【摘要】 目的 比较上臂三角肌下缘及腹部脐周皮下注射药物的疼痛程度以及两种注射部位药物注射后局部不良反应。 方法 将2009年9月-2010年5月在我院门诊注射室执行皮下注射的患者200例。采用自身对照，分别在三角肌下缘与腹部脐周行皮下注射，根据视觉模拟评分法，对所有患者进行疼痛程度评估，将所得数据进行对比分析。 结果 腹部脐周皮下注射较上臂三角肌下缘注射疼痛评分低，差异有统计学意义（Z=6.02，Plt;0.005），两组注射局部均无不良反应。 结论 腹部脐周皮下注射疼痛程度较上臂三角肌下缘皮下注射疼痛程度轻。【Abstract】 Objective To compare the difference in pain degrees between subcutaneous injection at the lower edge of upper arm deltoid and at the abdominal peri-umbilicus, and to observe the adverse reactions of the two ways of injection. Methods A total of 200 patients who were in the outpatient injection room from September 2009 to May 2010 were injected subcutaneously at the lower edge of upper arm deltoid and the abdominal peri-umbilicus with the method of self control; the pain degrees were assessed by visual analog score and the data were analyzed. Results The pain scores between the two groups differed much (Z=6.02,Plt;0.005), while the difference in space distributions between the two groups was not significant. Conclusion The pain of subcutaneous injection at the abdominal peri-umbilicus is lighter than that at the lower edge of upper arm deltoid.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.
ObjectiveTo study the changes of body weight, body length, tail length, femur length, bone mineral density, serum osteocalcin content and apoptosis of bone cells in rats under intermittent hypoxia condition, so as to explore the effects of intermittent hypoxia on bone growth.MethodsForty healthy male SD rats aged 3 to 4 weeks were selected and divided into 2 groups, 20 rats in each group. Group A: normoxic control group (normal diet and normoxic environment); group B: intermittent hypoxia group (normal feeding and was put into the hypoxic chamber to establish intermittent hypoxia environment), 8 hours a day (09:00 to 17:00), 4 weeks of modeling. The body weight, body length and tail length of the two groups were measured in every morning. At the end of 4 weeks after anesthesia, the body weight, body length, tail length and right femur length were measured. The body weight growth rate, body length growth rate and tail length growth rate were calculated. Blood samples were collected from the abdominal aortic, and the content of serum osteocalcin was measured by enzyme linked immunosorbent assay; the right femur bone mineral density was measured by automatic dual-energy X-ray bone densitometer; the apoptosis of bone cells was detected by immunofluorescence staining+TUNEL.ResultsThe body weight growth rate, body length growth rate, tail length growth rate and right femur length in group A were all higher than those in group B (P<0.05); serum osteocalcin content in group A was higher than that in group B (P<0.05); bone mineral density in group A was higher than that in group B (P<0.05); the apoptotic index of bone cells in group B was higher than that in group A (P<0.05). Pearson correlation analysis showed that the serum osteocalcin content was significantly positively correlated with the growth rate of body length, femoral length and bone mineral density (P< 0.01).ConclusionIntermittent hypoxia could reduce osteocalcin secretion, inhibit bone growth and sclerosis, and induce osteocyte apoptosis, thus delay the bone growth.
ObjectiveTo explore the mechanism of renal tubular epithelial cell apoptosis induced by endoplasmic reticulum stress in rats with intermittent hypoxia (IH) and the intervention effect of losartan.MethodsSixty SPF grade healthy male SD rats were randomly divided into four groups (15 rats in each group), namely as group A (control group), group B (IH group), group C (IH+losartan group), and group D (IH+saline group). The group C and D were intraperitoneally injected with losartan 30 mg/kg and the same dose of saline 30 minutes daily before the experiment, and then the group B, C and D were placed in the intermittent hypoxia chamber. After 6 weeks of modeling, serum of the rats was sampled to detect the renal function. Hematoxylin-eosin staining was used to observe histomorphological changes of the kidney; transmission electron microscopy was used to observe ultrastructural changes of the kidney; TUNEL was used to detect apoptotic index of the renal tubular epithelial cells; and RT-PCR method was used to detect expressions of caspase-12, JNK and CHOP mRNA in the kidney.ResultsThe differences of renal function among these four groups were statistically significant (all P<0.05). Hematoxylin-eosin staining and transmission electron microscopy showed the histomorphological and ultrastructural changes of the kidneys in group B, C and D compared with group A, and the damages in group B and D were more significant. TUNEL results showed that the apoptotic index of renal tubular epithelial cells in group B and D was significantly higher than that in group A (P<0.01), while that in group C was significantly lower than that in group B and D (all P<0.01). RT-PCR results showed that caspase-12, JNK and CHOP mRNA expressions were significantly higher in group B and D than those in group A (all P<0.01); caspase-12 mRNA expression was significantly lower in group C than that in group B and D (P<0.01; P<0.05); and CHOP mRNA expression was significantly lower in group C than that in group B and D (all P<0.01).ConclusionsIH may induce apoptosis of renal tubular epithelial cells by activating endoplasmic reticulum stress through caspase-12, JNK and CHOP. Losartan has protective effects on the kidney of rats with intermittent hypoxia. Its mechanism may be related to the inhibition of apoptotic pathways mediated by endoplasmic reticulum stress.
