BACKGROUND: Conservative treatment of osseous gonarthritis (OG) is mainly to reduce the loading of knee joint and maintain muscle exercise,and non-steroidal anti-inflammatory drugs serve as supplements in case of acute occurrence.OBJECTIVE: To investigate the effect of combination of intraarticular in jection of hyaluronate and pain-point injection of betamethasone in improving the pain symptom in patients with OG.DESIGN: Open experiment.SETTING: Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences.PARTICIPANTS: We selected 45 OG patients, who were aged 40 to 85years and received treatment in the clinic of Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences between January 2004 and October 2004.METHODS: OG parenteral solution was intraarticularly injected into the knee joint, 2.5 mL once a week, 5 weeks set as a disease course. Pain points around knee joint were searched for following thorough physical examination. Anti-inflammatory analgesic solution of 2.0-3.0 mL was injected at each pain point. Physical examination was repeated before treatment in each week. Injection at pain points was maintained if they were still present. Intraarticular injection of hyaluronate was performed only when the pain points disappeared after treatment.MAIN OUTCOME MEASURES: ① Pain score at rest and at exercise.② Time when pain disappeared and times of betamethasone administration.RESULTS: Totally 45 patients entered the result analysis. ① Pain at rest and at exercise 1 week after combination treatment of intraarticular injection of hyaluronate and pain-point injection of betamethasone was ignificantly lessened compared to that before treatment (P ＜ 0.01). Pain relief was more significant at rest than at exercise (P ＜ 0.01). ② Pain disappeared at (17.07±6.00)days after treatment on average. The average times of betamethasone administration was (2.42±0.78) times. ③ No local joint pain and other adverse reactions occurred after administration in any case.CONCLUSION: Combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone can effectively relieve the pain symptom of osseous gonarthritis, with no obvious adverse reactions.

Background and purpose:Obvious pulmonary dysfunction may exsist preoperatively in part of the patients undergoing pulmonary lobectomy. Volume-controlled ventilation (VC) during one-lung ventilation (OLV) may lead to lung injury in lung cancer patients with preoperative pulmonary dysfunction. However, pressure-regulated volume-controlled (PRVC) ventilation mode is a new type of ventilation mode, and can alleviate ventilation-induced lung injury. This study explored the effect of PRVC on respiratory mechanics, oxygenation index, pulmonary inlfam-matory response, and clinical outcomes in patients undergoing pulmonary lobectomy during OLV compared with VC mode.Methods:Forty ASAⅡ-Ⅲ patients with moderate to severe pulmonary dysfunction undergoing pulmonary lobectomy were randomly divided into group VC and group PRVC (n=20).PRVC ventilation mode was performed for patients in group VC during the ifrst 5 minutes after OLV, and then ventilation mode was switched to VC ventilation mode till the end of surgery. In the other group, ventilation modes were performed in reverse order. Ventilation settings remained unchanged when ventilation mode was switched. Respiratory mechanics, static lung compliance, hemody-namic parameters and arterial blood gas were obtained during the surgery. Blood samples and bronchoalveolar lavage (BALF) in ventilated lung were collected to determine the level of TNF-α, IL-1β, IL-6 and IL-8 at the end of surgery.Results:Both the peak expiratory pressure and static lung compliance in group PRVC were signiifcantly lower than those in group VC (P<0.01). However, there were no statistical difference in hemodynamic parameters (heart rate and blood pressure) and arterial blood gas analysis (pH,paO2andpaCO2) between the two groups during OLV, as well as postoperative pulmonary complications and length of hospital stay. The levels of TNF-α, IL-1β and IL-6 in BALF in group PRVC were signiifcantly lower than those in group VC (P<0.05), while there was no difference in blood sample. Conclusion:PRVC mode during OLV may relieve the extravagant airway pressure and then reduce the release of inlfammatory factors in ventilation lung, which might prevent acute lung injury induced by lung barotraumas, especially for those patients with pulmonary dysfunction preoperatively. Therefore, PRVC mode is a safe and effective ventilation mode for high-risk patients undergoing pulmonary lobectomy.

