ObjectiveTo investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in elder people. MethodsClinical data of 68 elderly patients with abdominal trauma were analyzed retrospectively.ResultsDiagnosis in 35 of 68 cases were confirmed within 12 hours after trauma (51.5%). Fiftyeight cases in this group were treated surgically and 10 cases with nonsurgical treament.There were 7 death, the overall mortality was 10.3%. The cause of death was septic shock and multiple organ systemic failure. ConclusionThe elder patient with abdominal trauma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. The principle of treatment is to choose positive surgery, to streng then the perioperative management, to protect the function of each important organ, and to prevent the occurrence of multiple organ dysfunction syndrome.
ObjectiveTo compare the outcomes of kidney transplantation (KT) between Tibetan and Han recipients.MethodsPatients greater than 18 years old, who had received the first ABO-compatible KT between April 2006 and March 2017, were retrospectively included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1∶3 ratio. Survival, renal function and adverse events of the two groups were compared.ResultsOf the 1 820 patients who fit the screening criteria, 123 Tibetans and 357 Hans were included after PSM. The median follow-up time was 48 months. There was no statistically significant difference in death-censored grafts survival (P=0.061) or patients survival (P=0.440) between the two groups. The serum creatinine was higher in Tibetans than that in Hans within one year after KT (P<0.05), and the estimated glomerular filtration rate was lower in Tibetans than that in Hans within 5 years after KT (P<0.05), but no difference thereafter (P>0.05). The incidence of delayed graft function in Tibetan patients after operation was higher than that in Han patients (4.9% vs. 1.4%, P=0.037), but there was no significant difference in the incidence of acute rejection, infection, reoperation, or cancer between the two groups (P>0.05).ConclusionTibetans receiving KT achieve excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L1 in 2 cases, L2 in 4 cases, L3 in 3 cases, and L4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation (P<0.05), and further improved at last follow-up (P<0.05). The ASIA scale after operation significantly improved when compared with that before operation (P<0.05), and there was no significant difference (P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation (P<0.05), and without significant loss of correction during the follow-up (P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
To investigate the protective effect of propofol on ischemia/reperfusion induced spinal cord injury in rabbits and its influence on excitatory amino acid (EAA). Methods Sixty New Zealand white rabbits weighing 2.0-2.5 kg, half males and half females, were selected. The infrarenal circumaortic clamping model was used. And 6 mL/kg different fluids were continuously infused through a catheter into the aorta distal to the clamping site at a speed of 12 mL/(kg?h) during the 30 minutes ischemia period. According to the different infusing l iquids, the rabbits were randomized into 6 groups(n=10 per group): group A, normal sal ine; group B, 10% intral ipid; group C, propofol 30 mg/kg; group D, propofol 40 mg/kg; group E, propofol 50 mg/kg; group F, propofol 60 mg/kg. At 0, 6, 24, and 48 hours after reperfusion, neurologic outcomes were scored on a Tarlov scale system. At 48 hours after reperfusion, the number of normal neurons in the anterior spinal cord was counted, and concentration of EAA in the lumbar spinal cord was measured by high performance l iquid chromatography. Results The neuroethological score was better in groups C, D, E and F than that of groups A and B (P lt; 0.05), the score of group E was the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The number of normal neurons in the anterior spinal cord of groups C, D, E and F was greater than that of groups A and B (P lt; 0.05), and group E was greater than groups C, D and F (P lt; 0.05). The concentration of EAA in groups A, B, C, D, E and F was greater than that of normal tissue, the group E was the lowest (P lt; 0.05), the groups A and B were the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). Concentrations of glutamate and aspartic acid were negatively correlated to normal neuron numbers in the anterior spinal cord and neuroethological scores 48 hours after reperfusion, and the corresponding correlation coefficient was — 0.613, — 0.536, — 0.874 and — 0.813, respectively (P lt; 0.01). Conclusion Propofol can significantly inhibit the accumulation of EAA in spinal cord and provide a protective effect against the ischemia/reperfusion injury induced spinal cord in rabbits.
