Preoperative administration of controlled-release oxycodone as a transition opioid for total intravenous anaesthesia in pain control after laparoscopic cholecystectomy

Background  The complexity of pain from laparoscopic cholecystectomy and the need for treating incident pain provide rationale for multipharmacological analgesia. We investigated the preoperative administration of controlled-release (CR) oxycodone as transition opioid from remifentanil infusion for pain after laparoscopic cholecystectomy. Methods  Fifty consecutive patients undergoing laparoscopic cholecystectomy were randomly, double-blindly assigned to treatment group (n = 25, CR oxycodone: 1 h before surgery and 12 h after the first administration) or to the control group (n = 25, placebo: administered at the same intervals). General anaesthesia was maintained with propofol and remifentanil target-controlled infusions (TCIs). All patients received ketorolac 30 mg i.v. Tramadol i.v. was administered for patient-controlled analgesia (PCA) postoperatively. Numerical rating scale for pain at rest and at movement (NRSr and NRSi), tramadol consumption, times to readiness to surgery and awakening, times to modified Aldrete’s and modified Post-Anesthetic Discharge Scoring System (PADSS) >9 and side effects were evaluated. Results  All NRSr and NRSi and tramadol consumption were significantly lower in the treatment group. The oxycodone group showed higher modified Aldrete’s scores at each time and reached a PADSS >9 faster. Side effects and postoperative nausea and vomiting episodes were comparable. Conclusions  We demonstrated the success of a multipharmacological treatment including opioid premedication with CR oxycodone used as transition opioid for TCI remifentanil infusion; the treatment group showed lower pain scores and rescue analgesic consumption, shorter time to discharge from recovery room and from surgical ward, and the same incidence of side effects, comparably to controls. Sources of financial support for the work: University of Parma, viale Gramsci 14, 43100 Parma PR, Italy.     

Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice

Introduction Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon’s hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice. Methods Prospectively collected data on 258 patients undergoing HALS (n = 109) or LA colectomy (n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared. Results HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)]. Conclusions Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits. Presented at the 2007 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, Las Vegas, Nevada.     

Analysis of patient selection and external validity in the Swedish contribution to the COLOR trial

Objective  The colon cancer laparoscopic or open resection (COLOR) trial is an international, randomised controlled trial comparing outcomes of open and laparoscopic surgery for colon cancer. The main purpose of this study was to determine representability by comparing included and nonincluded patients in the participating Swedish centres. Design  At eight centres, which included 391 of the 422 Swedish patients, a local database search was performed to identify retrospectively all patients (n = 2,384) who underwent surgery for colon cancer during the inclusion period, and data was retrieved from medical records. Results  Four hundred fifty-six patients were randomised, 65 of whom were excluded post randomisation (group 2), leaving 391 patients in the study (group 1). For 1,566 patients, valid exclusion criteria were found (group 3). Thus, 362 patients were eligible but not included (group 4). Relative to group 1, patients in group 4 had a significantly higher American Society of Anaesthesiologists (ASA) score, more advanced tumour stage and difference regarding the resections performed. Results showed that 1470 patients (62%) could be calculated as feasible for laparoscopic colon resection (LCR) in a clinical, nontrial situation. Conclusions  The study population in the Swedish part of the COLOR trial was representative of the eligible population with the exception of comorbidity, where those actually included had less severe comorbidity than the nonincluded but eligible patients. In Sweden, 50–60% of colon cancer patients can be operated on by laparoscopy. This work was supported by grants from the Swedish Cancer Society (Project Number 4287-B01-03XCC and Project Number 1921-B03-21XCC), the County Council of Stockholm, Assar Gabrielsson’s Foundation for Clinical Research, Jubileumskliniken Research Foundation, Sahlgrenska University Hospital and the Swedish Society of Medicine. A preliminary version of this paper was previously published in an academic thesis; “Laparoscopic and open surgery for colon cancer. Studies on costs and health related quality of life” by Martin Janson, Karolinska Institutet 2006, ISBN 91-7140-782-0.     

