Prognostic analysis of plantar fasciitis treated by pneumatic ballistic extracorporeal shock wave versus ultrasound guided intervention / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the medium- and long-term effect of pneumatic ballistic extracorporeal shock wave versus ultrasound-guided hormone injection in the treatment of plantar fasciitis.</p><p><b>METHODS</b>The clinical data were collected from patients with plantar fasciitis admitted to PLA General Hospital pain department from September, 2015 to February, 2017. The patients were randomly divided into ultrasound-guided drug injection group and shock wave group. The therapeutic parameters including the numerical rating scale (NRS) scores in the first step pain in the morning, American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, and thickness of the plantar fascia were monitored before and at 1 week, 1 month, 3 months, and 6 months after the treatment. The recurrence rate, effectiveness, and patient satisfaction were compared between the two groups at 6 months after the treatment.</p><p><b>RESULTS</b>Thirty-nine patients were enrolled in shock wave group and 38 patients in ultrasound group. The NRS scores in the first step pain in the morning were lowered after treatment in both groups (P<0.05), and the scores were significantly lower in ultrasound group than in shock wave group at 1 week and 1 month (P<0.01), but significantly higher in ultrasound group than in shock wave group at 3 and 6 months after treatment (P<0.05). The AOFAS functional scores were increased in both groups (P<0.05) at 6 months after treatment, was significantly lower in ultrasound group than in shock wave group than group B (90.44∓13.27 vs 75.76∓21.40; P<0.05). The effective rates in shock wave group and ultrasound group were 92.31% and 76.32%, respectively (P<0.05). Recurrence was found in 1 patient (2.56%) in shock wave group and in 8 (21.05%) in ultrasound group (P<0.05). The patient satisfaction scores were significantly higher in shock wave group than in ultrasound group (8.13∓2.67 vs 6.63∓3.75, P=0.048).</p><p><b>CONCLUSION</b>Pneumatic ballistic extracorporeal shock achieves better medium- and long-term outcomes than ultrasound-guided hormone injection in the treatment of plantar fasciitis.</p>

Effects of stroke volume variation, pulse pressure variation, and pleth variability index in predicting fluid responsiveness during different positive end expiratory pressure in prone position / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effects of different positive end expiratory pressures (PEEP) on functional hemodynamic parameters in patients lying in prone position during operation under general anesthesia.</p><p><b>METHODS</b>Totally 60 patients undergoing cervical vertebra operation or lumbar vertebra operation were studied. All patients were also monitored with Vigileo／FloTrac system. The functional hemodynamic parameters including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) under PEEP levels of 0 mmHg, 5 mmHg, 10 mmHg, and 15 mmHg were recorded before and after volume expansion (hydroxyethyl starch 6%,7 ml/kg). Fluid responsiveness was defined as an increase in stroke volume index (SVI) ≥ 15%(△SVI ≥ 15%). Responders were defined as patients demonstrating an increase in SVI ≥ 15% after intravascular volume expansion and non-responders as patients whose SVI changed <15%. Receiver operating characteristic (ROC) curves were generated for SVV, PPV, and PVI under different PEEP levels to determine their diagnosis accuracies and thresholds and their potential correlations.</p><p><b>RESULTS</b>In the prone position, SVV, PPV, and PVI were significantly higher compared to those in the supine position (P<0.05) and the mean arterial pressure significantly decreased (P<0.05); however, the changes of heart rate, stroke volume, SVI, cardiac output, and cardiac index showed no significant difference (P>0.05). In the prone position, along with the elevation of PEEP (0 mmHg, 5 mmHg, 10 mmHg, and 15 mmHg), the areas under the ROC curves of SVV were 0.864, 0.759, 0.718, and 0.521, the area under the ROC of PPV were 0.873, 0.792,0.705, and 0.505, and the area under the ROC of PVI were 0.851, 0.765 ,0.709, and 0.512. Under PEEP=0 mmHg, the diagnostic thresholds of SVV, PPV, and PVI were 10.5, 11.5, and 13.5. Under PEEP=5 mmHg, the diagnostic thresholds of SVV,PPV, and PVI were 11.5,13.5, and 14.5.Under PEEP=10 mmHg,the diagnostic thresholds of SVV, PPV, and PVI were 13.5,14.5, and 16.5.In the prone position,there was a significant correlation between SVV,PPV,PVI,and PEEP.</p><p><b>CONCLUSIONS</b>SVV,PPV and PVI can predict fluid responsiveness similarly under the PEEP levels of 0,5, and 10 mmHg. Their diagnostic thresholds increases with the PEEP and the diagnostic accuracies decrease with the PEEP. However, under the PEEP level of 15 mmHg, SVV, PPV, and PVI can not predict fluid responsiveness accurately.</p>

