National Medical Journal of China
Volume 100 · Issue 33 · 2020
Natl Med J China
The autonomic nerve is named because its function is mainly to control and regulate the metabolic activities shared by animals and plants, and it does not control the skeletal muscle movement unique to animals. It is also called autonomic nerve or visceral nerve because it mainly governs the involuntary activities of internal organs. Like somatic nerves, autonomic nerves also have two fiber components: sensory and motor, and their motor nerves are divided into sympathetic nerves and parasympathetic nerves. Although autonomic nerves do not participate in skeletal muscle movement, they participate in various basic life functions such as circulation, respiration, digestion, urogenital, body temperature regulation, etc., and also participate in nerve-humoral immune regulation. Therefore, the manifestations of autonomic nerve dysfunction diseases are very diverse. Through the regulation of autonomic nerve function, different diseases can be treated simultaneously, which often achieves unexpected good effects, which deserves attention and deep research.
Elderly patients have a higher risk of serious complications during the recovery period due to preoperative co-existing diseases and decline in their own organ function. The infusion rate of anesthetic, sedative and analgesic drugs should be gradually reduced 10 to 20 minutes before the end of the operation. During this process, appropriate analgesic drugs should be given to prevent explosive pain in order to prevent pain stress response caused by tracheal intubation and surgical trauma. Recommended opioids include fentanyl 1-2 μ g/kg, sufentanil 0.1-0.2 μ g/kg, or remifentanil 1-2 ng/ml; Tramadol 50 mg, or flurbiprofen axetil 50 mg, or parecoxib sodium 40 mg may be combined. Patients with fragile pulmonary function or advanced age (>75 years) should reduce opioid doses to avoid their inhibitory effects on respiration. In addition, local infiltration of 0.5% ~1.0% ropivacaine 10~20 ml in surgical wounds is also very effective in reducing pain during the recovery period of patients. Multimodal analgesia during the recovery period in elderly patients can help improve the success rate of extubation. Intraoperative continuous infusion of appropriate doses of dexmedetomidine helps to enhance tolerance to endotracheal intubation in elderly patients during the recovery period.
hypertensive intracerebral hemorrhage (HICH) is a disease caused by pathological changes in intracranial arterioles caused by long-term hypertension, and hyaline or fibrous degeneration of blood vessel walls, which weakens the elasticity of blood vessel walls and leads to blood vessel rupture and bleeding. When the patient is emotionally agitated, excessive mental or physical activity, and other factors cause a drastic increase in blood pressure, it can cause cerebral blood vessel rupture and bleeding. HICH is one of the serious complications of hypertension, and the incidence rate in European and American countries accounts for 9% to 28% of stroke[
To observe the clinical effects of CT-guided chemical destructive block of lumbar sympathetic nerve in the treatment of cold sensation of limbs.
In this retrospective analysis, clinical data of 43 patients with cold sensation of limbs treated by lumbar sympathetic chemical destructive block in the Affiliated Hospital of Jiaxing University from January 2015 to January 2018 were collected. The changes of heart rate, non-invasive blood pressure (NIBP), oxygen saturation (SpO2), plantar temperature and peripheral perfusion index (PI) of patients were recorded and analyzed before treatment and 5 min after injection of anhydrous ethanol. The patients were followed up at postoperative 1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years.
Fourty-three patients underwent bilateral lumbar sympathetic nerve chemical destructive block under the CT-guided, and all patients were punctured to the target successfully. The PI of patients before and after treatment were 1.2±0.6, 7.2±3.0 respectively, which was significantly increased after treatment compared with before treatment, and the difference was statistically significant (t=12.386, P<0.05). The plantar temperature of patients before and after treatment respectively were (29.6±1.7)℃, (34.6±1.1)℃, which was significantly increased after treatment compared with before treatment, and the difference was statistically significant (t=15.057, P<0.05). There were no significant differences in heart rate, NIBP and SpO2 between before and after treatment (all P>0.05). Lumbar sympathetic chemical destructive block was clinically effective in 39 patients (90.7%) and ineffective in 4 patients (9.3%). Among the 39 clinically effective patients, the curative effects were excellent in 29 cases and improved in 10 cases. Postoperative recurrence occurred in 10 cases (25.6%). The satisfaction rates of patients at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years after operation were 93.0%, 90.7%, 86.0%, 76.7%, 69.7%, 65.1% and 53.4%, respectively.
Lumbar sympathetic chemical destructive block is a safe and effective way for the treatment of cold sensation of limbs, which can improve the symptoms of cold sensation of limbs to some extent.