医学院心理专业学生心理防御机制调查

目的：对医学院医学心理专业的心理防御机制进行调查评估。方法：采用1989年版DSQ防御机制问卷对广东医学院医学心理专业学生（n＝25，三年级）及非心理专业学生（n＝274，三年级）进行调查。结果：心理专业学生动用成熟防御方式频率显著高于非心理专业学生（P＜0．05），而在不成熟防御机制（P＜0．01）及掩饰因子（P＜0．05）上得分显著低于非心理专业学生。结论：心理专业学生的防御方式优于非心理专业学生，心理健康状况较非心理专业学生更为良好。     

医学论文命题中常见的错误

医学论文的题名写作要反映论文中最主要的特定内容，在命题时要避免出现题名的结构类型与论文的内容不一致、题名含糊、题名空洞呈宣传鼓动性语态、题名与论文的主要内容不相干、题名不能准确反映论文主题、题名超出论文的主题、题名词序不合理等错误。     

医学科技论文几个高频词的用法

本文针对国内英文医学科技论文中较为常见的用词不当问题,总结了英语医学科技论文中一些常用词和表达的基本用法。     

Seminal papers in spinal surgery

Evidence based medicine should underpin the practice of all orthopaedic surgeons. Spinal pathology should be considered in the differential diagnosis for pain in every upper and lower limbs region and an understanding of spinal anatomy and physiology is vital in the management of the trauma patient.We present ten key articles, which have been selected for their impact within the field. They encompass trauma, degenerative, inflammatory, deformity and emergency spinal disorders. The articles range from level I randomized control trials to level V expert opinion. An understanding of their methodology and key findings should be part of the core knowledge encompassing spinal surgery and will, in particular, be of benefit for those preparing for final professional examinations.     

纳米骨组织材料用于骨质疏松治疗进展

目的旨在探究通过纳米骨组织材料治疗骨质疏松的进展,以促进其临床应用。方法由第一作者应用计算机检索PubMed、中国期刊全文数据库(CNKI)1997-05～2011-10相关文献。在标题、摘要、关键词中以"nano,osteoporosis,bone marrow mesenchymal stem cells(BMMSCs),treatment"或"纳米,骨质疏松,骨髓间充质干细胞,治疗"为检索词进行检索。选择文章内容与纳米技术治疗骨质疏松有关者,同一领域文献则选择近期发表在权威杂志文章。结果初检得到127篇文献,根据纳入标准选择36篇文献进行综述。结论纳米技术治疗骨质疏松已经成为骨质疏松治疗中的一项新兴技术。目前通过纳米技术治疗骨质疏松主要通过促进药物吸收,维持药物作用时间,增加药物靶向性,促进干细胞分化的机制来进行骨质疏松的治疗。目前常用的技术包括药物纳米化,纳米微载体,材料表面纳米化,纳米材料修饰干细胞等。但目前纳米技术治疗骨质疏松尚未成熟,仍有许多问题有待解决。     

2001—2010年MEDLINE收录某医院科技论文文献计量学分析

目的通过分析2001—2010年某医院科技论文被国际权威检索工具MEDLINE收录情况,以评价该院科研水平和学术地位,为科研管理部门提供信息参考。方法应用文献计量学和数理统计方法对2001—2010年MEDLINE收录某军区医院科技论文进行统计分析。结果近10年MEDLINE一共收录该院科技论文225篇,其中中文文献148篇、英文文献77篇,国内刊物发表文献166篇、国外刊物发表文献59篇,主要以国内期刊和中文文献为主;近5年来英文文献和国外刊物发表文献有所上升,其中国外刊物以美国、英格兰、荷兰等欧美国家为主;论文合作度达5.3,论文合作率达99.1%。结论近10年来,该院科研水平发展整体处在上升趋势,还应继续提高在国外刊物上的载文量,促进医院科研水平和学术地位的持续协调发展。     

国内近10年医学科技论文产出的文献计量学研究进展

文章对国内近10年来医学科技论文产出的文献计量学研究进展概况进行了综述。