【摘要】 目的 观察在腹腔镜胆囊切除术中，氯胺酮超前镇痛对瑞芬太尼麻醉后急性疼痛的影响。 方法 2009年10月-2010年1月，将择期行腹腔镜胆囊切除术患者90例，随机分为对照组（C组）、氯胺酮超前镇痛组（K组）、氯胺酮术毕镇痛组（K1组），每组30例。所有患者均采用瑞芬太尼复合丙泊酚静脉麻醉，K组在切皮前静脉给予氯胺酮0.5 mg/kg，K1组在关腹前静脉给予氯胺酮0.5 mg/kg，C组不给予任何药物。记录术毕患者麻醉恢复情况，各时间点疼痛程度。 结果 K组、K1组躁动发生率均明显低于C组（Plt;0.05）；术后2、4、8、24 h，K组VAS评分及镇痛药使用率明显低于C组和K1组（Plt;0.05）。 结论 氯胺酮超前镇痛能明显降低瑞芬太尼术后疼痛，并且不增加并发症发生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.
【摘要】 目的 观察晚期糖基化终产物（advanced glycosylation end prodrcts，AGE）对人结肠癌细胞株SW-480增殖的影响，并探讨其可能机制。 方法 不同浓度AGE干预SW-480细胞，噻唑蓝（MTT）法比较各组细胞活力，流式细胞术观察AGE对SW-480细胞周期的影响，蛋白质印迹法观察AGE对SW-480细胞CyclinD1表达的影响，端粒重复序列扩增法（telomeric repeat amplification protocol，TRAP）银染法观察AGE对SW-480细胞端粒酶活性的影响。MTT测细胞活力的检测设置空白对照组、100 μg/mL小牛血清白蛋白（bovine serum albumin，BSA）组及50、100、500 μg/mL AGE组，其余检测只设置100 μg/mL BSA组和100 μg/mL AGE组。 结果 MTT结果示AGE促进SW-480细胞的增殖，且呈浓度依赖性。100 μg/mL BSA组与100 μg/mL AGE组72 h后的细胞G0/G1期所占百分比分别为56.02%±0.58%、51.93%±1.01%，差异有统计学意义（Plt;0.05）。蛋白质印迹法示100 μg/mL AGE组72 h后CyclinD1的表达较100 μg/mL BSA组增加，差异有统计学意义（Plt;0.05）。TRAP银染法检测示100 μg/mL AGE干预SW-480细胞72 h后可以增加端粒酶活性（Plt;0.05）。 结论 AGE可促进人结肠癌细胞SW-480生长，呈剂量依赖性。其作用机制可能与AGE上调CyclinD1的表达加速G1/S期转换及增加端粒酶活性有关。【Abstract】 Objective To observe the effects of advanced glycosylation end products (AGE) on proliferation of SW-480 cells and study the possible mechanism. Methods Various concentrations of AGE were designed to have impact on SW-480 cells. Proliferation of SW-480 cells was assessed by thiazolyl blue tetrazolium bromide (MTT) assay; The impact of AGE on the cell cycle of SW-480 cells was analyzed by flow cytometry (FCM); the influence of AGE on expression of CyclinD1 was checked by Western blotting; and the impact of AGE on telomerase activity was examined by telomeric repeat amplification proctol (TRAP) sliver staining. For the MTT assay, blank control group, 100 μg/mL bovine serum albumin (BSA) group, 50, 100 and 500 μg/mL AGE groups were designed, while for other examinations, there were only 100 μg/mL BSA group and 100 μg/mL AGE group. Results MTT result showed that AGE increased the proliferation of SW-480 cells in a dose-dependent mode. The proportion of the cells at G0/G1 stage of the 100 μg/mL BSA group and the 100 μg/mL AGE experimental group were (56.02±0.58)% and (51.93±1.01)% respectively after 72 hours, with a significant difference (Plt;0.05); western blotting showed that the expression of CyclinD1 in the 100 μg/mL AGE group was significantly higher than that in the 100 μg/mL BSA group after 72 hours; TRAP silver staining demonstrated that telomerase activity increased significantly after treated with 100 μg/mL AGE for 72 hours. Conclusions AGE can promote the growth of SW-480 cells in a dose-dependent mode. Its mechanism is mainly by up-regulating the expression of CyclinD1 to shorten G0/G1 and increasing the telomerase activity significantly.
