关键词： Inguinal hernioplasty   Local anesthesia   Conscious sedation   Patient satisfaction   Randomized controlled trial  

摘要： PurposeConscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia *** trial was a single-centre, randomized, placebo-controlled, double-blinded trial where patients undergoing inguinal hernioplasty using local anaesthesia were randomized to receive local anaesthesia alone versus local anaesthesia and conscious sedation. The primary outcome of patient satisfaction was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). The study was powered to detect a significant difference in ISAS scores between groups. Comparisons were made using T test and Chi square tests. A p value of less than 0.05 was considered *** were 149 patients randomized: 78 to the local anesthesia (LA) group and 71 to the local anaesthesia and conscious sedation (LACS) group. For the primary outcome measure of patient satisfaction, the mean ISAS score was significantly greater in the LACS group (p=0.009). The experience of pain and pain severity was greater in the LA group (p=0.016;p=0.0162 respectively). No statistically significant difference was found between groups with respect to operative time, time to discharge or postoperative *** use of conscious sedation with local anesthesia for inguinal hernioplasty is safe, results in less pain experience and severity and is associated with better patient satisfaction. The use of conscious sedation does not delay patient discharge.

关键词： 1400 W   Arterial pressure   Cardiovascular   Heart rate   NO   N-Propyl-L-arginine  

摘要： The baroreflex is a prominent moment-to-moment mechanism regulating the blood pressure. The hippocampus is a limbic structure in which has been pointed out as part of central network regulating baroreflex. However, the local neurochemical mechanisms involved in control of baroreflex function are not completely understood. Thus, this study aimed to investigate the involvement of nitrergic neurotransmission present in the dorsal hippocampus in baroreflex control of heart rate in conscious rats. For this, we evaluated the effect of bilateral microinjection into the dorsal hippocampus of either the nitric oxide (NO) scavenger carboxy-PTIO, the selective neuronal nitric oxide synthase (nNOS) inhibitor Nw-Propyl-L-arginine (NPLA) or the selective inducible nitric oxide synthase (iNOS) inhibitor 1400 W in bradycardia evoked by blood pressure increases in response to intravenous infusion of phenylephrine, and tachycardia caused by blood pressure decreases evoked by intravenous infusion of sodium nitroprusside. Bilateral microinjection of carboxy-PTIO into the dorsal hippocampus decreased the baroreflex tachycardic response without affecting the reflex bradycardia. Hippocampus treatment with NPLA increased the baroreflex bradycardia gain without affecting the reflex tachycardia. Bilateral hippocampal treatment with 1400 W decreased the reflex tachycardia and increased the baroreflex bradycardic response. Overall, these findings provide evidence that hippocampal nitrergic mechanisms acting in a NOS isoform-specific manner plays a prominent role in control of baroreflex function. Indeed, the results indicate that nNOS and iNOS exerts an inhibitory influence on reflex bradycardia, whereas iNOS mediates the reflex tachycardia.

关键词： Transcutaneous electrical nerve stimulation   Pain relief   Transvaginal oocyte retrieval   Conscious sedation  

摘要： BackgroundTransvaginal oocytes retrieval is an essential step in in-vitro fertilization treatment. There are different pain relief methods, but none has been shown to be superior than the others. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological and non-invasive pain relief method. This study aims to compare the pain levels experienced by the women using the conscious sedation and those who had TENS in addition to conscious *** and analysisThis is a double-blinded randomized trial that will be carried out in a university-assisted conception unit. Women who will undergo oocyte retrieval under conscious sedation will be recruited. After randomization, women will be allocated to either the active TENS group or placebo TENS group (the TENS machine will not emit active impulse), in addition to the paracervical block and conscious sedation. The primary outcome is pain levels of women during the retrieval assessed by the visual analog scale. Secondary outcomes include satisfaction of women and postoperative side *** is an effective non-pharmacological and non-invasive method for pain relief in a number of clinical conditions. Both women and assisted conception unit can benefit if the addition of non-invasive, simple, and low-cost TENS application is proven to be superior than using conscious sedation and paracervical block *** ***, NCT03472430. Registered on 3 May 2018.

关键词： 实验动物   遗传质量控制   教育教学  

摘要： 实验动物遗传质量控制对实验动物生产和科学研究及生物医药产业有重要的影响,应该受到高度重视,但在实际工作中由于动物遗传质量问题发生滞后性和具隐蔽性等原因,使得实验动物的遗传质量问题长期存在。实验动物专业人员是未来动物实验的执行者、监督者和管理者。本文结合实验动物管理和应用动物进行科学研究的实际工作经验,从实验动物生产和动物实验过程中可能出现的遗传质量问题出发,在对实验动物专业技术人员培训和医学生实验动物教学中,分析问题可能的原因,提出了相应的解决办法和建议。通过教育和培训过程中的理论和实例的阐述,强化了专业技术人员和医学实验工作者对实验动物遗传质量控制重要性的认识,旨在保证实验动物的遗传质量,提高动物实验的真是性和准确性。本文也可为非专业技术人员处理实验动物遗传质量问题提供参考。

关键词： Motor cortex   Neurostimulation   Antinociception   Raphe nuclei   Spinal cord  

