Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery / 中国基层医药

Objective:To investigate the effect of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery.Methods:Sixty patients with differentiated thyroid cancer who received treatment in Ningbo Hospital of Traditional Chinese Medicine from January 2017 to April 2020 were included in this study. They were randomly assigned to receive either fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space (observation group, n = 30) or routine surgery + inferior thyroid artery exposure of recurrent laryngeal nerve (control group, n = 30). Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected were compared between the two groups. Parathyroid hormone (PTH) and blood calcium (Ca 2+) concentrations in the two groups were determined. The adverse reactions such as recurrent laryngeal nerve and parathyroid injury were observed in each group. Results:Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected in the observation group were (71.28 ± 10.08) minutes, (16.69 ± 4.65) mL, and (4.78 ± 1.26), respectively, which were significantly different from those in the control group [(69.27 ± 11.89) minutes, (17.14 ± 4.52) mL, (4.76 ± 1.22), t = 0.706, 0.380, 0.062, all P > 0.05]. Before surgery, there were no significant differences in PTH and Ca 2+ concentrations between the two groups [PTH: (50.24 ± 11.21) g/L vs. (50.21 ± 11.19) g/L; Ca 2+: (2.18 ± 0.08) mmol/L vs. (2.17 ± 0.09) mmol/L, t = 0.010, 0.454, both P > 0.05]. After surgery, PTH and Ca 2+ concentrations in the observation group were significantly higher than those in the control group [PTH: [(31.44 ± 6.09) g/L vs. (16.57 ± 2.35) g/L; Ca 2+: (2.07 ± 0.10) mmol/L vs. (1.23 ± 0.12) mmol/L, t = 12.477, 29.454, both P < 0.01]. Total incidence of adverse reactions in the observation group was significantly lower than that in the control group [10.00% (3/30) vs. 46.67% (14/30), χ2 = 9.931, P < 0.01). Conclusion:Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery is highly effective in the clinic. Accurate identification of recurrent laryngeal nerve in cricothyroid space is helpful to preserve the parathyroid gland and blood supply in situ, leads to a small range of changes in PTH and Ca 2+ concentrations, reduces postoperative complications, so as to protect the recurrent laryngeal nerve and parathyroid gland and thereby promote postoperative recovery.

IPACK block: emerging complementary analgesic technique for total knee arthroplasty / Bloqueo IPACK: Complemento analgésico emergente en artroplastia de rodilla

Abstract Introduction: Pain control in total knee arthroplasty (TKA) is a determining factor in the patient's rehabilitation process. With conventional peripheral blocking techniques for the posterior compartment, foot drop, and distal motor deficit have been reported. The infiltration between popliteal artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique. Objective: To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block. Methods: We conducted a prospective observational cohort study over a 6-month period in adults taken to TKA. Sociodemographic and anthropometric characteristics, laterality, postoperative pain, and opioid consumption, patient and surgeon satisfaction (Likert), postoperative nausea and vomiting, and walk in the first 24hours, were evaluated and reported with a descriptive analysis. Results: Twenty-seven patients taken to TKA received an IPACK block. The pain score remained in a mild level during the 48 hours of evaluation. In 73% of the cases, an opioid rescue dose was not required; 81% of the patients managed to walk in the first 24 hours. Conclusion: The IPACK block, combined with femoral block and neuraxial anesthesia, turn out to be an excellent analgesic strategy for TKA, achieving adequate pain management, prompt rehabilitation, and early ambulation of the patient.

Resumen Introducción: El control del dolor en artroplastia total de rodilla (ATR) es determinante en el proceso de rehabilitación del paciente. Con las técnicas convencionales de bloqueo periférico para el compartimiento posterior se ha reportado pie caído y déficit motor distal. Por lo anterior, se decidió evaluar en una cohorte las cualidades analgésicas del bloqueo IPACK como una técnica emergente prometedora. Objetivo: Describir el control analgésico, consumo de opioides y movilidad de pacientes programados para ATR usando bloqueo IPACK como adyuvante analgésico al bloqueo femoral. Métodos: Se realizó un estudio de cohorte prospectivo, en adultos llevados a ATR, durante 6 meses. Se evaluaron las características sociodemográficas, antropométricas, lateralidad, dolor postopera torio y consumo de opioides, satisfacción del paciente y del cirujano, náuseas y vómito postoperatorio, caminata en las primeras 48 h. Se informar los resultados de forma descriptiva. Resultados: En total, 27 pacientes a quienes se les realizó ATR obtuvieron bloqueo IPACK. La puntuación del dolor se mantuvo en una escala leve en un rango de 1-3 durante las 48 horas de seguimiento. En el 73% de los casos no se requirió una dosis de opioide de rescate. El 81% de los pacientes logró caminar en las primeras 24 horas. Conclusión: El IPACK, combinado con el bloqueo femoral y la anestesia neuroaxial, resultan ser una excelente estrategia analgésica para logar un adecuado control del dolor en ATR, pronta rehabilitación y deambulación temprana del paciente.

Detection of Serum IgE Specific to Mite Allergens by Immuno-PCR

BACKGROUND: Although a skin test is the primary option for detecting allergen-specific IgE in clinics, the serum IgE immunoassay is also important because it allows for the diagnosis of allergy without any accompanying adverse effect on the patient. However, the low detection limit of IgE levels by immunoassay may restrict the use of the method in some occasions, and improving its sensitivity would thus have a significant implication in allergy-immunology clinics. METHODS: In this study, we attempted to detect specific serum IgE by using immuno-polymerase chain reaction (IPCR) which combines the antigen-antibody specificity of enzyme-linked immunosorbent assays (ELISAs) with the amplification power of PCR. RESULTS: Our results demonstrated that Blo t5-specific serum IgE can be detected by IPCR with a 100-fold higher sensitivity than ELISA, and cross-reactivity of serum IgE to other mite allergens is able to be analyzed by using only 0.3 microliter of serum sample. Use of real-time IPCR seemed to permit more convenient determination of specific serum IgE as well. CONCLUSION: We believe that IPCR can serve as a valuable tool in determining specific serum IgE, especially when the amount of serum sample is limited.

Prevention of outflow block in piggy back liver transplantation / 中华肝胆外科杂志

Objective To investigate the impact of cavoplasty on the piggy back liver transplantation and on the prevention of hepatic outflow block. Methods Three patients received modified piggy back liver transplantation with venacavoplasty under single veno venous bypass. Results All the recipients had stability of dynamic circulation, short anhepatic phase and decreased hemorrhage during operation. Postoperatively all the patients recovered quickly with good liver function without any complications. Conclusions Venacavoplasty may overcome outflow block in piggy back liver transplantation and the technique can shorten anhepatic phase and decrease complications.