Quantitative Evaluation of Pain with Pain Index Extracted from Electroencephalogram / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The current pain assessment methods are strongly subjective and easily affected by outside influences, and there is an urgent need to develop a reliable objective and quantitative pain-monitoring indicator. The aim of this study was to evaluate the feasibility of using Pain index (Pi) to assess pain symptoms in pain patients.</p><p><b>METHODS</b>Subjects were enrolled from patients seeking treatment at Pain Medicine Center of China Medical University Aviation General Hospital from October 2015 to December 2016, such as postherpetic neuralgia, spinal cord injury, femoral head necrosis, lumbar disc herniation, trigeminal neuralgia, complex regional pain syndrome, perineal pain, phantom limb pain, etc., (pain group, n = 111), as well as healthy volunteers without subjective pain (control group, n = 100). The subjective pain symptoms in pain patients were evaluated by Pi and visual analogue scale/numerical rating scales (VAS/NRS), respectively, and the relationship between them was analyzed using single factor correlation analysis and multiple factor regression analysis.</p><p><b>RESULTS</b>Pi levels in the pain group were significantly higher than those of the control group (t = 6.273, P< 0.001), the correlation analysis of Pi and VAS/NRS score in the pain group showed that the Pearson correlation coefficient was 0.797 (P < 0.001); After adjusted for types of pain, pain sites, medication, gender, and age, Pi was found to be independently correlated to VAS/NRS score (P < 0.001).</p><p><b>CONCLUSIONS</b>Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool.</p>

Ovarian Damages Produced by Aerosolized Fine Particulate Matter (PM) Pollution in Mice: Possible Protective Medications and Mechanisms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ambient aerosol fine particulate matter (PM2.5) is associated with male reproductive toxicity in experiments and may have adverse effects in the female. However, studies evaluating the protective effects and precise mechanisms of aspirin, Vitamin C, Vitamin E, or ozone against toxic effects of PM2.5are sparse. This study was conducted to investigate the possible protective effects and mechanisms of aspirin, Vitamin C, Vitamin E, or ozone on fertility in female mice treated with PM2.5.</p><p><b>METHODS</b>Eighty-four ICR mice were divided into six groups: control group, PM2.5group, PM2.5 + aspirin group, PM2.5 + Vitamin C group, PM2.5 + Vitamin E group, and PM2.5 + ozone group. PM2.5was given by intratracheal instillation every 2 days for 3 weeks. Aspirin, Vitamin C, and Vitamin E were given once a day by oral gavage for 3 weeks, and ozone was administered by intraperitoneal injection once a day for 3 weeks. The levels of anti-Müllerian hormone (AMH), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured using enzyme-linked immunosorbent assay. Western blotting analysis was used to analyze the expressions of Bcl-2, Bax, and caspase-3 in ovaries. Changes in histological structure were examined by light microscope and electron microscopy was used to detect ultramicrostructure.</p><p><b>RESULTS</b>The results demonstrated that PM2.5 decreased AMH levels (P < 0.001); however, aspirin (P < 0.001), Vitamin C (P < 0.001), Vitamin E (P = 0.001), and ozone (P = 0.002) alleviated the decrease. Changes of IL-6, TNF-α, 8-OHdG, Bax/Bcl-2, and caspase-3 in PM2.5group were increased compared to control group (P < 0.001), while in PM2.5 + aspirin, PM2.5 + Vitamin C, PM2.5 + Vitamin E, and PM2.5 + ozone groups, they were statistically decreased compared to PM2.5group (P < 0.001 or P< 0.05).</p><p><b>CONCLUSIONS</b>PM2.5cause the damage of ovaries, and aspirin, Vitamin C, Vitamin E, and ozone antagonizes the damage. The protective mechanism is probably due to its ability to blunt the inflammatory and oxidative stress caused by PM2.5, which subsequently suppressing the expression of apoptotic regulatory protein and reducing the incidence of ovary apoptosis.</p>

Spine surgery may cause more spinal epidural hematomas than spinal puncture / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Spinal epidural hematoma (SEH) is a rare but acute and possibly devastating clinical event. The purpose of this study is to assess the multiple etiologies of SEH seen in an academic medical center over a 15-year span. We have examined the etiologies of SEH occurring in a single institution, the University of Pittsburgh Medical Center (UPMC) over the last fifteen years using an electronic record keeping system and database: the Medical Archive Retrieval System (MARS).</p><p><b>METHODS</b>We screened MARS from 1986 - 2001 using key words: epidural, hematoma and spinal. All potential SEH cases were reviewed and only those confirmed by surgical intervention were identified as positive SEH and reported in this study.</p><p><b>RESULTS</b>There were 17 cases of confirmed SEH. Among them, seven cases were from spontaneous bleeding, seven cases following spinal surgery, and three cases from traumatic spinal fracture. There were no findings of SEH that were related to spinal or epidural anesthesia. Among the seven patients with spontaneous SEH; two were receiving anti-coagulants for deep venous thrombosis (DVT) and had elevated prothrombin time (PT) and activated partial thromboplastine time (APTT), one had hemophilia (type B), four had hypertension, and three out of seven had chronic renal or liver disease. Among postoperative SEH patients, two of the seven patients were receiving chemotherapy and radiation therapy and one had ongoing hemodialysis for renal failure. Among three patients with traumatic SEH, two had ankylosing spondylitis. Six patients had a history of alcohol abuse.</p><p><b>CONCLUSIONS</b>Spontaneous bleeding is by far the leading cause of SEH with spinal surgery being the second leading cause. Patients with multiple co-morbidities that result in coagulopathy from a variety of causes include liver or renal disease, alcohol abuse, radiation therapy, or chemotherapy. Neuraxial anesthesia is an extremely rare cause of SEH.</p>

Intraoperative cardiac arrest during anesthesia: a retrospective study of 218,274 anesthetics undergoing non-cardiac surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.</p><p><b>METHODS</b>With approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Presbyterian University Hospital (PUH), USA.</p><p><b>RESULTS</b>We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.</p><p><b>CONCLUSIONS</b>Most intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.</p>