Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treati...Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.展开更多
The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,...The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,to address the shortcomings of the current medical education model and,secondly,to enhance medical students’independent thinking abilities and clinical diagnostic skills.The study enrolled 87 clinical medicine interns rotating at Jiangning Hospital in Nanjing from January to December 2024,dividing them into an experimental group(receiving ultrasound-guided puncture procedure training)and a control group(receiving conventional puncture procedure training).It was evident that both groups had successfully completed the requisite two-hour comprehensive course training program.A subsequent analysis of the teaching outcomes was then conducted through intergroup comparison.The findings indicated that the experimental group exhibited lower DOPS assessment scores in comparison to the control group(4.91±1.01 vs.5.84±1.22,p<0.05).However,the satisfaction levels of the experimental group with the teaching method reached 95.45%.This finding indicates that ultrasound-guided puncture techniques may offer a substantial advantage in terms of pedagogical approaches.However,it should be noted that students in the experimental group faced challenges such as high operational complexity and the need to pay attention to numerous details during actual procedures,leading to lower assessment scores.Conducting a systematic analysis of these issues can provide clear directions for the optimization of teaching methods in the future,thereby enhancing students’learning outcomes and clinical application capabilities.展开更多
Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound iso...Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.展开更多
Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients sche...Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients scheduled for surgery were randomly divided into two groups,with 30 patients in each.The control group received subarachnoid anesthesia with 2–2.5 mL of 0.33%ropivacaine.The experimental group received the same ropivacaine dose,followed by withdrawal of the needle to the epidural space and administration of 0.1 mg hydromorphone diluted to 5 mL.The anesthetic and analgesic effects,incidence of complications,and postoperative family satisfaction were observed in both groups.Results:Compared with the control group,the experimental group showed a higher anesthesia success rate,a shorter onset time,and a longer maintenance time of anesthesia(p<0.05).Postoperative analgesia at various time points was significantly better in the experimental group(p<0.05).The total incidence of complications was lower in the experimental group,though the difference was not statistically significant(p>0.05).Family satisfaction was significantly higher in the experimental group(p<0.05).Conclusion:CSE anesthesia using a 25G fine needle via a single puncture for pediatric lower limb surgery is safe and effective.It can significantly improve surgical outcomes and is worthy of clinical promotion.展开更多
BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)wit...BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.展开更多
Objective To observe the effects of a protocol consisting of warm needling with moxibustion at Xiàguān（下关 ST 7） plus shallow puncture on Bell＇s palsy（BP） in pregnancy.Methods Thirteen patients with BP rec...Objective To observe the effects of a protocol consisting of warm needling with moxibustion at Xiàguān（下关 ST 7） plus shallow puncture on Bell＇s palsy（BP） in pregnancy.Methods Thirteen patients with BP received an intervention of warm needling moxibustion at ST 7 plus shallow puncture,and were evaluated using the House–Brackmann facial nerve grading system（HB） before and after intervention.Result After intervention,the HB grade improved significantly（P0.05）.Conclusion Warm needling moxibustion plus shallow puncture is a safe and effective therapy for pregnant BP patients.BP in pregnancy appears to be more frequent in the last trimester.The severity of nerve injury and the timing for the first visit to the doctor after the onset of facial paralysis are essential factors for the recovery and prognosis of pregnant with BP.展开更多
Objective To observe the clinical effect of blood-letting puncture and cupping at Chōngxiāo（冲霄 Extra） point of Dong＇s unique Extra-ordinary points in the treatment of neck type of cervical spondylosis.Methods S...Objective To observe the clinical effect of blood-letting puncture and cupping at Chōngxiāo（冲霄 Extra） point of Dong＇s unique Extra-ordinary points in the treatment of neck type of cervical spondylosis.Methods Sixty-five patients of neck type of cervical spondylosis were selected and treated with blood-letting puncture and cupping at Chōngxiāo（冲霄 Extra） point once every two or three days,three times constituted one course and two successive courses were given,then the clinical effect was evaluated.Results The curative rate was 69.2%（45/65）,and the total effective rate was 92.3%（60/65）.Conclusion Blood-letting puncture and cupping at Dong＇s Chōngxiāo（冲霄 Extra） point can be used to treat neck type of cervical spondylosis with simple manipulation and obvious efficacy.展开更多
