Objective
To compare the effect of continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) on pain relief, rehabilitation efficacy, satisfaction degree following total knee arthroplasty (TKA) in an attempt to find a safe and effective analgesia at the stage of rehabilitation.
Methods
The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated. The patients with preoperative American Society of Anesthesiology (ASA) score of 1 to 3 were randomized into CFNB group (58 cases) and PCIA group(58 cases) according to the random number table. Both operations were performed under ultrasound guidance. Postoperative visual analogue score (VAS), knee function, incidence of adverse reaction, and satisfaction degree were compared between the two groups.
Results
Regardless of the score at postoperative 4 and 12 hours, VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [(3.2±1.1)points vs (4.1±1.5)points], 48 [(3.4±1.2)pointsvs (4.1±1.0) points] and 72 hours [(3.3±1.2)pointsvs (4.0±1.1)points] ( all P<0.05). Time to achieve knee rehabilitation training objectives like straight leg raise, walking with crutches, and passive bending to 90°were similar between the two groups. Both groups achieved comparable knee function status with respect to Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and maximal knee flexion angle at postoperative 3 months. Postoperative nausea and vomit were significantly more frequent in PCIA group (24%) than in CFNB group (14%) ( all P<0.05), but patients in both groups were satisfactory.
Conclusion
Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA, for it can control pain, accelerate rehabilitation training and function recovery, reduce adverse reaction as well as improve patients' satisfaction.
Key words:
Arthroplasty, replacement, knee; Pain; Continuous femoral nerve block/patient controlled intravenous analgesia
One case of rectal liver metastases was collected from our hospital, and the results were analyzed according to clinical laboratory examination and auxiliary examination. So this paper aims to enhance the clinicians’ awareness of rectal liver metastases through clinical data analysis, and increase early diagnosis rate and resection rate, combined with the application of chemotherapy and interventional treatment to improve prognosis and prolong survival time of the patients.
This study aimed to investigate the effects of hypoxia on the characteristics of human dental follicle cells (hDFCs).The tissue explant collagenase method was used to isolate hDFCs from young permanent teeth. The immunofluorescence technique was used to detect cell surface markers, and the multi-differentiation potential was detected by multilineage differentiation induction assay. Then, the hypoxic microenvironment was physically mimicked, and the cells were divided into the normoxia group (20%O₂) and the hypoxia group (2%O₂). The effects of hypoxia on cell migration and proliferation were examined by Transwell chamber test and CCK-8 assay, respectively. The gene and protein expression levels of stemness-related markers at both oxygen concentrations were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot, respectively. After osteogenic induction of both groups, qRT-PCR was performed to evaluate the osteogenesis-related gene, and alizarin red staining was used to assess the formation of mineralized nodules.With the multi-differentiation capacity of osteogenic cells, adipogenic cells, and nerves, hDFCs demonstrate strong stem cell characteristics and possess the criteria of mesenchymal stem cells, which can meet the requirements of seed cells in dental tissue engineering. Hypoxia was conducive to the maintenance of hDFC stemness. Hypoxia promoted the migration and proliferation of hDFCs. The hDFCs were induced to osteogenic differentiation under hypoxic conditions, thereby enhancing osteogenesis.Hypoxic microenvironment plays an important role in maintaining the stemness and promoting the proliferation, migration, and differentiation of hDFCs. Thus, this microenvironment could also serve several important functions in future clinical applications.目的 研究低氧对人牙囊细胞（hDFCs）生物学特性的影响。方法 利用组织块酶消化法从年轻恒牙中分离培养hDFCs；采用免疫荧光技术检测细胞表面标志物，多向诱导实验检测细胞多向分化潜能；模拟体外低氧微环境，将细胞分为常氧组（20%O₂）和低氧组（2%O₂），分别对两组细胞行Transwell小室试验检测低氧对细胞迁移的影响，采用CCK-8法检测低氧对细胞增殖的影响。通过实时定量聚合酶链反应（qRT-PCR）和Western blot分别从基因和蛋白水平检测hDFCs多能性相关标志物于不同氧体积分数下的表达；分别对两组细胞进行成骨诱导，qRT-PCR检测成骨相关基因，茜素红染色评估矿化结节的形成。结果 hDFCs具有较强的干细胞特征，具有成骨、成脂及成神经多向分化能力，符合间充质干细胞基本标准，能够满足牙组织工程构建对种子细胞的需求。低氧有利于hDFCs多能性的保持，同时促进了hDFCs的迁移和增殖。hDFCs于低氧中进行诱导时，其成骨分化能力得到增强。结论 低氧微环境对维持hDFCs多能性，促进hDFCs增殖、迁移和分化有重要作用。.
