ObjectiveTo summarize the progress of perioperative pain management in patients with lower limb vascular diseases. MethodRetrieved the literature about pain management in patients with lower limb vascular diseases both at home and abroad in recent years and reviewed the literature. ResultsLower limb vascular diseases were very common in elderly patients. Whether it was limb ischemic pain or surgery-related pain, it often increased the stress response and activation of the autonomic system, which was not conducive to the recovery of the disease. Good analgesic management was important for these patients. Perioperative pain management could be performed by intravenous analgesics, oral analgesics, local anesthesia, neuraxial anesthesia and peripheral nerve block. Acute and chronic pain should be actively managed during perioperative period. Pre-emptive analgesic strategies could be implemented in patients with severe peripheral vascular disease. ConclusionsGood perioperative analgesia management is necessary. Pain management which employes one or more analgesic methods is important in maximizing pain relief, function, and quality of life for this patient group.
ObjectiveTo study on the compatible stability of brevescapine injection in common solvents. MethodsBrevescapine injection was added into 0.9% sodium chloride injection,5% glucose injection,10% glucose injection (100,250,and 500 mL) respectively at room temperature.The pH value and visual appearance of the admixture were observed at immediate 0,1,2,4,6 hours after Brevescapine injection was added into the solvents.Scutellarin concentration was determined by the method of high performance liquid chromatography (HPLC). ResultsNo significant change was found in appearance and pH value of the admixture.And Scutellarin concentration changed obviously in the admixture of 100 mL 0.9% sodium chloride injection,100 mL 10% glucose injection and the three types of 5% glucose injection. ConclusionBrevescapine injections have better compatibility with 250 mL and 500 mL 0.9% sodium chloride injection,and it is incompatible with 5% glucose injection.In addition,the admixture injection should be finished within six hours.
ObjectiveTo explore the reliability and safety of diagnosis and treatment for cholecystocolonic fistula during laparoscopic cholecystectomy. MethodsData of patients with cholecystocolonic fistula in department of general surgery, Gansu provincial hospital from Jan 2002 to Dec 2015 were analyzed retrospectively. There were 112 cases diagnosed by routine intraoperative cholangiography from 11 472 laparoscopic cholecystectomy patients, including 33 males and 79 females, age from 58 to 84 years〔(67.4±12.6) years〕. ResultsOne hundred and twelve cases of cholecystocolonic fistula were diagnosed by routine intraoperative cholangiography in laparoscopic cholecystectomy. There were 105 cases of cholecystocolonic fistula performed laparoscopic cholecystectomy and colon repair, and 7 cases performed colostomy, no surgical complications occurred. Seventy cases were followed-up for 6-27 months〔(16.4±5.3)months〕after operation, no long-term complications occurred. ConclusionsThere is a lack of specific symptoms and special diagnosis for cholecystocolonic fistula before operation. Intraoperative cholangiography is a only objective method for diagnosis, and treatment of cholecystocolonic fistula by laparoscopic cholecystectomy and colon repair or colostomy is safe and reliable based on experienced laparoscopic skill.
ObjectiveTo systematically review the diagnostic value of FibroScan for the staging of liver fibrosis in chronic hepatitis B. MethodsWe searched the PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI databases for studies investigated the diagnostic value of FibroScan for hepatic fibrosis B from Jan. 1st, 2003 to Aug. 31st, 2013. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, Stata 13.0 software was used to analyze the data. ResultsA total of 15 studies involving 2 588 patients were included. The results of meta-analysis showed that:the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the AUC of SROC were 0.77 (95%CI 0.69 to 0.83), 0.84 (95%CI 0.70 to 0.87), 3.8 (95%CI 2.6 to 5.6), 0.29 (95%CI 0.22 to 0.38), 13 (95%CI 8 to 21), 0.82 (95%CI 0.82 to 0.88) for hepatic fibrosis; and were 0.81 (95%CI 0.73 to 0.87), 0.89 (95%CI 0.86 to 0.92), 7.5 (95%CI 5.3 to 10.3), 0.21 (95%CI 0.14 to 0.31), 36 (95%CI 20 to 65), 0.93 (95%CI 0.90 to 0.95) for early hepatic cirrhosis, respectively. ConclusionThe current evidence suggests that FibroScan is of good accuracy in the diagnosis of early hepatic fibrosis but not for hepatic cirrhosis in patient with chronic hepatitis B.
