A survey of chronic pain in China.

There is an extensive body of research about chronic pain and treatment in developed countries. In contrast there is a lack of research on this topic in developing countries including China. This study was aimed to estimate the prevalence of chronic pain in different regions of China. Data on pain and its treatment were collected from 9357 participants using questionnaires and telephone-based interviews, from 31 regions of China. Gathered data were then coded into electronic data acquisition system and descriptive and inferential statistical analysis was performed. Out of 9298 participants, the ratio of chronic pain was 31.54% with the proportion of male having chronic pain (33.86%) was higher than that of female (29.53%). The average age of participants with pain (45.02 ± 15.07 years) was higher than free-pain participants (36.19 ± 11.12 years). There were also significant differences between groups in occupation, education levels, and illness history. Proportion of patients with pain duration of 1 year was 12.104%, between 1 and 5 years was 60%, and over 10 years was 10.74%. There were 63.9% of patients with moderate pain and 36.1% with severe pain. About 43.042% of patients thought that pain resulted in sleep disorder, 38.99% thought that it causes anxiety, and about 33% thought depression and irritable bowel was the result of their pain. For the chronic pain, more than half of patients used naprapathy, cupping, and other physical therapies. Up to 2016, the ratio of pain incidence was over 30% in China. The location of pain was focused on back and upper limb. There has been a lack of proper treatment. Patients with pain had obvious economic burden, and their quality of life and psychology were significantly affected.

The role of intercellular transfer of P-glycoprotein in tumor drug resistance / 肿瘤研究与临床

Multidrug resistance is a major cause of clinical failure of tumor chemotherapy, study on the mechanisms of tumor multidrug resistance has been becoming a fascinating area in the field of tumor chemotherapy. The tumor multidrug resistance is generally considered to be due to the gene mutation, amplification or epigenetic changes that affect the uptake , metabolism or excretion of tumor drugs . P-glycoprotein is a transmembrane glycoprotein encoded by multidrug resistance gene MDR1, which leads to the principal contributor to tumor multidrug resistance. Research suggests that P-glycoprotein can metastasize through the tumor cells, thereby affecting tumor resistance. This article reviews the role of intercellular transfer of P-glycoprotein in tumor drug resistance.

The Mechanism of Occurrence and Rehabilitation of Heel Pain Based on Finite Element Method / 医用生物力学

Objective To investigate the mechanism of occurrence and rehabilitation of heel pain, so as to provide a theoretical basis for the effectiveness of heel pain treatment. Methods The CT and MRI data acquired from feet and knees of patients with heel pain were reconstructed to establish the bone-muscle composite finite element model. Based on the established model, the effect of calf muscle contracture on biomechanical properties of the foot and ankle was simulated by using the finite element method . Results When the calf muscles produce upward lifting power, plantar pressure was transferred from the heel area to the forefoot area, and there was no significant difference in pressure distribution by different combination schemes of muscle forces. The strain of the plantar fascia was increased, with stress concentration on the calcaneus surface. Under 240 N force, the peak stress at the Achilles tendon attachment position and the calcaneus nodules was up to 10.82 MPa and 11.2 MPa, respectively. Conclusions The stress concentration in calf muscles and Achilles led to the changes in biomechanics of the ankle, which resulted in heel pain. The method of improving the overall biomechanical environment by releasing concentrated stress to restore the position of the bones and joints of the ankle joint is the mechanism for rehabilitation of heel pain.

Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds.

BACKGROUND: The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation. METHODS: Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed. RESULTS: The skin expansion rate was 1:9-1:16, and the mean area of wounds repaired after three weeks was 64.8±7.3%TBSA, the wound healing rate was 91.8±3.7%. The mean area of the early excision group was 65.9±9.8 TBSA, where the healing rate was 94.5±5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1-2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304±2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities. CONCLUSIONS: Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds.

