Optimization strategy for anesthesia in patients with moyamoya disease undergoing revascularization: scalp nerve block combined with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the efficacy of scalp nerve block combined with general anesthesia in optimizing anesthesia in the patients with moyamoya disease undergoing revascularization.Methods:A total of 154 patients with moyamoya disease, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective revascularization, were divided into 2 groups ( n=77 each) using a random nunber table method: scalp nerve block combined with general anesthesia group (GN group) and general anaesthesia group (G group). Anesthesia was induced with intravenous midazolam 0.05 mg/kg, sufentanil 0.5-1.0 μg/kg, rocuronium 0.6 mg/kg and etomidate 0.2-0.3 mg/kg.After the patients were tracheally intubated after anesthesia induction, ipsilateral scalp nerve block (2 ml for supraorbital nerve block, 2 ml for supratrochlear nerve block; 3 ml for auriculotemporal nerve block, 3 ml for greater occipital nerve block, 3 ml for less occipital nerve block) was performed with 0.5% ropivacaine in GN group.The equal volume of normal saline was locally injected in G group.Anesthesia was maintained by inhalation of sevoflurane and intravenous infusion of remifentanil 0.05-0.10 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1.The consumption of intraoperative remifentanil, requirement for postoperative rescue analgesia, nausea and vomiting, length of postoperative hospital stay, and early neurological complications were recorded.The modified Rankin Scale scores were evaluated before operation, at discharge and at 6 months after operation. Results:Compared with G group, the consumption of intraoperative remifentanil and requirement for postoperative rescue analgesia were significantly decreased ( P<0.05), and no significant change was found in the incidence of postoperative nausea and vomiting, incidence of neurological complications, length of postoperative hospital stay, and modified Rankin Scale scores at each time point in GN group ( P>0.05). Conclusions:Scalp nerve block combined with general anesthesia can increase the perioperative analgesic efficacy and is helpful in achieving a low-opioid anesthesia mode when used in the patients with moyamoya disease undergoing revascularization.

An investigation of current application status of radiological diagnosis and treatment equipment in medical institutions in Shijiazhuang, China, 2019 / 中国辐射卫生

Objective To investigate the application of radiological diagnosis and treatment equipment and distribution of medical radiation levels in medical institutions at various levels in Shijiazhuang, China in 2019, and to lay a sound foundation for further radiation protection and management. Methods A universally designed questionnaire was used to investigate and compile data on the level of the sampled hospitals, the number of radiation workers, equipment information, the number of outpatients and emergency patients, the number of inpatients, and the frequency of radiological diagnosis and treatment; the application frequency of each radiological diagnosis and treatment item was calculated based on the demographic data of Shijiazhuang. Results In Shijiazhuang, there were 390 medical institutions (excluding dental clinics) certified for radiological diagnosis and treatment, with a total of 4262 radiation workers and 1215 radiological diagnosis and treatment devices; 1.11 radiological diagnosis and treatment devices were available per 10 000 people, and 3.89 radiation workers were available per 10 000 people. The number of annual outpatients and emergency patients was 30 208 471, the number of inpatients was 1 981 295, and the total number of people or times receiving radiological diagnosis and treatment was 5 987 230. The application frequency of medical radiation was 546.70 persons/times per 1000 people, with the highest frequency for X-ray diagnosis (534.63 persons/times per 1000 people), followed by diagnosis and treatment with nuclear medicine (6.16 persons/times per 1000 people), and the lowest frequency for radiotherapy (1.17 persons/times per 1000 people). In terms of regional distribution, the highest frequency of medical radiation fell in Yuhua District (1602.97 persons/times per 1000 people), and the lowest frequency fell in Shenze County (203.21 persons/times per 1000 people). Conclusion The development of medical radiation is imbalanced in Shijiazhuang, with high-quality medical resources concentrated mainly in the main urban area, thus resulting in long-term overworking of hospital staff and equipment in some areas. The government and health administration departments should strengthen macro-control and the rational allocation of medical resources; medical institutions at various levels should rationally use radiological diagnosis and treatment equipment, strengthen judgments on the justness of radiation, and strengthen the training of radiation workers on protection knowledge and radiation protection optimization.

