Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluat...Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.展开更多
As an effective solution for protecting the underlying permafrost and preventing roadway damages, the block-rock embankment(BRE) has been widely used on the Qinghai–Tibet Railway, Qinghai–Tibet Highway, and Ching–H...As an effective solution for protecting the underlying permafrost and preventing roadway damages, the block-rock embankment(BRE) has been widely used on the Qinghai–Tibet Railway, Qinghai–Tibet Highway, and Ching–Hong Road;and it will be promoted for other roadways in the future. To evaluate the adaptability of BRE, the catastrophe-progression method was adopted for the evaluation. By analyzing the factors affecting the stability of BRE and utilizing engineering experience, we were able to establish the mathematical model and divide the adaptability of BRE into five grades. After the verifying analysis of 28 practical engineering examples, the evaluation results are broadly in line with practical application effects. Therefore, the adaptability of BRE can be evaluated and predicted more accurately with this evaluation model.展开更多
Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pha...Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine;2) Propofol would have shorter post anesthesia unit recovery times;and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction;however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.展开更多
The Funan-Huoqiu area is located in the border tectonic belt between the North China and South China active block regions. By means of seismological and geological surveys and synthetic analysis, evidences of tectonic...The Funan-Huoqiu area is located in the border tectonic belt between the North China and South China active block regions. By means of seismological and geological surveys and synthetic analysis, evidences of tectonic deformation in lower intensity have been found in the area since Late Pleistocene, where small earthquakes are distributed linearly along the main faults, conjugate shear joints are developed in the Upper Pleistocene nearby the faults. In the south of the studied region, fissures with different lengths, widths and directions occurred successively in Gushi, Huoqiu, Funan and other places of the area, in the 1970’s, and the direction of the fissures is approximately consistent with that of the Feizhong fault and Wanglaorenji fault. The authors hold that the clustering of small earthquakes, the conjugate shear joints developed in the Upper Pleistocene, the crumpled deformation of materials on fault plane, and the development of modern surface fissures in the area all reflect that the energy in the crust was slowly released, and that the weak deformation took place in corresponding faults. There was only one destructive earthquake taking place in the area (the Jiangkouji {M_S43/4} earthquake). Altogather, there has been weak activity in the area since the Late Quaternary, and it is mainly shown as a creep-slip.展开更多
The western margin of Yangtze block and southwestern Sanjiang region absorbed much attention from geologists. It has been proved that there occurred a series of plate subduction, collision, assembly, rifting and break...The western margin of Yangtze block and southwestern Sanjiang region absorbed much attention from geologists. It has been proved that there occurred a series of plate subduction, collision, assembly, rifting and breakup processes between them since Palaeozoic and the tectonic evolutionary relationship between them is clear. But in Proterozoic this kind of links between them became unclear. Did they undergo the assembly and breakup processes of the Rodinia super continent? This paper will take a primary discussion on this question on the basis of basement component, structure characteristics and magmatic activities.1\ Basement features\;(1) In western margin of Yangtze block its basement is composed of crystalline basement and folded basement, a so\|called double\|layer structure. The crystalline basement is made up of Kangding group, Pudeng Formation and Dibadu Formation, among them Kangding group is a representative and composed mainly of migmatite, compositing gneiss, hornblende schist and granulitite. The isotopic age of crystalline basement is older than 1900Ma, so its geological time is late Archaean to early Proterozoic. The folded basement is composed of Dahongshan group, Hekou group, Kunyang group, Huili group and Yanbian group. Their rock associations are made up mainly of spilite\|keratophyre formation, carbonate formation, clastic rock and clastic rock formation with some basic volcanic rocks. The folded basement is assigned to be early and middle Proterozoic (1000~1700M a).展开更多
Due to unique geographical position and climatic characteristics,there are more economic,social,resource,environmental and other problems in urban construction of arid region. Old urban block of Kashgar and typical bl...Due to unique geographical position and climatic characteristics,there are more economic,social,resource,environmental and other problems in urban construction of arid region. Old urban block of Kashgar and typical block of Masdar ecological city of Abu Dhabi are taken as the research objects. Based on summarizing the characteristics of traditional block and newly built ecological block in arid region,comparative analysis on their space forms and environmental designs is conducted,and the association mechanism between ecological adaptability and space form is generalized. From the aspects of block layout,block space,open space and architectural form,ecological design strategy of the block in arid region is proposed,which could provide the reference for development and construction of ecological city in arid region of China.展开更多
We propose an image retrieval method based on interest image region by asymmetrical blocking. An image is segmented into the interest region and background region on a certain rule. For the interest image regions, the...We propose an image retrieval method based on interest image region by asymmetrical blocking. An image is segmented into the interest region and background region on a certain rule. For the interest image regions, the color histogram of the uneven blocks is extracted as the color characteristic. We also collect the mean and variance value of the Gabor filtering results of background blocks as texture features of the background image. Then, the images can be retrieved by synthesizing the image color and texture features. We test our approaches by analyzing the resuits of recall and precision indicators for the Corel image database. The experiment results show that the proposed method performs effectively and accurately, which is more effective to retrieve the distant-view images, and the achieved precision increases by about 10% without loss of the retrieval call compared with some other traditional search methods.展开更多
