Population pharmacokinetics of rocuronium delivered by target-controlled infusion in adult patients

Background Target-controlled infusion （TCI） has been recently developed and successfully implemented in clinical practice. The current study was to estimate the population pharmacokinetics of rocuronium TCI in adult patients using nonlinear mixed-effects model （NONMEM）, and to investigate the influence of relevant factors in adult patients. Methods Fourteen ASA Ⅰ-Ⅱ patients undergoing elective laparoscopy operation with general anesthesia were included. After induction, all patients received rocuronium by TCI system. The beginning target plasma concentration （Cpt） was 2.0 μg/ml, then increased Cpt according to the neuromuscular transmission monitoring. The endpoint of Cpt was determined when the T1 scale was blocked by 90%-95%. TCI rocuronium was stopped 30 minutes before the end of the operation. Arterial blood was drawn before anesthesia at 0, 2, 4, 6, 8, 10, 15, 20, 30, 45, 60, 120, 180, 240 and 360 minutes after the infusion of rocuronium was stopped for the analysis of plasma concentrations of rocuronium by liquid chromatography-mass spectrometry/mass spectrometry （LC-MS/MS）. The population pharmacokinetics analysis was performed using NONMEM program. Results The pharmacokinetics of TCI rocuronium in adult patients was best described by a three-comparment model. Pharmacokintic parameters were clearance （CL）1=0.205 L/min, CL2=0.324 L/min, CL3=0.0292 L/min, volumes of distribution （V）1=4.00 L, V2=2.28 L, V3=4.26 L, Vdss=10.54 L. Both age and weight as covariates affected the pharmacokinetic parameters. V1 and CL1 were negatively correlated with patient age. CL1 was positively correlated with weight. Conclusions No pharmacokinetic change was noted when rocuronium was administered via TCI. Both age and weight as covariates affected the pharmacokinetic parameters.     

A comparative study of the dose-response and time course of recovery of atra curium and rocuronium

Objective To compare the characteristics of the dose-response relationship and the time course of action between atracurium and rocuronium in adult patients anestheti zed with N(2)O-0(2)-fentanyl-thiopene. Methods Sixty patients, ASA grade Ⅰ, aged 18-50 years, scheduled for elective plastic s urgery were studied.All patients were randomly divided into either the atra c urium or rocuronium group.General anesthesia was maintained with 60% nitrous o xide and 40% oxygen, thiopentone, and fentanyl. Neuromuscular function was ass essed using an accelograph with train-of-four (TOF) stimulation at the wrist e very 12 seconds.The percentage depression of the first twitch (T(1)) was used as th e study parameter.The dose-response relationship of atracurium and rocuronium was determined by the cumulative dose-response technique.Results According to the dose-response curves established by a least squares linear reg ression, the potency ratio of atracurium to rocuronium was 1∶1.2. There were si gnificant differences in the ED(50), ED(90), and ED(95) between the two drugs. After the intravenous administration of equipotent doses of both dr ugs (1.5×ED(95)), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their rec overy indexes were similar.Conclusions Atracurium and rocuronium are low-potency nondepolarizing relaxants with in termediate duration. As compared to atracurium, the neuromuscular blocking eff ect of rocuronium was about 20% less potent and its duration of action was shorter.     

Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck

Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients.
Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5--67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 （including 1375 patients with the atlanto-occipital extension of 〉20° and the Mallampatti＇s grade I or II） and group 2 （containing 308 patients with the atlanto-occipital extension of 〈20° and the Mallampatti＇s grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia （TIVA） or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope （FOSL）. The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients.
Results In group 1, the intubation was accomplished during the first attempt in 1279 cases （93%） and the intubation time was 〈3 minutes in 1304 cases （95%）. In group 2, the intubation was completed by the first attempt in 114 patients （37%） and 123 patients had an intubation time of 〈3 minutes （40%）. Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patien     

Differential effects of controlled hypotension on gastric intramucosal pH and post-operational gastrointestinal functional under two different anesthesia methods

Objective： To observe the effects of controlled hypotension on gastric intrarnucosal pH and post-operational gastrointestinal functions using two specific anesthesia methods. Methods： Thirty patients（ASA II ）scheduled for ectomy of hepatocarcinoma, were randomly assigned to two groups： epidural block combined with intravenous anesthesia group（E group） and inhalation anesthesia group（G group）. Gastric PgCO2 and phi were monitored at different time points, before theintravenous induction of controlled hypotension, after 1 h and 2 h, and 1 h after the termination of controlled hypotension. In the meanwhile, the artery blood gas was analyzed. Results： There was no significant difference in blood gas indexes between E group and G group. However, phi decreased significantly after I h and 2 h of controlled hypotension（P 〈 0.05）, and during the same periods PgCO2 increased significantly（P 〈 0.05 or P 〈 0.01）, the time of bowel movement and defecating deferred significantly shorter in G group patients, when compared with E group patients. Conclusion： Epidural block in combination with general anesthesia can improve gastrointestinal blood flow during controlled hypotension and facilitates post-operational recovery of gastrointestinal functions.     

