The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.
Analgesia ; utilization ; Analgesics ; therapeutic use ; Anesthesia ; utilization ; Dental Care ; methods ; trends ; Dentists ; Dissent and Disputes ; Humans ; Outpatients ; Pain

OBJECTIVE: To probe into the application of antibiotics in orthopedic perioperative period. METHODS: The application of 591 patients with orthopedic disease in perioperative period from Jun. 2006 to Jun. 2008 were reviewed and analyzed. RESULTS: 591 patients were treated with antibiotics in perioperative period. 85 cases of preoperational medication accounted for 14% and 286 cases of drug combination 48%. Among 286 cases of drug combination, 263 cases of two-drug consisted of 92%, 23 cases of three-drug 8%; mean administration time was(9?2.3)d. CONCLUSION: Abuse, inappropriate use and inappropriate drug combination of antibiotics were existed, which need to be corrected.

Cardiovascular Diseases ; diagnosis ; therapy ; Humans ; Point-of-Care Systems ; Quality Control

Objective To investigate the role of ERK signaling pathway in spinal cord in reduction of neuropathic pain (NP) by electro-acupuncture (EA) at Zusanli and Yanglingquan.Methods Fifty male SpragueDawley rats,weighing 180-220 g,in which the intrathecal catheter was successfully placed without complications,were randomly divided into 5 groups (n =10 each):sham operation group (S group),chronic constrictive injury (CCI) group,acupuncture at acupoint group (EA group),acupuncture at non-acupoint group (NA-EA group),and ERK inhibitor U0126 group (U0126 group).NP was induced by CCI in groups CCI,EA,NA-EA and U0126.The animals were anesthetized with intraperitoneal chloral hydrate 300 mg/kg.The right sciatic nerve was exposed and 4 ligatures were placed on the sciatic nerve at 1 mm intervals.EA (intensity ＜ 1.5 mA,frequency 2Hz) of Zusanli and Yanglingquan lasting 30 min was performed once a day for 6 days starting from 4th day after induction of NP in group EA.EA was performed at the points 5 mm lateral to the acupoints of Zusanli and Yanglingquan on the operated side in group NA-EA.Intrathecal U0126 5 μg was started on 4th day after induction of NP twice a day for 6 consecutive days.The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured at 1 day before CCI (T0,baseline) and at days 3,5,7 and 9 after CCI (T1-4).The rats were sacrificed on 10th day after induction of NP and the right lumbar segment (L4-6) of the spinal cord was removed for determination of the expression of P2X3 receptor protein and mRNA,ERK1/2 and phosphorylated ERK1/2 (p-ERK1/2) in the spinal cord dorsal horn.Results Compared with group S,MWT was significantly decreased,TWL was significantly shortened,the expression of P2X3 receptor protein and mRNA,and p-ERK1/2 was up-regulated in the other 4 groups (P ＜ 0.01).Compared with CCI group,MWT was significantly increased,TWL was significantly prolenged,the expression of P2X3 receptor protein and mRNA,and p-ERK1/2 was downregulated in EA and U0126 groups (P ＜ 0.01),and no significant change in the parameters mentioned above was found in NA-EA group (P ＞ 0.05).Compared with EA group,MWT was significantly increased,TWL was significantly prolonged,the expression of P2X3 receptor protein and mRNA,and p-ERK1/2 was down-regulated in U0126 group (P ＜ 0.01).Conclusion ERK signaling pathway in spinal cord is involved in reduction of NP by EA at Zusanli and Yanglingquan.

Objective:To explore the application of EMG and bio-feedback instrument in the recovery of neurological function and hemorheology for patients with stroke.Methods: 65 patients with stroke were enrolled in this study and were randomly divided into combined group (33 cases) and control group (32 cases) as random number table. The patients of combined group were treated by rehabilitation training combined with reconstruction and treatment instrument of neurological function on the basis of basic medicine therapy. The patients of control group were treated only by rehabilitation training on the basis of basic medicine therapy. The clinical effects, the recovery situation of neurological function and the change situation of hemorheology before and after treatment were compared and analyzed.Results: The effective rate of clinical treatment was 96.97% in the combined group and it was 59.38% in the control group, and the difference of effective rate between the two groups was significant (x2=12.473,P<0.05). After treatment, the differences of the daily life behavior Barthel index scale and Fug I -Meyer Assessment (FMA) of motor function score between the two groups were significant (t=7.632,t=5.693;P<0.05). Besides, the plasma viscosity, erythrocyte ratio, platelet aggregation rate, erythrocyte deformation index, erythrocyte aggregation index and fibrinogen of combined group were significantly better than control group, and the differences of them were statistically significant (t=6.859, t=10.263,t=7.626,t=6.623,t=8.257,t=6.003;P<0.05).Conclusion:The reconstruction and treatment instrument of neurological function make a synergistic effect in the treatment of stroke, and it can effectively treat patient with stroke and improve their clinical symptoms. And it also can enhance the motor function of limbs and the self -help ability, and it can significantly improve each indexes of hemorheology of patients. Therefore, it can achieve the better clinical therapeutic effect.