Regional geochemical division is a mapping technique to divide an area into slices where the associations between geochemical elements are relatively simple and uniform. The result of division is expressed on a 2 D ma...Regional geochemical division is a mapping technique to divide an area into slices where the associations between geochemical elements are relatively simple and uniform. The result of division is expressed on a 2 D map. The scheme of regional geochemical division includes non supervised pattern recognition, elementary statistics and factor analysis. A practical example in a gold prospecting area in Jilin, China, and the corresponding explanation are presented. Regional geochemical division is a basic approach to the delineation of the geochemical blocks as well.展开更多
Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerv...Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.展开更多
BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade&...BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks.METHODS: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device.RESULTS: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin model.CONCLUSION: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.展开更多
The special seismic tectonic environment and frequent seismicity in the southeastern margin of the Qinghai-Tibet Plateau show that this area is an ideal location to study the present tectonic movement and background o...The special seismic tectonic environment and frequent seismicity in the southeastern margin of the Qinghai-Tibet Plateau show that this area is an ideal location to study the present tectonic movement and background of strong earthquakes in China's Mainland and to predict future strong earthquake risk zones. Studies of the structural environment and physical characteristics of the deep structure in this area are helpful to explore deep dynamic effects and deformation field characteristics, to strengthen our understanding of the roles of anisotropy and tectonic deformation and to study the deep tectonic background of the seismic origin of the block's interior. In this paper, the three-dimensional (3D) P-wave velocity structure of the crust and upper mantle under the southeastern margin of the Qinghai-Tibet Plateau is obtained via observational data from 224 permanent seismic stations in the regional digital seismic network of Yunnan and Sichuan Provinces and from 356 mobile China seismic arrays in the southern section of the north-south seismic belt using a joint inversion method of the regional earthquake and teleseismic data. The results indicate that the spatial distribution of the P-wave velocity anomalies in the shallow upper crust is closely related to the surface geological structure, terrain and lithology. Baoxing and Kangding, with their basic volcanic rocks and volcanic clastic rocks, present obvious high-velocity anomalies. The Chengdu Basin shows low-velocity anomalies associated with the Quaternary sediments. The Xichang Mesozoic Basin and the Butuo Basin are characterised by low- velocity anomalies related to very thick sedimentary layers. The upper and middle crust beneath the Chuan-Dian and Songpan-Ganzi Blocks has apparent lateral heterogeneities, including low-velocity zones of different sizes. There is a large range of low-velocity layers in the Songpan-Ganzi Block and the sub-block northwest of Sichuan Province, showing that the middle and lower crust is relatively weak. The Sichuan Basin, which is located in the western margin of the Yangtze platform, shows high-velocity characteristics. The results also reveal that there are continuous low-velocity layer distributions in the middle and lower crust of the Daliangshan Block and that the distribution direction of the low-velocity anomaly is nearly SN, which is consistent with the trend of the Daliangshan fault. The existence of the low-velocity layer in the crust also provides a deep source for the deep dynamic deformation and seismic activity of the Daliangshan Block and its boundary faults. The results of the 3D P-wave velocity structure show that an anomalous distribution of high-density, strong-magnetic and high-wave velocity exists inside the crust in the Panxi region. This is likely related to late Paleozoic mantle plume activity that led to a large number of mafic and ultra-mafic intrusions into the crust. In the crustal doming process, the massive intrusion of mantle-derived material enhanced the mechanical strength of the crustal medium. The P-wave velocity structure also revealed that the upper mantle contains a low-velocity layer at a depth of 80-120 km in the Panxi region. The existence of deep faults in the Panxi region, which provide conditions for transporting mantle thermal material into the crust, is the deep tectonic background for the area's strong earthquake activity.展开更多
Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analg...Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.展开更多
<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performan...<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.展开更多
Based on the earthquake activity characteristics of the diamond block in the Sichuan- Yunnan region and by using the method of the meso-scope damage dynamics and damage evolution, we studied the damage evolution proce...Based on the earthquake activity characteristics of the diamond block in the Sichuan- Yunnan region and by using the method of the meso-scope damage dynamics and damage evolution, we studied the damage evolution process for moderately strong earthquakes along two seismic belts. The original combination patterns of all the units which illuminate the changes from stable state to destroyed state are given. All these patterns can direct the earthquake prediction practice in this region.展开更多
Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia...Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia for lower extremity anesthesia. Such blocks can be used additionally as a source of postoperative pain relief.展开更多
<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior ...<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. <b>Methods:</b> After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. <b>Results:</b> There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. <b>Conclusions:</b> Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.展开更多
Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respirat...Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.展开更多
文摘Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.