The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and p...The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.展开更多
To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group recei...To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group received triple puncture treatment of 6 times per week for 4 weeks,and those in control group were given carbamazepine (300-600 mg per day) for at least 1 month.Before and after treatment,the primary outcomes including the total efficiency rate and the VAS pain scores,and the secondary outcomes including the frequency of pain attack and adverse events were observed.Sixty-two participants finished the study (33 in treatment group and 29 in control group individually).After treatment,the symptoms (mainly pain) of the two groups were alleviated.The total efficiency rate in the treatment group and control group was 90.9% and 75.9% respectively.The VAS pain scores and frequency of pain attack were significantly reduced in the treatment group as compared with the control group (P<0.05).The incidence of adverse events in the treatment group and control group was 9.1% and 24.1% respectively.It can be inferred that triple puncture can effectively improve the quality of life of patients with pTN and has less side effects.展开更多
In this article, some facts of the value distribution theory for meromorphic func- tions with maximal deficiency sum in the plane will be considered in the punctured plane, and also the relationship between the defici...In this article, some facts of the value distribution theory for meromorphic func- tions with maximal deficiency sum in the plane will be considered in the punctured plane, and also the relationship between the deficiency of meromorphic function in the punctured plane and that of their derivatives is studied.展开更多
Cardiac dysfunction, a common consequence of sepsis, is the major contribution to morbidity and mortality in patients. Sodium tanshinone IIA sulfonate(STS) is a water-soluble derivative of Tanshinone IIA(TA), a main a...Cardiac dysfunction, a common consequence of sepsis, is the major contribution to morbidity and mortality in patients. Sodium tanshinone IIA sulfonate(STS) is a water-soluble derivative of Tanshinone IIA(TA), a main active component of Salvia miltiorrhiza Bunge, which has been widely used in China for the treatment of cardiovascular and cerebral system diseases. In the present study, the effect of STS on sepsis-induced cardiac dysfunction was investigated and its effect on survival rate of rats with sepsis was also evaluated. STS treatment could significantly decrease the serum levels of C-reactive protein(CRP), procalcitonin(PCT), cardiac troponin Ⅰ(cTn-Ⅰ), cardiac troponin T(cTn-T), and brain natriuretic peptide(BNP) in cecal ligation and puncture(CLP)-induced) septic rats and improve left ventricular function, particularly at 48 and 72 h after CLP. As the pathogenesis of septic myocardial dysfunction is attributable to dysregulated systemic inflammatory responses, several key cytokines, including tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), interleukin-10(IL-10) and high mobility group protein B1(HMGB1), were detected to reveal the possible mechanism of attenuation of septic myocardial dysfunction after being treated by STS. Our study showed that STS, especially at a high dose(15 mg×kg–1), could efficiently suppress inflammatory responses in myocardium and reduce myocardial necrosis through markedly reducing production of myocardial TNF-α, IL-6 and HMGB1. STS significantly improved the 18-day survival rate of rats with sepsis from 0% to 30%(P < 0.05). Therefore, STS could suppress inflammatory responses and improve left ventricular function in rats with sepsis, suggesting that it may be developed for the treatment of sepsis.展开更多
Acupuncture combined with blood-letting puncturing and cupping Is quite effectivein treatment of migraine.The total effective rate of 300 cases is 95.7％.Combined treatment ofacupuncture and cupping can supplement eac...Acupuncture combined with blood-letting puncturing and cupping Is quite effectivein treatment of migraine.The total effective rate of 300 cases is 95.7％.Combined treatment ofacupuncture and cupping can supplement each other in strengthening the therapeutic effect and is agood way for relieving headache.展开更多
BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle...BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.RESULTS: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.CONCLUSION: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.展开更多
BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia fo...BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.展开更多
In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant differe...In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant difference in therapeutic effect (P【 0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.展开更多
BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture ...BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.展开更多
基金the financial contribution of the Groupe de Recherche En Médecine d’Urgence du CHUL (GREMUC)which is the local emergency department research group。
文摘Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.
