ABSTRACT
Objective:To investigate the correlation between 24 h blood pressure variability and early neurological improvement (ENI) in patients with large vessel occlusion (LVO) after endovascular thrombectomy (ET).Methods:Patients with LVO received ET in the Emergency Department, the Affiliated Hospital of Nantong University from January 2012 to February 2018 were enrolled retrospectively. During the first 24 h after ET, the blood pressure was recorded every 2 h, and blood pressure variability was evaluated by standard deviation (SD) and successive variation (SV). At 24 h after ET, the National Institutes of Health Stroke Scale (NIHSS) score was evaluated again. The re-evaluation of 0 point or a decrease of ≥4 from the baseline score was defined as ENI. Multivariate logistic regression analysis was used to evaluate the relationship between blood pressure variability and ENI. Results:A total of 74 patients with LVO received ET were enrolled, of which 39 (52.7%) had ENI. Univariate analysis showed that the proportion of patients with good recanalization in the ENI group after procedure were significantly higher than that in the non-ENI group ( P<0.05), while the average systolic blood pressure, average diastolic blood pressure, systolic blood pressure variability (SBPV) -SD and SBPV-SV within 24 h after ET and baseline total cholesterol level were significantly lower than those in the non-ENI group (all P<0.05). Multivariate logistic regression analysis showed that higher SBPV-SV was an independent risk factor for non-ENI (odds ratio 1.223, 95% confidence interval 1.038-1.440; P=0.016). Conclusion:Higher SBPV-SV after ET is associated with poor early neurological improvement in patients with LVO, and it is expected to be a potential target for blood pressure management in patients after ET.
ABSTRACT
Objective@#To discuss the influence of temperature-holding nursing in the anesthesia and stress state during the recovery period of general anesthesia for patients with thoracoscopic lung surgery.@*Methods@#120 patients with thoracoscopic lung surgery underwent the general anesthesia from January 2017 to July 2018 in our hospital were selected and randomly assigned to two groups, 60 cases in each group. At the recovery period, the control group was treated with conventional nursing; the observation group was treated with conventional nursing and temperature-holding nursing. At each time period, the body temperature, stress response and postoperative rehabilitation conditions were probed.@*Results@#At the end of the operation 30 minutes, 60 minutes and the end of the operation, the body temperature of the observation group was (36.39±0.34)°C, (36.50±0.38)°C, (36.56±0.38)°C, and the control group was (35.49±0.31)°C, (35.63±0.41) °C, (36.17±0.52)°C, the difference between the two groups was statistically significant (t=15.15, 12.01, 4.69, P<0.05). NE was (279.3±87.4)ng/L, (321.5±110.6)ng/L, (363.5±108.2) ng/L at 30 min, 60 min, and end of surgery. E was (342.5±81.6)ng/L, (320.2±59.4)ng/L, (169.4±54.2)ng/L at 30 min, 60 min, and end of surgery. NE in the control group were (244.8±87.5)ng/L, (390.8±98.6)ng/L, (469.7±97.7)ng/L, and E was (129.5±39.6)ng/, (187.0±51.3) ng/L, (327.6 ±68.9) ng/L, and he difference between the two groups was statistically significant (t=2.161~13.979, P <0.05).The operation time, the postoperative retention time of PACU, the complete recovery of consciousness and the time of removal of tracheal catheter in the observation group were (65.93±21.94) min, (32.85±3.22) min, (18.60±5.26) min, (24.19±6.73) min, respectively. The groups were (87.52±18.42) min, (50.06±4.27) min, (26.54±4.81) min, (32.40±8.05) min, and the difference between the two groups was statistically significant (t=5.838~24.927, P<0.05).@*Conclusion@#The temperature-holding nursing can improve the recovery conditions and reduce the stress response for patients with thoracoscopic lung surgery. It is worthy of clinical promotion.