文摘As an effective solution for protecting the underlying permafrost and preventing roadway damages, the block-rock embankment(BRE) has been widely used on the Qinghai–Tibet Railway, Qinghai–Tibet Highway, and Ching–Hong Road;and it will be promoted for other roadways in the future. To evaluate the adaptability of BRE, the catastrophe-progression method was adopted for the evaluation. By analyzing the factors affecting the stability of BRE and utilizing engineering experience, we were able to establish the mathematical model and divide the adaptability of BRE into five grades. After the verifying analysis of 28 practical engineering examples, the evaluation results are broadly in line with practical application effects. Therefore, the adaptability of BRE can be evaluated and predicted more accurately with this evaluation model.
文摘Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine;2) Propofol would have shorter post anesthesia unit recovery times;and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction;however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.
文摘The Funan-Huoqiu area is located in the border tectonic belt between the North China and South China active block regions. By means of seismological and geological surveys and synthetic analysis, evidences of tectonic deformation in lower intensity have been found in the area since Late Pleistocene, where small earthquakes are distributed linearly along the main faults, conjugate shear joints are developed in the Upper Pleistocene nearby the faults. In the south of the studied region, fissures with different lengths, widths and directions occurred successively in Gushi, Huoqiu, Funan and other places of the area, in the 1970’s, and the direction of the fissures is approximately consistent with that of the Feizhong fault and Wanglaorenji fault. The authors hold that the clustering of small earthquakes, the conjugate shear joints developed in the Upper Pleistocene, the crumpled deformation of materials on fault plane, and the development of modern surface fissures in the area all reflect that the energy in the crust was slowly released, and that the weak deformation took place in corresponding faults. There was only one destructive earthquake taking place in the area (the Jiangkouji {M_S43/4} earthquake). Altogather, there has been weak activity in the area since the Late Quaternary, and it is mainly shown as a creep-slip.
文摘The western margin of Yangtze block and southwestern Sanjiang region absorbed much attention from geologists. It has been proved that there occurred a series of plate subduction, collision, assembly, rifting and breakup processes between them since Palaeozoic and the tectonic evolutionary relationship between them is clear. But in Proterozoic this kind of links between them became unclear. Did they undergo the assembly and breakup processes of the Rodinia super continent? This paper will take a primary discussion on this question on the basis of basement component, structure characteristics and magmatic activities.1\ Basement features\;(1) In western margin of Yangtze block its basement is composed of crystalline basement and folded basement, a so\|called double\|layer structure. The crystalline basement is made up of Kangding group, Pudeng Formation and Dibadu Formation, among them Kangding group is a representative and composed mainly of migmatite, compositing gneiss, hornblende schist and granulitite. The isotopic age of crystalline basement is older than 1900Ma, so its geological time is late Archaean to early Proterozoic. The folded basement is composed of Dahongshan group, Hekou group, Kunyang group, Huili group and Yanbian group. Their rock associations are made up mainly of spilite\|keratophyre formation, carbonate formation, clastic rock and clastic rock formation with some basic volcanic rocks. The folded basement is assigned to be early and middle Proterozoic (1000~1700M a).
基金Supported by the National Natural Science Foundation of China(51578366)Independent Innovation Fund of Tianjin University(2017XSC-0127)Science and Technology Plan Project of Ministry of Housing and Urban-rural Development in 2017(2017-k2-012)
文摘Due to unique geographical position and climatic characteristics,there are more economic,social,resource,environmental and other problems in urban construction of arid region. Old urban block of Kashgar and typical block of Masdar ecological city of Abu Dhabi are taken as the research objects. Based on summarizing the characteristics of traditional block and newly built ecological block in arid region,comparative analysis on their space forms and environmental designs is conducted,and the association mechanism between ecological adaptability and space form is generalized. From the aspects of block layout,block space,open space and architectural form,ecological design strategy of the block in arid region is proposed,which could provide the reference for development and construction of ecological city in arid region of China.
