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Enhanced recovery after surgery (ERAS) is mainly based on evidence-based medicine to implement a series of measures to optimize perioperative management, reduce patients′ physiological and psychological trauma stress during perioperative period, reduce patients′ functional damage and promote patients′ functional recovery, so as to achieve rapid rehabilitation. ERAS has been widely used in clinic and achieved good clinical results. However, it still faces a series of problems that need further research to clarify the clinical path of ERAS required by different patients and different surgical methods. In particular, it is necessary to strengthen the research on risk factors of ERAS, minimally invasive surgery, goal-directed fluid therapy, anesthesia and postoperative pain management technology, pre rehabilitation and postoperative rehabilitation technology, and implement ERAS guided by the best outcome in the perioperative period.
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It is necessary to use objective and accurate methods to assess the changes of the consciousness of patients emergencing from general anesthesia. In this way, adverse medications during the waking period can be avoided, and it can ensure the stable and safe recovery of consciousness of the patients, quickly remove the adverse factors affecting the patients, and strive to reduce the occurrence of complications during the waking period. This article briefly reviews the research progress of bispectral index and other common clinical anesthesia depth monitoring techniques used to assess the changes of consciousness of patients awakening from general anesthesia, and explores the regular pattern of recovery of consciousness in patients awakening from general anesthesia, in order to reduce complications in the recovery period .
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Objective:To explore the application and effect of the situational case teaching in online internship teaching of anesthesiology.Methods:Thirty-four anesthesiology undergraduates in batch 2015 were randomized into two groups, the experimental group and the control group, with 17 students in each group. The experimental group adopted situational case teaching method, and the control group were taught by the traditional case-based teaching method. The questionnaire survey was used to assess the evaluation of students' personal comprehensive ability and teaching effect on the two groups. The data were analyzed by SPSS 19.0, and the measurement data were expressed by (mean ± standard deviation). Independent sample t test was used for comparison between the two groups, with significant difference when P<0.05. Results:The experimental group is superior than the control group in improvement of learning interest, self-learning ability, comprehensive expression and, communication ability, problem analyzing and solving ability, ability of uniting theory with practice, adaptability, and teamwork ability ( P<0.05). The recognition degree of this teaching mod and teaching effects is also significantly higher than that of the control group ( P<0.05). Conclusion:The situational case teaching mode has achieved good results in the online internship teaching of anesthesiology. This method can stimulate students' learning interest, improve learning efficiency, enhance students' ability of clinical practice and comprehensive quality, and also be beneficial to the improvement of teaching quality.
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This research focuses on the application of multiple interactive modes in online teaching, combined with the actual teaching cases of the anesthesia equipment course of Xiangya Anesthesiology Specialty of Central South University, showing in detail the preparations for interactive teaching before anesthesia equipment learning, the interaction in online classrooms, the extension of interactive teaching outside the classroom, and the evaluation of interactive teaching feedback mechanism throughout the implementation process. By establishing a "host-guest-viewer" mode, the effect of online live broadcasting is maximized. Through the 360-degree materialized explanation with students as the main body, we will make opening in the pain points and blocking points of online teaching in which students do not go to class and students have no thinking, and promote the improvement of online teaching quality and efficiency. In the following practice, we must continue to work on issues such as the improvement of teacher talent quality, the building of an efficient talent team, and the construction of practical application value evaluation systems for teaching.
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Objective To investigate the effects of resveratrol (Res) on motor function and the anterior horn neuron of lumbar spinal cord after acute sciatic nerve compression injury in rats.Methods The rat model with acute sciatic nerve compression injury was established in 32 Sprague Dawley (SD) rats,which were randomly divided into four groups:Res group,Dimethyl Sulfoxide (DMSO) group,Normal Saline (NS) group and sham-operation group.Res,DMSO and saline were successively injected by intraperitoneal for 10 days after established crush acute sciatic nerve compression injury model,while sham-operation group was sutured only after exposure to the sciatic nerve.The weight,the change of toe extension angle,and the sciatic functional index (SFI) of rats were observed at the 1st day before operation and the 1st,3rd,7th,and 10th days after surgery.The expressions of neuron-specific nuclear protein (NeuN) and microtubule-associate protein 2 (MAP2) were detected by immunofluorescent staining of I4-L6 spinal cord anterior horn on the 10th day after surgery.Results No significant changes were found in the weight of rats among four groups.Compared to the sham,the motor function of the injured limb in Res,DMSO,and NS rats was impaired,and the anterior horn neurons were seriously damaged.But the differences of the change of toe extension and the sciatic functional index of rats were significantly higher in Res group than that of the DMSO group and NS group (P ＜ 0.01) at the 3rd,7th,and 10th days after surgery.The expressions of NeuN and MAP2 in the anterior horn of rat lumbar spinal cord were up-regulated in Res group relative to DMSO and NS,and the number of neurons in the lumbar spinal cord was significantly relieved at the 10th days.Conclusions Res was significant to rat model of acute sciatic nerve injury,which could increase the number of neurons in the anterior horn of the spinal cord and help the recovery of motor function.
