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Objective:To evaluate the effect of electroacupuncture (EA) on gastric emptying in patients undergoing hepatobiliary surgery with preoperative fasting and drinking under the enhanced recover after surgery (ERAS) protocol.Methods:Seventy-six patients of both sexes, aged 18-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent elective laparoscopic hepatectomy or cholecystectomy from January 2019 to December 2020, were divided into 2 groups ( n=38 each) using a random number table method: control group (group C) and EA group.Both groups used the ERAS strategy of fasting and drinking before operation.Solid food was forbidden after 20: 00 the night before surgery, and 12.5% preoperative oral carbohydrate drinks 800 ml was taken orally from 20: 00 to 22: 00, and preoperative oral carbohydrate drinks 400 ml was taken orally from 5: 30 to 6: 00 on the morning of surgery.The bilateral Zusanli, Zhongwan, Neiguan, and Taichong were stimulated at 7: 30 in group EA, while sham acupoints were stimulated in group C. All the patients underwent ultrasonography of the gastric antrum at 8: 00 for measurement of the cross-sectional area (CSA) in the supine and right lateral decubitus positions (right-lat CSA), gastric volume (GV), ratio of gastric volume to weight (GV/W), and ratio of right-lat CSA to weight (CSA/W) were measured, and Perlas A semi-quantitative grating was performed.After induction of anesthesia, the level of mucous pepsin at the esophageal entrance was quantitatively determined by enzyme-linked immunosorbent assay, and positive expression was recorded.The adverse reactions such as nausea, vomiting and aspiration during induction of anesthesia were recorded. Results:Compared with group C, the supine CSA, right-lat CSA, GV, right-lat CSA/W, GV/W, Perlas A semi-quantitative grading, positive rate of pepsin and incidence of nausea were significantly decreased in group EA ( P<0.05). Conclusions:EA can promote gastric emptying in the patients undergoing hepatobiliary surgery with preoperative fasting and drinking under ERAS protocol.
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BACKGROUND@#Intra-articular injection is a classic strategy for the treatment of early osteoarthritis (OA). However, the local delivery of traditional therapeutic agents has limited benefits for alleviating OA. Exosomes, an important type of extracellular nanovesicle, show great potential for suppressing cartilage destruction in OA to replace drugs and stem cellbased administration. @*METHODS@#In this study, we developed a thermosensitive, injectable hydrogel by in situ crosslinking of Pluronic F-127 and hyaluronic acid, which can be used as a slow-release carrier to durably retain primary chondrocyte-derived exosomes at damaged cartilage sites to effectively magnify their reparative effect. @*RESULTS@#It was found that the hydrogel can sustainedly release exosomes, positively regulate chondrocytes on the proliferation, migration and differentiation, as well as efficiently induce polarization of M1 to M2 macrophages. Intraarticular injection of this exosomes-incorporated hydrogel significantly prevented cartilage destruction by promoting cartilage matrix formation. This strategy also displayed a regenerative immune phenotype characterized by a higher infiltration of CD163+ regenerative M2 macrophages over CD86+ M1 macrophages in synovial and chondral tissue, with a concomitant reduction in pro-inflammatory cytokines (TNF-a, IL-1b, and IL-6) and increase in anti-inflammatory cytokine (IL-10) in synovial fluid. @*CONCLUSION@#Our results demonstrated that local sustained-release primary chondrocyte-derived exosomes may relieve OA by promoting the phenotypic transformation of macrophages from M1 to M2, which suggesting a great potential for the application in OA.
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Objective@#To compare the efficacy of intra-articular injection of autologous platelet-rich plasma (PRP) with that of sodium hyaluronate for patients with knee osteoarthritis (KOA).@*Methods@#Fifty KOA patients were randomly divided into a PRP group (n=25) and a sodium hyaluronate group (n=25). Those in the PRP group were injected intra-articularly with 5 ml of autologous PRP every 2 weeks for 6 consecutive weeks, while the sodium hyaluronate group was given intra-articular injections of 2 ml of sodium hyaluronate once a week for 6 weeks. Both groups performed isokinetic strength training three times a week for 6 weeks. Before as well as 6 weeks, 3 months, 6 months and 12 months after the treatment, both groups were followed and evaluated using the Western Ontario and McMaster University osteoarthritis index (WOMAC). A Biodex System 4 isometric muscle strength testing system was used to evaluate the knees′ peak torque (PT) in flexion and extension, total power (TW), and average power (AP).@*Results@#Before the treatment there were no significant differences in pain, stiffness or average WOMAC score between the two groups. Afterward significant improvement was observed in the pain, stiffness and WOMAC scores of both groups. Compared with the sodium hyaluronate group, significantly greater decreases in the average WOMAC pain score were observed in the PRP group after the different intervals. That was also true of the average stiffness scores and the overall average WOMAC scores after 6 and 12 months. The flexor and extensor PT, TW and AP at the angular velocities of 60°/s and 90°/s also improved significantly in both groups after 6 weeks and 12 months, with the improvement of the PRP group significantly greater than that in the control group at the same time points.@*Conclusion@#Intra-articular injection of either autologous PRP or sodium hyaluronate can effectively alleviate the clinical symptoms of KOA when combined with isokinetic strength training. However, PRP is the more effective. Its use is worthy of clinical application and promotion.
