Objective To evaluate the clinic effects of acute hypervolemic hemodilution(AHH) combined with induced hypotension(CH) and autogolous(allogeneic) blood transfusion on patients undergoing total hip replacement.Methods Sixty patients undergoing total hip replacement randomly divided into two groups with 30 patients each.The patients in experimental group(n=30) receive 6% HES 15 ml/kg in 30 minutes after anesthesia,MAP were maintained in a range of(65±5) mm Hg by nitroglycerin.Control group(n=30)were managed in the same way,but induced artery blood pressure only in by nitroglycerin.The HR,MAP,CVP,blood loss,blood transfusion and the time of operation were recored.The Hb,Hct,PT,APTT and FG were measured at before of AHH,after of AHH and the end of operation.Results The blood loss in experimental group were significantly lower compared with its in control group(P0.01).The Hct and Hb in experimental group on after AHH and the end of operation were lower compared with those before AHH.The PT,APTT and FG were increased in experimental group as compared to that before AHH.No lung edema,heart failure and unconventionality bleeding occur in two groups.Conclusion AHH combined CH were safety and decrease blood loss in the total hip replacement,Autogolous blood transfusion can reduce the capacity of blood transfusion.
Objective:To investigate the relationship between apolipoprotein E gene polymerphism and syndrome of qi deficiency and phlegmheat in patients with cerebral infarction.Methods:We included 50 patients of cerebral infarction with the syndrome of qi deficiency and phlegmheat as well as 50 health control patients.ApoE gene polymorphism was evaulated in both groups using PCR-RFLP technique.Results:6 genotypes were detected:E2/2、E2/3、E2/4、E3/3、E3/4、E4/4,The frequencies of the ApoE3/4 genotype and the e4 allele in the cerebral infarction patients with the syndrome of qi deficiency and phlegmheat werehigher than those in the health control subjects,while the e2 allele frequence was lower,with significant statistical difference(P0.05)in both comparisons.Conclusion:Apolipoprotein E gene polymorphism was correlated to the syndrome of qi deficiency and phlegmheat in patients with cerebral infarction,so does e3/4 genotype.While e4 allele might the predisposing genes or the risk factor,and which indicated that the e2 allele might acted as a protective factor.
To evaluate the effect of different dose of anticoagulants in haemodialysis patients with acute coronary syndrome (not including ST-elevate myocardial infarction).
Methods
28 patients with ACS (not including ST-elevate myocardial infarction) were enrolled between March 2008 and March 2012 who started haemodialysis for 5–10 years in regular pattern. The patients were randomly divided into two groups: the routine group (n=12) and strengthen group (n=16). All patients were given routine therapy including regular haeparinised haemodialysis (three times a week), rest, oxygen inhaling, antiplatelet, reducing blood lipid levels, controlling the blood pressure. The patients in the routine group were given the factor X a inhibitor fondaparinux 2.5 mg every day except the haemodialysis days. The patients in the strengthen group were given fondaparinux 2.5 mg every day including the haemodialysis days. The course of treatment was 7 days. Observe the symptom, electrocardiogram, cardiac troponin T, coagulation function (PT, APTT, INR) for 14 days.
Results
One patient in routine group was died of heart failure, another patients in strengthen group exited because of gastrointestinal bleeding. The basic characteristics of the two groups were identical (p>0.05). Patients9 symptom relieved in (3.1±2.8) days in strengthen group and (5.0±3.6) days in routine group (p<0.05). Patients9 electrocardiogram returned to the origin in (4.5±2.1) days in strengthen group and (5.8±4.3) days in routine group (p<0.05). The cardiac troponin T of patients in strengthen group reduced to stable level in (4.7±5.2) days and (5.8±2.9) days in routine group (p<0.05). In the 3rd day and 5th day and 7th day and 9th day, the PT, APTT, INR in strengthen group were significantly longer than those in routine group (p<0.05).
Conclusions
Strengthen anticoagulant therapy in haemodialysis patients with acute coronary syndrome (not including ST-elevate myocardial infarction) is more effective than routine therapy, but we must be care of the risk of haemorrhage.
Prior to 2017, internal medicine (IM) residents at the University of Alberta did not have a standardised quality improvement (QI) educational curriculum. Our goal was to use QI principles to develop a resident sustained curriculum using the Evidence-based Practice for Improving Quality (EPIQ) training course.
Methods
Three one-year Plan–Do–Study–Act (PDSA) cycles were conducted. The EPIQ course was delivered to postgraduate year (PGY) 1–3 residents (n=110, PDSA 1) in 2017, PGY-1 residents (n=27, PDSA 2) in 2018 and PGY-1 residents (n=28, PDSA 3) in 2019. Trained residents were recruited as facilitators for PDSA 2 and 3. Residents worked through potential QI projects that were later presented for evaluation. Precourse and postcourse surveys and tests were conducted to assess knowledge acquisition and curriculum satisfaction. Process, outcome and balancing measures were also evaluated.
Results
In PDSA 1, 98% felt they had acquired understanding of QI principles (56% increase), 94% of PGY-2 and PGY-3 residents preferred this QI curriculum compared with previous training, and 65% of residents expressed interest in pursuing a QI project (15% increase). In PDSA 2, tests scores of QI principles improved from 77.6% to 80%, and 40% of residents expressed interest in becoming a course facilitator. In PDSA 3, self-rated confidence with QI methodology improved from 53% to 75%. A total of 165 residents completed EPIQ training and 11 residents became course facilitators.
