Comparative retrospective review of perioperative analgesia using ultrasound-guided programmed intermittent erector spinae plane block for video-assisted thoracoscopic lobectomy.

BACKGROUND: The retrospective cohort study was conducted to estimate the opioid-sparing anesthesia and limited side-effects with ultrasound (US)-guided ESPB using programmed intermittent bolus (PIB) or continuous infusion (CI) and standard opioid-based anesthesia in patients undergoing video-assisted thoracoscopic lobectomy (VATS). METHODS: Patients underwent VATS were stratified into either control group or one of the two ESPB groups in a 1:2:2 ratio depending on whether PIB was implemented or not. The primary endpoint was intra- and post-operative opioids consumption over the first 48 h following surgery. RESULTS: A total of 180 cases were included in the analysis. Cumulative perioperative opioid administration was found to be significantly different between PIB, CI and control group (both p < 0.001), and between PIB and CI group (p = 0.028). More specifically, the mean was 305.30 ± 51.35 mg, 339.68 ± 56.07 mg and 468.91 ± 79.84 mg in PIB, CI and control group. NRS scores at rest across all postoperative times were comparable in two ESPB groups, while significantly lower than control group, however, scores during exercising at postoperative 3, 6, 12 h were significantly lower in PIB group as compared to CI group. A wider anesthetized dermatomes with PIB was observed at 6, 24 and 48 h as opposed to the CI. The mean of levobupivacaine plasma concentration was significantly lower for PIB at postoperative 0.5, 12, 24 and 48 h after initiation than CI. However, local anesthetic toxicity was not observed in any of the two ESPB groups. CONCLUSIONS: When US-guided ESPB using PIB was performed preoperatively, it contributed to the minimization of intra- and post-operative opioid consumption due to better analgesia with a wider anesthetic dermatome opposed to conventional CI, whereas, it was also associated with lower risk of local anesthetic toxicity because of lower plasma concentration of levobupivacaine.

Segmentation and Completion of Human Motion Sequence via Temporal Learning of Subspace Variety Model.

Subspace-based models have been extensively employed in unsupervised segmentation and completion of human motion sequence (HMS). However, existing approaches often neglect the incorporation of temporal priors embedded in HMS, resulting in suboptimal results. This paper presents a subspace variety model for HMS, along with an innovative Temporal Learning of Subspace Variety Model (TL-SVM) method for enhanced segmentation and completion in HMS. The key idea is to segment incomplete HMS into motion clusters and extracting the subspace features of each motion through the temporal learning of the subspace variety model. Subsequently, the HMS is completed based on the extracted subspace features. Thus, the main challenge is to learn the subspace variety model with temporal priors when confronted with missing entries. To tackle this, the paper develops a spatio-temporal assignment consistency (STAC) constraint for the subspace variety model, leveraging temporal priors embedded in HMS. In addition, a subspace clustering approach under the STAC constraint is proposed to learn the subspace variety model by extracting subspace features from HMS and segmenting HMS into motion clusters alternatively. The proposed subspace clustering model can also handle missing entries with theoretical guarantees. Furthermore, the missing entries of HMS are completed by minimizing the distance between each human motion frame and its corresponding subspace. Extensive experimental results, along with comparisons to state-of-the-art methods on four benchmark datasets, underscore the advantages of the proposed method.

Emergent surgical retrieval of a left atrial appendage occluder migrated into the left ventricular outflow tract with secondary massive mitral regurgitation: A case report and literature review.

Thrombotic complications of atrial fibrillation continue to pose a significant challenge in clinical practice today. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative to oral anticoagulation for high-risk patients with atrial fibrillation. However, despite the potential benefits, there is still the possibility of life-threatening complications such as device dislocation. In this case study, we present a patient who experienced severe hemodynamic disturbances due to the embolization of LAAO device into the left ventricular outflow tract, resulting in a torn mitral valve and secondary massive mitral regurgitation, just 3 hours after the procedure. As a result, emergent surgical intervention was required to remove the device and repair the mitral valve. We also conducted a review of previous studies on the retrieval of dislodged left atrial appendage occluders through surgical procedures. It is crucial to maintain vigilance, foster interdisciplinary collaboration, and respond promptly to ensure the safety and efficacy of LAAO procedures.

Spatio-Temporal Contextual Learning for Single Object Tracking on Point Clouds.

