小儿扁桃体腺样体手术麻醉苏醒期并发症分析

目的 分析小儿扁桃体腺样体手术麻醉苏醒期并发症发生情况,探讨预防和减少其发生的措施.方法 对110例小儿扁桃体腺样体手术资料进行分析,观察与手术、麻醉、治疗药物等有关的并发症发生情况.结果 麻醉苏醒期总的并发症发生率为29%(32/110).其中与手术有关的并发症发生率为4.5%(5/110),与麻醉有关的并发症发生率为22.7%(25/110),无苏醒延迟和呕吐,与治疗药物有关的并发症发生率为1.8%(2/110).结论 术前控制感染、术中精细操作、气管导管拔出时机的恰当选择,可预防或减少小儿扁桃体腺样体手术麻醉苏醒期并发症的发生.     

Inter-hemispheric asymmetry of motor corticospinal excitability in major depression studied by transcranial magnetic stimulation

BACKGROUND: Imaging and electroencephalographic studies have reported inter-hemispheric asymmetries in frontal cortical regions associated with depression. This study aimed at comparing motor corticospinal excitability assessed by methods of transcranial magnetic stimulation (TMS) between the right and left hemispheres in patients with major depression and healthy controls. METHOD: Patients with major depression (n=35) and healthy controls (n=35) underwent a bilateral study of various motor corticospinal excitability parameters, including rest motor threshold (RMT), corticospinal silent period (CSP) duration and intra-cortical inhibition (ICI) and facilitation (ICF). Indexes of asymmetry were calculated, and the relationships between excitability parameters and clinical scores of depression were statistically analyzed. RESULTS: Depressed patients showed a reduced excitability of both excitatory (RMT, ICF) and inhibitory (CSP, ICI) processes in the left hemisphere, compared to the right hemisphere and to healthy controls. CONCLUSION: The present results confirmed the existence of inter-hemispheric asymmetries in frontal cortex activities of depressed patients in favor of a left-sided reduced excitability. This neurophysiological approach may help to guide repetitive TMS procedures in the treatment of depressive disorders.     

Botulinum neurotoxin E (BoNT/E) reduces CA1 neuron loss and granule cell dispersion, with no effects on chronic seizures, in a mouse model of temporal lobe epilepsy

Mesial temporal lobe epilepsy (MTLE) is often the result of an early insult that induces a reorganization in hippocampal circuitry leading, after a latent period, to chronic epilepsy. Hippocampal rearrangements during the latent phase include neuronal loss, axonal and dendritic plasticity, neurogenesis, and cell repositioning, but the role of these changes in epilepsy development is unclear. Here we have tested whether administration of the synaptic blocker botulinum neurotoxin E (BoNT/E) interferes with development of spontaneous seizures and histopathological changes following an episode of status epilepticus (SE). SE was induced by unilateral intrahippocampal injection of kainic acid in mice and BoNT/E was delivered to the same hippocampus 3 h later. We found that treatment with BoNT/E prolonged the duration of the latent period but did not block the occurrence of spontaneous seizures. At the histopathological level, BoNT/E reduced loss of CA1 pyramidal neurons and dispersion of dentate granule cells. Downregulation of reelin expression along the hippocampal fissure was also suppressed by BoNT/E treatment. Our findings indicate that administration of BoNT/E after SE inhibits specific morphological changes in hippocampal circuitry but not the development of spontaneous seizures. This indicates a dissociation between certain anatomical modifications and establishment of chronic epilepsy in MTLE.     

Magnetic suspension of the rotor of a ventricular assist device of mixed flow type

Abstract:  This work presents results of preliminary studies concerning application of magnetic bearing in a ventricular assist device (VAD) being developed by Dante Pazzanese Institute of Cardiology—IDPC (São Paulo, Brazil). The VAD-IDPC has a novel architecture that distinguishes from other known VADs. In this, the rotor has a conical geometry with spiral impellers, showing characteristics that are intermediate between a centrifugal VAD and an axial VAD. The effectiveness of this new type of blood pumping principle was showed by tests and by using it in heart surgery for external blood circulation. However, the developed VAD uses a combination of ball bearings and mechanical seals, limiting the life for some 10 h, making impossible its long-term use or its use as an implantable VAD. As a part of development of an implantable VAD, this work aims at the replacement of ball bearings by a magnetic bearing. The most important magnetic bearing principles are studied and the magnetic bearing developed by Escola Politécnica of São Paulo University (EPUSP-MB) is elected because of its very simple architecture. Besides presenting the principle of the EPUSP-MB, this work presents one possible alternative for applying the EPUSP-MB in the IDPC-VAD.     