The research was aimed at analyzing the value of the optimized eXtreme Gradient Boosting (XGBoost) algorithm-based ultrasound cardiogram images in the diagnosis of pregnant hypertension patients. A total of 145 pregnant women (85 cases suffered from hypertension disease during pregnancy and 60 other normal women were healthy) were selected as the reference to the comparison and analysis of ultrasound cardiac function parameter, common carotid artery parameter, and the coupling relationship between hearts and cervical vessels of pregnant hypertension patients. The results demonstrated ultrasound cardiac function parameter of pregnant hypertension patients as follows. The maximum volume of the left atrium (LAVmax) was 35.65 mm, left ventricular end-systolic volume (LVESV) was 31.07 mm, and left ventricular end-diastolic volume (LVEDV) was 88.73 mm. All the above indexes were obviously higher than those of the normal control group ( P<0.05 ). Besides, intima-media thickness (IMT) of common carotid artery (465.84 μm), pulse wave velocity (PWV) (8.09 m/s), pressure of turning point 1 from isovolumic contraction phase to ejection phase (PT1) (126.5 mmHg), arterial enhancement pressure (AP) (6.14 mmHg), and arterial pressure enhancement index (8.58%) were all significantly higher than those of the normal control group ( P<0.05 ). In addition, the correlation between the coupling ( E/A ) of hearts and carotid artery of pregnant hypertension patients and PWV was not obvious ( r=−0.08432 , P>0.05 ). The results of the research indicated that intima-media inside carotid artery of pregnant hypertension patients thickened obviously, and it became less elastic compared with that of normal healthy pregnant women. What is more, cardiac morphological changes were manifested mainly as the enlargement of the left atrial chamber and the thickening of the interventricular septum. Volume load and blood flow velocity both increased, and left ventricular diastolic function was damaged. XGBoost algorithm-based ultrasound cardiogram images could improve the diagnostic effects of hypertension during pregnancy effectively.
Background: Descending necrotizing mediastinitis (DNM) is an inflammation occurring in the oropharynx and descending to the deep cervical space and mediastinum, which is a serious infectious disease. The investigation of a new classification system and treatment methods for DNM is still necessary. Methods: A total of 139 patients with DNM caused by odontogenic or pharyngeal infection were retrospectively analyzed in last 20 years in the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into the traditional treatment Group T (Group T: 43 patients) and the new classification Group N (Group N: 96 patients). A new DNM classification was developed based on the progression of mediastinal infection as follows: type Ia: infection in the anterosuperior mediastinum; type I: infection in the anterior mediastinum; type II: infection in the posterior mediastinum; and type III: infection of the whole mediastinum. Results: There were 49, 8, 10, and 29 patients classified as type Ia, I, II, and III, respectively in the Group N. The type Ia DNM patients were managed with transcervical mediastinal drainage, and the patients with types I and II DNM underwent open (thoracoscopic) surgery, 1 patient within types I died. The 29 patients with type III were managed with unilateral or bilateral open (thoracoscopic) surgery, among them, 8 patients died. The mortality rate for patients with type III DNM was 27.6%. The overall mortality rate in Group N was 9.4%. The mortality rate for patients in the Group T was 25.6%. The mortality rate of Group N was significantly lower than that of Group T (P<0.05). Conclusions: We have carried out a new clinical classification of DNM, and selected the appropriate treatment method according to the classification, and achieved a better effect than the traditional treatment method.
To compare the effects of laparoscopic total or subtotal hysterectomy and myomectomy on ovarian reserve by measuring the serum level of anti-Mullerian hormone (AMH). A total of 96 patients with uterine fibroids underwent total laparoscopic hysterectomy (TLH group, n=32), laparoscopic subtotal hysterectomy (LSH group, n=31) and laparoscopic myomectomy (LM group, n=33). Changes in ovarian reserve were examined by measuring the level of AMH pre-operation and at 1 and 4 months post-operation. No significant differences existed in AMH in LM group[(1.42±0.65), (1.31±0.53) & (1.33±0.61) μg/L, P>0.05]. The levels of AMH in both groups were significantly lower than those at pre-operation[(1.17±0.11), (1.01±0.10), (0.48±0.54) & (1.18±0.93), (0.45±0.39), (0.14±0.0) μg/L, P<0.001]. The mean percentage decrease in AMH was lower in TLH group than that in LSH group at 4-month follow-up[(-37.4±37.6)% vs. (-27.0±23.0)%, P=0.017]. The results showed that LM had no effect on ovarian reserve. Both LSH and TLH had adverse effects on ovarian reserve and TLH was more marked.
Key words:
Hysterectomy, laparoscopic; Ovarian function
Objective To investigate the effect of glucocorticoids on pulmonary oxygenation function and Short-term prognosis Of pneumocystis carinii pneumonia(PCP)in patients with AIDS.Methods 58 PCP patients with AIDS from 2005 to 2008 were analyzed retrospectively.Oxygenation index(OI)was considered as marker of Glucocorticoids therapeutic effects.The therapeutic effects of Glucocorticoids were analyzed by analysis of variance.Results Glucocorticoids were used in 74.1%(43/58)of PCP with AIDS cases.All the case's OI have significantly increased after glucocorticoids treatment,there was no significant difference between the groups had application indication and the groups without application indication.The OI difference before and after glucocorticoids treatment was decreased with the increasing OI before treatment.There was no glucocorticoids-related serious adverse reactions were observed.Conclusion The PCP patients with AIDS could obtain pulmonary symptoms and function improvements with appropriate glucocorticoids treatment,especially for those OI less than 300 mm Hg before treatment.
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