Lidocaine is an amide local anaesthetic. In recent years, clinical evidence shows that perioperative intravenous lidocaine injection plays an active role in anti-inflammation, analgesia, anti-tumor and organ protection. Postoperative pain is severe in patients after thoracic surgery, and the incidence of pulmonary complications and cognitive impairment is high. These adverse reactions and complications are closely related to the inflammatory reaction after thoracic surgery. Intravenous infusion of lidocaine may have some effects on alleviating these adverse reactions and complications. Thus, this article reviews the current status of intravenous lidocaine injection in thoracic surgery and explores the related mechanisms to optimize the management of anaesthesia during the perioperative period of thoracic surgery.
Objective To synthesize the available evidence on the efficacy of using statins in the prevention of recurrent and new-onset atrial fibrillation (AF). Methods We searched PubMed, EMbase, EMB Reviews-Cochrane Central Register of Controlled Trials (Issue 3, 2007), CBMdisc, VIP, and CNKI databases from establishment to 15th Sep. 2007 to identify randomized controlled trials (RCTs) covering the use of statins for the patients with persistent AF after electrical cardioversion, paroxysmal and postoperative AF. Meta-analysis was performed using RevMan 4.3 software after the strict evaluation of the methodological quality of the included RCTs. Results Five RCTs including 470 patients were included. Significant heterogeneity was found when the data were pooled, so a random effect model was used for metaanalysis. Compared with placebo or no use of statins, the statins decreased risk of AF recurrence and postoperative AF (RR=0.61, 95%CI 0.43 to 0.88, P=0.008). Sensitivity analysis showed that the result was stable. The fail-safe number was 52.91. Conclusion The statins may decrease incidence of AF recurrence and postoperative AF. Because of the low quality and the small number of included studies, larger sample-size, randomized, double-blinded controlled trials are needed.
Objective To investigate the effect of repairing bone defect with tissue engineered bone seeded with the autologous red bone marrow (ARBM) and wrapped by the pedicled fascial flap and provide experimental foundation for cl inicalappl ication. Methods Thirty-two New Zealand white rabbits (male and/or female) aged 4-5 months old and weighing2.0-2.5 kg were used to make the experimental model of bilateral 2 cm defect of the long bone and the periosteum in the radius. The tissue engineered bone was prepared by seeding the ARBM obtained from the rabbits on the osteoinductive absorbing material containing BMP. The left side of the experimental model underwent the implantation of autologous tissue engineered bone serving as the control group (group A). While the right side was designed as the experimental group (group B), one 5 cm × 3 cm fascial flap pedicled on the nameless blood vessel along with its capillary network adjacent to the bone defect was prepared using microsurgical technology, and the autologous tissue engineered bone wrapped by the fascial flap was used to fill the bone defect. At 4, 8, 12, and 16 weeks after operation, X-ray exam, absorbance (A) value test, gross morphology and histology observation, morphology quantitative analysis of bone in the reparative area, vascular image analysis on the boundary area were conducted. Results X-ray films, gross morphology observation, and histology observation: group B was superior to group A in terms of the growth of blood vessel into the implant, the quantity and the speed of the bone trabecula and the cartilage tissue formation, the development of mature bone structure, the remolding of shaft structure, the reopen of marrow cavity, and the absorbance and degradation of the implant. A value: there was significant difference between two groups 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those three time points in groups A and B (P lt; 0.05). For the ratio of neonatal trabecula area to the total reparative area, there were significant differences between two groups 4, 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those four time points in group B (P lt; 0.05).For the vascular regenerative area in per unit area of the junctional zone, group B was superior to group A 4, 8, 12, and 16 weeks after operation (P lt; 0.05). Conclusion Tissue engineered bone, seeded with the ARBM and wrapped by the pedicled fascial flap, has a sound reparative effect on bone defect due to its dual role of constructing vascularization and inducing membrane guided tissue regeneration.