Background and purpose:Many patients may suffer from acute pain after radical mastectomy un-der general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anes-thesia on analgesia after radical mastectomy for breast cancer.Methods:Ninety-six patients underwent modiifed radical mastectomy for breast cancer were randomized with random number into group C (intercostal nerve block coupled with general anesthesia) and group G (general anesthesia), with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general an-esthesia was the same between the two groups. During the surgery, 10 μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 (T1), 12 (T2) and 24 h (T3) after surgery. The incidence of postoperative nausea and vomiting was also observed.Results:Sufentanil amount used intra- and post- operation were signiifcantly lower in group C [(25.2±3.5) and (3.3±1.2) μg] than that in group G [(40.5±4.3) and (8.4±2.2) μg] (P<0.01). The VAS scores on 2, 12 and 24 h after surgery in group C(0.45±0.15,1.75±0.08 and 2.05±0.12), were signiifcantly lower than those in group G (4.32±0.21, 4.88±0.13 and 4.78±0.16) (P<0.01). The incidences of nausea and vomiting on 2 and 24 h after surgery in group C (6.25% and 16.66%) were signiifcantly lower than those in group G (20.8% and 41.66%). There was no adverse complication related with intercostal nerve block in group C.Conclusion:Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modiifed radical mastectomy for breast cancer, which may improve postoperative pain control and reduce the usage of opioids and incidence of nausea and vomiting. Intercostal nerve block under ultrasound is quite safe and effective for patients.

Objective To investigate the best operative approach in the treatment of myasthenia gravis (MG) by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery (VATS). Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time, postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb's movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time,and incisional infection in VATS group [(77.5 ± 18.0) ml, ( 100.8 ± 11.8) ml,( 2.3 ± 0.5 ) d, 0 ] were superior to those in trans-sternal group[ (97.4 ± 14.3 ) ml, ( 175.8 ± 18.3 ) ml, ( 3.1 ±0.7 ) d, 6.2% ( 2/32 ) ] and median stemotomy group [ ( 130.1 ± 24.0) ml, ( 379.0 ± 45.6 ) ml, (4.2 ± 0.6) d,13.8% (9/65)] (P ＜0.05),and median sternotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb's movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group (P ＜0.05).Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is more advantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for primary hospitals without advanced technology and equipments.

Objective To investigate the effectiveness of target-controlled infusion (TCI) of etomidate and remifentanil for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixtynine ASA Ⅰ or Ⅱ patients of both sexes,aged 35-71 yr,weighing 41-83 kg,scheduled for elective EBUS-TBNA,were randomly divided into 3 groups ( n =23 each).In group Ⅰ,anesthesia was induced with TCI of propofol and iv injection of fentanyl 4 μg/ml,and the target plasma concentration (Cp) of propofol was set at 3-4 μg/ml.In group Ⅱ ,anesthesia was induced with TCI of propofol ( Cp 3-4 μg/ml) and remifentanil ( Cp 5 ng/ml).In group Ⅲ ,anesthesia was induced with TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml).After the patients lost consciousness,laryngeal mask airway was inserted to perform mechanical ventilation.PETCO2 was maintained at 30-40 mm Hg.BIS value was maintained at 40-60.The use of vasoactive agents (perdipine,ephedrine,atropine and esmolol) and occurrence of bucking during operation,emergence time,and the occurrence of nausea and vomiting within 24 h after operation were recorded.Blood samples were collected from the femoral vein at 30 min before induction,at the end of operation and at 24 h after operation for determination of the plasma cortisol concentration.Results The incidence of bucking and nausea and vomiting was significantly lower,the emergence time was significantly shorter,and the number of patients who needed vasoactive agents during operation was significantly smaller in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜ 0.05).The number of patients who needed vasoactive agents during operation was significantly smaller in group Ⅲ than in group Ⅱ (P ＜0.05).Compared with groups Ⅰ and Ⅱ,the plasma cortisol concentration was significantly decreased at the end of operation in group Ⅲ (P ＜ 0.05).There was no significant difference in the plasma cortisol concentration at each time point between groups Ⅰ and Ⅱ (P＞0.05).Conclusion TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml) can provide satisfactory anesthesia for EBUS-TBNA with few adverse effects.