Clinical reserch of stroke-associated pneumonia prevented with ramipril / 中华老年医学杂志

Objective To investigate the prevention of stroke-associated pneumonia (SAP) with Ramipril.Methods 404 acute stroke patients with primary hypertension were randomized into two groups.Group A received ramipril 2.5 mg once daily orally,and then were titrated up to 5 mg/d after a week.Group B received Candesartan 4 mg once daily orally,and then were titrated up to 8 mg/d after a week.The treatment course was 28 days.All patients received examination of Standardized Swallowing Assessment (SSA).The amelioration of swallow function and incidence of SAP after treatment were compared between the two groups.Results There were 10 patients suffering from SAP in group A and 21 patients in group B.The incidence of SAP was lower in group A(5.0％)than in group B(10.4％)(P＜0.05).The positive rate of SSA was 87.1 ％ in patients with SAP,higher than the total rate (47.5％).Dysphagia was improved in both groups after treatment.The rate of dysphagia improvement in group A and group B was 81.4％ and 66.3％ respectively.There was significant statistics difference in the positive case of SSA between two group (P＜ 0.05).Conclusions Orally treatment with ramipril is effective to prevent stroke-associated pneumonia and toimprove swallow function.

Effect of acupuncture on vascular permeability in patients undergoing open heart surgery under CPB / 中华麻醉学杂志

Objective To investigate the effect of electro-acupuncture (EA) on vascular permeability in patients undergoing open-heart surgery with CPB. Methods Thirty-two NYHA class Ⅰ or Ⅱ and ASA class Ⅱ or Ⅲ patients with BMI of 19-28 kg/m2 undergoing open heart surgery with CPB were randomly divided into 2 groups ( n = 16 each): Ⅰ control group and Ⅱ acupuncture group . The patients were premedicated with intramuscular phenobarbital 0.1 g, pethidine 50 mg and scopolamine 0.3 mg. Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with TCI of propofol and fentanyl in both groups. The patients were acupuncture points (neiguan, lieque, yunmen) were selected for stimulation with stimulator. Acupuncture stimulation was started from 30 min before anesthesia induction and continued until the end of operation. The level of sedation was monitored by BIS and maintained at 40-60 during operation. Urinary microalbumin concentration was used as a parameter of vascular permeability, and was measured before and at the end of operation. Blood samples were taken 24 h before and 24 h after operation for measurement of ALT, AST, total bilirubin, BUN and Cr. Results The two groups were comparable with respect to sex ratio, age, body weight, ASA physical status, and preoperative ejection fraction. There was no significant difference in renal and liver function between the 2 groups.Postoperative urinary microalbumin concentration was significantly lower in acupuncture group than in control group. Conclusion Acupuncture can reduce the effect of open heart surgery performed under CPB on vascular permeability.

Low hematocrit worsens cerebral injury after prolonged hypothermic circulatory arrest in rats.

PURPOSE: This study tests the hypothesis that low hematocrit (Hct) worsens cerebral injury after prolonged hypothermic circulatory arrest (HCA) in rats, and the mechanism involves variable expression of the genes C-Fos, Bcl-2 and Bax. METHODS: A rat HCA model was developed, and 40 animals were randomly assigned to four groups: Sham (sham) group, or Hct groups of Hct 10%, Hct 20% and Hct 30%. After 90 min of HCA at 18 degrees C, physiologic variables were recorded and brain morphological changes were evaluated with light and electron microscopy. Expressions of C-Fos, Bcl-2, Bax in various brain areas were measured by the reverse transcriptase polymerase chain reaction and standard immunohistochemistry techniques. RESULTS: The number of injured neurons in the hippocampus CA1 and parietal cortex in the Hct 10% group (CA1: 11.44 +/- 2.52; cortex: 13.65 +/- 2.31) exceeded the mean number of injured neurons in the Hct 20% group (CA1: 8.29 +/- 1.31; cortex: 10.68 +/- 1.24; P < 0.05) and the Hct 30% group. Mean mitochondrial injury scores were greatest at lower Hct levels, while the expression of C-Fos and Bax were highest in the Hct 10% group and lowest in the Hct30% group (P < 0.05). In contrast, the expression of the Bcl-2 mRNA was greatest in the Hct 30% group (P < 0.05). CONCLUSION: Low Hct worsens cerebral injury after prolonged HCA and CPB in rats, which may relate in part to the variable expression of the genes C-Fos, Bcl-2 and Bax.

