Objective To assess the growth station, the upper respiratory infection frequency and consultation frequency of the geographically defined high risk neonatal population at 1-year-old based on both birthweight and gestational age. Methods All infants admitted in our hospital from May in 2008 to May in 2009 were divided into three groups according to gestational age and birth weight, that were, group 1: born lt;32 completed gestational weeks and weighing ≥1 500 g; group 2: born after 32 completed gestational weeks and weighing lt;1 500 g; and group 3: born lt;32 completed gestational weeks and weighing lt;1 500 g. Information at 12 months corrected age about growth, the upper respiratory infection frequency and consultation frequency was collected. Results The growth rate of weight and head circumference in group 3 were lower than that in group 1, and the length growth rate was lower than that in group 1 and group 2. Infants in group 3 suffered from more airway infections (median: 15.5) than in group 1 (12.5) and group 2 (8.5). Infants in group 3 needed more medical consultations (median: 27.5) than those in group 1(17.5) and group 2 (15.5). Conclusions This study gives estimates for growth outcome, airway infection and consultation frequency at 12 months corrected age for very low birthweight infants (lt;1 500 g) and for very preterm infants (lt;32 completed gestational weeks). Gestational age and birth weight are the same important for predicting infants’ outcome and should therefore be integrated into clinical statistics.
ObjectiveTo summarize the clinical progress of minimally invasive techniques in treatment of pilonidal disease.MethodThe relevant literatures about minimally invasive techniques in the treatment of pilonidal disease in recent years were reviewed.ResultsAbout hair removal and carbolic acid injection, they had less damage, fewer complications, higher recurrence rate compared to other surgery, and did not affect the second treatment. The fibrin injection could not clarify its role in the treatment of pilonidal disease due to some defects in the clinical design. Bascom Ⅰhad the advantages of fast recovery and no need for hospitalization, with a recurrence rate of 8%–16%. According to the results of some current clinical researches, it was a promising operation. Sinus resection required further clinical evaluation due to the limited results of current researches. A clinical study of more than 1 000 cases over 10 years showed that the recurrence rate in 10 years was 16%. Compared with frequently used pilonidal operations, the trephine technique was associated with a lower recurrence rate and a lower incidence of postoperative complication. Some short-term clinical researches showed that endoscopic pilonidal sinus treatment was a safe, minimally invasive, and less complication treatment.ConclusionsCompared with frequently used pilonidal operations, minimally invasive technique has the advantages of shortening the hospital stay, shortening the healing time, and reducing complications. It is worth of application.
Objective To explore the clinical significance of IL-6 and 8-isoprostane( 8-iso-PG) in exhaled breath condensate( EBC) in chronic obstructive pulmonary disease ( COPD) and smoking. Methods 17 patients with stable COPD and 30 healthy controls( 14 smokers and 16 non-smokers) were included in this study. EBC was collected in all subjects with a self-designed experimental device. The concentrations of 8-iso-PG and IL-6 in EBC were determined by enzyme-linked immunosorbent assay. Results Both8-iso-PG and IL-6 levels significantly increased in the COPD patients [ ( 8. 37±5. 09) pg/mL and ( 4. 62 ±1. 73) pg/mL, respectively] compared with the healthy non-smokers[ ( 5. 23 ±3. 08) pg/mL and ( 3. 09 ±1. 85) pg/mL, respectively] ( both P lt;0. 01) . There was no difference between the COPD patients and thehealthy smokers( both P gt; 0. 05) . The IL-6 level significantly increased in the healthy smokers compared with the non-smokers [ ( 4. 06 ±1. 59) pg/mL vs ( 3. 09 ±1. 85) pg/mL, P lt;0. 05] , but the 8-iso-PG level was similar in the non-smokers and smokers( P gt;0. 05) . Conclusion Airway inflammation and oxide stress are persistent in stable COPD patients and are aggravated by smoking.
