Patients' expectations,experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.     

不可切除胃癌转化治疗的研究进展

胃癌在全国范围内是发病率最高的恶性肿瘤之一，在癌症相关死亡原因中排名第三。目前外科手术仍然是胃癌获得根治性治疗的主要手段，但是其中有30%~40%的进展期胃癌患者在初诊时就失去了根治手术的机会，因此不可切除胃癌转化为可切除胃癌是患者获得"治愈"的最佳选择。随着近些年来新型药物的出现、治疗手段的多样化及多学科诊治模式的发展，"转化治疗"的理念应运而生，从而延长患者生存时间并提高其生活质量。本文就不可切除胃癌的治疗现状与进展、"转化治疗"的应用等进行综述。     

肝内胆管癌转化治疗

肝内胆管癌（ICC）可切除率低，进展期ICC的治疗有效率不高，预后很差。转化治疗在多种晚期肿瘤中有一定的疗效，是目前晚期肿瘤治疗的研究热点。随着对ICC基因组的深入了解和新的治疗药物的开发及组合，基于系统化疗的联合治疗策略，精准靶向治疗，免疫检查点抑制剂等显示出较好的疗效，使得部分进展期ICC病人能降期转化手术，获得长期生存。     

Heteroepitaxy of Cerium Oxide Thin Films on Cu(111)

An important part of fundamental research in catalysis is based on theoretical and modeling foundations which are closely connected with studies of single-crystalline catalyst surfaces. These so-called model catalysts are often prepared in the form of epitaxial thin films, and characterized using advanced material characterization techniques. This concept provides the fundamental understanding and the knowledge base needed to tailor the design of new heterogeneous catalysts with improved catalytic properties. The present contribution is devoted to development of a model catalyst system of CeO₂ (ceria) on the Cu(111) substrate. We propose ways to experimentally characterize and control important parameters of the model catalyst—the coverage of the ceria layer, the influence of the Cu substrate, and the density of surface defects on ceria, particularly the density of step edges and the density and the ordering of the oxygen vacancies. The large spectrum of controlled parameters makes ceria on Cu(111) an interesting alternative to a more common model system ceria on Ru(0001) that has served numerous catalysis studies, mainly as a support for metal clusters.     

Light exposure required for optimum conversion of light activated resin systems

OBJECTIVE: The aim of this study was to evaluate the relationship between the degree of conversion (DC) of composites and the light intensity using LED-curing units and also to determine the amount of exposure required to achieve optimal curing. METHOD: The light outputs of light-curing units and the depths of cure of composites exposed to these units were determined using the methods outlined in modified ISO standards, ISO/TS10650 and ISO 4049, respectively. The distributions of DC in composites were investigated by IR spectra of microareas obtained at various depths from the irradiated surface of thin specimens cut out from the cured composites. IR spectra were measured using a Fourier transform infrared spectrometer equipped with a microscopic unit. DC was calculated from the changes in the amount of C=C double bonds in the IR spectra. RESULTS: The light intensity at various depths through the cured composite was calculated from the attenuation coefficient of each material, obtained from the linear relationship between the depth of cure and the logarithm of the amount of exposure, which is defined as the product of the irradiance and irradiation time. There was a third or fourth order regression relationship between DC and the logarithm of total light energy at a particular depth. SIGNIFICANCE: The minimum light energy required to produce a saturated DC was about 1000 s mW/cm2.     

