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Objective:To investigate the effect of enhanced recovery after surgery (ERAS) in percutaneous pedicle screw internal fixation treating thoracolumbar fracture patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with thoracolumbar fracture treated by percutaneous pedicle screw internal fixation at Second Hospital of Soochow University from October 2018 to April 2019. There were 42 males and 20 females, aged 27-59 years (mean, 43.9 years). Fracture site included T 11 in 4 patients, T 12 in 28, L 1 in 23 and L 2 in 7, and AO type contained type A1 in 40 patients, type A2 in 3, and type A3 in 19. Thirty-one patients were treated with ERAS nursing mode (ERAS group), and other 31 patients with routine nursing mode (control group). The postoperative recovery time of intestinal function, first time of expelling flatus and dejection time, hospitalization time, preoperative and postoperative pain visual analogue scale (VAS), Kolcaba comfort scale (GCQ), Oswestry disability index (ODI), incidence of abdominal distension, incidence of urinary tract infection, first wake up dizziness, urinary retention, and wound healing were compared between the two groups. Results:Period of follow-up for all patients was 3-6 months (mean, 4.5 months). Postoperative recovery time of intestinal function, first time of expelling flatus and dejection time in ERAS group were (7.2±2.0)hours, (10.7±3.7)hours and (26.7±6.4)hours, respectively, which were significantly decreased compared to control group [(19.2±5.6)hours, (22.5±5.1)hours, (72.5±12.4)hours] ( P<0.05). Hospitalization time was (4.7±1.3)days in ERAS group, shorter than that in control group [(5.9±1.5)days]. There was no significant difference in VAS preoperatively between the two groups ( P>0.05). VAS in ERAS group was (3.6±1.5)points, (2.8±0.8)points, (1.7±0.6)points at postoperative 1, 3 and 7 days, lower than that in control group [(4.6±1.3)points, (4.0±1.3)points, (2.7±0.9)points] ( P<0.05). GCQ score in ERAS group was (72.0±6.5)points, (75.0±11.1)points, (88.4±5.1)points and (89.3±4.5)points at 2 hours before operation and 2 hours, 1 days and 3 days after operation, which were higher than that in control groups [(54.0±7.2)points, (59.5±6.3)points, (62.7±5.9)points, (76.0±5.7)points] ( P<0.05). ODI in ERAS group was 37.3±5.8, 28.9±6.3 and 23.1±2.7 at 3 days, 1 month and 3 months after operation, which was markedly decreased compared to control group (44.9±7.9, 33.9±8.7, 30.3±5.3) ( P<0.05). Moreover, the incidence of abdominal distension, urinary tract infection and first wake up dizziness in ERAS group was 7%, 5%, 3%, respectively, reduced from that in control group (26%, 35%, 16%) ( P<0.05). No significant difference was observed in urinary retention wound healing of the two groups, but there was no difference in wound healing ( P>0.05). Conclusion:For thoracolumbar fracture patients treated with percutaneous pedicle screw internal fixation, ERAS has advantages over traditional nursing in attenuating pain, shortening hospitalization time, reducing postoperative abdominal distension and urinary tract infection, and accelerating functional recovery.
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A novel, simple and highly sensitive method was developed for the rapid analysis of phenolic antioxidants at trace level in edible oils. It was based on dispersive liquid-liquid microextraction ( DLLME ) and gas chromatography-mass/mass spectrometry ( GC-MS/MS) . Related important factors that may influence enrichment efficiency, such as type and volume of extraction solvent, type and volume of dispersive solvent, and extraction time were investigated and optimized in detail. The optimum conditions were as follows:a quick injection of 500 μL mixed solution ( methanol:acetonitrile=1:1 , V/V ) into 1 . 0 g oil sample with 3 mL n-hexane for 10 s of extraction time. Under the optimal conditions, the linearity (10-2000 ng/g), limits of detection (1. 5-2. 4 ng/g) and relative standard deviations (4. 0%-8. 3%) was obtained. The proposed method was applied for the analysis of 4 edible oil samples. Some of phenolic antioxidants were detected in three of them, and the recoveries of spiked samples were in the range of 81. 9%-118%.
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Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.
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Objective To observe the influence of using alpha-adrenergic receptor blocker and catheterization time on the success rate of a trial without catheter (TWOC) in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH).Methods The 124patients from January 2007 to December 2009,aged 62-90 years (mean age 71.3 years),diagnosed as AUR caused by BPH in emergency room,were enrolled in this study.They were randomized to two groups:(1) Medication group:60 cases,who were given alpha-adrenergic receptor blocker 4 mg daily for 2-3 days before TWOC.Among them,there were 30 cases with catheterization for 3 days,and the rest 30 cases for 7 days;(2)Control group:64 cases,who were without alpha-adrenergic receptor blocker.Among them,there were 30 cases with catheterization for 3 days,and the rest 34 cases for 7days.The urine culture was made when the catheter was drawn out.Results (1)The success rate of TWOC was higher in medication group than in control group (71.7% vs.53.1%,x2 =4.523,P=0.033).Both in medication group and control group,the success rate was higher in patients with catheterization for7 days than for 3 days (83.3% vs.60.0%,x2=4.022,P=0.045;67.7% vs.36.7%,P=0.013).(2)After follow-up for 6 months,the patients with catheterization for 7 days had lower incidence rate of second AUR and selective operation (x2 =4.538 and 4.709,P=0.033 and 0.030).(3)There was no significant difference in rate of urinary infection between the patients with catheterization for 7 days and for 3 days (20.3% vs.16.7%,P = 0.603).Conclusions Alpha-adrenergic receptor blocker could increase the success rate of TWOC,and the success rate of TWOC is much higher in patients with catheterization for 7 days than for 3 days,while the urinary infection rate is not significantly increased.
