全膝关节置换应用股神经阻滞镇痛与自控静脉镇痛的系统评价

背景：目前对全膝关节置换围手术期采用何种镇痛方法的效果差异存在争议. 目的：系统评价全膝关节置换术中应用股神经阻滞镇痛与患者自控静脉镇痛的疗效和安全性. 方法：全面搜索国内外关于全膝关节置换中应用股神经阻滞镇痛和患者自控静脉镇痛的随机对照研究资料,按照既定的纳入、排除标准,核定检出符合评价标准的文献,提取所需研究数据,采用RevMan 5.0.18软件进行Meta分析.评价指标包括术后24,48 h静息和活动时的目测类比评分、恶心呕吐胃肠道症状发生率、嗜睡等镇静过度发生率以及患者满意率. 结果与结论：纳入随机对照研究19篇,样本共计952膝,股神经阻滞组和患者自控静脉镇痛组分别为481膝和471膝.荟萃分析加权后,股神经阻滞与患者自控静脉镇痛相比,术后24,48 h静息和活动目测类比评分均较低（P 〈0.05）,无论是单次股神经阻滞还是连续股神经阻滞,差异均有显著性意义.在并发症发生率方面,股神经阻滞术后恶心呕吐及嗜睡发生率低于患者自控静脉镇痛（P 〈0.05）.结果提示,全膝关节置换术中采用股神经阻滞镇痛,无论是镇痛效果还是并发症发生率都优于患者自控静脉镇痛,且股神经阻滞镇痛患者满意度较高.但二者间的比较仍需大规模多中心的随机对照试验来进一步研究.     

听骨链CT仿真内窥镜成像技术的临床应用价值

目的　探讨听骨链CT仿真内窥镜 (CTVE)成像技术的初步临床应用价值。方法　使用HiSpeedCT/i扫描机 ,层厚 1 0mm、螺距 1 0、骨算法、视野 9 6cm× 9.6cm、间隔 0 1mm重建 ,对 10例正常中耳和 2 1例临床怀疑中耳病变 (14例手术 )的患者进行CTVE成像。正常及异常中耳的观察阈值分别为 - 6 0 0～ - 2 0 0HU和 5 0～ 30 0HU。结果　CTVE能清楚显示正常听骨链的形态、大小及相互关系 ,锤骨、砧骨及锤砧关节的显示率为 10 0 % (38/38) ,镫骨底板的显示率为 32 % (12 /38) ,只有 2 1%(8/38)可以分辨镫骨的前、后脚 ;18例中耳炎患者中 12例胆脂瘤形成 ,CTVE上有不同程度的听小骨破坏。 1例中耳畸形显示听骨链发育异常。结论　CTVE是一种新的、非侵袭性的方法 ,能显示听骨链的立体影像 ,有利于听骨链病变的显示和诊断     

脊柱后路截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤

目的 :探讨脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤的临床疗效。方法 :回顾性分析2012年1月~2014年1月采用脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤的15例患者。男14例,女1例;年龄22~44岁,平均35.7±6.1岁。患者均有腰背痛及后凸畸形,VAS评分6.8±0.8分,ODI为(55.4±12.8)%,局部后凸角51.9°±15.1°,整体后凸角61.6°±27.5°,4例伴有神经功能损伤,术前Frankel分级C级1例,D级3例,E级11例。所有患者均采用后路楔形截骨,术中进行截骨矫形前对Andersson损伤处的纤维组织和硬化骨进行彻底清除直至显露新鲜的松质骨。随访时间均为2年以上,收集患者随访期间的临床疗效评分(VAS和ODI)和影像学参数(局部后凸角、整体后凸角、胸腰段后凸角、腰椎前凸角、骶骨倾斜角和骨盆倾斜角),收集患者术后2年的全脊柱CT检查来评估螺钉置入和固定的情况,应用Bridwell椎间融合评估系统来评估损伤的愈合情况。结果 :所有手术均顺利完成,手术时间为279.4±32.9min,术中平均出血量1066.1±466.1ml。1例患者术中出现硬膜破裂,术中修补。1例患者术后出现肺部感染,应用抗生素治疗后痊愈。随访时间24~32个月,平均27.1±2.4个月。术后2年随访时,局部后凸角减小为7.9°±19.0°,平均矫正了44.6°±9.1°。整体后凸角减小为21.3°±10.6°(P0.05)。腰背疼VAS评分改善为0.7±0.6分(P0.05),ODI改善为(15.6±4.3)%(P0.05)。术后2年随访时原神经功能Frankel分级C级1例及D级3例均恢复为E级。CT显示Andersson损伤处均获得骨性融合,无内固定松动、断裂,均为Ⅰ级愈合。结论:脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤能够获得良好的融合和矫形效果,临床疗效满意。     

妈富隆治疗原发性痛经的初步研究

目的评价妈富隆治疗原发性痛经的有效性和安全性。方法采用随机,对照,双盲方法将原发性痛经患者分为对照组和实验组各30例。对照组服用安慰剂,实验组服用妈富隆各3个周期。采用总的痛经评分(Total Dysmenorrhea Score,TDS)和视觉模拟评分法(Visual Analog Scale,VAS)来评价药物的疗效,对比治疗前后痛经的改善情况和药物的副作用。结果治疗后实验组TDS和VAS较对照组明显降低(P<0.05)。实验组TDS和VAS在第2,3周期下降明显。实验组药物副作用发生率明显增高,但随时间的发展而下降,而在对照组无变化,无严重副作用发生。结论妈富隆治疗原发性痛经效果明显,比较安全,值得临床推广应用。     

Therapy of chronic wounds with water-filtered infrared-A (wIRA)

The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects.In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds.     

