[Four awareness of clinical lean management].

Along with changes of medical model, hospitals need to provide best outcome with lowest cost and best patient's experience rather than merely medical treatments. It is the cultivation of lean awareness to the doctors that could acquire such outcome. The healthcare lean awareness can be summarized as responsibility awareness, digitalized awareness, detail awareness, and outstanding awareness. Through the cultivation of lean awareness, humanism can immerse into the doctors'practice, which is conducive to train for the great masters of the medicine.

Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients.

BACKGROUND: Neuropathic pain after nerve injury is severe and intractable, and current drug and non-drug therapies offer very limited pain relief. Hyperbaric oxygen (HBO 2) has been clinically used for protection of the nervous system after acute injury. We investigated whether HBO 2 treatment could prevent and/or attenuate neuropathic pain in animals and in patients. METHODS: Mechanical allodynia and thermal hyperalgesia and neurochemical alterations of neuropathic pain were analysed in male, adult, Sprague-Dawley rats with sciatic nerve injury. Clinical trials were conducted in patients with idiopathic trigeminal neuralgia. RESULTS: Repetitive HBO 2 treatment [a combination of pressure at 3 atmosphere absolute (ATA) and pure oxygen] greatly inhibited behavioural signs of neuropathic pain manifested as thermal hyperalgesia and mechanical allodynia. Such an HBO 2 treatment also inhibited nerve injury-induced induction of c-Fos and activation of astrocytes and increased phosphorylation of NR2B receptor and the subsequent Ca 2+-dependent signals in rats. Neither high pressure (up to 3 ATA) nor pure oxygen alone resulted in analgesic effect. In clinical trials, one course of HBO 2 therapy (10 consecutive days) produced a rapid-onset, dose-dependent and long-lasting analgesic effects evidenced by the decreased doses of carbamazepine required for keeping patient pain at a minimum and decreased scores of visual analogue scales, which was used for patient's self-evaluation. CONCLUSIONS: These findings support that HBO 2 therapy is an effective approach for treating neuropathic pain in both animals and human beings and suggest that neural protection, anti-inflammation and inhibition of nerve injury-induced altered neural activity may contribute to the analgesic effect of HBO 2 therapy.

Efficacy of intracarotid propofol infusion and impact of cerebral blood flow alteration.

BACKGROUND: Intracarotid propofol infusion was studied in canines as an experimental basis for application of propofol in the Wada test. METHODS: First, efficacy and side-effects of propofol anaesthesia were studied in eight mongrel dogs that received intracarotid and i.v. propofol infusions for 30 min according to a cross-over design. Auditory evoked potentials were used to guide anaesthesia. Secondly, eight mongrel dogs received intracarotid propofol infusion during both normal and cerebral hyperperfusion states using nicardipine. Haemodynamics and clinical endpoints were compared between the two infusion conditions. RESULTS: We required 33 (7.6) mg propofol intracarotically vs 113 (17) mg propofol i.v. to achieve an anaesthetic state. The mean arterial pressure (MAP) decreased about 15-27% from the baseline during i.v. infusion. However, no obvious decrease of MAP was observed after intracarotid infusion. Administration of nicardipine increased the blood flow in the internal carotid artery by 17%. Then, the propofol dosage for achieving the anaesthetic effect increased from 7.7 (0.9) mg in the normal control to 11.3 (0.8) mg in the nicardipine group. The onset time of anaesthetic effect was prolonged and the recovery time was shortened during intracarotid infusion during cerebral hyperperfusion. CONCLUSIONS: Compared with i.v. propofol infusion, intracarotid infusion could reach and maintain the target anaesthetic depth with less dosage and without affecting MAP. In addition, increase of cerebral blood flow requires a higher propofol dose, prolongs onset, and shortens recovery time during intracarotid propofol anaesthesia, indicating that patients with a cerebral hyperperfusion state may need higher dose of anaesthetics during the Wada test.

Patterns of cytosine methylation in an elite rice hybrid and its parental lines, detected by a methylation-sensitive amplification polymorphism technique.

DNA methylation is known to play an important role in the regulation of gene expression in eukaryotes. In this study, we assessed the extent and pattern of cytosine methylation in the rice genome, using the technique of methylation-sensitive amplified polymorphism (MSAP), which is a modification of the amplified fragment length polymorphism (AFLP) method that makes use of the differential sensitivity of a pair of isoschizomers to cytosine methylation. The tissues assayed included seedlings and flag leaves of an elite rice hybrid, Shanyou 63, and the parental lines Zhenshan 97 and Minghui 63. In all, 1076 fragments, each representing a recognition site cleaved by either or both of the isoschizomers, were amplified using 16 pairs of selective primers. A total of 195 sites were found to be methylated at cytosines in one or both parents, and the two parents showed approximately the same overall degree of methylation (16.3%), as revealed by the incidence of differential digestion by the isoschizomers. Four classes of patterns were identified in a comparative assay of cytosine methylation in the parents and hybrid; increased methylation was detected in the hybrid compared to the parents at some of the recognition sites, while decreased methylation in the hybrid was detected at other sites. A small proportion of the sites was found to be differentially methylated in seedlings and flag leaves; DNA from young seedlings was methylated to a greater extent than that from flag leaves. Almost all of the methylation patterns detected by MSAP could be confirmed by Southern analysis using the isolated amplified fragments as probes. The results clearly demonstrate that the MSAP technique is highly efficient for large-scale detection of cytosine methylation in the rice genome. We believe that the technique can be adapted for use in other plant species.