The effect of intrathecal bupivacaine/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial

Robot-assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty-five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 μg morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg⁻¹ morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery-15 (QoR-15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR-15 on postoperative day 1; median (IQR [range]) 10% (1–8 [−60% to 50%]) vs. 13% (5–24 [−6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1–7 [0–41 mg]) vs. 15 mg (12–20 [8–61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1–6 [0–9]) vs. 5 (3–7 [0–9]), p = 0.001; less bladder spasms (NRS 1 (0–2 [0–10]) vs. 2 (0–5 [0–10]), p = 0.001 and less sedation; NRS 2 (0–3 [0–10]) vs. 3 (2–6 [0–10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1–7 [0–10]) vs. 0 (0–1 [0–10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot-assisted radical prostatectomy.     

白细胞介素-33在不同严重程度脓毒症中的变化

目的  分析血浆白细胞介素-33（IL-33）在不同严重程度脓毒症中的变化。方法  选取2012年1月- 2015年4月该院重症加强治疗病房（ICU）收治的120例脓毒症患者为研究对象。根据器官功能、感染严重程度将患者分为一般脓毒症组（36例）、严重脓毒症组（36例）和感染性休克组（48例）,并选取同期在该院行健康检查的120例志愿者作为对照组。比较患者ICU各时间的APACHE Ⅱ评分、降钙素原（PCT）、白细胞介素-33（IL-33）、白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）和可溶性人基质裂解素2（sST2）的变化;比较患者ICU住院时间和机械通气时间;比较不同预后脓毒症患者ICU各时间的IL-33水平变化。结果  脓毒症患者的APACHE Ⅱ评分、PCT和IL-33水平高于对照组,且脓毒症患者的APACHE Ⅱ评分、PCT和IL-33水平随患者病情加重而升高,差异有统计学意义（P <0.05）。脓毒症患者的ICU住院和机械通气时间随患者病情加重而延长,且感染性休克组的死亡率显著高于其余两组,差异有统计学意义（P <0.05）。脓毒症患者的APACHE Ⅱ评分,PCT、IL-33、IL-6、IL-1β、TNF-α、sST2水平与对照组比较,差异有统计学意义（P <0.05）。脓毒症患者的APACHE Ⅱ评分,PCT、IL-33、IL-6水平随ICU住院时间延长而降低,差异有统计学意义（P <0.05）。脓毒症患者的IL-1β、TNF-α、sST2水平随ICU住院时间延长,变化不明显（P >0.05）。入ICU 30 d后有9例患者死亡为死亡组,111例患者存活为存活组。死亡组患者的IL-33水平随ICU住院时间延长而上升,但差异无统计学意义（P >0.05）。存活组患者的IL-33水平随ICU住院时间延长而下降,死亡组患者入ICU 3 h内IL-33水平较存活组低,入ICU 24 h和5 d时IL-33水平高于存活组,差异有统计学意义（P < 0.05）。结论  脓毒症患者入ICU时血浆IL-33水平升高,而后随ICU住院时间延长而降低,且随患者病情加重而升高,因此血浆IL-33水平能提示患者的预后。

     

Underdevelopment of optic radiation in children with amblyopia: a tractography study

PURPOSE: To detect the abnormalities of the optic radiation (OR) in children with amblyopia by diffusion tensor imaging (DTI) and tractography. DESIGN: Prospective, nonrandomized clinical trial. METHODS: Fourteen children with amblyopia and 14 normally sighted children underwent DTI scanning. After the ORs were reconstructed by using tractography algorithm, voxels through which the anterior parts of ORs passed were determined for their values of fractional anisotropy (FA). The paired t test was applied to compare their mean FA values of right OR and left OR in the control group. For the amblyopia group, analysis of variance was conducted to determine the effect of laterality and vision status on the FA values. In addition, the voxel numbers of anterior and posterior parts of both ORs were calculated. The Student t test was used to compare the average FA of bilateral ORs and voxel numbers between the two groups. RESULTS: Comparison demonstrated left-higher-than-right asymmetry in both amblyopic children and normal children. We found no significant difference of average FA between the amblyopic group (0.4832 +/- 0.0225) and control group (0.4770 +/- 0.0273). Voxel numbers of the anterior parts of both ORs were not significantly different between the two groups, whereas voxel numbers of their posterior parts in the controls were more than that of amblyopic children. CONCLUSION: Tractography showed more voxels in the posterior ORs of normal children than in the amblyopic children, indicating that normal children have better development of the ORs. The underdevelopment of the ORs might reflect the dysfunction of visual cortex in children with amblyopia.     

