Risk factors for postoperative acute kidney injury in patients undergoing radical resection of malignant colorectal cancer / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative acute kidney injury (AKI) in patients undergoing radical resection of malignant colorectal cancer.Methods:Patients undergoing radical resection of malignant colorectal cancer from November 1, 2019 to December 1, 2020, were selected, and the medical records including gender, age, height, weight, American Society of Anesthesiologists (ASA) physical status, complications (hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease and renal insufficiency), neoadjuvant therapy before surgery, preoperative serum creatinine level (within 1-3 days before surgery), preoperative prophylactic ureteral intubation, operation methods, intraoperative blood loss and blood transfusion, intraoperative fluid infusion and urine output, intraoperative hypotension occurrence and duration, intraoperative prophylactic ileostomy, operation time, postoperative length of stay, postoperative complications (ileus, anastomotic leak/abdominal infection), postoperative antibiotics and nonsteroidal anti-inflammatory drugs use were retrospectively collected.Postoperative AKI was diagnosed based on Kidney Disease Improving Global Outcomes criteria.The patients were divided into AKI group and non-AKI group according to whether postoperative AKI occurred within 7 days after surgery, and the risk factors for postoperative AKI were screened by multivariate Poisson regression analysis.Results:A total of 543 patients were included in this study.There were 14 cases of postoperative AKI and the incidence was 2.6%.Poisson regression analysis showed that preoperative hypertension ( OR=5.04, 95% confidence interval 1.57-22.18, P=0.041) and postoperative use of vancomycin ( OR=8.87, 95% confidence interval 2.27-28.99, P=0.004) were the independent risk factors for postoperative AKI. Conclusion:Preoperative hypertension and postoperative use of vancomycin are the independent risk factors for postoperative AKI in patients undergoing radical resection of malignant colorectal cancer.

Safety and efficacy of botulinum toxin type A made in China for treatment of post-stroke upper limb spasticity: a randomized double-blind controlled trial / 中华神经科杂志

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

Post-laparoscopic analgesic effect of oxycodone combined with dexmedetomidine for gastric cancer patients / 实用医学杂志

Objective To observe the post-laparoscopic analgesic effect of oxycodone combined with dexmedetomidine for gastric cancer patients.Methods A total of 40 gastric cancer patients who underwent laparoscopy during November 2016 and January 2017 and assessed with physical status Ⅰ or Ⅱ according to American Society of Anesthesiologists,were randomly divided into 2 groups:oxycodone group (group O,n =20) and oxycodone plus dexmedetomidine group (group OD,n =20).The anestheasic effects at the time points of hours 2,5,8,11 and 24 after the operation were assessed by using visual analog pain score,times for pressing the pump,Ramsay score and patient's satisfaction index of the two groups.At the same time,the adverse effects of two groups were recorded and observed.Results The analgesic effect after starting the pump at hours 2,5,8,11,24 and 25,the VAS scores and the pressure time in group OD were significantly lower than in group O (P ＜ 0.05),and the Ramsay scores were insignificantly different between the groups (P ＞ 0.05).In group OD,the patient's satisfaction level was significantly higher than in group O (P ＜ 0.05).Nausea,vomiting and dizziness occurred in both groups without significantly difference between the two groups.Conclusion Oxycodone combined with dexmedetomidine can provide satisfactory analgesia for gastric cancer patients receiving laparoscopic surgery.

Effectiveness and safety of percutaneous vertebroplasty in the treatment of spinal metastatic tumor

Objective: To evaluate the effectiveness, safety and feasibility of percutaneous vertebroplasty in the treatment of spinal metastatic tumor

Methods: Thirty-four patients with spinal metastatic tumor who received treatment in the First Affiliated Hospital of Zhengzhou University from May 2014 to June 2015 were selected. Totally fifty diseased vertebrae were treated by percutaneous vertebroplasty. The curative effects were evaluated according to visual analogue scale [VAS] score, Oswestry Dability Index [ODI] and dose of pain reliever. The leakage conditions of bone cement and clinical complications were observed. The patients were followed up for 3 to 12 months

