OBJECTIVETo assess the influences of continuous femoral nerve block (CFNB) and patient-controlled intravenous analgesia (PCIA) on postoperative pain scores,knee rehabilitation,and stress response after total knee arthroplasty (TKA).

METHODSTotally 32 adult patients scheduled for elective total knee arthroplasty were equally randomized into CFNB group or PCIA group. Intraoperative hemodynamics and fentanyl dose were recorded. Pain was assessed at rest and during continuous passive motion (CPM) using a visual analog scale at post-anesthesia care unit (PACU) and 4, 8, 12, 24, and 48 hours postoperatively. Morphine consumption was also recorded. As indicators of stress and inflammatory response,the leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein (CRP), and serum cortisol were determined on admission, to operation room, immediately after skin incision, before extubation,on post-operation day 1 (POD1), and on POD2.

RESULTSCFNB group showed significantly lower heart rate compared with PCIA group 60 minutes and 90 minutes intraoperatively (Pü0.05). Intraoperative consumption of fentanyl was significantly lower in CFNB group (137.5∓44.4) μg than in PCIA group (264.1∓67.1) μg (Pü0.01). The CFNB group showed significantly lower VAS scores both at rest and during CPM compared with PCIA group at all time points (Pü0.05). Morphine consumption was significantly lower in CFNB group than in PCIA group at different time points (Pü0.05 or Pü0.01). The maximal continuous passive motion amplitude of CFNB group were significantly larger than that of PCIA group on POD1 [(55.0∓9.4) vs.(44.6∓9.9), P[(76.3∓11.0) vs. (67.5∓10.3), P<0.05]. The incidences of somnolence and nausea/vomiting in CFNB group were 37.5% and 37.5%, respectively,which were significantly lower than those of PCIA group (75.0% and 81.3%) (Pü0.05). Patient satisfaction scores on anesthesia and post-operative analgesia was significantly higher in CFNB group than in PCIA group (93.1∓7.9 vs. 79.1∓11.9, respectively) (Pü0.05).

CONCLUSIONAfter TKA,CFNB technique provides more stable intraoperative hemodynamics than PCIA, with better pain relief,faster postoperative knee rehabilitation,less side effects,and higher patient satisfaction.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesia, Patient-Controlled ; methods ; Arthroplasty, Replacement, Knee ; Female ; Femoral Nerve ; Humans ; Male ; Middle Aged ; Nerve Block ; methods ; Young Adult

The concept of neurovascular units studies the interaction between neural cells and blood vessels, regards the blood-brain barrier as the core,and relates with the neurodegenerative diseases.This paper reviewed the relationship be-tween neurovascular units and neurodegenerative diseases, such as Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease,multiple sclerosis,etc.

Exosome is a hot topic in the field of medical research in recent years, which can serve as new carriers for cell-to-cell communication, and show great potential in the diagnosis and treatment of ischemic stroke. microRNA containing in exosomes plays an important role in it. This article reviewed the research progress of exosomes in ischemic stroke on biomarkers, drug carriers, neurovascular remodeling, and treatment.

AIMTo observe mRNA expression of muscarinic acetylcholine receptors in spinal cord and brainstem in morphine dependent or withdrawal rats.

METHODSThe mRNA expression level of m1, m2, m3, m4 and m5 were determined by RT-PCR, the beta-actin mRNA expression was used as internal control.

RESULTSThe mRNA level of m1, m2, m3, m4 and m5 in spinal cord and m1 and m2 in brainstem were increased significantly during morphine dependence, and the levels of m1, m2, m3 and m4 in spinal cord and m1 in brainstem were decreased 1 h after the injection of naloxone (4 mg.kg-1, i.p.) in morphine dependent rats. Either scopolamine (0.5 mg.kg-1) or pirenzepine (10 mg.kg-1) was shown to significantly decrease the morphine withdrawal symptoms in rats. The levels of m1, m2, m3 and m5 in spinal cord were increased by pretreatment with pirenzepine and the levels of m2, m3 and m4 in spinal cord were increased by pretreatment with scopolamine.

