Strengthen application research of ultrasound technology in perioperative and pain medicine / 中国医师杂志

The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine.ultrasound is primarily used to evaluate blood volume and volume responsiveness,airway,lung and stomach volume,as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics.Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy,pathology and cardiac function.It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound,left auricular thrombosis,infective endocarditis,aortic dissection,intraoperative monitoring,etc.The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment,and improves the quality of perioperative and pain medical treatment.

Advantages of ultrasound-guided caudal epidural block over TIVA for transrectal ultrasound guided transrectal prostate biopsy / 中国医师杂志

Objective To compare the safety and efficacy of the caudal block and Total Intravenous Anesthesia (TIVA) for transrectal ultrasound (TRUS) guided prostate biopsy.Methods 60 elderly patients with transrectal ultrasound guided transperineal prostate biopsy were randomized into Group A and Group B.Patients in Group A received ultrasound guided caudal block (0.33％ ropivacaine 15 ml) and patients in Group B received TIVA.In operation room (T1),immediately before operation (T2) and at the end of operation (T3),mean artery pressure (MAP),heart rate (HR),breathing rate (BR) and pulse oxygen saturation (SpO2) were recorded.The patients in two groups were rated the level of mini-mental state examination (MMES) at 2 h,8 h and 24 h after operation.Complications during the whole study period were also evaluated.Results The values of MAP,HR and BR of T1 in group B were significantly lower than those at T2 (P＜0.05),and were lower than those in the group A (P ＜0.05).The MMSE value in group A [2 h (25.66 ± 1.71) and 8 h (26.13 ± 1.52)] was significantly higher than that in group B [2 h (27.96 ± 1.71) and 8 h (29.01 ± 0.77)] at after operation (P ＜ 0.05).The rate of usage of ephedrine (13％) and assisted ventilation (20％) in group B was higher.No significant differences were detected in side effects between the two groups.Conclusions Caudal block provides better anesthesia than TIVA for TRUS guided prostate biopsy without an increase of side effects,and it may be safely used during ambulatory surgery.

Multi-slice spiral CT (MSCT) : value of evaluating intestinal ischemia and therapeutic strategy for patients with intestinal obstruction / 中国医师杂志

Objective To explore early signs of strangulated bowel with multi-slice spiral CT (MSCT),and the ability of this diagnostic modality to indicate when surgical management is required for intestinal obstruction with ischemia.Methods A total of 746 patients of intestinal obstruction were investigated with MSCT scan.The final diagnosis was confirmed by surgery and/or angiography.According to the final diagnosis,those cases were divided into ischemia groups (n =70) and no ischemia group (n =676).According to surgical findings,the cases in ischemia group was divided into necrosis group (n =31) and no-necrosis group (n =39).The clinical manifestations,CT signs,and surgical/angiography findings were retrospectively evaluated in this study.Results Among the typical MSCT signs for evaluating intestinal ischemia of intestinal obstruction,no enhancement,thickening,and reduced unenhanced attenuation of bowel wall had relatively high sensitivity and specificity.However,intestinal expansion,pneumatosis and effusion was absence of high specificity,and gas in bowel wall or mesenteric vascular was absence of high sensitivity.Mesenteric congestion was another important sign for intestinal ischemia.Filling defect in mesenteric vascular was highly specific to diagnosis intestinal ischemia.The MSCT signs to assess intestinal necrosis in moderate-high risk intestinal obstruction included no enhancement of bowel wall (sensitivity 0.93,specificity 0.69),mesenteric congestion (sensitivity 0.97,specificity 0.64),filling defect in mesenteric vascular (sensitivity 0.78,specificity 0.92),and ascites (sensitivity 0.77,specificity 0.92).Conclusions MSCT is an important non-invasive examination in diagnosing intestinal blood perfusion disorder and intestinal necrosis.It is much more valuable to bowel obstruction assessment than the value of symptom and physical examinations of the patient.It can provide valuable guidance to treatment strategy of bowel obstruction patient.

TNF-α induces the release of high mobility group protein B1 through p38 mitogen-activated protein kinase pathway in microglia / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of p38 MAPK inhibitor (SB203580) on TNF-α -induced high mobility group protein B1 (HMGB1) expression in microglial cells.
@*METHODS@#Microglial cells were treated with TNF-α (25 ng/mL, TNF-α group), TNF-α plus SB203580 (10 μmol/L, TNF-α+SB203580 group), SB203580 (SB203580 group) or serum-free medium (control group). After 16 h of incubation, the protein levels of p-p38 MAPK and HMGB1, and mRNA levels of HMGB1 were examined by ELISA, Western Blot and RT-PCR, respectively.
@*RESULTS@#There was a significant increase in p-p38 MAPK and HMGB1 levels in TNF-α-treated microglia cells (P<0.01). The TNF-α-induced HMGB1 protein and mRNA expression was suppressed by SB203580.
@*CONCLUSION@#TNF-α up-regulates HMGB1 expression in microglial cells through activation of the p38 MAPK pathway.