ObjectiveTo observe the effect of Batroxobin and Urokinase on brain of diabetic rats following focal cerebral ischemia and reperfusion injury. To investigate the preventive mechanism of Batroxobin following focal cerebral ischemia and reperfusion injury in diabetic rats after thrombolysis therapy.MethodsDiabetic rat was induced by administrating streptozotocin intraperitoneally. Rat model of focal cerebral ischemia and reperfusion injury induced by intraluminal filament occlusion of middle cerebral artery(MCA) that removed 2h later was used. Batroxobin and Urokinase were administrated intravenously in different groups. Infarct volume,cerebral hemorrhage and matrix metalloproteinase (MMP)-2,MMP-9 were detected at 2h,24h,48h after ischemia and reperfusion injury.ResultsThe significant decrease of infarct volume were observed in Batroxobin and Urokinase groups. There were 5 rats observed cerebral hemorrhage in Urokinase group and no cerebral hemorrhage in Batroxobin group. The number of MMP-2 and MMP-9 positive cells in Batroxobin and Batroxobin Urokinase groups decreased compared with saline and Urokinase groups. ConclusionBatroxobin can decrease the infarct volume significantly without the complication of cerebral hemorrhage after ischemia and reperfusion injury in diabetic rats, which maybe relate to down regulation of the expression of MMP-2 and MMP-9.

Objective To investigate the effect of remifentanil and fentanyl on N-methyl-D-aspartate (NMDA) receptor currents in rat spinal cord dorsal horn neurons.Methods Whole-cell patch-clamp technique was used to record the NMDA receptor currents.The primary cultured E14SD rat spinal cord dorsal horn neurons (DH cells) were randomly divided into 3 groups (n =10 each):remifentanil group (group R),fentanyl group (group F) and control group (group C).DH cells were perfused with 4 nmol/L remifentanil (group R) or 10 μmol/L fentanyl (group F) for 60 min followed by washout.NMDA receptor currents were recorded immediately after administration (T0),at 15,30,45 and 60 min of action of drugs (T1-4),and at 15 and 30 min (T5-6) after washout.Results Compared with group C,no significant change in the peak NMDA receptor current was found at each time point in group F and at T0 and T1 in group R (P ＞ 0.05),and the peak NMDA receptor current was significantly increased at T2-6 in group R (P ＜ 0.01).The peak NMDA receptor current was significantly higher at T2-6 than at T0,while lower at T2-4 and T6 than at T5 in group R (P ＜ 0.01).Conclusion Remifentanil can increase NMDA receptor function in rat spinal cord horn neurons,and the peak effect is reached after washout,but fentanyl dose not have the effect.

Objective To investigate the integrated backscatter(IBS) changes of retina in hypertensive disease patients to offer the reference to clinician for ocular fundus changes of hypertensive disease.Methods One hundred chronic hypertension patients (100 eyes) were divided into 4 groups by clinical stages:① gradeⅠ,28 persons (28 eyes);② grade Ⅱ,27 persons (27 eyes);③ grade Ⅲ,24 persons (24 eyes);④ grade Ⅳ,21 persons (21 eyes).Thirty normal persons of 30 eyes were the control group.Their IBS values were measured on nose side of retina,and the correction IBS values(IBS%) were calculated.Results With the deterioration of hypertensive disease,the IBS(29.48±0.09,32.50±0.04,34.62±0.39,36.48±0.46,37.52±0.43) and IBS%[(68.50±2.11)%,(72.03±0.57)%,(74.29±0.77)%,(76.06±1.43)%,(77.45±0.75)%] of retina were gradually increased.The statistical difference were found among various groups(P=0.000).Conclusions With the deterioration of hypertensive retinopathy,the IBS and IBS% increased gradually.The IBS technique is a useful method to assess the retinopathy of hypertension.

Internal mammary lymph node irradiation (IMLNI) could reduce local recurrence and distant recurrence and improve survival.The NCCN Guidelines have updated the recommends in IMLNI.However, the relative toxicities of IMLNI to the heart and lungs should be carefully considered by clinicians, so individualized indications for IMLNI are needed.Internal mammary sentinel lymph node biopsy (IM-SLNB) could be an accurate technique to guide IMLNI with minimally invasive staging, and provide more survival benefits to patients.This article reviews the benefits of IMLNI, controls of the side effect, and discussion of IMLNI guided by IM-SLNB.

Objective To evaluate the safety and efficacy of intranasal dexmedetomidine and nitrous oxide/oxygen inhalation sedation assisted in tooth extraction in elderly outpatients.Methods Sixty elderly patients who need tooth extraction were divided into two groups,with 30 patients in each group.The groupⅠwas treated with nitrous oxide/oxygen inhalation sedation,and the groupⅡwas treated with intranasal dexmedetomidine and nitrous oxide/oxygen inhalation sedation.Recording those signs basis val-ue(T0 ),during the injection(T1 ),during the extraction(T2 ),10 min after extraction(T3 ):vital signs,Ramsay sedation score,anxie-ty score,VAS pain score and patients′degree of satisfaction.Results In groupⅡ,patients′degree of satisfaction were significantly higher than groupⅠ(P<0.05)after operation.The VAS pain scores and anxiety scores of groupⅡwere significantly lower than groupⅠ in T1 and T2 (P<0.05).In T2 ,group Ⅱ had lower heart rates (P<0.05).In T2 ,Ramsay score of group Ⅱ was higher than group Ⅰ(P<0.01).Conclusion Intranasal dexmedetomidine and nitrous oxide/oxygen inhalation sedation can be a safe and effective anesthetic method in tooth extraction of elderly patients.