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Objective To investigate the effects of resveratrol (Res) on motor function and the anterior horn neuron of lumbar spinal cord after acute sciatic nerve compression injury in rats.Methods The rat model with acute sciatic nerve compression injury was established in 32 Sprague Dawley (SD) rats,which were randomly divided into four groups:Res group,Dimethyl Sulfoxide (DMSO) group,Normal Saline (NS) group and sham-operation group.Res,DMSO and saline were successively injected by intraperitoneal for 10 days after established crush acute sciatic nerve compression injury model,while sham-operation group was sutured only after exposure to the sciatic nerve.The weight,the change of toe extension angle,and the sciatic functional index (SFI) of rats were observed at the 1st day before operation and the 1st,3rd,7th,and 10th days after surgery.The expressions of neuron-specific nuclear protein (NeuN) and microtubule-associate protein 2 (MAP2) were detected by immunofluorescent staining of I4-L6 spinal cord anterior horn on the 10th day after surgery.Results No significant changes were found in the weight of rats among four groups.Compared to the sham,the motor function of the injured limb in Res,DMSO,and NS rats was impaired,and the anterior horn neurons were seriously damaged.But the differences of the change of toe extension and the sciatic functional index of rats were significantly higher in Res group than that of the DMSO group and NS group (P ＜ 0.01) at the 3rd,7th,and 10th days after surgery.The expressions of NeuN and MAP2 in the anterior horn of rat lumbar spinal cord were up-regulated in Res group relative to DMSO and NS,and the number of neurons in the lumbar spinal cord was significantly relieved at the 10th days.Conclusions Res was significant to rat model of acute sciatic nerve injury,which could increase the number of neurons in the anterior horn of the spinal cord and help the recovery of motor function.
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Pain has been defined as an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage,or is described in terms of such damage.Pain individual difference increases the complexity of clinical diagnosis and treatment of pain.China started relatively late on pain research and standardized pain treatment.It is necessary for further research on pain related to the clinical problem,the development of pain translational medicine,and improvement of clinical quality.The paper carries on the review.
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Objective To investigate the effects of maternal behaviors in the rats with neuropathic pain (NP) on emotions of offspring rats and the relationship with DNA methylation in the amygdala.Methods Forty-eight healthy adult Sprague-Dawley rats (24 males and 24 females),weighing 200-250 g,were used in the study.Twelve female and 12 male rats were randomly selected,and NP was induced by chronic constriction injury (CCI).Each female rat was mated with one male rat at 10 days after CCI.Fortyeight F1 generation rats of maternal rats with NP were randomly divided into 2 groups (n =24 each) using a random number table:NP1 group and NP2 group.Forty-eight F1 generation rats of normal maternal rats were randomly divided into 2 groups (n=24 each) using a random number table:S1 group and S2 group.The F1 generation rats were cross-fed immediately after birth between group NP2 and group S2,and fed by their own mother rats in NP1 and S1 groups.All the offspring rats were fed to 21 days after birth by the maternal rats selected,and separately fed to 30 days after birth,and then subjected to behavioral testing.Retrieving and licking pups were recorded after delivery in maternal rats to evaluate the maternal behaviors.The mechanical and thermal paw withdrawal thresholds were measured in the offspring rats.Elevated plus maze and open field tests were conducted to detect anxiety and depression behaviors in the offspring rats.At 1 day after completion of behavioral testing,the expression of DNA methyltransferase 1 (DNMT1) and DNA methyltransferase 3a and 3b in the amygdala was detected by Western blot analysis.Results Compared with S1 or S2 groups,the latency to lick pups,latency to retrieve pups,and total retrieval time were significantly prolonged,and the total time spent licking pups was significantly shortened in NP1 group or NP2 group (P＜0.05 or 0.01).There was no significant difference in the mechanical and thermal paw withdrawal thresholds in the offspring rats between the four groups (P＞0.05).Compared with group S1,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Compared with group NP2,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Conclusion Decreased maternal behaviors in the rats with NP results in negative emotions including anxiety and depression in the offspring rats,and the mechanism is related to increased DNA methylation in the amygdala of the offspring rats.