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Objective To compare the efficacy of intra-articular injection of autologous platelet-rich plasma (PRP) with that of sodium hyaluronate for patients with knee osteoarthritis (KOA). Methods Fifty KOA patients were randomly divided into a PRP group ( n=25) and a sodium hyaluronate group ( n=25) . Those in the PRP group were injected intra-articularly with 5 ml of autologous PRP every 2 weeks for 6 consecutive weeks, while the sodium hyaluronate group was given intra-articular injections of 2 ml of sodium hyaluronate once a week for 6 weeks. Both groups performed isokinetic strength training three times a week for 6 weeks. Before as well as 6 weeks, 3 months, 6 months and 12 months after the treatment, both groups were followed and evaluated using the Western Ontario and McMaster University osteoarthritis index ( WOMAC) . A Biodex System 4 isometric muscle strength testing system was used to evaluate the knees' peak torque (PT) in flexion and extension, total power (TW), and average power (AP). Results Before the treatment there were no significant differences in pain, stiffness or average WOMAC score be-tween the two groups. Afterward significant improvement was observed in the pain, stiffness and WOMAC scores of both groups. Compared with the sodium hyaluronate group, significantly greater decreases in the average WOMAC pain score were observed in the PRP group after the different intervals. That was also true of the average stiffness scores and the overall average WOMAC scores after 6 and 12 months. The flexor and extensor PT, TW and AP at the angular velocities of 60°/s and 90°/s also improved significantly in both groups after 6 weeks and 12 months, with the improvement of the PRP group significantly greater than that in the control group at the same time points. Conclu-sion Intra-articular injection of either autologous PRP or sodium hyaluronate can effectively alleviate the clinical symptoms of KOA when combined with isokinetic strength training. However, PRP is the more effective. Its use is worthy of clinical application and promotion.
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Objective To study the effect of isokinetic strength training on upper limb motor function and activities of daily living (ADL) in stroke patients with hemiplegia. Methods From January to December, 2016, 56 stroke patients with hemiplegia were randomly di-vided into control group and observation group equally. Both groups received routine rehabilitation training, and the observation group ac-cepted hemiplegic limb flexor and extensor muscle isokinetic strength training in addition, for four weeks. They were assessed with Fugl-Meyer Assessment-upper limb (FMA-UL), modified Ashworth Scale (MAS), modified Barthel Index (MBI) and biomechanical index-es of elbow flexion and extension with Biodex System-4 before and after treatment. Results The scores of FMA and MBI improved after treatment (t>7.083, P2.369, P2.149, P2.027, P<0.05), except the peak torque at 60°/s angular velocity. Conclusion Isokinetic strength training can improve the motor function of upper limbs and activities of daily living in stroke patients with hemiplegia.
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Objective To explore the effect of sling exercise therapy (SET) for improving the balance and walking ability of patients with incomplete paraplegia.Methods The 37 patients were randomly divided into two groups:19 patients in the observation group and 18 cases in the control group.Both groups were given conventional rehabilitation training,including bridge training on the mat,kneeling position training,sit-stand training and orthosis walking training.The observation group was additionally provided with sling exercise therapy with multi-point,muhi axis sling suspension supine,prone with a neutral lumbar spine,supine with pelvic elevation and in a lateral position like an arch.Before the treatment and 6 weeks after the treatment,trunk control tests (TCTs) were administered.The Berg balance scale (BBS) and Holden's walking function classification were used to assess the subjects' balance and walking ability.Results There were no significant differences in the two groups' average TCT and BBS scores before the treatment.After 6 weeks of treatment the average scores of both groups had increased significantly,with a significantly bigger increase observed in the observation group.After the treatment,the average Holden classification of the observation group was significantly superior to that of the control group.Conclusion SET in addition to conventional rehabilitation training can significantly improve the balance and walking ability of patients with incomplete paraplegia.It is worthy of application in clinical practice.