ObjectiveTo explore the effects of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviation: PPH+sphincterotomy) on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.MethodsEighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects, then they were divided into a PPH group (n=42) and PPH+sphincterotomy group (n=43) according to the different treatment methods. The patient in the PPH group was treated with the PPH, while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group. The clinical efficacy, degree of pain, edema of wound margin, anal function, and the recurrence rate of symptoms were observed in two groups.Results① There were no significant differences in the baseline data such as the gender, age, course of disease, grading of internal hemorrhoids, and symptoms between the two groups (P>0.05). ② The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group [100% (43/43) versus 90.48% (38/42), χ2=4.297, P=0.038]. ③ The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment (P<0.05), the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment (P<0.05), and it was significantly lower on the 7th day than that on the 3rd day after the treatment (P<0.05). ④ The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group (χ2=20.237, P<0.001), and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group (t=13.514, P<0.001). ⑤ The resting pressure of anal canal after the treatment was significantly lower than that before treatment (P<0.05), and the diastolic pressure of anal canal after the treatment was significantly higher than that before the treatment (P<0.05) in the two groups. The resting pressure of anal canal in the PPH+sphincterotomy group was significantly lower than that in the PPH group and the diastolic pressure of anal canal was significantly higher than that in the PPH group (P<0.05) after the treatment. ⑥ In addition, the total recurrence rate of symptoms at 1 year in the PPH+sphincterotomy group was significantly lower than that of the PPH group [6.98% (3/43) versus 23.81% (10/42), χ2=4.647, P=0.031].ConclusionPPH+sphincterotomy could effectively relieve symptoms of severe mixed hemorrhoids, improve clinical efficacy, and reduce recurrence rate.
ObjectiveTo explore the effects of perioperative autologous platelet transfusion on postoperative complications and prognosis of adult cardiac surgery patient.MethodsUsing the method of systematic review of Cochrane Collaboration, we searched PubMed, Web of Science, EMbase, The Cochrane Library, CNKI and Wangfang databases, retrieving the literature from January 1970 to June 2020 to collect clinical randomized controlled trials on the effects of autologous platelet transfusion on complications and prognosis of adult cardiac surgery patients. The extracted valid data was analyzed by RevMan5.3 software.ResultsTen studies were included, with a total of 1 083 patients. The results of meta-analysis showed that there were statistical differences in the perioperative blood loss (MD=−195.15, 95%CI −320.48-−69.83, P=0.002) and perioperative blood transfusion (MD=−0.88, 95%CI −1.23-−0.52, P<0.001). There was no statistical difference in the death rate 30 days after the operation (RR=0.90, 95%CI 0.48-1.70, P=0.75), reoperations (OR=0.48, 95%CI 0.23-1.02, P=0.06), postoperative myocardial infarction (OR=1.29, 95%CI 0.48-3.51, P=0.61), postoperative infection (OR=1.71, 95%CI 0.89-3.29, P=0.11) or postoperative ICU retention time (MD=−0.31, 95%CI −0.67-0.05, P=0.09).ConclusionPerioperative autologous platelet transfusion can reduce perioperative blood loss and blood transfusion in adult cardiac surgery patients, but has no significant impact onprognosis and postoperative complications, which indicates that perioperative autologous platelet transfusion is a safe and beneficial blood protection measure for patients undergoing cardiac surgery.
ObjectiveTo reveal the scientific output and trends in pulmonary nodules/early-stage lung cancer prediction models. MethodsPublications on predictive models of pulmonary nodules/early lung cancer between January 1, 2002 and June 3, 2023 were retrieved and extracted from CNKI, Wanfang, VIP and Web of Science database. CiteSpace 6.1.R3 and VOSviewer 1.6.18 were used to analyze the hotspots and theme trends. ResultsA marked increase in the number of publications related to pulmonary nodules/early-stage lung cancer prediction models was observed. A total of 12581 authors from 2711 institutions in 64 countries/regions published 2139 documents in 566 academic journals in English. A total of 282 articles from 1256 authors were published in 176 journals in Chinese. The Chinese and English journals which published the most pulmonary nodules/early-stage lung cancer prediction model-related papers were Journal of Clinical Radiology and Frontiers in Oncology, respectively. Chest was the most frequently cited journal. China and the United States were the leading countries in the field of pulmonary nodules/early-stage lung cancer prediction models. The institutions represented by Fudan University had significant academic influence in the field. Analysis of keywords revealed that multi-omics, nomogram, machine learning and artificial intelligence were the current focus of research. ConclusionOver the last two decades, research on risk-prediction models for pulmonary nodules/early-stage lung cancer has attracted increasing attention. Prognosis, machine learning, artificial intelligence, nomogram, and multi-omics technologies are both current hotspots and future trends in this field. In the future, in-depth explorations using different omics should increase the sensitivity and accuracy of pulmonary nodules/early-stage lung cancer prediction models. More high-quality future studies should be conducted to validate the efficacy and safety of pulmonary nodules/early-stage lung cancer prediction models further and reduce the global burden of lung cancer.
