The primary intravenous anesthetics employed in clinical practice encompass dexmedetomidine(Dex),propofol,ketamine,etomidate,midazolam,and remimazolam.Apart from their established sedative,analgesic,and anxiolytic pro...The primary intravenous anesthetics employed in clinical practice encompass dexmedetomidine(Dex),propofol,ketamine,etomidate,midazolam,and remimazolam.Apart from their established sedative,analgesic,and anxiolytic properties,an increasing body of research has uncovered neuroprotective efects of intravenous anesthetics in various animal and cellular models,as well as in clinical studies.However,there also exists conficting evidence pointing to the potential neurotoxic efects of these intravenous anesthetics.The role of intravenous anesthetics for neuro on both sides of protection or toxicity has been rarely summarized.Considering the mentioned above,this work aims to ofer a comprehensive understanding of the underlying mechanisms involved both in the central nerve system(CNS)and the peripheral nerve system(PNS)and provide valuable insights into the potential safety and risk associated with the clinical use of intravenous anesthetics.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)pla...BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.展开更多
BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with ...BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.展开更多
BACKGROUND Managing sudden deafness(SD)in patients with diabetes mellitus(DM)is partic-ularly challenging due to the heightened risk of adverse effects associated with systemic drug administration.This study explores ...BACKGROUND Managing sudden deafness(SD)in patients with diabetes mellitus(DM)is partic-ularly challenging due to the heightened risk of adverse effects associated with systemic drug administration.This study explores the potential of retroauricular subperiosteal injection as a localized drug delivery method for a more effective and safe treatment.AIM To compare the efficacy of retroauricular subperiosteal injection vs systemic intravenous glucocorticoid(GC)administration for SD in patients with DM and assess the effects on blood glucose levels.METHODS A total of 128 cases of type 2 DM(T2DM)with SD diagnosed and treated in Zibo Central Hospital from February 2021 to July 2023 were divided into two groups:An observation group(66 cases receiving retroauricular subperiosteal injection of methylprednisolone)and a control group(62 cases receiving systemic intravenous administration of methylprednisolone).The two groups were compared in terms of therapeutic efficacy,hearing recovery,blood glucose level changes,and incidence of adverse reactions.Binary logistic regression was used to analyze the factors affecting therapeutic efficacy.RESULTS The observation group showed a significantly higher total effective rate(90.91%)compared with the control group(75.81%,P<0.05).Additionally,pure-tone hearing threshold,fasting plasma glucose,and 2-hour postprandial blood glucose were significantly lower in the observation group compared with the control group(P<0.05).The incidence of adverse reactions was also lower in the observation group than in the control group(7.58%vs 22.58%,P<0.05).A T2DM course longer than 5 years and systemic intravenous GC administration were identified as independent risk factors for treatment inefficacy(P<0.05).INTRODUCTION Sudden deafness(SD)is a clinical emergency characterized by rapid-onset hearing loss that is often accompanied by clinical symptoms such as tinnitus and vertigo[1].Although its pathogenesis remains unclear,it is supposedly associated with factors,including inner ear microcirculation disorders,autoimmune diseases,and viral infections[2,3].Patients with diabetes are particularly susceptible to microvascular complications due to poor long-term glycemic control,affecting the ear’s microcirculation,subsequently increasing the risk of SD[4].Type 2 diabetes mellitus(T2DM),a chronic metabolic disease,causes multiple microvascular damages throughout the body,complicating SD treatment in patients with diabetes[5,6].Inner ear microcirculation disturbances in patients with diabetes may exacerbate the risk of SD,and its pathological process may be related to vascular endothelial dysfunction,inflammatory reactions,and hemorrhological changes caused by diabetes mellitus(DM)[7].Current SD treatments include glucocorticoids(GCs),vasodilators,and hyperbaric oxygen therapy[8].GCs are widely used due to their anti-inflammatory and immunosuppressive effects[9].However,systemic GCs may cause blood glucose(BG)fluctuations and even increase the risk of complications in patients with DM,limiting their clinical use in this population[10].Therefore,there is a compelling and immediate need for a local alternative solution that minimally affects the metabolic mechanisms.In recent years,retroauricular subperiosteal injection has emerged as a localized administration modality for treating SD[11].This method allows drugs to directly act on the inner ear,avoiding the side effects of systemic administration and having a minor impact on BG levels,providing a potentially effective treatment for patients with diabetes[12].However,there is limited clinical evidence to compare the efficacy and glycaemic effects of retroauricular subperiosteal injection vs systemic intravenous GC administration in patients with SD and diabetes.This study aimed to explore the efficacy of retroauricular subperiosteal injection and systemic intravenous GC administration for treating patients with SD and DM and their effects on BG,providing a safer and more effective clinical treatment approach.展开更多
Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitori...The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitoring,complication observation and management,positioning and mobility away from the bed,and quality assurance.These Guidelines encompass all the phases of intravenous thrombolysis care for patients experiencing acute ischemic stroke.This article aims to elucidate the Guidelines by discussing their developmental background,the designation process,usage recommendations,and the interpretation of evolving perspectives,thereby providing valuable insights for clinical practice.展开更多
Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmo...Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.展开更多
This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to Novemb...This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to November 2024,a total of 60 elderly patients with PICC admitted to Guiqian International General Hospital were selected as research subjects.Using a digital random table method,these patients were randomly divided into a control group and an experimental group,with 30 patients in each.The control group received routine nursing care,while the experimental group received specialized intravenous therapy nursing intervention in addition to routine care.The nursing effects of both groups were comprehensively evaluated,including treatment compliance,psychological state,quality of life,incidence of complications,and satisfaction with nursing care.The results showed that after the intervention,the treatment compliance in the experimental group was significantly higher than that of the control group(P<0.05).Additionally,scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were markedly lower in the experimental group compared to the control group(P<0.05),indicating improved psychological well-being.The experimental group also scored higher in all dimensions of quality of life(P<0.05),and had a lower complication rate and higher satisfaction with nursing care(P<0.05).In conclusion,the application of specialized intravenous therapy nursing intervention in the care of elderly patients with PICC can significantly enhance treatment compliance,improve psychological status,elevate quality of life,and reduce complications,demonstrating strong clinical value and providing important guidance for future treatment and nursing of such patients.展开更多
Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bot...Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.展开更多
Objective:Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes.This study investigated whether optimizing intravenous thrombolytic(IVT)therapy stra...Objective:Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes.This study investigated whether optimizing intravenous thrombolytic(IVT)therapy strategies for stroke could reduce treatment delays.Methods:To reduce delays in IVT therapy for ischemic stroke,a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou,Zhejiang Province,from June 2021 to August 2023,which included developing a timeline process management system,forming a nurse-led stroke process management team,providing homogeneous training,standardizing the IVT therapy process for ischemic stroke,and introducing an incentive policy.During the pre-(from June 2021 to February 2022,group A)and post-(from March to November 2022,group B1;from December 2022 to August 2023,group B2[implementation of an additional incentive policy])of the implementation the strategy,the door-tocomputed tomographic angiography(CTA)time(DCT),CTA time,neurology consultation to consent for IVT,CTA-to-needle time(CNT),and door-to-needle time(DNT),the percentage of people who underwent CTA within 20 min,15 min,and 10 min and DNT within 60 min,45 min,and 30 min were collected and compared.Results:Following the implementation of the standardized IVT process management strategy for stroke,the DNT for group B1 and group B2 were 30(24,44)min and 31(24,41)min,respectively,both significantly lower than the 46(38,58)min in group A(P<0.001);the median DCT were both 13 min in group B1 and B2 lower than 17min in group A(P<0.001);the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A(P<0.001);similar results were observed during the neurology consultation to obtain consent for IVT and CNT.Compared with group A,the proportion of DCT20 min,15 min,and 10 min was higher in groups B1 and B2(P<0.05),and the same result was observed at DNT60 min,45 min,and 30 min(P<0.05).However,the additional incentive policy did not significantly differ between Group B2 and Group B1.Conclusions:Optimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke,significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments.Additionally,generating a timeline for the IVT therapy process by scanning positioning quick response codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.展开更多
BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To...BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.展开更多
The combination therapy of magnetic hyperthermia and thermosensitive liposomes(TSL)is an emerging and effective cancer treatment method.The heat generation of magnetic nanoparticles(MNPs)due to an external alternating...The combination therapy of magnetic hyperthermia and thermosensitive liposomes(TSL)is an emerging and effective cancer treatment method.The heat generation of magnetic nanoparticles(MNPs)due to an external alternating magnetic field can not only directly damage tumor cells,but also serves as a triggering factor for the release of doxorubicin from TSL.The aim of this study is to investigate the effects in the degree of tumor cell damage of two proposed injection strategies that consider intravenous administration.Since both MNPs and TSL enter the tumor region intravenously,this study establishes a biological geometric model based on an experiment-based vascular distribution.Furthermore,this study derives the flow velocity of interstitial fluid after coupling the pressure distribution inside blood vessels and the pressure distribution of interstitial fluid,which then provides the convective velocity for the calculation of subsequent nanoparticle concentration.Different injection strategies for the proposed approach are evaluated by drug delivery result,temperature distribution,and tumor cell damage.Simulation results demonstrate that the proposed delayed injection strategy after optimization can not only result in a wider distribution for MNPs and TSL due to the sufficient diffusion time,but also improves the distribution of the temperature and drug concentration fields for the overall efficacy of combination therapy.展开更多
Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 20...Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.展开更多
Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Met...Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.展开更多
BACKGROUND The possible existence of an acini–islet–acinar(AIA)reflex,involving mutual amylase and insulin interactions,was investigated in the current acute experiment on pigs.AIM To confirm the existence of an AIA...BACKGROUND The possible existence of an acini–islet–acinar(AIA)reflex,involving mutual amylase and insulin interactions,was investigated in the current acute experiment on pigs.AIM To confirm the existence of an AIA reflex and justify the placement of the exocrine and endocrine pancreatic components within the same organ.METHODS The study was performed on six pigs under general anesthesia.An intravenous glucose tolerance test was performed,with a bolus infusion of 50%glucose to the jugular vein,while amylase(5000 U/kg)or vehicle intrapancreatic infusions were administered via the pancreaticoduodenalis cranialis artery during 30 min with a 1 mL/min flow rate.RESULTS The amylase infusion to pancreatic arterial circulation inhibited and delayed the insulin release peak which is usually associated with the highest value of blood glucose and is typically observed at 15 min after glucose infusion,for>1 h.The intrapancreatic infusion of the vehicle(saline)did not have any effect on the time frame of insulin release.Infusion of 1%bovine serum albumin changed the insulin release curve dramatically and prolonged the high range of insulin secretion,far beyond the glucose peak.CONCLUSION Intrapancreatic arterial infusion of amylase interrupted the integrated glucose–insulin interactions.This confirms an AIA reflex and justifies placement of the exocrine and endocrine pancreatic components within the same organ.展开更多
Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence...Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.展开更多
Intravenous infusion,a common clinical drug treatment method,is widely used in the treatment of various diseases.Due to the invasive nature of puncture during intravenous infusion,patients may inevitably experience re...Intravenous infusion,a common clinical drug treatment method,is widely used in the treatment of various diseases.Due to the invasive nature of puncture during intravenous infusion,patients may inevitably experience resistance and tension when facing nursing staff performing infusion procedures.Additionally,the complexity of the nursing staff’s work and the impact of the infusion therapy environment can exacerbate the tension between nurses and patients,leading to risks such as drug leakage and needlestick injuries.This article focuses on the factors influencing extravasation during intravenous infusion and elaborates on how high-quality nursing interventions can reduce the incidence of adverse events during intravenous infusion.These interventions aim to improve patient satisfaction with intravenous infusion nursing care and ensure the safety of intravenous infusion procedures.展开更多
In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospit...In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospital. The irrational medical orders of PIVAS at the outpatient and emergency departments were retrospectively analyzed in Jun. 2015. We strengthened the pharmacy intervention on irrational medical orders since July 2015. All the cases were selected by systematic sampling method. Cased studied in Jun. 2015 served as the control group, whereas those studied in Jan. 2016 served as the intervention group. The irrational rate and the irrational number of daily average were compared between the control group and intervention group. The common type of irrational outpatient and emergency intravenous orders mainly included irrational use of solvents, irrational dosing interval and inappropriate compatibility of drugs. The irrational rate was reduced from 17.4% to 3.3% （P〈0.01）, and the irrational number of daily average was decreased from 5.23 to 1.00 （P〈0.01）. Pharmacy intervention can reduce the irrational rate of medical orders in our hospital, which is of great significance to promote rational drug use and improve medical quality.展开更多
Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in cl...Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.展开更多
基金supported by the National Key Research and Development Program of China(2018YFC2001802)the National Natural Science Foundation of China(82303765 and 82071251)+4 种基金Hubei Province Key Research and Development Program(2021BCA145)Open Foundation of Hubei Key Laboratory of Regenerative Medicine and Multi-disciplinary Translational Research(2022zsyx008)Program of Scientifc and Technological Project in Guizhou Province(Qian Ke He Ji Chu ZK[2022]Yi Ban 516 and Qian Ke He Ji Chu ZK[2021]Yi Ban 559)the Science and Technology Talents Growth Project in Education Department of Guizhou Province(Qian Jiao He KY Zi[2021]4Y211)Research project of Guizhou Administration of Traditional Chinese Medicine(QZYY-2021-082).
