Adaptive Predictive Control of Arterial Blood Pressure Based on a Neural Network During Acute Hypotension

In acute hypotension, an automated drug infusion system to control mean arterial blood pressure (MAP) has not been previously studied, though many investigations have examined the use of vasodilating drugs to control MAP in postoperative hypertension. Therefore, we examined an automated control of MAP during acute hypotension using a neural network (NN) approach. A proportional-integral-derivative (PID) control, an adaptive predictive control using a NN (APC(NN)), a combined control of APC(NN) and PID (APC(NN-PID)), a fuzzy control, and a model predictive control were tested in computer simulation based on the MAP response to norepinephrine (NE) of 25 microg ml(-1). In six anesthetized rabbits, using the NE of 25 microg ml(-1), the PID control, APC(NN), and APC(NN-PID) prevented severe hypotension compared to an uncontrolled condition. Under PID control, four of the six animals showed MAP oscillation. Using NE of 50 microg ml(-1), the rabbits recovered from acute hypotension for all systems tested but showed sustained MAP oscillation during PID control. In conclusion, utilization of a NN for adaptive predictive control systems could facilitate the development of an automated drug infusion apparatus because it provides robust control even when acute or large perturbations and inter-individual differences in the sensitivity to therapeutic agents occur.     

丙泊酚镇静下瑞芬太尼抑制喉罩置管和气管插管心血管反应的半数有效浓度比较

目的 测定抑制喉罩通气道LMA-Fastrach、LMA-Proseal置管和气管插管心血管反应的瑞芬太尼半数有效浓度以及比较置管期间相应脑电双频谱指数(BIS)的变化.方法 择期全麻下行胆囊切除术患者63例,美国麻醉医师协会(ASA)I～II级,按置管类型的不同随机均分为T、F、P 3组,每组21例.4 mg/L启动并调整丙泊酚靶控,使得BIS稳定于45～55,之后按Minto药代模式设置并启动瑞芬太尼效应室靶控,5 min后给0.6 mg/kg罗库溴铵,2 min后置管:T组气管插管,F组LMA-Fastrach置管,P组放置LMA-Proseal.比较患者麻醉诱导前、诱导后平均动脉压(MAP)、心率(HR)值及置管前后的BIS变化.记录置管前1、2min及置管后5min内的MAP、HR值以判定患者有无心血管反应.应用Dixon-Mood序贯法计算抑制3种置管心血管反应的瑞芬太尼的半数有效浓度(EC50).结果 与麻醉诱导前相比,3组麻醉诱导后MAP、HR均明显下降[MAP:T、F、P组麻醉诱导前后分别为(87.9+10.5)mmHg比(71.6+9.0)mm Hg,(91.8+8.8)mm Hg比(73.5±9.9)mm Hg,(87.2±10.2)mm Hg比(70.9+8.6)am Hg,HR:T、F、P组麻醉诱导前后分别为(78.8±11.6)次/min比(68.7+8.5)次/min,(74.8±10.3)次/min比(64.1±6.7)次/min,(76.7±8.2)次/min比(67.3±8.3)次/min,1 mm Hg=0.133 kPa,P<0.05],而置管前后的BIS值则无变化(P>0.05).瑞芬太尼抑制3组置管心血管反应的半数有效浓度依次为T组4.47 μg/L、F组4.78 μg/L、P组2.05 μg/L.结论 Minto模式靶控测得瑞芬太尼抑制3种置管心血管反应的EC50 LMA-Fastrach置管略高于气管插管,LMA-Proseal置管则最低.     

Depression and conservative surgery for breast cancer

BACKGROUND:

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE:

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS:

Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS:

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126).

CONCLUSION:

Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.     

胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

Modified Donor Lymphocyte Infusion after HLA-Mismatched/Haploidentical T Cell-replete Hematopoietic Stem Cell Transplantation for Prophylaxis of Relapse of Leukemia in Patients with Advanced Leukemia

We evaluated the safety and efficacy of donor lymphocyte infusion (DLI) with granulocyte colony-stimulating factor priming and short-term immunosuppressive agents for prophylaxis of relapse in patients with advanced leukemia after human leukocyte antigen (HLA)-mismatched T cell-replete hematopoietic stem cell transplantation (HCT). Twenty-nine patients received prophylactic DLI at a median 75 (33–120) days after HCT. Acute graft-vs-host disease (GVHD) grades 3–4 occurred in six patients, and all cases were controlled. Eleven patients were alive and relapse-free with a probability of leukemia-free survival (LFS) of 37.3 ± 9.6% at 3 years. Chronic GVHD was associated with a lower relapse rate and higher probability of LFS. Prophylactic-modified DLI is feasible in patients with advanced leukemia to prevent relapse after HLA-mismatched HCT. Xiao-Jun Huang: involved in conception and design, revising the article critically, and final approval of the version to be published; Dai-Hong Liu: performed research, analysis, and interpretation of data and drafting of the article and gave final approval of the version to be published; the other authors: performed research and gave final approval of the version to be published; the authors reported no potential conflicts of interest.     