角膜波面像差引导准分子激光原位角膜磨镶术(ORK-W)治疗近视临床研究

目的前瞻性研究角膜波面像差引导准分子激光原位角膜磨镶术(ORK-W)治疗近视临床效果。方法将球镜-8.00D以下,柱镜0.00D-3.00D的近视患者随机分成2组,实验组36例72眼行角膜波面像差引导准分子激光个体化切削(ORK-W),对照组30例(60只眼)行常规LASIK。观察术后1m裸眼视力、残余屈光度,角膜波面像差中的慧差、球差及总像差均方根RMS增加值,对比敏感度的改变,满意度等指标。结果术后裸眼视力、残余屈光度和满意度两组比较差异无统计学意义(P>0.05);但实验组角膜波面像差(慧差、球差、均方根RMS)的增加均较对照组明显小,两组差异有统计学意义(P<0.05),对比敏感度的改善较对照组也明显的好,两组差异有显著统计学意义(P<0.01)。结论角膜波面像差引导准分子激光个体化切削(ORK-W)可以减少术后角膜波面像差的增加,尤其减少慧差增加效果更明显,明显改善视觉质量。     

一测多评法测定藏药小米辣中3种辣椒碱的含量

目的：建立藏药小米辣中3种辣椒碱类化学成分含量测定的一测多评法,探讨一测多评法在民族药质量控制中的应用。方法：采用超高压液相色谱法,使用Waters ACQUITY BEH C18（2.1 mm×100mm,1.7 μm）色谱柱,流动相为乙腈-水（50︰50）,流速：0.2 mL·min^-1,柱温30℃,检测波长280 nm,进样量1 μL。以辣椒素为内参物,分别建立二氢辣椒素、降二氢辣椒素相对于辣椒素的相对校正因子,分别采用外标法和一测多评法测定3种辣椒碱的含量,并通过相对标准偏差（RSD）和Pearson系数比较二者结果的相对误差。结果：降二氢辣椒素、辣椒素、二氢辣椒素进样量分别在2.21~22.1 ng、8.96~89.6 ng、3.75~37.5 ng范围内线性关系良好;降二氢辣椒素和二氢辣椒素相对于辣椒素的相对校正因子分别为0.970和1.159;且在不同实验条件下重现性良好（RSD < 3.0%）;一测多评法的计算结果与外标法测得结果无显著差异。10批不同产地小米辣样品中降二氢辣椒素、辣椒素和二氢辣椒素的含量范围分别为0.0281%~0.0534%、0.258%~0.389%和0.115%~0.209%。结论：建立的一测多评法可作为小米辣中3种辣椒碱类化学成分的含量测定方法,一测多评法为民族药质量控制提供了一个新的模式与方法。     

Occupational dermatosis among sanders in the furniture industry

The prevalence of occupational skin disease was found to be 3.8% in a study of 479 sanders in the furniture-making industry in Singapore. 17 species of wood imported from South East Asia were used. The most common dermatoses from wood dust were pruritus (1.6%), irritant contact dermatitis (1.6%) and xerosis (1.4%). 2 sanders had miliaria. None had allergic contact dermatitis from wood dust. The arms and trunk were the most common site for pruritus and dermatitis from wood dust. It appeared that the woods commonly used in the furniture making industry are weak sensitizers. Appropriate preventive measures against irritant dermatitis such as dust control, protective clothing, and good personal hygiene should be adequate to prevent occupational dermatoses among the sanders.     

