Optimizing donor site analgesia after bone harvest from iliac crest

At Queens Medical Centre, Nottingham, alveolar bone grafts (ABG) for patients with cleft lip and palate (CLP) were performed by two surgeons following the same surgical protocol, but with different postoperative iliac crest donor site analgesia: surgeon A used a donor site bolus of levobupivacaine, whilst surgeon B used a donor site epidural catheter (EC) infusing levobupivacaine. A healthcare evaluation was conducted in two phases to establish the effectiveness of analgesia for CLP patients undergoing ABGs. Data were collected prospectively in 2016 and 2018. Cleft patients postoperative to ABG were included. Outcome measures were pain scores at 2, 4, 6, 12, and 24 hours, time to mobilization, and time to food intake. Mean pain scores at the first evaluation were <1 out of 10 for all time points, except 24 hours (score 2.0 for bolus, 1.8 for EC). There was no statistically significant difference between the groups for any of the outcomes measured. As EC conferred no advantage, surgeon B changed to bolus administration and a second evaluation was performed. The mean pain score for the second evaluation was 1.7 and higher pain scores were more common with lower doses of levobupivacaine. The data suggest that bolus injection can produce safe, effective pain control provided an adequate dose is given.     

OMFS moving into the recovery phase of the COVID-19 pandemic – a survey on general practice for elective local anaesthetic procedures

The COVID-19 pandemic has meant a halt to elective oral and maxillofacial procedures under local anaesthetic. As oral and maxillofacial departments enter the recovery phase of the COVID-19 pandemic there are many considerations to make regarding standard operating procedures. Thus, this survey was conducted to identify areas of consensus and divergence in practice during the recovery phase of the pandemic for local anaesthetic procedures in oral and maxillofacial units. Our findings show there are some areas of inconsistency of practice particularly in preoperative risk management and self-isolation as well as fallow time between patients for aerosol generated procedures and non-aerosol generated procedures.     

Influence of application vehicle on skin sensitization to methylchloroisothiazolinone/methylisothiazolinone: an analysis using the local lymph node assay

The murine local lymph node assay (LLNA) is a method for the identification of skin sensitizing chemicals in which activity is measured as a function of proliferative responses induced in draining lymph nodes following topical exposure of mice to the test material. More recently, the LLNA has also been used for the determination of relative skin sensitizing potency based upon the mathematical derivation of an EC3 value, this being the estimated concentration of test chemical necessary to provoke a 3-fold increase in lymph-node cell-proliferative activity compared with concurrent vehicle-treated controls. Here we describe the use of the LLNA to determine the influence of vehicle on the skin-sensitizing potency of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), the active ingredient of preservatives such as Kathon CG. To this end, LLNA responses to MCI/ MI were measured using the vehicles 4:1 acetone:olive oil (AOO), methyl ethyl ketone, dimethylsulfoxide, dimethylformamide, propylene glycol (PG) and acetone. It was found that the vehicle in which MCI/MI was applied had a substantial impact on activity, with derived EC3 values varying from 0.0049% with AOO to 0.048% with PG. With the other vehicles, EC3 values ranged from 0.0068 to 0.0076%. The skin sensitizing potency of MCI/MI as judged from LLNA responses is consistent with what is known of the requirements for sensitization in humans. It is proposed that the LLNA not only provides a method for determination of relative skin sensitizing potency, but is also appropriate for assessing the influence of vehicle matrix on sensitizing activity.     

233例结直肠腺瘤摘除术后随访和内镜监测的临床分析

目的 了解结直肠腺瘤(CRA)摘除后复发情况和结肠镜监测现状,探讨CRA复发的相关危险因素.方法 收集2005年6月至2009年12月安徽医科大学第一附属医院符合研究标准283例CRA摘除住院患者临床资料并进行随访.统计分析CRA摘除后复发率,结肠镜监测间期和CRA复发的关系及CRA复发的相关危险因素;分析肠镜监测组监测间期、频次,及未行监测的原因.结果 共随访CRA摘除后患者235例,随访率83.0％(235/283),其中生存患者233例,随访时间最短者12个月,最长66个月,随访时间中位数为(35.1±14.2)个月.结肠镜监测组患者115例,监测率为49.4％(115/233),复发率45.0％(50/111),未监测组118例;年龄≥60岁、体重指数≥25kg/m2、多发腺瘤(≥2个)与CRA复发明显相关,差异有统计学意义(x2值分别=4.299、5.291和8.883,P值分别=0.038、0.021和0.027);未监测组患者对CRA需要定期监测的知晓率明显低于监测组,差异有统计学意义(x2=37.819,P＜0.01).结论 CRA摘除术后复发率较高;高龄、高体重指数、多发腺瘤是预测CRA复发的独立危险因素;我院CRA摘除后结肠镜监测率低,主要原因在于患者对CRA摘除后定期监测重要性的认识不足.     