Range of motion during the perioperative period in total knee arthroplasty

INTRODUCTION: This study focused on the change in the range of motion (ROM) during the perioperative period, i.e., the preoperative and intraoperative ROM, and that on discharge, and compared the difference between posterior cruciate ligament-retaining (PCLR) and -sacrificing (PCLS) prostheses. MATERIALS AND METHODS: In this prospectively randomized study, we compared the changes in the ROM in PCLR (n = 50) and PCLS (n = 50) total knee arthroplasties. RESULTS: The mean flexion in PCLR prostheses was 130.0 degrees preoperatively, 120.0 degrees intraoperatively, and 105.0 degrees at discharge, and 125.0 degrees , 120.0 degrees , and 100.0 degrees , respectively, in PCLS. The designs did not differ statistically in each period (P > 0.05). Both designs showed significant correlations between the preoperative and intraoperative ROM, and between the preoperative and discharge ROM. Only the PCLS showed a significant correlation between the intraoperative and discharge ROM, and a significant difference was observed in correlation of rank coefficient between the two prostheses (P < 0.001). CONCLUSIONS: The PCLS design has an advantage in rehabilitation planning because of the predictable changes in the ROM during the perioperative period, although the acquired average ROM at discharge did not differ statistically.     

Influence of binocular competition on the expression profiles of CRMP2, CRMP4, Dyn I, and Syt I in developing cat visual cortex

The visual cortex is vulnerable to changes in visual input, especially during the critical period when numerous molecules drive the refinement of the circuitry. From a list of potential actors identified in a recent proteomics study, we selected 2 collapsin response mediator proteins (CRMP2/CRMP4) and 2 synaptic proteins, Dynamin I (Dyn I) and Synaptotagmin I (Syt I), for in-depth analysis of their developmental expression profile in cat visual cortex. CRMP2 and CRMP4 levels were high early in life and clearly declined toward adulthood. In contrast, Dyn I expression levels progressively augmented during maturation. Syt I showed low levels at eye opening and in adults, high levels around the peak of the critical period, and maximal levels at juvenile age. We further determined a role for each molecule in ocular dominance plasticity. CRMP2 and Syt I levels decreased in area 17 upon monocular deprivation, whereas CRMP4 and Dyn I levels remained unaffected. In contrast, binocular removal of pattern vision had no influence on CRMP2 and Syt I expression in kitten area 17. This study illustrates that not the loss of quality of vision through visual deprivation, but disruption of normal binocular visual experience is crucial to induce the observed molecular changes.     

Patient's satisfaction with perioperative care: development, validation, and application of a questionnaire

Background: Measuring patient satisfaction after anaesthesia care is complex.The existing patient satisfaction questionnaires are limitedand omit aspects of patient satisfaction, such as professionalcompetence, information provision, service, and staff–patientrelationship. The aim of our study was to develop a valid andreliable self-reported multidimensional questionnaire assessingpatient satisfaction that included these issues. Methods: The development of the Leiden Perioperative care Patient Satisfactionquestionnaire (LPPSq) was as follows: expert consultation, constructionof the pilot questionnaire, pilot study, statistical analysisof the results of the pilot study (validity, reliability, andfactor analysis), compilation of the definitive questionnaire,main study, and repeated statistical analysis (validity, reliability,and factor analysis). The overall patient satisfaction is expressedby the mean satisfaction score. Results: Three hundred and eighty-two patients consented to participatein the study; 80.4% of the patients (n=307) completed the questionnaire.The LPPSq isolated three dimensions: information (Cronbach’s=0.82), fear and concern (Cronbach’s =0.69), and staff–patientrelationship (Cronbach’s =0.94). Patient satisfactionwith perioperative care was not directly dependent on the outcomesof anaesthesia but how patients were approached and the amountof information they received. Age (P=0.001), gender (P=0.001),work situation (P=0.003), and specialty (P=0.017) were the characteristicsmost influencing patient satisfaction. Conclusions: We developed the LPPSq questionnaire to measure patient satisfactionwith perioperative care, of which anaesthesia care is an importantelement. In this study, information provision and the relationshipbetween staff and patient were the major determinants of patientsatisfaction.     