基金Education Foundation of Kangda College of Nanjing Medical University(Project No.:KDJYYJYB202332)Science Foundation of Kangda College of Nanjing Medical University(Project No.:KD2023KYJJ250)。
文摘The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,to address the shortcomings of the current medical education model and,secondly,to enhance medical students’independent thinking abilities and clinical diagnostic skills.The study enrolled 87 clinical medicine interns rotating at Jiangning Hospital in Nanjing from January to December 2024,dividing them into an experimental group(receiving ultrasound-guided puncture procedure training)and a control group(receiving conventional puncture procedure training).It was evident that both groups had successfully completed the requisite two-hour comprehensive course training program.A subsequent analysis of the teaching outcomes was then conducted through intergroup comparison.The findings indicated that the experimental group exhibited lower DOPS assessment scores in comparison to the control group(4.91±1.01 vs.5.84±1.22,p<0.05).However,the satisfaction levels of the experimental group with the teaching method reached 95.45%.This finding indicates that ultrasound-guided puncture techniques may offer a substantial advantage in terms of pedagogical approaches.However,it should be noted that students in the experimental group faced challenges such as high operational complexity and the need to pay attention to numerous details during actual procedures,leading to lower assessment scores.Conducting a systematic analysis of these issues can provide clear directions for the optimization of teaching methods in the future,thereby enhancing students’learning outcomes and clinical application capabilities.
基金supported by the National Natural Science Foundation of China(81803547)the Natural Science Foundation of Fujian Province,China(2021J01204)Fujian Provincial Regional Development Project(2021N3005)。
文摘Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.
文摘Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients scheduled for surgery were randomly divided into two groups,with 30 patients in each.The control group received subarachnoid anesthesia with 2–2.5 mL of 0.33%ropivacaine.The experimental group received the same ropivacaine dose,followed by withdrawal of the needle to the epidural space and administration of 0.1 mg hydromorphone diluted to 5 mL.The anesthetic and analgesic effects,incidence of complications,and postoperative family satisfaction were observed in both groups.Results:Compared with the control group,the experimental group showed a higher anesthesia success rate,a shorter onset time,and a longer maintenance time of anesthesia(p<0.05).Postoperative analgesia at various time points was significantly better in the experimental group(p<0.05).The total incidence of complications was lower in the experimental group,though the difference was not statistically significant(p>0.05).Family satisfaction was significantly higher in the experimental group(p<0.05).Conclusion:CSE anesthesia using a 25G fine needle via a single puncture for pediatric lower limb surgery is safe and effective.It can significantly improve surgical outcomes and is worthy of clinical promotion.
文摘BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
基金Supported by Zhejiang Traditional Chinese Medicine Technology Program 2016ZA076
文摘Objective To observe the effects of a protocol consisting of warm needling with moxibustion at Xiàguān（下关 ST 7） plus shallow puncture on Bell＇s palsy（BP） in pregnancy.Methods Thirteen patients with BP received an intervention of warm needling moxibustion at ST 7 plus shallow puncture,and were evaluated using the House–Brackmann facial nerve grading system（HB） before and after intervention.Result After intervention,the HB grade improved significantly（P0.05）.Conclusion Warm needling moxibustion plus shallow puncture is a safe and effective therapy for pregnant BP patients.BP in pregnancy appears to be more frequent in the last trimester.The severity of nerve injury and the timing for the first visit to the doctor after the onset of facial paralysis are essential factors for the recovery and prognosis of pregnant with BP.
文摘Objective To observe the clinical effect of blood-letting puncture and cupping at Chōngxiāo（冲霄 Extra） point of Dong＇s unique Extra-ordinary points in the treatment of neck type of cervical spondylosis.Methods Sixty-five patients of neck type of cervical spondylosis were selected and treated with blood-letting puncture and cupping at Chōngxiāo（冲霄 Extra） point once every two or three days,three times constituted one course and two successive courses were given,then the clinical effect was evaluated.Results The curative rate was 69.2%（45/65）,and the total effective rate was 92.3%（60/65）.Conclusion Blood-letting puncture and cupping at Dong＇s Chōngxiāo（冲霄 Extra） point can be used to treat neck type of cervical spondylosis with simple manipulation and obvious efficacy.
