BACKGROUND:Articular injections of opioids are widely adopted for pain management of total knee arthroplasty, with both peri-articular and intra-articular administration routes. Recent studies have indicated that commonly used anesthetics, steroids and non-steroidal anti-inflammatory drugs are associated with potential adverse effects. Peripheral opioids are relatively safe with lower complication rates, but great controversy exits regarding the analgesic effects. OBJECTIVE:To introduce the current clinical application status and basic research progress in peri-articular and intra-articular opioid injections for postoperative analgesia of knee arthroplasties. METHODS:A computer-based search in PubMed and Embase databases was conducted for clinical and basic research articles related to pain management of knee arthroplasties using peri-articular and intra-articular injections of opioids published from January 1967 to May 2015, using the keywords of“opioids;peri-articular injection;intra-articular injection;analgesia;knee arthroplasty”in English. Irrelevant, poorly related and repetitive studies were excluded. RESULTS AND CONCLUSION:Peri-articular and intra-articular opioids injection plans vary greatly between different institutions, which does not support reliable quantitative data synthesis for a meta-analysis. Controversy exists regarding its efficacy, but there are studies supporting the usage of opioids for providing effective analgesia in a dose-dependent manner. The peri-articular administration route is associated with lower complication rates including nausea and vomiting compared to systematic injections. Applications of opioids help to avoid potential chondrocyte and stem cel cytotoxicity caused by other anesthetics, steroids and non-steroidal anti-inflammatory drugs, which is important for pain management of total knee arthroplasties. Future investigations are required to promote articular analgesic effects and time duration by exploring more advanced drug combinations and dosage forms.

Objective Implementing the scientific research performance evaluation indicator system constructed to evaluate the situation of scientific research performance conducted by two basic Departments during the 12th Five-Year period in a general hospital.To understand the practical applicability of the scientific evaluation index system,and also propose comments and suggestions based on the comparison between assessment score and actual research situation in the departments.Methods Based on the database of scientific research management information platform,collect related research data from two basic departments of the hospital in latest five years.Using SPSS software to conduct statistical analysis on the total score of the first and two indicators,as well as the specific indicators of the three indicators,according to the performance evaluation index system and the weight built by the hospital.Results The index system can basically reflect the general information of scientific research input and output in the department,however,some indicators cannot truly reflect the index importance and the differences between the index weight is not significant,so it is necessary to make amendment based on demonstration.Conclusions Hospital should dynamically update the index system to make them match the developing strategy of the hospital,also important to combine them with research stimulation to guarantee more scientific management and better service to the research development of hospitals.

Objective To improve the knowledge of CT appearances of spondylolysis of the lumbar spine.Methods 32 patients with lumbar spinal spondylalysis were examed by Elscint 2400 CT.CT appearances were analyzed.Results The CT feature of spondylolysis was loop-broken sign.Spondylolisthesis was present in 25 cases,the CT mainfestations included the increased anterior pasterior diameter of spinal canal,wich sign,deformity of vertebral canal and pseudobulging disk.Other features included asymmetrical zygapophysial joints.Conclusion “loop-broken sign” is a relatively specific CT appearance of spondylolysis of the lumbar spine,which is significant in diagnosting spondylolysis without spondylolisthesis.

Due to the increasing use of hepatoeytes,the demand of hepatoeytes is increasing consistently in basic clinical research.The application of rational and efficient method of hepatoeyte isolation is a prereq-uisite for its application.At present,there are many methods of hepatoeyte isolation.This review summarizes the latest progress on them.

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Objective To evaluate the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of propofol given by target-controlled infusion (TCI) at loss of consciousness (LOC).Methods Eighty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index ≤25 kg/m2,scheduled for operations under general anesthesia,were randomly allocated to one of four groups(n=20 each): control group (group C) and dexmedetomidine 0.4 μg/kg group (group D1),dexmedetomidine 0.5 μg/kg group (group D2) and dexmedetomidine 0.6 μg/kg group (group D3).Dexmedetomidine 0.4,0.5 and 0.6 μg/kg were infused intravenously over 10 min in groups D1-3,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Propofol was then given by TCI and the EC50 was determined by up-and-down sequential trial.The target plasma concentration was set at 2.0μg/ml in the first patient in each group.The ratio of the target plasma concentration between the two consecutive patients was 1.1.Loss of response to eyelash stimulation and verbal command (2 times) was considered to be signs of LOC.The EC50 and 95％ confidence interval (CI) of propofol causing LOC were calculated.Complications such as bradycardia,hypotension and respiratory depression were recorded.Results The EC50 (95％ CI) of propofol causing LOC was 2.59 (2.51-2.67),2.09 (2.02-2.16),1.82 (1.70-1.95) and 1.60 (1.49-1.72) μg/ml in groups C and D1.3 respectively.The EC50 of propofol causing LOC was significantly lower in groups D1-3 than in group C.Dexmedetomidine significantly decreased the EC50 of propofol required for causing LOC in a dose-dependent manner in groups D1-3 (P ＜ 0.05).The incidences of bradycardia and hypotension were significantly lower in groups D1.3 than in group C (P ＜ 0.05).Compared with group D1,the incidence of bradycardia was increased in groups D2,3 and the incidence of hypotension was increased in group D3 (P ＜ 0.05),There was no significant difference in the incidences of bradycardia and hypotension between groups D2 and D3 (P ＞ 0.05).No patients developed respiratory depression.Conclusion The optimum dose for dexmedetomidine infused intravenously when combined with propofol given by TCI is 0.4 μg/kg and it can decrease the EC50 of propofol administered by TCI at LOC with no adverse reactions.

