Volume 93  ·   Issue 45  ·  2013

To evaluate anesthestic techniques for elderly patients during percutaneous endoscopic gastrostomy (PEG).

Clinical data about 5 cases aged 80 years or more undergoing PEG from June 2012 to May 2013 in Chinese People′s Liberation Army General Hospital were retrospectively analyzed and literature review.

Analgesia/minimal sedation combined with local anesthesia (LA including throat spray and operative site infiltrated) is employed in the one of patients with Tracheoesophageal Fistula (TEF), for the remaining patients, analgesia/deep sedation and LA combination were used, during induction, temporary respiratory depression, blood pressure and heart rate decreased occurred respectively in the different patient, assisted ventilation and ephedrineⅣwas effective, the anesthesia strategy was to maintain a desired sedation with propofol or etomidate intravenously in small increments or by adjusted infusion, and to keep SpO₂ at 95% or more with a supplemental oxygen through facemask under spontaneous ventilation.During the therapeutic period, an increase in blood pressure (BP) and heart rate (HR), slight cough occurred in one patient.Of all cases undergoing this procedure uneventfully and recovering well at the end of surgery without aspiration,asthma or airway obstruction,4 were placed with jejunal feeding tube successfully, the mean duration of surgery is 80 min, ranging between 40 and 150 min, no anesthesia-related or cardiorespiratory complications occurred at follow-up.

a combination of intravenous sedative/analgesic anesthesia with LA is efficiently and safely suited to the patients at advanced age during PEG, for anesthesiologists,it should be the most important tenets of anesthetic practice to have preanesthestic evaluation well done about cardiorespiratory function and the ability of individual cooperation with anesthesia providers, to control airway and to manage circulatory system intraoperatively.

To investigate the effect of endotracheal intubation (TT) or the laryngeal mask airway (LMA) on the incidence of perioperative respiratory adverse events in children with upper respiratory tract infection undergo general anesthesia.

From November, 2006 to October, 2012 in the Zhuji People′s Hospital, 76 children with upper respiratory tract infection approved by hospital ethic committee were randomly divided into 2 groups:groupⅠ (n=36), children were applied with endotracheal intubation during general anesthesia (TT group), while groupⅡ (n=40), laryngeal mask airway were used (LMA group).Intraoperative mean arterial pressure (MAP), hear rate (HR), pulse oximetry (SPO₂), and end-tidal carbon dioxide partial pressure (P_ETCO₂) were recorded during the surgery.The incidence of adverse events such as hypoxemia, fidgety, sore throat, and laryngospasm were evaluated in resuscitation room.We also assessed the pre-and postoperative symptoms of respiratory tract infection.

There was no significant difference in upper respiratory tract infection symptoms between two groups, and the children in both groups have good tolerance to TT or LMA.However, the hemodynamics status in LMA group were more stable than those in TT group after the LMA insertion or removing (P<0.05).The incidence of hypoxemia, fidgety, sore throat, and laryngospasm were significant lower in LMA group compared with those in TT group (P<0.05).

LMA could decrease the incidence of perioperative respiratory adverse events and can be safely used in children with upper respiratory tract infection undergo general anesthesia.

To explore the efficacy and safety of remifentanyl and propofol injection in total intravenous anesthesia for percutaneous radiofrequency ablation.

60 patients scheduled for PRFA were divided randomly into two groups:group A and group B.Each group contained 30 patients.Those in group A received remifentanyl and propofol injection, and the patients in group B were given oxycodone hydrochloride.The mean arterial pressure (MAP),heart rate (HR) and pulse oxygen saturation (SPO₂) were measured and recorded by monitor during the operation.The chest muscle rigidity,respiratory depression,nausea and vomitting,hypotensio and VAS were also recorded.

Compared with the preoperative,MAP,HR in group A decreased significantly during the operation,increased in group B (P<0.05).VAS was significantly lower in group A than that in group B (P<0.05).2 patients had respiratory depression,1 patient had nausea and vomiting reaction in group A.2 patients had vagus reflex,3 patient had nausea and vomitting reaction in group B.

Total intravenous anesthesia with remifentanyl and propofol for PRFA is safe and reliable.Respiratory and circulation should be monitored instantly and strictly.

