Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia

Background

Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when combined with continuous adductor canal block and LIA.

圆形头痛合并Ⅰ型Chiair畸形患者3例及文献分析

分析我科收治的3例圆形头痛（视频脑电图检查排除头痛型癫痫）患者合并Ⅰ型Chiair畸形的临床特征和治疗效果。3例患者，女性2例，男性1例。其中2例圆形头痛发作期出现咳嗽或Valsalva动作时头痛程度明显加重，另1例则咳嗽或Valsalva动作时头痛程度无变化。3例均未手术治疗，通过口服药物或联合疼痛区域神经阻滞治疗，头痛均完全缓解，目前随访均未复发。     

颈椎横突后结节间沟神经阻滞麻醉治疗颈椎间盘突出的效果

目的研究颈椎横突后结节间沟神经阻滞麻醉治疗颈椎间盘突出的效果。方法60例颈椎间盘突出患者,根据随机分配法将其分为实验组和参照组,每组30例。参照组患者在基础检查后实施颈椎后根神经阻滞麻醉治疗,实验组患者在基础检查以后实施颈椎横突后结节间沟神经阻滞麻醉治疗。比较两组患者治疗后日本骨科协会评估治疗分数(JOA)评分、复发及不良反应发生情况、治疗效果。结果治疗后,实验组患者临床症状、临床检查以及日常生活评分分别为(24.38±5.19)、(25.01±4.39)、(26.34±2.94)分,均高于参照组的(13.29±5.37)、(15.34±5.49)、(15.97±4.13)分,差异均具有统计学意义(P<0.05)。实验组复发率3.33%、不良反应发生率6.67%均低于参照组的20.00%、26.67%,差异具有统计学意义(χ²=4.043、4.320,P=0.044、0.038<0.05)。实验组优良率93.33%高于参照组的73.33%,差异具有统计学意义(χ²=4.320,P=0.038<0.05)。结论在颈椎间盘突出治疗中,实施颈椎横突后结节间沟神经阻滞麻醉治疗可以明显改善患者的临床症状,具有很高的临床应用价值。     

A prospective study of multimodal cocktail intercostal injection for chest pain relief after costal cartilage harvest for rhinoplasty

Our aim was to evaluate the efficacy and safety of multimodal cocktail intercostal injection for the relief of chest pain after costal cartilage harvest for rhinoplasty. Consecutive patients who underwent costal cartilage harvest during rhinoplasty were prospectively assigned as per patient preference to group A (injection containing ropivacaine, parecoxib sodium, epinephrine, and compound betamethasone), group B (intercostal nerve block (ICNB)), or group C (ICNB plus patient-controlled analgesia (PCA)). The outcomes were visual analogue scale (VAS) scores for chest pain after costal cartilage harvest, rescue analgesia, complications, and cost during the first two days. Of the 66 patients assessed, 63 (29 patients in group A, 13 in group B, and 21 in group C) were eligible and included. The VAS scores in group A were significantly lower than those in groups B and C (all p<0.001). Group A had a significantly lower rate of rescue analgesia due to a VAS score of more than 4 (3.45%, 1/29) compared with group B (46.15%, 6/13; p=0.001) and group C (28.57%, 6/21; p=0.012). Complications were observed only in group C (nausea/vomiting 28.57%; dizziness/headache 23.81%), which differed significantly from group A (p=0.002 and 0.006, respectively). The mean cost for group A (US $15 (0)) was significantly lower than it was for group C (US $113.1 (4.4), p<0.05), but higher than it was for group B (US $5.97 (0), p= -). Multimodal cocktail intercostal injection may be superior for chest pain relief after costal cartilage harvest for rhinoplasty compared with ICNB with or without PCA. Further study is warranted.     

结肠内支架在乙状结肠癌及直肠癌梗阻治疗中的应用

目的 探讨结肠内支架治疗直肠癌、乙状结肠癌梗阻的疗效和意义.方法 自2001年1月至2005年12月,共收治22例左侧大肠癌梗阻的患者,在内镜及X线辅助下进行了结肠内支架治疗.结果 22例患者结肠内支架置入均获成功,无一例发生肠穿孔、大出血.10例出现骶尾部疼痛,5例有少量血便,支架脱落2例.结论 结肠内支架治疗作为直肠癌、乙状结肠癌术前梗阻解除或晚期复发肿瘤的姑息治疗均能达到梗阻解除、避免肠造瘘术、改善患者生活质量的效果.     