Results: The average VAS score and ODI 24 h after treatment were much lower than those before treatment, and the difference had statistical significance [P<0.05]. The average VAS score and ODI at different follow up periods after treatment were not significantly different [P>0.05]. During follow up, nine patients stopped taking pain reliever, the dose of 18 patients had obvious reduction, and 7 patients kept previous dose; the incidence of bone cement leakage was 38.25%. Six patients had fever after surgery, but recovered after expectant treatment; 2 patients felt uncomfortable in the right lower limbs, but relieved after expectant treatment

Conclusion: Percutaneous vertebroplasty can relieve pain efficiently, improve the daily living ability, and significantly enhance the living quality of patients with spinal metastatic tumors, with small trauma and high safety

Efficacy analysis of short segmental screw fixation on the decayed vertebral of thoracolumbar tuberculosis / 中华骨科杂志

Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post-operative.The fusion rate at the end of post-operative follow-up:44 excellent cases,2 good cases.Conclusion When the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position in vertebral tuberculosis was higherthan 10mm,reliable stability and treatment efficiency were achieved with anteriorinternal fixation.

Whether free anterolateral thigh flaps are suitable for the elderly patients with oral cancer / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To identify the factors that were predictive of outcome and to determine the effect of age on perioperative complications.</p><p><b>METHODS</b>Reviewed the records of 1 100 consecutive patients who underwent anterolateral thigh flap free flap transfers for oral and maxillofacial cancer surgery defects between February 2002 and March 2013. All patients were divided into two groups: A group (< 60 years old) and B group (≥ 60 years old). Postoperative complications were analyzed from all patients.</p><p><b>RESULTS</b>There were 781 cases in A group and 319 in B group. The overall success rate was 97.2% (1 100/1 132) [97.3% (781/803) in A group, 97.0% (319/329) in B group, P > 0.05]. The overall complication rate was 27.5% (302/1 100) [25.9% (202/781) in A group, 31.3% (100/319) in B group, P = 0.064]. Multivariate Cox regression analyses revealed that American Society of Anesthesiologists (ASA) status (P < 0.001), operation time (P = 0.021) and comorbidity (P = 0.002) were the independent factor for the complication of patients. However, age (P > 0.05) was not an independent factor for the complication of patients.</p><p><b>CONCLUSIONS</b>Oral and maxillofacial reconstruction using anterolateral thigh flap free flaps in elderly patients can achieve similar outcomes as in younger patients. Controlling operative time is very important in reducing post-operative complications and improving the results of surgery.</p>

Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.</p><p><b>METHODS</b>Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.</p><p><b>RESULTS</b>Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).</p><p><b>CONCLUSION</b>Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.</p>

Single level artificial disc replacement versus anterior cervical fusion:range of motion and stability of cervical vertebra / 中国组织工程研究

BACKGROUND:Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications. ＜br> OBJECTIVE:To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis. ＜br> METHODS:A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrol ed from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group (replacement group;n=32) and anterior cervical decompression and fusion group (fusion group;n=27). They were fol owed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed. ＜br> RESULTS AND CONCLUSION:The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores (P＜0.05), while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores (P＜0.05). There were no significant differences between two groups (P>0.05). Range of motion of the replacement segment after treatment was (11.6±3.0)° in the replacement group, showing no significant differences as compared with before surgery (8.8±2.7)° (P>0.05). No significant activity was found at 3 months after treatment in the fusion group. During fol ow-up, the range of motion in the adjacent segments was smal er in the replacement group than in the fusion group (P＜0.05). No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group (P>0.05), but significant differences in the range of motion were detected before and after treatment in the fusion group (P＜0.05). The range of motion was apparently increased after treatment. These findings indicated that compared with the anterior cervical decompression and fusion, cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the range of motion and stability of the cervical replacement segment. Moreover, it does not have impacts on the range of motion in the segments near to the surgical wound, and can effectively maintain cervical curvature.