To investigate the correlation of effect of bronchial arterial embolization (BAE) in the treatment of hemoptysis and relative factors.

From December 2007 to August 2011, 105 patients with hemoptysis were admitted.BAE was carried out after bronchial artery arteriography and ensured bronchial artery anomaly.Patients were followed up 3 to 24 months.

All 105 cases were confirmed abnormal bronchial artery.And 101 cases (96.2%) were completed BAE, and among them, 91 cases (86.7%) were stoped bleeding, and 7 cases (6.7%) were excellence.The total effective rate was 93.4%.In follow-up period, there were 69 cases (65.7%) without recurrence, and 8 cases (7.6%) were recent recurrence and 10 cases (9.5%) were long-term recurrence, respectively.All factors were no obvious correlation to effect of BAE.

BAE is an effective treatment for hemoptysis.Effect of the BAE was irrespective to related factors.

To compare the efficacy of different time interval in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-severe Asherman′s syndrome.

A total of 125 women with moderate-severe Asherman′s syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled into this retrospective cohort study.All patients underwent second-look hysteroscopy after a certain period of the first hysteroscopic adhesiolysis, and the operation would be performed again if any adhesion existed.According to the different time interval of hysteroscopy examination, they were divided into 3 groups: A:<1 month (n=50), B:1-2 months (n=39), C >2 months (n=36).The effect of hysteroscopic adhesiolysis was evaluated by American Fertility Society (AFS) score.

The AFS score decreased significantly after hysteroscopic adhesiolysis in each group and the normal uterine rate was up to 64.8%.The median of decreased AFS score and normal uterine rate were as follows:group A:7 point and 78%, group B:7 point and 66.7%, group C:5 point and 44.4%.And groups A and B achieved significantly (P<0.01) greater reductions in the adhesion score than that of group C.The median time of recovery to normal uterine cavity were 1.64,2.75 and 5.26 months in each group and great differences existed among them (P<0.01).

The time interval of second-look hysteroscopy less than 1 month offers a better prognosis in the prevention of adhesion reformation for moderate-severe Asherman′s syndrome.

To explore the operative guiding values of facial nerve three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and three-dimensional fast imaging employing steady state acquisition three-dimensional fast imaging employing steady state acquisition (3D-FIESTA) scan.

A total of 125 cases of primary hemifacial spasm was treated at our hospital from 2004 to 2012.Among them, 80 cases received preoperative facial nerve MRA scan.The imaging and intraoperative findings were compared to determine the responsible blood vessels.

Responsible blood vessels were found in all 80 cases.Sixty patients (75%) had the involvement of single vessel of anterior inferior cerebellar artery (AICA,n=57), posterior inferior cerebellar artery (PICA, n=1), superior cerebellar artery (SCA, n=1) and vertebral artery (VA, n=1).Two or more vessels were implicated in 9 patients (11.25%).The culprits were AICA+ internal auditory artery (n=8) and PICA+ internal auditory artery (n=1).The source of responsible vessels of 11 cases could not be determined before surgery.Through intraoperative anatomy, 59 patients had single vessel lesions, including AICA (n=53), PICA (n=4), SCA (n=1) and VA (n=1).Among 14 cases of multiple vessels, there were AICA+ internal auditory artery (n=7), internal auditory artery+ PICA (n=2), AICA+ brain stem perforating artery (n=3) and AICA+ vein (n=2).Seven cases were uncertain.No significant statistical difference existed between two groups.

Facial nerve 3D-TOF-MRA and 3D-FIESTA scan can identify the status of responsible blood vessels to guide operations.

To explore the iconographic differences for pituitary adenoma, craniopharyngioma and Rathke cleft cyst involving both intrasellar and suprasellar regions.

A total of 99 eligible pathologically confirmed patients (pituitary adenoma, n=49; craniopharyngioma,n=35; Rathke cleft cyst,n=24) were selected during January 2008 and January 2012.The following characteristics were evaluated: (1) calcification or not and density of tumor on computed tomography (CT); (2) shape, size, extent and component characteristics, signal intensities of solid portions on T₂-weighted images, signal intensities of cystic portions on T₁-weighted images and enhancement patterns of solid portions and cyst walls and complicated hydrocephaly or not.A flowchart for differential diagnosis for three tumors was constructed based on statistical analysis of the results.

