硬膜外麻醉对老年前列腺电切术患者认知功能的影响

目的探讨硬膜外麻醉对老年前列腺电切术患者术后认知功能的影响。方法选取驻马店市中心医院2016年5月—2018年2月收治的106例行前列腺电切术老年患者,将其随机分成例数均等的两组,对照组采取全身麻醉方式,观察组患者实施硬膜外麻醉,比较两组麻醉效果和并发症及不良反应发生情况,采用简易精神状况检查量表(MMSE)评价患者术前术后认知功能情况。结果两组麻醉起效时间及麻醉效果比较,差异无统计学意义(P0.05),观察组麻醉恢复时间明显短于对照组,差异有统计学意义(P0.01);观察组心动过缓、尿潴留和低血压的发生率显著低于对照组,差异有统计学意义(P0.05),两组患者术前MMSE得分无显著性差异(P0.05),术后7 d、术后1个月时,观察组患者MMSE得分明显高于对照组(P0.01),对照组术后MMSE得分低于术前(P0.05)。结论硬膜外麻醉应用于前列腺电切术老年患者中麻醉效果满意,并发症及不良反应发生率低,对患者的认知功能影响较小,安全可行。     

二氢埃托啡的全麻辅助效应及对呼吸循环的影响

目的:探讨二氢埃托啡作为全麻辅助用药的效果及对呼吸循环功能的影响。方法:选择无心肺疾患的择期手术病人100例,分别于麻醉前、手术前及手术中给予一定剂量的二氢埃托啡,观察插管反应、吸入麻醉药的用量,及能反映呼吸、循环状况等指标的变化。结果:①辅助用二氢埃托啡后,吸入少量的氨氟醚或异氟醚即获得满意的麻醉效果。②麻醉量的二氢埃托啡有明显的呼吸抑制作用。③对循环功能影响不大。结论:二氢埃托啡是一有效的全麻辅助用药。     

不同种类的局麻药硬膜外麻醉复合吸入麻醉对异氟醚MAC值的影响

目的观察利多卡因和丁卡因硬膜外联合全麻对异氟醚MAC的影响。方法78例胆囊切除病人随机双盲分为四组,Ⅰ、Ⅱ、Ⅲ组均用硬膜外联合全麻,分别用1%利多卡因、0.15%丁卡因和其混合液做硬膜外麻醉,并吸入异氟醚全麻,Ⅳ组单纯吸入异氟醚全麻做对照。用电刺激左肩C5水平上下浮动法测异氟醚的MAC值。结果3组硬膜外联合全麻组异氟醚的MAC分别是:0.67±0.097%、0.68±0.084%、0.61±0.103%,3组间无显著差异;而全麻对照组的MAC为1.15±0.088%,硬膜外联合全麻组与全麻对照组比较有显著差异,可以显著降低异氟醚的MAC。结论利多卡因和丁卡因硬膜外联合全麻可以降低异氟醚的MAC值,但利多卡因和丁卡因及其混合液组中无显著差别,且表现相加作用,其作用机制可能一致。     

Characteristics of individuals meeting criteria for new onset panic attacks following exposure to a typhoon

The association between trauma exposure and panic attacks has received increased attention over the past decade, with mounting evidence suggesting an overlapping etiologic pathway. This study examined the incidence of new onset panic attacks in 775 Vietnamese individuals in the 2–3 months following Typhoon Xangsane. Pre-typhoon (Wave 1) and post-typhoon (Wave 2) assessments were conducted, allowing for consideration of factors occurring prior to the typhoon in addition to typhoon-relevant responding. Of the 775 participants, 11.6% (n=90) met criteria for lifetime panic attack pre-typhoon and 2.8% (n=22) met post-typhoon panic attack criteria. Individuals with pre-typhoon panic were significantly older and reported less education compared to the no-panic group. Individuals in both panic groups were more likely to screen positive on a Wave1 psychiatric screening measure, endorse greater typhoon exposure and prior traumatic event exposure and were significantly more likely to meet DSM-IV criteria for posttraumatic stress disorder (PTSD) and major depression (MDD) post-typhoon compared with persons reporting no history of panic attacks. Pre and post-typhoon panic exhibited similar patterns across variables and both panic conditions were associated with the development of PTSD and MDD, suggesting that persons experiencing panic attacks may represent a vulnerable population in need of early intervention services.     

Genetic and environmental influences on relationship between anxiety sensitivity and anxiety subscales in children

Anxiety sensitivity, a belief that symptoms of anxiety are harmful, has been proposed to influence development of panic disorder. Recent research suggests it may be a vulnerability factor for many anxiety subtypes. Moderate genetic influences have been implicated for both anxiety sensitivity and anxiety, however, little is known about the aetiology of the relationship between these traits in children. Self-reports of anxiety sensitivity and anxiety symptoms were collected from approximately 300 twin pairs at two time points. Partial correlations indicated that anxiety sensitivity at age 8 was broadly associated with most anxiety subtypes at age 10 (r = 0.11–0.17, p < 0.05). The associations were largely unidirectional, underpinned by stable genetic influences. Non-shared environment had unique influences on variables. Phenotypic results showed that anxiety sensitivity is a broad predictor of anxiety symptoms in childhood. Genetic results suggest that childhood is a developmental period characterised by genetic stability and time-specific environmental influences on anxiety-related traits.     

