Dexmedetomidine enhances ropivacaine-induced sciatic nerve injury in diabetic rats

BACKGROUND

Previous studies suggest that dexmedetomidine has a protective effect against local anaesthetic-induced nerve injury in regional nerve blocks. Whether this potentially protective effect exists in the context of diabetes mellitus is unknown.

METHODS

A diabetic state was established in adult male Sprague-Dawley rats with intraperitoneal injection of streptozotocin. Injections of ropivacaine 0.5%, dexmedetomidine 20 μg kg^-1 (alone and in combination), or normal saline (all in 0.2 ml) were made around the sciatic nerve in control and diabetic rats (n=8 per group). The duration of sensory and motor nerve block and the motor nerve conduction velocity (MNCV) were determined. Sciatic nerves were harvested at post-injection day 7 and assessed with light and electron microscopy or used for pro-inflammatory cytokine measurements.

RESULTS

Ropivacaine and dexmedetomidine alone or in combination did not produce nerve fibre damage in control non-diabetic rats. In diabetic rats, ropivacaine induced significant nerve fibre damage, which was enhanced by dexmedetomidine. This manifested with slowed MNCV, decreased axon density, and decreased ratio of inner to outer diameter of the myelin sheath (G ratio). Demyelination, axon disappearance, and empty vacuoles were also found using electron microscopy. An associated increase in nerve interleukin-1β and tumour necrosis factor-α was also seen.

CONCLUSIONS

Ropivacaine 0.5% causes significant sciatic nerve injury in diabetic rats that is greatly potentiated by high-dose dexmedetomidine. Although the dose of dexmedetomidine used in this study is considerably higher than that used in clinical practice, our data suggest that further studies to assess ropivacaine (alone and in combination with dexmedetomidine) use for peripheral nerve blockade in diabetic patients are warranted.

[Analysis of risk factors of ventricular arrhythmia in patients with Brugada syndrome]

Objective: To investigate the risk factors of ventricular arrhythmias in patients with Brugada syndrome. Methods: Clinical data of 60 Brugada syndrome patients admitted in the department of cardiology of the First Affiliated Hospital of Nanjing Medical University from March 2003 to December 2016 were collected and retrospectively analyzed. The age at diagnosis was (43.2±13.1) years (0.6-83.0 years), 98.3% were males (n=59), and the patients were followed up to (92±41) months (12-169 months). The 12-lead surface electrocardiogram (ECG) recorded at the time of diagnosis and showing the highest type 1 ST elevation, either spontaneously or after provocative drug test, was used for the analysis. Patients were divided into ventricular arrhythmia (VA, n=12) group and non-ventricular arrhythmia (non-VA, n=48) group depending on the presence or absence of clinical VA event. The demographic data and ECG data of the 2 groups were compared, and the independent risk factors of VA events were analyzed by stepwise logistic regression. Results: Incidence of family history of sudden death (7/12 vs. 22.9% (11/48)) and percentage of type 1 ST elevation in the peripheral ECG leads (6/12 vs. 16.67% (8/48)) were significantly higher in VA group than in non-VA group (both P<0.05). Max Tpeak-Tend (Max-Tpe) interval ((144±53)ms vs. (110±16)ms) and dispersion of Tpe ((74±50)ms vs. (43±17)ms) were significantly higher in VA group than in non-VA group (both P<0.05). The area under receiver operating characteristic (ROC) curves for the Max-Tpe interval was 0.693 and Max-Tpe interval ≥140 ms was determined as an optimized cutoff point with increased risk of VA event, which had a sensitivity of 50.0%, a specificity of 98.0%, a positive predictive value of 85.7%, and a negative predictive value of 88.7% for predicting VA event. The ROC curves for the dispersion of Tpe was 0.775 and dispersion of Tpe ≥45 ms was determined as an optimized cutoff point for predicting VA event, which had a sensitivity of 91.7%, a specificity of 64.6%, a positive predictive value of 39.3%, and a negative predictive value of 96.9% for predicting VA event. In multivariate analysis, Max-Tpe interval ≥140 ms (OR=27.53, 95%CI 1.07-706.77, P=0.045) and family history of sudden death (OR=24.63, 95%CI 2.05-295.38, P=0.011) were found to be the independent risk factors of arrhythmic events. Conclusions: Max-Tpe interval ≥140 ms and family history of sudden death are risk factors of VA event in included patients with Brugada syndrome.

