Postoperative delirium is one of the most common postoperative complications in elderly patients, affecting the outcome of approximately half of surgical patients. The pathogenesis of postoperative delirium is still unclear, but multivariate models of the etiology of postoperative delirium are well-validated and widely accepted, and 40% of postoperative delirium can be effectively prevented by targeting predisposing factors. Benzodiazepines have long been considered as predisposing factors for postoperative delirium. Although benzodiazepines are widely used in clinical practice, most relevant guidelines recommend avoiding the use of benzodiazepines in the perioperative period to reduce the incidence of postoperative delirium. Controversy exists regarding the association of benzodiazepine use with postoperative delirium. This article discusses the results of studies on perioperative benzodiazepines and postoperative delirium.
目的 評價地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查的效果。 方法 將2012年10月－12月擬行纖維支氣管鏡檢查，且按美國麻醉醫師協會分級Ⅰ或Ⅱ級的60例患者，隨機分為芬太尼組（F組）、地佐辛組（D組）、生理鹽水組（N組）,每組20例。采用雙盲法給藥，靜脈注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理鹽水0.1 mL/kg，5 min后3組緩慢靜脈注射丙泊酚2 mg/kg誘導后置入喉罩，術中保留自主呼吸，持續泵入丙泊酚4～6 mg/（kg·h）維持麻醉，觀察3組患者誘導前（T0）、誘導后時（T1）、纖維支氣管鏡操作時（T2）、術畢時（T3）及拔除喉罩時（T4）的生命體征，記錄丙泊酚總用量、蘇醒時間、蘇醒時的呼吸道疼痛視覺模擬評分（VAS），記錄術中及術后有關并發癥的發生情況。 結果 與N組相比，D、F兩組丙泊酚總用量減少、蘇醒時間縮短，頭昏及術中體動發生率、VAS評分明顯降低（P＜0.05）；呼吸暫停的發生率D組最低（P＜0.05）；惡心、嘔吐的發生率F組最高（P＜0.05）。 結論 地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查，麻醉效果滿意，術后鎮痛效果好，值得臨床推廣。
ObjectiveTo investigate the effects of overexpression of alpha/beta hydrolase domain-containing protein 5 (ABHD5) on the invasion and migration of human colon cancer cell line HCT116 and the pathway of adenosine monophosphate-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR).MethodsThe expression of ABHD5 in colon cancer tissues and its relationship with clinicopathological features was analyzed by UALCAN database. HCT116 cells were cultured in vitro and transfected with ABHD5 recombinant plasmid, then they were divided into control group, negative transfection group and ABHD5 transfection group. Real time quantitative PCR (qRT-PCR) was used to detect the expression of ABHD5 mRNA in HCT116 cells. The proliferation of HCT116 cells was detected by CCK-8 method. Transwell assay was used to detect the invasion and migration of HCT116 cells. The expression of matrix metalloprotein 9 (MMP-9), E-cadherin, Snail, and AMPK/mTOR pathway proteins p-AMPK, AMPK, p-mTOR and mTOR were detected by Western blot.ResultsThe results of the UALCAN showed that compared with normal colon tissues, the expression of ABHD5 mRNA in colon cancer tissues was decreased (P<0.05), and which in the adenocarcinoma and the N1 stage was lower than that of the mucinous adenocarcinoma (P<0.05) and N0 stage (P<0.05), respectively. Compared with the control group and the negative transfection group, the expression of ABHD5 mRNA in the ABHD5 transfection group was increased (P<0.05), the proliferation inhibition rate of HCT116 cells in the ABHD5 transfection group was increased (P<0.05), the numbers of migration and invasion cells in the ABHD5 transfection group were decreased (P<0.05), the expressions of MMP-9, Snail, p-mTOR and mTOR were reduced, and the expressions of E-cadherin, p-AMPK and AMPK were increased (P<0.05).ConclusionsThe overexpression of ABHD5 can inhibit the invasion and migration of colon cancer HCT116 cells, activate AMPK, and inhibit the expression of mTOR. It suggests that ABHD5 may play a role in inhibiting colon cancer by affecting AMPK/mTOR pathway.
Objective To investigate the effect of complete anterior bundle of medial collateral ligament (MCL) on the valgus stability of the elbow after reconstruction and to assess the efficacy of artificial tendon and interference screw in reconstruction the anterior bundle of MCL. Methods The bone-tendon of the elbow were made in 12 adult upper limb specimens. There were 8 males and 4 females, left side and right side in half. Using biomechanic ways and pressure sensitive film, the valgus laxity, the stress area of the humeroulnar joint, and the intra-articular pressure were measured in integrated anterior bundle of MCL (control group, n=12) and reconstructed anterior bundle of MCL with artificial tendon and interference screw (experimental group, n=12) in elbow flexion of 0, 30, 60, and 90°. Results There was no significant difference in the valgus laxity within group and between groups in different flexion degrees (P gt; 0.05). No significant difference was found in the intra-articular pressure in elbow flexion of 30, 60, and 90° within group and between groups (P gt; 0.05) except in elbow flexion of 0° (P lt; 0.05). The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30, 60, and 90° flexion in the control group (P lt; 0.05), but no significant difference was found within group and between groups in the other flexion degrees (P gt; 0.05). Conclusion The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow, after reconstructing the anterior bundle by using artificial tendon and interference screw, the medial stability of elbow can be recovered immediately.