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@# Objective To observe the effect of Kinesio taping combining with sling exercise therapy (SET) on the motor function for children with spastic hemiplegia. Methods From October, 2014 to April, 2016, 60 children with spastic hemiplegia of cerebral palsy were randomly divided into control group (n=20), SET group (n=20) and observation group (n=20), who accepted routine rehabilitation, routine rehabilitation+SET and routine rehabilitation+SET+Kinesio taping, respectively. They were assessed with Mallet Score, modified Ashworth Scale (MAS), Peabody Developmental Motor Scale-fine motor (PDMS-2FM) and Gross Motor Function Measure (GMFM)-C zone before and three months after treatment. Results The Mallet Score and the scores of PDMS-2FM and GMFM-C improved in all the groups after treatment (t>2.074, P<0.05), and improved the most in the observation group (F>10.032, P<0.001). The score of MAS decreased in the observation group after treatment (t=4.767, P<0.001), and was the least among these groups (F=4.262, P<0.05). Conclusion Kinesio taping combining with SET can improve the motion in the children with spastic hemiplegia, and promote the development of both fine and gross motor function.
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Objective To explore the application of direct observation of procedural skills (DOPS) in anesthesia-related effects skills teaching. Methods Anesthesia students in the Department of Anesthe-siology, Clinical Medical College, Yangzhou University between June 2013 and June 2015, received an anesthesia-related DOPS examination at the mid-internship and pre-delivery. Through the DOPS assessment results, the analysis of teachers' and students' satisfaction degree on the evaluation results, the teaching effect of DOPS was evaluated. At the same time, the students were surveyed to find out the satisfaction degree of DOPS. SPSS 18.0 was applied to processing the date. Measurement data were expressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results Interim assessment indicators for each individual average of more than four points , the individual departmental rotation examination scores were higher than the overall average score interim assessment results. Compared with interim assessment, satisfaction of teachers has made great progress in the end of assessment [(8.46 ± 0.32) vs. (8.14 ±0.60)], satisfaction of students was [(8.57 ±0.59) vs. (8.20 ±0.45)], satisfaction of the students was higher than the teachers [(8.57±0.59) vs. (8.46±0.32)], and the differences were statistically significant. Conclusion DOPS as an effective anesthesia-related skill of teaching and assessment method, can improve the level of anesthesia anesthesia-related skills of college students.
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Objective To evaluate the effect of electroacupuncture on postoperative cognitive func?tion in elderly patients undergoing carotid endarterectomy. Methods Fifty patients of both sexes, aged≥65 yr, of American Society of Anesthesiologists physical status Ⅱ orⅢ, with the educational level≥ the level of primary school, scheduled for elective unilateral carotid endarterectomy, were divided into 2 groups ( n=25 each) using a random number table: control group ( group C) and electroacupuncture group ( group EA). In group EA, electroacupuncture (frequency 2∕100 Hz, intensity 5-12 mA) of Baihui (GV20), Neiguan (PC6) and Zusanli (ST36) was performed throughout surgery starting from 30 min before opera?tion, and then general anesthesia was performed. General anesthesia was performed directly in group C. Before operation ( T0 ) , at the end of operation ( T1 ) and at 24 h after operation ( T2 ) , blood samples were collected from the internal jugular vein for determination of plasma S?100βprotein, tumor necrosis factor?αand brain?derived neurotrophic factor ( BDNF) concentrations by enzyme?linked immunosorbent assay. The cognitive function was assessed using Montreal Cognitive Assessment at T0,2 and at 3 and 7 days after opera?tion ( T3,4 ) . Results Compared with group C, the Montreal Cognitive Assessment scores were significantly increased at T2?4 , the plasma S?100β protein and tumor necrosis factor?α concentrations were significantly decreased at T1,2 , and the plasma BDNF concentrations were significantly increased at T2 in group EA ( P promotion of BDNF production and reduction of brain injury.
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According to the characteristics of minor students majored in clinical anesthesia, an objective structured clinical examination (OSCE) program was established. This OSCE was applied to clinical anesthesia minor students for departmental rotation examination. Meanwhile, a questionnaire was set to collect students' attitude towards the OSCE assessment program. Results showed that OSCE assessment program could objectively and comprehensively reflect the students' clinical skills. Students participated in OSCE were quite satisfied with its design, organization, quality and effectiveness.
