed to occupational lead

LIANG Jing, LUO Huan, CHEN Bin, CHANG Xiaoyan, WANG Ping, YU Guixin, LUO Hu

2013, 34(5):  720-723.  doi:10.3969/j.issn.1006-7795.2013.05.017

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Objective To explore the genetic toxicity of occupational lead exposure. Methods Sixty workers who came to our institute for occupational health examination from July to September 2012 were divided into two groups: lead group 38 people and non-lead group 22 people, all males. The uric lead was measured by graphite furnace atomic absorption spectrometry (GF-AAS), the Zn-protoporphyrin (ZPP) in blood was measured by surface fluorescence method, and lymphocyte micronucleus frequency (MNF, ‰) was detected using micro-whole blood culture method. Then statistical analysis was applied. Results There was no statistical difference in urine lead between lead group and non-lead group, but the differences in ZPP and MNF were significant (P<0.05). Furthermore, the result of statistical analysis showed that there was a strong positive correlation(r_s=0.778) between ZPP and MNF in lead exposed workers. Conclusion Occupational lead could increase the MNF in lead exposed workers, inducing chromosome aberration.

Occurrence analysis of outpatient prescription of university clinic and improving measures

HU Mei, ZHU Xian, HU Jun

2013, 34(5):  724-726.  doi:10.3969/j.issn.1006-7795.2013.05.018

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Objective By comparing the changes in prescription quality of hospital information management system and the situation, the existing problems has been found. Efforts has been made to establish the standard of prescription and combined administration level, to promote the rational use of drugs, ensure the quality of medical care and medication safety, eliminate the occurrence of accident. Methods In our hospital from 2009 June to 2010 and 2011 June, three periods of outpatient prescription and the prescriptions of antibiotics usage were statistically analyzed. Results In 2009 June, the total error rate was 54.14%, in 2010 June total error rate was 51.5%, and in 2011 June total error rate was 24.28%. The quality of outpatient prescription has been significantly improved. There was no significant difference in regard to rhe use of antibiotics in three stages. Conclusion The use of the hospital information management system makes the prescription quality obviously improved, antibiotic use is not much different in the three stages.

Isolation and identification of pseudomonas aeruginosa phages with broad host range in hospital

DAI Fangfang, ZHAO Xiuying, YU Yanhua, ZHANG Lili, CHEN Ming, YUAN Xingxing, LI Ning

2013, 34(5):  727-732.  doi:10.3969/j.issn.1006-7795.2013.05.019

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Objective To isolate, screen pseudomonas aeruginosa phages with broad host range from hospital sewage wastewater and test their host spectrum to daily clinical isolates of pseudomonas aeruginosa to explore the application value in clinical antibiotic therapy. Methods pseudomonas aeruginosa phages were isolated and identified with plague method and their host spectrum were screened using the same method, the homology of the host bacteria were analysed by Rep-PCR in order to confirm the host spectrum at gene level; The lysis coverage of the combination of the broad host range phages were tested using plague method. Results Fourteen pseudomonas aeruginosa phages were isolated from sewage wastewater of sixteen hospitals, among the fourteen phages there were four phages with broad host range. The lysis coverage rate of the combination of the four broad host range phages to thirty pseudomonas aeruginosa strains isolated from daily test was 96.7%, to the twelve Imipenem-resistant ones in the thirty pseudomonas aeruginosa strains was 91.7%, to all the drug susceptive ones was 100%, and to other drug resistant ones was 100%. Conclusion Four pseudomonas aeruginosa phages with broad host range were isolated from fourteen pseudomonas aeruginosa phages. The combination of the four broad host range phages can lyse twenty-nine in thirty strains isolated from daily clinical test, the lysis coverage rate of the combination of the four broad host range phages to Imipenem-resistant pseudomonas aeruginosa and other drug resistant pseudomonas aeruginosa was above 90%, the combination had a high lysis coverage rate and this can lay the foundation and provide feasibility for clinical antibiotic therapy.

Sevoflurane versus propofol anesthesia for craniotomy in adults：a systematic review and meta-analysis