Objective To optimize the in vitro culture system of C57/BL6 marrow mesenchymal stem cells (MSCs) and to investigate the effect of alcohol and acetaldehyde on MSCs. Methods The MSCs were isolated from the femur marrow of C57/BL6 mice and were cultured in the optimized system, so that highlypurified MSCs were harvested and identified by immunohistochemistry. Then, MSCs were cultured in the medium containing alcohol or its metabolic product acetaldehyde, with the following concentration groups: alcohol 5.7，17.0，50.0，100.0 and 150.0 mmol/L; acetaldehyde 4.5, 0.9, 0.18, 0.036, 0.007 2, 0.001 44 , 0.000 28 mmol/L. MSCs were cultured with α-MEM as the control group. After 3 days, their proliferation activity was measured by the MTT method. Results MSCs within 6 passages had a good stability and a high proliferation activity. They were identified to express CD90 but no CD34. The MTT assay showed that alcohol at the concentration greater than 100.0 mmol/L and acetaldehyde at the concentration greater than 4.5 mmol/L could inhibit proliferation of MSCs(P＜0.05) . But the proliferation activity might rise with an increase in the acetaldehyde concentration smaller than 0.18 mmol/L(P＜0.05) . Conclusion Theoptimized culture system can effectively isolate and culture MSCs. Both alcoholand acetaldehyde can inhibit proliferation of MSCs but toxicity of acetaldehydeis more serious.
ObjectiveTo evaluate the efficacy and safety of 41G ultramicroneedle subretinal injection of balanced salt solution (BSS) in the treatment of large diameter macular holes (MH). MethodsA prospective clinical intervention study. A total of 22 eyes of 22 large-diameter full-layer MH patients diagnosed by examination in Tianjin Eye Hospital from March to June 2024 were included in the study. The minimum diameter of MH in the affected eyes was all greater than 400 μm. The affected eyes received 25G pars plana vitrectomy combined with internal limiting membrane peeling and 41G ultramicroneedle subretinal injection of BSS. The affected eyes underwent best-corrected visual acuity (BCVA), microperimetry, fundus autofluorescence, and optical coherence tomography (OCT) examinations before and 1 and 3 months after surgery. BCVA was measured using the standard logarithmic visual acuity chart and converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The minimum and base diameter of MH were measured using OCT. Microperimetry was performed using a macular integrity assessment device, recording the macular integrity index (MII) and macular threshold (MT) within 10° of the macular. The changes in BCVA, MII, MT, and the closure of MH and the occurrence of complications were compared and analyzed before and after surgery. For the comparison of the same continuous indicators before and after surgery, Student's t-test was used if the data were normally distributed and had equal variances, and the Mann-Whitney U test was used if the data were not normally distributed; the correlation between different indicators was analyzed using Pearson correlation analysis. ResultsAmong the 22 cases (22 eyes), there were 4 males and 18 females; all were unilaterally affected. The age was 66 (60, 71) years. The duration of the disease was 5 (2.5, 12.0) months. The logMAR BCVA of the affected eyes was 1.24±0.57, and the MII and MT were 100.0 (99.53, 100.00) and 19.0 (13.23, 21.78) dB, respectively. One month after surgery, all MH were closed, with 20 (90.91%, 20/22) and 2 (9.09%, 2/22) eyes classified as typeⅠand Ⅱ closure, respectively. At the last follow-up, the logMAR BCVA was 0.62±0.58, and the MII and MT were 99.9 (59.45, 100.00) and 23.6 (19.33, 26.25) dB, respectively; compared with before surgery, the BCVA (t=3.579), MII (Z=－2.374), and MT (Z=－2.997) were significantly improved, and the differences were all statistically significant (P＜0.05). Correlation analysis showed that postoperative BCVA was significantly positively correlated with preoperative BCVA (r=0.41), the minimum and base diameter of MH (r=0.64, 0.58), disease duration (r=0.63), and age (r=0.50) (P＜0.05). No surgery-related complications occurred in all affected eyes during the follow-up period. Conclusion41G ultramicroneedle subretinal injection of BSS can effectively improve the hole closure rate of large diameter MH-affected eyes in the short term, improve visual function, and has good safety.