Study and exploration on standardization management of medical equipment in hospital / 医疗卫生装备

This paper systematically introduces the standardization management system of medical equipment and some effective methods in hospital from 7 aspects such as the concept of medical equipment standardization,basic ideas,current management situation,fundamental methods,main measures,main effectiveness and recommendations.It emphasizes the necessity to strengthen the standardization of medical equipment in hospital under the new period and new condition.Personnel,equipment,environment and management should be gotten the optimum combination in order to maintain the hospital overall strength and competition.Through this way it can make medical equipment enter into a well-ordered cycle of quality,efficiency and benefit.

Protective effects of high concentration fentanyl on brain slice injury induced by oxygen glucose deprivation / 中国药理学通报

Aim To investigate the protective effects of high concentration fentanyl on the brain slice injury induced by oxygen glucose deprivation(OGD).Methods Rat brain slices were made and randomly assigned to four groups:control(n=10),OGD(n=10),fentanyl 50 ?g?L~(-1)(F_(50),n=10) and fentanyl 500 ?g?L~(-1)(F_(500),n=10).Changes of the neuron injury and apoptosis were observed with TTC staining,LDH releases,TUNEL staining,immunohistochemistry and electromicroscope.In addition,changes of intracellular calcium were measured with confocal laser-scanning microscopy.Results F_(50) and F_(500) attenuated the decrease of TTC staining and the increase of LDH release induced by OGD in brain slices.Neuronal apoptosis and changes of neuronal ultrastructures were attenuated by F_(50) and F_(500).Bcl-2 and Bax protein expressions were increased after OGD.Bax protein expression was decreased by F_(50) and F_(500),while Bcl-2 protein expression was increased by F_(50)and F_(500).Intracellular calcium concentration was increased by OGD and then it was lowered by F_(50) and F_(500).The protective effects of F_(50) were more obvious than that of F_(500).Conclusions High concentrations of fentanyl have neuron protective effects against OGD injury in rat brain slices,and fentanyl 50 ?g?L~(-1) has more obvious protective effects than fentanyl 500 ?g?L~(-1).

The effect of propofol or/and procaine on human neutrophil function / 中华麻醉学杂志

Objective The study consisted of two parts: in part Ⅰ the effects of propofol or/and procaine on CD18, CD62L expression and superoxide anion (SOA) release of phorbol 12-myristal 13-acetate(PMA) stimulated human neutrophils (PMNs) were studied in vitro; in part Ⅱ the effects of propofol or/and procaine on IL-6 and TNF-?production in endotoxin-stimulated human whole blood were studied. Methods PMNs were separated from the whole blood obtained from healthy 20-40yr old subjects. Part Ⅰ consisted of 9 groups: in group 1 (control) phosphate buffer solution was added to PMNs; in group 2 PMNs were stimulated by PMA 100mg?ml-1 ; in group 3-5 different concentrations of propofol (0.4, 4.0,40?g?ml-1) were added to PMA stimulated PMNs; in group 6-8 different concentrations of procaine (1.5,15,150?g?ml-1 ) were added to PMA stimulated PMNs; in group 9 propofol 2?g?ml-1 and procaine 8?g?ml-1 were added to PMA stimulated PMNs. Part II also consisted of 9 groups: in groupl whole blood was mixed with normal saline; in group2 lipopolysaccharide (LPS) l?g?ml-1 was added to whole blood; in group 3-5 different concentrations of propofol (0.4,4.0,40?g?ml-1) were added to LPS stimulated whole blood; in group 6-8 different concentrations of procaine (1.5, 15, 150?g?ml-1 ) were added to LPS stimulated whole blood; in group 9 propofol 2?g?ml-1 and procaine 8?g?ml-1 were added to LPS stimulated whole blood. CD18, CD62L expressions were measured by flow cytometry. SOA release was determined by cytochrome C reduction in the presence or absence of superoxide dismutase (SOD) . IL-6 and TNF-? production were measured by using radioimmunoassay. Results Propofol or/and procaine depressed CD18 up-regulation, CD62L shedding and SOA release of PMA-stimulated PMNs and propofol was more effective than procaine. Propofol enhanced but procaine inhibited the increased production of TNF-? and IL-6 in the LPS stimulated whole blood but when propofol and procaine were used in combination. The effectof procaine predominated. Conclusions Propofol or/and procaine can attenuate tissue damage induced by neutrophils by inhibiting the function of neutrophils.