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Objective To study the type variation of microglial activation in spinal dorsal horn of rats after sciatic nerve injury.Methods Healthy adult male Sprague-Dawley rats were randomly divided into the control and experimental groups, 24 rats in each group.The experimental group underwent ligation of sciatic nerve trunk to generate nerve injury in the rats.The pain behavior in the rats was measured at the 1th, 7th and 14th postoperative days, and the changes of microglial activation in the rat lumbar spinal cord dorsal horn was detected by immunofluorescence staining.qRT-PCR assay was used to validate the activation trends of M1 and M2 types of microglia cells.Results No significant changes were found in the microglial cells in the spinal cord dorsal horn of rats in the sham-operation group during 14 days after operation.In the sciatic nerve ligation group at 1 day after operation, no significant change was observed in the number of microglial cells, but the expression of marker of M1 microglia was significantly increased.At 7 and 14 days after operation, the number of microglial cells and the expression of M1 microglia marker in the spinal cord dorsal horn were increased significantly.Conclusions Microglia activation in the spinal dorsal horn starts at the first day after sciatic nerve injury, and lasts at least for two weeks after the operation.M1 microglia activation dominates during this period.
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Objective To explore the role of spinal cord p300 in neuropathic pain induced by chronic constriction nerve injury (CCI) in rats.Methods Thirty two Sprague-Dawley (SD) rats were randomly divided into sham and CCI groups,14 days after surgery,immuno-fluorescence staining and Western blot were used to detect distribution and expression of p300 protein.After rats were successfully implanted with an intrathecal catheter and accepted CCI surgery,another 24 rats were randomly divided into three groups (n =8):dimethyl sulfoxide (DMSO) group,p300 acetyltransferase inhibitor C646 group,and control C37 group.Each rat were administered through the intrathecal catheter from day 7 to 14 and mechanical withdraw threshold were tested.Results (1) The p300 positive cells were detected mainly in neurons,and p300 protein in spinal cord of CCI group were significantly higher than sham group (P ＜0.05).(2) C646 alleviated significantly neuropathic pain in rats,without significant changes in pain threshold after injection of C37 and DMSO.Conclusions The p300 protein in spinal cord was involved in the development of neuropathic pain in rats,the mechanism may be referred to its acetyltransferase activity.
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Objective To evaluate the changes in the expression of acetylated histone H3 (Ac-H3) and deacetylase silent information regulator 1 (SIRT1) in dorsal root ganglions in a rat model of negative phenotype neuropathic pain.Methods Forty-eight male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 2 groups (n =24 each):sham operation group (group S) and C-fiber dysfunction group (group CFD).The rats were anesthetized with 10％ chloral hydrate 3 ml/kg.C-fiber dysfunction was induced by exposing sciatic nerve to 8％ capsaicin for 30 min in group CFD.The thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT) were measured before and on 1,3,7 and 14 days after CFD.Six rats were then sacrificed at each time and the lumbar segments (L5) of the dorsal root ganglions were removed for detection of SIRT1 mRNA expression (by RT-PCR) and Ac-H3 and SIRT1 protein expression (by Western blot).Results Compared with group S,TWL was significantly increased at 1,3,7 and 14 days after CFD,SIRT1 mRNA and protein expression was up-regulated and Ac-H3 expression was down-regulated at 3,7 and 14 days after CFD (P ＜ 0.05),while no significant change was found in MWT at each time point in group CFD (P ＞ 0.05).Conclusion The mechanism of negative phenotype neuropathic pain is related to up-regulation of deacetylase SIRT1 expression and decreased acetylation of histone H3 in rat dorsal root ganglions.
