BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiqu...BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.展开更多
The adductor muscle scar（AMS） is the fixation point of adductor muscle to the shell. It is an important organicinorganic interface and stress distribution area. Despite recent advances, our understanding of the stru...The adductor muscle scar（AMS） is the fixation point of adductor muscle to the shell. It is an important organicinorganic interface and stress distribution area. Despite recent advances, our understanding of the structure and composition of the AMS remain limited. Here, we report study on the AMS of three bivalves： Mytilus coruscus,Chlamys farreri and Ruditapes philippinarum. Results showed that there were significant differences among their AMS structures. Both M. coruscus and C. farreri were found to have a columnar layer above the nacreous platelet shell structure at the AMS and this layer was more organized in M. coruscus. There was no distinguishable twolayer structure in R. philippinarum. Atomic force microscopy（AFM） and Fourier transform infrared spectroscopy（FT-IR） results showed that the AMS was much smoother than the nacreous inner shell in all the three species and the AMS had minor different compositions from the nacreous shell layer. SDS-PAGE（sodium dodecyl-sulfate polyacrylamide gel electophoresis） study of the proteins isolated from the interface indicated that there was a 70 k Da protein which seemed to be specifically located to the highly organized columnar AMS structure in Mytilus coruscus. Further analysis of this protein showed it contained high level of Asx（Asp＋Asn）, Glx（Glu＋Gln） and Gly.The special structure and composition of the AMS might play important roles in the stability, adhesion and function at this stress distribution site.展开更多
We determined the full-length primary structure of the tropomyosin (TM)-1 and -2 proteins from the adductor muscle of the Japanese pearl oyster Pinctada fucata (Pifuc-TM-1 and Pifuc-TM-2), and found that they are each...We determined the full-length primary structure of the tropomyosin (TM)-1 and -2 proteins from the adductor muscle of the Japanese pearl oyster Pinctada fucata (Pifuc-TM-1 and Pifuc-TM-2), and found that they are each composed of 284 amino acid residues. We predicted the gene structure of P. fucata TM (Pifuc-TM) using Splign alignment of our cDNA with genomic sequences and elucidated that Pifuc-TM consists of 10 exons. Exons 1 - 3 and 5 - 10 are used to transcribe Pifuc-TM-1 mRNA, and exons 1 - 4 and 6 - 10 are used to transcribe Pifuc-TM-2 mRNA. Both genes share the same start and stop codons located in exon 1 and exon 10, respectively. Using quantitative real-time PCR, we determined that the Pifuc-TM-1 gene was mainly expressed in adductor phasic muscle, and at a relatively weaker level in adductor catch muscle, whereas the Pifuc-TM-2 gene was expressed equally in both phasic and catch muscles. They were weakly expressed in gill and mantle. Immunoblot analysis using anti-Pifuc-TM-1 and anti-Pifuc-TM-2 antibodies revealed that adductor phasic muscle contained Pifuc-TM-1, while adductor catch muscle contained both Pifuc-TM-1 and Pifuc-TM-2. Differential scanning calorimetry (DSC) analysis was carried out for Pifuc-TM-1 and Pifuc-TM-2 expressed in bacteria, as well as TM purified from P. fucata phasic and catch muscle tissues (phasic-TM and catch-TM). The DSC data indicated that phasic-TM was mainly composed of Pifuc-TM-1, whereas catch-TM contained Pifuc-TM-1 and Pifuc-TM-2. These findings suggest that the distribution of Pifuc-TM-1 and Pifuc-TM-2 in adductor muscle is specific to the muscle fiber type, and reflects the properties of each.展开更多
Myositis ossificans circumscribed is a bone and cartilage heterotopic non neoplastic proliferation inside the soft tissues. It is a benign focal heterotopic ossification process of soft tissues, and a rare disorder th...Myositis ossificans circumscribed is a bone and cartilage heterotopic non neoplastic proliferation inside the soft tissues. It is a benign focal heterotopic ossification process of soft tissues, and a rare disorder that occurs spontaneously or after local trauma. Clinical and radiographic appearances are quite hustler. A careful histological examination of biopsy straightens diagnosis is necessary. There is no consensus in support (surgical or/and medical). From Benign prognosis, evolution of this pathology is usually favorable. The authors report a case of giant myositis ossificans circumscribed post-traumatic localized on gluteus and adductor muscles of the right hip on a 26-year-old man. Through a review of literature the mechanism, the diagnostic methods and therapeutic will be discussed.展开更多
The transobturator tape (TOT) procedure is generally felt to be a safer surgical alternative to the ten sion-free vaginal tape procedure for women with stress urinary incontinence. We report a case of adductor internu...The transobturator tape (TOT) procedure is generally felt to be a safer surgical alternative to the ten sion-free vaginal tape procedure for women with stress urinary incontinence. We report a case of adductor internus myositis not associated with infection following the TOT procedure. To our knowledge this is the first case of this type reported in the literature. A 43 year old lady underwent a straightforward elective TOT procedure. There were no intraoperative complications. Immediately following the procedure she complained of pain in her right thigh. MRI confirmed abnormal oedema within the antero-inferior aspect of the right obturator internus muscle consistent with myositis secondary to tape insertion. The tape was removed the following day in theatre, following which her pain resolved. This case highlights a previously unreported complication as a result of the TOT procedure.展开更多