Exploration of the preponderant population for primary tumor resection of asymptomatic metastatic colorectal cancer / 国际肿瘤学杂志

Objective:To explore the population who benefit from primary tumor resection (PTR) of asymptomatic metastatic colorectal cancer (mCRC) .Methods:The clinicopathological data of 121 patients with asymptomatic mCRC with unresectable liver metastases treated in the First Affiliated Hospital of Yangtze University from January 2014 to January 2019 were retrospectively analyzed. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors.Results:The median overall survival (OS) of 121 mCRC patients was 20 months, and the 3- and 5-year survival rates were 34.71% and 10.74%. The median OS of PTR and non-PTR patients were 21 months and 18 months respectively, with no statistically significant difference ( χ2=0.79, P=0.375) . In 65 mCRC patients received targeted therapy, the median OS of PTR and non-PTR patients were 25 months and 28 months respectively, with no statistically significant difference ( χ2=1.65, P=0.199) . In 84 patients with mCRC of the left colon and rectum, the median OS of PTR and non-PTR patients were 24 months and 18 months respectively, with a statistically significant difference ( χ2=4.25, P=0.039) . In 37 patients with mCRC of the right colon, the median OS of PTR and non-PTR patients were 19 months and 17 months respectively, with no statistically significant difference ( χ2=0.18, P=0.675) . In 64 mCRC patients who received liver local treatment, the median OS of PTR and non-PTR patients were 36 months and 17 months respectively, with a statistically significant difference ( χ2=12.60, P<0.001) . In 57 mCRC patients who did not receive liver local treatment, the median OS of PTR and non-PTR patients were 15 months and 17 months respectively, with no significant difference ( χ2=0.58, P=0.445) . Univariate analysis showed that the location of the primary tumor ( HR=0.51, 95% CI: 0.25-0.76, P=0.025) , the degree of differentiation ( HR=1.46, 95% CI: 1.13-9.45, P=0.004) , the maximum diameter of the liver metastases ( HR=1.86, 95% CI: 1.35-4.60, P=0.012) , the level of serum carcinoembryonic antigen ( HR=3.55, 95% CI: 2.55-8.45, P<0.001) , local treatment of liver metastases ( HR=0.35, 95% CI: 0.19-0.93, P<0.001) were influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases. Multivariate analysis showed that the primary sites of the left colon and rectum ( HR=0.43, 95% CI: 0.25-0.93, P=0.039) , local treatment of liver metastases ( HR=0.78, 95% CI: 0.27-0.86, P<0.001) were independent influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases. Conclusion:Asymptomatic mCRC patients with unresectable liver metastases with primary sites of the left colon and rectum and local treatment of liver metastases can benefit from PTR.

Genotype I of Japanese encephalitis virus as the dominant genotype among mosquitoes in Shandong / 中华实验和临床病毒学杂志

Objective@#To analysis the genotype of Japanese encephalitis virus (JEV) in mosquitoes from Shandong province.@*Methods@#Mosquitoes were collected between August and September in Weishan county, Junan county, and Kenli county of Shandong province in 2016. Viruses were isolated by BHK-21 cell and identified by molecular method . Real-Time RT-PCR was conducted to detect the Japanese encephalitis virus carried by the mosquitoes.@*Results@#A total of 8418 mosquitoes divided into 81 pools including 3 species, Culex tritaeniorhynchus, Anopheles sinensis and Armigeres obturbans. Eight Japanese encephalitis viruses were isolated; 23 pools were positive by JEV specific real-time RT-PCR. Phylogenetic analysis on E sequence of JEV showed all JEV strains belonged to genotype Ⅰ JEV, and new strains that were homogenous with previous JEV strains isolated from Shandong.@*Conclusions@#Genotype Ⅰ JEV was the dominant genotype in Shandong province.

Analysis of genetic diversity and amino acid sequence of HIV-1 Vpr from a patient with AIDS dementia complex / 中华实验和临床病毒学杂志

Objective@#To study the sequence characteristics and variation of HIV-1 Vpr gene in different parts of an AIDS dementia complex (ADC) patient and provide basis for the study of the neurologic pathogenesis of HIV-1-assciatd dementia.@*Methods@#Genomic DNA was extracted from peripheral samples (lymph nodes, spleen, liver) and central nervous system (meninges, frontal lobe, temporal lobe gray matter, frontal white matter, basal ganglia cortex) of an ADC patient, The Vpr gene was amplified with nested polymerase chain reaction (PCR). PCR products were cloned into the pMD19-T vector. After transformation into DH5α competent E. coli, five positive clones were sequenced. The phylogenetic tree was built and genetic distance was calculated through MEGA6, and the values of ds/dn was calculated through SNAP, then the changes of the amino acid sites were analyzed.@*Results@#HIV-1 Vpr genes isolated from different tissues of the ADC patient had variations. Vpr HIV-1 gene sequences from central nervous system and peripheral tissues were intercrossed together in the phylogenetic tree. Central nervous system and peripheral HXB2 Vpr had no significant differences in genetic distance. The ds/dn of all the HIV-1 Vpr gene sequences were 3.3749.@*Conclusions@#The HIV-1 Vpr sequences were different in the ADC patient, and there were different variations in different parts of the peripheral and central regions. Whether these variations are related to the pathogenesis of ADC remains to be further studied.

Reform and practice of dual-track teaching mode during the clinical pathology in Chinese Medicine Universities / 中国医学装备

Objective:Dual-track teaching mode in higher colleges and universities of Chinese medicine in clinical pathology teaching reform and practice, so as to change the phenomenon of university students of traditional Chinese medicine western medicine foundation weak, and improve the teaching quality of clinical pathology.Methods: We use the traditional teaching method (LBL) and teaching method of the problem-based learning (PBL) to make double-track recess internship teaching model in clinical pathology, and in practice use the access type, interactive type and potential mining methods to motivate the students’ learning.Results: The dual-track teaching model realizes complementary teaching effect of a variety of teaching methods, makes the teaching quality enhance unceasingly. It not only exercises the students’ ability of autonomous learning, cultivate the students’ clinical thinking, but also stimulates students’ imagination and improves the students’ ability to analyze and solve practical problems.Conclusion: The dual-track teaching mode is worth popularizing in the higher colleges and universities of traditional Chinese medicine, and it can improve the students’ comprehensive quality and innovation and make it better from students to the role of the doctor.

Analysis of the failure pattern in 110 patients with radical resection of gastric cancer / 国际肿瘤学杂志

Objective To find the reasonable treatment strategy by analyzing the failure pattern and survival rates of radical resection of gastric cancer.Methods Data were collected from 110 patients with radical resection and adjuvant treatment of gastric cancer,counted up the number of cases that failure in different ways.The survival rate after operation was calculated by Kaplan-Meier.The chi-square test was used to find the differences in survival rates between different differentiation,location and gender.Results 1,3,5-year survival rates of 110 cases were 83.64％ (92/110),46.36％ (51/110),35.45％ (39/110),respectively.Malignant ascites was the main failure type for postoperative of gastric cancer,approximately accounting for 41.51％ (22/53),abdominal lymph node metastasis accounting for 30.19％ (16/53),anastomotic recurrence accounting for 13.21％ (7/53),abdominal implantation and mesenteric metastasis accounting for 9.43％ (5/53),organ metastasis accounting for 5.66％ (3/53).The 5-year local failure rate of concurrent chemoradiotherapy group was a little lower than that in adjuvant chemotherapy alone group (15.00％ ∶22.22％).The 1-year survival rates of adjuvant chemotherapy alone and concurrent chemoradiotherapy group were 84.44％ and 80.00％ respectively,with no significant difference (x2 =0.236,P =0.627).However,the 3,5-year survival rates of the two groups were 66.67％ vs 40.00％ and 53.33％ vs 20.00％ respectively,with statistically significant differences (x2 =4.930,P =0.026 ; x2 =7.294,P =0.007).Conclusion Peritoneal metastasis is the most common failure pattern for the patients with gastric cancer who received radical operation and adjuvant treatment.The relapse rate of concurrent chemoradiotherapy group is lower than that in adjuvant chemotherapy alone group,but the overall survival rate is similar.

