Effects of the costoclavicular block versus interscalene block in patients undergoing arthroscopic shoulder surgery under monitored anesthesia care: a randomized, prospective, non-inferiority study / 대한마취과학회지

Background@#Recent studies have reported that costoclavicular blocks (CCBs) can consistently block almost all branches of the brachial plexus while sparing the phrenic nerve and provide effective analgesia after shoulder surgery. We aimed to compare the efficacy of the CCB with that of the interscalene block (ISB) as the sole blocking technique for shoulder surgery. @*Methods@#A total of 212 patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ISB or CCB based on a non-inferiority design. All patients received titration sedation with propofol under monitored anesthesia during surgery. The primary outcomes were the proportion of patients with complete motor blockade of the suprascapular nerve (SSN) and incidence of hemidiaphragmatic paralysis (HDP). The secondary outcomes included block-related variables, complications, and postoperative pain scores. @*Results@#The proportion of patients with complete motor blockade of the SSN at 20 min between the CCB and ISB groups (53% vs. 66%) exceeded the predefined non-inferiority margin of −5%, but was comparable at 30 min (87% vs. 91%). The CCB resulted in a significantly lower incidence of HDP (7.55% vs. 92.45%), Horner’s syndrome (0% vs. 18.87%), and dyspnea (0% vs. 10.38%) than the ISB. None of the patients experienced failed blocks or required conversion to general anesthesia. Pain scores were comparable between the groups. @*Conclusions@#Ultrasound-guided CCBs may be comparable to ISBs, with fewer unfavorable complications in patients with impaired lung function undergoing arthroscopic shoulder surgery.

Initial exploration of choice of the donor site of flap and its repair strategy / 中华烧伤杂志

Objective@#To explore the choice of the donor site of flap and the repair method of secondary wound of flap donor site in tissue repair and reconstruction operation.@*Methods@#From January 2014 to September 2018, 62 cases of scar contracture deformity, 15 cases of skin tumor, 20 cases of skin and soft tissue injury, and 25 cases of chronic wound were admitted to the Burn Center of People′s Liberation Army of First Affiliated Hospital of Air Force Medical University, with 84 males and 38 females, aged from 3 to 89 years. Four repair strategies adopted for tissue repair and reconstruction and good repair of the donor site of flap were as follows: designing the flap rationally according to the condition around the wound or the size and shape of wound, choosing pre-expanded technique of the donor site of flap for repair of scar deformity optimally, making full use of the surrounding condition of flap donor site, and repaired with the distal flap, i. e. replacing the important site with secondary site. The donor site of flap was repaired by direct suture or peripheral flap and distal flap. The wound size of patients ranged from 3.0 cm×2.0 cm to 20.0 cm×18.0 cm, and the flap area ranged from 3.5 cm×2.0 cm to 25.0 cm×22.0 cm. The survival condition of flap, healing condition of donor site and recipient site, and follow-up condition of donor site and recipient site were recorded.@*Results@#Wounds of 122 patients were repaired with a total of 148 flaps designed by the above four repair strategies. All the flaps survived well, and the wound and flap donor site healed well. Follow-up for 3 to 36 months showed that the shape and function of recipient site and flap donor site were satisfactory.@*Conclusions@#According to the specific condition of the wound and anatomical structure of the surrounding tissue of flap donor site, overall surgical design with flexibility and personalization can achieve effects of good repair of the wound and reduce the secondary damage of flap donor site.

Skin needle embedding for obese impaired glucose tolerance / 中国针灸

<p><b>OBJECTIVE</b>To explore the effect difference between the skin needle embedding therapy and western medication for obese impaired glucose tolerance (IGT).</p><p><b>METHODS</b>A total of 300 cases of obese IGT were assigned into an embedding group and a western medication group by random number table, 150 cases in each one. Standardized diagnosis and treatment programs were applied to reduce blood pressure, lipid, weight, and exercise and scientific diet management were used. 0.25 g oral deltamine was prescribed three times a day in the western medication group. Thumb-tack needle for subcutaneous embedding was at bilateral Weiwanxiashu (EX-B 3), Ganshu (BL 18), Pishu (BL 20), Tianshu (ST 25) and Zusanli (ST 36) for 36 to 48 hours on Monday and Thursday, 3 months as a session, with other acupoints differentiated. All the treatment was given for 2 years. The indexes included the blood sugar indexes [fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c)], incidence of hypoglycemia, obesity indexes [waist circumference, body mass index (BMI)], blood lipid indexes [serum total cholesterol (TC), serum triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)], liver and kidney function indexes [serum creatinine (Scr), blood urea nitrogen (BUN) and blood uric acid (UA), glutamic-pyruvic transaminase (ALT)] and TCM symptom score. The effects and the incidence of type 2 diabetes were evaluated.</p><p><b>RESULTS</b>After treatment, 2 h PG and HbA1c reduced in the two groups (<0.01,<0.05) and the results in the embedding group were better (both<0.05). After treatment, the incidence of hypoglycemia in the embedding group was 0.7% (1/150), and that in the western medication group was 1.3% (2/150), without statistical difference (>0.05). After treatment, waist circumference and BMI reduced in the two groups (both<0.01) and the improvements in the embedding group were better (both<0.05). TC, TG and LDL-C after treatment were lower than those before treatment, and HDL-C were higher in the two groups (all<0.05), without statistical different values before and after treatment between the two groups (all>0.05). Scr, BUN, UA and ALT before and after treatment in the two groups had no statistical difference (all>0.05), without statistical difference after treatment between the two groups (all>0.05). The TCM score after treatment was lower than that before treatment in the embedding group (<0.05), and the difference was not statistical in the western medication group (>0.05). The different value of TCM score in the embedding group was better than that in the western medication group (<0.01). The total effective rate in the embedding group was 98.0% (147/150), which was superior to 92.7% (139/150) in the western medication group (<0.05). The incidence of type 2 diabetes was 2.0% (3/150) in the embedding group, and that was better than 7.3% (11/150) in the western medication group (<0.05).</p><p><b>CONCLUSION</b>Thumb-tack needle for subcutaneous embedding for 2 years could apparent improve the indexes of IGT, which is better than western medication, without liver and kidney damage.</p>