Characterizing the Effects of a "Switchable Water" Additive on the Aqueous Solubility of Small Molecules

"Switchable water" is an aqueous solution containing a water-soluble amine additive that exhibits CO₂ -switchable properties, such as large changes in ionic strength, by forming an ammonium bicarbonate salt. Switchable water has been used to reversibly "salt-out" organic compounds from water. This study explores the salting out of several compounds in switchable water when CO₂ is present and also explores the solubility of small molecules in switchable water, compared to pure water, when CO₂ is absent. The results show that organic compounds are generally more soluble in switchable water than pure water in the absence of CO₂ , but less soluble in the presence of 1 atm CO₂ . Exceptions include carboxylic acids and phenols which, presumably due to their acidity, are more soluble in switchable water than in pure water, even when CO₂ is applied. Kirkwood-Buff solvation theory was applied to gain insights into the effects of the amine additive on the aqueous solubility of caffeine. Furthermore, the switchable properties of the additives allow for the preparation of switchable aqueous two-phase systems.

Posterior hemivertebra resection in combination with screw rod internal fixation in the treatment of pediatric congenital scoliosis

Congenital scoliosis, a commonly seen disease occurring in children, can not only affect the growth, but also can uglify the individual which can severely affect the health and quality of life of children. To investigate the efficacy of posterior hemivertebra resection in combination with screw rod internal fixation in the treatment of congenital hemivertebra scoliosis, 115 patients were randomly divided into an observation group and a control group. Patients in the observation group were treated by posterior hemivertebra resection in combination with screw rod internal fixation, while patients in the control group were treated by posterior hemivertebra resection only. The surgical evaluation indicators, postoperative improvement of scoliosis and incidence of complications were recorded. The results demonstrated that the observation group had longer average operation time and less average blood loss compared to the control group, and the differences had statistical significance (P less than0.05); the correction efficacy of the observation group was superior to that of the control group (P less than 0.05); the incidence of postoperative complications in the two groups had no significant difference, but the incidence of correction loss of the observation group was much lower than that of the control group (P less than 0.05). In conclusion, posterior hemivertebra resection in combination with screw rod internal fixation is a highly efficient and safe treatment which can significantly relieve the clinical symptoms and cause few complications.

Glial fibrillary acidic protein as a prognostic marker of acute ischemic stroke

Background:

We investigated the association between serum levels of glial fibrillary acidic protein (GFAP) and stroke functional outcomes in a cohort of 286 patients with acute ischemic stroke (AIS).

Methods:

We prospectively studied 286 patients with AIS who were admitted within 24 h after the onset of symptoms. Serum levels of GFAP and National Institutes of Health Stroke Scale (NIHSS) were measured at admission. The primary end point was stroke functional outcome among 1-year after stroke onset. We used logistic regression models to assess the relationship between GFAP levels and stroke outcomes.

Results:

The GFAP level was obtained with a median value of 0.18 (interquartile ranges (IQRs): 0.09–0.28) ng/ml. In multivariable models adjusted for age, gender, and other risk factors, GFAP levels were associated with an increased risk of a NIHSS>6 (odds ratio (OR) = 1.55; 95% confidence interval (CI): 1.16–1.89; p = 0.012). The poor outcome distribution across the GFAP quartiles ranged between 12.7% (first quartile) and 70.4% (fourth quartile). After adjusting for other established risk factors, in multivariate models comparing the Q3 and Q 4 quartiles against the Q1 of the GFAP, the levels of GFAP were associated with poor outcome, and the adjusted risk of poor outcome increased by 211% (3.11[1.80–5.05], p < 0.001) and 522% (6.22[2.98–11.83], p < 0.001), respectively. Interestingly, GFAP improved the ability of NIHSS score to diagnose poor outcomes (area under the curve [AUC] of the combined model 0.82; 95% CI: 0.77–0.88; p = 0.02).