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Objective:To investigate the changes of cyclooxygenase-2 (COX-2) expression in the spinal cord dorsal horn atfer intrathecal a speciifc p38MAPK inhibitor-SB203580 on neuropathic pain in rats induced by chronic constrictive injury (CCI) to the sciatic nerve. Methods:Twenty-four male SD rats atfer intrathecal catheter placement were randomly divided into 4 groups:a sham group with sham surgery, the neuropathic pain model of a NS group, a DMSO group and an SB group were established by CCI to sciatic nerve. NS or DMSO or SB203580 was injected IT NS or 2%DMSO or SB203580 twice a day for 5 consecutive days starting at 6th day when the model of chronic constrictive injury was established. Mechanical stimuli were measured before the surgery and on 1st, 3rd, 5th, 7th, 9th, and 11th day atfer the surgery. hTen all rats were sacriifced and the lumbar segment of spinal cord was removed to determine the COX-2 expression in the dorsal horn by immunocytochemistry. Results:Day 1 to 11 after the surgery, the threshold to mechanical on the surgery side was signiifcantly lower in the NS group and the DMSO group than in the sham group. Day 7 to 11 atfer the sugery, the threshold to mechanical on the surgery side was signiifcantly lower in the SB group than in the NS group and the DMSO group. hTe expression of spinal COX-2 was higher in the NS group and the DMSO group than in the sham group, but lower in the SB group than in NS group and the DMSO group. Conclusion:Intrathecal administration of SB203580 has signiifcant analgesic effect in the CCI rat model. Expression of COX-2 is signiifcantly reduced when p38MAPK is inhibited by intrathecal SB203580, and p38MAPK stimulation is essential for COX-2 expression.
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Objective To evaluate the role of CREB-binding protein (CBP) in cyclooxygenase 2 (COX-2) expression in spinal cord in a rat model of neuropathic pain (NP).Methods Forty male SD rats weighing 220-250 g in which intrathecal catheter was successfully implanted were randomly divided into 4 groups (n=10 each):sham operation group (group Sham),group NP,negative control group (group NC) and group CBP.NP was induced by CCI at 5 days after successful implantation of the intrathecal catheter.Normal saline,negative lentivirus vector (RNAi-NC-LV) and CBP shRNA lentivirus vector (CBP RNAi-LV) 20 μl were injected intrathecally at 7 days after CCI in groups NP,NC and CBP,respectively.Paw withdrawal threshold to mechanical stimuli (MWT)and paw withdrawal latency to thermal stimulus (TWL) were measured at 1 day before operation and at 3,5,7,10,12 and 14 days after operation.The rats were sacrificed after the measurement of MWT and TWL at 14 days after operation and the lumbar segment of the spinal cord was then removed for determination of the expression of CBP,acetylated histone H3/H4 (Ac-H3,Ac-H4) and COX-2 protein (by immunohistochemistry),and CBP and COX-2 mRNA (by RF-PCR).Results Compared with group Sham,MWT and TWL were significantly decreased at different time points after operation in groups NP,NCand CBP,and the expression of CBP,Ac-H3,Ac-H4 and COX-2 protein,and CBP and COX-2 mRNA was up-regulated at 14 days after operation in groups NP and NC (P ＜ 0.05).Compared with group NP,MWT and TWL were significantly increased at 10,12 and 14 days after operation and the expression of CBP,Ac-H3,Ac-H4 and COX-2 protein,and CBP and COX-2 mRNA was downregulated at 14 days after operation in group CBP (P ＜ 0.05).Conclusion CBP is involved in the development of NP by up-regulating COX-2 expression and increasing histone H3 and H4 acetylation in spinal cord.
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OBJECTIVE@#To investigate the incidence of awareness during general anesthesia and analyze the risk factors in anesthetic practice and patient populations.@*METHODS@#A total of 2 300 patients who underwent general anesthesia were included. Perioperative data and anesthetic drugs were collected prospectively. Patients were interviewed twice postoperatively with the same structured questionnaire. Each patient was classified into categories as no awareness, possible awareness, and awareness.@*RESULTS@#Twenty-one patients (0.91%) definitely reported awareness, and another 205 (8.91%) reported possible awareness. Few of the patients with awareness required psychological intervention. ASA physical status III-IV and propofol maintenance were associated risk factors of awareness.@*CONCLUSION@#The incidence of intraoperative awareness is high in the clinical practice in major medical centers.