The clinical classification of sigle pedicled double island free anterolateral thigh flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To summarize the anatomic characteristic of sigle pedicled double island free anterolateral thigh flaps and to evaluate its application and classification.</p><p><b>METHODS</b>Between January 2010 and March 2013, 76 patients underwent free femoral anterolateral double island flap reconstruction of the defects in oral and maxillofacial region. Summarized the anatomic features of perforators, such as the number and origin of the perforators.</p><p><b>RESULTS</b>According to the anatomic features and regularity of perforators, 76 cases of femoral anterolateral double island flaps were divided into 3 types: trunk type (type I), 15 cases (20%), in which the perforators of two flaps originated in descending branch and transverse branch of lateral femoral circumflex artery respectively; branch type (type II), 55 cases (72%), in which both the perforators originated in lateral femoral circumflex artery descending branch or lateral femoral circumflex artery transverse branch; bifurcation type (type III), 6 cases (8% ), in which two perforators originated in the two bifurcation of one perforator. Among the 76 cases, 75 survived and 1 showed partial necrosis.</p><p><b>CONCLUSIONS</b>According to the anatomic features and regularity of perforators, femoral anterolateral double island flaps can be divided into 3 types: trunk type (I type), branch type (II type), bifurcation type (III type).</p>

Jugular vein reconstruction by longitudinal constriction suture venoplasty and microvascular anastomosis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To seek a new method for reconstructing bilateral intemrnal jugular vein invaded by metastasis lymph node in advanced oral cancer patients.</p><p><b>METHODS</b>A combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions.</p><p><b>RESULTS</b>Postopera-tive follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60% (3/5).</p><p><b>CONCLUSION</b>Microvascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.</p>

Effects of different doses of fentanyl on brain areas activated by pain: evidence from functional magnetic resonance imaging / 中华麻醉学杂志

Objective To investigate the effects of different doses of fentanyl on pain-activated brain areas as demonstrated by functional magnetic resonance imaging (fMRI) at 3.0 T.Methods Twenty healthy right-handed male volunteers aged 20-40 yr were randomly divided into 2 groups ( n =10 each); group F1 (fentanyl 1.0 μg/kg) and group F2 (fentanyl 1.5 μg/kg).Mechanical stimulation with von Frey filaments (vFFs,300 g) was delivered to left sole.The intensity of pain was assessed by VAS scores.fMRI was performed before and after fentanyl administration and the changes in the brain areas activated by pain were recorded.Results In group F1 ipsilateral (left) cingulate gyrus was activated after a bolus of fentanyl 1.0 μg/kg under stimulation with vFFs 300 g,while in group F2 bilateral cingulate gyrus and contralateral (right) insula were activated under vFFs stimulation after fentanyl 1.5 μg/kg.Conclusion Cingulate gyrus and insula may be the target brain areas of fentanyl analgesia.

Location of brain areas in which pain is induced by mechanical noxious stimulation: a functional magnetic resonance imaging study / 中华麻醉学杂志

Objective To locate the brain areas in which pain was induced by mechanical noxious stimulation by using functional magnetic resonance imaging.Methods Twenty healthy male volunteers,aged 20-40 yr,with body mass index of 18-25 kg/m2,were involved in this study.The volunteers were stimulated with 300 g von Frey filaments.Functional magnetic resonance imaging examinations were performed 1 week later.The monitoring data were collected during the scanning.The images were analyzed with SPM2 software.Results Bain areas in which pain was induced by mechanical noxious stimulation with 300 g yon Frey filaments were bilateral anterior cingulate gyrus,right contralateral insula and bilateral primary somatic sensory cortex.Conclusion The brain areas in which pain is induced by mechanical noxious stimulation include bilateral anterior cingulate gyrus,right contralateral insula and bilateral primary somatic sensory cortex.

Efficacy of pedicle screw technique in treatment of os odontoideum combined with atlantoaxial dislocation / 中华创伤杂志

ObjectiveTo evaluate the efficacy and radiological variation of pedicle screw technique in the treatment of os odontoideum combined with atlantoaxial dislocation.MethodsFifteen patients with os odontoideum combined with atlantoaxial dislocation were treated with occipitocervical fusion or atlantoaxial fixation.Two patients with irreducible atlantoaxial dislocation were treated surgically with transoral anterior atlantoaxial release and one treated with posterior arch removal plus occipitocervical fusion.Two patients with atlas deformity and one infant were treated with occipitocervical fusion.The rest patients were treated with posterior reduction and pedicle screw internal fixation.Clinical manifestations and imaging changes were followed up to evaluate the clinical efficacy.ResultsAll patients were followed-up for average 26 months (range,7-47 months).Neurological recovery was significantly improved in 13 patients and took a turn for the better in two.The average JOA scores was increased from average preoperative 8.27 to postoperative 15. According to Hirabayashi,the average improvement rate was77％,including 10 patients with excellent outcomes and five with good outcomes,with excellence rate of100％.The cervical-medullary angle was increased from average preoperative 130.3° to postoperative151.7°.Postoperative X-rays and CT showed good atlantoaxial alignment and solid bony fusion in all pa-tients,with no shedding or breakage of the fixators.ConclusionOccipitocervical fusion or adantoaxial fixation through pedicle screw technique is an effective method for treatment of os odontoideum combined with irreducible atlantoaxial dislocation.