摘要： Motor cortex stimulation (MCS) is an effective therapy for refractory neuropathic pain. MCS increases the nociceptive threshold in healthy rats via endogenous opioids, inhibiting thalamic nuclei and activating the periaqueductal gray. It remains unclear how the motor cortex induces top-down modulation of pain in the absence of persistent pain. Here, we investigated the main nuclei involved in the descending analgesic pathways and the spinal nociceptive neurons in rats that underwent one session of MCS and were evaluated with the paw pressure nociceptive test. The pattern of neuronal activation in the dorsal raphe nucleus (DRN), nucleus raphe magnus (NRM), locus coeruleus (LC), and dorsal horn of the spinal cord (DHSC) was assessed by immunoreactivity (IR) for Egr-1 (a marker of activated neuronal nuclei). IR for serotonin (5HT) in the DRN and NRM, tyrosine hydroxylase (TH) in the LC, and substance P (SP) and enkephalin (ENK) in the DHSC was also evaluated. MCS increased the nociceptive threshold of the animals;this increase was accompanied by activation of the NRM, while DRN activation was unchanged. However, cortical stimulation induced an increase in 5HT-IR in both serotonergic nuclei. MCS did not change the activation pattern or TH-IR in the LC, and it inhibited neuronal activation in the DHSC without altering SP or ENK-IR. Taken together, our results suggest that MCS induces the activation of serotonergic nuclei as well as the inhibition of spinal neurons, and such effects may contribute to the elevation of the nociceptive threshold in healthy rats. These results allow a better understanding of the circuitry involved in the antinociceptive top-down effect induced by MCS under basal conditions, reinforcing the role of primary motor cortex in pain control.

关键词： Wireless body area network   quality of service   coordinator   medium access control   emergency data   OMNeT plus  

摘要： Wireless body area network is a type of wireless sensor network that enables efficient healthcare system. To minimize frequent sensor replacement due to resource restrictions, it is necessary to improve energy efficiency in wireless body area network. This article deals with energy efficiency and quality-of-service improvement together in novel wireless body area network architecture. A novel wireless body area network architecture is designed with dual sink nodes in order to minimize delay and energy consumption. A novel insistence-aware medium access control protocol which is aware of criticality of sensed data is presented in the proposed wireless body area network. Prior knowledge-based weighted routing algorithm is responsible to select optimal route for data transmission. In prior knowledge-based weighted routing, weight value is computed by considering significant metrics such as residual energy, link stability, distance, and delay in order to improve energy efficiency and quality of service in the network. Energy consumption is further minimized by incorporating graph-based sleep scheduling algorithm. In graph-based sleep scheduling, criticality of sensor node is also considered as major metric. In coordinator, split and map-based neural network classifier is involved to perform packet classification. After classification, packets are assigned to corresponding sink node according to packet type. Then, throughput and delay metrics are improved by frame aggregation process which is involved in sink node. Extensive simulation in OMNeT++ shows better performance in network lifetime, throughput, residual energy, dropped packets, and delay.

关键词： Redundant target effect   TMS   V1   Unconscious vision   Blindsight   Motion perception  

摘要： The study of blindsight has revealed a seminal dissociation between conscious vision and visually guided behavior: some patients who are blind due to V1 lesions seem to be able to employ unconscious visual information in their behavior. The standard assumption is that these findings generalize to the neurologically healthy. We tested whether unconscious processing of motion is possible without the contribution of V1 in neurologically healthy participants by disturbing activity in V1 using transcranial magnetic stimulation (TMS). Unconscious processing was measured with redundant target effect (RTE), a phenomenon where participants respond faster to two stimuli than to one stimulus, when the task is just to respond as fast as possible when one stimulus or two simultaneous stimuli are presented. We measured the RTE caused by a motion stimulus. V1 activity was interfered with different stimulus onset asynchronies (SOA) to test whether TMS delivered in a specific time window suppresses conscious perception (participant reports seeing only one of the two stimuli) but does not affect unconscious processing (RTE). We observed that at each SOA, when TMS suppressed conscious perception of the stimulus, the RTE was also eliminated. However, when visibility of the redundant target was suppressed with a visual mask, we found unconscious processing of motion. This suggests that unconscious processing of motion depends on V1 in neurologically healthy humans. We conclude that the neural mechanisms that enable motion processing in blindsight are modulated by neuroplastic changes in connectivity between subcortical areas and the visual cortex after the V1 lesion. Neurologically healthy observers cannot process motion unconsciously without functioning of V1.

关键词： 高等学校   内部控制   风险意识   教职工  

摘要： 随着《行政事业单位内部控制规范(试行)》的颁布与实施,各公立高校内部控制建设与实施工作陆续启动。内部控制制度的建设与实施需要依靠具体的"人"来执行,执行人风险控制意识的高低决定了内部控制制度推行的效果。以A高校为调研对象,研究不同学历、职称、工作年限及工作岗位的教职工对风险控制的认知度、需求度以及整体意识的差异情况,分析高校教职工在风险控制意识方面存在的不足,并有针对性地提出强化风险控制意识的建议,为推进公立高校内部控制制度的建设与实施、消除风险控制意识的"木桶效应"提供一定的参考依据。

关键词： Recovery position   CPR   Breathing assessment   Out-of-hospital cardiac arrest   Head-tilt and chin-lift   Schoolchildren  

摘要： Background: Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation. Aim: To compare breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing. Methods: Schoolchildren aged 10-12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place. Result: 192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001;OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001;OR = 21.094), (p = 0.002;OR = 4.553). Conclusion: The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.

关键词： 意识形态   "139"工作体系   落实着力点  

摘要： 本文从围绕意识形态工作这"一个中心",针对自身存在的九个风险问题,结合实际夯实"三个责任",从"九个方面"逐一防范化解,建构起别具特色的"139"防范意识形态风险工作体系,切实巩固了党的领导核心地位.