ObjectiveTo systematically review the effectiveness and safety of interventions which target to improve the rate of successful extubation in preterm infants.MethodsPubMed, Web of Science, Cochrane Library, Chongqing VIP database, China National Knowledge Infrastructure, and Wanfang Database were searched for articles published from the dates of establishment of databases to August 2020, which compared different noninvasive respiratory support models or different doses of caffeine to improve the rate of successful extubation in preterm infants in randomized controlled trials. The references of included articles were also retrieved. And then a meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 randomized controlled trials involving 4 536 preterm infants were included. Compared with nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC) reduced the nose injury rate [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.15, 0.57), P=0.000 3] and the pneumothorax rate [OR=0.18, 95%CI (0.06, 0.55), P=0.003]; nasal intermittent positive pressure ventilation (NIPPV) reduced the extubation failure rate [OR=0.33, 95%CI (0.23, 0.48), P<0.000 01], the reintubation rate [OR=0.36, 95%CI (0.20, 0.65), P=0.000 7], the respiratory failure rate [OR=0.33, 95%CI (0.17, 0.64), P=0.000 9], and the pneumothorax rate [OR=0.29, 95%CI (0.12, 0.70), P=0.006]; and biphasic positive airway pressure (BiPAP) reduced the reintubation rate [OR=0.21, 95%CI (0.09, 0.46), P=0.000 1]. Compared with low-dose caffeine, high-dose caffeine reduced the extubation failure rate [OR=0.44, 95%CI (0.32, 0.60), P<0.000 01] and the bronchopulmonary dysplasia rate [OR=0.69, 95%CI (0.48, 0.99), P=0.04], but increased the rate of tachycardia [OR=1.99, 95%CI (1.22, 3.25), P=0.006].ConclusionAccording to the current evidence, compared with NCPAP, NIPPV and BiPAP could be used to improve the rate of successful extubation in preterm infants, HFNC could be used to decrease the risk of nose injury and pneumothorax; the optimal dose of caffeine should be chosen after evaluating the risk of adverse reactions such as tachycardia.
【摘要】 目的 對骶正中動靜脈的位置分布及變異進行解剖觀察及實際測量其與周圍重要結構的位置關系，為臨床醫師提高腰骶椎前路手術安全性提供必要的參考信息。 方法 收集2008年5月-2011年1月期間因疾病及意外死亡者新鮮人體尸體標本30例，對其進行解剖學研究，觀察并測量骶正中動、靜脈的發出點與走行，骶正中動、靜脈的數量與缺失情況，以及骶正中動、靜脈間的相互走行關系。 結果 ①骶正中動脈在主動脈發出以及走行的位置相對固定，無明顯多支與缺失情況；骶正中動脈均為腹主動脈根部背側發出，未見發出點位于左右髂總動脈。發出后行于左側髂總靜脈后方，跨過腰5/骶1椎間盤下行。骶正中靜脈與骶正中動脈伴行的情況占總數的60.0%；②骶正中靜脈多支常見，沒有發現有骶正中靜脈的缺失。1支的占總標本數的66.7%，2支的占30.0%，3支的占3.3%。 結論 當選擇分叉下入路，應該特別注意骶正中動靜脈的解剖位置。動脈的變異相對較小，而靜脈的變異程度非常大，發出點變異，多支的情況多見，這些原因都造成了靜脈容易損傷的原因，在手術中應該特別注意。【Abstract】 Objective To investigate the clinical significance of anatomical features of middle sacral artery and vein for lumbar-sacral spinal surgery. Methods We carried out anatomical research on 30 cadavers caused by diseases or accidents collected between May 2008 and January 2011. We dissected the vascular system anterior to lumbar vertebrae to learn their characteristics. The initial point of middle sacral artery and confluent point of veins, and the numbers of, and the companion relationship between middle sacral arteries and veins were chosen as the indexes to be measured. Results The middle sacral arteries started from the aorta, and their locations were relatively fixed without absence or multi-branches. All the middle sacral arteries derived from the dorsal side of abdominal artery root, and were not started from the common iliac artery. Then, the sacral arteries went at the back of left common iliac vein, and went down after traversing the inter-vertebral disk between the fifth lumbar and first sacral vertebra. About 60% of the middle sacral veins were accompanied with the arteries. Multi-branches of the middle sacral veins were frequently seen, and no absence was observed. One-branch, two-branch and three-branch middle sacral veins occupied 66.7%, 30.0% and 3.3% respectively out of the total. Conclusions When choosing downward branch approach during the operation, we should pay special attention to the anatomical locations of the middle sacral arteries and veins. Compared with the arteries, there are greater variations of the veins including variations of the confluent point and branches which can cause the veins to be quite vulnerable.
Objective To investigate the surgical treatment method and the curative effect of tibial nonunion with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap. Methods From January 1996 to December 2008, 18 cases of tibial nonunion were treated with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap, interlockingintramedullary nail ing and cancellous bone graft of distal tibial. There were 14 males and 4 females, with an average age of 32.5 years old (range, 24-67 years old). Fracture site was middle in 10 cases and distal in 8 cases. Primary injury cause included 12 cases of traffic accident and 6 cases of bruise. The tibial nonunion reasons were manual reduction and plaster immobil ization in 8 cases, small spl int immobil ization in 4 cases, intramedullary nail fixation in 2 cases (no bone graft), plate fixation in 4 cases (including 3 cases of plate fixation and free il iac bone graft). Nonunion occurred after the first surgery. The time from nonunion to operation was 8 to 16 months, with an average of 10.5 months. The size of periosteal flap was 7 cm × 5 cm and distal tibial cancellous bone graft volume was 5-10 g. Results All incision achieved heal ing by first intention after operation without flap necrosis and infection. All patients were followed up 6-36 months with an average of 20.8 months. All tibial nonunion healed 5-7 months after operation. According to Johner-Wruh scoring, the results were excellent in 14 cases, good in 3 cases, and fair in 1 case; the excellent and good rate was 94.4%. Conclusion Superficial peroneal vascular tibiofibularfascia pedicel tibiofibular periosteal flap and interlocking intramedullary nail ing can attain good results in treating nonunion of tibia and fibula because of being stable internal fixation and promoting the heal ing of nonunion.
