Objective
To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures.
Methods
A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected.
Results
There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05).
Conclusion
For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.
Objective To explore the role of renin-angiotensin system( RAS) in acute lung injury( ALI) /acute respiratory dysfunction syndrome( ARDS) by using amouse cecal ligation and puncture ( CLP)model.Methods The ALI/ARDS animal models were assessed bymeasuring blood gas, wet/dry lung weight ratio( W/D) , and lung tissue histology 18 hours after CLP operation. After the ALI/ARDS models was successfully established, immunohistochemistry, western blotting and radioimmunity were used to investigate the changes of several key enzymes of RAS, such as ACE, ACE2 and Ang Ⅱ. In addition, two groups of animals received a separate intraperitoneal injection of angiotensin-converting enzyme ( ACE) inhibitor captopril or recombinant mouse ACE2 ( rmACE2) after CLP, then the changes of RAS in ALI/ARDS modelswere observed. Results The extensive lung injuries can be observed in the lung tissues from CLP-treated animals 18 hours after operation. The CLP-induced ALI/ARDS led to an increase in the wet/dry weight ratio of the lung tissues, and a decrease in the PaO2 /FiO2 [ ( 194. 3 ±23. 9) mm Hg vs ( 346. 7 ±20. 5) mm Hg,P lt;0. 01] . Immunohistochemistry and western blotting tests of the lung tissues from CLP-treated animals showed a decrease in the ACE2 protein level. However, in both the CLP and sham mice there were no significant differences between the two groups. CLP markedly increased Ang Ⅱ level in lungs and plasma of mice, and RAS drugs significantly impacted the Ang Ⅱ levels of mice. Compared with the CLP group,captopril or rmACE2 led to a decrease of the Ang Ⅱ level in mice [ Lung: ( 1. 58 ±0. 16) fmol /mg,( 1. 65 ±0. 21) fmol /mg vs ( 2. 38 ±0. 41) fmol /mg; Plasma: ( 178. 04 ±17. 87) fmol /mL, ( 153. 74 ±10. 24) fmol /mL vs ( 213. 38 ± 25. 44) fmol /mL] . Conclusions RAS activation is one of the characteristics of CLP-induced ALI/ARDS in mice models. ACE and ACE2 in RAS have a different role in the regulation of AngⅡ synthesis, while ACE has a positive effect in generating AngⅡ, and ACE2 shows a negative effect.
ObjectiveTo systematically review the efficacy and safety of acupuncture as adjuvant treatment on sepsis related gastrointestinal dysfunction. MethodsThe PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, VIP and SinoMed databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to July, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 20 RCTs involving 1 384 patients were included. The results of meta-analysis showed that the bowel sound frequency per minute on the 7th day (MD=0.82, 95%CI 0.57 to 1.07, P<0.01), the effective rate of improvement in sepsis-related gastrointestinal dysfunction on the 7th day (RR=1.38, 95%CI 1.25 to 1.54, P<0.01), intra-abdominal pressure at 7th day (MD=?1.52, 95%CI ?2.21 to ?0.83, P<0.01), gastric residential volume on the 7th day (MD=?14.94, 95%CI ?24.72 to ?5.16, P<0.01), APACHE-Ⅱ score at 7th day (MD=?2.40, 95%CI ?3.56 to ?1.24, P<0.01), concentrations of procalcitonin on the 7th day (MD=?1.82, 95%CI ?2.68 to ?0.97, P<0.01) in the acupuncture group were all superior to the conventional treatment group. However, there was no significant difference between the two groups concerning the 28-day mortality. ConclusionCurrent evidence shows that acupuncture adjuvant treatment can promote the recovery of bowel sounds, reduce intra-abdominal pressure, and decrease gastric residual volume in patients with sepsis and gastrointestinal dysfunction, with good safety. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Stroke is a common and frequently-occurring disease, which seriously endangers human health. Rehabilitation treatment can effectively reduce the disability rate of stroke and improve the quality of life. The tertiary rehabilitation treatment system for stroke can effectively improve the motor function of stroke patients and improve the quality of life. This paper focuses on the choices and methods of physical therapy and occupational therapy at all levels of the hospitals and in different periods of the disease. It also aims to summarize the tertiary rehabilitation strategy for motor dysfunction in stroke patients, to provide references for all levels of hospitals and communities, achieve standardization and unification of rehabilitation treatment, as well as the rehabilitation efficacy of homogeneity.