Conclusion:

GFAP levels are a novel and complementary biomarker to predict functional outcome 1 year after AIS

Diamines as switchable-hydrophilicity solvents with improved phase behaviour

Removing solvents by distillation is not a sustainable process because it requires the use of volatile solvents and a high energy input. An alternative is to use a switchable-hydrophilicity solvent (SHS), which can be removed from products and recycled without any distillation step. SHSs are solvents that reversibly switch between hydrophilic and hydrophobic forms with the addition and removal of a trigger such as CO₂. Monoamine SHSs can be separated from dissolved products by extraction into carbonated water, but the solvent removal is limited by the distribution coefficient of the SHS between the carbonated water phase and the product phase. In this article, the use of diamines as SHSs with improved distribution coefficients is explored. Several diamine SHSs are identified and their properties compared to those of monoamine SHSs. Comparisons include the pK_aH (the pK_a of the conjugate acid of a base) and log K_ow (log of the octanol–water partition coefficient) requirements for amines to act as SHSs, distribution coefficients, removal from hydrophobic liquids, switching speeds, and risks to the environment and human health and safety.

Diamine switchable-hydrophilicity solvents can be removed from products, by carbonated water, with much greater efficiency than past switchable solvents.

High-performance solution-based CdS-conjugated hybrid polymer solar cells

In this study, hybrid BHJ – bulk heterojunction polymer solar cells were fabricated by incorporating CdS quantum dots (QDs) in a blend of P3HT (donor) and PCBM (acceptor) using dichlorobenzene and chlorobenzene as solvents. CdS QDs at various ratios were mixed in a fixed amount of the P3HT and PCBM blend. The prepared samples have been characterized by a variety of techniques such as I–V and EQE measurements, atomic force microscopy (AFM), scanning electron microscopy (SEM) and ultraviolet-visible (UV-vis) spectroscopy. The mixing of QDs in the polymer blends improved the PCE – power conversion efficiency of the solar cells under standard light conditions. The improved PCE from 2.95 to 4.41% is mostly due to the increase in the fill factor (FF) and short-circuit current (J_sc) of the devices with an optimum amount of CdS in the P3HT:PCBM blend. The increase in J_sc possibly originated from the formation of a percolation network of CdS. The conjugation of QDs has increased the absorption of the active layers in the visible region. These results well matched as reported, conjugation of CdS in the perovskite active layer increased the absorption and PCE of the devices relative to those of the perovskite films. This increment in parameters is attributed to the decrease in charge recombinations that improved the performance of the doped device.

In this study, hybrid BHJ – bulk heterojunction polymer solar cells were fabricated by incorporating CdS quantum dots (QDs) in a blend of P3HT (donor) and PCBM (acceptor) using dichlorobenzene and chlorobenzene as solvents.

[Ultrasound imaging increases first-attempt success rate of neuraxial block in elderly patients]

Objective: To verify whether preprocedural ultrasound of the lumbar spine could improve first-attempt success rate (defined as a successful neuraxial anesthesia with only one skin puncture) of neuraxial block in elderly patients. Methods: From septemble 2015 to February 2016, 200 elderly patients undergoing lower-limb surgery with neuraxial block at the Peking Universty Third Hospital were enrolled in this study.RandA 1.0 software was used to randomize patients into two groups: conventional surface landmark-guided group (group LM) and ultrasound-assisted group (group US). Ultrasound scanning of the lumbar spine was performed to determine the suitable insertion point of US group, using a low-frequency (2-5 MHz) curved-array probe in both paramedian sagittal oblique plane and transverse median plane.Spinal anesthesia was done via the paramedian approach.The primary outcome was the rate of successful access to subarchnoid space on the first needle insertion attempt.Secondary outcomes included the following: number of needle insertion attempts, number of needle redirection times, actual epidural needle insertion depth, time taken to eastablish landmarks, time taken to perform the spinal anesthesia (the duration between local infiltration and bupivacaine injection), procedure time (the duration from sterilizing the back to converting into supine position), total time (the sum of the time to establish landmarks and the procedure time), adverse events during the procedure and anesthesia related complications. Results: A total of 191 patients successfully received combined spinal-epidural anesthesia by resident anesthesiologists, 9 patients (7 patients in group LM vs 2 patients in group US) failed.The first-attempt success rate in group LM was 37.6%, while the first-attempt success rate in group US was 68.4%, the difference between the two groups was significant (χ²=18.112, P<0.01). In group LM, the number of needle insertion attempts and needle redirection attempts were 2(1, 3) and 5(3, 10), respectively. In group US, the number of needle insertion attempts and needle redirection attempts were 1(1, 2) and 3(0, 5), respectively.The differences in the number of needle insertion attempts and needle redirection attempts between the two groups were significant (Z=-4.132, -4.077, all P<0.01). In group US, the time spent on determining the insertion point, on puncture, on finishing the procedure and the total time were as the following: 2.8(2.6, 3.1), 2.5(1.8, 4.1), 7.8(6.5, 8.9), 10.6(9.5, 11.9) min.In contrast, in group LM, those indices were as the following: 0.4(0.3, 0.4), 4.1(2.2, 6.3), 8.8(7.5, 11.4), 9.2(7.8, 11.9) min.There were significant differences in the above factors between the two groups (Z=-11.931, -4.025, -3.550, -3.290, all P<0.01). The paramedian sagittal oblique scanning image was superior to that of the transverse median plane. Conclusions: For elderly patients, ultrasound imaging before neuraxial block increases first-attempt success rate, decreases puncture time.The strengths of prepuncture ultrasound scanning outweighs its longer total time.