SUMMARY Delayed postoperative spinal epidural hematoma(DPSEH) is a rare and potentially devastating complication of laminoplasty, and cervical nerve root palsy occurs more frequently than DPSEH, especially with C5 nerve root palsy. The authors describe a case of DPSEH with C5 nerve root palsy that developed in a patient 3 days after he underwent laminoplasty. In this case, a 78-year-old man with a history that having taken Aspirin without the doctor’s instruction for 5-6 years,he underwent cervical laminoplasty for mild myelopathy. On the 3rd postoperative day, he complained of weakness of his left upper extremity and could not raise his left arm. The symptom aggravated in the next few days. On the 9th postoperative day, there was an obvious motor deficit of both upper and lower extremities. Magnetic resonance imaging demonstrated abnormal signal characteristics consistent with a hematoma at levels C3-C4, compressing spinal cord. The clot was evacuated during emergency revision surgery, and the postoperative course after the operation was uneventful and the muscle strength was improved five days later. Therefore, the symptoms of DPSEH are not so typical that its possibility should be kept in mind. Sometimes a differential diagnosis should be made with C5 nerve root palsy which may only represent weakness of upper extremities. The authors recommend that magnetic resonance imaging is helpful for the diagnosis of DPSEH and a revision surgery should be taken as soon as possible once the hematoma causing the neurologic deterioration was confirmed.

OBJECTIVETo record the electrical activities of Antirior cingulate cortex (ACC) neurons by in vivo multi-channel recording methods using the model of complete freund's adjuvant (CFA) induced conditioned place avoidance (C-CPA), which has been set up in our previous studies.

METHODSThe electrode was self-made and the CPA responses were recorded by in vivo multi-channel recording method.

RESULTS(1) The electrical activities of ACC neurons could be successfully recorded by the self-made electrode. (2) Before or after the injection of CFA, rats were respectively conditioned to the different place. The firing rates of ACC neurons in the CFA-paired place vs that in the non-CFA-paired place was (0.853 ± 1.377) imp/s vs (0.221 ± 0.971) imp/s (P < 0.05, n = 26). (3) The CPA responses in the CFA-paired place vs that in the non-CFA-paired place were (303.55 ± 61.77)s vs (140.32 ± 33.52)s(P < 0.05, n = 6).

CONCLUSIONThe firing rates of rACC (rostral Anterior Cingulate Cortex) neurons were involved in the occurrence of the affective pain.

Animals ; Electrodes ; Freund's Adjuvant ; Gyrus Cinguli ; cytology ; Neurons ; cytology ; Pain ; diagnosis ; Pain Measurement ; methods ; Rats ; Rats, Sprague-Dawley

Objective To analyze the implementation problems of hospital-level research after the reform at a tertiary referral hospital,and provide strategies for further management.Methods Using statistical analysis of the application,funding and implementation of hospital-level research,summarizing the problems in the process of research.Results 55.79％ of the issue can be completed on schedule,the main reason is that the research could not reach the subject mission.The subjects about the management and care progressing better than clinical and medical issues.Conclusions The hospital level research completion should to be increased,the main reasons including that papers published been delayed,the researchers invested too little in the implementation process and research funding could not be effectively use.Recommend hospital to strengthen the system construction of research input and use,not only promoting collaboration and communication between different disciplines,but also building a comprehensive research platform,and then improving the level of scientific research management.

The proportion of external research projects has constantly increasing in tertiary hospitals in recent years.However,compared with the government funded projects,the importance of those external research have not been recognized by both researchers and managers,and leading to various problems in project management.This article elucidates the problems and countermeasures of external research project management in tertiary hospital,with an attempt to further improve the management system and promote the overall development of the hospital scientific research.