Objective To investigate the safety and feasibility of preoperative non-indwelling catheter in primary unilateral total knee arthroplasty (TKA) without tourniquet . Methods From January 2016 to January 2017, a total of 60 patients undergoing primary unilateral TKA surgery were randomly divided into preoperative non-indwelling catheter group (group NIC, n=30) and indwelling catheter group (group IC, n=30) . The patients in group NIC were not retained catherter, and the patients in group IC were retained catherter. All patients did not use tourniquet. The time of first urination, the volume of first urination, and the occurrence of urine retention, urinary irritation symptoms and urinary tract infection of patients in two groups were analyzed. The incidence of venous thrombosis of the lower extremity was also recorded. Results There were statistical differences (P<0.05) between group NIC and group IC in the time of first urination [(3.2±0.6) vs. (4.5±1.8) hours] and urine volume [(262.5±29.4) vs. (391.6±50.2) mL], but there was no significant difference (P>0.05) between the two groups in urinary retention (6.7% vs. 16.7%), urinary tract irritation (33.3% vs. 23.3%), or urinary tract infection (0.0% vs. 16.7%). Conclusion Preoperative non-indwelling catheter in primary unilateral TKA without tourniquet is safe and feasible.
Hyperprolactinemia is the common clinical syndrome; the causes of hyperprolactinemia are physiological, pharmacological, and pathological, in which prolactinoma is the most common cause. In drug therapy, dopamine agonists are the first choice, but there are 10%–20% of the patients who are resistant to drug therapy. This paper mainly summarized the causes, treatments, mechanisms of drug resistance, treatment during pregnancy, and progresses in the treatment of prolactinoma, so as to provide some theoretical basis to further research of hyperprolactinemia.
摘要:目的： 探討肝癌患者行射頻消融術圍手術期的肝功能變化情況,以及相應的護理措施。方法:對2006～2009年6月在我院接受射頻消融術治療的91例肝癌患者,監測其圍手術期的肝功能指標,如丙氨酸氨基轉移酶及總膽紅素等變化情況,分析射頻消融術對肝功能的影響,總結相應的護理措施。 結果:全組無死亡病例。射頻消融術后早期丙氨酸氨基轉移酶及總膽紅素與術前有顯著差異（P＜005）。結論: 肝癌患者行射頻消融術后早期肝功能減退,應加強護理措施,促進患者恢復。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.
Objective To systematically review the efficacy of oxygen therapy for diabetic foot ulcers (DFUs). MethodsThe PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCT) on the efficacy of different oxygen therapies for DFUs from inception to April 1, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Statistical analysis was performed using R software, and GraphPad Prism was used for graphical representations. ResultsA total of 61 RCTs involving 4 306 DFUs cases were included in the analysis. The oxygen therapies examined primarily included hyperbaric oxygen, topical oxygen, and ozone therapy. The surface under the cumulative ranking curve (SUCRA) indicated that hyperbaric oxygen therapy ranked highest for healing rate, area reduction rate, and healing time (SUCRA values were 0.957, 0.868, and 0.869, respectively). However, hyperbaric oxygen therapy also ranked higher for amputation rate and adverse events (SUCRA values were 0.616 and 0.718, respectively). Further subgroup analysis revealed that hyperbaric oxygen therapy maintained the highest ranking in area reduction rate across subgroups defined by publication language and treatment duration. ConclusionHyperbaric oxygen therapy has advantages in terms of healing rate, area reduction rate, and healing time for DFUs, but it is also associated with higher amputation rates and adverse events. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的 調查規范化培訓護士的職業自我概念現狀，以期為其培訓方案提供參考依據。 方法 2010年10月－11月采用護理專業自我概念量表對某三甲綜合醫院2009級、2010級175名規范化培訓護士進行面對面問卷調查。 結果 88.37%規范化培訓護士職業自我概念積極，5個維度得分從高到低分別是溝通交流、技能、靈活性、領導、滿意度。2010級規范化培訓護士職業自我概念總得分（t=?2.027，P=0.044）及領導維度得分（t=?3.258，P=0.001）高于2009級者，而技能（t=2.120，P=0.036）、靈活性（t=2.054，P=0.042）維度得分低于2009級；有職業興趣的規范化培訓護士其領導維度得分高于無職業興趣的規范化培訓護士（t=2.063，P=0.043）。 結論 護士規范化培訓中除注重技能培訓外還應加入情感教育課程，建立領導能力評價體系等。
Postoperative delirium (POD) is a serious postoperative complication, which is significantly correlated with poor prognosis such as prolonged hospital stay and increased rate of readmission. POD is the result of multiple factors, and intervention targeting at its risk factors can significantly reduce the incidence of POD. At present, POD prevention tends to be multidisciplinary and cluster-oriented, aiming at forming a process-oriented, whole-perioperative assessment and intervention path. However, at present, there are few studies on POD peri-anesthetic period intervention, and there are many controversies. All guidelines and expert consensus are also blank in this part, and further studies are needed to fill the gaps. This paper discusses the current prevention strategies for POD during peri-anesthetic period, guiding future studies and further improving the intervention strategies for POD during peri- anesthetic period, so as to reduce the occurrence of POD.