Inhibition of proliferation of PC-3 human prostate cancer by antagonists of growth hormone-releasing hormone: lack of correlation with the levels of serum IGF-I and expression of tumoral IGF-II and vascular endothelial growth factor

BACKGROUND: Antagonists of growth hormone-releasing hormone (GHRH) such as JV-1-38 can inhibit androgen-independent prostate cancer directly by several mechanisms and/or indirectly by suppressing growth hormone/insulin-like growth factor-I (GH/IGF-I) axis. To shed more light on the mechanisms involved, the effects of JV-1-38 on PC-3 human prostate cancer were compared with those of somatostatin analog RC-160 in vivo and in vitro. METHODS: Nude mice bearing PC-3 tumors received JV-1-38 (20 microg), RC-160 (50 microg) or a combination of JV-1-38 and RC-160. The concentration of IGF-I in serum and the expression of mRNA for IGF-II and vascular endothelial growth factor (VEGF) in tumor tissue were investigated. RESULTS: In vivo, the final volume of PC-3 tumors treated with JV-1-38 was significantly lowered by 49% (P < 0.01), whereas RC-160 exerted only 30% inhibition (NS), compared with controls. Combined use of both compounds augmented tumor inhibition to 63% (P < 0.001). Serum IGF-I levels were decreased only in mice treated with RC-160. JV-1-38 suppressed mRNA for IGF-II in PC-3 tumors by 42%, whereas RC-160 alone or in combination with JV-1-38 caused a 65% reduction. JV-1-38 and RC-160 used as single drugs decreased the expression of VEGF by 50%, and their combination caused a 63% reduction. In vitro, JV-1-38 inhibited the proliferation of PC-3 cells by 39%. This effect could be partially reversed by addition of IGF-I to the serum-free medium. RC-160 alone did not affect the PC-3 cell growth in vitro, but in combination with JV-1-38 it augmented the antiproliferative effect of the GH-RH antagonist to 72%. Exposure to JV-1-38 in vitro reduced the expression of mRNA for IGF-II in PC-3 cells by 55% but did not change VEGF mRNA levels, whereas RC-160 had no effect. CONCLUSIONS: The antiproliferative effect of JV-1-38 was not associated with the suppression of serum IGF-I and was only partially correlated with the expression of IGF-II and VEGF in PC-3 tumors, suggesting that other mechanisms play a role in the antitumor action of GHRH antagonists. Nevertheless, the stronger inhibition of tumor growth after combined treatment with JV-1-38 and RC-160 indicates that the interference with multiple local stimulatory factors leads to an enhanced inhibition of prostate cancer.     

Enhancement of protein kinase C activity and chemiluminescence intensity in mitochondria isolated from the kidney cortex of rats treated with cephaloridine

The development of nephrotoxicity induced by cephaloridine (CER) has been reported to be due to reactive oxygen species (ROS). Protein kinase C (PKC) has been suggested to modulate the generation of ROS. We investigated the possible participation of ROS generation assessed by chemiluminescence (CL) and PKC activity in rat kidney cortical mitochondria in the development of CER-induced nephrotoxicity. We first evaluated the magnitude of the nephrotoxic damage caused by CER in rats. The plasma parameters and ultrastructural morphology changes were increased markedly 24hr after the treatment of rats with CER. We demonstrated that the treatment of rats with CER clearly evoked not only enhancement of Cypridina luciferin analog (CLA)-dependent CL intensity, but also the activation of PKC in mitochondria isolated from the kidney cortex of rats 1.5 and 3.5 hr after injection of the drug. These changes were detected in advance of those observed in plasma and by electron microscopy. The increase in CLA-dependent CL intensity detected in the kidney cortical mitochondria 1.5 and 3.5 hr after injection of CER was inhibited completely by the addition of superoxide dismutase, suggesting the generation of superoxide anion in these mitochondria during the early stages of CER-induced nephrotoxicity. These results suggest that the activation of PKC and the enhancement of superoxide anion generation in kidney cortical mitochondria precede the increases in plasma parameters and the electron micrographic changes indicative of renal dysfunction in rats treated with CER. Additionally, they suggest a possible relationship between PKC activation in mitochondria and free radical-induced CER nephrotoxicity in rats.     

Testing the measurement equivalence of paper and touch-screen versions of the EQ-5D visual analog scale (EQ VAS)

OBJECTIVES: This study examined the measurement equivalence of the original paper-based vertical format of the EQ-5D visual analog scale (EQ VAS) with a touch-screen computer-based horizontal format. METHODS: A total of 314 subjects were administered two modes of the EQ VAS in a randomized crossover design. One mode was the original paper-based 20 cm vertical EQ VAS; the other mode was touch-screen-based. Measurement equivalence was assessed by testing the 95% confidence interval of the mean differences from an equivalence threshold of -3 to +3 points on the VAS and evaluating the intraclass correlation coefficient (ICC). RESULTS: The adjusted mean (SE) EQ VAS score was 80.96 (0.87) on the paper and 79.59 (0.85) on the touch-screen. The mean (CI) difference between scores on the two formats was 1.37 with a confidence interval of 0.175-2.559, wholly contained within the equivalence interval. The ICC was 0.75, indicating acceptable agreement between the two modes. Almost a third (30.1%) of the respondents reported identical scores on both formats. CONCLUSION: These results provide evidence for the measurement equivalence of this EQ VAS touch-screen administration mode with the original paper mode.