Alkanes ; adverse effects ; Empyema ; chemically induced ; complications ; Humans ; Male ; Middle Aged ; Pneumonia ; chemically induced ; complications

In order to find a method to determine the location and depth of epidural puncture through intervertebral foramen, the distance between both intervertebral foramina and the depth from epidural space to lumbodorsal skin were measured with computerized tomography(CT). These data were taken as a guide during lumbar epidural puncture through intervertebral foramen in 12 fresh corpses ,and needles were all successfully inserted into epidural spaces. Afterwards, this method was applied to the lumbar epidural puncture of 60 adult patients with lumbar vertebral disk herniation, in the sense that the distance between both intervertebral foramina and epidural depth were measured with CT as the guide in the epidural puncture through intervertebral foramen; only at sigle puncture, the epidural spaces of 56 cases were successfully inserted into ,with the rate of success being 90.3%. It is suggested that the dis- tance between both intervertebral foramina and epidural depth measured by CT, paly an important role in successful lumbar epidural puncture through intervertebral foramen.

Abdominal Pain ; etiology ; Acute Disease ; Adult ; Atropine ; therapeutic use ; Chemical and Drug Induced Liver Injury ; etiology ; therapy ; Diarrhea ; etiology ; Fatal Outcome ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; etiology ; Muscarinic Antagonists ; therapeutic use ; Mushroom Poisoning ; complications ; therapy

Objective This study is to investigate the set-up accuracy of thermoplastic mask used for immobilization of nasopharyngeal carcinoma (NPC) patients being treated by Intensity Modulated Radia- tion Therapy (IMRT).Methods Nineteen patients with early stage nasopharyngeal carcinoma (T1- T2N0M0),treated by fractionated intensity-modulated radiation therapy,underwent repeated CTs during their 6-week treatment course.We evaluated their anatomic landmark coordinates in a total of 85 repeated CT data sets and respective x,y and z shifts relative to their position in the 19 treatment-planning reference CTs.Results The translation in x,y,and z-axes with their mean value derived from both positive and negative set-up errors was-0.84 mm(x-axis),+0.65 mm(y-axis) and +0.01 mm(z-axis).Mean target isocenter translation was (0.89?0.69) mm,(0.82?0.79) mm,(0.95?1.24) mm in x,y and z-direc- tions,respectively.The mean total magnitude vector and 95% CI of isocenter motion were 1.87 mm and 4.65 mm.The data measured over the 6-week fractionated course of treatment revealed a slight deterioration of isocenter accuracy.The 95% CI,considered by us to be a valuable parameter for characterizing the sys- tem,of 4.17 mm for measurement within the first 3 weeks increased to 5.12 mm in the last 3 weeks of treat- ment.Conclusions The sequential CT scanning is a pronounced valuable method of evaluating the quality of departmental specific patient positioning procedures.The thermoplastic mask is eyed as well suited tool for immobilization and repositioning of NPC patients receiving intensity-modulated radiation therapy.

OBJECTIVE: We hypothesize that the amplitude of low-frequency fluctuations (ALFF) is involved in the altered regional baseline brain function in social anxiety disorder (SAD). The aim of the study was to analyze the altered baseline brain activity in drug-naive adult patients with SAD. METHODS: We investigated spontaneous and baseline brain activities by obtaining the resting-state functional magnetic resonance imaging data of 20 drug-naive adult SAD patients and 19 healthy controls. Voxels were used to analyze the ALFF values using one- and two-sample t-tests. A post-hoc correlation of clinical symptoms was also performed. RESULTS: Our findings show decreased ALFF in the bilateral insula, left medial superior frontal gyrus, left precuneus, left middle temporal gyrus, right middle temporal pole, and left fusiform gyrus of the SAD group. The SAD patients exhibited significantly increased ALFF in the right inferior temporal gyrus, right middle temporal gyrus, bilateral middle occipital gyrus, orbital superior frontal gyrus, right fusiform gyrus, right medial superior frontal gyrus, and left parahippocampal gyrus. Moreover, the Liebowitz Social Anxiety Scale results for the SAD patients were positively correlated with the mean Z values of the right middle occipital and right inferior occipital but showed a negative correlation with the mean Z values of the right superior temporal gyrus and right medial superior frontal gyrus. CONCLUSION: These results of the altered regional baseline brain function in SAD suggest that the regions with abnormal spontaneous activities are involved in the underlying pathophysiology of SAD patients.
Adult* ; Anxiety ; Anxiety Disorders* ; Brain* ; Humans ; Magnetic Resonance Imaging* ; Orbit ; Parahippocampal Gyrus

INTRODUCTION: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Conscious Sedation ; Endoscopy, Gastrointestinal ; Hospitals ; Humans ; Hypnotics and Sedatives ; Singapore

Asthma is a serious health problem that involves not only the respiratory system but also the central nervous system. Previous studies identified either regional or network alterations in patients with asthma, but inconsistent results were obtained. A key question remains unclear: are the regional and neural network deficits related or are they two independent characteristics in asthma? Answering this question is the aim of this study. By collecting resting-state functional magnetic resonance imaging from 39 patients with asthma and 40 matched health controls, brain functional measures including regional activity (amplitude of low-frequency fluctuations) and neural network function (degree centrality (DC) and functional connectivity) were calculated to systematically characterize the functional alterations. Patients exhibited regional abnormities in the left angular gyrus, right precuneus, and inferior temporal gyrus within the default mode network. Network abnormalities involved both the sensorimotor network and visual network with key regions including the superior frontal gyrus and occipital lobes. Altered DC in the lingual gyrus was correlated with the degree of airway obstruction. This study elucidated different patterns of regional and network changes, thereby suggesting that the two parameters reflect different brain characteristics of asthma. These findings provide evidence for further understanding the potential cerebral alterations in the pathophysiology of asthma.
Asthma/diagnostic imaging* ; Brain/diagnostic imaging* ; Brain Mapping ; Humans ; Magnetic Resonance Imaging

Resection of oral and maxillofacial tumors is often accompanied by the inferior alveolar nerve neurectomy, resulting in abnormal sensation in lower lip. It is generally believed that spontaneous sensory recovery in this nerve injury is difficult. However, during our follow-up, patients with inferior alveolar nerve sacrifice showed different degrees of lower lip sensory recovery. In this study, a prospective cohort study was conducted to demonstrate this phenomenon and analyze the factors influencing sensory recovery. A mental nerve transection model of Thy1-YFP mice and tissue clearing technique were used to explore possible mechanisms in this process. Gene silencing and overexpression experiments were then conducted to detect the changes in cell morphology and molecular markers. In our follow-up, 75% of patients with unilateral inferior alveolar nerve neurectomy had complete sensory recovery of the lower lip 12 months postoperatively. Patients with younger age, malignant tumors, and preservation of ipsilateral buccal and lingual nerves had a shorter recovery time. The buccal nerve collateral sprouting compensation was observed in the lower lip tissue of Thy1-YFP mice. ApoD was demonstrated to be involved in axon growth and peripheral nerve sensory recovery in the animal model. TGF-β inhibited the expression of STAT3 and the transcription of ApoD in Schwann cells through Zfp423. Overall, after sacrificing the inferior alveolar nerve, the collateral compensation of the ipsilateral buccal nerve could innervate the sensation. And this process was regulated by TGF-β-Zfp423-ApoD pathway.
Mice ; Animals ; Lip/innervation* ; Prospective Studies ; Mandibular Nerve/pathology* ; Sensation/physiology* ; Trigeminal Nerve Injuries/pathology*