A snowman shape, solid characteristics and homogeneous enhancement of solid portion were more common in pituitary adenomas; a lobulated shape, third ventricle compression by superior tumor extension, mixed solid and cystic characteristics, reticular enhancement of solid portion, calcification on CT scan and complicated hydrocephalus were more common in craniopharyngioma; an ovoid shape, small tumor size, cystic characteristics and none or thin cyst wall enhancement were more common in Rathke cleft cysts.

The above iconography characteristics are helpful in the differential diagnosis of three tumors involving both intrasellar and suprasellar regions.

To provide evidence-based medicine rationales for the diagnosis and treatment of lumbar disc herniation (LDH) in Chinese adolescents.

The related medical literature of pediatric LDH between January 1990 and December 2012 was collected by retrospective searches of WANGFANG and CNKI databases.The data concerning mechanism, clinical manifestations, diagnosis and treatment were recorded and analyzed.

A total of 1208 cases of LDH in adolescents were retrieved from 45 articles.Most of them were males (74.2%).And the primary cause was trauma (65.9%).Their clinical presentations were characterized by mild symptoms and serious physical signs.And 87.0% of them had a positive straight-leg raising test.Single-level intervertebral disk protrusion accounted for 92%.And the levels were at L4-L5 (54.7%) and L5-S1 (37.6%).There was a higher incidence of lumbar scoliosis deformity (38.2%), lumbar spine physiological curvature change (41.4%) and loss of vertebral height (33.6%) in adolescents than adults.There were many different treatments for pediatric LDH.Each method had its own advantages and disadvantages.The success rates of micro endoscopic discectomy (MED) and open discectomy were more than 90%.

Trauma is a common cause of pediatric LDH.Males are more frequently affected.The single-level protrusion of L4/5 or L5/S1 has a much higher incidence.Positive straight-leg raising test and imaging findings of lumbar scoliosis deformity,lumbar spine physiological curvature change and a loss of vertebral height may aid the diagnosis.Normally conservative treatment is offered.And chemonucleolysis, MED and open discectomy are alternative options.

To explore the clinical profiles,imaging features and prognosis of patient with multicentric giant cell tumor of bone (MGCT).

Nine MGCT patients treated at our hospital between 1997 and 2010 were retrospectively examined.They had two or more separate lesions of giant cell tumor.There were 5 males and 4 females with an average age of 23 (14-37) years.Three patients (33%) were under 20 years old.There were 29 tumors in the series with an average of 3.2 (range, 2-10) per patient.Among 6 of them, a second lesion did not develop for>2 years after initial presentation.There were>2 sites of tumor involvement (n=4) and 10 lesions (n=1).Two patients had synchronous lesions involves 2 isolated locations.Twenty-nine lesions were located in spine, rib, femur, tibia, foot, hand, fibula and humerus.Three lesions of 2 patients involved metaphysic of long bones, one of whom was skeletally immature.All lesions had the typical histological features of giant cell tumor.The tumors were treated with curettage or resection was performed according to location and the Campanacci grade.

Twenty-two lesions underwent surgery in all 29 lesions of 9 patients.A total of 31 operations were performed.The average follow-up period was 6 (3-10) years.Four lesions of 2 patients had no recurrence during follow-up.Ten lesions (34%) relapsed in all 29 lesions and 4 operations were performed firstly at other hospitals.Seven patients had one or more recurrences with an average recurrence time of 2.5 years (range,2 months-9 years).Six cases of local recurrence were within the first 2 years.Post-radiotherapy malignant transformation developed in 1 male patient with 10 lesions dying of malignant pulmonary metastasis.The total recurrence rate was similar to that of unifocal giant cell tumor.

MGCTs are likely to occur more in a younger population than unifocal giant cell tumors.And its risk of recurrence depends on the type of surgery.It is similar to the risk of recurrence for unifocal GCT.MGCT has vessel-axial distribution and multicentric generation.Long-term follow-up is necessary.

To explore the value of Magnetic resonance imaging (MRI) in the early rheumatoid arthritis (RA).

56 patients (24 men and 32 women) fulfilling the 2010 ACR/ EULAR for RA, 34 with early RA,and 22 with established RA, (disease duration<12 months, and>12 months, respectively) were enrolled in the study.MRI of the dominant hand and wrist was performed by using short time inversion recovery (STIR), plain and contrast-enhanced T1-weighted sequences.Evaluation of bone marrow edema, bone erosions and synovitis was performed with the OMERACT RA MRI scoring system.