Application of ultrasonic surface location for internal jugular vein catheterization via central approach / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the clinical value of ultrasonic surface localization in internal jugular vein catheterization.</p><p><b>METHODS</b>Totally 150 patients with American Society of Anesthesiologists physical status I -III who were planning to receive elective surgeries were randomized into anatomical landmark group, ultrasonic surface positioning group, and ultrasound-guided group using computed random table, with 50 cases in each group. The right internal jugular vein catheterization was performed after tracheal intubation. In the anatomic landmark group, patients were punctured using surface marks through central approach. In ultrasonic surface positioning group and ultrasound-guided group, patients were punctured with ultrasonic localization and guidance through central approach. The relationship between internal jugular vein and carotid artery, the position of the needle into the vein, the success rate of puncture, the change times of puncture point, and the complications were recorded.</p><p><b>RESULTS</b>Ultrasound scan revealed that the relationship between the right internal jugular vein and the right common carotid artery could be divided into three types: parallel (12.7%), partial overlapping (69.3%), and complete overlapping (18.0%). The average "safety distance" of jugular vein puncture was (1.15 +/- 0.47) cm. The success rate of the first puncture attempt in ultrasonic surface positioning group and ultrasound-guided group were 78.0% and 82.0%, respectively, which was significantly higher than that in anatomic landmark group (22.0%) (P < 0.05), whereas the complication incidence in anatomic landmark group (12.0%) were significantly higher than those in ultrasonic surface positioning group (0) and ultrasound-guided group (0) (P < 0.05).</p><p><b>CONCLUSIONS</b>Ultrasonic surface positioning applied during internal jugular vein catheterization is helpful to reveal the inner diameters as well as the origin and course of arteries and veins in the puncture and identify the abnormalities as early as possible. As a simple support technique for internal jugular vein puncture, it is suitable for clinical application.</p>

Anesthetic management for neurosurgery using intraoperative magnetic resonance imaging / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the anesthetic management for neurosurgery using intraoperative magnetic resonance imaging (iMRI).</p><p><b>METHODS</b>Thirty patients with intracranial tumor received MRI for preoperative safety screening and the operation was performed with general anesthesia and support by MRI-compatible machines. The operative time, frequency and duration of MRI, MRI-related time (from the preparation for MRI to the beginning of the surgery), time delay by MRI, body temperature at the initial iMRI and special issues related to the scanning and perioperative anesthesia were recorded.</p><p><b>RESULTS</b>Thirty patients successfully completed the operations without any incidents related to anesthesia or scanning. The mean frequency of MRI was 1.8, the mean duration of MRI was 29.24 ∓ 10.10 min, and the MRI-related time was 43.83 ∓ 10.23 min; the time delay MRI was 92.63 ∓ 28.31 min, and the body temperature was significantly higher at 2 h after MRI than that after induction.</p><p><b>CONCLUSION</b>In the anesthetic management for neurosurgery with iMRI, the anesthesiologists should focus on the safety precaution and anesthetic modulation according to the special environment and procedure of iMRI.</p>

The ability of pleth variability index to predict fluid responsiveness in mechanically ventilated patients under general anaesthesia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the ability of pleth variability index (PVI) in predicting fluid responsiveness in mechanically ventilated patients under general anesthesia.</p><p><b>METHODS</b>From August to November 2009, 25 patients were enclosed in this study following anesthesia induction. PVI was continuously displayed by the Masimo Radical 7. All patients were also monitored with Vigileo/FloTrac system. Haemodynamic data such as cardiac index (CI), stroke volume variability (SVV), mean arterial pressure, heart rate, central venous pressure, PVI, perfusion index were recorded before and after volume expansion (hetastar 6%, 7 ml/kg). Fluid responsiveness was defined as an increase in CI ≥ 15% (ΔCI ≥ 15).</p><p><b>RESULTS</b>SVV and PVI were significantly higher in the responders (16.0% ± 2.6% and 20.5% ± 3.7%) than those in non-responders (11.6% ± 1.4% and 13.8% ± 2.6%) respectively (P < 0.05). The SVV threshold of 13.5% before volume expansion was able to discriminate the responders from the non-responders with a sensitivity of 88.2% and a specificity of 87.5%. The threshold for PVI was 15.5%, the same sensitivity of 88.2% and specificity of 87.5% were obtained. There was a significant relationship between PVI before volume expansion and change in CI after volume expansion (r = 0.683, P < 0.01), the same as the changes of SVV (r = 0.600, P < 0.01).</p><p><b>CONCLUSION</b>PVI as a new dynamic indices can predict fluid responsiveness non-invasively in mechanically ventilated patients during general anesthesia.</p>