Mixed General Linear Model Analysis of Quantitative Electroencephalographic (qEEG) Data

ABSTRACT

This paper describes a mixed general linear analysis of the quantitative electroencephalogram (qEEG). The modeling is similar to regression, which builds a regression or ‘best-fit’ model for the data structure but, in addition, provides for correlations between observations. A mixed linear model states that data consists of two parts: fixed effects and random effects. Fixed effects determine the expected values of the observations, while random effects account for the stochastic deviations from these expected values both between and within individuals. Since errors are independent between subjects, the deviations from the expected values may also be modeled using a repeated measures approach. The term ‘repeated measures’ in this model refers to data with multiple observations from one specific source. It is reasonable to assume that these observations from the same source are correlated, even if only slightly, in some measurable way. Consequently, statistical analysis of repeated measures data gives a more accurate prediction capability when the issue of covariation between these measures is addressed.

With mixed model methodology now available (e.g., the mixed procedure [Mixed PROC] of the SAS® system), the covariance structure can be incorporated into the statistical model. Disregarding potential random effects not specific to single individuals and absorbing potential within-subject random effects into the covariance matrix allows one to work with a simplified model.

The use of a mixed procedure and its method of modeling the data structure appear to provide an accurate and objective method of analysis resulting in quantifiable equations for testing predictions. Essentially, this method allows the physiological pattern of each individual in the study, not related to any other variable, to be represented and accounted for in the model. Several comparative examples will be used to highlight the information that can be hidden in data structures depending on the type of statistical analysis used.     

Microvascular free tissue transfer in head and neck and esophageal surgery

Successful reconstruction for excisional defects of the head and neck and esophagus was accomplished in 93 percent of our patients using microvascular free tissue transfer. Complete failure occurred in 7 percent of the patients. Major defects after head and neck cancer surgery constituted the main indication for use of microvascular free tissue transfer for reconstruction. Ninety-four percent of the patients had undergone an extensive excisional procedure. A wide range of cutaneous, myocutaneous, and osteocutaneous free flaps, as well as free bowel autotransfers were used. Complete failure was three times higher in the previously irradiated patients (4 of 41 patients) compared with nonirradiated patients (1 of 34 patients). Morbidity and mortality rates were consistent with expected ranges in patients who were undergoing major head and neck resection. Donor site complications occurred in 23 percent. Thin flaps are favored for reconstruction of anterior defects in the oral cavity, whereas bulkier flaps are more suitable for deeper defects in the oropharynx and hypopharynx. The advantages are both aesthetic and functional. The free jejunal autograft is considered the reconstructive method of choice for defects produced by laryngopharyngoesophagectomy. Highly developed and sophisticated microsurgical skills continue to be the mainstay of success. The implication of free tissue transfer failure, especially for defects of the upper aerodigestive tract, are impressive in terms of morbidity, mortality, and cost. These considerations limit the application of this method of reconstruction to centers that have sophisticated and productive reconstructive surgeons with microsurgical skills.     

Use of the BioMedicus centrifugal pump in traumatic tears of the thoracic aorta

Traumatic blunt thoracic aortic injury is a clinical entity of increasing incidence. After the diagnosis of traumatic tear of the aorta is made, there is some controversy over whether the aorta should be repaired using cardiopulmonary bypass, a heparinized shunt, or cross-clamping and graft interposition without a shunt or bypass. At Allegheny General Hospital, 19 patients were treated for traumatic tears of the thoracic aorta between July 1, 1977, and June 30, 1983. They can be divided into two groups: Group 1 (July 1, 1977, through October 31, 1981), in which no shunt or bypass or only a heparinized shunt was used, and Group 2 (November 1, 1981, through June 30, 1983), in which left atrium-femoral artery bypass was performed using a BioMedicus heparinless pump and tubing. Among the 10 patients in Group 1, 4 died and 2 had paraplegia postoperatively. Among the 9 patients in Group 2, 1 died and none experienced paraplegia following operation. We believe that the BioMedicus centrifugal pump is a simple, safe means of perfusing the lower body, kidneys, and spinal column without necessitating heparinization in a patient with multiple injuries or the placement of a cumbersome heparinized shunt. Because of the simplicity and the reliability demonstrated, this pump should be considered for use in all patients with traumatic tears of the thoracic aorta.     

Functional monitors of rejection in small intestinal transplants

Absorption of cyclosporine and uptake of radiolabelled glucose by the transplanted small intestine in the dog was investigated to develop physiologic markers of rejection. Cyclosporine in olive oil was given orally, and glucose-14C was instilled into an isolated pouch constructed from the transplanted jejunum. Biopsies were simultaneously obtained from an isolated pouch made from the transplanted ileum. The absorption data were correlated with the histologic findings. Absorption of cyclosporine was of the same magnitude in autotransplanted dogs as it was in allotransplanted dogs with a normal graft. Absorption of cyclosporine in allotransplanted dogs with histologic signs of rejection was significantly reduced. Peak uptake of glucose-14C was noted 5 to 10 minutes after instillation of the isotope in autotransplanted and allotransplanted dogs with a normal graft. Allotransplanted dogs undergoing rejection had a delayed appearance of peak uptake and significantly reduced absolute uptake. In conclusion, absorption of cyclosporine and uptake of radiolabelled glucose can be utilized as functional monitors of intestinal allograft rejection.