[Initial study of transthoracic echocardiography guided three-dimensional printing on the application of assessment of structural heart disease]

Objective: To investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model (TTE Guided 3DPM) on the assessment of structural heart disease (SHD). Methods: From February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of (44±22) years. compared to conventional three dimensional transthoracic echocardiography (3D-TTE), and took direct intraoperative findings as "Golden Standard" simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect (VSD), thirty-two patients without SHD were designed as negative control. Results: The sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa=0.745, P<0.01, indicated that the results of 3DTTE and the gold standard were generally consistent.P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa=0.955, P<0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM, P value was greater than 0.05, the difference was not statistically significant, kappa=0.879, P<0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings. Conclusion: TTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.

Beneficial effects of renal denervation on cardiac angiogenesis in rats with prolonged pressure overload

AIM

Renal denervation (RDN) has beneficial effects on cardiac remodelling and function in resistant hypertension. We aimed to investigate the impact of RDN on cardiac angiogenesis during prolonged pressure overload.

METHODS

Cardiac pressure overload was reproduced by transverse aorta constriction (TAC) procedure in adult Sprague Dawley male rats (n = 35). RDN/sham-RDN procedure was performed in surviving rats at 5 weeks after TAC.

RESULTS

Five weeks post-TAC, transthoracic echocardiography revealed that myocardial hypertrophy occurred in TAC rats, with ejection fraction and fractional shortening not significantly changed. At the end of 10 weeks, cardiac systolic function was preserved in RDN group, but not in sham group. CD31 immunohistochemical staining showed that RDN-treated rats had higher cardiac capillary density than sham rats. However, no significant between-group difference was observed in the kidneys. A decreased protein expression of left ventricle vascular endothelial growth factor (VEGF) was observed in sham group, while RDN attenuated this decrease. Compared with sham, RDN resulted in a higher protein expression of VEGF receptor 2 (VEGFR2) and phosphorylated endothelial nitric oxide synthase (p-eNOS) in the heart.

CONCLUSION

Renal denervation benefits cardiac angiogenesis during sustained pressure overload, involving regulation of VEGF and VEGFR2 expression as well as activation of eNOS.

Decreased REG1α expression suppresses growth, invasion and angiogenesis of bladder cancer

BACKGROUND

Previous study has indicated association between REG1α and bladder cancer. The aim of this study was to investigate the role of Regenerating gene I alpha (REG1α) in bladder cancer.

METHODS

The role of REG1α in bladder cancer cell proliferation, migration and VEGF-induced angiogenesis was explored in vitro and in vivo. Immunohistochemistry (IHC) analysis was assessed to determine the expression of REG1α in ten paired bladder cancer and adjacent non-cancerous tissues, and in 296 bladder cancer samples.

RESULTS

Down-regulation of REG1α expression significantly reduced the proliferation, migration, invasion and VEGF-induced angiogenesis in vitro and the growth of xenograft tumors in vivo. VEGF expression in bladder cancer is associated with REG1α expression and recurrence. REG1α was overexpressed in bladder cancer tissues compared with adjacent normal samples. Patients with elevated REG1α exhibited shorter recurrence times and poor survival.

CONCLUSION

Downregulation of REG1α expression can reduce tumor growth, migration, invasion and angiogenesis. Our study demonstrates that REG1α can be used as a marker of recurrence and prognosis in bladder cancer. Therefore, REG1α targeting in bladder cancer patients represents a promising therapeutic strategy.