人体β-胡萝卜素的肠转化和吸收后转化的研究

目的 :为了解部分中国人体内 β 胡萝卜素 ( β carotene ,以下简称 β C)转化维生素A (vitaminA ,以下简称VA)的效率 ,开展了本研究。方法 :使用稳定同位素稀释法对 15名 5 0 60岁健康农村志愿者 (男 9,女6)进行β C人体代谢实验。 2周适应期和 5 6天实验期内 ,志愿者接受常规膳食 ,避免大量VA和 β C摄入以及烟、酒和营养补充剂。实验第 1天 ,给受试者含 6mg氘标记 β C( 2 H8β C)玉米油胶丸 ,随半流质早餐 (脂肪热能比 2 5 % )一起摄入。实验第 4天 ,受试者以同样方法摄入含 3mg氘标记醋酸视黄醇 ( 2 H8RAC)油剂胶丸。实验第 1天和第 4天摄入标记物后 0 ,3 ,5 ,7,9,11,13h时 ,实验第 2 ,3 ,5 ,6,7,8,9,10 ,14,2 1,2 8,3 5 ,42 ,49,5 6天晨空腹时 ,采静脉血。用高效液相色谱仪 (HPLC)分离血清 β C和VA组分 ,再分别使用气相质谱仪(GC MS)和液相质谱仪 (LC MS)测定VA和 β C组分的同位素丰度。根据VA和 β C的浓度和同位素丰度 ,描述标记VA和β C在体内应答的血液动力学曲线。 结果 :所有 15名受试者对2 H8RAC应答明显 ;但是在对2 H8β C的应答方面 ,只有 11名受试者2 H4视黄醇应答曲线明显 ,有 4名受试者血清2 H4视黄醇应答曲线非常微弱。经过对备份血清样品进行的多次重复GC MS测定 ,我们目前初步?     

Quantitative evidence of peripheral conversion of angiotensin within the human leg: effects of local angiotensin-I administration and angiotensin-converting enzyme inhibition on regional blood flow and angiotensin-II balance across the leg

Summary The renin-angiotensin system relevantly contributes to the maintenance of systemic vascular tone and there is experimental evidence that large amounts of angiotensin-converting enzyme (ACE) are present in peripheral vascular tissues, including resistance vessels. To determine and quantify peripheral vascular conversion of angiotensin-I (ANG-I) to angiotensin-II (ANG-II) across the human leg, the response of regional blood flow to local regional intra-arterial infusion of ANG-I and changes in associated ANG-I1 balance were evaluated during ANG-I infusion and following additional ACE inhibition. Ten sodium-loaded healthy men were enrolled in the study. Following cannulation of both femoral arteries and the right femoral vein, leg blood flow was determined (indocyanine-green dye-dilution method) at baseline conditions and during constant intra-arterial infusion of haemodynamically ineffective doses of ANG-I as well as following concomitant intra-arterial administration of low doses of the non-sulfhydril ACE inhibitor cilazapril. From the transfemoral arterio-venous differences in ANG-II plasma concentrations and the corresponding regional blood (plasma) flow, the ANG-II balance across the leg was calculated. Systemic blood pressure did not change throughout the trial, indicating that no major systemic effects were present during ANG-I infusion or concomitant ACE inhibition. Moreover, arterial ANG-II plasma concentrations were not significantly changed by ANG-I infusion. Leg blood flow decreased to below baseline values following ANG-I infusion, increasing again then in a dose-dependent manner during concomitant cilazapril administration. The calculated baseline ANG-II balance across the leg revealed a net extraction in 6 out of 10 subjects and a net ANG-II formation in 4. Following ANG-I, a shift towards net ANG-II formation or decrease in extraction was seen in 8 subjects, while 2 had no change in ANG-II balance.During concomitant ACE inhibition, ANG-II balance was again shifted towards net extraction or reduced formation. Our results confirm that, in man, considerable regional arterio-venous differences in ANG-II plasma concentrations are present, resulting in either net transfemoral extraction or net formation of the peptide. It is suggested that systemic vascular conversion of circulating ANG-I might contribute to the maintenance of peripheral vasuclar tone in man. Send offprint requests to S. Gasic at the above address     

苯并恶唑类化合物的研究——Ⅰ.化合物的合成及光物理性能

合成了四种结构类型的苯并恶唑化合物共15个:测试了它们的红外吸收光谱,以及它们在DMF中的紫外吸收、荧光发射和激光发射光谱。苯基取代物的荧光量子产率在0.64～0.66,无激光性能。其余的化合物荧光量子产率都大于0.70,在最大吸收波长下的激光转换效率为2.5～5.9%。