YU Yun, ZHANG Kaiying, HAN Ruquan

2013, 34(5):  733-741.  doi:10.3969/j.issn.1006-7795.2013.05.020

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Objective To evaluate the efficacy and safety of sevoflurane and propofol anesthesia for craniotomy in adults.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and other electronic databases were used to collect the randomized controlled trails (RCTs) on sevoflurane in comparison with propofol for the maintenance of anesthesia for craniotomy in adults. The risks of bias in the included studies were assessed in accordance with The Cochrane Handbook for Systematic Reviews of Interventions. After data extraction, Meta-analysis was performed with RevMan software. Results A total of 17 RCTs involving 1 330 patients were included. The results of Meta-analysis demonstrated that compared with sevoflurane anesthesia, propofol tended to provide better brain relaxation [RR=0.95, 95% CI (0.91, 0.24), P=0.02], lower intracranial pressure (ICP) before skull flap removing [MD=3.81, 95%CI (2.80, 4.82), P < 0.000 01] and lower oxygen saturation of jugular vein bulb (SjvO2) [MD=10.24, 95% CI (7.87, 12.61), P < 0.000 01]. It was shown that there were no significant differences between the two groups in adverse events such as intraoperative hypertension, hypotension, tachycardia and bradycardia, and postoperative shivering. In addition, it was indicated that both eye-opening time and extubation time were similar in the two groups. The incidence of postoperative nausea and vomiting (PONV) was lower in propofol group compared to sevoflurane group [RR=1.56, 95% CI (1.16, 2.10), P=0.004]. Conclusion The current evidence shows that intravenous anesthesia with propofol anesthesia provides better brain relaxation, lower ICP before skull flap removing and decreased occurrence of PONV in comparison with sevoflurane.

The survival and functional status of the aged patients during the first year after initiation of hemodialysis

WANG Ying, JIA Yanli, ZHANG Hua, SUN Yi

2013, 34(5):  742-745.  doi:10.3969/j.issn.1006-7795.2013.05.021

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Objective To evaluate the survival and functional status of the aged patients during the first year after initiation of hemodialysis. Methods Incident patients with end stage of renal disease starting hemodialysis between 1 July 2009 and 30 June 2011 were included in the study. The clinical data of the aged patients(≥65 years) and non-elderly patients(18~65 years) were collected. Activities of daily life (ADL) scores were measured at the initiation of dialysis and at 3,6,12 months after the initiation of dialysis. Results A total of 51 patients were included in this study. Elderly MHD patients accounted for 75%. There were no difference in complications,the levels of eGFR,serum albumin and Hb(P>0.05). Sixteen patients in the elderly group died during the first year. The main causes of death contain infection,cardiovascular and cerebrovascular disease. At the first time of dialysis, the ADL scores of the aged patients were significantly lower than those of the non-elderly patients(P<0.01).Twelve months after the initiation of dialysis, the ADL scores had been maintained in 90% of the 20 surviving patients in the aged group.Conclusion The aged patients account for the main population of ESRD patients initiating hemodialysis. Higher mortality rates were seen in the aged HD patients in the first year, especially in the first 3 months of treatment. The main causes of death contain infection and cardiovascular disease. The ADL scores of 90% of the aged group had been maintained during the first year after initiation of hemodialysis.

Oral contraceptive use among women after abortion

LUO Lanrong, LI Jian

2013, 34(5):  746-751.  doi:10.3969/j.issn.1006-7795.2013.05.022

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Objective PAFPS (post abortion family planning service) is absolutely important for women who have just undergone abortion. We are trying to help women use effective contraceptive methods such as COC (combined oral contraceptives) immediately after abortion. This study was designed to study oral contraceptive use among women after abortion.Methods Forty eight women taking COC who had induced abortion between Aug. and Oct. 2011 in Beijing Obstetrics and Gynecology Hospital were followed up at 3 months and 12 months respectively. Questions would be asked about the use of COC. Counseling would be taken too. Forty-eight women who received two follow-ups were taken as the objects of research. Results 1.Use of two cycles COC. 14.6%(7/48)didn't finished the first cycle pills, the main influencing factor was about the security of pills; 58.3%(28/48)stopped after the first cycle, the main influencing factor was failing the management of pills. 16.7%(8/48)stopped after the second cycle mainly due to the concern about the safety of COC. Only 10.4%(5/48) continued to use pills after two cycles. 2. Use of contraceptive method. About 43.7%(21/48) women didn't used any contraceptive methods before abortion verse 100% women who had sexual life all used contraceptive methods after abortion. Compare to the ratio of use of efficient contraceptive method including COC and IUD(Intrauterine device)of 3 months after the abortion, the second follow-up showed the ratio has significantly increased. But the ratio of COC didn't increased significantly. 3. Side effect. Only 4.2% (2/48) women had felt nausea during taking pills. But almost 39.6% (19/48) women stopped taking pills because of anxious about adverse reactions. 4. Others. 10.4% (5/48) women who felt their skin of face were improved during they were taking pills.Conclusion 1PAFPS should be effective and efficient. What we did could promote the use of contraceptive methods. Oral contraceptives act as an efficient, safe, method of contraception are very suitable for women using immediately after abortion. According to our study, there were different main influencing factors in the different stage of taking pills after abortion. As a result, focused consultation including the main influencing factors as well as the non-contraception benefit, various forms of follow-up can ensure the efficient and long-term of consultation which can help women insist on using efficient methods of contraception such as COC.