Relationship between depth of anesthesia and effect-site concentration of propofol during induction with the target-controlled infusion technique in elderly patients

Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.     

Effects of Acute Normovolemic Hemodilution on Perioperative Coagulation and Fibrinolysis in Elderly Patients Undergoing Hepatic Carcinectomy

Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.     

Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism

Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients （group Ⅰ） underwent conventional neck exploration and open parathyroidectomy.Thirteen patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intra     

Effect of Jisuikang （脊髓康） on Kinetic Dysfunction in Patients after Spinal Injury

Objective： To explore the effect of Jisuikang （脊髓康, JSK） on kinetic dysfunction in patients after spinal injury. Methods： Eighty-four patients with spinal injury were assigned equally, according to a randomizing digital table to the treated group and the control group. Conventional treatment was given to both groups, and JSK was additionally given to the treated group. Changes of various kinetic function concerning parameters including kinetic score, grades of spinal injury, effectiveness of the treatment and available recovery rate in patients allocated in the treated group and the control group were observed and compared in the way issued by Association of Spinal Injury of America （ASIA）. Results： Better effects were shown in the treated group than those in the control group in improving kinetic score （92.00 ± 9.95 scores vs 83.76 ± 24.12 scores）, ASIA overall improvement rate （69.05% vs 45.24%） and grades of effectiveness （P〈0.05）. However, the difference of available recovery rate between the two groups was insignificant （P〉0.05）. Cenclusien： JSK could prevent secondary alteration of spinal injury, promote the recovery and regeneration of nerve tissues, but could not restore the function of a necrotic spine.     

Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy

Objective To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy.Methods Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1-2 mg/kg) and either remifentanil (2 μg/kg) or fentanyl (2.5 μg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2∶1) and continuous infusion of either remifentanil (0.2 μg·kg-1·min-1) or fentanyl (0.03 μg·kg-1·min-1). Results The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P<0.05). There was no significant difference between the two groups in terms of side effects.Conclusions Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.     

老年患者全麻术后顺式阿曲库铵与罗库溴铵的残余作用比较

目的观察老年患者全麻术后顺式阿曲库铵与罗库溴铵的残余效应。方法择期全麻手术患者80例,随机分为罗库溴铵组(Ⅰ组)与顺式阿曲库铵组(Ⅱ组),每组40例。均采用静吸复合麻醉,术中采用四个成串刺激(TOF)监测肌松变化,术毕常规使用新斯的明拮抗。观察拔管即刻、麻醉后恢复室(PACU)的TOF值,记录应用拮抗剂到拔管、转入PACU的时间间隔及测量TOF值时的疼痛强度。结果Ⅰ组在拔管时TOFr<0.7和TOFr<0.9的残余肌松发生率分别为52.5%、87.5%,均高于Ⅱ组的45%和72.5%,但差异无统计学意义(P>0.05);两组患者在PACU的TOFr明显高于拔管即刻的TOFr,差异有统计学意义(P<0.05)。所有患者对测量TOF值时的疼痛强度VAS评分均<50mm。结论老年患者罗库溴铵的残余机松发生率高于顺式阿曲库铵,长时间手术可优先选择顺式阿曲库铵;对无新斯的明使用禁忌证的老年患者术毕应常规拮抗肌松,可减少术后残余肌松的发生。     

