Objective To analyze and explain how to treat 1 patient with post-ERCP hemobilia based on best clinical evidence. Methods We used EST and EPBD, ENBD, Hemobilia as key words to search MEDLINE （1978 ～ 2004） and CBMdisc（1978 ～ 2004） to find the best clinical evidence and evaluated the quality of evidence. Results According to the evidence, we found that endoscopic papillary balloon dilation （EPBD） or endoscopic nasobiliary drainage （ ENBD ） may be more effective and better tolerated in the treatment ofpost-ERCP hemobilia. Our patient did not receive sufficient medical treatment after hemobilia. He was not given a general assessment before surgery including liver function tests. As a result, the patient died of liver failure and its complications. Conclusions We should treat such patients promptly and efficiendy after hemobilia. We should also evaluate their general condition properly before the operation.
Objective To investigate the assessment and treatment methods for unilateral spatial agnosia as well as its influence on the functional recovery of patients after stroke, so as to comprehensively understand unilateral spatial agnosia and formulate an effective treatment plan to improve the effect of rehabilitation for stroke patients. Methods A total of 86 patients with unilateral spatial agnosia were analyzed and a pre-treatment and post-treatment comparison was done. Results Of the 86 patients, 21% suffered from unilateral spatial agnosia. The occurrence of unilateral spatial agnosia was related to the location of the stroke lesion. The treatment group witnessed significant improvement after rehabilitation training of correcting unilateral spatial agnosia (Plt;0.05). Conclusion The correct rehabilitation method is beneficial for an early improvement in a patient’s cognitive ability. This also lays a foundation for the recovery of function in their limbs.
【Abstract】 Objective To discuss the main points of techniques and ranges of fusion in posterior operation ofdegenerated lumbar scol iosis compl icated spinal stenosis. Methods From February 2001 to September 2006, 23 cases with degenerated lumbar scol iosis stenosis were treated by posterior operation. There were 9 males and 14 females, with the average age of 65.3 years (ranging from 52 years to 71 years). The course of the diseases was 4 to 8 years. All patients were presented with severe low back pain. All patients were measured for Cobb angle of curves(17° to 53°), and lordosis angle of lumbar (-20° to -10° 10 cases, -40° to -20° 13 cases). Ten cases in which Cobb angle was smaller than 20° were operated by l imited segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation. For the rest 13 cases in which Cobb angle was bigger than 20° were operated by canal decompression, longer instrument for scol iosis correction, intervertebral fusion and posterior-lateral fusion. The fixation and fusion were located at L4-S1 in 6 cases, L1-5 in 5, L2-5 in 4, L1-S1 in 5, L2-S1 in 2 and T10-S1 in 1. Results There was no patient who died from the operation. Average Cobb angle in coronal plane was 0° to 21° with the average of 15.6°. The lumbar lordosis angle was -48.0° to -18.2° with the average of -36.4°. There were 21 cases (91%) with sciatica and intermittent claudication who were clearly released. There were 20 cases (87%) whose low back pain intensely decreased. Three cases with drop-foot returned to normal activities. During the mean 15-month (6 to 54 months) follow-up for 23 cases, there was no change of corrected results and fusion rate was 100%. Conclusion For degenerated lumbar scol iosis patients, the most important purpose of the treatment is to improve cl inical symptoms through sufficient decompression of neural structures. Lumbar stabil ization reconstruction and benign spinal biomechanics l ine conduce to longterm curative effect. Overall estimate of the cl inical appearances and imageology characters is necessary when the decision, that segments are needed to be fixed and fused should be made. The strategy of the individual ized treatment may be the best choice.
