Patients' expectations,experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.     

Isolation and characterization of cellulose from date palm tree spathe sheath

This study deals with a series of operations to isolate the micro-cellulose from the palm tree spathe sheath by using a modified chemical method to take into account the low cost and the completion speed and its characterization using X-ray diffraction technique (XRD), infrared spectroscopy (FTIR) and scanning electron microscope coupled with element analyzer (SEM/EDX). The results showed that the extraction method succeeded in obtaining very pure microscopic fibers with a width of 2–10 μm with a crystallinity index equal to 79.21%, containing the two cellulose features Iβ and II, that, the conversion ratio of the first to the second was estimated at 32, 87%.     

Use of biomimetic microtissue spheroids and specific growth factor supplementation to improve tenocyte differentiation and adaptation to a collagen-based scaffold in vitro

Tenocytes represent a valuable source of cells for the purposes of tendon tissue engineering and regenerative medicine and as such, should possess a high degree of tenogenic differentiation prior to their use in vivo in order to achieve maximal efficacy. In the current report, we identify an efficient means by which to maintain differentiated tenocytes in vitro by employing the hanging drop technique in combination with defined growth media supplements. Equine tenocytes retained a more differentiated state when cultured as scaffold-free microtissue spheroids in low serum-containing medium supplemented with l-ascorbic acid 2-phosphate, insulin and transforming growth factor (TGF)-β1. This was made evident by significant increases in the expression levels of pro-tenogenic markers collagen type I (COL1A2), collagen type III (COL3A1), scleraxis (SCX) and tenomodulin (TNMD), as well as by enhanced levels of collagen type I and tenomodulin protein. Furthermore, tenocytes cultured under these conditions demonstrated a typical spindle-like morphology and when embedded in collagen gels, became highly aligned with respect to the orientation of the collagen structure following their migration out from the microtissue spheroids. Our findings therefore provide evidence to support the use of a biomimetic microtissue approach to culturing tenocytes and that in combination with the defined growth media described, can improve their differentiation status and functional repopulation of collagen matrix.     

Shortening peel-away sheaths prior to dialysis line insertion--potential decrease of patient risk.

Placement of tunnelled dialysis lines is effective using ultrasoundand fluoroscopic guidance [1] and has a higher success ratethan ‘blind’ insertion [2]. After the ultrasound guided access into a neck vein, wires andcatheters are guided in to a suitable position in the     

国外经皮冠状动脉腔内成形术后留置动脉鞘管的护理进展

经皮冠状动脉腔内成形术（PTCA）是近30年来治疗冠心病的主要技术之一，其相应的护理技术在过去近10年里有着明显的改进。本文以穿刺股动脉途径为重点综述国外PTCA术后留置动脉鞘管的护理进展：动脉外鞘管拔除责任者、拔除时间、拔管后局部压迫方法等内容，旨在提升PTCA术后的护理质量。     

100例腰骶神经根神经病的热成象研究

目的对腰骶神经根病患者的神经损伤程度与热成象体表温差的相关性进行研究。方法将１００例腰骶神经根病患者按照热成象检查结果分为正常（２３例）与异常（７７例）两组。在热成象异常组中，根据临床病变程度并结合腱反射改变进一步划分神经损伤程度为轻（３１例）、中（３３例）、重度（１３例）３组，比较３组的温差ΔＴ均值。结果热成象异常的轻、中、重３组温差ΔＴ均值分别为１．１３±０．３４，１．４６±０．５８和２．３５±１．２０（Ｆ检验Ｐ＜０．０００１）。各组间比较差异也均具有非常显著性意义。结论本研究结果提示神经损伤程度与体表温差具有相关性，即神经损伤程度愈重，患侧相应的体表温度愈低，温差越大。热成象具有对神经损伤程度进行初步定量评估的价值。     

前臂肌腱部分移位修复桡尺远侧关节脱位的应用解剖

目的为前臂肌腱部分移位修复桡尺远侧关节脱位提供解剖学依据。方法30侧成人上肢标本,将尺侧腕屈肌腱、尺侧腕伸肌腱、桡侧腕长伸肌腱、肱桡肌腱作形态学测量,将尺侧腕屈肌腱、尺侧腕伸肌腱进行力学测试。结果尺侧腕屈肌腱长(16.7±2.7)cm;尺侧腕伸肌腱长(14.9±2.5)mm;桡侧腕长伸肌腱长(19.0±2.0)cm;肱桡肌腱长(11.7±2.4)cm。力学测试:尺侧腕屈、伸肌腱其全肌腱破坏载荷分别为(2.4±0.9)Mpa、(3.1±0.9)Mpa,半肌腱破坏载荷分别为(2.2±0.9)Mpa、(2.5±0.8)Mpa,t检验无显著性差异。结论前臂肌腱部分转位有足够的长度和强度修复桡尺远侧关节脱位。