Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA最新文献

Objective: To investigate the effects of penehyclidine hydrochloride(PH)/atropine combined with neostigmine for antagonizing residual neuromuscular block on the hemodynamics.

Methods: Eighty patients with elective upper abdominal surgery were randomized equally into PH group and atropine group. Five minutes after the completion of surgery, PH 0.02 mg/kg (in PH group) or atropine 0.02 mg/kg (in atropine group) in combination with neostigime 0.03 mg/kg were given intravenously to reverse the residual neuromuscular block. The heart rate (HR), mean arterial pressure (MAP) and end-tidal CO(2) pressure (P(ET)CO(2)) were recorded 5 min before anesthesia induction, 1 min before injection and 2, 5, 10, and 15 min after injection, respectively.

Results: During the investigation, HR in PH group did not undergo conspicuous changes (P>0.05). HR after the injection was markedly faster than that before the injection in atropine group (P<0.01) and did not recover till 15 min after the injection (P>0.05). MAP and P(ET)CO(2) showed no evident changes and no significant difference was observed between the two groups during the investigation (P>0.05).

Conclusion: Compared with atropine, PH does not obviously affect HR and BP, but atropine may accelerate HR.

Objective: To verify whether chronic enhanced external counterpulsation (EECP) may repair artery endothelial cells (ECs) damage resulted from hypercholesteremia in pigs.

Methods: EECP was performed for 36 hours in pigs with hypercholesteremia and the left descending artery (LDA) was isolated for scanning electron microscopy (SEM). The ECs were collected from the thoracic aorta and analyzed by proteomic technique.

Results: The ECs of hypercholesteremia pigs showed irregular arrangement with obvious desquamation of coronary ECs and formation of atherosclerotic plaque, and these lesions were milder in EECP-treated pigs. Six over-expressed proteins were detected in the endothelial cells in EECP-treated pigs in comparison with those of the hypercholesteremia pigs.

Conclusion: Chronic EECP helps restore cell morphology and repair functional damage of ECs resulted from hypercholesteremia by regulating endothelial protein expressions, and consequently improves cell adhesion and intracellular metabolism and reduces EC apoptosis.

Objective: To explore the diagnostic criteria and physiopathological features of severe bacterial pneumonia in rats.

Methods: A total of 60 Sprague Dawleg rats were randomly divided into 3 groups, namely the model group (n=24), observation group (n=24), and control group (n=12). The rats in the former two groups were intratracheally instilled with Klebsiella pneumoniae suspension at different doses, while those in the control group received intratracheal administration of 1 ml saline. On the 2nd, 4th, and 6th days after intratracheal instillation, 1/3 of the rats in each group were killed to determine the hemodynamics, arterial blood gas (ABG), peripheral hemogram, leukocytes and neutrophils in the bronchoalveolar lavage fluid (BALF), followed by pathological examination of the lung.

Results: Obvious hemodynamic changes occurred in the rats of the model group on the 5th day and ABG changes appeared on the 4th day. The changes in peripheral hemogram, leukocytes and neutrophils in the BALF, and lung pathology of the rats in the model group were more obvious than those in the observation group on each time point. As the time prolonged, the changes in the hemodynamics, ABG, peripheral hemogram, leukocytes and neutrophils in the BALF and pathology of the lung exacerbated in the model group and observation group, but all these indices in the control group remain unchanged after bacterial inoculation.

Conclusion: The severity of pneumonia in rats increases with the dose increment of the administered Klebsiella pneumoniae suspension, which mimics the pathological changes in severe bacterial pneumonia in human.

Objective: To investigate the drug susceptibility of the clinical bacterial isolates to provide evidence for more adequate use of antibiotics.

Methods: Altogether 1017 clinical bacterial isolates were identified by BD Phoenix and tested for resistance against antimicrobial agents by K-B method. WHONET5 was applied for the analysis.

Results: The most frequent bacteria detected included P. aeruginosa (19.37%), coagulase-negative Staphylococci (CNS, 17.70%), E. coli (13.27%), S. aureu (SA, 12.09%), E. faecalis (11.8%), and K. pneumoniae (7.57%). In gram-negative isolates, the susceptibility rate of imipenem was 81.5%, and that of ceftazidime was above 70%. The incidences of E.coli and K. pneumoniae isolates producing extended spectrum beta-lactamase (ESBLs) were 34.8% and 45.5% respectively. In gram-positive isolates, the susceptibility rates of vancomycin and Teicoplanin were 98.8% and 100.0% respectively, and those of furazolidone, imipenem, amikacin, piperacillin/ tazobactam were above 70%. The oxacillin resistant rates of CNS and SA were 78.2% and 46.8%.

Conclusion: The 1017 clinical bacterial isolates are characterized by high ratio of ESBL production and oxacillin resistance, suggesting the importance of adequate use of antimicrobial agents and effective control measures for reducing the drug resistance and preventing the spread of multi drug- resistant bacteria.

Objective: To investigate the therapeutic effect of phacoemulsification for primary closed-angle glaucoma complicated with cataract.