CONCLUSIONThe adaptive expression of muscarinic receptors at spinal and supraspinal levels play important role in mediating morphine dependence and withdrawal in rats.

Animals ; Brain Stem ; drug effects ; metabolism ; Gene Expression ; drug effects ; Male ; Morphine ; toxicity ; Morphine Dependence ; metabolism ; RNA, Messenger ; biosynthesis ; drug effects ; Rats ; Rats, Sprague-Dawley ; Receptors, Muscarinic ; biosynthesis ; classification ; genetics ; Spinal Cord ; drug effects ; metabolism ; Substance Withdrawal Syndrome ; metabolism

Objective To investigate the effect of electroacupuncture (EA) preconditioning on apoptosis after cerebral ischemia-re-perfusion (I/R). Methods A total of 72 male Sprague-Dawley rats were randomly divided into sham group (n=24), model group (n=24) and EA group (n=24). The rats in latter two groups were occluded the right middle cerebral arteries for two hours and reperfused. EA group was treated with EA at Baihui (GV20) for two weeks before modeling. They were as-sessed with modified Neurological Severity Scores (mNSS) 24 hours after modeling. Then, the cerebral infarct volume was measured with TTC staining, the apoptosis was detected with TUENL assay, and the expression of p53, Bax and Bcl-2 proteins in ischemic penumbra was detected with Western blotting. Results Compared with the model group, the score of mNSS, cerebral infarct volume and the number of TUNEL-posi-tive cells all significantly decreased (P<0.05) in EA group; while the expression of p53 and Bax proteins de-creased (P<0.05), Bcl-2 increased (P<0.05), and Bax/Bcl-2 decreased (P<0.05).Conclusion EA preconditioning can induce tolerance to cerebral I/R injury, which might associate with the inhibition of p53 protein and down-regulation of the Bax/Bcl-2 ratio in ischemic penumbra, to inhibit cerebral cell apoptosis.

OBJECTIVE: To explore the effect of electroacupuncture on heroin seeking behavior and FosB expression in relevant brain regions. METHODS: Rat model of heroin relapse behaviors was developed with progressive fixed ratio program,and model rats were randomly divided into 3 groups: a restraint group, a needle retention group, and a electroacupuncture group. The heroin seeking behavior was elicited by a small dose of heroin. FosB expression in relevnt brain region was assessed with immunohistochemical technique. RESULTS: Tests on reinstatement of drug seeking behavior induced by heroin priming showed that compared with the restraint group, active pokes in the electroacupuncture group decreased significantly(P<0.05). Compared with the restraint group, the expression of FosB positive nuclei in Acd, Pcg and CeA of rats brain both in the electroacupuncture group and the needle retention group (P<0.05) decreased significantly. In LC, the expression of FosB positive nuclei in the needle retention group decreased significantly compared with the restraint group (P<0.05). CONCLUSION Continuous acupuncture and needle retention attentuate the reinstatement of heroin-seeking behaviors induced by heroin priming, and the inhibitory effect may be mediated partially by the expression of FosB in relevant regions which are involved in the process of heroin addiction.
Amygdala ; metabolism ; Animals ; Behavior, Animal ; Brain ; metabolism ; Electroacupuncture ; methods ; Heroin Dependence ; metabolism ; psychology ; therapy ; Male ; Nucleus Accumbens ; metabolism ; Proto-Oncogene Proteins c-fos ; biosynthesis ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Objective To analyze the safety of atrial septal defect closure using Da Vinci surgical system. Methods Totally 23 atrial septal defect patients hospitalized from July to December 2016 underwent atrioseptopexy by using Da Vinci surgical system. The effect of atrioseptopexy was observed under cardiopulmonary bypass conditions. Results All the patients had the operation completed successfully, with the operating time being (2.8 ±0.5)h, the intraoperative cardiopulmonary bypass time being (35.4±18.4)min, aortic clamping time being (25.9±8.4)min, postoperative mechanical ventilation time being (5.7±1.5)h, amount of thoracic drainage fluid from 50 to 300 ml and postoperative hospital stay being (7 ±5.1)d. The follow-up 1 and 3 months after discharge showed there were no complications and death occurred, and the examinations by chest X-ray film and heart color ultrasound found no abnormality. Conclusion Da Vinci surgical system gains advantages in safety, reliability, patient satisfaction, operative incision and surgical trauma, and thus is worthy promoting clinically.