Objective To assess the feasibility of integrated 18F-FDG PET-CT for the differentiation of malignancy from benign lesions of heart and pericardium. Methods A total of 23 cases (malignancy∶benign= 13∶10) with cardiac and pericardial lesions confirmed by pathology or clinic were analyzed in the present study. All lesions were evaluated semi-quantitatively using maximum standard uptake values (SUVmax) and SUVmax lesion/blood, and the density of the heart and pericardium lesions and the relationship with surrounding tissues were evaluated. The differences of SUVmax and SUVmax lesion/blood between benign and malignant lesions were analyzed using Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CT and PET-CT respectively. Results The maximum SUV showed significant difference between malignancy(6. 5 ) and benign ( 1.5 ) ( Z = - 3. 601, P ＜ 0. 01 ), the SUVmax Lesion/Blood of malignancy and benign were 3.4 and 0. 9 respectively, also with significant difference(Z = -3. 600, P ＜0. 01 ). The optimal cut-off value of SUVmax is 3.5-4. 0 and SUVmax Lesion/Blood is 1.3-2. 0. The sensitivity, specificity, accuracy, PPV and NPV of CT and PET-CT were 76. 9％ ( 10/13 ), 100. 0％ ( 10/10) ,87.0％ (20/23), 100. 0％ ( 10/10 ), 76. 9％ ( 10/13 ) and 100. 0％ ( 13/13 ), 90. 0％ (9/10), 95.7％(22/23),92.9％ (13/14),100.0％ (9/9) respectively. Conclusion 18F-FDG PET-CT can correctly differentiate benignity and malignancy of cardiac and pericardial lesions.

Objective To analyze the correlations between liver lipid level determined by liver 3.0 T 1H-MRS in vivo and influencing factors using multiple linear stepwise regression. Methods The prospective study of liver 1H-MRS was performed with 3.0 T system and eight-channel torso phased-array coils using PRESS sequence. Forty-four volunteers were enrolled in this study. Liver spectra were collected with a TR of 1500 ms ,TE of 30 ms, volume of interest of 2 cm ×2 cm ×2 cm, NSA of 64 times. The acquired raw proton MRS data were processed by using a software program SAGE. For each MRS measurement, using water as the internal reference, the amplitude of the lipid signal was normalized to the sum of the signal from lipid and water to obtain percentage lipid within the liver. The statistical description of height, weight, age and BMI, Line width and water suppression were recorded, and Pearson analysis was applied to test their relationships. Multiple linear stepwise regression was used to set the statistical model for the prediction of Liver lipid content. Results Age (39.1 ± 12. 6) years, body weight (64.4 ± 10. 4) kg,BMI (23.3 ±3.1) kg/m2, linewidth (18.9 ±4.4) and the water suppression (90.7 ±6.5)% had significant correlation with liver lipid content (0.00 to 0.96%, median 0. 02% ), r were 0.11,0. 44,0. 40,0. 52, - 0. 73 respectively(P < 0. 05 ). But only age, BMI, line width, and the water suppression entered into the multiple linear regression equation. Liver lipid content prediction equation was as follows: Y =1.395-(0.021 × water suppression) + (0.022 × BMI) + (0.014 × line width) - ( 0. 064 × age),and the coefficient of determination was 0.613, corrected coefficient of determination was 0.59. Conclusion The regression model fitted well, since the variables of age, BMI, width, and water suppression can explain about 60% of liver lipid content changes.