文摘The primary intravenous anesthetics employed in clinical practice encompass dexmedetomidine(Dex),propofol,ketamine,etomidate,midazolam,and remimazolam.Apart from their established sedative,analgesic,and anxiolytic properties,an increasing body of research has uncovered neuroprotective efects of intravenous anesthetics in various animal and cellular models,as well as in clinical studies.However,there also exists conficting evidence pointing to the potential neurotoxic efects of these intravenous anesthetics.The role of intravenous anesthetics for neuro on both sides of protection or toxicity has been rarely summarized.Considering the mentioned above,this work aims to ofer a comprehensive understanding of the underlying mechanisms involved both in the central nerve system(CNS)and the peripheral nerve system(PNS)and provide valuable insights into the potential safety and risk associated with the clinical use of intravenous anesthetics.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.
基金Supported by the Foundation of Jiangsu Provincial Commission of Health and Family Planning,No.QNRC2016353the Commission of Health and Family Planning Xuzhou,No.KC22206.
文摘BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.
文摘BACKGROUND Managing sudden deafness(SD)in patients with diabetes mellitus(DM)is partic-ularly challenging due to the heightened risk of adverse effects associated with systemic drug administration.This study explores the potential of retroauricular subperiosteal injection as a localized drug delivery method for a more effective and safe treatment.AIM To compare the efficacy of retroauricular subperiosteal injection vs systemic intravenous glucocorticoid(GC)administration for SD in patients with DM and assess the effects on blood glucose levels.METHODS A total of 128 cases of type 2 DM(T2DM)with SD diagnosed and treated in Zibo Central Hospital from February 2021 to July 2023 were divided into two groups:An observation group(66 cases receiving retroauricular subperiosteal injection of methylprednisolone)and a control group(62 cases receiving systemic intravenous administration of methylprednisolone).The two groups were compared in terms of therapeutic efficacy,hearing recovery,blood glucose level changes,and incidence of adverse reactions.Binary logistic regression was used to analyze the factors affecting therapeutic efficacy.RESULTS The observation group showed a significantly higher total effective rate(90.91%)compared with the control group(75.81%,P<0.05).Additionally,pure-tone hearing threshold,fasting plasma glucose,and 2-hour postprandial blood glucose were significantly lower in the observation group compared with the control group(P<0.05).The incidence of adverse reactions was also lower in the observation group than in the control group(7.58%vs 22.58%,P<0.05).A T2DM course longer than 5 years and systemic intravenous GC administration were identified as independent risk factors for treatment inefficacy(P<0.05).INTRODUCTION Sudden deafness(SD)is a clinical emergency characterized by rapid-onset hearing loss that is often accompanied by clinical symptoms such as tinnitus and vertigo[1].Although its pathogenesis remains unclear,it is supposedly associated with factors,including inner ear microcirculation disorders,autoimmune diseases,and viral infections[2,3].Patients with diabetes are particularly susceptible to microvascular complications due to poor long-term glycemic control,affecting the ear’s microcirculation,subsequently increasing the risk of SD[4].Type 2 diabetes mellitus(T2DM),a chronic metabolic disease,causes multiple microvascular damages throughout the body,complicating SD treatment in patients with diabetes[5,6].Inner ear microcirculation disturbances in patients with diabetes may exacerbate the risk of SD,and its pathological process may be related to vascular endothelial dysfunction,inflammatory reactions,and hemorrhological changes caused by diabetes mellitus(DM)[7].Current SD treatments include glucocorticoids(GCs),vasodilators,and hyperbaric oxygen therapy[8].GCs are widely used due to their anti-inflammatory and immunosuppressive effects[9].However,systemic GCs may cause blood glucose(BG)fluctuations and even increase the risk of complications in patients with DM,limiting their clinical use in this population[10].Therefore,there is a compelling and immediate need for a local alternative solution that minimally affects the metabolic mechanisms.In recent years,retroauricular subperiosteal injection has emerged as a localized administration modality for treating SD[11].This method allows drugs to directly act on the inner ear,avoiding the side effects of systemic administration and having a minor impact on BG levels,providing a potentially effective treatment for patients with diabetes[12].However,there is limited clinical evidence to compare the efficacy and glycaemic effects of retroauricular subperiosteal injection vs systemic intravenous GC administration in patients with SD and diabetes.This study aimed to explore the efficacy of retroauricular subperiosteal injection and systemic intravenous GC administration for treating patients with SD and DM and their effects on BG,providing a safer and more effective clinical treatment approach.
