BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain.
OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty.
METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine.
RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P<0.05), and the severe knee, which had less visual analogue scale scores than the minor one, turned out to increase more obviously than the minor knee (P>0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.

Objective To explore the mental education and continuing education among non-psychiatric medical workers of the general hospitals in Guangzhou city.Methods A cross-sectional study was carried out in 17 general hospitals of Guangzhou city including 2617 participants from December 2012 to April 2013.Results Among 2617 participants,41.6％ of them hadn't taken part in psychiatric course study,66.9％ hadn't received psychiatric rotation,and 66.7％ hadn't received psychiatry and related training;93.8％ of the medical staff had interest in mental specialized training courses,of which 72.0％ medical staff stood for training classes/participation,72.3％ medical staff most satisfied with 4-5 days of a training course,strengthen training every 6 months (2 days) and a psychiatrist to connect.Conclusion Non-psychiatric medical workers of the general hospitals in Guangzhou city lack the knowledge of mental health,and mental health care training are urgently needed.

Objective To characterize the female urinary microbiome associated to OAB (overactive bladder) and investigate relationships between urinary microbiome and psychological factors.Methods 30 women with OAB and 25 asymptomatic controls were recruited and required to finish the overactive bladder symptom score,self-rating anxiety scale,self-rating depression scale and quality of life questionaires.Urine specimens were collected by transurethral catheterization and processed for 16S rRNA gene sequencing.Sequencing reads were processed using QIIME.Analyses for bacterial genera biomarker was used LEfSe algorithms.Bivariate correlations were assessed using Pearson's correlation.Results The two cohorts showed no significance difference in their demographic characteristics.OAB patients had significantly higher scores on overactive bladder symptom score,self-rating anxiety scale,self-rating depression scale and quality of life than controls (P ＜ 0.001).We found that bacterial diversity (Chao1 index:1 854.09 ± 1 239.34) and richness (Simpson index:0.75 ±0.23) were decreased in OAB samples than those of controls (Chao1 index:2 866.27 ± 1 795.22;Simpson index:0.86 ± 0.12;P =0.02).At the family level,Enterobacteriaceae and (17.6％ vs.8.1％;P =0.03) Bifidobacteriaceae (14.8％ vs.3.6％;P =0.01) were significantly more abundant in the OAB samples than the controls.Compared to controls,7 genera increased in OAB patients (e.g.,Proteus and Aerococcus) and 13 reduced (e.g.,Lactobacillus and Prevotella).There are negative correlations between scores on Self-Rating Depression Scale and both Chao1 (r =-0.458,P =0.011) and shannon indexes (r =-0.516,P =0.003) in OAB patients,which indicates that OAB patients with depression have further reductions in bacterial diversity and richness.Conclusions The aberrant urinary microbiome may serve as disease biomarkers and potential therapeutic targets of OAB.A negative correlation between depression scores and both bacterial richness and diversity in OAB patients indicated that there might be a connection between central nervous system and urinary microbiome.

Objective To explore the relationships among the central nervous system,the lower urinary tract and urinary microbiome by a rat model of stress-induced voiding dysfunction.Methods Rats were randomly assigned to stress group (exposure to water-avoidance stress for 10 days),stress-withdrawal group (exposure to the stress and then withdrawal for 2 weeks) or control group.On day 11 for stress and control groups or 2 weeks after day 11 for stress-withdrawal group,the Light-dark box transition test,lower abdominal pain threshold,micturition frequency and cystometry measurements were determined.Urine specimens were collected and processed for 16S rDNA gene sequencing.Results Compared to control group,the water-avoidance stress dramatically decreased in the time spent in the light area (P ＜0.01) and decreased mechanical pain threshold in stress group,which were reversed in stress-withdrawal group.While there was no significant difference in the micturition frequency between the control and stress-withdrawal groups,the stress group (20.33 ± 3.77) showed significantly more micturition frequencies than control (8.14 ± 2.23) and stress-withdrawal group (9.67 ± 1.89) (P ＜ 0.01).The stress dramatically increased voiding contractions in both the stress (7.33 ± 1.79) and stress-withdrawal (4.83 ± 1.06) groups compared to control rats (2.71 ± 1.38) (P ＜ 0.05).However,the stress-withdrawal group showed less voiding contractions than the stress group (P =0.03).The bacteria diversity in stress group were dramatically higher than those of the other two groups (P ＜ 0.01).Almost all specimens of the control rats were dominated by Enterococcacae,whereas samples from the stress group contained more diverse bacteria.The diversity of microbiota in the stress-withdrawal group was between those of the other two groups.LEfSe identified genera differed significantly among groups:Lactococcus and Proteus were significantly increased in in the stress-withdrawal group;Halomonas,Aggregatibacter,Haemophilus,Pseudomonas and Streptococcus were significantly higher in the stress group.Conclusions Water-avoidance stress experiments demonstrated the impact of stress on bladder function and urinary microbiome,which tended to be ameliorated after a two-week withdrawal from stress.Further research is needed to understand the connections between central nervous system,bladder and urinary microbiome.