Objective To observe and evaluate the clinical effect of the new fenestration rammer in the treatment of thoracolumbar burst fracture by posterior internal fixation and reduction of lamina with finite fenestration decompression. Methods Patients with thoracolumbar burst fractures admitted to Zigong Fourth People’s Hospital between September 2017 and January 2020 were retrospectively selected. The patients were divided into observation group and control group according to different surgical methods. The observation group used a new tamping device with finite fenestration rammer of unilateral lamina to reduce the spinal occupying bone mass, and the control group used conventional instruments for reduction of intraspinal fracture masses. The operation time, intraoperative blood loss, CT measurement of sagittal diameter ratio of spinal canal and the number of cases of postoperative vertebral empty shell phenomenon were recorded in the two groups, and Frankel grading evaluation of spinal nerve function was conducted. Results A total of 67 patients were included. There were 33 cases in the observation group and 34 cases in the control group. The patients in both groups were followed up for 12 to 16 months, with an average of (14.45±2.25) months. The improvement rate of Frankel rating in each group was 100%. In the control group and the observation group, except for the sagittal diameter ratio of spinal canal before operation (P=0.616), the operation time [(150.44±26.47) vs. (120.91±20.86) min], the intraoperative blood loss [(244.41±42.97) vs. (183.33±34.56) mL], the sagittal diameter ratio of spinal canal one week after operation [(92.50±2.32)% vs. (93.72±2.40)%], the sagittal diameter ratio of spinal canal at the last follow-up [(91.50±2.96)% vs. (93.17±3.27)%] and the occurrence of empty shell phenomenon (13 vs. 5 cases) were statistically significant (P<0.05). The intragroup comparison showed that the sagittal diameter ratio of spinal canal was improved one week after operation and at the last follow-up compared with that before operation (P<0.05), there was no significant difference in the sagittal diameter ratio of spinal canal between one week after operation and the last follow-up (P>0.05). Conclusions The new fenestration rammer can effectively reduce the spinal occupying bone mass in thoracolumbar burst fracture, effectively restore the volume of the spinal canal, achieve the purpose of decompression, effectively prevent the formation of vertebral shell, maximize the retention of the stable structure of the posterior column, and avoid iatrogenic nerve injury. It is safe and effective.
【摘要】 目的 探討預混門冬胰島素對2型糖尿病（type 2 diabetes mellitus，T2DM）患者血漿成纖維細胞生長因子-21（fibroblast growth factor-21，FGF-21）水平的影響。 方法 2008年2—12月采用酶聯免疫吸附試驗測定44例正常人及37例采用預混門冬胰島素治療前后的T2DM患者的血漿FGF-21水平，分析血漿FGF-21水平與體質量指數（body mass index，BMI）、體內脂肪百分比（FAT%）、腰臀比、血脂、血糖、糖化血紅蛋白（hemoglobin A1c， HbA1c）、游離脂肪酸（free fatty acid，FFA）等的關系。 結果 治療前T2DM組患者血漿FGF-21[（1.79±0.04） μg/L]水平明顯高于正常對照組[（1.35± 0.21） μg/L]，差異有統計學意義（Plt;0.01）。T2DM組經16周預混人胰島素類似物（BIAsp 50和BIAsp 30）治療后FFA、HbA1c、空腹血糖、餐后2 h血糖均降低（Plt;0.01），空腹血漿FGF-21水平降低至（1.33±0.39） μg/L，與治療前比較差異有統計學意義（Plt;0.01）。相關分析發現T2DM組患者血漿FGF-21水平與BMI呈正相關（r=0.53，Plt;0.01），BMI是影響T2DM患者血漿FGF-21水平的獨立相關因素。 結論 預混人胰島素類似物能有效改善T2DM患者代謝紊亂，同時能顯著降低FGF-21水平。【Abstract】 Objective To investigate the effects of treatment with aspart insulin on plasma fibroblast growth factor-21 (FGF-21) levels in patients with type 2 diabetes mellitus (T2DM). Methods From February to December 2008, plasma FGF-21 levels were measured by enzyme-linked immunosorbent assay in 37 patients with T2DM treated with aspart insulin and 44 normal controls. The relationship between plasma FGF-21 levels and body mass index (BMI), percentage of body fat (FAT%), waist-hip ratio (WHR), blood lipid, blood glucose, hemoglobin A1c (HbA1c), and free fatty acid (FFA) was analyzed. Results Before treatment, plasma FGF-21 level was significantly higher in T2DM patients [(1.79±0.04) μg/L] than that in the normal controls [(1.35±0.21) μg/L] (Plt;0.01). After 16 weeks of treatment with premixed human insulin analogues (BIAsp 50 and BIAsp 30), FFA, HbA1c, fasting plasma glucose and 2-hour postprandial blood glucose decreased significantly (Plt;0.01), and fasting plasma FGF-21 level decreased to (1.33±0.39) μg/L which was significantly different from that before treatment (Plt;0.01). Correlation analysis showed that plasma FGF-21 level was positively correlated with BMI (r=0.53,Plt;0.01), which was an independent factor in influencing the FGF-21 level in the patients. Conclusion Aspart insulin treatment can remarkably improve glucose metabolism and significantly decrease the fasting plasma FGF-21 level.
Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.
ObjectiveTo explore the application value of thin CT angiography (CTA) of pedicle sagittal plane of axis for preoperative evaluation planning pedicle screw placement.MethodsBetween February 2016 and August 2017, 34 patients (68 pedicles) who underwent thin CTA scan before posterior axial surgery were retrospectively analyzed. The vertebral artery development was statistically analyzed. The continuous layers of transverse process hole pedicle height more than or equal to 4 mm (f) were measured and read. The axial fixation methods, clinical manifestations of vertebral artery and spinal cord injury and the bone union of fractures or implants were recorded. Postoperative results of pedicle screws were evaluated by CT scan.ResultsThe right sides of 8 cases and the left sides of 18 cases were dominant vertebral arteries, and equilibrium was reached in 8 cases; f>9 layers were found in 16 pedicles,f=9 layers in 27 pedicles, f=8 layers in 17 pedicles, and f<8 layers in 8 pedicles. The 43 pedicles off≥9 layers used pedicle screw fixation; in the 17 pedicles of f=8 layers, 16 used pedicle screw fixation, and the other one used laminar screw fixation; in the 8 pedicles of f<8 layers, 4 used pedicle screw fixation, and the other 4 used laminar screw fixation. A self-defined pedicle screw grading system was used to evaluate the excellence, and the result showed that,f>9 layers: 14 pedicles were class A, 2 were class B, none was class C;f=9 layers: 16 pedicles were class A, 7 were class B, 4 were class C; f=8 layers: 3 pedicles were class A, 5 were class B, 8 were class C; f<8 layers: none was pedicles class A or class B, 4 were class C. The other 4 lamina screws fixation didn’'t invade the spinal canal. One case of pedicle class C showed clinical manifestations of mild dizziness and drowsiness. The patients were followed up for 6-11 months with an average of (8±3) months, and the fracture or bone graft fusion were observed after 6 months of following-up.ConclusionBased on preoperative CTA thin layer scanning, through measuring and reading continuous layers of transverse process hole pedicle height more than or equal to 4 mm, can effectively judge the security of axial pedicle screws in order to subsequently choose the reasonable operation methods so as to improve success rate and decrease surgical risk.
ObjectiveTo investigate the distance between the screw-out point and the middle sacral artery, and evaluate the safety when the S1 pedicle screw placed by the three cortical fixation techniques.MethodsFrom March to June 2018, randomized CT scan data of 98 adult pelvic angiography were selected to measure the distance from the middle sacral artery to the anterior edge of the vertebral body (a) and the distance from the middle sacral artery to the midline of the vertebral body (b). S1 screw entry point was set as the intersection of lines where extension of S1 facet joint inferior margin and lateral margin cross over. Introversion angles of 10, 15, 20, and 25° were used; the distance between the screw insertion point and the middle sacral artery (d) was measured.ResultsThe middle sacral artery was usually located on the left side of the upper endplate plane of S1. The distance a was (5.40±2.95) mm in 49 males and (4.43±2.32) mm in 49 females, and the difference between the males and females was not statistically significant (t=1.818, P=0.72). The distance b was (12.07±5.42) mm in 45 males and (14.12±4.88) mm in 48 females, and the difference between the males and females was not statistically significant (t=–1.914, P=0.59). The distance d was (12.67±6.00), (9.40±5.17), (7.50±3.76), and (8.10±3.64) mm when the nail was placed at a common internal inclination of 10, 15, 20, and 25°. The differences in the distance d at a common internal inclination of 10° vs. 15°, 10° vs. 20°, 10° vs. 25°, and 15° vs. 20° were all statistically significant (t=16.828, 11.609, 6.073, 6.254; P<0.008 3); there was no statistically significant difference in that at 15°vs. 25°, or 20° vs. 25° (t=2.034, –1.723; P>0.05).ConclusionBy analyzing the relationship between the middle sacral artery and the upper endplate plane of the S1 vertebra, the risk of middle artery injury is small while the biomechanical stability of the screw is increased when using the Lenham method.