Artificial prosthesis is an important tool to help amputees to gain or partially obtain abled human limb functions. Compared with traditional prosthesis which is only for decoration or merely has feedforward control channel, the perception and feedback function of prosthesis is an important guarantee for its normal use and self-safety. And this includes the information of position, force, texture, roughness, temperature and so on. This paper mainly summarizes the development and current status of artificial prostheses in the field of perception and feedback technology in recent years, which is derived from two aspects: the recognition way of perception signals and the feedback way of perception signals. Among the part of recognition way of perception signals, the current commonly adopted sensors related to perception information acquisition and their application status in prosthesis are overviewed. Additionally, from the aspects of force feedback stimulation, invasive/non-invasive electrical stimulation, and vibration stimulation, the feedback methods of perception signals are summarized and analyzed. Finally, some problems existing in the perception and feedback technology of artificial prosthesis are proposed, and their development trends are also prospected.
With the advantage of providing more natural and flexible control manner, brain-computer interface systems based on motor imagery electroencephalogram (EEG) have been widely used in the field of human-machine interaction. However, due to the lower signal-noise ratio and poor spatial resolution of EEG signals, the decoding accuracy is relative low. To solve this problem, a novel convolutional neural network based on temporal-spatial feature learning (TSCNN) was proposed for motor imagery EEG decoding. Firstly, for the EEG signals preprocessed by band-pass filtering, a temporal-wise convolution layer and a spatial-wise convolution layer were respectively designed, and temporal-spatial features of motor imagery EEG were constructed. Then, 2-layer two-dimensional convolutional structures were adopted to learn abstract features from the raw temporal-spatial features. Finally, the softmax layer combined with the fully connected layer were used to perform decoding task from the extracted abstract features. The experimental results of the proposed method on the open dataset showed that the average decoding accuracy was 80.09%, which is approximately 13.75% and 10.99% higher than that of the state-of-the-art common spatial pattern (CSP) + support vector machine (SVM) and filter bank CSP (FBCSP) + SVM recognition methods, respectively. This demonstrates that the proposed method can significantly improve the reliability of motor imagery EEG decoding.
Transcatheter aortic valve replacement (TAVR) has become a common theraputic option for aortic stenosis, but the evidence for precise anatomy for TAVR is accumulating. This paper presents the case of an 71-year-old female patient who had an extremely high risk of coronary obstruction due to both coronary ostia lying too low. The patient underwent TAVR with the help of coronary protection successfully. During the procedure, the patient was protected with wires only for both coronaries. After deployment, angiofluoroscopy suggested that chimney stenting should be applied for left coronary. The whole procedure was unenventful and both coronaries were seen.
ObjectiveTo investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space.MethodsTwelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C3, 4, 5 cases of C4, 5, 3 cases of C5, 6, and 2 cases of C6, 7. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation.ResultsThe average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one (P<0.05).ConclusionThe effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.
External trigeminal nerve stimulation (eTNS) is a new non-invasive physical and electrical stimulation therapy based on the anatomical characteristics of the trigeminal nerve. It can control seizures by regulating epilepsia-related brainstem nuclei and part of forebrain structures, regulating neuroinflammation, improving synaptic plasticity and promoting neurogenesis, which has broad clinical application prospects. It has been approved by the European Union as an adjuvant treatment for drug-resistant epilepsy patients over the age of 9 years old. Therefore, this article mainly reviews the central nervous system regulatory mechanism of eTNS in improving epilepsy, eTNS stimulation mode and parameters.
Objective To evaluate the clinical applicability of clinical practice guidelines in China in the past 5 years, and to provide suggestions for better development and implementation of guidelines. Methods A cross-sectional study was conducted. A total of 61 guidelines issued by the Chinese Medical Association and the Chinese Medical Doctor Association from 2015 to 2020 were selected randomly based on CNKI database. Each guideline was evaluated by medical staff from three regions using the instrument for evaluating clinical applicability of guidelines (version 2.0). Quantitative data were described by mean, standard deviation, median and interquartile range, while qualitative data were described by frequency and composition ratio. Results A total of 6 904 valid questionnaires were collected from 119 medical institutions in 26 provinces of China. The results showed that the standardized scores ranged from 54.4% to 72.7% (median 64.3%) for accessibility, from 66.1% to 83.3% (median 74.9%) for readability, from 53.7% to 94.7% (median 86.0%) for acceptability, and ranged from 61.4% to 81.0% (median 72.5%) for feasibility. Approximately 4.3% of the medical staff considered that there were obstacles to implement the guidelines, including environmental factors (32.1%), medical staff factors (26.5%), guidelines factors (22.5%), and patients or family factors (18.9%). Conclusion The overall clinical applicability of the guidelines selected in this study is satisfactory. However, it is necessary to improve the accessibility of clinical guidelines. In addition, to improve the clinical applicability, it is suggested that medical staff should be trained and provided with supporting resources.