Research of anxiety disorder in patients with abnormal pregnancy history

LYU Wei, CAO Xindong, ZHOU Heng

2013, 34(5):  752-755.  doi:10.3969/j.issn.1006-7795.2013.05.023

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Objective To investigate the prevalence of anxiety disorder in patients with abnormal pregnancy history and its correlation factors. Methods From April 2012 to June 2013, 156 patients with abnormal pregnancy history from our genetic consultation outpatient clinic were evaluated by psychological clinic doctors, using Hamilton Anxiety Scale (HAMA). Patients whose score were above 14 (including 14) were diagnosed as anxiety. Results ①Seventy-one of 156 (45.5%) cases were diagnosed as anxiety. ②To compare the following 5 factors with the onsets of anxiety, that is, patients' age, educational level, living environment (rural or urban), incomes, with/without development abnormalities. The results showed patients' age was significantly relevant to anxiety(P=0.008), that is, the incidence of anxiety was increased with patients' age. Furthermore, Patients over 35 years-old are more likely to have anxiety mood. Educational level is another factor related to anxiety(P=0.028). Patients with higher educational background are more likely to have anxiety mood. Conclusion Nearly half of patients with abnormal pregnancy background have anxiety mood, especially elderly patients. A genetic consultation doctor should pay more attention to identify patients' anxiety disorders and give them professional psychological therapy.

Clinical observation of serum Vitamin A, E levels during the early gestation

ZHANG Luping, WANG Xinli, LI Yanrong, CAO Tong, GAO Wanli

2013, 34(5):  756-758.  doi:10.3969/j.issn.1006-7795.2013.05.024

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Objective This article was to discuss and study the level of vitamin A and vitamin E in the blood during the early gestation. It helps to develop early interventive and preventive measure.Methods Totally 1 002 cases of early pregnancy patients were chosen from the obstetrics clinic of our hospital during January to August in 2012. The level of vitamin A and vitamin E in the blood was detected by high performance liquid chromatography (HPLC). Results Totally 1 002 cases of pregnant women were chosen to participate in this study. The level of vitamin A in the blood of 35.13% cases was lower than normal value. The level of vitamin A in the blood of 0.80% cases was higher than normal value. The level of vitamin E in the blood of no cases was lower than normal value. The level of vitamin E in the blood of 16.17% cases was higher than normal value. Conclusion The level of vitamin A in the blood during the early gestation is a little bit lower. It should attach importance to the level of vitamin A in the blood and its influencing factors. It will help to develop early interventive and preventive measure. Measuring the level of vitamin A and E in pregnancy is significant to adjust nutrition structure for pregnancy.

Comparison of the effects of different pulse widths of 595 nm flashlamp-pumped pulsed dye laser in the treatment of hypertrophic scars and keloid

ZHONG Shan, MEI Xueling, ZHAO Junying

2013, 34(5):  759-765.  doi:10.3969/j.issn.1006-7795.2013.05.025

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Objective To determine the efficacy and to compare the effects of different pulse widths of 595 nm flashlamp-pumped pulsed dye Laser(PDL) in the treatment of hypertrophic scars and keloid. Methods Eleven patients with hypertrophic scars and keloid were treated with 595 nm PDL at 1.5 ms with 7-8.5 J/cm² using a 7 mm spot size; another 11 patients were treated with 595 nm PDL at 0.45 ms with 5-6.5 J/cm² using a 10 mm spot size. Treatment composed of 3 sessions at 4-week to 6-week intervals. Scars were evaluated using the Vancouver scar scale(VSS). Patients evaluated pain and pruritus using a scale from 0 to 10.Results The average sum of the VSS showed significant improvement after the first treatment using 1.5 ms and 0.45 ms pulse 595 nm PDL. The improvement of the VSS after the first to the third treatment were 45.45%, 63.64%, 100% (using 1.5 ms pulse) and 54.55%, 90.90%, 100% (using 0.45 ms pulse) respectively. There was no significant difference between 1.5 ms and 0.45 ms pulse treatment groups in the VSS, the individual parameters of the VSS, pain scale and pruritus scale.Conclusion The 595 nm PDL is a safe and effective treatment of hypertrophic scars and keloid. Both the 1.5 ms and 0.45 ms pulse 595 nm PDL resulted in scar improvement, there was no significant difference between them.

Transport System in Cells——Introduction of Nobel Prize in Physiology or Medicine 2013

ZHANG Ting, WANG Xiaomin

2013, 34(5):  776-781.  doi:10.3969/j.issn.1006-7795.2013.05.029

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The Nobel Prize in Physiology or Medicine 2013 is divided to James E. Rothman, Randy W. Schekman and Thomas C. Südhof, for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells.