Dermatoscope for the diagnosis of erythema with purpura induced by lidocaine/prilocaine cream:A case report

BACKGROUND Lidocaine/prilocaine(EMLA)cream is a local anesthetic that is applied to the skin or mucosa during painful therapeutic procedures with few reported side effects.CASE SUMMARY Here,we report the use of dermatoscopy to identify a case of erythema with purpura,a rare side effect,after the application of 5%EMLA cream.CONCLUSION We conclude that erythema with purpura is caused by irritation and toxicity associated with EMLA,but the specific mechanism by which the toxic substance affects skin blood vessels is unclear.In response to this situation and for cosmetic needs,we recommend tranexamic acid,in addition to routine therapy,to prevent changes in pigmentation in patients with dermatitis.

Analysis of the Effects of Local Injection of Epinephrine and Lidocaine on Postoperative Pain and Bleeding in Children Undergoing Tonsillectomy

Objective:To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy.Methods:Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected.The children were randomly divided into two groups of 34 cases each.The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine.The postoperative pain,operation time,blood pressure changes,and intraoperative blood loss of the two groups of children were observed and analyzed.Results:The postoperative pain,operation time,and intraoperative blood loss scores of the children in the observation group were 4.36±0.69,0.36±0.09,and 39.36±1.78 respectively,which were significantly better than those of the children in the control group(P<0.05)at 5.36±0.77,0.79±0.05,and 45.36±1.56,respectively.The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group(P>0.05).Conclusion:Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

工程教育中心何以推动科教融合——荷兰4TU工程教育中心的探索性单案例研究

工程教育中心作为建立在大学或研究机构中的跨学科交叉合作平台,是连接科学研究与教育实践的纽带,在高质量工程人才培养中发挥着重要作用。荷兰4TU工程教育中心利用4所顶尖理工大学在工程学科和教育领域的独特优势,积极与研发单位、教育单位、企业部门合作,通过将前沿科学研究彻底融入工程课程设计、教学模式等多个方面,形成了独具一格的科教融合工程人才培养模式。文章从战略目标、组织架构、运行机制、质量保障4个维度详实分析了4TU工程教育中心推动科教融合的内在机制,总结归纳其在主题项目设置、教育共同体形成、课程体系迭代、创新网络构建、内外部质量保障等方面的核心特征,期望对我国科教融合的工程教育改革与建设有所启示。

沉默TUFM通过AMPK/mTOR信号通路调控线粒体自噬对肺源性心脏病模型大鼠肺动脉高压的影响

目的探讨线粒体翻译延伸因子Tu(TUFM)通过线粒体自噬促进肺动脉高压(PAH)血管重塑的作用机制。方法2022年1月—2023年6月于辽宁省人民医院中心实验室进行实验。将36只健康雄性Sprague-Dawley大鼠随机分为空白对照(Ctrl)组、模型(PAH)组、TUFM过表达(OE)组、OE阴性对照(OE-NC)组、短发夹RNA(Sh)敲除TUFM(Sh)组和Sh-NC阴性对照(Sh-NC)组,每组6只。除Ctrl组外,其余大鼠均一次性腹腔注射1%野百合碱(60 mg/kg)诱导心源性肺水肿PAH大鼠模型;大鼠肺动脉平滑肌细胞(PASMC)在低氧(3%O 2)条件下培养24 h模拟体内肺动脉高压微环境,分为常氧(Norm)组、低氧(Hyp)组、小干扰RNA(SiRNA)-1组、SiRNA-2组、Si-NC组、OE-NC组和OE组。右心导管插管和脉冲多普勒超声检测大鼠肺血流动力学;苏木素-伊红染色检测肺小动脉病理结构;免疫荧光共染检测TUFM组织定位;细胞计数法检测细胞增殖;透射电镜观察线粒体结构和自噬小体;蛋白免疫印迹检测TUFM、自噬、凋亡和磷酸腺苷活化蛋白激酶(AMPK)/哺乳动物雷帕霉素靶蛋白(mTOR)通路相关蛋白表达。结果与Ctrl组比较,PAH组大鼠TUFM蛋白表达升高,且主要与PASMC标志物α平滑肌肌动蛋白(α-SMA)在肺小动脉内膜存在共定位,而与内皮细胞标志物CD31无共定位,肺动脉收缩压(PASP)升高,肺动脉血流加速时间(PAAT)缩短,远端肺小动脉管壁呈向心性增厚,管腔狭窄几乎堵塞,TUFM、苄氯素1重组蛋白(BECN1)、人微管相关蛋白轻链3(LC3)II/I和B淋巴细胞瘤2(Bcl2)蛋白表达升高,P62、Bcl2相关X蛋白(Bax)和凋亡酶激活因子(Apaf)蛋白表达降低(P<0.05);与PAH组比较,OE组PASP升高,PAAT缩短,肺小动脉管壁厚度升高,肺动脉TUFM、BECN1、LC3II/I和Bcl2表达升高,P62、Bax和Apaf表达降低(P<0.05);与PAH组比较,Sh组PASP降低,PAAT延长,肺小动脉管壁厚度和管腔狭窄度有所改善,TUFM、BECN1、LC3II/I和Bcl2表达降低,P62、Bax和Apaf表达升高(P<0.05)。与Norm组比较,Hyp组PASMC细胞TUFM蛋白表达升高;与Si-NC组细胞相比,SiRNA-1和SiRNA-2组P62、Bax蛋白表达升高,BECN1、LC3II/I、Bcl2、TUFM表达降低,线粒体结构完整,PASMC细胞增殖活性降低,细胞p-AMPK表达降低,p-mTOR表达升高(P<0.05);与OE-NC组比较,OE组细胞P62和Bax蛋白表达降低,BECN1、LC3II/I、Bcl2和TUFM表达升高,部分线粒体损伤崩解,嵴断裂消失,PASMC细胞增殖活性明显升高,细胞p-AMPK表达升高,p-mTOR表达降低(P<0.05)。结论沉默TUFM可通过激活AMPK/mTOR信号通路促进线粒体自噬加速PAH肺动脉平滑肌细胞凋亡。

秦川牛宰后成熟过程中线粒体翻译延长因子Tu与能量代谢的关联性分析

目的:线粒体翻译延长因子Tu(mitochondrial Tu translation elongation factor,TUFM)已被证明参与秦川牛宰后成熟过程中的细胞自噬活动,实验探究该过程中TUFM表达与能量代谢变化的关系。方法:以秦川牛背最长肌为研究对象,测定4℃不同成熟时间(0、2、12、24、48、96、144、192 h)TUFM表达量及含量、葡萄糖(glucose,GLU)、乳酸(lactic acid,LA)、腺苷三磷酸(adenosine triphosphate,ATP)、二磷酸腺苷(adenosine diphosphate,ADP)、单磷酸腺苷(adenosine monophosphate,AMP)6种物质含量以及乳酸脱氢酶(lactate dehydrogenase,LDH)、琥珀酸脱氢酶(succinate dehydrogenase,SDH)、磷酸丙糖异构酶(triose phosphate isomerase,TPI)、苹果酸脱氢酶(malate dehydrogenase,MDH)、细胞色素c氧化酶(cytochrome c oxidase,COX)5种酶活性的变化情况。结果:在秦川牛宰后成熟期间,GLU、ATP、ADP、AMP含量和LDH、SDH、TPI活性均呈下降趋势,TUFM表达量、MDH活性及LA和TUFM含量均呈先上升后下降趋势,COX活性呈先下降后上升再下降趋势。能量代谢各指标和TUFM蛋白主要在宰后初期发挥作用,对宰后初期及宰后中后期分别进行Pearson相关性分析,结果表明,在宰后初期牛背最长肌中TUFM表达量与MDH、LA呈极显著正相关(P<0.01),与ATP、ADP、AMP、LDH、SDH、TPI、COX、GLU呈极显著负相关(P<0.01)。在宰后中后期,TUFM表达与所有指标(GLU、LA、ATP、ADP、AMP、LDH、MDH、SDH、TPI、COX)均呈极显著正相关(P<0.01)。结论:在宰后初期TUFM表达量逐渐增加,可为肌肉细胞提供能量从而用于能量代谢途径,该过程可能是TUFM正向参与细胞自噬所致。在宰后中后期能量短缺时,TUFM可能抑制细胞自噬,优先将能量用于除细胞自噬外的其他重要途径(如能量代谢途径)以维持细胞稳态。综上,在宰后成熟过程中TUFM具有双重作用,可调节细胞自噬为能量代途径提供能量,有助于维持宰后能量代谢持续的时间。

绵羊肺炎支原体EF-Tu蛋白的原核表达及多克隆抗体制备

[目的]克隆绵羊肺炎支原体(Mycoplasma ovipneumoniae,Mo)EF-Tu基因,原核表达获得EF-Tu蛋白,制备抗EF-Tu蛋白的兔源多克隆抗体,为研究肺炎支原体EF-Tu蛋白的结构和功能奠定基础。[方法]采用重叠延伸PCR方法将pET-28a-EF-Tu质粒中EF-Tu基因中间的TGA密码子突变为TGG,并对测序结果与其他支原体参考株进行相似性比对和遗传进化分析,利用在线软件对其推测的蛋白序列进行生物信息学分析。将突变后的重组质粒转化大肠杆菌BL21(DE3)感受态细胞进行原核表达,经SDS-PAGE和Western blotting鉴定,利用镍柱亲和层析法纯化,以纯化的EF-Tu融合蛋白免疫家兔制备多克隆抗体,采用间接ELISA和Western blotting检测多克隆抗体效价及免疫反应性。[结果]试验成功突变了EF-Tu基因中TGA位点,并构建了融合表达His标签pET-28a-EF-Tu′原核表达载体。生物信息学分析表明,克隆的EF-Tu基因与绵羊肺炎支原体MoGH3-3菌株相似性最高,亲缘关系最近;编码387个氨基酸,无N-糖基化位点和跨膜区域,存在10个丝氨酸、20个苏氨酸、4个酪氨酸磷酸化位点,二级结构由无规则卷曲(35.14%)、α-螺旋(26.87%)、延伸链(26.87%)及β-转角(11.11%)构成。SDS-PAGE和Western blotting结果显示,目的蛋白大小约为43 ku,蛋白纯化浓度为0.615 g/L。ELISA和Western blotting结果显示,制备的多克隆抗体效价可达1∶128 000,能够特异性识别EF-Tu融合蛋白,具有良好的免疫反应性。[结论]本研究成功突变了EF-Tu基因的TGA密码子,原核表达并纯化获得EF-Tu融合蛋白,制备其多克隆抗体效价为1∶128 000,为后续研究肺炎支原体EF-Tu蛋白结构和生物学功能及其疫苗研发提供了试验基础。

异氟烷麻醉对小鼠自发肌电及TUS/TMAS诱发肌电的影响

经颅超声刺激(TUS)和经颅磁声耦合刺激(TMAS)调控运动皮层效果明显,但受限于清醒状态动物难以束缚,已有研究大多在麻醉状态下进行,对麻醉减弱调控效果的分析集中于中枢神经系统。本研究记录了异氟烷麻醉下24只小鼠的肢体自发肌电和TUS/TMAS诱发肌电,定量分析了麻醉对自发肌电和诱发肌电发放率、潜伏期、时长和幅值的影响。结果显示,随着异氟烷输出浓度从0.40%增加至0.75%,每周期内小鼠自发肌电频次减少约50%,肌电发放时长变短,呈抑制状态;TUS/TMAS诱发肌电的成功率分别降低约50%和70%、潜伏期均延长约0.1 s、时长分别缩短约0.3和0.5 s,表明TUS/TMAS对运动皮层的调控效果随麻醉程度的加深而减弱。肢体自发和诱发肌电在发放率和时长上存在关联性特征,提示麻醉状态下小鼠自发肌电抑制状态可能是刺激效果减弱的影响因素之一。

A Comparative Study between Dexmedetomidine Alone versus Combined Low Dose of Dexmedetomidine and Lidocaine for the Hemodynamic Response to Endotracheal Extubation in Patient Undergoing Abdominal Surgery—A Prospective Randomized Controlled Study

Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg in softening hemodynamic stress response and estimated quality of extubation in study groups. Materials and Methods: The patients in our study, one hundred and fifty of both gender, ASA class I &II patients, aged 20 - 50 years old subject to elective abdominal operations under general anesthesia were allocated into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, the patients in Group N, D, and DL have given 0.9% normal Saline intravenous bolus infusion, dexmedetomidine 1 μg/kg and Dexmedetomidine 0.5 μg/kg, respectively within a 10-minute period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation, Group N and D patients received 0.9% normal Saline intravenous bolus infusion, but in Group DL received Lidocaine 1 mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular times after that for two hours. Extubation quality was assessed by extubation quality scale. Aldrete’s recovery score and Ramsay sedation score were also recorded and also any complications were noted and recorded. Results: All the hemodynamic parameters significantly elevated extubation and numerous periods of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p-value = 0.001). Response of tachycardia was seen in 41 (82%) in patients of N group, compared to 18 (36%) and 20 (40%) in D & DL group respectively (p = 0.001). Hypertensive response statistically significant noticed in 40 (80%) patients of N group, 9 (18%) of D group and 12 (24%) of DL group (p = 0.001). Tachycardia duration and the response of hypertension were significantly prolonged in the control group. As regards extubation quality, the three groups differed in D Groups (1.93 ± 0.57) and DL (1.51 ± 0.57) had decreased scores compared to group N (2.67 ± 0.48) modulating smoother extubation (p Conclusion: Low combined dose of (Dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg) IV was useful as much as Dexmedetomidine 1 μg/kg IV in softening hemodynamic stress responses during emergence.

A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery

Objective: This prospective randomized study aimed to evaluate the effect of IV lidocaine infusion or gabapentin and their combination in providing efficient analgesia after thyroid surgery. Methods: Eighty-eight patients scheduled for thyroidectomy were randomized into four equal groups (n = 22). Group P (placebo) patients received placebo capsules 1 h preoperatively and intravenous (IV) saline infusion. Group L (Lidocaine): patients received placebo capsules 1 h preoperatively and IV bolus lidocaine 1.0 mg/kg followed by infusion 2 mg/kg/h. Group G (Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV saline infusion. Group LG (Lidocaine-Gabapentin) patients received 600 mg gabapentin capsules 1 h preoperatively and IV bolus of 1.0 mg/kg lidocaine followed by infusion 2 mg/kg/h. (lidocaine or saline infusion started before induction of anesthesia and continued until the end of surgery). Intraoperative fentanyl consumption and hemodynamic changes were recorded. Postoperative total tramadol consumption, time to first analgesic request, visual analog scale (VAS) of pain, sedation level, and side effects were assessed for 24 hours. Results: (LG) group had significant lower intraoperative fentanyl and lower postoperative tramadol consumption (p < 0.001) compared to (P), (L) and (G) groups, with prolonged time of first analgesic request (p < 0.001) compared to (P) and (L) groups, and lower VAS compared to other groups (p < 0.001 or p < 0.01). There was significantly lower postoperative nausea and vomiting (PONV) in G & LG groups compared to (P) group (p < 0.01). Conclusion: The combination of preoperative gabapentin and intraoperative lidocaine infusion provided more analgesic effect than either drug alone with lower and more delayed postoperative analgesic requirements and lower VAS. (PONV) was lower in groups received gabapentin.

Comparation of the eutectic mixture of lidocaine/prilocain versus benzocaine gel in children

Objective: To compare the anesthetic effect of a non commercial eutectic mixture of 4% lidocaine/ prilocaine (PLO 4%) and 20% benzocaine gel (Hurricaine?), as topical anesthetic, prior to inferior alveolar nerve block and buccal infiltration anesthe-sia in 5-12 year old children. Study design: Infiltrative anesthesia was applied in 50 children, divided in two groups (n = 25) using PLO 4% and Hurricaine? as topical anesthesia prior to infiltration. Physical reac-tions were registered using the Sound-Eyes- Motor Scale. Physiological changes expressed by ar-terial pressure and heart rate. Subjective pain re-sponse was scored on a Facial Image Scale. Physical physiological and subjective response was related to the type of topical anesthetic, age and sex using χ2 and Mann-Whitney U test. Results: Physical responses to puncture were similar and localized in the state of comfort with both anesthetics. Girls showed more ocular response than boys. Subjective pain perception and physiological reactions showed no anesthetic- or sex-related differences, except for heart rate before and after the procedure which was significantly higher in girls. Conclusions: PLO 4% showed the same capacity as Hurricaine? in reducing pain response to needle puncture. Girls expressed more needle puncture-related pain than boys. The young children showed most prior comfort and less discomfort to the puncture than older children.

Comparative Study between Lidocaine 2% and Dexamethasone Local Wound Infiltration Effect on Postoperative Pain Post Mastectomy: A Randomized Controlled Study

Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 patients candidate for Mastectomy were included. Participants were equally randomized into two groups;Group A, in which patients received 10 ml Lidocaine 2% and Group B, in which patients received 16 mL Dexamethasone. In both groups, the drugs were given via local infiltration in the subcutaneous layer of the Mastectomy wound immediately after skin closure. Pain control was assessed post-operatively in the first 24 hours using the visual analogue scale (VAS) in addition the need for additional analgesia was recorded. Results: There was a statistically significant lower VAS score in group A (Lidocaine group) when compared to those in group B (Dexamethasone group) 1 h, 6 h, 12 h postoperatively with no significance 24 h postoperatively (36% vs 64% 1 h, 28% vs 64% 6 h, 30% vs 72% 12 h and, 80% vs 60% 24 h). This statistical significance was evident throughout the post-operative hours (1 h, 6 h, 12 h). Though local Lidocaine caused marked improvement of pain in bigger number of patients in group A than group B, yet it showed no statistical significance 24 h post-mastectomy. Furthermore, the number of participants that needed additional doses of analgesia lower in group A (48% vs 56%) in comparison to group B, but still showed no statistical significance. Conclusion: Local injection of Lidocaine 2% in Mastectomy wounds, has an upper hand in reducing the post-operative pain and showed a lesser need for post-operative analgesia when compared to local Dexamethasone injection.

An Investigation of Moxibustion Treatment for Abscesses in the Song Dynasty:Focusing on the“Jiu Ai Tu”

Jiu Ai Tu(The Moxa Treatment)from the Song dynasty is the earliest surviving painting that focuses on the subject of acupuncture and moxibustion.This paper takes the medical activities depicted in the artwork as its research object and systematically analyzes the external treatment methods for abscesses during the Song dynasty reflected in Jiu Ai Tu.By examining the understanding of abscesses during that period,the paper explores the level of development in external medicine techniques.By analyzing the medical awareness and behaviors of patients when facing such severe illnesses,it aims to explore the societal cognition and experiences regarding health and disease.The paper attempts to present the folk medical ecology of the Song dynasty represented by Jiu Ai Tu.

