ObjectiveTo analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.MethodsThe clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.ResultsThe rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.ConclusionFor patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.
【Abstract】Objective To explore the feasibility that the recipient against donor antigen-specific T lymphocytes clones are formed,and the suicide genes are induced into the clone. In the end it may induce the transplanted-organ tolerance. Methods The recipient rats were immunized by the donor rats-splenocytes, then the recipient’s T cell were isolated, purified and diluted with limited-dilute methods into single cell.The T cells were cultured by adding raise cells,ConA or IL2 under the different concentration and at last the T cell clone were formed. Results A stable recipient against donor antigen-specific T cell clone was established. The difference among the different immune groups was very significant(tgt;t0.05). The T cell clone was not formed without raise cells or only with raise cells. The rare clone could be formed by ConA stimulation but without IL-2. The clone-forming rate was associated with concentration of IL-2. ConclusionThe mature T cell is able to proliferate to form clone when the condition is suitable. The recipient is immunized with donor rats spleen cellular antigen. The T cells clones selected in the end are donor antigen-specific.
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
Objective To analyze midterm effectiveness of percutaneous compression plate (PCCP) for femoral neck fractures in young and middle-aged patients. Methods The clinical data of 173 young and middle-aged patients with femoral neck fractures who met the selection criteria and were treated with PCCP internal fixation between January 2011 and March 2019 were retrospectively analyzed. Among them, there were 102 males and 71 females; the age ranged from 18 to 59 years, with an average age of 44.9 years. The injury causes included falling in 112 cases, traffic accident in 32 cases, falling from height in 21 cases, struck in 7 cases, and sprain in 1 case. According to Garden classification, there were 90 cases without displacement (51 cases of type Ⅰ and 39 cases of type Ⅱ) and 83 cases with displacement (51 cases of type Ⅲ and 39 cases of type Ⅳ). According to Pauwels classification, there were 10 cases of type Ⅰ, 88 cases of type Ⅱ, and 75 cases of type Ⅲ. The time from injury to operation was 1-14 days, with an average of 4.5 days. The operation time, intraoperative blood loss, perioperative blood transfusion, and hospitalization stay were recorded; the fracture reduction was evaluated by Garden alignment index at 1 day after operation; fracture healing and complications were observed, and Harris score was used to evaluate the effectiveness at last follow-up. Results The operation time was 34-130 minutes (mean, 78.6 minutes); the intraoperative blood loss was 10-250 mL (mean, 93.2 mL); 171 cases did not receive blood transfusion during perioperative period, 2 patients received blood transfusion of 400 mL and 800 mL respectively; the hospitalization stay was 3-19 days (mean, 11.3 days). All 173 cases were followed up 11-103 months, with an average of 42.6 months. Postoperative reduction quality was satisfactory in 170 cases and unsatisfactory in 3 cases. There were 13 cases of osteonecrosis of femoral head, 1 case of screw cutting out, 2 cases of screw withdrawal, 5 cases of femoral neck shortening, and no deep vein thrombosis in the lower extremity requiring surgical intervention. Fractures healed in 172 patients, and the healing time ranged from 3.0 to 7.5 months, with an average of 3.6 months; 1 case of nonunion occurred. Internal fixation was removed after fracture healing in 51 patients. At last follow-up, Harris score was excellent in 156 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 96.5%. ConclusionThe treatment of femoral neck fractures with PCCP has advantages of rigid fixation, immediate weight-bearing, and sliding compression, reducing the incidences of osteonecrosis of femoral head and nonunion.
Objective To investigate the feasibility of the anastomosis of the anterior branch of obturator nerve and the muscular branch of femoral nerve. Methods Five fresh frozen cadavers, including 3 males and 2 females, were included. Both of the obturator nerve, femoral nerve and their branches were dissected, then their routes and anatomical positions were observed. The diameter and the number of myelinated nerve fiber of the anterior branch of obturator nerve and femoral nerve muscular branches were measured, as well as the overlap distance between them. Results The diameter of myelinated nerve fiber of the anterior branch of obturator nerve was (3.80±1.22) mm; the number of myelinated nerve fiber was 11 358±800. The diameters of the rectus femoris branch and the medial femoral branch were (1.60±0.54) mm and (2.20±0.66) mm, respectively; the number of myelinated nerve fiber were 4 961±655 and 6 666±466. Both the diameter and number of myelinated nerve fiber were close to the anterior branch of obturator nerve. The anterior branch of obturator nerve could be directly anastomosed with each nerve branch of femoral nerve in nontension, and the overlap distance was about 30 mm. Conclusion It is feasible to repair the femoral nerve by transposed the anterior branch of obturator nerve and anastomosed with the femoral nerve muscular branches. And the rectus femoris branch and the medial femoral branch should be taken as the recipient nerve.
