罗哌卡因复合不同药物骶管内超前注入用于小儿术后镇痛的比较

目的:比较罗哌卡因复合芬太尼、氯胺酮和曲马多骶管内超前注入用于小儿术后镇痛的效果及安全性。方法:120例择期行下腹部手术的患儿随机分为4组,每组30例。0.25%罗哌卡因(A组)、0.25%罗哌卡因 芬太尼2μg/kg(B组)、0.25%罗哌卡因 氯胺酮0.5mg/kg(C组)和0.25%罗哌卡因 曲马多1mg/kg(D组)。结果:用OPS法及Ramsay法分别进行镇痛及镇静评分并随访副作用的发生率。OPS<4分的百分率B、C、D组明显高于A组(P<0.05),D组与B、C组在术后12h、24h时亦有显著差异。镇静评分B、C、D组在术后6h内各时点明显高于A组(P<0.05)。D组术后6h内各时点镇静评分明显低于C组(P<0.05),皮肤瘙痒、恶心呕吐发生率B组明显高于A、C和D(P<0.05)。结论:罗哌卡因复合曲马多镇痛效果较好,且副作用较少,优于罗哌卡因复合氯胺酮和芬太尼。     

Bloqueo interfascial serrato-intercostal como estrategia ahorradora de opioides en cirugía supraumbilical abierta

Introduction

The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures.

Effect of procainamide on the postrepolarization refractoriness in cardiac muscle: evaluation using the block coupling interval in the artificial isthmus model in the canine right atrium

The post-repolarization refractoriness (PRR) is an important factor to determine the conduction block in cardiac muscle. Recently, we proposed the block coupling interval (BCI) as an useful electrophysiological index for evaluating the PRR. In the present study, the effect of procainamide on PRR was evaluated using the BCI and the effective refractory period (ERP). In five beagle dogs, radiofrequency linear ablation was performed on the right atrial surface parallel to the AV groove, forming an artificial isthmus (8-10 mm width and 15-20 mm length). Bipolar recordings were performed in the isthmus at a resolution of 1.2 mm and single extrastimuli with eight basic drive trains were delivered to cause conduction blocks in the isthmus. When a conduction block occurred, the recorded coupling interval at the recording site just proximal to the site of block was defined as BCI. At the site of the block, the ERP and duration of the monophasic action potential (MAP) at each drive cycle length was measured. The PRR was calculated using two different formulas: (1) [ERP-MAP] and (2) [BCI-MAP]. Procainamide was administrated intravenously at a dose of 15 mg/kg after the control study and the whole study protocol was repeated. The site of the block in an individual dog was always the same. BCI, ERP, and MAP were all shortened in accordance with the shortening of the basic drive cycle length, and the BCI was always the longest, ERP the middle, and the MAP was the shortest. The administration of procainamide prolonged each parameter, but the order of BCI > ERP > MAP remained unchanged. The PRR calculated as [BCI-MAP] was prolonged from 15 +/- 10 ms to 29 +/- 8 ms by the administration of procainamide (P = 0.048), but [ERP-MAP] was unchanged (8 +/- 10 ms vs 8 +/- 4 ms). In the conduction block model in the canine right atrium, procainamide prolonged the [BCI-MAP], but did not change the [ERP-MAP]. The procainamide effect of prolonging the PRR might be expressed better by the change in the BCI than the ERP.     

硬膜外阻滞辅助按摩治疗腰椎间盘突出症的疗效观察

本文采用硬膜外阻滞辅助按摩治疗椎间盘突出症患者２５例，经临床观察证实，本文方法疗程短，治愈率高、痛苦小、患者易接受。每日治疗一次，７次为一疗程。第一疗程治愈率达７６％，第一、第二疗程会计治愈率达９６％。全部患者均随访３个月以上，且无一例复发。     

Inappropriate shock delivery by implantable defibrillators with dual chamber pacing during nonsustained ventricular tachycardia in patients with heart block

Transvenous implantable cardioverter defibrillators (ICDs) have improved the management of patients with ventricular tachycardia/ventricular fibrillation (VT/VF). Many patients with sustained VT/VF have bradyarrhythmias and nonsustained VT. Shock delivery due to nonsustained VT would be an undesirable feature. Abortive shock capability (noncommitted shocks) is a feature available in devices to prevent delivery of shocks for nonsustained VT. Recently, the availability of dual chamber pacing capability has improved the efficacy of ICDs by obviating the need of separate pacemaker implantation in patients with VT/VF and concomitant bradyarrhythmias. However, interaction between bradyarrhythmias and VT/VF has not been described and has important clinical implications. We report a case in which a patient with complete atrioventricular (AV) block and ventricular arrhythmias received an inappropriate shock following spontaneous termination of nonsustained VT, showing an important shortcoming of devices with these features.     