Objective To characterize the urinary microbial profile of male non-muscle invasive bladder cancer patients compared to healthy controls.Methods Between March,2017 and September,2017,mid-stream urine from 26 non-muscle invasive bladder cancer and 18 non-neoplastic controls were collected by the clean method,then centrifuged and processed for 16S rRNA gene sequencing.Sequencing reads were processed for evaluating alpha diversity and beta diversity using QIIME.LEfSe algorithm was performed to identify potential bacterial genera biomarker.Results The smoking cases were more in tumor group than those in control group(21 vs.7,P ＜ 0.01).The urinary microenvironment of bladder cancer was characterized by increased bacterial richness (Observed species index,Chaol index and Ace index,125.77 ± 69.64 vs.80.38 ± 46.24;142.82 ± 76.74 vs.90.68 ± 47.62;and 147.92 ± 77.68 vs.88.19 ± 45.38,all P ＜ 0.05) and by the enrichment of some bacterial genera (e.g.,Acinetobacter and Anaerococcus).Significant difference in β diversity was found between cancer and non-cancer group (ANOSIM,P =O.009).A clear hierarchical clustering of cancer samples was observed,suggesting a common dysbiosis associated to bladder cancer.Conclusions Patients with non-muscle invasive bladder cancer exhibit a different microbial community compared to non-neoplastic controls,suggesting a possible pathophysiological correlation between microbiome and bladder cancer.Urinary microbial community may be associated with the prognosis of NMIBC.

Objective:To study the preliminary clinical results of the No-touch technique in laparoscopic pancreaticoduodenectomy for pancreatic head cancer.Methods:A retrospective analysis was consulted on 11 patients who underwent laparoscopic pancreaticoduodenectomy for pancreatic head cancer at the Pancreas Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from April 2019 to April 2020. There were 5 males and 6 females, with a Mean±SD age of (63.6±12.2) years. Preoperative evaluation showed all patients were diagnosed to have resectable pancreatic head carcinoma with no local invasion into adjacent arteries and veins, and without metastasis. The surgical strategy consisted of no initial Kocher manoeuvre with no flipping or pulling of the pancreaticoduodenal area. Through unwinding of the pancreatic uncinate process, the pancreatic blood vessels, nerves and lymphatic vessels were completely detached to isolate the tumor. Finally, the pancreaticoduodenal area was totally resected and the digestive tract was reconstructed using the Child’s method. The operation time, intraoperative blood loss, postoperative complications, postoperative pathology and follow-up data of the patients were evaluated.Results:All patients completed the laparoscopic operation without any need for conversion to laparotomy. The operation time of the 11 patients was (422.2±102.2) min, and the bleeding volume was (102.7±65.4) ml. There were 2 patients who developed pancreatic fistula, with 1 patient having a biochemical fistula and 1 patient a grade B fistula. There was no grade C fistula. Other complications included 1 patient with delayed gastric emptying. There were no biliary fistula, no postoperative abdominal bleeding, and no perioperative death. Postoperative pathology showed 6 patients had lymph node metastases, with a positive lymph nodes rate of (4.8±4.4)%. All patients had R 0 resection. The follow-up survival data of the 11 patients showed one patient to develop intrahepatic metastasis 1 month after operation and he died 9 months after operation. Another patient developed liver metastases 2 months after operation. The remaining patients were tumor-free. Conclusion:Laparoscopic pancreaticoduodenectomy using the No-touch isolation and resection technique could achieve complete resection of tumors, and it can safely and effectively be applied to patients with pancreatic head cancer.

