Effect of local blocking on osteoarthritis of the hip

Objective:To provide an effective treatment for the Osteoarthritis of the hip by observing the effect of local blocking of HongHua injection on relieving hip pain.Methods:Methods from June 2015 to May 2017,60 patients with Osteoarthritis of the hip in Wangjing Hospital of Chinese Academy of Sciences were randomly divided into treatment group and control group,30 cases in each group.The treatment group was given local blockingof HongHua injection treatment,control group using Compound Betamethasone Injection local closed treatment.Visual analogue scale(VAS)score,pericoxal local tenderness and hip mobility were used to evaluate the therapeutic effect.The therapeutic indicators at six different time points after 1 days,3 days,7 days,2 weeks and 1 months after treatment were compared.Results:All the 60 cases completed treatment and follow-up,and there were no cases of abscission.There was no significant difference in gender,age,etiology,classification and Harris score before treatment between the two groups(P>0.05),which was comparable.VAS score:There was no significant difference between the two groups on the 1st,3rd,7th and 2nd week after treatment(P>0.05),but the treatment group was lower than the control group on the 1st month after treatment(P<0.01).Hip joint activity:There was no significant difference in hip joint activity between the two groups 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Local tenderness around hip:The efficacy of the midpoint inguinal tenderness score was similar between the two groups at 1 day,7 days,2 weeks and 1 month after treatment(P>0.05);the treatment group was lower than the control group at 3 days after treatment(P<0.01);the adductor starting tenderness score had no significant difference at 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Conclusion:Local blockingof HongHua injection is effective and effective in treating hip pain in Osteoarthritis of the hip.The HongHua injection has many advantages,such as good safety and wide indications.It is worthy of further clinical application.

Features and Principles the Spread of Local Anesthetic Blockade of the Sciatic Nerve at Depends on the Amount of Anesthetic

Aim: To study the features of local anesthetic solution spreading during sciatic nerve block in dependence on the anesthetic solution volume. Material and Methods: One hundred and sixty nine cases of sciatic nerve blocks done under ultrasonic visualization control were analyzed. Sciatic nerve blocks were performed by lidocaine in volumes 30;25;20;15;12.5;10;7.5;6.5;5;4.5 ml. The cross-section area, equal to local anesthetic spreading, was determined;the extension of the anesthetic solution spreading along sciatic nerve was calculated. Results: The anesthetic agent solution spreads along sciatic nerve in proximal and distal direction, forming a kind of cylinder. The minimum volume of the local anesthetic, which covers sciatic nerve in the whole, is 5 ml. A rare (1.77%) variation of sciatic nerve structure was described, in which tibial and common peroneal nerves develop directly from the branches of sacral plexus. Conclusion: The decrease of the local anesthetic volume leads to reduction of its spreading distance and cross-section area. Ultrasonic visualization can provide for sciatic nerve anatomical peculiarities, which can have an effect on the block quality.

Classification of Gastric Lesions Using Gabor Block Local Binary Patterns

The identification of cancer tissues in Gastroenterology imaging poses novel challenges to the computer vision community in designing generic decision support systems.This generic nature demands the image descriptors to be invariant to illumination gradients,scaling,homogeneous illumination,and rotation.In this article,we devise a novel feature extraction methodology,which explores the effectiveness of Gabor filters coupled with Block Local Binary Patterns in designing such descriptors.We effectively exploit the illumination invariance properties of Block Local Binary Patterns and the inherent capability of convolutional neural networks to construct novel rotation,scale and illumination invariant features.The invariance characteristics of the proposed Gabor Block Local Binary Patterns(GBLBP)are demonstrated using a publicly available texture dataset.We use the proposed feature extraction methodology to extract texture features from Chromoendoscopy(CH)images for the classification of cancer lesions.The proposed feature set is later used in conjuncture with convolutional neural networks to classify the CH images.The proposed convolutional neural network is a shallow network comprising of fewer parameters in contrast to other state-of-the-art networks exhibiting millions of parameters required for effective training.The obtained results reveal that the proposed GBLBP performs favorably to several other state-of-the-art methods including both hand crafted and convolutional neural networks-based features.

Different Volumes of Local Anesthetics in Ultrasound-Guided Combined Interscalene-Supraclavicular Block for Traumatic Humeral Fracture

Background: Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. However, dual block requires high dose of local anesthetic (LA). We examined if Ultrasound (U/S) guided block helps to decrease the required volume of LA by visualizing trunks, so we only need injection of LA toward cervical nerve roots C5 and C6 aiming to block branches escaped from supraclavicular block. Patients and methods: Ninety-three patients were randomly allocated into one of three equal groups, each included 31 patients. All patients received SCB 20 ml (10 ml Bupivacaine 0.5% plus 10 ml lidocaine 2%) and ISB with different volumes of LA according to the group as follow: group A: 20 ml, group B: 15 ml, and group C: 10 ml. Result: No significant difference in onset of block (sensory and motor) and duration of block (motor only) between the three groups (P value > 0.05). The duration of sensory block was significantly longer in group A (760.65 ± 30.87 minutes) than in either group B (740.48 ± 21.15 minutes, P value P value P value P value P value P value < 0.001). Conclusion: A reduced volume of LA can be used in ultra sound guided ISB in combined with SCB to give satisfactory level of anesthesia to entire length of the arm, but the sensory block duration and duration of post-operative analgesia will be decreased significantly with decreasing the volume.