Single object tracking (SOT) is one of the most active research directions in the field of computer vision. Compared with the 2-D image-based SOT which has already been well-studied, SOT on 3-D point clouds is a relatively emerging research field. In this article, a novel approach, namely, the contextual-aware tracker (CAT), is investigated to achieve a superior 3-D SOT through spatially and temporally contextual learning from the LiDAR sequence. More precisely, in contrast to the previous 3-D SOT methods merely exploiting point clouds in the target bounding box as the template, CAT generates templates by adaptively including the surroundings outside the target box to use available ambient cues. This template generation strategy is more effective and rational than the previous area-fixed one, especially when the object has only a small number of points. Moreover, it is deduced that LiDAR point clouds in 3-D scenes are often incomplete and significantly vary from frame to another, which makes the learning process more difficult. To this end, a novel cross-frame aggregation (CFA) module is proposed to enhance the feature representation of the template by aggregating the features from a historical reference frame. Leveraging such schemes enables CAT to achieve a robust performance, even in the case of extremely sparse point clouds. The experiments confirm that the proposed CAT outperforms the state-of-the-art methods on both the KITTI and NuScenes benchmarks, achieving 3.9% and 5.6% improvements in terms of precision.

Pulmonary Artery Pressure and Variations in Arterial Blood Pressure During the Induction Period of General Anesthesia in Elderly Patients.

OBJECTIVE: To determine the correlation of old age, pulmonary artery pressure (PAP) and mean arterial blood pressure (MABP) during anesthetic induction in elderly patients. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Central Hospital affiliated to Chongqing Medical University from September 2016 to September 2019. METHODOLOGY: A total of 75 elderly patients with pulmonary hypertension, who underwent surgery under general anesthesia, were inducted. Each 25 patients were allocated into 65-74 years, 75-84 years, and ≥85 years groups. PAP was invasively measured using a right heart floating catheter before induction, while MAP was measured using an invasive radial artery catheter at one minute before and within five minutes after anesthetic induction. RESULTS: PAP and PAMP, both increased with age (p <0.001). MAP at one minute before induction significantly increased with aging, while MAP measured at 1, 3 and 5 minutes after anesthetic induction, exhibited tendencies of significant decrease with aging (p <0.05). The correlation analysis results revealed that mean MAP during anesthesia induction was significantly associated with PASP before induction (r = -0.384 and -0.532 for Kendall and Spearman correlation analyses; both p<0.05). CONCLUSION: Increased PAP may be involved in the association between with aging and increased risk of hypotension during induction. Key Words: General anesthesia, Hypotension, Pulmonary arterial blood pressure, Old age.

Effect of Intravenous Lidocaine Infusion on Postoperative Early Recovery Quality in Upper Airway Surgery.

OBJECTIVES/HYPOTHESIS: Systemic infusions of lidocaine have been widely used as perioperative analgesic adjuvants. The aim of this randomized, double-blinded, controlled trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality in upper airway surgery. STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled trial. METHODS: A total of 99 patients were randomly assigned to the lidocaine group (group L) or the control group (group C). The patients received 2 mg/kg lidocaine completed within 10 minutes before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hr lidocaine (group L) or the same volume of 0.9% normal saline (group C) intravenously during anesthesia. The Quality of Recovery-40 (QoR-40) survey was administered on the preoperative day (Pre) and postoperative days 1 (POD1) and 2 (POD2). The primary endpoint was QoR-40 score on POD1 and POD2. RESULTS: Compared with Pre, global QoR-40 scores on POD1 and POD2 were significantly lower (P < .05). Compared with group C, global QoR-40 scores were significantly higher in group L on POD1 and POD2 (P < .05). Among the five dimensions of QoR-40, the scores for physical comfort, emotional state, and pain were superior in group L compared to group C (P < .05). Compared with group C, the consumption of remifentanil and diclofenac as well as the incidence of postoperative nausea and vomiting (PONV) and postoperative 48-hour numeric rating scale (NRS) scores in group L were significantly lower (P < .05). CONCLUSIONS: Systemic lidocaine infusion can improve QoR-40 scores in patients with upper airway surgery, reduce the dosage of intraoperative opioids, decrease the incidence of PONV and NRS scores 2 days after surgery, thus improving postoperative early recovery quality. LEVEL OF EVIDENCE: 1b Laryngoscope, 131:E63-E69, 2021.

Effect of High Suspension and Low Incision Surgery Based on Traditional Ligation of Chinese Medicine in Treatment of Mixed Haemorrhoids: A Multi-centre, Randomized, Single-Blind, Non-inferiority Clinical Trial.