【摘要】目的探讨重症急性胰腺炎(SAP)时胰腺组织的诱导型一氧化氮合成酶(iNOS)、内皮素（ET1） mRNA表达状态, 以及与血浆中NO、ET1浓度和肠道损伤的关系及丹参治疗的影响。方法Wistar大鼠45只随机分为3组:SAP模型组(A组),SAP丹参治疗组(B组),假手术 组(C组),进行不同治疗和观察分析。结果A组血中淀粉酶(AML)、ET1、NO、内毒素(LPS)含量、125 I白蛋白累积指数及腹水量均显著高于C组(Plt;0.01);与A组比较,B组胰腺ET1和iNOS mRNA表达较弱,血中AML、ET1、NO、LPS及腹水量显著下降(Plt;0.01),125 I白蛋白累积指数较A组也有下降,但无差异(Pgt;0.05)。结论SAP时存在肠道损伤,胰腺组织ET1、iNOS mRNA的过度表达,使血中ET1、NO浓度升高,造成肠道屏障功能受损,肠通透性增加,引起内毒素血症。丹参注射液通过减轻SAP时胰腺的病理损害程度,下调胰腺ET1和iNOS mRNA的表达,使血中ET1、NO浓度下降,对SAP及其肠道损伤有一定治疗作用。
ObjectiveTo investigate the effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods A clinical data of 46 patients with Sanders type Ⅱand Ⅲ calcaneal fractures met the selective criteria between March 2016 and March 2021 was retrospectively analyzed. The factures were fixed with minimally invasive plate and medial supporting cannulated screws via tarsal sinus approach in 20 cases (group A) and with minimally invasive plate in 26 cases (group B). There was no significant difference between groups in term of the gender, age, injury causes, fracture type and side, the time from injury to operation, and preoperative calcaneal length and width, Böhler angle, Gissane angle, and visual analogue scale (VAS) score (P>0.05). The operation time, intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing were recorded. The pain improvement of patients was evaluated by VAS scores before operation and at 48 hours after operation. The ankle joint function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 12 months after operation. Besides, the calcaneal length and width, Böhler angle, and Gissane angle were measured by X-ray films before and after operation. Furthermore, the difference (loss value) between 3, 12 months and 1 day after operation was calculated. Moreover, the fracture healing and healing time was observed. ResultsAll operations of two groups were successfully completed. The incisions healed by first intention, and no vascular/nerve injury or incision infection occurred. The operation time of group A was significantly longer than that of group B (P<0.05). There was no significant difference in the intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing (P>0.05). All patients were followed up 12-36 months (mean, 14.8 months). The VAS scores at 48 hours after operation were significantly lower than those before operation in the two groups (P<0.05); there was no significant difference in the difference of pre- and post-operative VAS score between groups (P>0.05). The AOFAS scores at 12 months after operation were significantly higher than those at 3 months after operation in the two groups (P<0.05); and there was no significant difference between groups at 3 and 12 months (P>0.05). X-ray films showed that the fractures of the two groups healed and there was no significant difference in healing time (P>0.05). There was no significant difference in calcaneal length and width and Gissane angle between groups at each time point (P>0.05), but there was significant difference in Böhler angle between groups at 12 months (P<0.05). The imaging indexes of the two groups significantly improved at each time point after operation when compared with those before operation (P<0.05). There was no significant difference between different time points after operation (P>0.05) in the imaging indexes of group A. There were significant differences in the calcaneal length, calcaneal width, and Gissane angle of group B between 12 months and 1 day, 3 months after operation (P<0.05), and there was no significant difference between 1 day and 3 months after operation (P>0.05). The differences in Böhler angle of group B between different time points after operation were significant (P<0.05). There was no significant difference between groups in the loss of all imaging indexes at 3 months after operation (P>0.05). The losses of calcaneal width, Böhler angle, and Gissane angle in group A at 12 months after operation were significantly smaller than those in group B (P<0.05), and there was no significant difference in the loss of calcaneus length between groups (P>0.05). ConclusionCompared with only minimally invasive plate fixation, the combination of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of less trauma, less incision complications, reliable fracture reduction and fixation, and good long-term stability.