Effects of Repeated Injection of Local Anesthetic on Sciatic Nerve Blocks Response

In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression compound action potentials (CAP), rats were anesthetized with halothane, ventilated, monitored and supported with stable hemodynamics and temperature. Posterior tibial nerve distally and sciatic nerve in thigh were exposed, placed on bipolar silver electrodes for stimulation and recording respectively. Three sequential sciatic nerve blocks were performed between these electrodes using 0.15 ml of 3 % chloroprocaine. Nine rats were chosen to observe the effects of repeated sciatic nerve blocks on CAP. In another 18 rats, a second investigator exposed the sciatic nerve near its origin at spinal cord and randomly performed nerve cut and sham (n=9), and closed the incision blinding the electrophysiologic investigator. The results showed that electrical stimulated tibial nerve induced sciatic nerve Aα/β, Aδ, C fiber mediated CAP waves. CAP amplitudes were remained stable during whole experimental procedure. CAP amplitudes were decreased completely with 3% chloroprocaine blocked sciatic nerve and recovered fully. The duration of CAP depression were reduced with repeated blocks. There were no selective blocked effects on Aα/β, Aδ, C fiber mediated CAP. With sciatic nerve cut proximally, there was no statistical significant tachyphylaxis with 3 % chloroprocaine repeated blocked sciatic nerve, and the duration of first and third blocked Aδ fiber mediated CAP was 108±20 and 92±14 min respectively (P>0.05). In normal rats the duration of first and third blocked Aδ fiber mediated CAP was 110±20 and 75±16 min respectively (P<0.05). It was suggested that tachyphylaxis to local anesthetics can occur in rats repeated blocked sciatic nerve when assayed in vivo by duration of depression CAP. The continuity of sciatic nerve with spinal cord is one of the important factors affecting the development of tachyphylaxis.

Outcome Values of Adding Sodium Bicarbonate, Dexamethasone and Fentanyl to Local Anesthetic in Peribulbar Block during Vitreoretinal Surgeries. A Randomized Prospective Study

Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.

结合血管拓扑和Non-local CNN-GCN的肺动静脉分离方法

为解决肺CT影像中动、静脉血管的自动分离、精确提取问题,提出一种结合血管拓扑与连接非局部卷积神经网络和图卷积网络(Non-local CNN-GCN)的肺动静脉自动分离方法.首先,使用尺度空间粒子采样方法将血管树表示为一组中心线体素粒子;然后,根据粒子体素及其相邻体素构造拓扑图,并从拓扑图中提取只包含动脉或静脉分支的拓扑子图;最后,基于拓扑图训练Non-local CNN-GCN分类器,并利用拓扑子图来改进分类结果.在16例CT影像数据上进行训练和测试,结果显示,本方法能有效去除动静脉黏连点,分类平均准确度达94%.

Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.

The Use of “Scalp Block” in Pediatric Patients

Infiltration of the nerves of the scalp with local anesthetics is used in adults for a variety of head and neck procedures and craniotomies with many benefits, from hemodynamic stability to reduced postoperative pain. We here succinctly review the current evidence for “scalp block” in pediatric patients.

一类Block型李代数的2-局部导子

对一类Block型李代数的2-局部导子进行研究,证明了这类Block型李代数的2-局部导子都是导子.

Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

以神经阻滞专题为导向的硕士研究生局部解剖学教学设计

局部解剖学在外科硕士研究生的培养中占据着核心位置,尤其是对于神经阻滞等精细操作技能的学习。本研究团队通过对传统教学模式的创新,开发了“以神经阻滞专题为导向”的教学设计,旨在提升研究生在局部解剖学及其在临床实践中应用的理解和技能。本文详细介绍了该教学设计的原则、思路、内容和方法,通过多元化教学策略,提升学生的学习动力和实践技能。尽管面临资源、团队构建和学习动力不一致等方面的挑战,本教学设计在提高教学效果和培养具有高尚医德、丰富知识和精湛技能的医学人才方面展现出显著潜力,对医学教育的发展和创新具有重要的参考价值。

不同局麻药佐剂在周围神经阻滞中的应用进展

超声引导下周围神经阻滞技术在临床麻醉和术后镇痛中的应用越来越广泛。目前,怎样缩短周围神经阻滞的起效时间、延长所用局麻药的作用时间、降低局麻药的毒性反应、增强周围神经阻滞效果是临床麻醉关注的热点问题。许多学者为了缩短周围神经阻滞麻醉的起效时间,增强阻滞效果,延长阻滞的作用时间,尝试了在局麻药中加入多种佐剂进行研究,对比了在周围神经阻滞中应用不同局麻药佐剂的作用效果。本文将对近年来在周围神经阻滞中应用不同局麻药佐剂的应用和研究进展做一综述,以期为临床麻醉医生进行周围神经阻滞提供指导。

Can repeated scorpion bite lead to development of resistance to the effect of local anesthetics? Maybe it does!