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
文摘The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitoring,complication observation and management,positioning and mobility away from the bed,and quality assurance.These Guidelines encompass all the phases of intravenous thrombolysis care for patients experiencing acute ischemic stroke.This article aims to elucidate the Guidelines by discussing their developmental background,the designation process,usage recommendations,and the interpretation of evolving perspectives,thereby providing valuable insights for clinical practice.
文摘Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.
文摘This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to November 2024,a total of 60 elderly patients with PICC admitted to Guiqian International General Hospital were selected as research subjects.Using a digital random table method,these patients were randomly divided into a control group and an experimental group,with 30 patients in each.The control group received routine nursing care,while the experimental group received specialized intravenous therapy nursing intervention in addition to routine care.The nursing effects of both groups were comprehensively evaluated,including treatment compliance,psychological state,quality of life,incidence of complications,and satisfaction with nursing care.The results showed that after the intervention,the treatment compliance in the experimental group was significantly higher than that of the control group(P<0.05).Additionally,scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were markedly lower in the experimental group compared to the control group(P<0.05),indicating improved psychological well-being.The experimental group also scored higher in all dimensions of quality of life(P<0.05),and had a lower complication rate and higher satisfaction with nursing care(P<0.05).In conclusion,the application of specialized intravenous therapy nursing intervention in the care of elderly patients with PICC can significantly enhance treatment compliance,improve psychological status,elevate quality of life,and reduce complications,demonstrating strong clinical value and providing important guidance for future treatment and nursing of such patients.
基金supported by the Health and Health Development Promotion Project-Anesthesia and Critical Care Research Project(No.KM-20240219-01)。
文摘Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.
基金supported by Zhejiang Provincial Medical and Health Science and Technology Plan Project(2023KY448).
文摘Objective:Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes.This study investigated whether optimizing intravenous thrombolytic(IVT)therapy strategies for stroke could reduce treatment delays.Methods:To reduce delays in IVT therapy for ischemic stroke,a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou,Zhejiang Province,from June 2021 to August 2023,which included developing a timeline process management system,forming a nurse-led stroke process management team,providing homogeneous training,standardizing the IVT therapy process for ischemic stroke,and introducing an incentive policy.During the pre-(from June 2021 to February 2022,group A)and post-(from March to November 2022,group B1;from December 2022 to August 2023,group B2[implementation of an additional incentive policy])of the implementation the strategy,the door-tocomputed tomographic angiography(CTA)time(DCT),CTA time,neurology consultation to consent for IVT,CTA-to-needle time(CNT),and door-to-needle time(DNT),the percentage of people who underwent CTA within 20 min,15 min,and 10 min and DNT within 60 min,45 min,and 30 min were collected and compared.Results:Following the implementation of the standardized IVT process management strategy for stroke,the DNT for group B1 and group B2 were 30(24,44)min and 31(24,41)min,respectively,both significantly lower than the 46(38,58)min in group A(P<0.001);the median DCT were both 13 min in group B1 and B2 lower than 17min in group A(P<0.001);the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A(P<0.001);similar results were observed during the neurology consultation to obtain consent for IVT and CNT.Compared with group A,the proportion of DCT20 min,15 min,and 10 min was higher in groups B1 and B2(P<0.05),and the same result was observed at DNT60 min,45 min,and 30 min(P<0.05).However,the additional incentive policy did not significantly differ between Group B2 and Group B1.Conclusions:Optimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke,significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments.Additionally,generating a timeline for the IVT therapy process by scanning positioning quick response codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.
基金The Kunshan Social Development Science and Technology Special Project,No.KS2241.
文摘BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.