Effect of propofol on high- voltage-activated calcium currents in rat hippocampal neurons / 中华麻醉学杂志

Objective To investigate the effect of propofol on the high-voltage-activated calcium currents [ICa(HVA)] in rat hippocampal neurons. Methods Hippocampal neurons were prepared from Wistar rats and cultured. ICa(HVA) was recorded using whole-cell patch clamp technique. Different concentrations of propofol were added to the culture. The effect of propofol on ICa(HVA) Was evaluated. Results ICa(HVA) was inhibited by propofol in 300 μmol/L reduced peak ICa(HVA) by (24±6)%, (33 ±5) %, (36±7)% and(38±3)% respectively with a mean IC50 of 3.8 μmol/L and Hill coefficient of 0.35. Vmax was shifted from (4.0± 2.0) mV to (3.8 ± 1.6) mV. The V1/2 of inactivation curve was shifted from (- 32 ± 5) mV to (- 35 ± 4) mV and the slope factor was 31 ± 5 and 35 ± 6 before and after administration respectively. Conclusion Propofol produces significant inhibition of calcium currents in the central neurons which may partly explain the action of propofol on central nervous system.

Suppression of delayed rectifier potassium currents in rat hippocampal neurons by ketamine / 中华麻醉学杂志

Objective To investigate the effect of ketamine on the delayed rectifier outward potassium currents (IK) using whole-cell patch clamp technique. Methods Pyramidal neurons were enzymatically isolated from Wistar rat hippocampus. The effect of ketamine on the IK was assessed using whole-cell patch clamp technique. We measured the amplitude of the delayed outward rectifier IK by activating depolarizing pulse from -50 mV to 40 mV. Different concentrations of ketamine were added and potassium currents were measured. Results IK was inhibited by ketamine in a concentration-dependent manner. The five concentrations of ketamine (10, 30, 100, 300, 1000 ?mol/L) reduced peak IK currents by (10 ? 4)% , (19?4)%, (31 ?5)%, (50?7)%, (54?8) % respectively, with a mean IC50 of (100?18)?mol/L and Hill coefficient of 1.33?0.48. The V1/2 of activation curve was shifted from (1.82 ? 0.20) mV to (9.30 ? 1.03) mV (n = 8, P

Liver resection for spontaneous rupture of primary hepatocellular carcinoma / 中国普通外科杂志

Objective To study the therapeutic effect of liver resection for spontaneous rupture of primary(hepatocellular) carcinoma(SRHCC).Methods The clinical data of 15 patients with ruptured SRHCC treated by liver resection were retrospectively analysed.Results In this group there were 12 males and 3 females.Eight underwent emergent hepatectomy,2 cases had second stage surgery at 40 days after initial operation to control bleeding and 5 cases had operation after 40 days of conservative treatment.Operation included partial right hepatectomy in 8 patients,median lobectomy in one patient,left lateral lobectomy in 2 patients,left(median) lobectomy in 2 patients,left hemihepatectomy in 1 patient,right tumor resection in 1,and left tumor resection in one patient.One of 5 patients with Child grade B liver function died of liver failure at 5 days(after) operation.The operative mortality was 6.7%.Twelve of the 14 patients who surrived were followed up.The median postoperative survival time was 18 months.The 1-,3-and 5-year survival rates were(58.3)%,25%,16.7%,respectively.One patient has been alive and free of tumor for 6 years and 2 months.Conclusions Liver resection is the best treatment for ruptured SRHCC and should be performed when possible.Hepatic resection for SRHCC can result in a long survival time.