Research progress of the structure, function and mechanism of Sestrin / 中国医师杂志

Sestrins is a stress-induced protein family, which is characterized by increased expres-sion in disease or stress, and plays its role in anti-inflammation, anti-oxidation and anti-aging, but its spe-cific molecular mechanisms and signal pathways are very complex. This review summarizes the related re-searches on sestrin in the past few years, and analyzes its specific functions and recent research progress in combination with its molecular structure.

Application of superficial iliac island flap in wound repair after resection of mons pubis hypertrophic scar / 中国医师杂志

Objective To explore the repair effect of the superficial iliac island flap for the hypertrophic scar of mons pubis after burned.Methods From July 2013 to July 2016,the author had treated 26 patients with mons pubis hypertrophic scar after burned.There were 19 males and 7 females among them.The age was from 1 year and 5 months to 10 years old.The scar area was of 6 cm ×5 cm-15 cm ×8 cm.Some of the patients had external genital malformations caused by scar contracture.Surgery removed the scar and completely released the basic shape of the vulva.It had to expand the superficial iliac island flap of 1 cm according to the size of the wound,and sufficient length of vascular pedicle according to the distance from the wound to the flap.The flap was cut in the superficial of the deep fascia,and reserved about 2cm wide fat along the superficial iliac artery.The superficial vein was located in the fat.The wound was covered by the flap,which was rotated directly or through a subcutaneous tunnel.Results Twenty six patients were treated with a single operation and no vascular crisis occurred.All the flaps survived.One patient delayed incision healing due to the high incision tension,and the remaining patients were in primary healing.The postoperative follow-up found that all the flaps had thin thickness,similar color to the surrounding skin,soft texture and feeling.Conclusions There are obvious signs of scarring in the mons pubis area after deep burns,and scar contracture can cause vulvar deformity.The superficial iliac island flap,which has a thin thickness,soft texture,similar color,and can be sutured directly for the donor site,is a good choice to repair the mons pubis hypertrophic scar.

Diagnostic utility of S100A1, GLUT-1 and Caveolin-1 in renal tumors with oncocytic features: a comparative study / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the immunohistochemical expression of S100A1, GLUT-1 and Cavolin-1 and its diagnostic significance in renal tumors with oncocytic features.</p><p><b>METHODS</b>Tissue microarray and immunohistochemical staining for S100A1, GLUT-1 and Cavolin-1 were carried out in 59 cases of renal tumors with oncocytic features, including 19 cases of renal oncocytoma, 15 cases of clear cell renal cell carcinoma (CCRCC) with eosinophilic cells, 11 cases of eosinophilic variant of chromophobe renal cell carcinoma, 7 cases of oncocytic papillary renal cell carcinoma and 7 cases of epithelioid angiomyolipoma.</p><p><b>RESULTS</b>S100A1 was expressed in renal oncocytoma, with a positive propotion of 16/19 (including 14 cases showing widespread and strong positivity). On the other hand, the rate of expression of S100A1 was 2/11 in eosinophilic variant of chromophobe renal cell carcinoma, 10/15 in CCRCC with eosinophilic cells, 3/7 in oncocytic papillary renal cell carcinoma and 6/7 in epithelioid angiomyolipoma (P>0.05). The difference of S100A1 expression between renal oncocytoma and eosinophilic variant of chromophobe renal cell carcinoma was statistically significant. GLUT-1 was located in cell membrane, with a positive rate of 13/15 in CCRCC with eosinophilic cells, 7/19 in renal oncocytoma, 4/7 (weak) in oncocytic papillary renal cell carcinoma, 1/11 in eosinophilic variant of chromophobe renal cell carcinoma and 0/7 in epithelioid angiomyolipoma. The rate of expression of Cav-1 was 6/15 in CCRCC with eosinophilic cells, 2/7 in oncocytic papillary renal cell carcinoma, 5/7 in epithelioid angiomyolipoma, 2/11 (weak) in eosinophilic variant of chromophobe renal cell carcinoma and 0/19 in renal oncocytoma. S100A1 showed high sensitivity and 50% specificity in the diagnosis of renal oncocytoma. GLUT-1 and Cav-1 showed high specificity and sensitivity in the diagnosis of CCRCC and epithelioid angiomyolipoma.</p><p><b>CONCLUSIONS</b>S100A1 is widely expressed in various oncocytic renal neoplasms and helpful in differential diagnosis of renal oncocytoma from eosinophilic variant of chromophobe renal cell carcinoma, but not from other 3 oncocytic renal tumors. Overexpression of GLUT-1 can be used in distinction between CCRCC and renal oncocytoma. Cav-1 is widely expressed in CCRCC and epithelioid angiomyolipoma but not in renal oncocytoma. Cav-1 expression thus rules out renal oncocytoma.</p>