Analysis of Single Nucleotide Polymorphisms in the Gamma Block of the Major Histocompatibility Complex in Association with Clinical Outcomes of Hematopoietic Cell Transplantation: A Center for International Blood and Marrow Transplant Research Study

HLA haplotype mismatches have been associated with an elevated risk of acute graft-versus-host disease (aGVHD) in patients undergoing HLA-matched unrelated donor (URD) hematopoietic cell transplantation (HCT). The gamma block (GB) is located in the central MHC region between beta and delta blocks (encoding HLA-B and -C and HLA-DQ and -DR antigens, respectively) and contains numerous inflammatory and immune regulatory genes, including Bf, C2, and C4 genes. A single-center study showed that mismatches in SNPs c.2918+98G, c.3316C, and c.4385C in the GB block (C4 SNPs) were associated with higher risk of grade III-IV aGVHD. We investigated the association of GB SNP (GBS) mismatches with outcomes after 10/10 and 9/10 URD HCT (n?=?714). The primary outcome was acute GVHD. Overall survival, disease-free survival, transplantation-related mortality, relapse, chronic GVHD, and engraftment were also analyzed. DNA samples were GBS genotyped by identifying 338 SNPs across 20 kb using the Illumina NGS platform. The overall 100-day incidence of aGVHD grade II-IV and II-IV were 41% and 17%, respectively. The overall incidence of matching at all GBSs tested and at the C4 SNPs were 23% and 81%, respectively. Neither being matched across all GB SNPs tested (versus mismatched) nor having a higher number of GBS mismatches was associated with transplantation outcomes. There was no association between C4 SNP mismatches and outcomes except for an unexpected significant association between having 2 C4 SNP mismatches and a higher hazard ratio (HR) for relapse (association seen in 15 patients only; HR, 3.38, 95% confidence interval, 1.75 to 6.53; P?=?.0003). These data do not support the hypothesis that mismatching at GB is associated with outcomes after HCT.     

Role of High‐Molecular‐Weight Homopolymers on Block Copolymer Self‐Assembly: From Morphology Modifier to Template

For block copolymer (BCP)/homopolymer self‐assembly systems, the molecular weight of homopolymers is usually lower than that of BCPs. Herein, the cooperative self‐assembly of polystyrene‐b‐poly(ethylene glycol) (PS‐b‐PEG) BCPs with high‐molecular‐weight polystyrene (PS) homopolymers is reported. The molecular weight of PS homopolymers is 3–63 times that of the PS blocks. Typically, a spherical micelle–vesicle–large sphere morphology transition is observed by increasing the weight fraction of PS homopolymers in the polymer mixtures (f _HP). Dynamic process studies reveal that with adding water to the solution of polymer mixtures in organic solvent, the homopolymers first collapse into globules, and their size increases with f _HP and the molecular weight. Then these PS globules cooperatively self‐assemble with the PS‐b‐PEG BCPs. Depending on their size, these PS globules play different roles in the self‐assembly process. Small PS globules act as morphology modifiers inducing the micelle–vesicle transition, while large PS globules serve as self‐assembly templates for PS‐b‐PEG resulting in large spheres.     

A New Associative Diblock Copolymer of Poly(ethylene glycol) and Dense 1,2,3‐Triazole Blocks: Self‐Association Behavior and Thermoresponsiveness in Water

In this work, new diblock copolymers of poly(ethylene glycol) (PEG) and dense 1,2,3‐triazole blocks (EGm‐b‐APn and EGm‐b‐ABn, where m and n denote the degrees of polymerization), are synthesized by copper(I)‐catalyzed azide–alkyne cycloaddition polymerization of 3‐azido‐1‐propyne (AP) and 3‐azido‐1‐butyne (AB), respectively, in the presence of PEG possessing a propargyl group. Their self‐association behavior and thermoresponsive property in water are investigated. The characterization data indicate that EG45‐b‐AP6 and EG45‐b‐AP14 form dominantly spherical micelles, EG18‐b‐AP4 and EG18‐b‐AP10 form vesicles, and EG18‐b‐AB7 forms rodlike micelles. Aqueous solutions of EG18‐b‐AP10, EG45‐b‐AP14, and EG18‐b‐AB7 undergo lower critical solution temperature (LCST)‐type phase separation. The thermoresponsive association behavior can be controlled by adjusting the ratio of block lengths and by attaching methyl substituents.