Edema, erosions, and synovitis were present in early RA and established RA, and the prevalence was 88.2% (30/34), 91.1% (31/34), 100% (34/34) and 90.9% (20/22), 95.4% (21/22),100% (22/22), respectively.But no significant difference was found in two group (P>0.05).Significant differences in edema and erosions were found between earlier RA and established RA (P<0.05).No significant difference was found in synovitis (P>0.05).

Bone marrow edema, bone erosions and synovitis are important sign of early RA.But bone edema and erosions in MRI may play an important role in the diognosis of early RA.

To determine whether different cell plating densities could influence the potential differentiation of immortalized human mesenchymal stem cells (hMSC-TERT).

Extensive characterization was performed for two independent cell lines derived from parental hMSCTERT cell line based on different plating densities during expansion in culture: 1∶2 (hMSC-TERT2) and 1∶20 (hMSC-TERT20).Their adipocytic, osteogenic, neuronal differentiation potential in vitro and multidirectional differentiation potential in vivo were analyzed by immunohistochemistry for pathologic tissue markers.

hMSC-TERT2 formed cellular adipose foci and mineralized tuberculum after in vitro induction while hMSC-TERT20 showed adipocytes but no adipose foci or mineralized tuberculum.The positive rate of h MSC-TERT2 formed tissues on VIM, GFAP and LCA (89.17%±5.97%, 72.5%±10.11% and 76.67%±11.15%) under SCID murine skin were more than that of hMSC-TERT20 formed tissues (0.33%±0.65%, 9.58%±4.29% and 22.08%±6.95%).

The cell lines derived at high plating density may have more powerful differentiation potential in vitro and in vivo than those derived at low cell plating density.

To explore the effects on Aβplaques of neural stem cells transplanted into an Alzheimer disease mouse model.

A total of twenty 12-monthes-old APP+PS1 double transgenic AD mice were randomly divided into two groups.One group received neural stem cells transplantation, that was NSC group, another mice received an equal quantity 0.01 mol/L PBS, as positive control group.After 5 weeks transplantation, the total number of Aβplaques examined by immunohistochemistry, the ratio of compact of Aβplaques by TSstaining, and whether NSCs migrate into Aβplaques by immunofluorescence monitoring.

There was no difference in total number of Aβplaques between NSC group (181±12) and PBS (179±14) group after transplantation (P>0.05).There was no difference in the number of TS+ plaques between NSC group (54.9%) and PBS (55.7%) group after eight weeks NSCs transplantation (P>0.05). (2) However, engrafted NSCs showed partial chemotaxis toward Aβplaques.

NSCs transplantation did not have a significant impact on Aβplaques of AD mice, but the tropism of engrafted NSCs may be capable of replacing lost or damaged cells and reverse the course of AD mice in some extent.

To explore the expression and significance of autophagy in endplate cartilage of rats during aging process.

The end-plate chondrocytes were isolated from 3, 6 and 12-month SD rats respectively.And the natural culture and rapamycin groups were assigned.Alizarin red staining was used to observe the morphological changes of cells.And RT-PCR was employed to detect the expressions of typeⅡ collagen, proteoglycan, SOX-9 and matrix metalloproteinase (MMP-13).The expressions of Beclin-Ⅰ and LC3 were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The rate of autophagy was observed by monodansylcadaverine (MDC) staining and methyl thiazolyl tetrazolium (MTT) for cell survival rate.

Alizarin red staining showed that cells might reflect the process of intervertebral disc degeneration.The expressions of polysaccharide, Sox-9, typeⅡcollagen, Beclin-1 and LC3 in endplate chondrocytes significantly decreased with advancing age (P<0.05).The incidence of autophagy significantly decreased (P<0.05).The cell viability of each group significantly decreased (P<0.05).Compared with control group, the cell viability of rapamycin group significantly increased (P<0.05).

During aging process, the expressions of autophagy related-gene LC3 and Beclin-1 significantly decrease with the reduced activity of end-plate chondrocyte.And autophagy activity may be correlated with the development and degeneration of intervertebral disc.