Objective To explore the effect of body mass and body mass index (BMI) on proton hepatic MRS water suppression at 3.0T. Methods The prospective study of hepatic proton MRS was performed with GE Signa Excite HD 3.0T system and eight-channel torso phased-array coils using PRESS sequence in 44 healthy subjects. Liver spectra were collected with TR of 1500 ms, TE of 30 ms, VOI of 2 cm×2 cm×2 cm and NSA of 64 times. Areas and heights for metabolites resonances were caulculated. Results Group with small mass has lower height ([161.2±8.5] cm vs [167.7±6.2])cm, lower BMI ([20.8±2.3] kg/m~2 vs [25.6±2.6]kg/m~2), better water suppression effect (min-max: 90-96 vs 65-94;median: 94 vs 93), smaller height (min-max: 1.41×10~4-5.76 ×10~5 vs 3.45×10~4-1.75×10~6;median: 9.00×10~4 vs 2.58×10~5) and integrated area (min-max: 4.27×10~4-2.00×10~7 vs 1.24×10~5-5.00×10~7;median: 2.64×10~5 vs 1.19×10~6)of Lip2 than larger weight group. Standardized lipid content (min-max: 0-0.11 vs 0-0.96;median: 0.01 vs 0.04) was less. Group with lower BMI had lower weight ([55.2±8.2]kg vs [71.2±7.8]kg), smaller age ([33.2±11.9]years vs [45.6±9.4]years), better water suppression effect(min-max: 90-96 vs 65-95;median: 94 vs 93) smaller of height (min-max: 1.41×10~4-5.76×10~5 vs 3.45×10~4-1.75×10~6;median: 7.37×10~4 vs 2.11×10~5) and integrated area (min-max: [4.27×10~4-2.00×10~7] vs [1.24×10~5 -5.00×10~7];median: 2.64×10~5 vs 1.19×10~6) of Lip2 than larger weight group. Standardized lipid content (min-max: 0-0.08 vs 0.01-0.96;median: 0.01 vs 0.04) was less. There was significant correlation among water suppression, weight (r=-0.478, P=0.001) and BMI (r=-0.494, P=0.001). Conclusion Lipid accumulation in the liver may be the result of increased fat portion of the body depending on mass and BMI, and hinder to achieve effective water suppression.

Objective To evaluate the effect of intravenous Gd-DTPA on 3.0T proton MR spectroscopy (MRS) water suppression and shimming. Methods Prospective study of proton MRS was performed with GE Signa Excite HD 3.0T system and eight-channel phased-array coils with PRESS sequence (head, liver and kidney, respectively). Routine auto prescan program was operated to record full width half maximum (FWHM) and water suppression (WS%). Routine scan was performed after injection of Gd-DTPA, then prescan program was reoperated to record FWHM and WS%. The data of FWHM and WS% in head, liver and kidney were compared between before and after injection of Gd-DTPA with the Wilcoxon matched pairs signed test. Results WS% of spectroscopy of head and liver after administration of Gd-DTPA decreased significantly (T_+=12, T_-=66, P=0.02; T_+=0, T_-=45, P=0.007). The effect of shimming of kidney after administration of Gd-DTPA was poor (T_+=0, T_-=435, P<0.001) and WS% of spectroscopy of kidney after administration of Gd-DTPA decreased significantly (T_+=0, T_-=435, P<0.001). Conclusion WS% of spectroscopy in head, liver and kidney can be impacted negatively by Gd-DTPA. Gd-DTPA has great influence on shimming of spectroscopy of kidney, but has little influence on shimming of spectroscopy of head and liver. It is better to acquire MRS data before administration of contrast medium in kidney.

Objective To observe the effect of full width half max (FWHM) on spectra signal-to-noise ratio (SNR), NAA/Cr, Cho/Cr and water suppression at 3.0T MR. Methods GE Signa Excite HD 3.0T MR scanner with 8 channel phrased-array head and neck coil was used. The respective study of liver 1H-MRS was performed using PRESS sequence. A total of 49 spectrums were obtained with parameters of TR 1500 ms, TE 30 ms, NSA 128. FWHM and water suppression were recorded automatically and the subjects were divided into better shimming group (FWHM<10 Hz) and worse shimming group (FWHM≥10 Hz). Independent t test was used to analyze the Cr_SNR, NAA/Cr, Cho/Cr, water suppression and volume of interest (VOI). Results Compared with worse shimming group, better shimming group could provide better Cr_SNR (t=5.976, P<0.001), higher NAA/Cr (t=2.469, P=0.017), lower Cho/Cr (t=-4.460, P<0.001) and smaller VOI (t=3.862, P<0.001). Conclusion When single voxel proton spectroscopy of head is adopted with 3.0T MR, small VOI is easy to achieve effective shimming, and better shimming is helpful to improve SNR, the ratio of main metabolites as well as water suppression.