Tag: nevin manimala

Zhonghua Yi Xue Za Zhi. 2021 Jul 20;101(27):2147-2151. doi: 10.3760/cma.j.cn112137-20210314-00630.

ABSTRACT

Objective: To investigate the serratus anterior plane block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy. Methods: From October 2020 to February 2021, Sixty-four patients of Beijing Tongren Hospital, Capital Medical University scheduled for radical mastectomy with general anesthesia,were divided into two groups (n = 32 each) using a random number table method: thoracic paravertebral block group (TPVB group) and serratus anterior plane block combined with pectoral nerves block I group (S&P group). All patients received patient controlled intravenous analgesia (PCIA) postoperatively. The numerical rating scale (NRS) at post anesthesia care unit (PACU), 4, 8, 12, 24, 48 h after operation were compared between the two groups. Sufentanil cumulative dosage of PCIA in 24 h and 48 h, first press time after operation, total press times, the dosage of propofol, remifentanil and vasoactive drugs during operation, intraoperative blood pressure and heart rate, the operation time of block and adverse effects were all compared. Non-inferiority could be claimed if the difference of sufentanil cumulative dosage in 24 h between S&P group and TPVB group is higher than the negative value (-3.8) of the non-inferiority effect. Results: There was no significant difference in postoperative NRS at PACU, 4, 8, 12, 24, 48 h after operation, first press time after operation, total press times, propofol and remifentanil dosage, sufentanil cumulative dosage of PCIA in 24 h and 48 h, and adverse effects (all P>0.05). The sufentanil cumulative dosage of PCIA in 24 h of S&P group and of TPVB group were (15.8±4.7) μg and (15.2±3.2) μg. The 95% confidence interval (CI) of the difference between S&P group and of TPVB group was -1.478 to 2.694, and the lower limit was greater than non-inferiority margin -3.8. The mean arterial pressure of TPVB patients after induction and at the beginning of the operation were (63±7) mmHg and (70±7) mmHg, which were significantly lower than the (77±5) mmHg and (79±8) mmHg at the same time in the combination group (both P<0.05). The frequency of vasoactive drugs usage in TPVB group was 56.3%, which was statistically significant higher than the 18.8% in S&P group (P<0.01). Nerve block time in TPVB group was 10 (9, 11) min, which was significantly longer than 8 (6, 10) min in S&P group (P<0.01). Conclusion: The serratus anterior block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy, and the intraoperative hemodynamics is more stable and the block time is shorter than that of thoracic paravertebral block for radical mastectomy.

PMID:34275250 | DOI:10.3760/cma.j.cn112137-20210314-00630

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2071-2076. doi: 10.3760/cma.j.cn112137-20201019-02866.

ABSTRACT

Objectives: To explore the short and long term outcomes of coronary artery disease(CAD) patients with heart failure with reduced ejection fraction (HFrEF) after two different revascularization strategies. Methods: The CAD patients with HFrEF who had undegone successful revascularization from January 1, 2005 to December 31, 2014 in Anzhen Hospital were analyzed based on registries. The baseline characteristics, changes of left heart function and the MACCE after a mean follow-up of 3.1 years were compared. Results: A total of 1 813 CAD patients with HFrEF who had undergone successful PCI (n=687) or CABG (n=1 126) satisfied the inclusion criteria were included. The age of all patients included was (59.6±10.0) years and male patients accounted for 83.1%. For the coronary angiographic features, the CABG group showed higher SYNTAX score (27.3±10.2 vs 31.1±10.4, P<0.01) and greater left ventricular end diastolic diameter (LVEDD) [(59.8±7.2) vs (57.9±7.7)mm, P<0.001]. The LVEF before revascularization was similar in PCI and CABG group [(35.8±5.1)% vs (35.9±4.6)%, P>0.05]. At three-month, one-year or three-year follow-up after revascularization, the improvement of LVEF was similar in the two groups (P>0.05). After multivariable adjustment, three-year outcomes revealed that the risks of all-cause mortality and cardiac death were not statistically significant between CABG and PCI group (16.3% vs 14.3%, HR=1.5, 95%CI: 1.2-2.1, P=0.07; 8.5% vs 8.2%, HR=1.3, 95%CI: 1.1-1.4, P=0.20). With regards to other endpoints, CABG group had a higher rate of stroke (6.2% vs 2.9%, HR=2.9, 95%CI:2.3-3.6, P<0.01) but a lower rate of repeat revascularization (6.5% vs 15.1%, HR=0.5, 95%CI:0.3-0.7, P<0.01) compared to PCI group. And for patients with SYNTAX score≥33, PCI group showed a comparable risk of all-cause mortality or cardiac death (HR=0.8, 95%CI: 0.4-1.3, P=0.06; HR=0.7, 95%CI:0.4-1.0, P=0.90). Conclusions: In CAD patients with HFrEF who had undergone successful revascularization, PCI is not inferior to CABG for long-term survival. PCI should be taken into consideration to become an alternative strategy in patients with left ventricular dysfunction.

PMID:34275241 | DOI:10.3760/cma.j.cn112137-20201019-02866

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2077-2080. doi: 10.3760/cma.j.cn112137-20201228-03485.

ABSTRACT

Objective: To explore the relationship between microsurgery and prognosis of acoustic neuroma. Methods: A total of 553 acoustic neuroma surgical cases admitted to the First Affiliated Hospital of Soochow University from January 1, 1986 to September 30, 2016, were collected retrospectively. They were divided into 1986-1995 group, 1996-2005 group, and 2006-2016 group. The general information, tumor size, preoperative hospital stay, total hospital stay, operation time, intraoperative blood transfusion, use of neuroelectrophysiological monitoring, internal auditory canal wall grinding, tumor resection degree, postoperative facial nerve function rating (House-Brackmann grading), discharge status, and quality of life assessment KPS of patients were statistically analyzed. Results: Compared with the 1986-1995 group and the 1996-2005 group, the average age of patients in the 2006-2016 group ((52.9±13.3) years) was larger but the overall tumor volume ((3.7±0.8) cm) was smaller, and preoperative hospital stay ((4.9±1.9) days), the total hospital stay ((19.4±6.4) days) was significantly reduced, the operation time ((4.6±1.0) hours) was shortened, the intraoperative blood transfusion rate (18.5%) was significantly reduced, the intraoperative neuroelectrophysiological monitoring utilization rate (8.9%), and the internal auditory canal rate (12.7%) was higher. While increasing the tumor total resection and near total resection rate (89.2%), it further improved the postoperative facial nerve function retention rate (71.5%), and significantly increased the discharge cure rate (88.5%) (P<0.05). At the same time, the postoperative quality of life assessment good rate (KPS≥60 points) and excellent rate (KPS≥80 points) of the patients in the 2006-2016 group increased significantly, reaching 94.2% and 45.8% (P<0.05). Conclusion: The maturity of microsurgery techniques and the use of intraoperative neuroelectrophysiological monitoring can shorten the treatment cycle of patients with acoustic neuroma, increase the tumor resection rate and postoperative facial nerve function retention rate, and effectively improve the quality of life of patients after surgery.

PMID:34275242 | DOI:10.3760/cma.j.cn112137-20201228-03485

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2081-2084. doi: 10.3760/cma.j.cn112137-20210105-00019.

ABSTRACT

Twenty-five patients diagnosed with otogenic vertigo at the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital from January to June 2020 were selected. Among them, 8 cases were male and 17 cases were female, aged (48±13) years. All the patients underwent internet combined with offline follow-up vestibular rehabilitation for 12 weeks, which included vestibulo-ocular reflex exercises, proprioceptive exercises and static/dynamic balance exercises. Computerized dynamic posturography (CDP) and dizziness handicap inventory (DHI) scores were compared before and after rehabilitation. The DHI score improved significantly after 12 weeks of vestibular rehabilitation (48.3±15.9 vs 26.7±17.9, t=5.319, P<0.001). Meanwhile, the sensory organization test (SOT) score was also improved (73.3±8.1 vs 76.1±6.6, t=2.066, P=0.050), while the difference of motor control test (MCT) latent stage score before and after rehabilitation was not statistically significant (140±13 vs 141±16, t=0.791, P=0.436). The current study demonstrates that vestibular rehabilitation based on mobile internet is convenient, economical and effective, and patients can benefit from it.

PMID:34275243 | DOI:10.3760/cma.j.cn112137-20210105-00019

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2060-2065. doi: 10.3760/cma.j.cn112137-20210305-00563.

ABSTRACT

Objective: To investigate the Helicobacter pylori (H. pylori) eradication rate and improvement of dyspepsia in patients who were newly diagnosed with H. pylori infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Methods: Patients who were newly diagnosed with dyspepsia and H. pylori infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was H. pylori eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. Results: A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the H. pylori eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, P=0.001). In the group of all enrolled patients, the symptom dyspepsia after H. pylori eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), P<0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), P<0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), P<0.001], the early satiety [1(1, 1) vs 4(1, 4), P<0.001], and the heartburn [1(1, 1) vs 1(1, 4), P<0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful H. pylori eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), P<0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), P=0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), P<0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, P=0.09). Conclusions: Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the H. pylori eradication rate without increasing the incidence of adverse events. H. pylori eradication therapy can improve symptoms of patients with H. pylori infection and dyspepsia.

PMID:34275239 | DOI:10.3760/cma.j.cn112137-20210305-00563

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2066-2070. doi: 10.3760/cma.j.cn112137-20201224-03458.

ABSTRACT

Objective: To explore the effect of video distraction on preoperative separation anxiety and induction compliance of preschool children receiving strabismus surgery under general anesthesia. Methods: In this prospective trial, 80 children aged 3 to 6 years scheduled for strabismus surgery under inhalation anesthesia were randomly allocated to one of two groups, a control group and a video distraction group, with 40 cases in each group. Children in the video distraction group continuously watched videos from waiting in the holding area, separating with parents, entering the operating room and induction of anesthesia, while children in the control group didn’t watch videos during the same process. The modified Yale Preoperative Anxiety Scale (mYPAS) of children were recorded upon arriving at the holding area(T₁)and separating with parents(T₂). Induction Compliance Checklist (ICC) score was recorded when the anesthesia induction was performed. The emergence time, the occurrence rate of adverse events in post-anesthesia care unit (PACU) including nausea and vomiting, laryngospasm, severe cough, hypoxemia and sinus bradycardia, incidence of postoperative adverse reactions such as pain, dizziness, nausea and vomiting and lethargy, the parents’ satisfaction of anesthesia were also assessed. Results: There were no significant difference in mYPAS score and the proportion of mYPAS score>30 between 2 groups at T₁ (all P>0.05). At T₂, the mYPAS score and the proportion of mYPAS score>30 in video distraction group were (34.41±13.23) and 52.50%, which were lower than those in control group (50.64±20.96, 87.50%) with statistically significant difference (all P<0.05). The ICC score of video distraction group was lower than that of the control group, which was (1.83±2.26) vs (4.03±2.99), and the difference was statistically significant (P<0.05). The proportion of children with ICC score=0 in video distraction group was 37.50%, which was higher than that in the control group (12.50%), while the proportion of children with ICC score=4-10 was lower than that of the control group, which was 17.50% vs 45.00%, and the difference was statistically significant (P<0.05). No significant intergroup differences were observed in emergence time, incidence of adverse events in PACU, and incidence of postoperative adverse reactions (P>0.05). The parents’ satisfaction of anesthesia in the video distraction group was (9.23±0.89), which was higher than that in the control group (8.63±1.23), with statistically significant (P<0.05). Conclusion: Preoperative video distraction alleviates separation anxiety, improves induction compliance of preschool children receiving strabismus surgery under general anesthesia, and increases the parents’ satisfaction of anesthesia.

PMID:34275240 | DOI:10.3760/cma.j.cn112137-20201224-03458

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2044-2049. doi: 10.3760/cma.j.cn112137-20210128-00264.

ABSTRACT

Objective: To explore the prognosis of individualized vestibular rehabilitation (VR) in patients with intractable vertigo and work out an effective and normative rehabilitation program. Methods: A total of 35 patients diagnosed with intractable vertigo who visited Eye & ENT Hospital of Fudan University from September 2017 to December 2019 were enrolled. All the participants consisted of 15 males and 20 females, aged from 24 to 71 years old, and underwent an individualized VR. Follow-ups were conducted at 2 and 4 weeks post-rehabilitation. Assessments consisted of self-rating anxiety scale (SAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence sacle (ABC), computerized dynamic posturography (CDP), and video-electronystagmograph (VNG) were performed. Results: SAS, DHI, ABC scores gradually improved after VR. The scores of SAS scale of pre-VR, 2 and 4 weeks post-VR were 41±8, 37±8 and 36±8, respectively. The scores of DHI were 56(40, 78), 46(22, 74), 16(6, 76), respectively. Meanwhile, the scores of ABC were 80±17, 87±11 and 91±9, respectively. There were significant statistical differences of aforementioned three scale scores at different time points (P=0.020, P<0.01, P=0.002), which was not influenced by age and gender (all P>0.05). No interactive effects were revealed among age, gender and time (all P>0.05). The improvement of vestibular function to control balance was statistically significant after 2-and 4-week rehabilitation (both P<0.001). The value of directional preponderance was significantly improved after 4-week VR (P=0.007), while no obvious improvement was found after 2 weeks treatment (P=0.593). There was a statistically significant difference in the value of unilateral weakness (UW) between pre-VR and post-VR since 2 weeks (P=0.001). Conclusion: Individualized VR in patients with intractable vertigo can not only eliminate anxiety, control dizziness, increase activities of daily life, but also improve the function of vestibulo-spinal and vestibulo-ocular reflex pathways.

PMID:34275236 | DOI:10.3760/cma.j.cn112137-20210128-00264

Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Jul 9;56(7):693-696. doi: 10.3760/cma.j.cn112144-20201210-00609.

ABSTRACT

Objective: To explore the effect of the application of mixed reality (MR) technology in clinical teaching of fibular flap preparation. Methods: Twenty residents from the Department of Oral and Maxillofacial Surgery in School of Stomatology, the Fourth Military Medical University in 2018 and 2019 participated in the present study. They were randomly divided into two groups according to the method of random drawing. The teaching content of the two groups was fibular flap preparation. The MR group was taught by using the new teaching mode which was mainly based on MR, while the conventional teaching group was educated by conventional teaching method. At the end of the training, the theoretical knowledge and operational skills of the residents were statistically analyzed to evaluate the learning effect. Questionnaire survey was also conducted. Each item in the questionnaire was scored between 0 and 5, representing poor to excellent. Results: The theoretical scores of MR group (91.4±4.4) were higher than that of the conventional teaching group (83.3±3.2) (P<0.01). The durations of preoperative marking and simulated osteotomy in MR group [(5.7±1.2) and (20.9±2.28) min, respectively] were shorter than those in the conventional teaching group [(7.2±1.7) and (26.1±3.6) min, respectively] (P<0.05). The results of the questionnaire showed that MR group had a significant improvement in the scores of classroom atmosphere, satisfaction, three-dimensional construction, theoretical knowledge and problem-solving ability (P<0.01). However, there was no statistically significant difference in scores of learning concentration between the two groups (P>0.05). Conclusions: The application of MR technology achieved a better teaching effect, which could help residents to deeply understand the methods of fibular flap preparation, and showed a broad application prospect.

PMID:34275226 | DOI:10.3760/cma.j.cn112144-20201210-00609

Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Jul 9;56(7):646-651. doi: 10.3760/cma.j.cn112144-20210405-00162.