Effects of hemodilution on neurological injury and cerebral amino acid content after circulatory arrest during profound hypothermia in rats / 中华麻醉学杂志

Objective To investigate the effects of different degrees of hemodilution on neurological injury and amino acid content in different brain areas after deep hypothermic circulatory arrest (DHCA) . Methods Forty-eight male adult SD rats weighing 400-450 g were randomly divided into 4 groups ( n = 12 each); group 1 Hct 10% (H1); group II Hct 20% (H2); group III Hct 30% (H3) and control group (C). All animals except those in control group underwent DHCA at 18 ℃ for 90 min (including cooling and rewarming) under general anesthesia with fentanyl, ketamine and droperidol. Different degrees of hemodilution were accomplished by changing the composition and volume of priming solution used in cardiopulmonary bypass (CPB) . Hct was determined before, at the initiation of CPB and beginning of rewarming. PaO2, pH and blood lactate of arterial blood and SO2 of venous blood from internal jugular vein (SjvO2 ) were determined at the beginning and end of cooling and rewarming. The animals were killed and brains removed after recovery of circulatory function for the count of injured neurons and determination of glutamate (Glu), aspartate (Asp), glycine (Gly), ?-aminobutyric acid (GABA) and taurine (Tau) contents in cortex, hippocampus and thalamus. Results The number of injured neurons in hippocampus and parietal cortex was significantly smaller in Hct 30 % group than in the other two groups (P

Effect of intracarotid or intravenous injection of propofol on the neuronal apoptosis of hippocampus in rats undergoing cardiopulmonary bypass / 中国药理学通报

Aim To compare the different effect of intracarotid and intravenous injection of propofol on the neuronal apoptosis of hippocampus in rats undergoing cardiopulmonary bypass.Methods Fifty rats were randomly assigned to five groups. Shame group (Group Non-CPB,n=10); group cardiopulmonary bypass(group CPB,n=10);group intravenous injection of propofol 2 mg?kg -1?h -1 (group P_ 2V,n=10);group intravenous injection of propofol 10mg.kg -1?h -1 (group P_ 10V,n=10);group intracarotid injection of propofol 2 mg?kg -1?h -1 (group P_ 2a,n=10).Mean arterial pressure(MAP)and heart rate(HR) were monitored. Changes of the neuronal apoptosis of hippocampus were observed with TUNEL staining, Bax and bcl-2 mRNA and protein expressions were measured by RT-PCR and Western blot. In addition,neuronal ultrastructures were observed. Results Neuronal apoptosis and changes of neuronal ultrastructures of hippocampus were attenuated in group P_ 2a and P_ 10V,but the apoptosis of neurons was not attenuated in group P_ 2v. Bcl-2 and Bax mRNA expression increased undergoing CPB. Bax mRNA expression decreased after CPB in group P_ 2a and P_ 10V. Bcl-2 mRNA expression increased in group P_ 2a and P_ 10V. But Bcl-2 and Bax mRNA expression in group P_ 2V was not significantly different compared with that of group CPB. Bcl-2 and Bax protein expression measured by Western blot showed the same trend with mRNA expressions. Compared with baseline values, MAP and HR in group P_ 2V and P_ 2a remained unchanged. But the MAP and HR in group P_ 10V changed compared with group CPB and baseline value.Conclusions intracarotid injection of propofol attenuated the injury of brain at a fraction of the intravenous dose and with less adverse systemic and cerebrovascular side effects.