OBJECTIVE: To observe the clinical effect of high suspension and low incision (HSLI) surgery on mixed haemorrhoids, compared with Milligan-Morgan haemorrhoidectomy. METHODS: A multi-centre, randomized, single-blind, non-inferiority clinical trial was performed. Participants with mixed haemorrhoids from Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing Rectum Hospital, Air Force Medical Center of People's Liberation Army of China, and Puyang Hospital of Traditional Chinese Medicine were enrolled from September 2016 to March 2018. By using a blocked randomization scheme, participants were assigned to two groups. The experimental group was treated with HSLI, while the control group was treated with Milligan-Morgan haemorrhoidectomy. The primary outcome was the clinical effect evaluated at 12 weeks after operation. The secondary outcomes included the number of haemorrhoids treated during the operation, pain scores, use of analgesics, postoperative oedema, wound healing, incidence of anal stenosis, anorectal manometry after operation, as well as surgical duration, length of stay and total hospitalization expenses. A safety evaluation was also conducted. RESULTS: In total, 246 eligible participants were enrolled, with 123 cases in each group. There was no significant difference in the clinical effect between the two groups (100.00% vs. 99.19%, P>0.05). Compared with the control group, the number of external haemorrhoids treated during the operation and the pain scores after operation were significantly reduced in the experimental group (P<0.05 or P<0.01); the patient number with wound healing at 2 weeks after operation and the functional length of anal canal at 12 weeks after operation were significantly increased in the experimental group (P<0.05). There was no significant difference in the incidence of anal stenosis, the numbers of patients using analgesics and patients with postoperative oedema between the two groups after operation (P>0.05). The surgical duration and length of stay in the experimental group were significantly longer than those in the control group, and the total hospitalization expense was significantly higher than that in the control group (all P<0.05). No adverse events were reported in either group during the whole trial or follow-up period. CONCLUSION: HSLI had the advantages of preserving the skin of anal canal completely, alleviating postsurgical pain and promoting rapid recovery after operation. (Registration No. ChiCTR1900022883).

[Construction of prokaryotic expression vector of HPV16E6 gene and its expression].

Prokaryotic expression vector of mouse HPV16E6 gene was constructed. A pair of primers were designed according to the digestion sites in plasmid pGEX-KG and the HPV16E6 gene sequence published by GenBank. The DNA fragment of 321bp was amplified by PCR from the HPV recombinant plasmid with HPV16E6 gene, then cloned into pGEX-KG and transformed into the host E. coli strain JM109. The fragment was conformed to the original sequence, which indicated that fusion expression vector pGEX-KG-HPV16E6 was constructed. The pGEX-KG-HPV16E6 plasmid was taken and transformed into BL21(DE3) for expression. Induced by IPTG at 37 degrees C, the expression product of HPV16E6 gene was identified by SDS-PAGE and Western blot. HPV16E6 fusion protein had been expressed successfully in the form of inclusion bodies, the molecular weight of fusion protein being 38 kD. Meanwhile, the optimum condition of HPV16E6 fusion protein expression was induced with 1.0 mmol/L IPTG for 4h. The fusion protein reacted specifically with the antibodies against HPV16E6. HPV16E6 gene was successfully expressed in E. coli, which could be used as a basis for preparing HPV16E6 vaccine in human.

Research on a physical activity tracking system based upon three-axis accelerometer for patients with leg ulcers.

Venous leg ulcerations are a common problem, with high prevalence in the middle-aged and elderly population, and more attention on research of their physical activities has been paid, as they have great effects on the blood circulation of the lower limb. With enough, appropriate training, the chronic venous ulcerations in the lower limb can be avoided and alleviated, and venous hypertension can be reduced effectively. The study deals with a physical activity tracking system for the patients based on a three-axis accelerometer. The system uses a three-axis accelerometer, a microcontroller, and a wireless Bluetooth module to form a data acquisition platform to acquire accelerations of the lower limb movement, and sends it to a smart mobile phone via the wireless Bluetooth module. The system takes advantages of the smart mobile phone to guide the chronic venous leg ulcers to do prescribed rehabilitation exercises for the lower limb muscles, perform acceleration data preprocessing, wavelet transform and reconstruction, denoising and feature extraction, obtain the results of the rehabilitation exercises, and then give reasonable evaluation and judgment. It is helpful to treat underlying venous reflux, create such an environment that allows skin to grow across an ulcer, and accelerate ulcer healing process consequently.