Efficacy of lidocaine wet compress combined with red-light irradiation for chronic wounds

BACKGROUND Chronic wounds that fail to progress through normal phases of healing present a significant healthcare burden owing to prolonged treatment and associated costs.Traditional wound care typically involves regular dressing changes,which can be painful.Recent approaches have explored the use of lidocaine to manage pain and red-light irradiation(RLI),known for its anti-inflammatory and cell proliferation effects,to potentially enhance wound healing.AIM To investigate the therapeutic efficacy of lidocaine wet compression(LWC)combined with RLI for chronic wounds.METHODS We enrolled 150 patients with chronic wounds from the Wound and Ostomy Outpatient Clinic of the Second Hospital of Anhui Medical University from April to September 2022.The wounds were treated with dressing changes.The patients were randomly assigned to the control and experimental groups using a random number table and given the same first dressing change(2%LWC for 5 min and routine dressing change).From the second dressing change,in addition to 2%LWC for 5 min and routine dressing change,the experimental group received RLI,whereas the control group continued to receive the same LWC and dressing change.The first and second dressing changes were performed on days 1 and 2,respectively.The third dressing change was performed 3 d after the second change.The frequency of subsequent dressing changes was determined based on wound exudation and pain.Pain during the first three dressing changes was evaluated in both groups.The average number of dressing changes within 28 d and the degree of wound healing on day 28 were also recorded.RESULTS During the initial dressing change,no noticeable differences were observed in the pain levels experienced by the two groups,indicating similar pain tolerance.However,during the second and third dressing changes,the experimental group reported significantly less pain than the control group.Furthermore,over 28 d,the experimental group required fewer dressing changes than the control group.CONCLUSION Notably,the effectiveness of wound healing on the 28th day was significantly higher in the experimental group than that of in the control group.The combination of LWC and RLI was effective in reducing early-stage pain,promoting wound healing,decreasing the frequency of dressing changes,and enhancing patients’overall quality of life with chronic wounds.

Effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalatopharyngoplasty

Objective：To evaluate the effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalatopharyngoplasty. Methods： Sixty patients were randomly divided into 4 groups： In the control group patients were given saline; in the lidocaine group patients were given 1.0 mg/kg lidocaine ; in the diltiazem group patients were given 0. 2 mg/kg diltiazem; and in the lidocaine plus diltiazem group patients were given 1.0 mg/kg lidocaine and 0. 2 mg/kg diltiazem. These drugs were given 2 rain before tracheal extuhation. Values for SBP, DBP, and HR were recorded, on arriving at the operating room, immediately at the end of the surgery, at the time of injection of the study drugs, at tracheal extubation, at 1 min and 5 min after extubation. The quality of extubation according to the Sebel＇s grading scale were compared among the 4 groups. Results：During extubation in the control group HR, SBP and DBP increased significantly when compared to baseline levels. Both lidocaine （1.0 mg/kg） and diltiazem （0. 2 mg/kg） successfully alleviated these increases. The suppressive effect of diltiazem was greater than that of lidocaine. The combinative use of the two drugs minimized the increases. The administration of lidocaine significantly suppressed bucking or coughing compared with the other groups. Conclusions： The pressor responses and tachycardia occurring in patients with uvulopalatopharyngoplasty during emergence from anesthesia and tracheal extubation, can be easily blocked by a bolus dose of 1.0 mg/kg lidocaine, 0. 2 mg/kg diltiazem or the comhinative use of the two drugs. And the concurrent use of lidocaine and diltiazem alleviated the hemodynamic changes more obviously.

Comparative efficacy of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery:A randomized clinical trial

Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.

The water-soluble TF3 component from Eupolyphaga sinensis Walker promotes tibial fracture healing in rats by promoting osteoblast proliferation and angiogenesis

Objective:To determine the active components of Eupolyphaga sinensis Walker(Tu Bie Chong)and explore the mechanisms underlying its fracture-healing ability.Methods: A modified Einhorn method was used to develop a rat tibial fracture model.Progression of bone healing was assessed using radiological methods.Safranin O/fast green and CD31 immunohistochemical staining were performed to evaluate the growth of bone cells and angiogenesis at the fracture site.Methylthiazoletetrazolium blue and wound healing assays were used to analyze cell viability and migration.The Transwell assay was used to explore the invasion capacity of the cells.Tubule formation assays were used to assess the angiogenesis capacity of human vascular endothelial cells(HUVECs).qRT-PCR was used to evaluate the changes in gene transcription levels.Results: Tu Bie Chong fraction 3(TF3)significantly shortened the fracture healing time in model rats.X-ray results showed that on day 14,fracture healing in the TF3 treatment group was significantly better than that in the control group(P=.0086).Tissue staining showed that cartilage growth and the number of H-shaped blood vessels at the fracture site of the TF3 treatment group were better than those of the control group.In vitro,TF3 significantly promoted the proliferation and wound healing of MC3T3-E1s and HUVECs(all P<.01).Transwell assays showed that TF3 promoted the migration of HUVECs,but inhibited the migration of MC3T3-E1 cells.Tubule formation experiments confirmed that TF3 markedly promoted the ability of vascular endothelial cells to form microtubules.Gene expression analysis revealed that TF3 significantly promoted the expression of VEGFA,SPOCD1,NGF,and NGFR in HUVECs.In MC3T3-E1 cells,the transcript levels of RUNX2 and COL2A1 were significantly elevated following TF3 treatment.Conclusion: TF3 promotes fracture healing by promoting bone regeneration associated with the RUNX2 pathway and angiogenesis associated with the VEGFA pathway.

Malignant hyperthermia as a rare complication of local lidocaine injection:A case report

BACKGROUND Malignant hyperthermia(MH)is a hypermetabolic disorder of skeletal muscles triggered by exposure to volatile anesthetics and depolarizing muscular relaxants.It manifests with clinical presentations such as tachycardia,muscle rigidity,hyperpyrexia,and rhabdomyolysis in genetically predisposed individuals with ryanodine receptor or calcium voltage-gated channel subunit alpha1 S mutations.Local anesthetics,such as lidocaine,are generally considered safe;however,complications can arise,albeit rarely.Lidocaine administration has been reported to induce hypermetabolic reactions resembling MH in susceptible individuals.The exact mechanism by which lidocaine might trigger MH is not fully understood.Although some mechanisms are postulated,further research is needed for a better understanding of this.CASE SUMMARY We present the case of MH in a 43-year-old male patient with an unknown genetic predisposition following a lidocaine injection during a dental procedure.This case serves as a reminder that while the occurrence of lidocaine-induced MH is rare,lidocaine can still trigger this life-threatening condition.Therefore,caution should be exercised when administering lidocaine to individuals who may be susceptible to MH.It is important to note that prompt intervention played a crucial role in managing the patient’s symptoms.Upon recognizing the early signs of MH,aggressive measures were initiated,including vigorous intravenous normal saline administration and lorazepam.Due to the effectiveness of these interventions,the administration of dantrolene sodium,a specific antidote for MH,was deferred.CONCLUSION This case highlighted the significance of vigilant monitoring and swift action in mitigating the detrimental effects of lidocaine-induced MH.Caution should be exercised when administering lidocaine to individuals who may be predisposed to MH.It is very important to be aware and vigilant of the signs and symptoms of MH as early recognition and treatment intervention are important to prevent serious complications to decrease mortality.

Comparison between the Effects of Alfentanil, Lidocaine and Their Composition in Controlling the Hemodynamic Responses at the Time of Awake Extubation of Patients

Background and aim: Instability in the hemodynamic symptoms has been common at the time of extubation in patients and the cause to create the side effects. The aim of this research was to study the effect of injection of Alfentanil, Lidocaine and their composition in reduction of side effects arising from extubation. Materials and methods: 172 patients (20 - 40 years old) that referred to Shahid Rajaee Hospital in 2014 and had been under the orthopedic surgery, were divided randomly and by using colored cards into four equal groups (43 patients in each group). Alfentanil (5 microgram/kilogram) was injected to the first group. The second group received Lidocaine (1 milligram/ kilogram). The composition of these two drugs was injected to the third group and the normal equal volume of Saline was injected to the fourth group which was the control group. The means of systolic and diastolic blood pressure, average arterial pressure and the number of heartbeat at the time of extubation were measured and registered 1, 5, 10, 15 and 20 minutes after extubation. Also, the amount of situation of bucking after extubation was registered in the groups. Results: The demographic results were similar in all groups. The mean of systolic blood pressure and number of heartbeats in the group of Alfentanil and composition of Alfentanil-Lidocaine had significant reduction (p 0.05). The situation of bucking in three treatment groups had significant reduction in comparison with control group. Conclusion: Alfentanil and composition of it with Lidocaine both had caused reducing the systolic blood pressure and heartbeats.