To observe the perioperative efficacy of stellate ganglion block (SGB) in functional endoscopic sinus surgery (FESS) in chronic sinusitis patients with hypertension.
A total of 60 patients with chronic sinusitis complicated with hypertension who were scheduled to undergo FESS in the Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University from April 2018 to December 2019 were selected and divided into SGB group and control group by random number table method. SGB were performed at 24 hours before surgery and induction of general anesthesia alternately, while the control group was not treated. During the operation, controlled hypotension were performed in both groups. Hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 24 hours before surgery(T0), before anesthesia induction (T1), at the beginning of surgery (T2), at the end of surgery (T3), and at 24 hours after surgery(T4).Plasma epinephrine and norepinephrine concentrations were measured at T0, T1, T3 and T4. The dosage of anesthesia and other drugs, operative time, bleeding amount and extubation time were recorded, while the quality of the operative field was evaluated. VAS scores were assessed at 1, 6 and 24 hours after surgery.
In the SGB group, SBP, DBP and MAP in T1, T2, T3, T4 and HR in T1, T4 were lower than those in the control group (all P<0.05). Compared with T0, SBP, DBP, MAP and HR in T1, T2, T3, T4 all decreased in SGB group (all P<0.05); In the control group, SBP, DBP and MAP only decreased in T2 and T3, and HR fluctuated significantly (P<0.05). In the SGB group, plasma epinephrine and norepinephrine concentrations at T1, T3 and T4 were lower than those in the control group (P<0.05). Compared with T0, plasma epinephrine and norepinephrine concentrations in the SGB group fluctuated in positive and negative phases, while those in the control group increased (P<0.05). The pain scores in SGB group at 6 and 24 hours after surgery were 1.3±0.7 and 2.6±0.9, which were lower than 1.7±0.7 and 3.1±0.9 in the control group (t=-2.290, -2.050, all P<0.05).
SGB may effectively improve hemodynamics, maintain homeostasis, reduce anesthesia and surgical complications in patients with chronic sinusitis and hypertension in perioperative period.
To investigate the effects of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy.
From December 2019 to April 2020, 60 patients receiving single-port video-assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected. The patients were randomly and equally divided into control group and paravertebral block group using a random number table. Patients of paravertebral block group were injected into the thoracic 4-5 intercostal, paravertebral 1 cm using 0.375% ropivacaine (20 ml) with thoracoscopy-guided at the end of surgery, while patients of control group were given patient controlled intravenous analgesia (PCIA). Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of postoperative adverse reactions, additional dose and times of pethidine, the time to resume eating, the rate of postoperative active cough, the first time to get out of bed after surgery and postoperative hospital stay of two groups′ patients were recorded. t test and chisquare test were used for statistical analysis.
The VAS score of paravertebral block group were lower than those of control group at all time points (all P<0.05). The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points (all P<0.05). The additional dose and times of pethidine of paravertebral block group were (8.2±2.3) mg and (0.2±0.1) time, which were lower than (87.8±15.3) mg and (1.8±0.3) time of control group, the differences were statistically significant (t=28.91, 34.37, all P<0.05). Incidence of nausea, vomiting and pruritus of paravertebral block group were 10.0%, 6.7% and 0, which were lower than 40.0%, 30.0% and 13.3% of control group, the differences were statistically significant (χ2=7.20, 5.45, 4.29, all P<0.05). The rate of postoperative active cough of paravertebral block group was 33.3%, which was higher than 10.0% of control group, the difference was statistically significant (χ2=4.81, P<0.05). The time to resume eating, the first time to get out of bed after surgery and postoperative hospital stay were (6.5±0.4) h, (20.9±3.1) h and (4.6±1.0) d, which were lower than (8.5±0.7) h, (28.6±4.8) h and (6.1±1.3) d of control group, the differences were statistically significant (t=13.47, 7.39, 4.19, all P<0.05).
Thoracic paravertebral block under thoracoscopy-guided can effectively reduce the postoperative pain of single-port thoracoscopic lobectomy, with fewer adverse reactions, and is beneficial to postoperative recovery.
To compare the perioperative blood loss in patients undergoing a total knee arthroplasty (TKA) across three different techniques: computer-assisted navigation surgery (CAS), patient specific instrumentation (PSI) and conventional instrumentation (CI).
Ninety consecutive patients with severe knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital Orthopedics Department from January 2018 to December 2018 were enrolled in this prospective study. The patients were randomly divided into three groups (30 case in each group): CAS-TKA group, PSI-TKA group and CI-TKA group. The study measured intraoperative blood loss, total blood loss, hidden blood loss, decreases of hemoglobin and hematocrit, and the post-TKA blood transfusions in the three groups. One-way ANOVA was used to detect the differences among the cohorts, and LSD was used for the post-hoc test.
