布比卡因和罗哌卡因竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的比较

目的 比较布比卡因和罗哌卡因超声引导下竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的有效性和安全性。方法 随机将60例择期胸腔镜手术患者均分为布比卡因组（n=30）和罗哌卡因组（n=30）。全麻诱导前分别采用布比卡因或罗哌卡因行单次竖脊肌平面阻滞。观察患者阻滞范围及术后1,6,12,24,48 h静息和咳嗽疼痛视觉模拟评分（visual analogue scale,VAS）;记录术后48 h氟比洛芬酯给药次数及给药时间;观察竖脊肌平面阻滞后气胸等不良事件及术后恶心呕吐等不良反应发生情况。结果 布比卡因组阻滞范围稍广,但与罗哌卡因组比较差异无统计学意义（χ²=1.2,P>0.05）。布比卡因组术后1,6,12 h患者静息和咳嗽VAS评分低于同时点罗哌卡因组（P<0.05）,术后24,48 h静息和咳嗽VAS评分高于组内术后12 h（P<0.05）,术后48 h氟比洛芬酯使用人均次数小于罗哌卡因组（P<0.05）。2组术后第2个12 h氟比洛芬酯使用例次均高于同组术后第1个12 h（P<0.05）。2组竖脊肌平面阻滞后不良事件及术后不良反应发生情况差异无统计学意义。结论 布比卡因和罗哌卡因超声引导下单次竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛,都是有效的和安全的,有效镇痛时间均仅12 h左右。比较而言,布比卡因镇痛效果更好。     

不同浓度罗哌卡因腹横肌平面阻滞用于剖宫产术后镇痛的效果

目的探讨不同浓度罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产术后镇痛的效果。方法选择ASAⅠ或Ⅱ级剖宫产产妇150例,随机均分为三组:A组、B组和C组术后双侧TAP分别注射0.25%、0.20%、0.15%罗哌卡因1.5mg/kg,并使用PCIA。观察和记录术后4、8、12、24和48h产妇VAS评分。并记录产妇镇痛满意率、镇痛泵按压次数及发生TAP相关并发症(穿破腹膜入腹腔、腹壁严重损伤、感染出血、局麻药误入血管及局麻药中毒)。结果与C组比较,术后不同时点A组产妇VAS评分明显降低(P0.05)。术后不同时点A组和B组VAS评分差异无统计学意义。与C组比较,A组和B两组产妇对镇痛满意率明显增加、镇痛泵按压次数明显减少(P0.05)。三组产妇未发生穿破腹膜入腹腔、腹壁严重损伤、感染出血、局麻药误入血管及局麻药中毒等TAP相关并发症。结论 0.20%以上罗哌卡因TAP阻滞联合PCIA用于剖宫产术后镇痛是安全有效的。     

A forced running wheel system with a microcontroller that provides high-intensity exercise training in an animal ischemic stroke model

We developed a forced non-electric-shock running wheel (FNESRW) system that provides rats with high-intensity exercise training using automatic exercise training patterns that are controlled by a microcontroller. The proposed system successfully makes a breakthrough in the traditional motorized running wheel to allow rats to perform high-intensity training and to enable comparisons with the treadmill at the same exercise intensity without any electric shock. A polyvinyl chloride runway with a rough rubber surface was coated on the periphery of the wheel so as to permit automatic acceleration training, and which allowed the rats to run consistently at high speeds (30 m/min for 1 h). An animal ischemic stroke model was used to validate the proposed system. FNESRW, treadmill, control, and sham groups were studied. The FNESRW and treadmill groups underwent 3 weeks of endurance running training. After 3 weeks, the experiments of middle cerebral artery occlusion, the modified neurological severity score (mNSS), an inclined plane test, and triphenyltetrazolium chloride were performed to evaluate the effectiveness of the proposed platform. The proposed platform showed that enhancement of motor function, mNSS, and infarct volumes was significantly stronger in the FNESRW group than the control group (P<0.05) and similar to the treadmill group. The experimental data demonstrated that the proposed platform can be applied to test the benefit of exercise-preconditioning-induced neuroprotection using the animal stroke model. Additional advantages of the FNESRW system include stand-alone capability, independence of subjective human adjustment, and ease of use.     

Clinician accuracy when subjectively interpreting articulating paper markings

Aims:

The aim of this study was to determine whether Subjective Interpretation of paper markings is a reliable method for identifying the relative occlusal force content of tooth contacts.

Methodology:

295 clinicians selected the “Most Forceful” and “Least Forceful” occlusal contacts in six occlusal-view photographs of articulating paper marks that were later compared against computerized occlusal analysis relative occlusal force measurements of the same tooth contacts. Means and standard deviations were calculated by years in clinical practice and by number of occlusion courses taken. A Chi-square analysis was also performed.

