Objective To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in preventing propofol injection induced pain. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2012), CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that: a) the incidence of propofol injection induced pain in the 5-HT3 group was obviously lower than the control group (RR=0.14, 95%CI 0.09 to 0.21, Plt;0.000 01); b) as to the severity of pain, there was no statistical difference between the two groups (RR=0.84, 95%CI 0.56 to 1.26, P=0.39); the 5-HT3 group was obviously lower that the control group in the incidence of both moderate pain (RR=0.25, 95%CI 0.19 to 0.34, Plt;0.000 01) and severe pain (RR=0.16, 95%CI 0.10 to 0.24, Plt;0.000 01); and c) as to the incidence of postoperative adverse reaction: the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting (RR=0.19, 95%CI 0.11 to 0.34, Plt;0.000 01) and shivering (RR=0.20, 95%CI 0.12 to 0.33, Plt;0.000 01) as well. Conclusion 5-HT3 receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
ObjectiveTo investigate the effectiveness of arthroscopic reinforced reconstruction of anterior cruciate ligament (ACL) with autologous hamstring tendon combined with anchor suture band. MethodsBetween February 2016 and March 2018, 60 patients who were to be treated with arthroscopic ACL reconstruction and met the selection criteria were selected in the study. Among them, 30 cases were reconstructed with autologous hamstring tendon combined with anchor suture band (trial group), and 30 cases were reconstructed with simple autologous hamstring tendon (control group). There was no significant difference in gender, age, disease duration, cause of injury, injury side, and preoperative Lysholm score, Tegner score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). After reconstruction, the patients in the trial group were allowed to start knee flexion and extension activities early without wearing an adjustable brace, while the patients in the control group were required to wear an adjustable brace for 12 weeks. The knee joint function (Lysholm score, Tegner score, IKDC score) and stability (Lachman test and pivot shift test) were compared between the two groups after operation.ResultsThere was no significant difference in graft diameter between the two groups (t=1.061, P=0.115). Compared with the control group, the operation time of the trial group was significantly different (t=4.924, P=0.000). All incisions healed primarily. In the control group, the intramuscular venous thrombosis occurred in 2 cases after operation. Both groups were followed up 18 months. The Lysholm score, Tegner score, and IKDC score of the two groups at each time point after operation were significantly higher than those before operation (P<0.05); the above scores in the trial group were significantly higher than those in the control group at 3, 6, and 9 months after operation (P<0.05); there was no significant difference between the two groups at 18 months after operation (P>0.05). There was no significant difference in Lachman test results between the two groups at each time point after operation (P>0.05). There was a significant difference in pivot shift test results at 6 months after operation between the two groups (P<0.05); but there was no significant difference at other time points (P>0.05). ConclusionThe effectiveness of ACL reinforcedreconstruction with autologous hamstring tendon combined with anchor suture band is satisfactory. Compared with using autologous hamstring tendon alone, it has better initial strength and joint stability, and is more conducive to early postoperative functional exercise and functional recovery of knee joint.
目的 探討異氟醚吸入麻醉對（SD）老年大鼠學習和記憶的影響。 方法 36只SD健康雄性大鼠隨機分為異氟醚麻醉組和對照組，每組各18只。麻醉組給予2%異氟醚和40%氧氣誘導及維持麻醉3 h，對照組單純吸入含40%氧氣的空氧混合氣體3 h。麻醉組或對照組干預結束24 h后開始為期1周的盲法測試學習記憶能力。 結果 麻醉組大鼠與對照組大鼠相比，Y-迷宮測試成績錯誤反應次數差異無統計學意義（P＞0.05）；除第7天麻醉組大鼠起步電壓高于對照組（P＜0.05）外，其余時間兩組大鼠起步電壓差異均無統計學意義（P＞0.05）；除第3天麻醉組大鼠跑步電壓高于對照組（P＜0.05）外，其余時間兩組大鼠跑步電壓差異均無統計學意義（P＞0.05）。 結論 2%單純異氟醚吸入麻醉不改變老年大鼠麻醉后學習和記憶能力。
Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis (HAE), and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia (r=0.472, P=0.031), the amount of bleeding (r=0.524, P=0.015), the amount of erythrocyte suspensions infusion (r=0.627, P=0.002), and the amount of plasma infusion (r=0.617, P=0.003). There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [(23.74±15.84), (15.52±19.40) h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different (P<0.05) at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption (P<0.05); and the free calcium after blocking and opening increased with a temporary decrease (P<0.05); the hemoglobin decreased significantly after interruption and clamping (P<0.05). Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.