The Effect of Exogenous Adenosine in Patients with Neurally-Mediated Syncope and Sick Sinus Syndrome

The effects of a 20-mg IV, bolus of adenosine 5'triphosphate (ATP) on the heart rhythm was studied in 79 patients affected by neurally-mediated syncope (26 cases) or sick sinus syndrome (22 cases) or both syndromes (31 cases) and in 31 healthy control subjects in order to examine the sensitivity of cardiac purinoceptors in such circumstances. During ATP infusion, the sinus cycle lengthened to > 2 seconds in no control, in 1 (4%) patient with neurally-mediated syncope, in 5 (23%) patients with sick sinus syndrome, and in 13 (42%) patients with both neurally-mediated and sick sinus syndromes (P = 0.01). Atrioventricular block occurred in 14 (45%) of controls, in 10 (38%) patients with neurally-mediated syncope, in 4 (18%) patients with sick sinus syndrome, and in 13 (42%) patients with both neurally-mediated syncope and sick sinus syndrome (n.s.). Thus, exogenous ATP exerts different effects on patients with neurally-mediated syncope and patients with sick sinus syndrome. In fact, intrisic disease of the sinus node is necessary to modulate an abnormal adenosine-mediated sinus arrest, whereas patients affected by neurally-mediated syncope alone show a normal sensitivity to the drug administration. The effect of ATP on atrioventricular conduction is greater than that on sinus node and is of similar magnitude in patients and controls; thus the clinical meaning of ATP induced atrioventricular block remains uncertain.     

The indications and applications of interscalene brachial plexus block for surgery about the shoulder

Due to increasing use of interscalene brachial plexus block (ISBPB) for surgery about the shoulder, it was our purpose to review the indications, techniques, complications, and most recent advances of interscalene brachial plexus block. All MEDLINE publications regarding interscalene and brachial plexus block from July 1966 to July 2003 were reviewed, analyzed and scrutinized. ISBPB provides surgical anesthesia and perioperative analgesia for procedures involving dermatomes C5 through C7. ISBPB is reliably performed with very high success (≥94% effectiveness) and few major complications (≤0.4%). Recent advances in ISBPB techniques, including perineural catheters for patient-controlled interscalene analgesia, afford superior postoperative pain relief, early rehabilitation, and excellent patient satisfaction. When performed by trained personnel, ISBPB is a safe and effective regional anesthetic technique with rapidly developing applications aimed to improve postoperative analgesia following surgery of the proximal upper limb.     

一种提高直肠癌诊断精度的基于U型网络和残差块的电子计算机断层扫描图像分割算法EI北大核心CSCD

作为确定病灶与诊断的重要基础,医学图像分割已成为生物医学领域中极其重要的热门研究领域之一,其中基于全卷积神经网络和U型网络(U-net)等神经网络的医学图像分割算法得到越来越多研究人员的重视。目前,医学图像分割算法应用于直肠癌诊断的研究报道较少,且已有的研究对直肠癌的分割结果精度不高。本文提出了一种结合图像裁剪和预处理方法的编码—解码卷积网络模型。该模型在U型网络的基础上,借鉴残差网络思想,用残差块代替传统的卷积块,有效避免了梯度消失的问题。此外,本文还采用了图像增广的方法提高了所提模型的泛化能力,并在"泰迪杯"数据挖掘挑战赛所提供的数据集进行测试。测试结果表明,本文提出的基于残差块的改进U型网络模型结合图像裁剪预处理,可以大大提高直肠癌的分割精度,得到的戴斯系数在验证集上达到0.97。     

Comparison of postoperative pain control methods after bony surgery in the foot and ankle

Background

We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery in the foot and ankle.

Local anaesthetic dosage of peripheral nerve blocks in children: analysis of 40 121 blocks from the Pediatric Regional Anesthesia Network database

Background

The knowledge regarding appropriate dosage of local anaesthetics for peripheral nerve blocks in children is very scarce. The main objective of the current investigation was to evaluate dosing patterns of local anaesthetics in children receiving peripheral nerve blocks across multiple paediatric hospitals in the USA. We also sought to estimate the incidence of local anaesthetic systemic toxicity.