Serum alkaline phosphatase (ALP) has long been used as a biomarker for the liver, kidney, and bone. Currently, increasing evidence suggests a correlation between serum ALP and cardiovascular disease (CVD). Research has shown that serum ALP affects endothelial cell function and induces changes in pyrophosphate through various mechanisms to accelerate vascular calcification and promote cardiac fibrosis. Therefore, this article reviews the potential value of serum ALP in CVD through relevant research, revealing the specific relationship between serum ALP and CVD, in order to provide new ideas for the prevention and treatment of CVD.
Selective attention promotes the perception of brain to outside world and coordinates the allocation of limited brain resources. It is a cognitive process which relies on the neural activities of attention-related brain network. As one of the important forms of brain activities, neural oscillations are closely related to selective attention. In recent years, the relationship between selective attention and neural oscillations has become a hot issue. The new method that using external rhythmic stimuli to influence neural oscillations, i.e., neural entrainment, provides a promising approach to investigate the relationship between selective attention and neural oscillations. Moreover, it provides a new method to diagnose and even to treat the attention dysfunction. This paper reviewed the research status on the relationship between selective attention and neural oscillations, and focused on the application prospects of neural entrainment in revealing this relationship and diagnosing, even treating the attention dysfunction.
ObjectiveTo investigate the association between preoperative systemic immune-inflammation index (SII) and early allograft dysfunction (EAD) in liver transplant recipients. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria in the West China Hospital of Sichuan University from January 2015 to December 2019 were collected. The postoperative EAD was analyzed. The generalized propensity score weighting (GPSW) were used to balance the confounding factors affecting the occurrence of EAD. ResultsA total of 390 patients who met the inclusion and exclusion criteria were enrolled in this study, 93 cases of EAD occurred, the incidence of EAD was 23.8%. The recipient’s model for endstage liver disease score and Child-Pugh grade, the donor’s body mass index, age, and graft weight, and the intraoperative cold ischemia time, liver transplantation time, intraoperative blood loss, total infusion, red blood cell transfusion, autologous blood reinfusion, fresh frozen plasma transfusion, concentrated platelet transfusion, total red blood cell and autologous blood transfusions were balanced by GPSW, then the overall mean correlation coefficient of the 14 covariables and SII decreased from 0.049 to 0.039, and each covariable reached the standard of less than 0.1. The binary logistic regression analysis based on GPSW showed that there was no significant association between SII and EAD (P=0.371). ConclusionFrom preliminary result of this study, it is not found that preoperative SII of liver transplantation patients is related to occurrence of postoperative EAD.
The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO2 of S group were significantly higher before CPB time of rewarming than that before SGB (P＜0.05), much higher than corresponding non-blocked side rSO2 before CPB (P＜0.05), and much higher than rSO2 level in group C before CPB and after CPB(P＜0.05). The non-blocked side rSO2 in group S before anesthesia were much lower than basic levels and those in group C (P＜0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO2 compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.
ObjectiveTo evaluate the mid-term effectiveness of arthrolysis and hinged external fixation for the treatment of stiff elbow caused by heterotrophic ossification.MethodsBetween January 2014 and December 2017, 11 patients with stiff elbow caused by heterotrophic ossification were admitted. There were 9 males and 2 females with an average age of 32 years (range, 14-48 years), and left side in 6 cases and right side in 5 cases. The cause of stiff elbow included humerus fracture in 5 cases, ulna fracture in 2 cases, fracture of capitulum radii in 1 case, dislocation of capitulum radii in 1 case, terrible triad of the elbow in 1 case, and soft tissue injury in 1 case. The disease duration ranged from 7 to 18 months (mean, 11 months). Preoperative active range of motion of elbow was (19.6±17.5)° and Mayo score was 34.1±9.7. All patients received the treatment of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator, and active and passive rehabilitation with the help of hinged external fixator. The hinged external fixators were removed after 2 months.ResultsAll patients were followed up 13-36 months (mean, 19.1 months). All incisions healed by first intention, and no complication of infection or nerve lesion occurred postoperatively. At last follow-up, the results of X-ray films showed that no heterotrophic ossification recurred. The active range of motion of elbow was (116.4±16.6)° and Mayo score was 93.2±7.8, showing significant differences when compared with preoperative ones (t=17.508, P=0.000; t=16.618, P=0.000).ConclusionThe application of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator can improve the elbow’s range of motion significantly and obtain a good mid-term effectiveness.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.