罗库溴铵采用靶浓度控制输注给药与按TOF监测调控输注给药的药效学比较

目的用靶浓度控制输注法(TCI)与按4个成串刺激监测(TOF)调控持续增长静脉泵入法,对罗库溴铵的药效学进行比较,探讨罗库溴铵TCI的可行性和优劣性。方法选择30例ASAⅠ~Ⅱ级,无神经肌肉疾患,拟在全麻下行择期手术的女性患者,随机分成罗库溴铵靶浓度控制输注组(Ⅰ组,15例)和按TOF监测调控输注组(Ⅱ组,15例),以TOF刺激方式,监测拇内收肌的颤搐反应作为肌松效果的判定指标。Ⅰ组应用TCI技术,诱导时效应室靶浓度为9 mg/L,达最大阻滞时将效应室靶浓度调至4 mg/L,维持期依据临床指标调节靶浓度,同时记录TOF监测结果,但不作为调整肌松药用量的指标;Ⅱ组应用TOF监测技术诱导时采用单次推注0.6 mg/kg(2ED95)罗库溴铵,待肌松恢复至T1/Tc达10%时开始持续泵注,调节泵注速度使T1/Tc在10%~20%之间。记录2组神经肌肉阻滞监测的显效时间、起效时间、维持时间、恢复指数,并记录罗库溴铵在各阶段的用量,插管条件以及TOF监测情况。以全凭静脉麻醉(TIVA)进行麻醉诱导和维持。全部病例在肌松恢复期不予拮抗,使其自然恢复。当TOF恢复至T1/Tc≥75%时结束肌松监测,呼吸恢复满意后拔管。结果2组罗库溴铵的起效时间分别为(73.3±26.6)s和(88.7±36.2)s,没有统计学差异,但I组稍快于Ⅱ组。诱导用药量分别为(0.86±0.09)mg/kg和(0.60±0.00)mg/kg,差异具有统计学意义(P<0.01)。Ⅰ组的单位时间维持用药量为(6.48±2.28)μg/(kg.min),Ⅱ组为(8.23±2.35)μg/(kg.min),差异有统计学意义(P<0.05)。Ⅰ组的平均维持靶浓度为4.47 mg/L(4~5.5 mg/L)。维持阶段的TOF监测,I组T1/Tc(%)在0~2之间2例,在2~20之间7例,在20~50之间6例,T4/T1(%)均在0~25之间;Ⅱ组T1/Tc(%)均在10~20之间,T4/T1(%)均在0~25之间。停药后2组的肌松恢复过程无明显差异。2组的总平均用药量无明显差异。结论靶控输注罗库溴铵可安全用于临床,在效应室靶浓度为9 mg/L时诱导可以在70 s左右顺利进行气管插管,应用4.5 mg/L效应室靶浓度可使60%的患者维持满意的肌松效果。停药后恢复指数为(19.6±8.4)min。由于仍未解决个体差异问题,尚不能完全取代TOF监测给药。     

Pulmonary vein antrum isolation of pre-excited atrial fibrillation

Background Pulmonary vein antrum isolation (PVAI) of pre-excited atrial fibrillation (AF) is controversial. This study aimed to observe the therapeutic effects of PVAI on pre-excited AF.

Methods Twenty-nine patients with pre-excited AF were prospectively divided into a PVAI group (group I, 19 cases) and a control group (group II, 10 cases). To each case in group I, PVAI was performed, and then electroanatomical mapping of accessory pathways (AP) and ablation were constructed on a three-dimensional (3D) map of the valve annulus. Only AP ablation was performed in each case of group II.

Results Of the 29 cases, three were found to have dual APs, two had intermittent APs, and the remaining 24 had single APs. All APs were successfully ablated after the procedure. There were no significant statistical differences in the AP procedure duration ((77.4±21.3) minutes vs. (85.3±13.1) minutes), the AP ablation time ((204±34) seconds vs. (223±62) seconds) and the AP X-ray exposure time ((18.6±4.4) minutes vs. (19.1±4.5) minutes) respectively between groups I and II. As compared with the control group (5 of 10 cases, 50%), the PVAI group had a significantly lower AF recurrence rate (2 of 19 cases, 11%; P <0.05) during follow-up of (20.5±10.0) months. All seven patients who recurred were successfully abolished by a second ablation.

Conclusions In patients with pre-excited AF, PVAI is an effective therapeutic approach with a low AF recurrence rate. 3D electroanatomical maps of AP contributed to the high success rate of ablation without significantly prolonging of operational duration and X-ray exposure time.

     

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.     

快速康复外科促进术后胰岛素敏感性的恢复

Background  Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.

Methods  Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.

Results  Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.

Conclusion  Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

     

Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis

Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.     

Transradial artery intervention: an alternative approach for renal artery stent implantation?

Background  Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS). This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.