Objective To investigate the time l imit of repairing old sciatic nerve defect in rats and observe the repair effect of autogenous nerve transplantation on old sciatic nerve defect in rats. Methods Thirty-six SD rats of clean grade wererandomized into 6 groups (n=6 per group). The animal model of nerve defect was made by transecting left sciatic nerve at the mid-thigh level. For groups A1, B1 and C1, defects were repaired by the contralateral autogenous nerve transplantation 1, 3 or 6 months after nerve damage and for the control groups of A2, B2 and C2, defects were not repaired. After operation, the gait, toe skin and leg muscle were examined weekly. Three months after autograft, a combination of electrophysiology examination, fluoro gold (FG) retrograde tracing and histological assessment including l ight microscopy, TEM was util ized to investigate the nerve functional recovery. Results Lameness and foot skin ulcers were observed in each group after nerve damage. At 2 months after autograft, such denervation symptoms were only improved in groups A1 and B1. At 3 months after autograft, the motor conduction velocity was (21.84 ± 6.74), (20.02 ± 4.17) and (16.09 ± 8.21) m/s in groups A1, B1 and C1, respectively, showing no statistically significant difference between them (P gt; 0.05). The ampl itude of compound muscle action potential (CAMP) was (12.68 ± 4.38), (9.20 ± 3.43) and (1.22 ± 0.39) mV in groups A1, B1 and C1, respectively, indicating significant differences between groups A1, B1 and group C1 (P lt; 0.05). No CAMP was evident in groups A2, B2 and C2. FG retrograde tracing conducted 3 months after autograft showed that the positive cells were most common in group A1 with big soma, mild in group B1 and lest in group C1 with smallest soma. Gastrocnemius Masson staining showed that the fiber morphology of gastrocnemius in groups A1 and B1 was close to normal, while the rest 4 groups had an obvious atrophy of muscle fiber. The fiber cross-section area was (340.73 ± 118.46), (299.88 ± 119.75), (54.33 ± 53.43), (78.60 ± 51.38), (65.62 ± 25.36), and (40.93 ± 28.22) μm2 in groups A1, B1, C1, A2, B2 and C2, respectively, indicating a significant difference between groups A1, B1 and groups C1, A2, B2 (P lt; 0.05). Neurohistology observation showed that more regenerated nerve fibers were observed in group A1 and B1, but less in group C1. The myel in sheath was thick in groups A1 and B1, while it was thin in group C1. Only SCs and hyperplastic collagen fiber were found in groups A2, B2 and C2. Conclusion Autogenous nerve transplantation is capable of repairing 1- and 3- month sciatic nerve defect to some degree in rat, but repair effect is not obvious on 6-month sciatic nerve defect in rats.
ObjectiveThe aim of this study was to assess the disease burden of non-COVID-19 lower respiratory infection (LRI) in China during the period 1990−2021, particularly during the period 2019−2021. MethodsData on the burden of disease for LRI in China were obtained from the GBD 2021 database. A Joinpoint regression model was used to describe the changes in disease burden trends of LRI in China from 1990 to 2021, and the results are presented in terms of average annual percentage change (AAPC). ResultsIn 2021, the age-standardized incidence rate of LRI in China was 2 853.31/100 000, the age-standardized rate of DALY was 347.67/100 000, and the age-standardized mortality rate was 14.03/100 000. Compared with 1990, the AAPC were −2.13%, −6.89% and −4.10% respectively. In contrast, during the COVID-19 pandemic, both showed a decreasing and then increasing trend, except for the age-standardized incidence rate, which showed a decreasing trend. Children under 5 years of age have experienced the greatest reduction in the burden of disease over the past decades, while the burden of disease has increased in absolute terms for the elderly over 70 years of age. Compared with 1990, the disease burden of LRI in China due to each pathogenic microorganism has decreased. And during 2019−2021, all pathogens showed an increasing trend, except for ASMR caused by influenza (APC=−55.21%) and respiratory syncytial virus (APC=−53.35%). In 2021, the primary attributable risk factors for LRI mortality in China shifted from household air pollution due to solid fuels, childhood underweight, and childhood stunting in 1990 to ambient particulate matter pollution, smoking, and secondhand smoke. ConclusionThe disease burden of LRIs in China showed an overall decreasing trend from 1990 to 2021, but with large variations between age groups and pathogens. During the two years following the outbreak of the COVID-19 pandemic, the incidence of LRI in China, along with the disease burden caused by influenza and respiratory syncytial virus, significantly declined. Over the past few decades, the attributable risk factors for mortality and DALYs have undergone substantial changes. To address this phenomenon, targeted measures should be implemented to reduce the burden of LRI on the population caused by air pollution and smoking.
