Determination of the median effective dose (ED50) of bupivacaine and ropivacaine unilateral spinal anesthesia

Background

Unilateral spinal anesthesia (USpA) has been reported to potentiate spinal anaesthesia and is used in geriatric patients. The purpose of this study was to determine the median effective dose (ED₅₀) of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine USpA for geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

Methods

A total of 60 geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery were enrolled in this study. The patients were randomized into 2 groups to receive either intrathecal 0.5% hypobaric bupivacaine USpA (group B) or 0.5% hypobaric ropivacaine USpA (group R). Effective anesthesia was defined as a T10 sensory blockade level maintained for more than 60 min, and a Bromage score of 3 on the operation side within 10 min after injection with no additional epidural anesthetic required during surgery. The ED₅₀ of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine was calculated using the Dixon and Massey formula.

Results

No significant differences were found between the two groups in terms of demographic data. The ED₅₀ of 0.5% hypobaric bupivacaine USpA was 4.66 mg (95% confidence interval CI 4.69–4.63 mg) mg and that of 0.5% hypobaric ropivacaine USpA was 6.43 mg (95% CI 6.47–6.39 mg) for geriatric patients undergoing hip replacement surgery.

Conclusion

We find the ED₅₀ were lower, and the ED50 of 0.5% hypobaric bupivacaine and ropivacaine was 4.66 mg (95% CI 4.69–4.63 mg) and 6.43 mg (95% CI 6.47–6.39 mg), respectively, for USpA in geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

     

Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age

European Journal of Orthopaedic Surgery & Traumatology - Closed reduction and spica cast is still the preferred treatment option for children presenting with developmental dysplasia of the hip...     

我国PBL教学研究现状分析

目的：分析我国学者近10年来在医药卫生领域已发表的以问题为基础的学习(problem-based learning,PBL) 研究的现状,以期为国内医药卫生领域PBL教学的开展提供借鉴与参考。方法：计算机检索获取PBL教学研究。用VOSviewer 1.6.10软件对纳入文献的年代、发表期刊、作者及其单位和关键词等信息进行提取和分析。对高产作者、高产机构和高频关键词进行聚类分析,并生成可视化知识图谱。结果：纳入国内医药卫生领域PBL教学研究共计5 993篇,年发文量于2012年以后迅速增长。发文量最多的期刊为《中国高等医学教育》(437篇)。15 802位作者参与了研究的发表,发文量大于5篇的作者仅占0.84%。发文量前3位的机构为新疆医科大学第一附属医院(100篇)、西安交通大学第一附属医院(76篇)和中国医科大学(65篇)。主要作者形成了13个合作团体,主要机构形成了4个研究团队,但各作者之间、机构之间合作较少。研究的主题主要有4个,主要的研究热点是医学相关课程教学模式的探索及应用。结论：我国医药卫生领域PBL教学研究的数量呈由递增到递减的趋势,高产作者较少,参与研究的团体较多,机构团队较少,各团体、机构之间的联系不够紧密,仍需进一步增强合作。研究主题较局限,仍需开拓新的研究主题。     

Does the vascular development of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?

PurposeThe purpose of this study was to identify the correlation between the vascular development of the femoral head and avascular necrosis (AVN) in patients with developmental dysplasia of the hip (DDH) treated by closed reduction (CR).MethodsWe retrospectively reviewed 78 patients with DDH treated by CR (83 hips). The vascular maturity, number of vessels and perfusion changes of the femoral head were assessed on perfusion MRI (pMRI) before and after CR.ResultsThe number of vessels (mean 4.2 sd 1.4) of the femoral head and the ratio (36.1%) of mature vessels (type III) on the dislocated side were significantly less than those at contralateral side (mean 6.0 sd 1.2; 82.2%) (p < 0.001). Of the included 83 hips, 39 hips (61.5%) showed decreased perfusion of the femoral head, including partial decreased (Class B, 47.0%) and global decreased (Class C, 14.5%), at the dislocated side, which was significantly more than those at contralateral side (0.0%) (p < 0.001). In total, 32 out of 83 hips (38.5%) developed AVN. The rate of AVN with Class A (18.8%) which perfusion of the femoral head was normal (unchanged or enhanced) was significantly less than those with Class C (66.7%) (p = 0.006).ConclusionThe vascular development and perfusion changes of the femoral head on the dislocated side are significantly worse than those at contralateral side. Immature vascularity of the femoral head before CR and poor perfusion of the femoral head after CR may be risk factors for AVN in patients with DDH.Level of evidenceIII     