ObjectiveTo review the research progress of in vivo bioreactor (IVB) for bone tissue engineering in order to provide reference for its future research direction.MethodsThe literature related to IVB used in bone tissue engineering in recent years was reviewed, and the principles of IVB construction, tissue types, sites, and methods of IVB construction, as well as the advantages of IVB used in bone tissue engineering were summarized.ResultsIVB takes advantage of the body’s ability to regenerate itself, using the body as a bioreactor to regenerate new tissues or organs at injured sites or at ectopic sites that can support the regeneration of new tissues. IVB can be constructed by tissue flap (subcutaneous pocket, muscle flap/pocket, fascia flap, periosteum flap, omentum flap/abdominal cavity) and axial vascular pedicle (axial vascular bundle, arteriovenous loop) alone or jointly. IVB is used to prefabricate vascularized tissue engineered bone that matched the shape and size of the defect. The prefabricated vascularized tissue engineered bone can be used as bone graft, pedicled bone flap, or free bone flap to repair bone defect. IVB solves the problem of insufficient vascularization in traditional bone tissue engineering to a certain extent.ConclusionIVB is a promising method for vascularized tissue engineered bone prefabrication and subsequent bone defect reconstruction, with unique advantages in the repair of large complex bone defects. However, the complexity of IVB construction and surgical complications hinder the clinical application of IVB. Researchers should aim to develop a simple, safe, and efficient IVB.
ObjectiveTo figure out the factors affecting the prognosis of liver transplantation and the research progress on methods for predicting the prognosis of liver transplantation so as to provide guidance and reference for the distribution of liver sources and the perioperative treatment of liver transplantation.MethodThe literatures related to the factors influencing the prognosis of liver transplantation and the methods in predicting the prognosis were searched in the PubMed, CNKI, Wanfang, and other databases and the results were analyzed and summarized.ResultsThe liver transplantation was an effective method in the treatment of end-stage liver diseases. The main factors affecting the prognosis of liver transplantation included the change of internal environment, systemic inflammatory response, and general systemic conditions. On the basis of Model for End-stage Liver Disease (MELD), the new prediction model built in combination with the blood sodium ion, lactate, muscle mass, or reticulocyte count and hemoglobin concentration had improved the prognostic prediction ability of liver transplantation.ConclusionsIt is possible to predict the prognosis of patients with liver transplantation more accurately by selecting a more targeted prediction model combined with the factors affecting the prognosis of liver transplantation. It might provide a reference for perioperative management and treatment and make the limited liver source play the most role and save more lives.
Skin cancer is a significant public health issue, and computer-aided diagnosis technology can effectively alleviate this burden. Accurate identification of skin lesion types is crucial when employing computer-aided diagnosis. This study proposes a multi-level attention cascaded fusion model based on Swin-T and ConvNeXt. It employed hierarchical Swin-T and ConvNeXt to extract global and local features, respectively, and introduced residual channel attention and spatial attention modules for further feature extraction. Multi-level attention mechanisms were utilized to process multi-scale global and local features. To address the problem of shallow features being lost due to their distance from the classifier, a hierarchical inverted residual fusion module was proposed to dynamically adjust the extracted feature information. Balanced sampling strategies and focal loss were employed to tackle the issue of imbalanced categories of skin lesions. Experimental testing on the ISIC2018 and ISIC2019 datasets yielded accuracy, precision, recall, and F1-Score of 96.01%, 93.67%, 92.65%, and 93.11%, respectively, and 92.79%, 91.52%, 88.90%, and 90.15%, respectively. Compared to Swin-T, the proposed method achieved an accuracy improvement of 3.60% and 1.66%, and compared to ConvNeXt, it achieved an accuracy improvement of 2.87% and 3.45%. The experiments demonstrate that the proposed method accurately classifies skin lesion images, providing a new solution for skin cancer diagnosis.