Anatomic and clinical study of minimally invasive total hip arthroplasty through anterolateral intermuscular approach / 中华创伤杂志

Objective To investigate the anatomic structure of the Chinese people,develop the procedure of minimally invasive total hip arthroplasty through the anterolateral intermuscular approach and investigate its clinical outcome.Methods Three fresh adult cadavers(6 hips)were used for study of the anatomic construction of the anterolateral intermuscular approach in Chinese people.Sixteen patients were treated with minimally invasive total hip arthroplasty through anterolateral intermuscular approach.The clinical results and operation technique were recorded.Results The anterolateral intermuscular approach was a triangle muscular interval slightly parallel to the femur.The medial-superior angle of the triangle muscular interval consists of the anterior border of gluteus medius and tensor fascia lata muscle with juncture of muscles,where the inferior branch of superior gluteal nerve entered into tensor fascia lata muscle.The average incision length was 8.8 cm(7-10 cm),with mean blood loss of 350 ml(250-550 ml).The patients took out-of-bed activity 3-5 days after operations.During operations,anterior border injury in deep portion of the gluteus medius muscle was observed in seven patients and the injured muscles were trimed or repaired.All patients were followed up for 18-39 months(averaged 27.7 months).Most of the patients had excellent location of the phantoms,except that one acetabulum had a little pitch angle and two acetabulums had a little abduction angle.No complication was observed.The mean Harris scores of hip for all patients was increased from preoperative(39.1±6.7)points to(80.6±11.3)points on six month,(88.7±9.6)points on 12 month and(91.4±13.5)points on 24 months(11 patients).No patient suffered from gluteus medius muscle weakness during the follow-up.ConclusionAnterolateral intermuscular approach has the advantages of simple anatomic construction,small incision,little operative injury,muscle sparing and fast recovery without separate muscle or tendon and is suitable for the Chinese patients.Exact incision and special operative instruments should be emphasized to avoid the increase of acetabular pitch angle and abduction angle.

Small external fixation devices combined with flap for fracture and dislocation of articulations interphalangeaes / 中华显微外科杂志

Objective To explore the outcome of small external fixation devices combined with flap for fracture and dislocation of articulationes interphalangeaes.Methods Twelve cases (13 fingers) with fracture and dislocation of articulationes interphalangeae were treated with small external fixation devices combined with flap.Blood vessel grafting and crossing anastomosis were performed.The area of the flap was 1.0 cm ×1.5 cm -2.5 cm × 3.0 cm.Results Follow-ups lasting from 6 months to 2 years showed that all fingers and flaps were survived postoperatively.Fixation average time of small external fixation was 37 days.Fracture healing was found in all cases with satisfactory effect and with better apperance.Conclusion Small external fixation devices combined with flap was proper for fracture and dislocation of articulationes interphalangeae.

Injuries of avulsion and severance of upper extremity caused by flexion and rotation and their functional reconstruction / 中华创伤骨科杂志

Objective To study the injuries of avulsion and severance of upper extremity caused by flexion and rotation and application of tissues of chest side and back in functional reconstruction of the upper extremity. Methods The primary or fosterage replantations were performed from 2000 July to 2003 September for 6 cases of the injuries of avulsion and severance of upper extremity caused by flexion and rotation. After the operation, the shoulder joint was immobilized at abduction of 90 degrees and elbow joint was fixated at inflexion of 100 degrees. 4 weeks later, the fixation was removed and the regular functional training was started. Results Follow-ups ranging from 3 months to 2 years revealed that all the cases of replantation were successful. After operation, the shoulder joint could abduct 50?～90?, anteflect 50?～70?, extend backwards 20?～30?, and adduct 20?～40?. The elbow joint could flex 100?～140?and extend -20?～0?. 3 months after reconstruction, the muscle strength of elbow flexion recovered to Ⅳ～Ⅴdegrees. Conclusion Application of tissues of chest side and back to repair avulsion and severance of upper extremity stage by stages and layer by layer is an ideal method to resolve the contradiction between wound coverage and functional reconstruction because it can restore both the function and appearance.