ABSTRACT

Objective: To investigate the accuracy of pure titanium and cobalt-chromium alloy frameworks fabricated using the additive manufacturing (AM) of selective laser melting technology (SLM) for the mandibular implant-supported fixed prostheses and the maxillary removable partial denture (RPD), and to provide a reference for clinical application of SLM pure titanium frameworks. Methods: One edentulous mandibular model with implants and screw fixed abutments at bilateral canines and the first molars was selected and used as the mandibular full arch implant-supported model. At the same time, a Kennedy class Ⅰ maxillary dentition defect model was selected. The digital models were obtained by scanning the dental models, and the metal frameworks of the mandibular full arch implant-supported denture and the maxillary RPD (design model) were designed using the 3 Shape software. Meanwhile, 12 mandibular frameworks in the cobalt-chromium alloy and the pure titanium (6 in each group were treated with heat treatment, while the other 6 were not treated), and 7 maxillary frameworks in the cobalt-chromium alloy and the pure titanium were respectively made by SLM with the improved dual-laser metal printer. The axial direction of the printing powder accumulation was taken as the Z-axis. During the design process, the software (3Shape Dental System 2018) automatically generated the X-axis and Y-axis, X axis was the sagittal axis of the dental model and Y axis was the coronal axis of the dental model. The deviation of the interface center of the abutment of the digital model of the mandibular frameworks from the design model in the X, Y and Z axes was analyzed. As for the trueness of the mandibular framework, the larger the deviation data was, the worse the trueness was. The deviation of the whole maxillary framework and 7 measuring points (palatal plate center point and bilateral occlusal rests, I bars, proximal plates) were analyzed. The fitness of the whole maxillary framework to the design model was expressed by root mean square (RMS) of the deviation data, and the fitness of measuring points was expressed by the mean±standard deviation of the data. The trueness differences of each group before and after heat treatment of the mandibular framework and the fitness of the maxillary framework were compared. Results: The cobalt-chromium alloy frameworks showed lower trueness on the X, Y, Z-axes [(96.3±12.1), (86.3±11.4), (61.2±13.2) μm] than did the pure Ti frameworks [(82.3±11.2), (72.2±10.2), (51.2±11.6) μm] by SLM, and the heat treatment could reduce the discrepancy between the SLM frameworks and STL models, for pure titanium frameworks [(62.4±11.3), (55.2±13.2), (41.3±10.8) μm] and for cobalt-chromium alloy [(84.5±10.5), (72.3±11.2), (54.2±11.6) μm]. For the thin RPD major frameworks, pure titanium had better fitness [(121.3±17.0) μm] than cobalt-chromium alloy [(174.0±18.3) μm] by SLM, and the difference was statistically significant (P<0.05). Conclusions: Pure titanium frameworks fabricated by SLM additive manufacturing technology exhibited better fitness and trueness than did the Co-Cr frameworks after heat treatment respectively, and this satisfied the requirements of implant-supported fixed prostheses and RPD major metal frameworks.

PMID:34275219 | DOI:10.3760/cma.j.cn112144-20210405-00162

Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Jul 9;56(7):652-658. doi: 10.3760/cma.j.cn112144-20210315-00120.

ABSTRACT

Objective: To quantitatively evaluate the accuracy of multi-color and multi-hardness dental models printed by using the photopolymer jetting (PJ) technology, and to provide protocol for the clinical application. Methods: A maxillary partially edentulous (Kennedy class Ⅱ subclass 1) standard digital model obtained through scanning and processing was selected as reference data. Five monochromatic DLP (digital light processing) models with single hardness were printed by printer DLP-800d based on DLP technology (DLP group), and five multi-color and multi-hardness PJ models were printed by printer J300Plus based on PJ technology (PJ group). Scan the printed model and register the scanning data to the reference data in Geomagic Studio 2013 software. The three-dimensional (3D) deviations of the whole and each area, including residual dentition, abutments adjacent to the edentulous area, gingiva, gingiva in the distal-extended edentulous area, gingiva in other edentulous areas, gingiva supporting the removable partial denture (RPD), were calculated and represented by the root mean square error (RMS) value. The smaller the RMS value was, the higher the trueness of printing was. The scanning data of the five models in the same group were registered in pairs to calculate the 3D deviation. The smaller the RMS value was, the higher the precision of printing was. The threshold of clinical acceptability was 200 μm. Statistical analysis was performed to compare the difference of trueness and precision between the two groups. Results: The overall trueness of the DLP group [57.70 (2.10) μm] was significantly better than that of the PJ group [71.00 (7.70) μm]. The overall precision of the DLP group [15.20 (5.05) μm] was significantly better than that of the PJ group [37.55 (15.55) μm]. The overall trueness and precision of both groups were within the clinically acceptable range. Conclusions: The domestic PJ printer used in this study can print multi-color and multi-hardness dental models with good trueness and precision, which can provide integrated 3D printing technology support for realizing the simulation of regional hardness differentiation between soft and hard tissues of dental models.

PMID:34275220 | DOI:10.3760/cma.j.cn112144-20210315-00120