Study on the antibacterial effect of active ingredient of se-enriched Macleya cordata / 中国生化药物杂志

Objective To study on antibacterial effect of active ingredient of se-enriched Macleya cordata.Methods Penicillin sodium and saline as control, detected the average inhibition zone diameter of se-enriched Macleya cordata group ( containing 0.96 mg/mL sanguinarine) on 9 common bacteria with disc agar diffusion method;20% methanol and saline as control, se-enriched Macleya cordata group which the average inhibition zone diameter was minimum, without se-enriched Macleya cordata group and penicillin sodium were diluted with 20% methanol, made concentration of 0.48, 0.24,0.12,0.06, 0.03 mg/mL.minimal inhibitory concentration ( MIC) of each treatment group was determined by agar dilution method, evaluated antibacterial effect of se-enriched Macleaya cordata group.Results se-enriched Macleya cordata group could improve antibacterial effect significantly, the average inhibition zone of 100 μg/mL sodium selenite treatment group was minimum(Φ15.33 mm);MIC of se-enriched Macleya cordata group on E.coli O1 , E.coli P22 , E.Dublin reduced from 0.96 to 0.24 mg/mL;MIC of S.typhimurium and S.suipare were 0.12 mg/mL;MIC of S.aureus and S.suis were 0.06 mg/mL; MIC of E.Dublin and L.murrayi were less than 0.03 mg/mL.Conclusion Se-enriched Macleya cordata improves the antibacterial effect signififcantly, and it lays the theoretical foundation for development and utilization of se-enriched Macleya cordata for future.

Effect of tetramethylpyrazine pretreatment on the expression of c-fos and heat shock protein 70 during hypoxia-reoxygenation in cultured fetal rat hippocampal neurons / 中华麻醉学杂志

Objective To investigate the effect of tetramethylpyrazine pretreatment on the expression of cfos and heat shock protein (HSP70) during hypoxia-reoxygenation (H/R) in cultured fetal rat hippocampal neurons. Methods After the neurons were cultured and identified, they were randomly divided into 5 groups ( n = 24each): control group (group C), H/R group, and low, median and high concentration of tetramethylpyrazine pretreatment groups (group L, M and H). The neurons were exposed to 2 h of hypoxia followed by 24 h of reoxygenation. Tetramethylpyrazine was added with the final concentrations of 60, 200 and 800 μg/ml in group L, M and H respectively, and then the neurons were incubated for 1 h before H/R. The apoptosis rate, cell viability and expression of c-fos and HSP70 were detected. Results The cell viability was significantly lower, while the apoptosis rate was significantly higher in group A/R, L and H than in group C (P ＜0.01). The cell viability and HSP70expression were significantly higher, while the apoptosis rate and c-fos expression were significantly lower in group L, M and H than in group A/R, and in group M and H than in group L (P＜ 0.05). The cell viability and HSP70expression were significantly lower, while the apoptosis rate and c-fos expression were significantly higher in group H than in group M ( P ＜ 0.01 ).Conclusion The mechanism by which tetramethylpyrazine pretreatment inhibits the apoptosis in cultured fetal rat hippocampal neurons during H/R may be related to the dowm-regulation of c-fos expression and up-regulation of HSP70 expression.

Bone morphogenetic protein-oriented multi-factor combined application in promoting osteogenesis:recent progress / 第二军医大学学报

Bone morphogenetic proteins (BMPs) play a pivotal role in the formation,induction and repair of the bone; BMPs have been confirmed to induce bone formation.Transforming growth factor-beta,insulin-like growth factor-Ⅰ and basic fibroblast growth factor also contribute to bone formation; combination of the factors with BMPs can promote the healing of fracture and non-union,which may have a bright future in orthopedics.