Relation of apical dendritic spikes to output decision in CA1 pyramidal cells during synchronous activation: a computational study

Recent studies on the initiation and propagation of dendritic spikes have modified the classical view of postsynaptic integration. Earlier we reported that subthreshold currents and spikes recruited by synaptic currents play a critical role in defining outputs following synchronous activation. Experimental factors strongly condition these currents due to their nonlinear behaviour. Hence, we have performed a detailed parametric study in a CA1 pyramidal cell model to explore how different variables interact and initiate dendritic spiking, and how they influence cell output. The input pattern, the relative excitability of axon and dendrites, the presence/modulation of voltage-dependent channels, and inhibition were cross analysed. Subthreshold currents and spikes on synaptically excited branches fired spikes in other branches to jointly produce different modalities of apical shaft spiking with a variable impact on cell output. Synchronous activation initiated a varying number and temporal scatter of firing branches that produced in the apical shaft-soma axis nonpropagating spikes, pseudosaltatory or continuous forward conduction, or backpropagation. As few as 6-10 local spikes within a time window of 2 ms ensure cell output. However, the activation mode varied extremely when two or more variables were cross-analysed, becoming rather unpredictable when all the variables were considered. Spatially clustered inputs and upper modulation of dendritic Na(+) or Ca(2+) electrogenesis favour apical decision. In contrast, inhibition biased the output decision toward the axon and switched between dendritic firing modes. We propose that dendrites can discriminate input patterns and decide immediate cell output depending on the particular state of a variety of endogenous parameters.     

放射性脑损伤和脑肿瘤复发的鉴别诊断

放射性脑损伤是放射治疗的严重的并发症,其与脑肿瘤复发的鉴别诊断非常困难,目前主要依靠影像学诊断,核磁共振弥散加权像、磁共振波谱、正电子发射型计算机体层显像、单光子发射计算机体层显像等被认为对于鉴别诊断有一定的帮助,但其敏感性和特异性还有待于进一步研究。最终确诊依赖标本的组织学检查。     

局部亚低温治疗对急性脑出血患者应激激素的影响

目的观察局部亚低温治疗对急性脑出血患者应激激素的影响。方法将78例脑出血患者随机分为亚低温组(38例)和常规治疗组(40例),两组在常规药物综合治疗基础上,亚低温组加用局部亚低温治疗;观察两组治疗前、治疗后第3d、第7d血浆促肾上腺皮质激素(ACTH)、促肾上腺皮质释放激素(CRH)、皮质醇(CS)和醛固酮(ALD)的变化,并与健康对照组比较;比较各组治疗前、治疗第21d两组临床神经功能缺损程度评分(NDS)及疗效。结果两组患者治疗前ACTH、CRH、CS和ALD水平与健康对照组比较明显增高(均P<0.01);治疗第3d、第7d逐步下降,与常规治疗组相比亚低温组各项指标下降更明显(均P<0.01)。治疗第21d亚低温组NDS评分明显低于常规治疗组(P<0.05),显效率、总有效率明显高于常规治疗组(均P<0.01)。结论局部亚低温治疗可降低脑出血患者应激激素分泌,促进患者神经功能恢复,明显改善预后。     

The sodium channels of the neuroblastoma x glioma 108 CC 15 hybrid cell change their sensitivity for volatile and local anesthetics upon continuous passage

Summary We have studied the ion flux through the sodium channels of low passage number (<50p.) and high passage number (>150p.) neuroblastoma x glioma hybrid cells using [¹⁴C] guanidinium and specific neurotoxins to induce channel opening and closing. The sodium channels of low passage number hybrid cells could be opened by veratridine alone, suggesting the presence of voltage dependent channels in agreement with electrophysiological studies reported in the literature. The sodium channels of the high passage number hybrid cells, however, needed the synergistic action of veratridine and scorpion toxin for activation suggesting that these channels are silent. The [¹⁴C] guanidinium ion flux through the sodium channels of the high passage number hybrid cells was inhibited by significantly lower concentrations of the volatile anesthetics (halothane, isoflurane and enflurane) and the lcoal anesthetics (tetracaine and bupivacaine) than the comparable flux through the sodium channels of the low passage number hybrid cells.Dedicated to Prof. Dr. E. Wecker on the occasion of his 65th birthday.