HSP47 siRNA对体外培养HTCF细胞生物学行为及TGF-β1表达水平的影响

目的:探究热休克蛋白47(HSP47)siRNA对体外培养人眼Tenon囊成纤维(HTCF)细胞生物学行为及转化生长因子-β1(TGF-β1)表达水平影响。方法:体外培养HTCF细胞,并分为:空白对照组、空载体组和转染组;转染组根据HSP47基因序列设计并合成干扰siRNA序列,构建载体并导入HTCF细胞中;空载体组导入空白载体。采用RT-PCR和蛋白质印迹实验检测细胞中HSP47 mRNA和蛋白的表达情况,采用克隆形成实验、流式细胞术、Transwell法及划痕实验检测细胞增殖、凋亡、侵袭及迁移,蛋白质印迹实验检测增殖、凋亡、侵袭、迁移蛋白和TGF-β1的表达情况。结果:相比空载体组,转染组HSP47 mRNA和蛋白的表达、克隆形成率、细胞愈合率、侵袭细胞数目、Ki67、N-cadherin、TGF-β1蛋白相对表达水平显著降低(P<0.05),E-cadherin蛋白相对表达水平显著升高(P<0.05),但细胞凋亡率、Bcl-2和Bax蛋白相对表达水平均无差异(P>0.05)。结论:HSP47 siRNA可以通过抑制TGF-β1蛋白的表达降低HTCF细胞的增殖、侵袭及迁移能力,但对HTCF细胞的凋亡无明显影响。     

弱视儿童和正常儿童的灰质VBM比较研究

目的利用基于体素的形态学(voxel-basedmorphometry,VBM)比较,探讨弱视儿童中灰质发育的异常。方法13例弱视儿童和14例视力正常儿童进行了3DT1WI扫描,数据在SPM2下进行头颅标准化、分割、平滑的后处理后,对病例组和对照组的数据进行归一化处理,将体素内的信号转换为灰质密度的差别,以双样本独立t检验进行病例组和对照组的基于体素的灰质密度比较,分析弱视患者灰质病变的区域。结果弱视组和对照组的左侧额中回,海马旁回和梭状回,颞下回和双侧距状回的灰质密度差异具有统计学意义,P<0.001。这些区域的体素数目从12个至36个不等。结论基于体素的形态学研究能够发现弱视儿童中与视觉相关的大脑区域的灰质发育异常,从而为探讨引起弱视的神经结构发育异常提供了有用的信息。     

Detection of abnormal visual cortex in children with amblyopia by voxel-based morphometry

PURPOSE: To detect the abnormalities of gray matter in children with amblyopia by voxel-based morphometry (VBM). DESIGN: Prospective, nonrandomized clinical trial. METHODS: Thirteen children with amblyopia and 14 normally sighted children underwent magnetic resonance (MR) examination. The two groups were age-matched with a mean age of 5.8 years. In the amblyopia group, five children had strabismus amblyopia, and eight had anisometropic amblyopia. We analyzed the original 3-dimensional T1 brain images using the VBM module within the widely used analysis software package SPM2 (Welcome Department of Cognitive Neurology, London, United Kingdom). After normalization, segmentation, and smoothing of the images, comparison between amblyopic and control groups was derived for the gray matter of the entire brain using parametric statistics. RESULTS: The results of VBM analysis indicated that the amblyopic group had decreased gray matter density in the middle frontal gyrus, parahippocampal gyrus, fusiform gyrus, inferior temporal gyrus of the left hemisphere, and the bilateral calcarine cortices. The radii of these regions ranged from 12 to 36 voxels. These abnormalities were consistent with morphologic changes in brain regions related to visual function. CONCLUSIONS: Using MR and VBM analysis, we detected morphologic changes in the visual cortex of children with amblyopia, which may indicate developmental abnormalities of visual cortex during the critical growth period.     

脉络膜新生血管经TTT治疗前后微视野变化

目的 应用微视野检查技术评价经瞳孔温热疗法（TTT）治疗脉络膜新生血管（CNV）前后的视功能变化.方法 12例13只经荧光素眼底血管造影证实有CNV的年龄相关性黄斑病变（AMD）和高度近视患眼,在接受TTT治疗前后分别行微视野检查.结果 TTT治疗前,6眼有相对暗点,7眼有绝对暗点.治疗后与治疗前相比较,6眼TTT前检出相对暗点的患眼中,治疗后视力提高者4眼,1眼视力下降,1眼视力无明显变化;6眼中5眼TTT治疗后激光照射处视网膜的光敏度提高,1眼降低.所有被检出有绝对暗点的患眼治疗后视力均无明显变化,视网膜的光敏度不变.结论 微视野检查能客观评估TTT治疗CNV的疗效.