Percutaneous computed tomography-guided iodine-125 seeds implantation for unresectable pancreatic cancer

BACKGROUND

To examine the safety and clinical efficacy of computed tomography (CT)-guided radioactive iodine-125 (125I) seeds implantation for patients with unresectable pancreatic cancer.

MATERIALS AND METHODS

A group of 26 patients with pathologically confirmed unresectable pancreatic cancer underwent percutaneous CT-guided 125I seeds implantation. Part of them received transarterial chemotherapy and/or percutaneous transhepatic cholangial drainage before or after seeds implantation. The primary endpoints were the objective response rates, local control rates, and overall survival.

RESULTS

CT scan 2 months after treatment revealed complete response (CR) in 8 patients, partial response (PR) in 9 patients. Overall response rate (CR + PR) is 65.38%. Local control rate was 88.46%. Median survival of the whole group was 15.3 months, whereas for Stage III and IV was 17.6 and 9.1 months, respectively. The estimated 1-year survival was 30.77%.

CONCLUSIONS

We consider CT-guided 125I seeds implantation as a safe, effective, uncomplicated treatment for unresectable pancreatic cancer.

Polymorphisms of Flanking Region of the ASB15 Gene and Their Associations with Performance Traits in Chicken

Research on the identity of genes and their relationship with traits of economic importance in chickens could assist in the selection of poultry. In this study, an F₂ resource population of Gushi chickens crossed with Anka broilers was used to detect single-nucleotide polymorphisms (SNPs) in the flanking region of the ASB15 gene by DNA sequencing and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). One SNP of -1271 C>T in 5' flanking region of the chicken ASB15 gene and two SNPs of the 10618 A>G and 10716 G>A in 3' flanking region were identified. Furthermore, the 10618 A>G and 10716 G>A in 3' flanking region were in complete linkage. Association analysis results showed that -1271 C>T was not associated with performance traits, while the 10618 A>G and 10716 G>A were significantly associated with BW2, 4, 6, 8, 10, 12, SL12, CD8, CW4, 8, 12, BSL4, 8, 12, and SEW, EW, WW, BMW, LW, CW, SFT. Our results suggest that the ASB15 gene profoundly affects chicken performance traits.

[Ultrasound-assisted neuraxial anesthesia in a patient with previous lumbar laminectomy and fusion: a case report]

A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Efficacy and safety of liraglutide versus sitagliptin, both in combination with metformin, in Chinese patients with type 2 diabetes: a 26-week, open-label, randomized, active comparator clinical trial

AIMS

To compare the efficacy and safety of liraglutide versus sitagliptin as add-on to metformin after 26 weeks of treatment in Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

This 26-week open-label, active comparator trial (NCT02008682) randomized patients (aged 18-80 years) with T2DM inadequately controlled with metformin [glycated haemoglobin (HbA1c) 7.0-10.0% (53-86 mmol/mol)] 1 : 1 to once-daily subcutaneously administered liraglutide 1.8 mg (n = 184) or once-daily oral sitagliptin 100 mg (n = 184), both as add-on to metformin. The primary endpoint was change in HbA1c from baseline to week 26.

RESULTS

Liraglutide was superior to sitagliptin in reducing HbA1c from baseline [8.1% (65 mmol/mol)] to 26 weeks, as evidenced by estimated mean HbA1c change of -1.65% (-18.07 mmol/mol) versus -0.98% (-10.72 mmol/mol), respectively [estimated treatment difference for liraglutide vs sitagliptin of -0.67% (95% CI -0.86, -0.48) or -7.35 mmol/mol (95% CI -9.43; -5.26); p < 0.0001]. More patients receiving liraglutide (76.5%) than sitagliptin (52.6%) achieved the HbA1c target of <7.0% (53 mmol/mol) at week 26 [odds ratio 3.65 (95% CI 2.18, 6.12); p < 0.0001]. Reductions in fasting plasma glucose, 7-point self-measured plasma glucose and body weight were greater with liraglutide than with sitagliptin (p < 0.0001 for all). More patients experienced nausea (14.8% vs 0.5%), diarrhoea (8.2% vs 2.2%) and decreased appetite (10.9% vs 0.5%) with liraglutide than sitagliptin. Two hypoglycaemic episodes were confirmed for liraglutide and one for sitagliptin; none were severe or nocturnal.