Anatomic relationship of the internal jugular vein and the common carotid artery in Chinese people / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Variations in position and relationship between the internal jugular vein (IJV) and the common carotid artery (CCA) may lead to inadvertent artery puncture which could be disastrous during central venous access. We demonstrated the anatomic relationship of the IJV with CCA in order to find the optimal site and avoid damage of CCA.</p><p><b>METHODS</b>Two hundred and twenty surgical patients were enrolled. We analyzed the distance and relationship between the IJV and CCA at three cross sections (upper border of the thyroid cartilage, cricoid cartilage and second tracheal ring) by ultrasonography and then measured the diameters of the IJV and CCA and the distances from the IJV and CCA to the skin.</p><p><b>RESULTS</b>Twenty patients were excluded on the basis of exclusion criteria. From up to down at bilateral neck, the IJV became gradually more superficial while the CCA became deeper. The diameter of the IJV became gradually larger while that of the CCA gradually smaller. The IJV from lateral to the CCA gradually moved to the front of the CCA, so the percent overlap of the IJV and CCA was gradually increased. Compared with the left side at the same transverse scan level, the distance between the CCA and IJV was wider at the right side and the right IJV was wider. The IJV location in 11 patients was medial to the CCA at one or more transverse scan levels. The angle between the IJV and CCA was significantly small in elderly patients. The CCA had already furcated at the level of the upper border of the thyroid cartilage in seven patients at the right side and in 12 patients at the left side.</p><p><b>CONCLUSIONS</b>There are variations in the position and relationship between the IJV and CCA. It is relatively more difficult to puncture at the left side of the neck, at a lower position or in elderly patients. On the contrary, it is relatively easier to puncture at the right side, at the level of the cricoid cartilage or in younger patients.</p>

Effects of pravastatin and granulocyto-colony stimulating factor in mobilizing endothelial progenitor cells in mice with myocardial ischemia / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effects of pravastatin and granulocyto-colony stimulating factor (G-CSF) in mobilizing endothelial progenitor cells (EPCs) in mice with myocardial ischemia, and explore the possible mechanism of EPC mobilization.</p><p><b>METHODS</b>Ninety-six mice were randomly divided into 4 groups (n=24), namely the control group, saline group, pravastatin group and G-CSF group. In the latter 3 groups, myocardial ischemia was induced with isoprenine followed by intraperitoneal injections of normal saline, pravastatin and G-CSF for 5 consecutive days. On days 1, 5, 7, and 9 after establishment of myocardial ischemia, 6 mice from each group were randomly selected for measurement of the EPC count and serum concentrations of vascular endothelial growth factor (VEGF).</p><p><b>RESULTS</b>Compared with the control group, EPC count increased slightly in the saline group on days 1, 5, and 7. EPC count increased significantly in pravastatin group on days 5, 7 and 9 in comparison with that of the saline group, and the increment was more obvious in G-CSF group. In comparison with the control group, the concentrations of VEGF augmented on days 5, 7 and 9 in the order of saline group, pravastatin group and G-CSF group. The effect of G-CSF on EPC mobilization was positively correlated to VEGF concentrations.</p><p><b>CONCLUSION</b>Myocardial ischemia induces EPC mobilization and VEGF release. Both Pravastatin and G-CSF can enhance EPC mobilization from the bone marrow and VEGF release, but G-CSF produces a stronger effect on EPC mobilization in association of VEGF release.</p>

Studies of potassium channel in pulmonary artery smooth muscle cells derived from renal hypertensive rat / 中国应用生理学杂志