Setting priorities for improving the preoperative assessment clinic: the patients' and the professionals' perspective

BACKGROUND: The quality of the preoperative assessment clinic (PAC) is determined by many factors. Patients' experiences are important indicators, but often overlooked. We prepare to set priorities to improve the PAC by obtaining detailed patients' feedback on the quality of the PAC, and establishing the value patients and professionals attach to different care aspects, using the Patient Experiences with the Preoperative Assessment Clinic questionnaire. METHODS: The PAC's standard of service was determined for five care aspects (dimensions), using patients' feedback. The importance of a dimension to patients was determined by calculating the effects of the dimensions on patients' overall appraisal. In addition, professionals were asked to rate the importance of the different care aspects. RESULTS: Patients had the most positive experiences with the nurse, and the least positive experiences with waiting. However, waiting was least important to patients. When combining the PAC's standard of service with the value given to the dimensions by patients and professionals separately, we found in both instances that waiting was in greatest need of improvement. This was followed by reception, the anaesthetist, remaining experiences, and finally the nurse. CONCLUSIONS: Quality improvement of the PAC can be achieved by obtaining patients' feedback on the quality, determine a PAC's standard of service, recognize service areas that require improvement, and identify actions appropriate to bring about improvement. The value patients and professionals attach to different aspects of care can then be used to prioritize improvements.     

Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists

BACKGROUND: Tobacco use interventions in surgical patients who smoke could benefit both their short-term outcome and long-term health. Anaesthesiologists and surgeons can play key roles in delivering these interventions. This study determined the practices, attitudes, and beliefs of these physicians regarding tobacco use interventions in Japan. METHODS: Questionnaires were mailed to a national random sampling of Japanese anaesthesiologists and thoracic surgeons (1000 in each group). RESULTS: The survey response rate was 62%. More than 80% of respondents agreed or strongly agreed with the statements affirming the benefits of abstinence to surgical patients. However, only 26% of surgeons and 6% of anaesthesiologists reported almost always providing help to their patients to quit smoking. Compared with anaesthesiologists, surgeons were more likely to perform the elements of current recommendations for brief intervention, and to have attitudes favourable to tobacco use interventions. The most significant barrier to intervention identified by both groups was a lack of time to perform counselling. Compared with non-smokers, physicians who smoked were less likely to perform each of the recommended tobacco interventions CONCLUSIONS: Although current rates of intervention provided by anaesthesiologists and surgeons are low, there is considerable interest among these physicians in learning more about interventions. Given the relatively high prevalence of smoking in Japan and the potential for surgery to serve as a 'teachable moment' to promote abstinence from smoking, leadership by these specialists in the area of tobacco control could have a major impact on public health in Japan.     

Ca2+ signalling and early embryonic patterning during zebrafish development

1. It has been proposed that Ca2+ signalling, in the form of pulses, waves and steady gradients, may play a crucial role in key pattern-forming events during early vertebrate development. 2. With reference to the embryo of the zebrafish (Danio rerio), herein we review the Ca2+ transients reported from the cleavage to segmentation periods. This time-window includes most of the major pattern-forming events of early development, which transform a single-cell zygote into a complex multicellular embryo with established primary germ layers and body axes. 3. Data are presented to support our proposal that intracellular Ca2+ waves are an essential feature of embryonic cytokinesis and that propagating intercellular Ca2+ waves (both long and short range) may play a crucial role in: (i) the establishment of the embryonic periderm and the coordination of cell movements during epiboly, convergence and extension; (ii) the establishment of the basic embryonic axes and germ layers; and (iii) definition of the morphological boundaries of specific tissue domains and embryonic structures, including future organ anlagen. 4. The potential downstream targets of these Ca2+ transients are also discussed, as well as how they may integrate with other pattern-forming signalling pathways known to modulate early developmental events.