The overall intraoperative blood loss of all patients was 6 ml (5~8 ml). The mean total blood loss and hidden blood loss in CAS-TKA group, PSI-TKA group and CI-TKA group was (1 147.0±301.8) and (1 140.1±301.9)ml, (1 044.3±454.1) and (1 038.5±454.0)ml, (1 154.0±483.6) and (1 145.3±482.7)ml, respectively; there was no significant differences among the three groups (F=0.639, 0.616, both P>0.05). There were no patients who received allogeneic blood transfusion. There were no significant differences in decrease of hemoglobin and hematocrit among the three groups neither (both P>0.05).
Compared with conventional TKA, CAS and PSI does not increase the total blood loss of TKA. However, they both demonstrate a potential benefit in reducing blood loss of TKA.
To investigate the relationship between white matter lesions and spatial navigation ability in patients with mild cognitive impairment (MCI).
A total of 32 MCI patients [age (66±11) years, 16 males and 16 females] who were treated in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to February 2018 were selected, and matched with age, gender and education level of 28 healthy controls (NC) [age (70±11) years, 19 males and 9 females] underwent spatial navigation ability test and neuropsychology scale evaluation. In the cross-sectional study, all subjects simultaneously underwent 3.0T magnetic resonance three-dimensional liquid inversion recovery sequence and high-resolution T1 weighted imaging scan. The Wisconsin White Matter Hyperintensities Segmentation Toolbox (W2MHS) was used to automatically mark and extract the volume of the white matter hyperintensity.
The average error distances of egocentric virtual (P=0.002) and allocentric virtual (P=0.039) of MCI patients are greater than that of the control group, but the average error distance of mixed (allocentric-egocentric virtual) navigation had no statistic difference between two groups (P=0.070). The volume of the whole white matter hyperintensity, periventricular white matter hyperintensity, and deep white matter hyperintensity showed no significant differences between two groups (all P>0.05). Partial correlation analysis showed that after controlling for age, gender, education level and whole brain volume, the average error distance of mixed (allocentric-egocentric virtual) navigation in MCI patients was positively correlated to the volume of the whole white matter hyperintensity, deep white matter intensity, and periventricular white matter hyperintensity (r=0.469, 0.434, 0.512, all P<0.05). The average error distance of allocentric virtual navigation is positively correlated with the volume of periventricular white matter hyperintensity (r=0.403, P=0.033). There is no correlation between the average error distance of egocentric virtual navigation and the hyperintensity of white matter.
The spatial navigation ability of patients with MCI is related to white matter lesions, which is of great significance for further research on the potential biological mechanisms affecting human spatial navigation ability.
To investigate the factors related to recanalization of intramural hematoma-type carotid artery dissection (CAD).
Retrospective analysis was performed on 56 patients (61 CADs) with intramural-hematoma type CAD confirmed by multimodal imaging examination based on cervical vascular ultrasound (CDU) in the Stroke Center of the First Affiliated Hospital of Suzhou University from August 2015 to May 2019. The clinical and imaging data were collected, and the time from onset to visit is bounded by 14 days. CDU follow-up was performed at 3, 6, and 12 months after the onset. According to the results of the 12-month follow-up, patients were divided into complete recanalization group and incomplete recanalization group. The clinical data, ultrasonic manifestations and drug treatment of patients between the two groups were compared. Multivariate logistic regression analysis was used to analyze the related factors affecting vascular recanalization.
Vascular recanalization: the rates of complete recanalization at 3, 6 and 12 months were 42.6% (26/61), 55.7% (34/61) and 59.0% (36/61), respectively. While among the 25 vessels in the incomplete recanalization group, 26.2% (16/61) showed residual stenosis and 14.8% (9/61) showed persistent occlusion. Comparison between the complete recanalization group and the incomplete recanalization group: the differences in the proportion of time from onset to visit ≤ 14 days, the echo type of intramural hematoma, and the proportion of vascular occlusion were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the time from onset to visit ≤14 days (OR=5.625, 95%CI: 1.302-24.293, P=0.021), and the hypoechoic intramural hematoma (OR=4.888, 95%CI: 1.304-18.320, P=0.019) were positively correlated with complete recanalization, while the dissection vascular occlusion (OR=0.234, 95%CI: 0.059-0.932, P=0.039) was negatively correlated with complete recanalization.
CDU showed that hypoechoic intramural hematoma-type CAD treated with standard medications in the acute phase had a higher complete recanalization rate, while the recanalization rate of patients with dissecting vessel occlusion decreased. Early evaluation can provide a basis for clinical individualized treatment.