Objective Interpretation of the growing body of global literature on health care risk is compromised by a lack of common understanding and language. This series of articles aims to comprehensively compare laws and regulations, institutional management, and administration of incidence reporting systems on medical risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, so as to provide evidence and recommendations for health care risk management policy in China. Methods?We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results?A total of 146 documents were included in this study, including 2 laws (1.4%), 17 policy documents (11.6%), 41 guidance documents (28.1%), 37 reviews (25.3%), and 49 documents giving general information (33.6%). The United States government implemented one law and one rule of patient safety management, while the United Kingdom and Australia each issued professional guidances on patient safety improvement. The four countries implemented patient safety management policy on four different levels: national, state/province/district, hospital, and non-governmental organization. Conclusion?The four countries and one district adopted four levels of patient safety management, and the administration modes can be divided into an “NGO-led mode” represented by the United States and Canada and a “government-led mode” represented by the United Kingdom, Australia, and Taiwan.
Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, and to provide evidence and recommendations for healthcare risk management policy in China. Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews, and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results (1) A total of 142 documents were included in this study. The United States had the most relevant documents (68). (2) The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses, and now includes all patient safety incidents. (3) The incidence-reporting systems can be grouped into two models: government-led and legal/regulatory/NGO-collaborative. (4) In two cases, reporting systems were established for specific incident types: One for death or serious injury events (the sentinel events database in Britain, SIRL), and one for healthcare-associated infections (NHSN in America). (5) Compared to the four countries, Taiwan’s system put more emphasis on public welfare, confidentiality, and information sharing. The contents of reporting there covered every aspect of risk management to create a more secure environment. Conclusion (1) Britain’s national reporting and learning system was representative of a government-led model; (2) The United States was the earliest country to have a reporting system, which included a limited range of incident types. Management of incidents became more reliable with increased application of laws, regulations, and guidances; (3) Both the Canadian and the Australian systems drew from the American experience and are still developing; (4) The Taiwanese system was comprehensive and is an instructional case.
ObjectiveTo compare the biomechanical difference between petal-shaped poly-axial locking plate and tension band wire cerclage in fixing star-shaped 6-part patellar fractures in cadaver model, and provide the experimental data for clinical use.MethodsThe paired 12 knee specimens from 6 human cadavers were randomly divided into 2 groups (the control group and the test group) after a star-shaped 6-part patellar fracture model was established. The specimens were weighted, and the control group was fixed with tension band wire cerclage and the test group was fixed with petal-shaped poly-axial locking plate. The specimens were connected to CMT5105 biomechanics test machine by a customized fixture, the total fracture gap of patellar fracture blocks was measured before testing. The knee extensor load test was performed to record the extensor load of knees at 90° flexion to extension. Then the anti gravity physiological knee extension process at 90° flexion was stimulated according to the knee extensor load. The cyclic times until failure and the total fracture gap of patellar fracture blocks after failure were recorded.ResultsThe specimens weight and the total fracture gap of patellar fracture blocks before testing between 2 groups had no significant difference (t=0.410, P=0.690; t=0.650, P=0.530). In the biomechanical test, there was no significant difference of knee extension load between 2 groups (t=0.490, P=0.638). The total fracture gap after failure in test group was significantly smaller than that in control group (t=3.026, P=0.013), and the cyclic times until failure in test group was significantly more than that in control group (t=2.277, P=0.046). The failure reasons in control group were all the wires slipped off the Kirschner wires, while the failure reasons in test group were the screws pulled out from the upper pole in 5 cases (83.3%) and from the lower pole in 1 case (16.7%).ConclusionThe petal-shaped poly-axial locking plate has better biomechanical stiffness to fix the star-shaped 6-part patellar fractures when compared with tension band wire cerclage method. However, this type of fracture is a serious comminuted type, and the early excessive activity still carries the risk of displacement.
ObjectiveTo investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity. MethodsA retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation. Results The patients’ incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant (P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation (P<0.05) except for mMPTA (P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°. ConclusionLUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.