Methods: Phacoemulsification with posterior chamber foldable intraocular lens implantation was performed in 55 cases (58 eyes) of acute or chronic primary closed-angle glaucoma complicated with cataract. The changes of visual acuity, intraocular pressure, central anterior chamber depth and anterior chamber angle were observed after operation and the patients were followed up for 6 months.

Results: Compared with those before operation, the postoperative best corrected visual acuity and anterior chamber depth were improved, the intraocular pressure was reduced, and the closed chamber angle was partially reopened.

Conclusion: Phacoemulsification with posterior chamber foldable intraocular lens implantation not only improves the visual acuity but also controls the intraocular pressure, and can be a valuable method for treating primary closed-angle glaucoma with cataract.

Objective: To investigate the diagnostic value of magnetic resonance imaging (MRI) for lower limb osteosarcoma by comparing the findings between X-ray and MRI.

Methods: Fifteen surgically or pathologically confirmed patients with lower limb osteosarcoma (11 males and 4 females) underwent both plain and enhanced MRI (with CT scanning in 4 cases) in addition to radiography, and the findings were compared.

Results: The diagnostic accuracy of both MRI and X-ray film was 100%. Compared with X-ray, MRI was capable of clear display of the lesion extent, perpendicular periosteal reaction, the two layers of Codman's triangle and the skip lesions.

Conclusion: Plain X-ray film provides a convenient and practical diagnostic modality for lower limb osteosarcoma, but MRI has better performance in clearer display of the tumor range and identification of early-stage lesions.

Objective: To observe the effect of primary percutaneous coronary intervention (PCI) on plasma B-type natriuretc peptide (BNP) in patients with acute myocardial infarction (AMI).

Methods: Thirty-eight patients with AMI were divided into two groups for PCI (n=26) and conventional treatment (n=12). The plasma BNP levels were measured by fluorescence immunoassay (FIA) in these patients immediately, 24 h, 7 d, and 30 days after admission, and the infarct-related coronary arteries (IRA) were treated only with emergency interventional therapy in PCI group.

Results: BNP of the patients in the PCI and conventional treatment group B increased immediately and 24 h after admission, but there was no significant difference between the two groups (243.74+/-75.68 vs 228.65+/-82.32 and 283.42+/-88.66 vs 275.48+/-89.67, P>0.05). BNP in PCI group decreased but that in conventional treatment group increased 7 days after admission, showing significant difference between them (203.63+/-59.42 vs 388.74+/-108.52, P<0.05 ). BNP remained significantly lower in the PCI group than in the other group 30 days after admission (96.31+/-43.22 vs 237.66+/-75.48, P<0.01). Emergency PCI for different IRA resulted in the significant difference in BNP between the patients, and intervention of the left anterior descending artery (LAD) resulted in more obvious BNP reduction in comparison with that due to interventional of the right coronary artery (RCA) and left circumflex coronary artery (LCX). The changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) were correlated to the changes of BNP. The mean BNP in the 3 fatal cases was nearly 10-fold higher than the normal level.

Conclusions: BNP of AMI patients decreases on days 7 and 30 after reperfusion therapy with primary PCI, and the reduction can be more obvious 30 days after admission.

Objective: To investigate the clinical effects of anterolateral decompression and fixation on thoracolumbar fractures complicated with incomplete paraplegia.

Methods: Thirty-six patients with thoracolumbar fractures complicated with incomplete paraplegia were treated with anterolateral decompression and fixation.

Results: The patients were followed up for an average of 18 months, which showed satisfactory recovery of the intervertebral space height and thoracolumbar vertebral curvature. The average Cobb's angle, spinal canal index and Frankel were improved remarkably, and none of the patients developed such complications as break or mobilization of the plate screw.

Conclusion: Anterolateral decompression and fixation can directly and completely decompress the vertebral canal, promote the functional recovery of the spinal nerves and reconstruct the alignment of the spine as an ideal approach for treatment of thoracolumbar fractures with obvious spinal canal-occupying lesions or severe kyphos complicated with incomplete paraplegia.

Objective: To establish a method for rapid molecular detection of Streptococcus pneumoniae and Haemophilus influenzae in the early stage of infection.

Methods: Specific DNA probes for Streptococcus pneumoniae and Haemophilus influenzae and 16 S rRNA universal probe of bacteria were synthesized by polymerase chain reaction (PCR) and labeled with biotin. The DNA of the bacteria, virus and fungi were hybridized with these probes respectively prior to application for examination of the clinical samples.

Results: The DNA probes of 263, 351, and 370 bp were amplified by PCR. Streptococcus pneumoniae and Haemophilus influenzae reacted only with their corresponding probes, and no cross reaction of the bacterial universal probe with virus and fungi was noted. The method could detect bacterial DNA in as small amount as 1 ng. Of the 100 sputum specimens, 11 were found to be positive for Streptococcus pneumoniae and 8 for Haemophilus influenzae, with a positivity rate greater than that by sputum culture.

Conclusion: DNA probe detection is simple, rapid, and specific for clinical examination of Streptococcus pneumoniae and Haemophilus influenzae.