To introduce and evaluate a technique to precisely localize the transverse-sigmoid sinus junction (TSSJ) in retrosigmoid craniotomy.
This was a single-center prospective randomized controlled study. Sixty-three patients, 29 male and 34 female, who would undergo retrosigmoid craniotomy admitted to Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical Universityfrom March to October 2019 were enrolled in the study and were divided into trial group and control group according to the computer-generated random numbers. Preoperative venous computed tomographic angiography (CTA) combined with 3-dimensional computed tomography computed tomography (3D CT) was randomly given to the patients(n=32). Asterion was used for identification of the TSSJ in the controls (n=31). The main outcome measures as postoperative complications and relevant intraoperative indicators were compared.
Incision length, craniotomy time, bone window sizein trial group were shorter or smaller than those of the controls, as(6.8±0.5) cm vs (8.0±1.5) cm, (37±8) min vs (45±15) min, (8.7±1.2) cm2 vs (10.2±2.4) cm2 respectively, with statistical significance (all P<0.05). No statistical significance was found in bleeding amount, incidence of sinus injury and cerebrospinal fluid leakage. While incidence of neck pain was lower in case group (15.63% vs 38.71%;P=0.04) and the remission time of incisional pain in case group was shorter [(6±1) d vs (9±2) d; P=0.01].
While the technique is used, the center of the keyhole should be located at transitional place of the lateral part of the occipitomastoid suture, the retromastoid ridge and the superior nuchal line. Compared with the traditional craniotomy method marked by asterion, it has great advantages in reducing incidence of postoperative complications, craniotomy time, and the remission time of incisional pain.
To investigate the prevalence and predictors of intraplaque hemorrhage (IPH) in ischemic stroke patients with intracranial atherosclerosis.
Ischemic stroke patients with intracranial atherosclerosis who were consecutively admitted to Beijing Tsinghua Changgung Hospital from January 2017 to April 2018 were retrospectively analyzed. High-resolution magnetic resonance vessel wall imaging was used to assess atherosclerotic plaque characteristics of intracranial artery. Possible variables correlated with IPH were compared between IPH and no-IPH groups, as well as in symptomatic IPH and no symptomatic IPH groups. Logistic regression analysis was used to determine the predictors of all IPH and symptomatic IPH in intracranial artery.
A total of 276 ischemic stroke patients with intracranial atherosclerosis were included, of which, 41.3% (114/276) were IPH-postive, and 28.1%(32/114) of them were symptomatic. In multivariate regression analysis, maximum wall thickness was independently associated with the presence of all IPH and symptomatic IPH (OR=2.15, 95%CI: (1.42-3.24) and OR=3.46, 95%CI: (1.94-6.17), respectively).
The prevalence of IPH in ischemic stroke patients with intracranial atherosclerosis is much higher than expected. Moreover, atherosclerosis plaque burden is independently associated with IPH, but it is non-specific in identifying symptomatic IPH.
To evaluate the stress status of femoral head and neck, screws and acetabulum caused by femoral neck shortening after internal fixation of femoral neck fracture with finite element method, and to analyze the stress of proximal femoral neck and acetabulum from the mechanical point of view.
CT scan data of hip of a healthy adult female were collected. Three-dimensional reconstruction MICs and related module function simulation was used to establish the postoperative shortening model of femoral neck fracture with Pauwells angle>50°, which was treated with cannulated screws. The models were divided into four groups: normal femoral neck without shortening, shortening for 2.5 mm, shortening for 7.5 mm and shortening for 12.5 mm. The finite element analysis software MSC. Nastran2012 was used to do the mechanical analysis. The acetabulum surface, femoral head surface, proximal femur and the maximum stress, stress nephogram and other relevant data were collected.
The maximum tensile stress and the maximum stress at the fracture site of the femoral neck increased gradually with the increasing of shortening of femoral neck, however, the maximum compressive stress under the femoral neck and the medial cortex decreased gradually; the maximum stress on the surface of the femoral head was 14.9, 15.0, 16.3 and 16.3 MPa, respectively; the maximum stress on the surface of the acetabulum was 10.1, 10.1 and 10.5,11.7 MPa, respectively.
The mechanical environment of the hip joint changes with femoral neck shortening. With the increasing of femoral neck shortening, the peak stress of the acetabulum increases continuously. When the femoral neck is shortened seriously, the load distribution is uneven and the complex mobility of hip joint is decreased. In addition, the change of shortening might play a role in the necrosis of femoral head.