Ezrin mRNA target site selection for DNAzymes using secondary structure and hybridization thermodynamics

Ezrin, a membrane organizer and linker between plasma membrane and cytoskeleton, is well documented to play an important role in the metastatic capacity of cancer cells especially for osteosarcoma cells. It has provided an ideal target for cancer gene therapy. RNA-cleaving 10–23 DNAzymes, consisting of a 15-nucleotide catalytical domain flanked by two target-specific complementary arms, can cleave the target mRNA at purine–pyrimidine dinucleotide effectively. In the present study, we designed and screened the target sites for 10–23 DNAzymes against ezrin mRNA by using multiple computational methods with combination of secondary structural and hybridization thermodynamic parameters. Then, we testified the activities of the DNAzymes directed against these selected target sites in vitro. Our results show that AU1751 is the most effective target site of ezrin mRNA for DNAzymes because of its ideal secondary structure and hybridization thermodynamics. So, there is a significant correlation between the multiple computational methods and the efficacy of the corresponding DNAzymes. These provide a rational, efficient way for DNAzymes selection.     

OSAHS、OSAHAHT最者血清基质金属蛋白酶9及其抑制因子水平

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）、阻塞性睡眠呼吸暂停低通气综合征相关性高血压（obstructive sleepapnea-hypopnea associated hypertension，OSAHAHT）患者血清基质金属蛋白酶9（MMP-9）及其抑制剂，基质金属蛋白酶组织抑制因子1（TIMP-1）水平的变化。方法 用酶联免疫吸附法对20例OSAHS、OSAHAHT患者血清MMP-9和TIMP-1水平测定，与16例健康对照组进行比较。结果 OSAHS、OSAHAHT患者血清MMP-9水平较正常对照组明显升高，有显著统计学意义，TIMP-1在OSAHS与对照组无明显差异，在OSAHAHT与对照组有明显差异，OSAHS、OSAHAHT患者血清MMP-9与反映睡眠呼吸暂停严重程度的指标有明显相关性。结论 OSAHS、OSAHAHT患者存在MMP-9及TIMP-1代谢的异常，血清MMP-9可反映睡眠呼吸暂停病情的严重程度。     

胰腺癌抗原SC6的分离及其特性分析

目的获得胰腺癌重组噬菌体抗体筛检及鉴定的靶抗原．方法用ｐｒｏｔｅｉｎＡｓｅｐｈａｒｏｓｅ４Ｂ柱纯化的单抗ＳＣ６吸附到ＣＮＢｒｓｅｐｈａｒｏｓｅ４Ｂ特异亲合层析柱上，分离出ＳＣ６抗原，再用ＳＤＳＰＡＧＥ，Ｗｅｓｔｅｒｎｂｌｏｔｉｎｇ、免疫化学和氨基酸自动分析仪等检测其有关的特性．结果此抗原在ＳＤＳＰＡＧＥ，Ｗｅｓｔｅｒｎｂｌｏｔｉｎｇ上显示一条带，Ｍｒ６７００００，性质属糖蛋白，其中含１７种氨基酸，与ＣＡ１９９等多种抗原不同，在胰腺癌组织中的阳性表达率为９１２％．结论该抗原是一种与胰腺癌相关的新肿瘤标志物，这为其分子克隆等研究提供了新的抗原蛋白．