CONCLUSIONS

Liraglutide provided better glycaemic control and greater body weight reduction than sitagliptin when administered as add-on to metformin. More patients had nausea, diarrhoea and decreased appetite with liraglutide versus sitagliptin.

[A clinical study of the efficacy of automated intermittent boluses for continuous fascia iliaca block]

OBJECTIVE

To compare two different regimens of continuous ultrasound-guided fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA).

METHODS

Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing selective single total hip replacement in Peking University Third Hospital from May.2015 to Mar.2016 were included. Before neuraxial block, continuous ultrasound-guided FICB were administered. Patients were randomly divided into the continuous infusion group(n=30) and the automated intermittent boluses group(n=30). 10 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the continuous infusion group. 10 ml of 0.2% ropivacaine was automated injected every 60 mins in the automated intermittent boluses group. Numerical Rating Pain Scale(NRPS)was used to assess pain intensity at 4, 8, 12, 24, 36, 48 h after block at rest and during functional exercise. The usage of pethidine postoperatively, the incidence of opioid related adverse effect and patient satisfaction scores at 48 h were also recorded.

RESULTS

The pain score at rest 8, 12, 24, 36 h of the automated intermittent boluses group were 2 (1-3), 2 (1-3), 2 (1-3), 2 (1-3) score, which were lower than the continuous infusion group: 4 (2-6), 3 (2-5), 4 (3-5), 2 (1-4) score, the differences were statistically significant (Z=-6.493, -6.267, -6.235, -3.244, all P<0.05). The pain score during active and passive functional exercise at 8, 12, 24, 36 h of the automated intermittent boluses group were 4 (3-5), 4 (3-5), 2 (1-3), 1(0-3) score, which were lower than the continuous infusion group: 6 (4-7), 5 (4-7), 4 (2-6), 4 (2-5) score, the differences were statistically significant (Z=-6.499, -6.499, -5.081, -6.667, all P<0.05). The usage of pethidine postoperatively and the incidence of opioid related adverse effect of the automated intermittent boluses group were 10.0% and 3.3%, which were lower than the continuous infusion group: 33.3% and 26.7% , the differences were statistically significant (χ(2)=5.057, 4.500, all P<0.05). Patient satisfaction score at 48 h of the automated intermittent boluses group was (8.3±0.7)score, which was higher than the continuous infusion group: (7.4±0.7)score, the difference was statistically significant (t=-5.632, P<0.05).

CONCLUSIONS

Both regimens can provide effective analgesia after total hip arthroplasty. Compared with the continuous infusion group, the automated intermittent boluses group for continuous fascia iliaca block can provide better analgesic effect , with less remedial analgesia.

[Ultrasound-assisted neuraxial anesthesia in a patient with previous lumbar laminectomy and fusion: a case report]

A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Cloning and prokaryotic expression of the porcine lipasin gene

Lipasin has recently been demonstrated to be involved in lipid metabolism. In this study, two specific primers were used to amplify the lipasin open reading frame from porcine liver tissue. The polymerase chain reaction product was cloned to a pGEM®-T Easy Vector, digested by SalI and NotI, and sequenced. The lipasin fragment was then cloned to a pET21(b) vector and digested by the same restriction enzyme. The recombinant plasmid was transferred to Escherichia coli (BL21), and the lipasin protein was induced with isopropyl-β-D-thiogalactopyranoside. The protein obtained was identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis and western blotting. A pET-lipasin prokaryotic recombinant expression vector was successfully constructed, and a 25.2-kDa protein was obtained. This study provides a basis for further research on the biological function of porcine lipasin.

Dual-rail optical gradient echo memory

We introduce a scheme for the parallel storage of frequency separated signals in an optical memory and demonstrate that this dual-rail storage is a suitable memory for high fidelity frequency qubits. The two signals are stored simultaneously in the Zeeman-split Raman absorption lines of a cold atom ensemble using gradient echo memory techniques. Analysis of the split-Zeeman storage shows that the memory can be configured to preserve the relative amplitude and phase of the frequency separated signals. In an experimental demonstration dual-frequency pulses are recalled with 35% efficiency, 82% interference fringe visibility, and 6° phase stability. The fidelity of the frequency-qubit memory is limited by frequency-dependent polarisation rotation and ambient magnetic field fluctuations, our analysis describes how these can be addressed in an alternative configuration.