Pain is a common symptom among populations with life-limiting illnesses. Like all clinicians, family physicians involved in the care of these patients should acquire the skills and knowledge required to provide good pain control in order for the patients and their caregivers to achieve optimal quality of life. This paper is a review and presentation of the definition, classification, assessment and management of pain at the end of life based on available guidelines and evidence.

Objective To investigate the quality of life (QOL) of patients with frequent premature ventricular contractions (PVCs) and the effects of radiofrequency catheter ablation (RFCA) on them.Methods 120 patients with frequent PVCs,100 cases with frequent APCs and 60 healthy persons were assessed by 36-Health survey questionnaire (SF-36) originally.Three months later,the QOL of 48 cases received RFCA and 72 cases with drug therapy were evaluated again by SF-36.Meanwhile,decrease of PVCs were also calculated between these two groups.Results The scores of physiological function and mental health in patients with PVCs were lower than that of cases with APCs,while the score of bodily pain in patients with PVCs was higher (P value:0.0002-0.0380).In addition,the quality of life in patients with frequent PVCs were worse than healthy control(P value:0.0001-0.0915).Three months later,PVCs in 48 cases with frequent PVCs received RFCA were much fewer than that of 72 cases with drug therapy (t=18.8682,P＜0.01),and the quality of life in the former was much better than the latter (F=15.329-39.274,P＜0.01).Conclusion Frequent PVCs can deteriorate the patients' quality of life.RFCA can control or eliminate PVCs in these patients and markedly improve the quality of life of them.

Forensic Ballistics ; Humans ; Maxillofacial Injuries ; surgery ; Wounds, Gunshot ; surgery

Bone Transplantation ; Humans ; Mandible ; transplantation ; Transplantation, Homologous

Humans ; Maxillofacial Injuries ; diagnosis ; surgery ; Wounds, Gunshot ; diagnosis ; surgery

BACKGROUND: Xenograft cortical bone is an easy and inexpensive bone graft material, which has good biocompatibility and bio-mechanical properties. As a bone graft, it can function as biological framework for new bone growth and bio-supporting. Moreover, it can also be processed into internal fixation devices.OBJECTIVE: To review the biological properties, preparation methods and clinical applications of heterogeneous cortical bone for fracture fixation.METHODS: A computer-based online search of Pubmed database (1990-01/2009-05) and CNKI (1990-01/2009-05) was performed for related articles with key words of "Xenograft cortical bone, Bone graft, Fixation" in English and Chinese.RESULTS AND CONCLUSION: A total of 128 articles were collected. Xenograft cortical bone has a good biological performance, in particular, a certain degree of bio-mechanical properties. It is not only able to complete bone filling, bone induction, but also function as internal fixator following processing. However, the traditional preparation process reduces their bio-mechanical properties. Heterogeneous cortical bone can be widely used in intra-articular fractures and cancellous bone fracture fixation, and can be self-absorbed, avoiding the second operation. However, its instability limits its initial mechanical properties of fractures at other sites.

A 65-year-old lady with End-Stage Renal Failure (ESRF) receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) was admitted acutely for altered mental status and neurological symptoms. She presented to the Emergency Department with bilateral upper limb weakness and clumsiness, bilateral lower limb weakness for 1 day’s duration. In addition, her family members reported altered behaviour for the previous 1 day. On examination, the patient had slurred speech, weakness in all limbs and brisk reflexes throughout. Significantly, she had been diagnosed with herpes zoster 2 days earlier by a family physician, for which she was started on oral acyclovir. Our patient was diagnosed as having acyclovir toxicity and commenced on urgent haemodialysis. Her symptoms resolved completely after 2 days. Our case details the uncommon but potentially fatal complication of acyclovir toxicity in patients with renal impairment, reinforces the importance of dose reduction in these patients and demonstrates haemodialysis as a good form of treatment for acyclovir toxicity. Family physicians should be familiar with dose adjustments for common medications prescribed to ESRF patients in the outpatient setting as the burden of chronic kidney disease increases in Singapore.

Objective To compare oligoneucleotide arrays with sequence specific primer polymerase chain reaction (PCR-SSP) for HLA-DR genotyping in order to develop a new technique of genotyping for donors and recipients in kidney transplantation. Methods Sixty DNA samples of donors and recipients were subjected to HLA-DR typing by oligoneucleotide arrays and PCR-SSP simultaneously. The results of the two typing techniques were analyzed.Results Of 60 samples using the two above-mentioned typing techniques, the results in 56 samples were identical with the accordance rate being 93 %, and in the remaining 4 unidentified samples verified by the other laboratory, oligoneucleotide arrays made 1 allele miss typing for 2 samples , 1 allele mistaking for 1 and PCR-SSP made 1 allele miss typing for 1 sample. Among the total, 20 samples retyping was made and its reproduction rate was 96 %. Conclusion The oligoneucleotide arrays technique for HLA genotyping has advantage of high sensitivity, high efficiency, high level standard and it is incomparable.

Objective To explore the effects of wound healing and histological changes by utilizing ultrapulse CO2 fractional laser for the treatment of superficial scar in dermal-epidermal junction (DEJ) in rabbit ears.Methods We adopted traditional iodophor treatment and moist exposed burn ointment treatment repairing the wound and utilizing ultra pulse CO2 fractional laser for the treatment of rabbit ears superficial scar.The superficial scars in rabbit ear were induced with ultra pulse CO2 fractional laser.In 1,2,4,8 weeks tissue samples would be taken.Using electron microscopy we observed DEJ ultrastructure and light microscopy to observe the histological changes of the dermal papilla and PAS staining for epidermis basement membrane.Results The wound healing time of moist exposed burn ointment group was shorter than that of iodophor group (P＜0.05).The number of hemidesmosomes and anchoring fibers in the moist exposed burn ointment group on the 8th week was more than the 1th week,The number of hemidesmosomes and anchoring fibers in the iodophor group on 8th week was more than 1th week (P ＜0.05).The number of hemidesmosomes and anchoring fibers in the iodophor group was less than the moist exposed burn ointment group (P＜0.05).Conclusions U1trapulse CO2 fractional laser can cause ultra structural changes in scarring dermal-epidermal junction area,wet wound healing environment promotes the reconstruction of DEJ district organization,and rebuilding the function of the scar skin has the positive significance.

Objective To study the effects of propofol on cognitive function and expression of BDNF in the cerebral cortex after the traumatic brain injury (TBI).Methods Forty-eight SD rats treated with the Morris water maze were randomly divided into 3 groups with 16 rats in each group.Rats in the sham group were subjected to the operative procedure but prevented from traumatic brain injury.Rats in the control group and the propofol group were subjected to the traumatic brain injury named Feeney.After the operation,rats in the propofol group were injected propofol for 6 hours.The neurological functional status and the cognitive function of rats were assessed with NSS scores and Morris water maze tests on 3d and 14d post operation.RT-PCR and Westeron Blot were used to detect the expressional changes of BDNF in the injured cerebral cortex.Results Compared with the sham group,NSS scores and the latencies of escape among rats in the control group were increased and times of crossing platform were decreased at 3d and 14 d post operation (P ＜0.01),and the mRNA and protein levels of BDNF were decreased at 3d post operation (P ＜0.01).Compared with the control group,the mRNA and protein levels of BDNF in the propofol treated rats were increased at 3d and 14d post operation (P ＜0.01),NSS scores were lower at 14d (P ＜0.01),the latencies were shorter and the times were increased (P ＜0.01).Conclusion Propofol improves the the expression of BDNF in the injured cerebral cortex and facilitates the recovery of the neurological and cognitive function in rats with traumatic brain.