Objective To compare the effect between vascularization osteogenesis and membrane guided osteogenesis in the bone repair by the tissue engineered bone with pedicled fascial flap packing autologous red bone marrow (ARBM), so as to provide a reference for the bone defect repair in cl inic. Methods The tissue engineered bone was constructed with ARBM and the osteoinductive absorbing recombinant human materials with recombinant human bone morphogenetic protein 2. Sixty New Zealand rabbits (aged 4-5 months, weighing 2.0-2.5 kg) were randomly divided into group A (n=16), group B (n=22), and group C (n=22). The complete periosteum defect model of 1.5 cm in length was prepared in right ulnar bone, then the tissue engineered bone was implanted in the bone defect area in group A, the tissue engineered bonewith free fascial flap in group B, and the tissue engineered bone with pedicled fascial flap in group C. At 4, 8, 12, and 16 weeks, the tissue of bone defect area was harvested from 4 rabbits of each group for the general, histological, and immunohistochemical staining observations; at 8, 12, and 16 weeks, 2 rabbits of groups B and C, respectively were selected to perform ink perfusion experiment by axillary artery. Results The general observation showed that the periosteum-l ike tissues formed in the fascial flap of groups B and C, chondroid tissues formed in group B, new bone formed in group C, and the fibrous and connective tissues in group A at 4 and 8 weeks; a few porosis was seen in group A, more new bone in group B, and bone stump formation in group C at 12 and 16 weeks. Histological observation showed that there were few new blood vessels and new bone trabeculae in groups A and B, while there were large amounts of new blood vessels and mature bone trabeculae in group C at 4 and 8 weeks. There were a few new blood vessels and new bone trabeculae in group A; more blood vessels, significantly increased mature trabeculae, and the medullary cavity formation in group B; and gradually decreased blood vessels, the mature bone structure formation, and the re-opened medullary cavity in group C at 12 and 16 weeks. The immunohistochemical staining observation showed that the levels of CD105, CD34, and factor VIII were higher in group C than in groups A and B at different time points.The bone morphometry analysis showed that the trabecular volume increased gradually with time in 3 groups after operation; the trabecular volume in group C was significantly more than those in groups A and B at different time points (P lt; 0.05); and there was significant difference between groups A and B (P lt; 0.05) except the volume at 4 weeks (P gt; 0.05). The vascular image analysis showed that the vascular regenerative area ratio in group C was significantly higher than those in groups A and B at different time points (P lt; 0.05). The ink perfusion experiment showed that the osteogenic zone had sparse ink area with no obvious change in group B, while the osteogenic zone had more intensive ink area and reached the peak at 8 weeks, then decreased in group C. Conclusion The tissue engineered bone with pedicled fascial flap packing ARBM has the vascularization osteogenesis effect at early stage, but the effect disappears at late stage gradually when the membrane guided osteogenesis is main.
Objective To investigate the effect of domestic porous tantalum encapsulated with pedicled fascial flap on repairing of segmental bone defect in rabbits’ radius. Methods A total of 60 New Zealand white rabbits (aged 6- 8 months and weighing 2.5-3.0 kg) were randomly divided into the experimental group and control group (30 rabbits each group). A 1.5 cm segmental bone defect in right radius was established as the animal model. The porous tantalums encapsulated with pedicled fascial flaps (30 mm×20 mm) were implanted in the created bone defect in the experimental group, and the porous tantalums were only implanted in the control group. X-ray films were observed at the day after operation and at 4, 8, and 16 weeks after operation. Specimens were taken out at 4, 8, and 16 weeks after operation for HE staining and toluidine blue staining observation. The maximum load force and bending strength were detected by three point bending biomechanical test, and the Micro-CT analysis and quantitative analysis of the new bone volume fraction (BV/TV) were performed at 16 weeks after operation to compare the bone defect repair abilityin vivo in 2 groups. Results All incisions healed by first intention without wound infection. At 4, 8, and 16 weeks after operation, the X-ray films showed that the implants were well maintained without apparent displacement. As followed with time, the combination between the implants and host bone became more and more closely, and the fracture line gradually disappeared. HE staining and toluidine blue staining showed that new bone mass and maturity gradually increased at the interface and inside materials in 2 groups, and the new bone gradually growed from the interface to internal pore. At 16 weeks after operation, the three point bending biomechanical test showed that the maximum load force and bending strength in the experimental were (96.54±7.21) N and (91.26±1.76) MPa respectively, showing significant differences when compared with the control group [(82.65±5.65) N and (78.53±1.16) MPa respectively] (t=3.715, P=0.004; t=14.801, P=0.000). And Micro-CT analysis exhibited that there were a large amount of new bone at the interface and the surface of implant materials and inside the materials. The new bone BV/TV in the experimental group (32.63%±3.56%) was significantly higher than that in control group (25.07%±4.34%) (t=3.299, P=0.008). Conclusion Domestic porous tantalum encapsulated with pedicled fascial flap can increase local blood supply, strengthen material bone conduction ability, and promote the segmental bone defect repair.