Clinical data of 43 patients who underwent endoscopic resection for gastrointestinal stromal tumors (GIST) of length ≤1.2 cm at the Digestive Endoscopy Center of the 909th Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into the endoscopic ligation resection (ELR) group ( n=27) and the endoscopic submucosal excavation (ESE) group ( n=16). The general, perioperative and follow-up data of the two groups were compared. The results showed that there was no significant difference in the general data between the two groups. The operation time was 20.0 (18.0,25.0) min in the ELR group and 27.5 (23.0,37.5) min in the ESE group, showing significant difference ( U=92.5, P=0.001). The en bloc resection rates were 100.0% (27/27) in the ELR group and 81.3% (13/16) in the ESE group, showing significant difference ( P=0.045). The postoperative hospital stays were 3 (2,4) days in the ELR group and 5 (4,6) days in the ESE group, showing significant difference ( U=125.5, P=0.020). There was no significant difference in the intraoperative bleeding rate, intraoperative hemorrhage volume, intraoperative perforation rate, number of hemostatic clips or postoperative complications including hemorrhage, fever and peritonitis between the two groups ( P>0.05). During the follow-up, there was no recurrence or metastasis of GIST in both groups. ELR and ESE can be safe and effective for small GIST ≤1.2 cm in diameter. Compared with the ESE group, the operation time and postoperative hospital stay are shorter with higher en bloc resection rate in the ELR group.

Objective To investigate the effects of downstaging and neoadjuvant reetal(NAR) score on the prognosis of patients with clinical stage Ⅲ middle-low rectal cancer undergoing preoperative concurrent chemoradiotherapy.Methods From 2006 to 2014,195 patients who were admitted to our hospital and diagnosed with clinical stage Ⅲ middle-low rectal cancer by pelvic magnetic resonance imaging or computed tomography were enrolled.All patients received preoperative radiotherapy with doses of 42-50.4 Gy (median:50 Gy,93.8％ of patients received doses of ≥ 50 Gy) and concurrent chemotherapy with capecitabine ± oxaliplatin.Total mesorectal (R0) excision surgery was performed at 4-15 weeks (median:7 weeks) after concurrent chemoradiotherapy.The effects of downstaging (stage yp0-Ⅱ) and NAR score (calculated based on cT staging and ypT/N staging) on the prognosis were evaluated.The 3-year disease-free survival (DFS) rate was calculated using the Kaplan-Meier method and analyzed by log-rank test.Results In all the patients,the median follow-up time was 44 months (6.7-125.5 months);the 3-year DFS rate was 76.8％.Downstaging after preoperative chemoradiotherapy was a significant prognostic factor for the 3-year DFS (92.2％ vs.56.8％,P=0.000).The median NAR score was 15.0(0-65.0) in all the patients.Patients with NAR scores of ≤ 15.0 had significantly improved 3-year DFS than those with NAR scores of＞15.0(90.1％ vs.57.0％,P=0.001).In patients with downstaging,those with NAR scores of ≤8.4 had significantly improved prognosis compared with those with NAR scores of＞ 8.4(95.1％ vs.87.5％,P=0.022).Conclusions Patients with downstaging after preoperative concurrent chemoradiotherapy for stage c Ⅲ middle-low rectal cancer have satisfactory prognosis.The NAR score is an effective prognostic predictor.