Methods  A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied. Radial sheath system (Terumo, Japan) was used to get access to the radial artery. Radial tourniquet (Terumo) was used to stop bleeding. A 5Fr MPA (COOK, USA) was used to perform selective renal arteriography. Percutaneous renal artery stent systems were used to perform renal artery stenting. 

Results  Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis. The descending aorta could not be catheterized in one patient because of the type III aortic arch. Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7%. There was no puncture site hematoma or pseudoaneurysm. Mean procedure time was (38.4±7.2) minutes, the mean amount of contrast agent used was (93.2±6.3) ml, and the mean postprocedure bleeding time was (3.2±1.9) minutes.

Conclusion  Transradial renal artery intervention is technically reliable with less invasion, rapid recovery, fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis.

     

新斯的明拮抗顺阿曲库铵肌松效应时机分析

目的 探讨新斯的明拮抗顺阿曲库铵肌松效应的最佳时机。方法 需行全麻择期手术的成年患者42例,以丙泊酚和瑞芬太尼靶控静脉输注维持麻醉。用加速度仪以4个成串刺激（TOF）方式透皮刺激腕部尺神经获得T1基础值。监测静注2倍ED95顺阿曲库铵后诱发肌颤搐反应的抑制和恢复过程。术毕将患者随机等分成三组,A组肌力自然恢复,B组和C组分别于TOF的T1显现和T1恢复到基础值20%时给予新斯的明拮抗。记录三组TOF的T1恢复到基础值25%、50%、75%、95%以及TOFr恢复到0.75和0.90的时间,记录给予新斯的明前和注药后自主呼吸的恢复情况。结果 T1恢到基础值75%的时间,B组（8.2±1.5） min和C组（13.0±2.8 ）min明显比A组（21.5±5.9 ）min快（P<0.01）,B组亦比C组快（P<0.01）;TOFr=0.75的时间,B组（10.9±4.4） min比A组（26.6±4.0） min和C组（13.7±2.1 ）min快（P<0.01）。T1显现时三组患者均无自主呼吸,A组出现微弱自主呼吸时,T1=76%,TOFr=0.55。结论 新斯的明拮抗顺阿曲库铵肌松作用的最佳时机以TOF的T1显现时给药为宜。     

Monitoring the source of mesenchymal stem cells in patients after transplantation of mismatched-sex hematopoietic stem cells plus third-party cells

Background In bone marrow transplant patients, the microenvironment in bone marrow is damaged after chemotherapy or radiotherapy. Subsequent to allogenic hematopoietic stem cell transplantation in patients with clinically successful engraftments, the source of mesenchymal stem cells （MSCs） remains controversial. To further verify the stimulatory effect of the simultaneous transplantation of cells from second donors on engraftment success for hematopoietic stem cell transplantation in support of donor MSCs engraftments, the aim of this study is to monitor the dynamics of the engraftment of bone marrow-derived MSCs in patients after transplantation with mismatched-sex hematopoietic stem and third-party cells. Methods In this study, the hematopoietic stem cells from 32 clinical donors of different sexes that resulted in successful engraftments were selected for transplantation and were classified into three groups for research purposes： group A consisted of 14 cases of transplantation with bone marrow and recruited peripheral hematopoietic stem cell transplantation, group B contained 8 cases of simultaneous re-transfusion of MSCs from the second donor, and group C contained 10 cases of simultaneous re-transfusion of umbilical blood from the second donor. The bone marrow from 32 patients with successful engraftments of hematopoietic transplantation were selected and sub-cultured with MSCs. Flow cytometry （FCM） was used to measure the expression of surface antigens on MSCs. Denaturing high-performance liquid chromatography （DHPLC） in combination with polymerase chain reaction amplification of short tandem repeats （STR- PCR） was used to measure the engraftment status of fifth-generation MSCs in patients. Fluorescence in situ hybridization （FISH） revealed the sex origin of the fifth-generation MSCs in 32 patients. Dynamic examinations were performed on patients receiving donor transplantations. Results The progenies of fifth-generation MSCs were successfully cultured in 32 cases. The results of FCM demonstrated that the expression levels of CD14＋ and CD45＋ cells were lower than 0.04% in the fifth-generation MSCs. The analysis using DHPLC and FISH showed similar results. One patient from group B also received a temporary transplantation of MSCs from the donor. The MSCs in the remaining 31 patients all originated from the patients themselves. Conclusions After transplantation, the MSCs present in patients originated from the host. In patients transplanted with MSCs from a second donor, the phenomenon of temporary chimerization of MSCs was observed.