Conclusions
Having a structured QI curriculum and working through practical QI projects provided valuable QI training for residents. Feedback was positive, and with each PDSA cycle there was increased resident interest in QI. Developing this curriculum using validated QI tools highlighted areas of change opportunity thereby enhancing acceptance. As more cycles of EPIQ are delivered and more residents become facilitators, it is our aim to have this curriculum sustained by future residents.
Objective To study the therapeutic effects of cerebellar fastigial nucleus electrical stimulation(FNS)on motor and depression symptoms and monoamine neurotransmitters in the spinal cord fluid of patients with Parkinson's disease(PD).Methods65 patients with idiopathic Parkinson's disease following depression were divided into stimulation group(FNS+Madopar,n=35)and control group(Madopar,n=30).The stimulation group took Modopar,and treated with FNS,30 miniutes once a day for 30 days.The control group took Modopar only.Madopar dose has no change during the treatment.The patients were evaluated by Webster Parkinson's Disease Evaluation Form,and Hamilton Depression Scale(HAMD)before and after FNS treatment.The loading of monoamine neurotransmitters was measured by high performance liquid chromatography-electrochemical process.ResultsAfter the treatment,the stimulation group improved in clinical feature and depression,scored significantly lower on Webster and HAMD than the control group(P0.05);the loading of 5-hydroxytryptamine(5-HT)in spinal cord fluid increased;however noradrenalin and dopamine had no different.But there was no significant change in the symptoms and the loading of monoamine neurotransmitters in the control group.ConclusionFNS is efficient to relieve the motor and depression symptoms of PD,which possible mechamism might be central neuroprotection and the release of 5-HT by FNS induction.
Objective To explore the clinical value of determination of SF,CA-199 and CEA in bronchoalveolar lavage fluid and serum on terminal lung cancer patients who were treated by photon knife. Methods IRMA was utilized to determine in serum SF,CA-199 and CEA,before,after and 6 months after the radiotherapy on 48 terminal lung cancer patients who were treated by photon knife (the experimental group). 58 patients of benign lung disease (the contrast group) were included for comparison. Results The concentration level of SF,CA-199,CEA in BALF and serum in the experimental group was significant higher than that in the contrast group (P0.01). In the experimental group,each indicatrix of BALF was higher than that in serum (P0.01),but in the contrast group,no difference was found. The concentration level of SF,CA-199 and CEA on each stage of the experimental group was significant lower than that before the radiotherapy (P0.01). The indicatrix's descent was more manifested 3 months after the radiotherapy,and in the following period the descent was slow. Conclusion The SF,CA-199 and CEA are negatively correlated with the terminal lung cancer patient's conditions after the radiotherapy,especially in BALF. It is significant to determine SF,CA-199 and CEA on terminal lung cancer patients who were treated by photon knife. It could be applied to reflect the patient's conditions to assess the prognosis.
Objective:To explore the clinical efficacy of Sugan Jieyu capsules in the treatment of generalized anxiety disorder.Methods:Eighty patients with generalized anxiety disorder were equally randomized into two groups.The treatment group received Sugan Jieyu capsules and the control group received Duloxetine Tablets.The treatment course covered six weeks.The clinical effect was assessed by Hamilton anxiety scale(HAMA),and adverse reaction was assessed by treatment emergent symptom scale(TESS).Results:The cure rate was 12.5% and the total effective rate was 80.0% in the treatment group,and was 15% and 82.5% respectively in the control group,the differences being insignificant(P 0.05).During the treatment,the scores of HAMA were gradually decreased in both groups,and the differences were significant at the end of treatment(P 0.05compared with those before treatment).The differences of HAMA scores between the two groups after treatment was insignificant(P 0.05),and the incidence of adverse reactions between the two groups was also insignificant(P 0.05).Conclusion:Sugan Jieyu capsules are effective and safe for the treatment of generalized anxiety disorder.
Objective To explore the carative effects of scopolamine combined with prostaglandin E_1 in treatment of pulmonary heart disease with respiratory failure. Methods 72 cases were randomly divided into control group (37 casess) with routine therapy and experimental group (35 cases) with scopolamine combined with prostaglandin E_1 based on routine treatment. The to evaluate the results. Results The rate of effect was 85.7% in experimental group and 45.9% in the control group,there was a significant difference in statitics (P0.01). The experimental group’s PaO_2 and SaO_2 in post-treatment one wkke were significantly higher than in the control group (P0.01). Conclusions Scopolamine combined with prostagiandin E_1 was obviously effective in the treatment of pulmonary heart disease with respiratory failure.
Objective To evaluate the effect of subgingival delivery of 2% minocycline hydrochloride gel on sulfide level in periodontal pockets after scaling and root planing(SRP) in periodontal patients with halitosis.Methods Fifteen mild or moderate periodontitis patients with halitosis were enrolled.Split-mouth design was used that SRP or SRP + minocycline was randomly applied for the right or left half of the mouth.The sulfide level in periodontal pocket,probing depth(PD),clinical attachment level(CAL),bleeding index(BI),plaque index(PLI) were recorded before and after treatment for 6 weeks and 3 months.The percentages of spirochetes were evaluated by Congo red smear.Results All the sulfide,PD,CAL,BI,PLI,and spirochetes were decreased significantly after SRP or SRP + minocycline treatment(P0.05).However no significant differences were observed between SRP or SRP + minocycline treatment after treated for 6 weeks and 3 months.Conclusion The results demonstrated that subgingival administration of minocycline gel after SRP did not show more favorable periodontal healing results compared with SRP treatment alone.The sulfide level in pocket was reduced significantly for at least 3 months by both treatments.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)