Objective To formulate an evidence-based treatment plan for a patient with malignant pleural mesothelioma.Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2007), PubMed (1996 to February 2007) and EMbase (1974 to February 2007) to identify the best available clinical evidence. Results Five randomized controlled trials, 4 systematic reviews and 1 health economic evaluation were included. According to the current evidence, as well as the patient’s clinical condition and preference, 5 cycles of raltitrexed plus cisplatin were given to the patient along with thoracic drainage and other symptomatic treatment. And the follow-up after 4 months indicated that this treatment plan was appropriate for the patient. Conclusion Evidence-based approaches helped us to prepare the most appropriate chemotherapy plan for this patient and will help improve the therapeutic results for patients with malignant pleural mesothelioma.
Objective To analyze the equipment and the working model of Pakistan international medical rescue team in Wenchuan earthquake in order to provide the first hand references for our medical rescue. Methods We analyzed the aim, the staff composition, the medical equipment, the logistic material and the working model of the Pakistan international medical rescue team by working with the Pakistan team, and summarized its strengths and weaknesses. Result The main aim of the Pakistan international medical rescue team is to search, rescue and treat the wounded and sick in mass casualty incident. The team consisted of 28 staffs, including 2 leaders (the executive leader was an epidemic expert, and the vise leader was an administrative officer), 6 clinical doctors, 2 nurses, 3 medical technicians, 10 field search and rescue staffs and 5 logistics staffs. The medical equipment included a field ambulance, 7 field tents and 2 marine satellite phones. The medical equipment and instruments include an X-ray table, a B-ultrasound scanner, an ECG tester, a set of surgery operation equipment and 2 sets of ICU instruments. The main medicines included antibiotics, analgesics and for trauma treatment. Narcotic drugs and surgical supplies supported 200 patients; fluid infusion and drugs were enough for 500 patients; other laboratory reagents were enough for 500 patients; oral drugs, disinfection cotton and bandages were for 3 000 patients. Logistics materials contained a set of cooking appliances, 2 sets of toilet facilities and enough rice, flour and water for the whole team for two weeks. The field tent hospital was built in one day. In the field tent hospital, 1 256 patients were treated, 14 surgeries were performed, 236 X-ray and B-ultrasound examinations as well as 314 biochemical examinations were conducted within 10 days. Conclusion With complete disciplines and rational structure, the configuration of the Pakistan team is fitful for its aim, and it balances the function of search, rescue and public health. Apart from equipment and instruments enough for 300-500 patients rescue, the team also considers both its own survival and environmental protection. The outcome would be better if they could arrive at the spot in the first week after the earthquake happened.
Objective To explore the mechanism of chronic intermittent hypoxia (CIH) on renal damage with normal diet and high-fat diet. Methods Twenty-four healthy male Wistar rats of SPF grade were randomly divided into 4 groups (n=6 in each group), namely group A (normoxia and common diet), group B (normoxia and high fat diet), Group C (CIH and common diet), and group D (CIH and high fat diet). The serum cystatin C (Cys-C) was measured and the renal CHOP protein was detected by immunohistochemistry. The ultrastructural changes of glomeruli and renal tubules were observed under electron microscope. Results The levels of Cys-C in group B, group C and group D were significantly higher than those in group A (P<0.05). The mean density of endoplasmic reticulum stress (ERS) marker protein CHOP in group B, group C and group D was significantly higher than that in group A (P<0.05). Electron microscope revealed focal nuclear pyknosis in the partly renal tubular epithelial cells, sparse and scattered brush border in group B and group C, also revealed nuclear pyknosis in a large number of tubular epithelial cells, sparse and scattered brush border in group D. Conclusion CIH can activate the ERS mediated renal tubular epithelial apoptosis, thus induce ultrastructure changes and damage of kidney.