文摘The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.
文摘To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group received triple puncture treatment of 6 times per week for 4 weeks,and those in control group were given carbamazepine (300-600 mg per day) for at least 1 month.Before and after treatment,the primary outcomes including the total efficiency rate and the VAS pain scores,and the secondary outcomes including the frequency of pain attack and adverse events were observed.Sixty-two participants finished the study (33 in treatment group and 29 in control group individually).After treatment,the symptoms (mainly pain) of the two groups were alleviated.The total efficiency rate in the treatment group and control group was 90.9% and 75.9% respectively.The VAS pain scores and frequency of pain attack were significantly reduced in the treatment group as compared with the control group (P<0.05).The incidence of adverse events in the treatment group and control group was 9.1% and 24.1% respectively.It can be inferred that triple puncture can effectively improve the quality of life of patients with pTN and has less side effects.
基金supported by the National Natural Science Foundation of China(11201395)supported by the Science Foundation of Educational Commission of Hubei Province(D20132804)supported by the Science Foundation of Jiangxi Province(20122BAB201006)
文摘In this article, some facts of the value distribution theory for meromorphic func- tions with maximal deficiency sum in the plane will be considered in the punctured plane, and also the relationship between the deficiency of meromorphic function in the punctured plane and that of their derivatives is studied.
文摘Cardiac dysfunction, a common consequence of sepsis, is the major contribution to morbidity and mortality in patients. Sodium tanshinone IIA sulfonate(STS) is a water-soluble derivative of Tanshinone IIA(TA), a main active component of Salvia miltiorrhiza Bunge, which has been widely used in China for the treatment of cardiovascular and cerebral system diseases. In the present study, the effect of STS on sepsis-induced cardiac dysfunction was investigated and its effect on survival rate of rats with sepsis was also evaluated. STS treatment could significantly decrease the serum levels of C-reactive protein(CRP), procalcitonin(PCT), cardiac troponin Ⅰ(cTn-Ⅰ), cardiac troponin T(cTn-T), and brain natriuretic peptide(BNP) in cecal ligation and puncture(CLP)-induced) septic rats and improve left ventricular function, particularly at 48 and 72 h after CLP. As the pathogenesis of septic myocardial dysfunction is attributable to dysregulated systemic inflammatory responses, several key cytokines, including tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), interleukin-10(IL-10) and high mobility group protein B1(HMGB1), were detected to reveal the possible mechanism of attenuation of septic myocardial dysfunction after being treated by STS. Our study showed that STS, especially at a high dose(15 mg×kg–1), could efficiently suppress inflammatory responses in myocardium and reduce myocardial necrosis through markedly reducing production of myocardial TNF-α, IL-6 and HMGB1. STS significantly improved the 18-day survival rate of rats with sepsis from 0% to 30%(P < 0.05). Therefore, STS could suppress inflammatory responses and improve left ventricular function in rats with sepsis, suggesting that it may be developed for the treatment of sepsis.
文摘Acupuncture combined with blood-letting puncturing and cupping Is quite effectivein treatment of migraine.The total effective rate of 300 cases is 95.7％.Combined treatment ofacupuncture and cupping can supplement each other in strengthening the therapeutic effect and is agood way for relieving headache.
文摘BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.RESULTS: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.CONCLUSION: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.
基金Supported by the Applied Medical Research Project of Hefei Health and Family Planning Commission,No.Hwk2020yb0016.
文摘BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.
文摘In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant difference in therapeutic effect (P【 0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.
基金Supported by The Key R&D Project in Jiangsu Province,No.BE2017603 and No.BE2017675the Key Program of Medical Science and Technology Development Projects in Nanjing,No.ZKX19016.
文摘BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.