Objective:To examine the surgical approach, practical cognition as well as clinical effect of the orthotopic resection for laparoscopic pancreatoduodenectomy(OLPD).Methods:From March 2019 to December 2019, 32 cases were treated with laparoscopic pancreatoduodenectomy (LPD) in a novel approach without mobilization of pancreatoduodenum in Pancreas Center of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine.There were 16 male patients and 16 female patients.The mean age was (64.8±9.5) years old.Body mass index was 14.9 to 31.0 kg/m 2.All patients were diagnosed as ampullary or pancreatic head tumors and were not unresectable cases.In the surgical strategy, Kocher′s dissociation, turning and pulling of the pancreaticoduodenal region, was not performed first.Anatomy in situ, separation of vessels which enter and exit from pancreas, separation of lymphatics and isolation of tumors were carried out in priority through the combined middle and left posterior approaches.Finally, the pancreatic head and duodenum region was mobilized and the entire resection of pancreas in situ was carried out.Digestive tract reconstruction was performed through Child method. Results:Postoperative pathology showed that 27 cases were pancreatic or ampullary malignant tumors and five cases were benign tumors among 32 patients.The operative time was (357.3±64.3) minutes.The diameter of pancreatic ducts was (3.0±1.0) mm. The pancreas of 20 cases (62.5%) were soft. Five patients suffered from pancreatic fistula (Grade B) and one patient suffered from intra-abdominal hemorrhage postoperatively.No other complications like pancreatic fistula (Grade C) or biliary fistula delayed gastric emptying or mortality were encountered.The postoperative hospital day was (13.7±3.6) days.Conclusions:Combining the multi-angle of the laparoscopic approaches and excising the pancreaticoduodenal specimen in situ, OLPD is a kind of surgical method which can realize the concept of no touch tumor surgery.Patients who undergo the OLPD can receive better treatments and results.

Objective:To examine the surgical approach, practical cognition as well as clinical effect of the orthotopic resection for laparoscopic pancreatoduodenectomy(OLPD).Methods:From March 2019 to December 2019, 32 cases were treated with laparoscopic pancreatoduodenectomy (LPD) in a novel approach without mobilization of pancreatoduodenum in Pancreas Center of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine.There were 16 male patients and 16 female patients.The mean age was (64.8±9.5) years old.Body mass index was 14.9 to 31.0 kg/m 2.All patients were diagnosed as ampullary or pancreatic head tumors and were not unresectable cases.In the surgical strategy, Kocher′s dissociation, turning and pulling of the pancreaticoduodenal region, was not performed first.Anatomy in situ, separation of vessels which enter and exit from pancreas, separation of lymphatics and isolation of tumors were carried out in priority through the combined middle and left posterior approaches.Finally, the pancreatic head and duodenum region was mobilized and the entire resection of pancreas in situ was carried out.Digestive tract reconstruction was performed through Child method. Results:Postoperative pathology showed that 27 cases were pancreatic or ampullary malignant tumors and five cases were benign tumors among 32 patients.The operative time was (357.3±64.3) minutes.The diameter of pancreatic ducts was (3.0±1.0) mm. The pancreas of 20 cases (62.5%) were soft. Five patients suffered from pancreatic fistula (Grade B) and one patient suffered from intra-abdominal hemorrhage postoperatively.No other complications like pancreatic fistula (Grade C) or biliary fistula delayed gastric emptying or mortality were encountered.The postoperative hospital day was (13.7±3.6) days.Conclusions:Combining the multi-angle of the laparoscopic approaches and excising the pancreaticoduodenal specimen in situ, OLPD is a kind of surgical method which can realize the concept of no touch tumor surgery.Patients who undergo the OLPD can receive better treatments and results.

Pancreaticoduodenectomy is one of the most difficult abdominal operations, and the difficulty in resection and complicated digestive tract reconstruction have brought great challenges for surgeons. At present, laparoscopic pancreaticoduodenectomy has been widely used in clinical practice, and compared with traditional 2D laparoscopy, 3D laparoscopy has the features of high magnification, high definition, and three-dimensional vision, which enables surgeons to see more clearly and operate more accurately, and thus it has great potential to be widely used in pancreaticoduodenectomy.

Objectives:To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI).Methods:A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding.Results:Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( HR 7.28, 95% CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age ( HR 1.04, 95% CI 1.01-1.07, P<0.01), and low levels of ejection fraction ( HR 0.95, 95% CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO ( HR1.67, 95% CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions:Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.