ObjectiveTo investigate the mechanism of the early kidney injury in rats caused by intermittent hypoxia, and investigate the intervention effect of edaravone.MethodsEighty male Wistar rats were randomly divided into a control group (NC), an intermittent hypoxia group (IH), an intermittent hypoxia edaravone treatment group (IH+NE), and an intermittent hypoxia normal saline matched group (IH+NS). After 4 weeks of model establishment, serum urea nitrogen and creatinine concentration were determined. Pathological changes of kidney were observed under light microscope, and ultrastructural changes of glomeruli and renal tubules were observed under electron microscope. The kidney injury molecule 1 (KIM-1) protein was detected by immunohistochemistry. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), hydroxyl radical and Bcl-2 mRNA, Caspase-3 mRNA, Bax mRNA in homogenate of kidney tissue were measured.ResultsSerum urea nitrogen in each group showed no significant difference. Serum creatinine increased significantly in IH group and significantly decreased after edaravone treatment. There were no significant pathological damages in NC group under light and electron microscopy. IH group showed varying degrees of renal tubule damages compared with NC group. Compared with NC group, the mean optical density of KIM-1 protein in IH group and IH + NS group significantly increased (P<0.01), and the mean optical density of KIM-1 protein in IH+NE group significantly decreased (P<0.01). Compared with NC group, the activity of SOD in IH group and IH+NS group significantly decreased, the content of MDA and hydroxyl radical increased, the expression of Bcl-2 mRNA decreased, the expression of Caspase-3 mRNA and Bax mRNA increased, Bcl-2/Bax decreased. After edaravone intervention, the activity of SOD in kidney tissue of rats significantly increased, the content of MDA and hydroxyl radical significantly decreased, the expression of Bcl-2 mRNA increased, the expression of Caspase-3 mRNA and Bax mRNA decreased, Bcl-2/Bax increased.ConclusionsIntermittent hypoxia can cause kidney injury through oxidative stress and regulation of Bcl-2, Bax and Caspase-3. KIM-1 may be used as a sensitive indicator for monitoring early kidney injury. Edaravone can prevent kidney injury induced by intermittent hypoxia though scavenging oxygen free radical, improving antioxidant capacity, regulating cell apoptosis mediated by regulating Bcl-2/Bax and Caspase-3.
Objective To analyze the EEG characteristics and clinical significance of subclinical epilepsy from frontotemporal lobe.Methods A collection of patients with epilepsy who had subclinical seizures monitored by 24-hour video EEG from January 2020 to January 2021 in the Neurology Department of General Hospital of Tianjin Medical University General Hospital, and analyzed the duration of seizures and the number of seizures on the EEG.The characteristics and clinical significance of onset time (sleep period/waking period), interictal discharge, and number of leads involved in seizures.Results A total of 18 patients were enrolled, and 280 clinical seizures (11/18) and 34 clinical seizures (9/18) were captured. Among them, 2 patients had both subclinical seizures and clinical seizures. Frontal lobe origin, 235 subclinical seizures and 15 clinical seizures; temporal lobe origin, 26 subclinical seizures and 19 clinical seizures; frontotemporal lobe origin, subclinical seizures 19 times, no clinical seizures were captured. In the subclinical seizure group (11/18), there were 163 sleep episodes (58.2%) and 117 (41.8%) during waking phase; in the clinical seizure group (9/18), 16 episodes during sleep (47.1%) , 18 seizures (52.9%) in the awake period. Among the leads involved in seizures, <6 leads, 270 subclinical seizures, and no clinical seizures; ≥6 leads, subclinical seizures 10 times, and 34 clinical seizures. In the total duration of seizures: the clinical seizure group was (27.43±17.73) s, with a median value of 30s; the subclinical seizure group was (20.10±15.68) s, with a median value of 13 s. In the analysis of Spearman related factors, the subclinical seizure group was positively correlated with the sleep period (P=0.000), and negatively correlated with the normal nuclear magnetic field (P=0.004).Conclusion The epilepsy originated from the frontotemporal lobe has the characteristics of short clinical seizures, fewer leads involved, more likely to occur during sleep, and subclinical seizures that are more likely to occur when the MRI is abnormal. Therefore, strengthening the monitoring of long-term video EEG for patients with epilepsy and attaching importance to the interpretation of EEG during sleep will help to detect the subclinical seizures of patients and further improve the management of patients with epilepsy.