Results:

The mean correct for 295 participant dentists was 1·53 (±1·234). There were no significant differences found for years in practice (P>0·16) or number of occlusion courses taken (P>0·75). The Chi-square analysis showed a sensitivity of 12·6%, a specificity of 12·4%, a positive predictive value of 12·58%, and a negative predictive value of 12·42%. Chance was calculated at 12·5% correct.

Conclusions:

Subjective Interpretation is an ineffective clinical method for determining the relative occlusal force content of tooth contacts. The reported low scores obtained from a large group of participant dentists suggest clinicians are unable to reliably differentiate high and low occlusal force from looking at articulating paper marks. This longstanding method of visually observing articulating paper marks for occlusal contact force content should be replaced with a measurement-based, objective method.     

咬合抬高对后牙重度磨耗患者咀嚼肌表面肌电值的影响

目的：探讨后牙重度磨耗患者咬合抬高后对咀嚼肌表面肌电反应的影响。方法：随机选取2012年1月至2014年1月在我北京航空总医院口腔诊疗中心就诊的,伴有双侧后牙重度磨耗的患者40名为受试对象,其中男性23名,女性17名,年龄40-50岁,治疗前及咬合抬高不同距离后分别进行咬肌及颞肌的肌电检查,并对结果采用多样本均数比较的单因素方差分析进行统计学处理。结果：切牙区颌间距离增加1mm时,双侧咬肌,双侧颞肌肌电值差异无统计学意义。切牙区颌间距离增加2mm时,左侧咬肌,右侧咬肌,左侧颞肌肌电值差异无统计学意义,右侧颞肌肌电值有所增加（17.08±3.27 VS 24.66±3.18,P〈0.05）。切牙区颌间距离增加3mm时,除右侧咬肌肌电值差异无统计学意义外（22.35±3.14 VS 27.74±4.26,P〉0.05）,左侧咬肌,左侧颞肌,右侧颞肌肌电值差异均有统计学意义。切牙区颌间距离增加4mm时,双侧咬肌,颞肌肌电值差异均有统计学意义。结论：切牙区颌间距离增加2mm时对咬肌和颞肌肌电值影响不大,切牙区颌间距离增加3mm会对咬肌和颞肌肌电值产生较大影响。     

Tricuspid Annular Plane Systolic Excursion (TAPSE) for Risk Stratification and Prognostication of Patients with Pulmonary Embolism

BackgroundThe categorization of pulmonary embolism (PE) as non-massive, sub-massive, and massive helps guide acute management. The presence of right ventricular (RV) strain differentiates sub-massive from non-massive PEs. Unlike laboratory markers and electrocardiogram changes, the classic parameters used in the echocardiographic diagnosis of RV strain have a technical component that is operator-dependent.ObjectiveThis narrative review will describe the physiologic effects of a PE on the RV and how this affects prognosis. It will summarize the literature evaluating the accuracy and prognostic ability of tricuspid annular plane systolic excursion (TAPSE) in the echocardiographic assessment of RVfunction. The review will describe the appeal of TAPSE for this purpose, provide cutoff measurements, and then illustrate how to perform the technique itself, while offering associated pearls and pitfalls in this bedside evaluation.DiscussionRV function and dynamics undergo acute changes in the setting of a PE. RV dysfunction predicts poor outcomes in both the short and long term. However, RV strain is difficult to capture on echocardiography due to the chamber's complex geometric shape and contraction. From the apical four-chamber window, TAPSE offers a quantitative measure that is more easily performed with high interobserver reliability for evaluating systolic RV contraction. This measurement carries prognostic value in patients diagnosed with PE.ConclusionsAlong with other more qualitative echocardiographic parameters, TAPSE can be used as a simple quantitative measure of RV dysfunction for differentiating sub-massive from non-massive PEs. This categorization helps guide acute management and disposition.     

肝静脉的冠状断层解剖学研究

目的为MRI和多层螺旋CT在冠状断面上诊断肝疾患及肝外科手术提供断层解剖学依据。方法用30例成人躯干部连续冠状断层标本、10例成人腹部MRI冠状图像及5例成人肝内管道多层螺旋CT三维重建图像,观测了肝左、中、右静脉及其重要属支的走行、分布及其与肝门静脉的关系。结果依左外叶的外形特征,将肝左静脉的回流形式分为4型。来自段Ⅷ腹侧部的静脉全部汇入肝中静脉,来自段Ⅷ背侧部的静脉全部汇入肝右静脉。而位于段Ⅷ腹侧部和背侧部之间的静脉（V8i）,其回流形式可分为3型。肝右静脉的主干多出现于下腔静脉及其稍后层面,在冠状断面上可分为4型。结论冠状断面在显示肝静脉及其属支的上、下走行方面具有明显优势。以V8i为标志,将段Ⅷ分为腹侧和背侧两个亚段。这种亚段划分有利于探讨一种新的和更加安全的肝外科手术方式。