基金Supported by the National Natural Science Foundation of China (50803016)
文摘We propose an image retrieval method based on interest image region by asymmetrical blocking. An image is segmented into the interest region and background region on a certain rule. For the interest image regions, the color histogram of the uneven blocks is extracted as the color characteristic. We also collect the mean and variance value of the Gabor filtering results of background blocks as texture features of the background image. Then, the images can be retrieved by synthesizing the image color and texture features. We test our approaches by analyzing the resuits of recall and precision indicators for the Corel image database. The experiment results show that the proposed method performs effectively and accurately, which is more effective to retrieve the distant-view images, and the achieved precision increases by about 10% without loss of the retrieval call compared with some other traditional search methods.
文摘Regional geochemical division is a mapping technique to divide an area into slices where the associations between geochemical elements are relatively simple and uniform. The result of division is expressed on a 2 D map. The scheme of regional geochemical division includes non supervised pattern recognition, elementary statistics and factor analysis. A practical example in a gold prospecting area in Jilin, China, and the corresponding explanation are presented. Regional geochemical division is a basic approach to the delineation of the geochemical blocks as well.
文摘Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.
文摘BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks.METHODS: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device.RESULTS: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin model.CONCLUSION: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.
基金supported by China earthquake scientific array exploration Southern section of North South seismic belt(201008001)Northern section of North South seismic belt(20130811)+1 种基金National Natural Science Foundation of China(41474057)Science for Earthquake Resllience of China Earthquake Administration(XH15040Y)
文摘The special seismic tectonic environment and frequent seismicity in the southeastern margin of the Qinghai-Tibet Plateau show that this area is an ideal location to study the present tectonic movement and background of strong earthquakes in China's Mainland and to predict future strong earthquake risk zones. Studies of the structural environment and physical characteristics of the deep structure in this area are helpful to explore deep dynamic effects and deformation field characteristics, to strengthen our understanding of the roles of anisotropy and tectonic deformation and to study the deep tectonic background of the seismic origin of the block's interior. In this paper, the three-dimensional (3D) P-wave velocity structure of the crust and upper mantle under the southeastern margin of the Qinghai-Tibet Plateau is obtained via observational data from 224 permanent seismic stations in the regional digital seismic network of Yunnan and Sichuan Provinces and from 356 mobile China seismic arrays in the southern section of the north-south seismic belt using a joint inversion method of the regional earthquake and teleseismic data. The results indicate that the spatial distribution of the P-wave velocity anomalies in the shallow upper crust is closely related to the surface geological structure, terrain and lithology. Baoxing and Kangding, with their basic volcanic rocks and volcanic clastic rocks, present obvious high-velocity anomalies. The Chengdu Basin shows low-velocity anomalies associated with the Quaternary sediments. The Xichang Mesozoic Basin and the Butuo Basin are characterised by low- velocity anomalies related to very thick sedimentary layers. The upper and middle crust beneath the Chuan-Dian and Songpan-Ganzi Blocks has apparent lateral heterogeneities, including low-velocity zones of different sizes. There is a large range of low-velocity layers in the Songpan-Ganzi Block and the sub-block northwest of Sichuan Province, showing that the middle and lower crust is relatively weak. The Sichuan Basin, which is located in the western margin of the Yangtze platform, shows high-velocity characteristics. The results also reveal that there are continuous low-velocity layer distributions in the middle and lower crust of the Daliangshan Block and that the distribution direction of the low-velocity anomaly is nearly SN, which is consistent with the trend of the Daliangshan fault. The existence of the low-velocity layer in the crust also provides a deep source for the deep dynamic deformation and seismic activity of the Daliangshan Block and its boundary faults. The results of the 3D P-wave velocity structure show that an anomalous distribution of high-density, strong-magnetic and high-wave velocity exists inside the crust in the Panxi region. This is likely related to late Paleozoic mantle plume activity that led to a large number of mafic and ultra-mafic intrusions into the crust. In the crustal doming process, the massive intrusion of mantle-derived material enhanced the mechanical strength of the crustal medium. The P-wave velocity structure also revealed that the upper mantle contains a low-velocity layer at a depth of 80-120 km in the Panxi region. The existence of deep faults in the Panxi region, which provide conditions for transporting mantle thermal material into the crust, is the deep tectonic background for the area's strong earthquake activity.
文摘Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.
文摘<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.
文摘Based on the earthquake activity characteristics of the diamond block in the Sichuan- Yunnan region and by using the method of the meso-scope damage dynamics and damage evolution, we studied the damage evolution process for moderately strong earthquakes along two seismic belts. The original combination patterns of all the units which illuminate the changes from stable state to destroyed state are given. All these patterns can direct the earthquake prediction practice in this region.
文摘Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia for lower extremity anesthesia. Such blocks can be used additionally as a source of postoperative pain relief.
文摘<b>Introduction:</b> Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. <b>Methods:</b> After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. <b>Results:</b> There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. <b>Conclusions:</b> Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.
文摘Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.