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Adult , Female , Humans , Male , Middle Aged , Anesthesia, General , Anesthetics, Intravenous , Awareness , China , Epidemiology , Incidence , Intraoperative Complications , Epidemiology , Propofol , Risk FactorsABSTRACT
OBJECTIVE: To investigate the factors affecting shoulder joint functions following artificial humeral head replacement. METHODS: A total of 22 patients with complex fracture of proximal humerus, managed by humeral head replacement in Changhai Hospital of The Second Military Medical University from June 2006 to December 2008 were collected, including 12 males and 10 females, with average age of 67 years (52-86 years). During the procedure, soft tissue damage was minimized, the bone of the tuberosity was reserved as much as possible, appropriate matching size of humerus head prosthesis was selected, and early staging functional rehabilitation was performed. Neer's scoring system was used to evaluate the treatment results after replacement. RESULTS: The 22 patients were followed up for 10-30 months, mean 22.6 months. The shoulder joint functions of 14 cases were recovered more quickly through early post-operative staging rehabilitation, No shoulder joint unstable and stiff occurred. The shoulder joint functions of 8 cases were recovered slowly as they complained pain and did not perform early physical therapy after surgery, shoulder joint of 2 cases presented little unstable and 1 case presented stiff. Only 4 cases of all complained occasionally slight shoulder pain, but could continue daily work. The mean movement ranges of shoulder were as follow: mean flexion for 96°(80°-103°), mean extension for 38° (32°-45°), mean abduction for 86°(80°-110°), mean adduction for 31°(30°-35°), mean external rotation for 32°(30°-37°) and internal rotation for 42° (10°-75°). No vasculardamage, nerve damage, lessening prosthesis or prosthesis dislocation was found in all cases. Based on Neer's scoring system, 5 cases were rated as excellent, 11 as good and 4 as fair, with excellent rate of 82% and case satisfaction rate of 87%. CONCLUSION: In order to recover maximally the shoulder joint functions for post-artificial humeral head replacement, we must try our best to avoid soft tissue damage, reserve the bone of the tuberosity, select appropriate humerus head prosthesis, perform early post-operative staging rehabilitation, as well as maintain a normal retroversion of the prosthesis.
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BACKGROUND: Skinfold thickness instrument was used to analyze the distribution and development of subcutaneous fat. This method is simple, economic, and widely used. OBJECTIVE: To investigate the body fat development and age changes in female adults from Maonan nationality in Guangxi province. DESIGN, TIME AND SETTING: The cluster sampling investigation was performed at the Department of Anatomy, Basic College, Youjiang Medical College for Nationalities from September to October 2006. PARTICIPANTS: Using random sampling method, 533 healthy adult females of Maonan nationality and aged 25-75 years were selected from Huanjiang county of Guangxi province. They all live in Huanjiang count for over 10 years and their parents were also Maonan nationality. Taking five years were served as a group, totally 10 groups. METHODS: The indexes were measured and calculated by professionals according to Handbook of Human Measure. The equipment was modified skinfold thickness instrument. The database was set up in computer. MAIN OUTCOME MEASURES: Skinfold thickness of triceps brachii, anterior superior iliac spine, inferior angle of scapula and gastrocnemius. Four indexes were compared with other groups in China. RESULTS: The torso skinfold was thicker than limb ones. Skinfold thickness decreased with age after it came to the maximum. Compared with other minornationalities, the skinfold of Maonan adult females in Huanjiang of Guangxi province was thinner than Daur and Uzbek, but thicker than Bouyei nationality. CONCLUSION: The skinfold thickness of Chinese Maonan nationality in Guangxi province has a wavy change. It is thicker than Bouyei nationality and thinner than those in Dong nationality and Daur nationality and Uzbek nationality.
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Objective To investigate the Allelic and haplotype frequency distribution of seventeen short tandem repeat loci of Y chromosome in Heiyi Zhuang ethnic groups in Guangxi province.Methods Seventeen Y-STR loci,of which the template DNAs were extracted from blood samples of 184 unrelated male individuals in Heiyi Zhuang population,were amplified by using the AmpFlSTR YfilerTM.The PCR products were genotyped with ABI PRISM 310 genetic analyzer.Results The Gene diversity ranged from 0.4910 to 0.9727 at DYS456、DYS389Ⅰ、DYS390、DYS389Ⅱ、DYS458、DYS19、DYS385a\b、DYS393、DYS391、DYS439、DYS635、DYS392、Y-GATA-H4、DYS437、DYS438、DYS448.A total of 180 different haplotypes were observed,The haplotype diversity value calculated from all 17 loci was 0.99976.The significant difference of the allelic frequency distribution in Y-STR loci was found between Heiyi Zhuang population and other observed populations.Conclusion The 17th Y-STR loci in Heiyi Zhuang population of Guangxi province are highly affluent genetic polymorphic and can offer valuable genetic datas for paternity testing and paternal genetic lineages evolution.