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<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of electroacupuncture (EA) combined with transperineal injection of botulinum toxin-A (BTX-A) on neurogenic bladder caused by spinal cord injury.</p><p><b>METHODS</b>One day af ter surgery, 35 cases of spinal cord injury accompanied with neurogenic bladder were randomly divided into a BTX-A plus EA group (20 cases, group A) and a BTX-A group (15 cases, group B). The two groups were both treated with regular rehabilitation training of bladder function and injection of 200 IU (4 ml) BTX-A through perineum external urethral sphincter; the group A was additionally treated with EA at Zhongji (CV 3), Guanyuan (CV 4), Shenshu (3BL 23), Huiyang (BL 35) and Baliao (Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34)), once a day, 40 min per treatment. The treatment was given 6 times per week for 4 weeks. The urination status in two groups before and after treatment was observed, and urodynamics examination and urethral pressure test were also made.</p><p><b>RESULTS</b>After 4-week treatment, mean times of urinary incontinence, mean urethral catheter output, pressure of bladder and volume of urinary incontinence were all improved in two groups (all P<0.05), which were more significant in the group A (all P<0.05). The residual urine, maximum bladder capacity, maximum urethral closure pressure and maximum urine flow rate were all improved in two groups after treatment (all P<0.01); the improvement of residual urine, maximum bladder capacity, maximum urethral closure pressure in the group A was more significant than that in the group B (all P<0.05).</p><p><b>CONCLUSION</b>Electroacupuncture com bined with transperineal injection of BTX-A could effectively improve the urination dysfunction in patients with neurogenic bladder after spinal cord injury.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Botulinum Toxins, Type A , Combined Modality Therapy , Electroacupuncture , Injections , Spinal Cord Injuries , Treatment Outcome , Urinary Bladder, Neurogenic , Drug Therapy , Therapeutics , UrinationABSTRACT
Objective To observe the effect of scalp acupuncture plus body weight support treadmill (BWST) training on motor function and ambulation of lower limbs in spastic cerebral palsy. Method Sixty-six eligible subjects with cerebral palsy were divided by using random number table into group A (n=20), group B (n=23), and group C (n=23). Group A was intervened by regular rehabilitation training, group B was by BWST in addition to the treatment given to group A, and group C was intervened by scalp acupuncture in addition to the treatment given to group B. The dimension D and E of Gross Motor Function Measure (GMFM) scale and Activities of Daily Living (ADL) were adopted for evaluation before treatment and after 3-month treatment. Result Before treatment, there were no significant differences in comparing the indexes among the three groups (P>0.05). After 3-month treatment, the D-dimension scores of GMFM were respectively (25.38±4.85), (29.54±5.70), and (32.37±6.58) in the three groups; the E-dimension scores were respectively (55.35±11.64), (60.80±12.47), and (65.74±13.50); the ADL scores were (60.24±14.49), (68.25±13.74), and (76.30±14.58); the scores were significantly increased in all three groups after intervention (P＜0.01), and the D-dimension and E-dimension scores of group B and C were significantly higher than those of group A (P＜0.05), and the scores of group C were significantly higher than those of group B (P＜0.05). Conclusion Scalp acupuncture plus BWST can improve the motor function and walking ability of lower limbs in spastic cerebral palsy, and thus enhance of ADL of the patients.
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Objective To explore the effect of acupuncture on ankle varus after stroke. Methods 61 stroke patients with ankle varus were randomly divided into two groups. The control group (n=30) was treated with exercise and function electrical stimulation (FES), while the observation group (n=31) was treated with acupuncture in addition. Clinical Spasticity Index (CSI), Simplified Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Berg Balance Scale (BBS), and Holden Functional Ambulation Category (FAC) were applied to as-sess ankle spasticity, lower limb motor function, the activities of daily living (ADL), balance function and walking ability respectively be-fore and 8 weeks after treatment. Results Compared with pre-treatment, two groups improved in the ankle spasticity, lower limb motor func-tion, ADL, balance function and walking ability 8 weeks after treatment (P<0.05), and the observation group was better than the control group (P<0.05). Conclusion Acupuncture can facilitate to improve the ankle spasticity, lower limb motor function, ADL, balance function and walking ability for stroke patients ankle varus.
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ObjectiveTo investigate the risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients after colorectal cancer surgery.Methods One hunderd and twenty ASA Ⅱ or Ⅲ patients aged ≥ 65 yr undergoing colorectal cancer surgery were divided into POCD group and non-POCD group according to the results of the Mini-Mental State examination (MMSE) at 7th day after operation.Age,weight,sex,the educational level,anatomical location of the tumor,TNM stages,complications,preoperative TCM syndrome type,duration of anesthesia,emergence time,the blood loss during opertion and the number of intraoperative hypotension were recorded.The cognitive function was assessed at 1 d before operation and at 1,3,7 d after operation using MMSE.The risk factors for POCD were analyzed by multivariate logistic regression analysis.ResultsThe incidence of POCD was 29.2 ％.Logistic regression analysis results indicated that age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension were the risk factors for POCD( P ＜ 0.05).Conclusion Age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension are risk factors for POCD in elderly patients after colorectal cancer surgery.