<p><b>AIM</b>To investigate the differences of membrane capacitance, membrane current, current density and I-V curves between smooth muscle cells isolated from RHR and NTR pulmonary arteries.</p><p><b>METHODS</b>Under antiseptic conditions, the left renal artery was exposed through a retroperitoneal flank incision and carefully dissected free of the left renal vein. A silver clip with an internal diameter of 0.2-0.3 mm was placed around the left renal artery, resulting in partial occlusion of renal perfusion. SBP was observed by tail blood pressure. Whole cell recordings were made from smooth muscle cells freshly isolated from pulmonary arteries derived from RHR or NTR.</p><p><b>RESULTS</b>The average membrane capacitance was (3.43 +/- 1.16) pF, decreased by 31.1%; membrane current was (0.54 +/- 0.26) nA, decreased by 68.2%; current density was (180 +/- 90) pA/pF, decreased by 48.6%; membrane potential was (-26.96 +/- 7.23) mV, decreased by 2.5%, all compared with that of NTR respectively. Iptakalim hydrochloride at the concentration of 0.1-100 micromol/L can significantly increased NTR potassium currents. Iptakalim hydrochloride 1-100 micromol/L can significantly increased RHR potassium currents.</p><p><b>CONCLUSION</b>Membrane capacitance, membrane current, membrane potential were decreased, I-V curves were shift downward, compared with that of NTR. Iptakalim hydrochloride might significantly increase NTR and RHR potassium currents.</p>

Comparison of the Effect of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Postoperative Nausea and Vomit In Gynecologic and Obstetric Patients / 中国康复理论与实践

@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.

Comparison of the Effect of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Postoperative Nausea and Vomit In Gynecologic and Obstetric Patients / 中国康复理论与实践

@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.

Effect of Patient-controlled Epidural Analgesia and Patient-controlled Intravenous Analgesia on Pulmonary Function after Thoracotomy / 中国康复理论与实践

@#ObjectiveTo compare the effect of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on pulmonary function in post-thoracotomy patients.Methods33 ASA Ⅰ～Ⅱ patients undergoing selective esophagectomy were randomly divided into the PCEA group (n=16, treated with morphine plus bupivacaine) and PCIA group (n=17, treated with morphine plus droperidol) for 3 days postoperatively. Pulmonary function indices including respiratory rate (RR), tidal volume (Vt), vital capacity (Vc) and pulse oximetry (SpO2) were recorded before operation and on the first 2 days after operation. Pain scores with visual analogue scale (VAS) at rest, deep breathing and with cough, and adverse effects were also recorded.ResultsRR increased, Vt , Vc and SpO2 decreased markedly in both groups postoperatively compared with the base line (P<0.01), but there were no significant differences between two groups. VAS scores were much lower in PCEA group, especially, when the patient was at deep breathing or during coughing (P<0.001).ConclusionPCEA is superior to PCIA in pain relief, but contributes no more than PCIA in improving pulmonary function in post-thoracotomy patients.

Protective effects of propofol on cultured rat hippocampal neurons against anoxia-induced injury / 中华麻醉学杂志

Objective To determine if propofol can protect cultured rat hippocampal neurons from anoxia-induced injury and elucidate the underlying mechanism.Methods Neonatal Wistar rats were decapitated. Hippocampus was isolated, minced and digested with 0.125 % trypsin at 371 for 25 min, then centrifuged at 1000 r/min for 5 min. The supernatant was discartled and the precipitate was resuspended in growth medium. The cell suspension was incubated at 37 ℃ for 10 days. The cultured hippocampal neurons were randomly divided into 3 groups: control group(group C) ,anoxia group(group A), propofol + anoxia group (group PA) . Group PA was further divided into 3 subgroups of different end-propofol concentrations:3, 12,48 mg?L-1 . The cultured neurons were transferred to low glucose medium and incubated at 37 ℃ in closed incubator filled with anoxic atmosphere (95% N2-5% CO2) for 24 h in group A and group PA (following addition of propofol) . The cell survival rate in each group was measured by MIT colorimetry. The real-time changes in [Ca2+ ]i in cultured hippocampal neurons induced by anoxia or glutamate or KCL were measured by fluorescence and laser scan confocal microscopy ( LSCM) after staining with fluo-3/AM.Results The hippocampal neurons developed acute swelling and widespread degeneration following anoxia. Propofol attenuated the neuronal injury at 12 and 48 mg?L-1 in a dose-dependent manner and significantly increased the cell survival rate following anoxia (P