AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranso...AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the pancreas.RESULTS: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups(26 d vs 30 d,P = 0.65,and 0% for both respectively).CONCLUSION: Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.展开更多
The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climat...The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climate changes, and landform evolution since the Middle Pleistocene. Based on geomorphological, sedimentological, and chronological investigations, 6-8 terraces are identified in the lower reaches of Yalong catchment and its tributary--the Anning River. The electron spin resonance （ESR） or optically stimulated luminescence （OSL） data on the alluvial sediments in the upper portion of terraces indicate that they formed in 1.10, 0.90, 0.72, 0.06-0.04, 0.03-0.02, and 0.01 Ma. Tectonic uplift and the climatic cycle controlled the formation of the Yalong River terraces. The former dominated the dissection depths and incision rates, whereas the latter controlled the transformation between accumulation, which developed during the glacial period, and incision, which developed during the glacial-interglacial transition. The Yalong downstream incised rapidly from 1.10 to 0.72 Ma and rapidly from 0.06 Ma until the present; the terraces developed during these two periods. The incision rates in space during the two periods indicate the uplifting extent of the Jinpingshan area, which decreases toward the east and the south. The results reveal two rapidly uplifting stages in the SE Tibetan Plateau, including an accelerated uplifting since 0.06 Ma. Since the Middle Pleistocene, the tectonic uplift of the SE and NE parts of the Tibetan Plateau is synchronous, according to the same development stages of the river terraces of the Yalong downstream and the Yellow River in the Lanzhou area of the NE Tibetan Plateau. The difference in the horizontal displacement between the Xianshuihe Fault and the Anninghe Fault bend resulted in the rapid uplift of the Jinpingshan area. The incision rate for the spatial distribution of the Yalong downstream is the geomorphologicai response of crustal shortening and uplift differences in the SE margin block of the Tibetan Plateau. The southeastward diffusion process of the Tibetan Plateau was recorded.展开更多
<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people...<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people with dementia, 8% answered that they “accept more” and 32% answered that they “recognize a minority”. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of the passive horticultural therapy was effective in preventing dementia/MCI. Start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, VIII (24M) was evaluated in August 2020, and IX (27M) also measured ANS during activity. At that time, they divided into the Group E who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the Group F who HCT continued. In the evaluation of VIII (24M), it was found that the cognitive function of the Group E was significantly reduced compared to VII, and Group F did not show a significant decrease. ADL decreased and depressive symptoms increase by continuing a life with less going out due to the influence of COVID 19 regardless of the use of the facility. It became clear that both Group E and Group F show good changes in ANS balance in the IX. Therefore, by utilizing horticultural therapy that the power of nature and plants in addition to utilizing welfare facilities for the elderly, cognitive impairment in COVID 19</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> It was expected to lead to prevention and prevention of negative psychology and behavior such as depressive views and depressive tendencies. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In the trend from the start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, various activity restrictions have been implemented in Japan since March 2020, and the number of elderly people who do not receive long-term care or rehabilitation has increased. Therefore, in August and November 2020, when the spread of COVID19 was reduced, cognitive function evaluation was carried out. At that time, they divided into the elderly group (Group E) who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the elderly group (Group F) who HCT continued.</span></span></span></span>展开更多
基金Supported by a research grant of the University Hospitals of Geneva(to Bühler L)
文摘AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the pancreas.RESULTS: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups(26 d vs 30 d,P = 0.65,and 0% for both respectively).CONCLUSION: Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.
基金supported by the Project of China Geological Survey (grant nos.1212011120071,201211077-3 and 1212011120182)
文摘The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climate changes, and landform evolution since the Middle Pleistocene. Based on geomorphological, sedimentological, and chronological investigations, 6-8 terraces are identified in the lower reaches of Yalong catchment and its tributary--the Anning River. The electron spin resonance （ESR） or optically stimulated luminescence （OSL） data on the alluvial sediments in the upper portion of terraces indicate that they formed in 1.10, 0.90, 0.72, 0.06-0.04, 0.03-0.02, and 0.01 Ma. Tectonic uplift and the climatic cycle controlled the formation of the Yalong River terraces. The former dominated the dissection depths and incision rates, whereas the latter controlled the transformation between accumulation, which developed during the glacial period, and incision, which developed during the glacial-interglacial transition. The Yalong downstream incised rapidly from 1.10 to 0.72 Ma and rapidly from 0.06 Ma until the present; the terraces developed during these two periods. The incision rates in space during the two periods indicate the uplifting extent of the Jinpingshan area, which decreases toward the east and the south. The results reveal two rapidly uplifting stages in the SE Tibetan Plateau, including an accelerated uplifting since 0.06 Ma. Since the Middle Pleistocene, the tectonic uplift of the SE and NE parts of the Tibetan Plateau is synchronous, according to the same development stages of the river terraces of the Yalong downstream and the Yellow River in the Lanzhou area of the NE Tibetan Plateau. The difference in the horizontal displacement between the Xianshuihe Fault and the Anninghe Fault bend resulted in the rapid uplift of the Jinpingshan area. The incision rate for the spatial distribution of the Yalong downstream is the geomorphologicai response of crustal shortening and uplift differences in the SE margin block of the Tibetan Plateau. The southeastward diffusion process of the Tibetan Plateau was recorded.
文摘<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people with dementia, 8% answered that they “accept more” and 32% answered that they “recognize a minority”. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of the passive horticultural therapy was effective in preventing dementia/MCI. Start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, VIII (24M) was evaluated in August 2020, and IX (27M) also measured ANS during activity. At that time, they divided into the Group E who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the Group F who HCT continued. In the evaluation of VIII (24M), it was found that the cognitive function of the Group E was significantly reduced compared to VII, and Group F did not show a significant decrease. ADL decreased and depressive symptoms increase by continuing a life with less going out due to the influence of COVID 19 regardless of the use of the facility. It became clear that both Group E and Group F show good changes in ANS balance in the IX. Therefore, by utilizing horticultural therapy that the power of nature and plants in addition to utilizing welfare facilities for the elderly, cognitive impairment in COVID 19</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> It was expected to lead to prevention and prevention of negative psychology and behavior such as depressive views and depressive tendencies. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In the trend from the start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, various activity restrictions have been implemented in Japan since March 2020, and the number of elderly people who do not receive long-term care or rehabilitation has increased. Therefore, in August and November 2020, when the spread of COVID19 was reduced, cognitive function evaluation was carried out. At that time, they divided into the elderly group (Group E) who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the elderly group (Group F) who HCT continued.</span></span></span></span>