目的:探讨颅脑损伤合并视神经损伤的发病机制及治疗.方法:对23例颅脑损伤合并视神经损伤患者的临床资料做回顾性分析。结果:经过积极治疗部分患者视力有不同程度改善。结论:治疗颅脑损伤合并视神经损伤,强调神经外科和眼科协同处理,掌握治疗时机。
The utilisation of statistical analysis plan (SAP) has the potential to enhance the reliability, transparency, and impartiality of statistical analysis procedures in the context of clinical studies. These plans are primarily designed for late phase clinical studies, namely phase Ⅱ and phase Ⅲ randomised controlled trials. The extended SAP reporting guidelines for early phase clinical studies, i.e., phase Ⅰ clinical studies and phase Ⅱ non-randomised controlled trials, have been expanded from the original reporting guidelines in six key areas: trial purpose, design, Bayesian statistics, data simulation, sample size, and the application of ICH E9 (R1). The expanded reporting guidelines facilitate the standardisation of SAP for early phase clinical trials, enhance the transparency and reproducibility of early phase clinical studies, and thereby improve the quality of early phase clinical studies. This, in turn, plays a pivotal role in later phase clinical studies.
Objective To investigate the operative indication and clinical efficacy of combination of external fixator and volar approach fixation in treatingdistal radius fracture. Methods From March 2000 to March 2005, 28 patients with distal radius fracture were treated with combination of external fixator and volar approach fixation. Dorsal external fixator was used to maintain wrist in functional position, combinated volar plate or Kirschner wire fixation after reduction was achieved. Bone graft was necessary if there were severe comminuted cortical bone or compress of cancellous bone. Of 28 patients, there were 21 males and 7 females, aging from 1854 years with a median age of 41 years. The locations were the left side in 4 cases and the right side in 24 cases. According to typing criterion for AO, 18 cases were classified as C2 and 10 cases as C3. One case wasaccompanied with dislocation of lunate bone. Results Among 28 patients, 24 were followed up for an average of 8.5 months. The anatomical relationship of their wristjoint were reestablished and retained. Overall good to excellent results were achieved in 87%, excellent in 16 cases, good in 5 cases and fair in 3 cases. Conclusion A combination of external fixator and volar approach fixation is an effective method of treating fractures of the distal radius，because distal radius fracture is unstable or difficult to close reduction. Volarfixation can avoid operative complication, and external fixator can obtain satisfactory reduction and function.
ObjectiveTo evaluate the effectiveness of a new type of sutured titanium wire combined with titanium nail internal fixation in correction of serious old medial canthus deformity.MethodsBetween March 2012 and June 2015, 18 patients with unilateral serious old medial canthus deformity were treated. There were 14 males and 4 females. The patient’s age ranged from 23 to 62 years (mean, 42 years). The causes of deformity included accident injury in 10 cases, boxing injury in 4 cases, sharp device scratching in 3 cases, and animal bite in 1 case. All patients had been treated with suture or steel wire fixation in other hospitals to correct the medial canthus deformity and the deformity recurred. The interval between this operation and the first operation was 6 months to 2 years (mean, 16 months). The nasal root or medial canthus skin scar incision was used as the operative approach, and the adhesion of the medial canthus ligament to the adjacent tissues was fully loosened, then the tail end of the new type sutured titanium wire was fixed to the residual end of the medial canthus ligament. After passing through the scar tissue, the needle end of wire was fixed on the titanium nail in the bone wall of anterior lacrimal crest. The position and shape of the medial canthus angle was determined by adjusting the tightness of titanium wire.ResultsAll incisions healed by first intention. All patients were followed up 6-12 months (mean, 10 months). In 16 cases, the medial canthus deformity was obviously corrected, and the appearances of bilateral eyes were basically symmetrical, without exposure of titanium nail and titanium wire. The medial canthus was retreated at 2 mm after 6 months in 2 cases, who were satisfied with their appearance without reoperation.ConclusionApplication of the new type of suture titanium wire combined with titanium nail in the correction of serious old medial canthus deformity can achieve good effectiveness with the low recurrence rate.
Poly(styrene-block-isobutylene-block-styrene) (SIBS) and its crosslinked product crosslinked polyisobutylene (xPIB) are a kind of novel thermoplastic elastomer. They have excellent biocompatibility and stability, which are suitable for long-term implantation in human body. At present, SIBS is widely used in cardiovascular diseases, and also has preliminary application in ophthalmology. This article reviews the application and research progress of SIBS and xPIB in ophthalmic glaucoma minimally drainage tube material, intraocular lens material, new sclera buckle material and orbital defect filler, with a view of providing reference for the clinical application of such biomedical materials in ophthalmology.