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Objective To explore the safety and efficacy of laparoscopic nephron sparing nephrectomy for renal tumor. Methods The data of 72 patients diagnosed as renal rumor and treated with laparoscopic nephron sparing nephrectomy were retrospectively analyzed.Procedure detailed as following:firstly,the renal tumor was exposed completely after routine institution of 4 passages;secondly,the tissue 3 cm around the tumor was labeled and then incised using cool scissors after Bulldog occlusion of the renal artery;thirdly,the lesion was covered with anti-bleeding gauze and then intermittently sutured using 1-0 absorbable Dixon suture and crossing Hem-o-lok. Results Operation time was 90-190 min,with warm ischemia time 12-40 min.Bleeding volume was 20-600 m1.with one intra-operative infusion and 4 post-operative infusions.Pathological diagnosis was clear cell RCC in 52 cases,angiomyolipoma in 14,chromophobe RCC in 5,and collective duct cancer in 1 case.Hospitalization time was 5-12 days.With 1-52 months follow-up,no tumor recurrence and metastasis was observed. Conclusions Treatment by laparoscopic nephron sparing nephrectomy for renal tumor could be safe and efficient,but operative experiences and skills are needed.The method of intermittent suture and crossing Hem-o-lok could be useful to shorten the operation time and reduce the complications.
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Objective To observe the effect of three immunosuppressive agents on the function of human adult islets of langerhans in vitro, and explore the suitable immunosuppressive protocols for human islet transplantation.Methods In vitro, the isolated and purified islets were incubated with the immunosuppressive agents (mycophenolic acid, sirolimus, and FTY720) at different concentrations for 24 h, then stimulated by glucose at low ((2.8) mmol/L) and high ((16.7) mmol/L) levels. The (insulin) release after stimulations was detected using ELISA kit, and stimulation index was calculated.(Results) In control group (no agents exposure), the insulin release were ((7.37)?(1.74)) ng/ml at low (level) and ((15.15)?(5.39)) ng/ml at high level respectively, with stimulation index achieved to (2.06)?(0.46). Compared to control group, treatment with mycophenolic acid led to dramatic reduction of (insulin) release (P
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Objective To lower immunogenesis of human adult islets,reduce the dose of immunosuppressors and promote wide development of transplantation of adult islets,isolated adult islets were in vitro pretreated.Methods Isolated adult islets were cultured at 24 ℃ for 2 days(24 ℃ group) or pretreated using MHC-II monoclonal antibody(monoclonal antibody and complements were added and cultivated for another day following one-day-24 ℃-culture,antibody group) as observation groups.Adult islets were cultured at 37 ℃ in CMRL 1066 medium plus 20 % fetal bovine serum for 2 days as control.The immunogenics of the islets was detected using lymphocyte-islet mixed culture(MILC) and immunohistochemical staining of HLA-DR and lymphocyte common antigen(LCA).The function and activity of the islets were identified using()~3H-leucine incorporation assay,insulin release test and in situ apoptosis assay.Results Compared with control,MILC stimulation index was remarkably lower in the antibody group(P(0.05)).The percentage of HLA-DR and LCA positive cells in the antibody groupand in the 24 ℃ group was much lower than that in control(All P
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OBJECTIVE By analyzing the high risk factors for pulmonary fungus infection in intensive care units of neurosurgery,this paper may be regarded as a good reference for early diagnosis and treatment. METHODS According to the domestic diagnostic standard on pulmonary fungus infection,we analyzed the clinical data of 58 patients with pulmonary fungus infection in department of neursurgery. RESULTS Totally 117 strains of fungi were isolated from the 58 cases.Candidiasis was the most frequent type,accounting for 92.3%.Some factors,such as the severity of underlying diseases,long-time coma,long-term use of broad-spectrum antibiotic,abuse of glucocorticoid,the open airway and some traumatic intubations might be regarded as the high risk factors for pulmonary fungus infection.Fluconazole showed good clinical effects on the treatment of fungus infection. CONCLUSIONS It is important to eliminate the high risk factors for pulmonary fungus infection,to provide early diagnosis and to use prophylactic antifungal agent,which can reduce the incidence rate of pulmonary fungus infection.