门急诊静脉输注中药注射剂环节的质量控制与管理效果

目的:加强对门急诊输液室护士在静脉输注中药注射剂(traditional Chinese medicine injection,TCMI)输液过程中的环节管理,减少静脉输注TCMI的药品不良反应(adverse drug reaction,ADR)发生率.方法:总结导致静脉输注TCMI的ADR发生的因素,制订并落实护士配液的相关制度,执行《药品使用说明》的相关要求,加强对护士的培训和管理,将这些措施应用于门急诊输液患者的治疗和护理的工作中.结果:加强静脉输注TCMI的护理环节管理后,望京医院门急诊输注TCMI的不良反应发生率由2013年的0.024％,降至2015年的0％.结论:通过加强对护士的培训、对患者的告知和强化护理安全等多个环节的管理,可以有效减少TCMI在使用过程中ADR的发生率.     

Efficacy of mefenamic acid and hyoscine for pain relief during saline infusion sonohysterography in infertile women: a double blind randomized controlled trial

Objectives

To evaluate the efficacy and level of satisfaction from mefenamic acid and hyoscine when used for pain relief during saline infusion sonohysterography.

Study design

In this double blind randomized controlled trial, 141 nulliparous women were allocated to receive 500 mg of mefenamic acid, 10 mg of hyoscine or a placebo, which was packed in the same outer capsule. Saline infusion sonohysterography (SIS) was performed 30 min later by one operator. Pain and satisfaction scores were evaluated using a 10 cm visual analog scale. Baseline characteristics, pain and satisfaction scores were compared among the three groups. Pain scores were recorded before, after catheter insertion, during, immediately after, and 30 min after the procedure.

Results

No statistically significant differences were found in baseline characteristics, pain and satisfaction scores among the three groups. Maximum pain during SIS was 4.40 ± 3.34, 4.67 ± 3.14 and 4.85 ± 3.19 in the mefenamic acid, hyoscine and placebo groups respectively. There was a 31.1% prevalence of intrauterine abnormality and the most frequent finding was endometrial polyp.

Conclusion

There is no benefit in using mefenamic acid and hyoscine in the prevention of pain occurring from SIS.     

Low Dose Epidural Analgesia During Labor: Comparison Between Patient Controlled Epidural Analgesia with Basal Continuous Infusion and Intermittent Bolus Technique

Objectives

To compare the efficacy and safety of patient controlled epidural analgesia with basal continuous infusion versus intermittent bolus for labor analgesia using fentanyl and bupivacaine.

Methods

In this prospective study, 60 parturients having singleton term uncomplicated pregnancy in early active labor were included. 30 parturients were allocated to receive patient controlled epidural analgesia + basal continuous infusion (Group-A) and 30 received intermittent bolus on demand (Group-B). Efficacy of technique was assessed in terms of quality of analgesia on 0–10 cm verbal analogue scale. Effect on labor was assessed by duration of labor, mode of delivery, and parturient’s satisfaction. Neonatal outcome was measured by Apgar score. Data were expressed as mean ± SD and analysed using Student ‘t’ test and chi square test where appropriate. P < 0.05 was considered statistically significant.

Results

Analgesic efficacy of both the groups was comparable. Maternal satisfaction was better in group A than in group B but the results did not achieve statistical significance. Effect on labor and neonatal outcome were comparable.

Conclusions

Both the techniques appear to be safe for the mother and neonate with excellent analgesic efficacy. In a busy obstetric unit with increased demand of epidural analgesia, patient controlled epidural analgesia with basal continuous infusion may be preferred.     

Long-Term Results of Prophylactic Donor Lymphocyte Infusions for Patients with Multiple Myeloma after Allogeneic Stem Cell Transplantation

The major reason for treatment failure after allografting in multiple myeloma (MM) is relapse. Donor lymphocyte infusions (DLIs) are considered a valuable post-transplant strategy mainly for relapsed patients but using them to prevent relapse in MM has been reported rarely. In the present study, we examined the efficacy of prophylactic DLIs after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in myeloma patients with a long-term follow-up of more than 5 years. A total of 61 patients with MM who did not relapse or develop disease progression after allo-HSCT were treated with prophylactic DLI in an escalating fashion (overall 132 DLI procedures) to deepen remission status and prevent relapse. Overall response rate to DLI was 77%. Thirty-three patients (54%) upgraded their remission status, 41 patients (67%) achieved or maintained complete remission, and 26% achieved a molecular remission. Incidence of acute graft-versus-host disease (GVHD) grade II to IV was 33% and no DLI-related mortality was noted. After a median follow-up of 68.7 months from first DLI the estimated 8-year progression-free survival (PFS), and overall survival (OS) in a landmark analysis was 43% (95% confidence interval [CI], 28% to 57%) and 67% (95% CI, 53% to 82%), respectively, with best outcome for patients who acquired molecular remission (8-year PFS was 62% and 8-year OS was 83%). Prophylactic escalating DLI in a selected cohort of MM patients to prevent relapse after allograft resulted in a low incidence of severe GVHD and encouraging long-term results, especially if molecular remission is achieved.