Objectives: This study aims to analyze the impact of age and sex on botulinum neurotoxin (BoNT-A) dosing and outcomes in adductor spasmodic dysphonia (AdSD).Methods: A database review of all spasmodic dysphonia patien...Objectives: This study aims to analyze the impact of age and sex on botulinum neurotoxin (BoNT-A) dosing and outcomes in adductor spasmodic dysphonia (AdSD).Methods: A database review of all spasmodic dysphonia patients treated with BoNT from 1989 to 2018 at the Mayo Clinic in Arizona was performed. Only patients who had received ≥4 injections of BoNT-A for AdSD were included. Patients were divided into two cohorts to analyze age, with an age of first treatment cutoff of 60 years. Patients were divided into male and female cohorts to analyze sex.Results: The final analysis included 398 patients. The mean dose of BoNT-A per treatment was significantly higher in the younger cohort (4.4 vs. 3.9 units,p = 0.048). The mean maximal benefit was similar (72% vs. 70%,p = 0.48);however, the mean length of benefit was significantly shorter in younger patients (3.0 vs. 3.6 months,p < 0.01). The mean BoNT-A dose was significantly higher in the female cohort (4.2 vs. 3.6 units,p = 0.02). The mean maximal benefit was similar (69% vs. 75%,p = 0.58), as was the mean length of benefit (3.2 vs. 3.5 months,p = 0.11).Conclusions: This study suggests that age and sex influence BoNT-A dosing and outcomes in AdSD.展开更多
目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随...目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。展开更多
Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate t...Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.展开更多
文摘BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.
基金The Basic Scientific Fund for National Public Research Institutes of China under contract No.2011T10the National Natural Science Foundation of China-Shandong Joint Grant U1406402-5+2 种基金Qingdao Talents Program under contract No.13-CX-20the National Natural Science Foundation of China under contract Nos 31100567,41176061,41521064,41306074 and 31160098the Taishan Scholar Program
文摘The adductor muscle scar（AMS） is the fixation point of adductor muscle to the shell. It is an important organicinorganic interface and stress distribution area. Despite recent advances, our understanding of the structure and composition of the AMS remain limited. Here, we report study on the AMS of three bivalves： Mytilus coruscus,Chlamys farreri and Ruditapes philippinarum. Results showed that there were significant differences among their AMS structures. Both M. coruscus and C. farreri were found to have a columnar layer above the nacreous platelet shell structure at the AMS and this layer was more organized in M. coruscus. There was no distinguishable twolayer structure in R. philippinarum. Atomic force microscopy（AFM） and Fourier transform infrared spectroscopy（FT-IR） results showed that the AMS was much smoother than the nacreous inner shell in all the three species and the AMS had minor different compositions from the nacreous shell layer. SDS-PAGE（sodium dodecyl-sulfate polyacrylamide gel electophoresis） study of the proteins isolated from the interface indicated that there was a 70 k Da protein which seemed to be specifically located to the highly organized columnar AMS structure in Mytilus coruscus. Further analysis of this protein showed it contained high level of Asx（Asp＋Asn）, Glx（Glu＋Gln） and Gly.The special structure and composition of the AMS might play important roles in the stability, adhesion and function at this stress distribution site.
文摘We determined the full-length primary structure of the tropomyosin (TM)-1 and -2 proteins from the adductor muscle of the Japanese pearl oyster Pinctada fucata (Pifuc-TM-1 and Pifuc-TM-2), and found that they are each composed of 284 amino acid residues. We predicted the gene structure of P. fucata TM (Pifuc-TM) using Splign alignment of our cDNA with genomic sequences and elucidated that Pifuc-TM consists of 10 exons. Exons 1 - 3 and 5 - 10 are used to transcribe Pifuc-TM-1 mRNA, and exons 1 - 4 and 6 - 10 are used to transcribe Pifuc-TM-2 mRNA. Both genes share the same start and stop codons located in exon 1 and exon 10, respectively. Using quantitative real-time PCR, we determined that the Pifuc-TM-1 gene was mainly expressed in adductor phasic muscle, and at a relatively weaker level in adductor catch muscle, whereas the Pifuc-TM-2 gene was expressed equally in both phasic and catch muscles. They were weakly expressed in gill and mantle. Immunoblot analysis using anti-Pifuc-TM-1 and anti-Pifuc-TM-2 antibodies revealed that adductor phasic muscle contained Pifuc-TM-1, while adductor catch muscle contained both Pifuc-TM-1 and Pifuc-TM-2. Differential scanning calorimetry (DSC) analysis was carried out for Pifuc-TM-1 and Pifuc-TM-2 expressed in bacteria, as well as TM purified from P. fucata phasic and catch muscle tissues (phasic-TM and catch-TM). The DSC data indicated that phasic-TM was mainly composed of Pifuc-TM-1, whereas catch-TM contained Pifuc-TM-1 and Pifuc-TM-2. These findings suggest that the distribution of Pifuc-TM-1 and Pifuc-TM-2 in adductor muscle is specific to the muscle fiber type, and reflects the properties of each.
