AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large...AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large- caliber side-viewing duodenoscope. METHODS: The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD). RESULTS: Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required. CONCLUSION: n-ERCP is likely a well-tolerable methodwith less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.展开更多
Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination ...Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.展开更多
To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedure...To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.展开更多
Objective： To observe the therapeutic effect and effect on plasm endothelin （ET） and nitric oxide （NO） of acupuncture in treating variant angina pectoris. Methods： Sixty-two patients with variant angina pectoris...Objective： To observe the therapeutic effect and effect on plasm endothelin （ET） and nitric oxide （NO） of acupuncture in treating variant angina pectoris. Methods： Sixty-two patients with variant angina pectoris were randomly divided into the acupuncture group of 32 cases and the control group of 30 cases. The patients in control group were treated by nitrate, Ca^2＋ antagonist and aspirin for 4 weeks. The patients in acupuncture group were treated by needling Neiguan （PC 6）, Sanyinjiao （SP 6）, Zusanli （ST 36）, Xinshu （BL 15） Taichong （LR 3） and Shenmen （HT 7） on the basis of western medicine.Results： In acupuncture group, 24 cases were markedly effective, 6 cases were effective and 2 cases got no effect. In control group, 20 cases were markedly effective, 5cases were effective and 5 cases got no effect. The therapeutic effect of acupuncture treatment was significantly prior to that of control treatment （x^2 = 95.4, P 〈 0. 05）. In acupuncture group, posttreatment plasm NO, 86.9±23.15 μmol/L, was markedly higher than pretreatment NO, 63.8±22. 07μmol/L. There was significant difference between them （t= 2.925, P〈 0.01）. In the two groups, plasm ET reduced after treatment. There was significant difference in plasm ET between posttreatment and pretreatment in the two groups （P 〈 0.01）. There was significant difference in reduced plasm ET after treatment between acupuncture group and control group （P 〈 0. 05）. Conclusion： Acupuncture in assistant treating variant angina pectoris could improve the clinical symptoms obviously and reduce the level of plasm ET and NO.展开更多
In order to analyze the influence of blade outlet angle on inner flow field and performance of low-specific-speed centrifugal pump, the flow field in the pump with different blade outlet angles 32.5°and 39° ...In order to analyze the influence of blade outlet angle on inner flow field and performance of low-specific-speed centrifugal pump, the flow field in the pump with different blade outlet angles 32.5°and 39° was numerically calculated. The external performance experiment was also carried out on the pump. Based on SIMPLEC algorithm, time-average N-S equation and the rectified k-ε turbulent model were adopted during the process of computation. The distributions of velocity and pressure in pumps with different blade outlet angles were obtained by calculation. The numerical results show that backflow areas exist in the two impellers, while the inner flow has a little improvement in the impeller with larger blade outlet angle. Blade outlet angle has a certain influence on the static pressure near the long-blade leading edge and tongue, but it has little influence on the distribution of static pressure in the passages of impeller. The experiment results show that the low-specific-speed centrifugal pump with larger blade outlet angle has better hydraulic performance.展开更多
文摘AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large- caliber side-viewing duodenoscope. METHODS: The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD). RESULTS: Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required. CONCLUSION: n-ERCP is likely a well-tolerable methodwith less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.
文摘Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.
文摘To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.
文摘Objective： To observe the therapeutic effect and effect on plasm endothelin （ET） and nitric oxide （NO） of acupuncture in treating variant angina pectoris. Methods： Sixty-two patients with variant angina pectoris were randomly divided into the acupuncture group of 32 cases and the control group of 30 cases. The patients in control group were treated by nitrate, Ca^2＋ antagonist and aspirin for 4 weeks. The patients in acupuncture group were treated by needling Neiguan （PC 6）, Sanyinjiao （SP 6）, Zusanli （ST 36）, Xinshu （BL 15） Taichong （LR 3） and Shenmen （HT 7） on the basis of western medicine.Results： In acupuncture group, 24 cases were markedly effective, 6 cases were effective and 2 cases got no effect. In control group, 20 cases were markedly effective, 5cases were effective and 5 cases got no effect. The therapeutic effect of acupuncture treatment was significantly prior to that of control treatment （x^2 = 95.4, P 〈 0. 05）. In acupuncture group, posttreatment plasm NO, 86.9±23.15 μmol/L, was markedly higher than pretreatment NO, 63.8±22. 07μmol/L. There was significant difference between them （t= 2.925, P〈 0.01）. In the two groups, plasm ET reduced after treatment. There was significant difference in plasm ET between posttreatment and pretreatment in the two groups （P 〈 0.01）. There was significant difference in reduced plasm ET after treatment between acupuncture group and control group （P 〈 0. 05）. Conclusion： Acupuncture in assistant treating variant angina pectoris could improve the clinical symptoms obviously and reduce the level of plasm ET and NO.
基金supported by National Natural Science Foundation of China granted No.50976105,No.51276172Zhejiang Provincial Natural Science Foundation Granted No.R1100530
文摘In order to analyze the influence of blade outlet angle on inner flow field and performance of low-specific-speed centrifugal pump, the flow field in the pump with different blade outlet angles 32.5°and 39° was numerically calculated. The external performance experiment was also carried out on the pump. Based on SIMPLEC algorithm, time-average N-S equation and the rectified k-ε turbulent model were adopted during the process of computation. The distributions of velocity and pressure in pumps with different blade outlet angles were obtained by calculation. The numerical results show that backflow areas exist in the two impellers, while the inner flow has a little improvement in the impeller with larger blade outlet angle. Blade outlet angle has a certain influence on the static pressure near the long-blade leading edge and tongue, but it has little influence on the distribution of static pressure in the passages of impeller. The experiment results show that the low-specific-speed centrifugal pump with larger blade outlet angle has better hydraulic performance.