A Comparative Study between Intravenous Fentanyl and Intravenous Lidocaine on Attenuation of Hemodynamic Pressor Responses to Laryngoscopic Intubation: A Prospective Cohort Study, Ethiopia

Introduction: Laryngoscopic intubation is an insertion of endotracheal tube into the trachea for maintenance of airway during general anesthesia. Smooth intubation requires attenuation of pressor responses and maintenance of baseline hemodynamic stability. The primary outcome of this study is to compare intravenous fentanyl and lidocaine as an anesthetics adjuvant on attenuation of hemodynamic pressor responses to Laryngoscopic intubation in elective surgical adult patients. Methods: This prospective cohort study recruits 114 patients who underwent elective surgery under general anesthesia with laryngoscopy and endotracheal tube intubation. The study was conducted from January 1, 2018 to March 30, 2018. Systemic random sampling technique was used to select the study participants. Those patients that received intravenous fentanyl 2 micrograms per kilogram three minutes before intubation as an anesthetics adjuvant are considered as Fentanyl-group (group F). The Lidocaine-group (group L) was those patients who receive 2% intravenous lidocaine 1.5 milligrams per kilogram three minutes before intubation as anesthetics adjuvant. Hemodynamic parameters (heart rate and blood pressure) and other variables were documented starting from 3 minutes before intubation to 5 minutes after intubation. Results: The mean heart rate at first minute after intubation was significantly lower in fentanyl group (98.91 ± 15.6 beats per minute (bpm)) compared to lidocaine (107 ± 15.45 bpm), t (112) = 2.8, p = 0.006. Systolic blood pressure was also significantly lower in fentanyl group (141.9 ± 18.9 millimeters of mercury (mmHg)) compared to lidocaine (150 ± 18.098 mmHg), t (112) = 2.45, p = 0.016 at first minute after intubation. At third minute after intubation, heart rate was significantly lower in fentanyl group compared to lidocaine, t (112), p = 0.037. No difference was in heart rate and blood pressure among the group at 5th minute after intubation (p > 0.05). Conclusion and Recommendations: Fentanyl was better on attenuation of hemodynamic pressor responses to laryngoscopic intubation when compared to lidocaine. Therefore, using fentanyl pre-operatively to attenuate pressor responses especially during intubation is important.

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

Background: After functional endoscopic nasal surgery, emergence agitation is not uncommon. The aim of this trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality and incidence of emergence agitation in patient undergoing functional endoscopic sinus surgery. Study Design: Prospective, randomized, double-blinded, placebo-controlled trial. Methods: 100 patients of ASA I and II, aged 18 - 50 years, of both sexes scheduled for FEES, were assigned into two groups. In Group L;patients received an intravenous bolus infusion of 1.5 mg/kg lidocaine just before induction of anesthesia followed by a continuous infusion of 2 mg/kg/h during the operation and until the end of the surgery. In Group C;patients received normal saline infusion with the same volume as group L according to the same protocol. The primary endpoints were incidence of emergence agitation and postoperative recovery quality (QoR-40) score on first postoperative day (POD1). Results: Incidence of emergence agitation was significantly lower in group L (P < 0.05) compared with group C. Global QoR-40 scores on POD1 were significantly lower in both groups compared with preoperative assessment, it was significantly higher in group L on POD1 (P < 0.05) than in group C. Among the five dimensions of QoR-40, the scores for physical comfort and pain were superior in group L compared to group C (P < 0.05) at POD1. Conclusion: Systemic lidocaine infusion can improve QoR-40 scores and decrease incidence of emergence agitation in patients scheduled for FEES, also it reduces the duration of stay in PACU after surgery.