Treatment of old scaphoid fractures by internal fixation with modified common screws / 中华创伤骨科杂志

Objective To introduce treatment of old scaphoid fractures by internal fixation with common screws which have been modified into compression-like ones.Methods Twenty-five patients with old scaphoid fracture were admitted to our department from January,1995 to December,2002.They were 17 cases of delayed union,and eight cases of non-union and pseudoarticulation formation.All the patients were treated with open re- duction anti internal fixation by modified common cortical bone screws,some threads of which bad been erased so that they could act somewhat like compression ones.The modified screws were driven into the reduced scaphoid by simple surgical instruments to fix and compress the fracture ends.Results Nineteen cases were followed up for one to six years (mean,3 years).Fourteen cases of fracture healed,with an average healing time of 7 months.The mean extension-flexion arc of the injured wrists was between 106 degrees and 128 degrees.Three cases failed to heal,and two cases experienced deformed and sunken proximal scaphoid.Conclusions Common cortical bone screws can be easily changed into compression-like ones to treat old scaphoid fractures and result in satisfactory,clinic outcome.In addition,they are easily available,can be inserted through joint facet with limited negative effect on the joint,and play a double role of compression and fixation.

The use of unilateral external fixators in treatment of distal shaft fractures of humerus / 中华创伤骨科杂志

Objective To retrospectively analyze the results of unilater al external fixators in the treatment of the distal third fractures of humeral s hafts. Methods From October 1997 to October 2002, 33 patients from 15y-70y (ave rage 31y) with the distal third fractures of humeral shafts were treated with un ilateral external fixators. They included 3 transverses fractures, 1 oblique fra cture, 9 spiral fractures and 20 comminuted fractures. 15 cases were treated wit h open reduction and fixation with external fixators and limited internal fixati on, 10 cases were treated with open reduction and fixation with external fixator s, and 9 cases were treated with closed reduction and fixation with external fix ators. 9 cases with radial nerve injury undewent nerve exploration. External fix ators were removed after bone healing. Duration of follow-up was 8 to 24 m (ave rage 18 m). Results The time of bone healing was 11 to 22 w (average 14 w). At t he latest follow-up, the function of injured radial nerves in 9 preoperative ca ses and 2 postoperative cases and the motion function of elbow were restored to normal. There were only 7 cases of superficial pin site infection which were cur ed with oral antibiotics and pin site care with mild disinfectants. Conclusion U nilateral external fixators can play special roles and have good results in the treatment of the distal third fractures of humeral shafts, combined with open re duction and limited internal fixation.

RELATION OF SEVERITY OF LOW BACK PAIN TO TYPE OF PROLAPSED INTERVERTEBRAL DISC / 解放军医学杂志

In this study the relation between the extent and type of disc protrusion and the clinical severity of symptoms of low back pain was observed. Our series consisted of 300 consecutive cases of lumbar disc protrusion,with their diagnosis confirmed by intraoperative observation. Preoperative pain severity was assessed using a back pain scale that combined the symptoms of back pain and sciatica. Intraoperaative pathological findings of disc were documented and comparesd with preoperative symptoms and signs. The pathological changes of disc were classified as following four subtypes: bulging disc (85 cases), protruding disc (104 cases), extruded disc (72 cases) and sequestered disc (39 cases). Our results suggest that severity of pain in patients with herniated lumbar disc is related to position of herniation rather than magnitude and exent of herniation. Inflammed intraspinal tissues are significantly associated with low back pain and sciatica.

Clinical Study on A Newly Designed Tenodesis with Polymolecular Polyethlene Fastener / 中国运动医学杂志

Aim To investigate the clinical importance of a newly designed tenodesis with polymolecular polyethlene fastener. Methods Eighty-nine patients with knee ligaments injuries were reconstructed with the technique of newly designed tenodesis. Rehabilitation program started under the instruction of the therapist from the next day of the surgery.Results The tenodesis on all patients in our study were successful. The fasteners in two patients and the transplants in three patients were blocked in the bone tunnel during the operation. One fastener was taken out from the bone tunnel under arthroscopy. The patients were followed up for 19 months averagely (from 6 months to 49 months), most of them showed a stable knee without complain, except two patients feel uncomfortable after vigorous activities; seven patients show little laxity in anterior drawer test (ADT) or posterior drawer test (PDT) and three patients had 20-degree limitation of knee flexion. Lysholm scale score were 56?8 and 89?5 before and after operation, respectively ( P