ObjectivesTo evaluate the effects of Pulmonary Embolism Response Team (PERT) on treatment strategies and long-term prognosis in patients with acute pulmonary embolism before and after the implementation of the first PERT in China. Methods The official start of PERT (July 2017) was took as the cut-off point, all APE patients who attended Beijing Anzhen Hospital of Capital Medical University one year before and after this cut-off time were included through the hospital electronic medical record system. The APE patients who received traditional treatment from July 5, 2016 to July 4, 2017 were recruited in the control group (Pre-PERT group), and the APE patients who received PERT mode treatment from July 5, 2017 to July 4, 2018 were recruited as the intervention group (Post-PERT group). Treatment methods during hospitalization were compared between the two groups. The patients were followed up for one year after discharge to evaluate their anticoagulant therapy, follow-up compliance and long-term prognosis. Results A total of 108 cases in the Pre-PERT group and 102 cases in the Post-PERT group were included. There was no significant statistical difference between the two groups in age and gender (both P>0.05). Anticoagulation therapy (87.3% vs. 81.5%, P=0.251), catheter-directed treatment (3.9% vs. 2.8%, P=0.644), inferior vena cava filters (1.0% vs. 1.9%, P=1.000), surgical embolectomy (2.0% vs. 0.9%, P=0.613), systemic thrombolysis (3.9% vs. 4.6%, P=0.582) were performed in both groups with no significant differences between the two groups. The use rate of rivaroxaban in the Post-PERT group was higher than that in the Pre-PERT group at one year of discharge, and the use rate of warfarin was lower than that of the Pre-PERT group (54.5% vs. 32.5%; 43.6% vs. 59.0%, P=0.043). The anticoagulation time of the Post-PERT group was longer than that of the Pre-PERT group (11.9 months vs. 10.3 months, P<0.001). The all-cause mortality within one year, hemorrhagic events and the rate of rehospitalization due to pulmonary embolism were not significantly different between the two groups, (10.4% vs. 8.6%), (14.3% vs. 14.8%), and (1.3% vs. 2.5%, χ2=3.453, P=0.485), respectively. Conclusions APE treatment was still dominated by anticoagulation and conventional treatment at the early stage of PERT implementation, and advanced treatment (catheter-directed treatment and surgical embolectomy) is improved, it showed an expanding trend after only one year of implementation although there was no statistical difference. At follow-up, there is no increase in one-year all-cause mortality and bleeding events with a slight increase in advanced treatment after PERT implementation.
ObjectiveTo investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries.MethodsA clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Among them, 19 were male and 11 were female, aged 17-48 years (mean, 28.2 years). The PCL injury was caused by traffic accident in 8 cases, sport in 14 cases, falling and bruising by a heavy objective in 5 cases, and other injuries in 3 cases. The interval between injury and operation was 10-90 days (mean, 39.3 days). The PCL injury was rated as grade Ⅱ in 6 cases and grade Ⅲ in 24 cases. The posterior drawer test was positive in 26 cases and the inverse Lachman test was positive in 24 cases. The International Knee Documentation Committee (IKDC) score was 61.37±8.49, and the objective IKDC ligament grading was near normal in 2 cases, abnormal in 8 cases, and significantly abnormal in 20 cases. The modified Lysholm knee score was 62.20±5.67. The knee range of motion (ROM) was (101.83±8.15) °.ResultsThe operative time ranged from 70 to 110 minutes (mean, 79.7 minutes). All incisions healed by first intetion. All patients were followed up 12-24 months (mean, 19.0 months). There were 3 cases of deep vein thrombosis in the lower extremity after operation, and 1 case of approximately 10° limitation of knee extension. At last follow-up, the posterior drawer test was positive in 2 cases and the inverse Lachman test was positive in 1 case, with significant differences compared with the preoperative period (χ2=38.571, P=0.000; χ2=36.274, P=0.000). The IKDC score was 84.67±3.67, and the objective IKDC ligament grading was normal in 16 cases, nearly normal in 10 cases, abnormal in 3 cases, and significantly abnormal in 1 case; the modified Lysholm knee score was 90.37±4.49; all of the above indexes were significantly better than preoperative ones, and the differences were significant (t=?12.387, P=0.000; Z=?2.810, P=0.005; t=?22.865, P=0.000). Knee ROM was (88.33±9.86)° at 1 month after operation and reached (113.33±13.48)° at last follow-up, showing significant differences between pre- and post-operation (P<0.05). MRI re-examination showed that the form and position of reconstructed PCL were satisfactory.ConclusionIt can obtain good short-term effectiveness for PCL injuries by arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon, which has the advantages of reliable surgical approach, safe operation, and precise effectiveness.
目的 評價地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查的效果。 方法 將2012年10月－12月擬行纖維支氣管鏡檢查，且按美國麻醉醫師協會分級Ⅰ或Ⅱ級的60例患者，隨機分為芬太尼組（F組）、地佐辛組（D組）、生理鹽水組（N組）,每組20例。采用雙盲法給藥，靜脈注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理鹽水0.1 mL/kg，5 min后3組緩慢靜脈注射丙泊酚2 mg/kg誘導后置入喉罩，術中保留自主呼吸，持續泵入丙泊酚4～6 mg/（kg·h）維持麻醉，觀察3組患者誘導前（T0）、誘導后時（T1）、纖維支氣管鏡操作時（T2）、術畢時（T3）及拔除喉罩時（T4）的生命體征，記錄丙泊酚總用量、蘇醒時間、蘇醒時的呼吸道疼痛視覺模擬評分（VAS），記錄術中及術后有關并發癥的發生情況。 結果 與N組相比，D、F兩組丙泊酚總用量減少、蘇醒時間縮短，頭昏及術中體動發生率、VAS評分明顯降低（P＜0.05）；呼吸暫停的發生率D組最低（P＜0.05）；惡心、嘔吐的發生率F組最高（P＜0.05）。 結論 地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查，麻醉效果滿意，術后鎮痛效果好，值得臨床推廣。