As a novel soluble guanylate cyclase stimulator, vericiguat can improve myocardial and vascular function, reduce ventricular remodeling, myocardial hypertrophy, inflammation and fibrosis, and delay the progression of heart failure by interfering with cell signaling pathways. Vericiguat not only can significantly reduce the risk of heart failure-related hospitalization or cardiovascular death, but also is well tolerated and compliant by patients, which can increase the additional benefit and improve prognosis of patients with heart failure with reduced ejection fraction. This article will review the mechanism and research progress of vericiguat in heart failure with reduced ejectionfraction.
Objective To summarize research progress of infrapatellar fat pad derived mesenchymal stem cells (IFP-MSCs) in treatment of osteoarthritis (OA). Methods The recent domestic and international literature on IFP-MSCs was reviewed. The mechanisms and latest research progress of IFP-MSCs in the treatment of OA were summarized and analyzed from aspects such as basic biological characteristics, core therapeutic mechanisms, preclinical research evidence, bioengineering strategies for optimizing therapeutic effects, and the current status of clinical studies and application. ResultsThe main mechanism of IFP-MSCs for OA treatment lies in the significant paracrine effect. By releasing cytokines, exosomes, etc., IFP-MSCs work synergistically to exert anti-inflammatory effects, protect cartilage, and promote repair. Preclinical studies have verified its efficacy and mechanism in vitro and in animal models. To promote clinical translation, researchers have developed a series of bioengineering strategies, including standardized cell preparation and functional preprocessing (such as three-dimensional culture, inflammatory factor stimulation), genetic engineering modification, exosome engineering, and the design of intelligent delivery carriers, aiming to optimize cell functions and achieve precise treatment. Preliminary clinical studies have confirmed its safety and short-term benefits in improving symptoms. ConclusionAlthough there are still challenges such as cell heterogeneity and long-term efficacy verification, by integrating cutting-edge technologies such as three-dimensional organ chips and single-cell omics, IFP-MSCs are expected to promote the development of OA treatment to a new stage of personalization and high efficiency, providing a new direction for future stem cell-based precise repair strategies.
Objective To investigate the effectiveness of all-arthroscopic treatment for Pipkin type Ⅰ and Ⅱ femoral head fractures. Methods A retrospective analysis was conducted on the clinical data of 13 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures who underwent all-arthroscopic reduction and fixation between May 2015 and May 2024. The cohort included 10 males and 3 females, with an average age of 27.4 years (range, 14-40 years). The mechanisms of injury involved traffic accidents in 11 cases and falls from a height in 2 cases. According to the Pipkin classification, there were 7 type Ⅰ and 6 type Ⅱ fractures. Seven patients presented with concomitant posterior hip dislocation. The interval from injury to surgery ranged from 1 to 10 days, averaging 3.2 days. Fixation was achieved using bioabsorbable suture anchors in 7 cases, bioabsorbable screws in 4 cases, and Herbert screws in 2 cases. Key parameters including operation time, intraoperative blood loss, complications, and fracture healing time were recorded. At last follow-up, hip joint function was evaluated using the Harris hip score and the Thompson-Epstein evaluation criteria. Results The operation time ranged from 100 to 140 minutes, with an average of 119.5 minutes. The intraoperative blood loss ranged from 20 to 65 mL, with an average of 40.8 mL. No postoperative complication such as neurovascular injuries occurred, and all incisions healed by primary intention. All 13 patients were successfully followed up 9-24 months, with an average of 16 months. The fracture healing time ranged from 10 to 18 weeks, averaging 14.1 weeks. During the follow-up, no complication such as traumatic osteoarthritis, osteonecrosis of the femoral head, heterotopic ossification, or internal fixation failure was observed. At last follow-up, the Harris hip score ranged from 91 to 97, averaging 94.6. Based on the Thompson-Epstein criteria, the clinical outcomes were graded as excellent in 9 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion For Pipkin type Ⅰ and Ⅱ femoral head fractures, all-arthroscopic fixation represents a safe and effective therapeutic strategy. The individualized selection of Herbert screws, bioabsorbable screws, or suture anchors based on the specific characteristics of the fracture fragments offers significant clinical advantages. This approach ensures minimal invasiveness, minimal disruption of the femoral head blood supply, and a low complication rate.
ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.