Analgesic effect of epidural anesthesia via the intervertebral foramen approach in percutaneous transforaminal endoscopic discectomy: a retrospective study.

BACKGROUND: Satisfactory intraoperative analgesia is critical for percutaneous transforaminal endoscopic discectomy (PTED). Local anesthesia (LA) and epidural anesthesia (EA) are recommended for PTED. LA alone does not achieve satisfactory pain management during PTED and other analgesics or sedatives are usually needed. Traditional EA, which involves implanting an epidural catheter through the midline or paramedian, has disadvantages such as difficulty in catheterization and increased preoperative preparation time. Rather than performing conventional EA, we injected local anesthetics through the intervertebral foramen during the puncture process, which we termed lumbar transforaminal EA (LTEA), and observed its feasibility and safety. This study aimed to conduct a comprehensive comparison of differences in analgesia between LA and LTEA in patients with PTED. METHODS: We performed a retrospective analysis of patients who underwent PTED between January 2018 and January 2021. Patients were divided into LA and LTEA groups. Data obtained from the electronic medical records included primary outcomes (visual analog scale [VAS] scores and anesthesia satisfaction rate) and secondary outcomes, including vital signs such as heart rate (HR), mean arterial pressure (MAP), total dosage of fentanyl, operation time, X-ray exposure time, Oswestry Disability Index (ODI) scores, and complications. RESULTS: In total, 160 patients (80 in each group) were analyzed in this study. The VAS scores for lumbar and leg pain were significantly lower in the LTEA group than in the LA group (P < 0.0001). The anesthesia satisfaction rate was 90.0% in the LTEA group and 72.5% in the LA group (P < 0.005). MAP and HR values in the LTEA group were significantly lower than those in the LA group (P < 0.05). The total dose of fentanyl in the LTEA group was significantly lower than that in the LA group (P < 0.05). As for ODI values, the average operation time, X-ray exposure time, and incidence of complications were not significantly different between the two groups (P > 0.05). CONCLUSIONS: LTEA simplifies the process of EA and can achieve a good analgesic effect intraoperatively without increasing the preoperative preparation time; thus, it may be adopted as an alternative mode of anesthesia during PTED surgery.

Research on Effects of Oropharyngeal Aspiration on Incidence of Ventilator-Associated Pneumonia in Patients with Cerebral Hemorrhage in ICU.

Cerebral hemorrhage is a kind of intracranial hemorrhage caused by nontraumatic vascular rupture of the cerebral parenchyma, which is a common cerebrovascular disease with a high disability rate and mortality. This study aimed to explore the effects of oropharyngeal aspiration in reducing ventilator-associated pneumonia in patients with cerebral hemorrhage in ICU. In this study, 96 patients with cerebral hemorrhage were selected as the subjects. They received surgical treatment, and then they were transferred into ICU of Fourth Affiliated Hospital of Harbin Medical University from December 2019 to March 2020. The patients were randomly divided into intervention group and control group, with 48 in each group. The intervention group received periodic oropharyngeal aspiration, while the control group received routine nursing measures. After the intervention, the incidence of ventilator-associated pneumonia and the positive rate of amylase α-trachea cannula specimens were recorded and compared between the two groups. After the intervention, the incidence of ventilator-associated pneumonia was 14.89% in the intervention group and 39.58% in the control group, with a statistically significant difference. And, the α-amylase positive rate, mechanical ventilation time, and ICU care duration of endotrachea cannula specimens in the intervention group were significantly lower than those in the control group. In conclusion, oropharyngeal aspiration can effectively reduce the incidence of ventilator-associated pneumonia after cerebral hemorrhage and shorten mechanical ventilation and ICU care duration. It promotes the rehabilitation of patients.

Intensive Patients' Education and Lifestyle Improving Program in CAD Patients.

The objective of this article is to investigate the effects of intensive patients' education and lifestyle improving program (IPEL) on anxiety, depression, and overall survival (OS) in coronary artery disease (CAD) patients with anxiety and depression. In all, 224 CAD patients with anxiety and depression were randomly assigned to IPEL or control group. In Stage I, the IPEL group received IPEL and usual care, while the control group only received usual care. In Stage II, patients were further followed up and OS analysis was performed. Hospital Anxiety and Depression Scale-anxiety (HADS-A) and HADS-depression (HADS-D) were used to assess anxiety and depression. IPEL reduced HADS-A score at Month 9 (M9)/M12, and the percentage of anxiety at M12 and HADS-A score changed. IPEL reduced HADS-D score at M12, and the percentage of depression at M12 and HADS-D score changed compared with control. Patients with nonanxiety/nondepression at M12 in the IPEL group showed better OS. IPEL reduces anxiety and depression and improves OS in CAD patients.

Polysaccharides from Dendrobium huoshanense stems alleviates lung inflammation in cigarette smoke-induced mice.

The present work investigated the inhibitory activity of the polysaccharide from cultivated Dendrobium huoshanense (cDHP) on lung inflammation in cigarette smoke (CS)-induced mouse model. cDHP was mainly composed of mannose and glucose in a molar ratio of 1.89: 1.00, and had a backbone with linkages of 1,4-Manp, 1,4-Glcp, 1,4,6-Manp and 1-Glcp. Hematoxylin and Eosin (HE) staining and immunohistochemistry analysis showed that cDHP can increase alveolar number, thicken alveolar wall, inhibit pulmonary bulla formation and decrease inflammatory cell infiltration as compared to the model group. ELISA determination revealed that cDHP can inhibit CS-induced enhancement in TNF-α and IL-1ß secretion in serum and lung. These results suggested that cDHP can resist CS-induced lung inflammation. Further, the phosphorylation analysis of p65, IκB, p38 and JNK as well as the DNA binding activity analysis of NF-κB and AP-1 implied that the anti-inflammation function of cDHP is mediated via regulating NF-κB and MAPK signaling.

[Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury].

OBJECTIVE: To survey the risk factors for early death of patients with acute severe traumatic cervical spinal cord injury. METHODS: A retrospective analysis of data of consecutive patients with acute severe traumatic cervical spinal cord injury admitted from January 1st 1994 to October 1st 2012 were made. The patients died within 30 days or not were allocated for death group or survival group. The risk factors for early death were analyzed through univariate analysis and logistic analysis. RESULTS: Among 1093 patients with acute traumatic cervical spinal cord injury, 352 patients with severe injury were included, and the early death rate was 14.49% (51/352). The leading causes of spinal cord injury were vehicle accidents (153 cases) and falls (117 cases). The main causes of early death were respiratory failure (16 cases), multiple organ failure (MOF, 14 cases) and gastrointestinal bleeding (11 cases). Combining the results of univariate and logistic analysis, it was found that high acute physiology and chronic health evaluation II(APACHEII) score [>15, odds ratio (OR)=11.595, P=0.000], high damage level (OR=3.519, P=0.032), hyponatremia (OR=6.316, P=0.000), neurogenic shock (OR=6.209, P=0.000), pulmonary infection (OR=14.627, P=0.000) and tracheostomy (OR=8.983, P=0.000) were risk factors for early death of patients with acute severe traumatic cervical spinal cord injury, however, the impact of gender, age, surgery, fracture and dislocation, high central fever, and administration of steroids on early death of patients with acute severe traumatic cervical spinal cord injury were uncertain. CONCLUSION: The factors reflecting disease severity and occurrence of related complications were more important in predicting the early death among patients with acute severe traumatic cervical spinal cord injury, while the influence of age, surgical manipulation etc. were minor factors.