文摘Myositis ossificans circumscribed is a bone and cartilage heterotopic non neoplastic proliferation inside the soft tissues. It is a benign focal heterotopic ossification process of soft tissues, and a rare disorder that occurs spontaneously or after local trauma. Clinical and radiographic appearances are quite hustler. A careful histological examination of biopsy straightens diagnosis is necessary. There is no consensus in support (surgical or/and medical). From Benign prognosis, evolution of this pathology is usually favorable. The authors report a case of giant myositis ossificans circumscribed post-traumatic localized on gluteus and adductor muscles of the right hip on a 26-year-old man. Through a review of literature the mechanism, the diagnostic methods and therapeutic will be discussed.
文摘The transobturator tape (TOT) procedure is generally felt to be a safer surgical alternative to the ten sion-free vaginal tape procedure for women with stress urinary incontinence. We report a case of adductor internus myositis not associated with infection following the TOT procedure. To our knowledge this is the first case of this type reported in the literature. A 43 year old lady underwent a straightforward elective TOT procedure. There were no intraoperative complications. Immediately following the procedure she complained of pain in her right thigh. MRI confirmed abnormal oedema within the antero-inferior aspect of the right obturator internus muscle consistent with myositis secondary to tape insertion. The tape was removed the following day in theatre, following which her pain resolved. This case highlights a previously unreported complication as a result of the TOT procedure.
文摘Objectives: This study aims to analyze the impact of age and sex on botulinum neurotoxin (BoNT-A) dosing and outcomes in adductor spasmodic dysphonia (AdSD).Methods: A database review of all spasmodic dysphonia patients treated with BoNT from 1989 to 2018 at the Mayo Clinic in Arizona was performed. Only patients who had received ≥4 injections of BoNT-A for AdSD were included. Patients were divided into two cohorts to analyze age, with an age of first treatment cutoff of 60 years. Patients were divided into male and female cohorts to analyze sex.Results: The final analysis included 398 patients. The mean dose of BoNT-A per treatment was significantly higher in the younger cohort (4.4 vs. 3.9 units,p = 0.048). The mean maximal benefit was similar (72% vs. 70%,p = 0.48);however, the mean length of benefit was significantly shorter in younger patients (3.0 vs. 3.6 months,p < 0.01). The mean BoNT-A dose was significantly higher in the female cohort (4.2 vs. 3.6 units,p = 0.02). The mean maximal benefit was similar (69% vs. 75%,p = 0.58), as was the mean length of benefit (3.2 vs. 3.5 months,p = 0.11).Conclusions: This study suggests that age and sex influence BoNT-A dosing and outcomes in AdSD.
文摘目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。
文摘Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.
文摘目的 探讨收肌管阻滞(ACB)联合静脉自控镇痛(PCIA)对行全膝关节置换术患者术后抑郁状态的影响。方法选择行全膝关节置换术的患者随机分为ACB联合PCIA组(A组)40例和PCIA组(B组)40例。B组术后给予PCIA镇痛方法,A组在B组基础上术前联合ACB镇痛。记录术后2 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、72 h(T_(5))静息和运动VAS评分,术后补救镇痛药物使用情况,恶心呕吐发生情况,术前、术后1 d、术后3 d医院焦虑抑郁量表(HADS)评分。结果A组患者T1~T4时静息和运动VAS评分明显低于B组(P<0.05);A组患者术后补救镇痛药物使用量明显减少(P<0.05),恶心呕吐发生率明显降低(P<0.05);A组患者术后1 d HADS评分及术后出现显著的抑郁症状(HADS-D≥8)的患者比例明显低于B组(P<0.05);术后1 d HADS评分与T1~T4时静息和运动VAS评分呈明显正相关(P<0.05);术后3 d HADS评分与T_(1)~T_(3)时静息和运动VAS评分呈明显正相关(P<0.05)。结论ACB联合PCIA相比单纯PCIA在全膝关节置换术后镇痛效果更加显著,并可减少术后抑郁的发生,促进患者快速康复。