An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.

面向超分辨率重建的层次间局部特征增强网络

基于卷积神经网络的超分辨率重建模型以单项传播为主,层次越靠后感知信息的能力越微弱,导致层次间局部特征部分丢失,难以实质提升网络的特征表达能力。针对此问题,提出层次间局部特征增强网络。该方法由级联残差模块、层次间特征增强块和特征感知注意力机制组成。级联残差模块通过有效残差连接增加对残差分支信息的利用;层次间特征增强块提取不同深度特征的依赖关系,自适应调整中间层特征权值增强捕获关键信息的能力;特征感知注意力机制采用方向感知和位置判断的方式准确定位和识别感兴趣对象。多项标准数据集的实验结果表明,该方法能改善超分辨率的视觉重建效果,整体性能优于现有方法。

IPACK阻滞与LIA在膝关节矫形术的应用效果比较

目的:比较腘动脉与膝关节后囊间隙(IPACK)阻滞与关节周围局部浸润镇痛(LIA)在膝关节矫形术后镇痛中的效果。方法:招募60例膝关节矫形术患者,随机分为IPACK阻滞组(I组)和LIA组(L组)。I组行IPACK阻滞,L组行LIA。记录疼痛评分、满意度评分、主动屈膝最大角度、步行距离、镇痛补救率和不良事件发生情况。结果:与L组比较,8h(T2)时点I组静态疼痛评分降低,差异有统计学意义(Z=-2.171,P<0.05);与L组比较,T2,24h(T3)时点I组动态疼痛评分降低,差异有统计学意义(Z=-1.277、-2.841,P<0.05);与L组比较,I组羟考酮应用率降低,差异有统计学意义(χ^(2)=6.667,P<0.05);与L组比较,I组术后2~3d患者主动屈膝最大角度增加,差异有统计学意义(Z=-2.088、-2.426,P<0.05)。结论:IPACK阻滞较LIA更适合于膝关节矫形术后镇痛。

基于HRNet的高分辨率遥感影像道路提取方法

高分辨率遥感影像中,传统的道路提取方法存在着精度低、鲁棒性低的问题,提出基于高分辨率网络(high-resolution net, HRNet)实现高分辨率遥感影像道路分割。对HRNet进行改进,将相同分辨率的HRNet子网的输出与输出层结果进行拼接并输入非局部块,两个损失函数Cross-entropy Loss和Dice Loss用来解决道路数据集样本不平衡问题。实验结果表明,改进的HRNet在公开的CHN6-CUG道路数据集上的分割性能与其他方法相比对道路的提取效果更好,在召回率、均交并比和F1分数3个方面分别达到了97.65%、84.91%和97.25%。

地方视角下苏州古城滨水街区节点活力营造策略——以山塘历史文化街区为例

江南城市水网纵横,水资源孕育了极具地方特色的滨水街区。随着城市建设发展,河道不再承载其原本的功能,街区滨水空间逐渐衰败。历史文化街区的地域特色及其在现代社会发展中如何平衡,关系到文化与历史记忆的传承。文章从“地方性”视角切入,对街区滨水空间节点进行分类研究,为节点活力营造提出具体策略。

选择性神经阻滞在自体动静脉内瘘成形术中的应用及对内瘘成熟的影响

目的:评估选择性神经阻滞在自体动静脉内瘘(AVF)成形术中的有效性及对术后内瘘成熟率的影响。方法:本研究为回顾性队列研究,选取2022-01-01~2022-12-31在北京大学第三医院海淀院区行AVF成形术的患者,根据术前麻醉类型分为选择性神经阻滞组(S组)和局部浸润麻醉组(L组)。采用视觉模拟评分法(VAS)比较两组患者术中的疼痛程度,术后即刻、4周、8周、12周的吻合血管内径及肱动脉血流量,并比较两组的内瘘成熟率。结果:共纳入207例患者,S组44例(21.26%),L组163例(78.74%)。与L组相比,S组患者术前吻合血管内径更细(P<0.05),术中VAS更低(Z=-2.598,P=0.009),麻醉后5 min的吻合静脉内径、术后即刻肱动脉血流量更大(P<0.05)。S组患者术后内瘘头静脉内径及肱动脉血流量明显高于L组(均P<0.05),4周和8周时S组的成熟率明显高于L组(P均<0.05),12周时两组成熟率差异无统计学意义(χ^(2)=1.616,P=0.204)。结论:选择性神经阻滞用于AVF成形术时,可安全有效镇痛,兼具扩张血管、增加术后内瘘血流量及提高短期内瘘成熟率的优势,尤其适合于血管较细的患者。