This paper reports a case of a middle-aged male patient with intermittent fever and fatigue onset, severe hypoalbuminemia in the later stage, and various immune indexes were abnormal. The initial diagnosis of systemic lupus erythematosus and Sjogren's syndrome was systemic lupus erythematosus and Sjogren's syndrome. The fever improved after sufficient glucocorticoids and albumin supplementation, but the hypoalbuminemia was difficult to correct. During hospitalization, the patient suddenly suffered from acute abdomen, which was later confirmed to be small intestinal perforation. The postoperative pathology showed that it was intestinal diffuse large B-cell lymphoma, and the final diagnosis was intestinal diffuse large B-cell lymphoma, which simulated connective tissue disease. For patients with autoimmune diseases with atypical clinical manifestations, if they have a condition that cannot be explained by this disease, they should be highly alert to the possibility of lymphoma. The incidence of lymphoma originating from small intestine is low, the clinical symptoms are occult, and the diagnosis is difficult.
Listeria monocytogenes (LM) is a food-borne conditional pathogen whose infection can lead to listeriosis (LD). This paper reports the diagnosis and treatment of LM isolated from blood culture of a pregnant woman at 16 weeks of gestation and the pregnancy outcome.
Osteoporosis is a common comorbidity of hemophilia, and the incidence probability of hemophilia patients is significantly higher than that of normal people. The main factors of its occurrence are long-term fixation, lack of weight-bearing exercise and blood-borne viral infection, but the specific pathogenesis is not yet clear and needs further research. Preventive treatment requires long-term exercise rehabilitation and prophylactic coagulation factor replacement therapy, while taking anti-osteoporosis drugs and bone health supplements to maintain bone mass.
Pain causes a series of discomfort reactions. During the development of neuropathic pain, a series of abnormal changes can occur in the neuroactivity of undefined zone (ZI) and posterior thalamic nucleus (Po), but the specific mechanism is still unknown. In particular, the exact cell type and molecular mechanism of the ZI-Po neural circuit for pain regulation are still unclear. The study found that parvalbumin (PV) -positive neurons of ventral ZI (ZIv) can project to Po (ZIv-Po), directly participating in and promoting pain behavior, while when the ZIv-Po circuit is selectively inhibited, the basal pain domain of mice increases. Furthermore, it was also found that the axonal ends of the ZIv-Po loop specifically express cannabinoid type 1 receptors (CB1Rs) and that cannabinoids alleviate pain responses through presynaptic inhibition. In further pathological pain models, selective inhibition of the ZIv-Po circuit or injection of cannabinoids in the Po can alleviate pain behavior. These results illustrate the key role of the ZIv-Po circuit in regulating pain behavior and the key mechanism by which endocannabinoids inhibit pain behavior by regulating the ZIv-Po circuit.
The incidence of complications of pancreatic surgery is still high, mainly caused by gastrointestinal complications (such as pancreatic fistula). Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are commonly used for pancreatic surgical analgesia. The study aimed to investigate whether patient-controlled intravenous analgesia reduces the incidence of gastrointestinal complications of pancreatic surgery. 371 patients undergoing elective pancreaticoduodenectomy between June 30, 2015 and October 1, 2017 at nine European pancreatic surgery centers were enrolled. Randomized to PCIA (n =185) and EDA (n=186), using the modified intention-to-treat analysis and completed treatment analysis of 248 patients (124 in each group) from 22 February to 25 April 2019.
Functional magnetic resonance imaging (MRI) and electrophysiological studies have shown that the formation of consciousness depends on large-scale thalamic-cortical and cortical-cortical interactions. However, it is unclear how neurons in different cortical layers and neural circuits function. The study simultaneously recorded the electrical activity of each layer of the centrolateral thalamus (CL) and frontoparietal cortex in rhesus monkeys in waking, sleeping, and anesthetic states, respectively, and found that neurons located in the thalamus and deep cortical layers were most sensitive to changes in the level of consciousness, whether in natural sleep or in unconscious states induced by different anesthetics. Deep cortical neuronal activity is maintained through interactions with the CL region. The level of consciousness also depends on the feedback provided by deep neurons to superficial (rather than deep) neurons, suggesting that remote feedback and intracortical column signaling are very important. To show the causal relationship, the researchers electrically stimulated the CL region of the macaques under anesthesia, which effectively aroused the macaques (or effectively caused the macaques to appear "awake"). The effects of this manipulation depend on the specific site of stimulation and the specific frequency. The study showed that specific layers of the thalamic cortex are associated with consciousness, and in this article, the researchers reported a method to reduce consciousness disorders through targeted deep brain stimulation.
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