基金Project supported in part by the National Natural Science Foundation of China(Grant Nos.62471144 and 62071124)in part by the Conselho Nacional de Desenvolvimento Científico e Tecnológico(BR)(CNPq)(Grant No.315546/2021-2)。
文摘The combination therapy of magnetic hyperthermia and thermosensitive liposomes(TSL)is an emerging and effective cancer treatment method.The heat generation of magnetic nanoparticles(MNPs)due to an external alternating magnetic field can not only directly damage tumor cells,but also serves as a triggering factor for the release of doxorubicin from TSL.The aim of this study is to investigate the effects in the degree of tumor cell damage of two proposed injection strategies that consider intravenous administration.Since both MNPs and TSL enter the tumor region intravenously,this study establishes a biological geometric model based on an experiment-based vascular distribution.Furthermore,this study derives the flow velocity of interstitial fluid after coupling the pressure distribution inside blood vessels and the pressure distribution of interstitial fluid,which then provides the convective velocity for the calculation of subsequent nanoparticle concentration.Different injection strategies for the proposed approach are evaluated by drug delivery result,temperature distribution,and tumor cell damage.Simulation results demonstrate that the proposed delayed injection strategy after optimization can not only result in a wider distribution for MNPs and TSL due to the sufficient diffusion time,but also improves the distribution of the temperature and drug concentration fields for the overall efficacy of combination therapy.
基金approved by the Ethics Committee of Arak University of Medical Sciences,Arak,Iran(No.IR.ARAKMU.REC.1402.033)registered in the Iranian Registry of Clinical Trials(No.IRCT20141209020258N183).
文摘Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.
文摘Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.
文摘BACKGROUND The possible existence of an acini–islet–acinar(AIA)reflex,involving mutual amylase and insulin interactions,was investigated in the current acute experiment on pigs.AIM To confirm the existence of an AIA reflex and justify the placement of the exocrine and endocrine pancreatic components within the same organ.METHODS The study was performed on six pigs under general anesthesia.An intravenous glucose tolerance test was performed,with a bolus infusion of 50%glucose to the jugular vein,while amylase(5000 U/kg)or vehicle intrapancreatic infusions were administered via the pancreaticoduodenalis cranialis artery during 30 min with a 1 mL/min flow rate.RESULTS The amylase infusion to pancreatic arterial circulation inhibited and delayed the insulin release peak which is usually associated with the highest value of blood glucose and is typically observed at 15 min after glucose infusion,for>1 h.The intrapancreatic infusion of the vehicle(saline)did not have any effect on the time frame of insulin release.Infusion of 1%bovine serum albumin changed the insulin release curve dramatically and prolonged the high range of insulin secretion,far beyond the glucose peak.CONCLUSION Intrapancreatic arterial infusion of amylase interrupted the integrated glucose–insulin interactions.This confirms an AIA reflex and justifies placement of the exocrine and endocrine pancreatic components within the same organ.
文摘Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.
基金Henan Medical Science and Technology Research and Development Program in 2023“Analysis of Causes of Extravasation in Intravenous Infusion and Construction of Nursing Intervention Model”(Project No.LHGJ20230029)。
文摘Intravenous infusion,a common clinical drug treatment method,is widely used in the treatment of various diseases.Due to the invasive nature of puncture during intravenous infusion,patients may inevitably experience resistance and tension when facing nursing staff performing infusion procedures.Additionally,the complexity of the nursing staff’s work and the impact of the infusion therapy environment can exacerbate the tension between nurses and patients,leading to risks such as drug leakage and needlestick injuries.This article focuses on the factors influencing extravasation during intravenous infusion and elaborates on how high-quality nursing interventions can reduce the incidence of adverse events during intravenous infusion.These interventions aim to improve patient satisfaction with intravenous infusion nursing care and ensure the safety of intravenous infusion procedures.
文摘In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospital. The irrational medical orders of PIVAS at the outpatient and emergency departments were retrospectively analyzed in Jun. 2015. We strengthened the pharmacy intervention on irrational medical orders since July 2015. All the cases were selected by systematic sampling method. Cased studied in Jun. 2015 served as the control group, whereas those studied in Jan. 2016 served as the intervention group. The irrational rate and the irrational number of daily average were compared between the control group and intervention group. The common type of irrational outpatient and emergency intravenous orders mainly included irrational use of solvents, irrational dosing interval and inappropriate compatibility of drugs. The irrational rate was reduced from 17.4% to 3.3% （P〈0.01）, and the irrational number of daily average was decreased from 5.23 to 1.00 （P〈0.01）. Pharmacy intervention can reduce the irrational rate of medical orders in our hospital, which is of great significance to promote rational drug use and improve medical quality.
文摘Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.