ABSTRACT
Objective To discuss the influence of temperature-holding nursing in the anesthesia and stress state during the recovery period of general anesthesia for patients with thoracoscopic lung surgery. Methods 120 patients with thoracoscopic lung surgery underwent the general anesthesia from January 2017 to July 2018 in our hospital were selected and randomly assigned to two groups, 60 cases in each group. At the recovery period, the control group was treated with conventional nursing; the observation group was treated with conventional nursing and temperature-holding nursing. At each time period, the body temperature, stress response and postoperative rehabilitation conditions were probed. Results At the end of the operation 30 minutes, 60 minutes and the end of the operation, the body temperature of the observation group was (36.39 ± 0.34)°C, (36.50 ± 0.38)°C, (36.56 ± 0.38)°C, and the control group was (35.49 ± 0.31)°C, (35.63 ± 0.41) °C, (36.17 ± 0.52)°C, the difference between the two groups was statistically significant (t=15.15, 12.01, 4.69, P<0.05). NE was (279.3 ± 87.4)ng/L, (321.5 ± 110.6)ng/L, (363.5±108.2) ng/L at 30 min, 60 min, and end of surgery. E was (342.5±81.6)ng/L, (320.2± 59.4)ng/L, (169.4±54.2)ng/L at 30 min, 60 min, and end of surgery. NE in the control group were (244.8± 87.5)ng/L, (390.8±98.6)ng/L, (469.7±97.7)ng/L, and E was (129.5±39.6)ng/, (187.0±51.3) ng/L, (327.6 ± 68.9) ng/L, and he difference between the two groups was statistically significant (t=2.161~13.979, P<0.05).The operation time, the postoperative retention time of PACU, the complete recovery of consciousness and the time of removal of tracheal catheter in the observation group were (65.93±21.94) min, (32.85±3.22) min, (18.60±5.26) min, (24.19±6.73) min, respectively. The groups were (87.52±18.42) min, (50.06 ± 4.27) min, (26.54 ± 4.81) min, (32.40 ± 8.05) min, and the difference between the two groups was statistically significant (t=5.838~24.927, P<0.05). Conclusion The temperature-holding nursing can improve the recovery conditions and reduce the stress response for patients with thoracoscopic lung surgery. It is worthy of clinical promotion.
ABSTRACT
Objective To investigate the risk factors for hemorrhagic transformation (HT) and poor outcomes in patients with acute ischemic stroke after mechanical thrombectomy.Methods The patients with acute ischemic stroke received mechanical thrombectomy were enrolled retrospectively.The demography,vascular risk factors and other clinical data of the patents were collected.The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at day 90.Good outcome was defined as mRS score 0-2.The patients were divided into either a HT group or a non-HT group according to their HT conditions.Multivariate logistic regression analysis was used to identify the independent risk factors for HT and poor outcomes.Results A total of 48 patients with acute ischemic stroke received mechanical thrombectomy were enrolled,including 25 males (52.1％).Their mean age was 64.77± 9.14 years.The mean National Institutes of Health Stroke Scale (NIHSS) score was 17.70 ± 3.77.Twenty-two patients (45.8％) occured HT,of which 9 were symptomatic HT;24 (50.0％) had good outcomes.The proportion of males in the HT group was significantly lower than that in the non-HT goup (30.4％vs.72.0％;x2 =8.293,P =0.004),while the proportions in patients with diabetes (65.2％ vs.36.0％;x2 =4.090,P =0.043) and atrial fibrillation (78.3％ vs.44.0％;x2 =5.880,P =0.015),as well as the baseline fasting blood glucose level (8.514 ± 4.400 mmol/L vs.6.354 ± 1.472 mmol/L;t =2.319,P =0.025) were significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that the atrial fibrillation (odds ratio [OR] 6.136,95％ confidence interval [CI] 1.617-23.291;P =0.042) was a risk factor for the occurrence of HT after mechanical thrombectomy.The proportion of diabetic patients (29.2％ vs.70.8％;x2 =8.333,P=0.04) and baseline NIHSS score (16.050±4.865 vs.19.210±4.423);t=2.310,P=0.026) of the good outcome group were significantly lower than those of the poor outcome group,while the proportions of patients in atrial fibrillation (75.0％ vs.45.8％;x2 =4.269,P =0.039),anterior circulation stroke (87.5％ vs.62.5％;x2 =4.000,P =0.046) middle cerebral artery (75.0％ vs.29.2％;x2 =10.113,P =0.006),vertebral basilar artery (37.5％ vs.12.5％;x2 =10.113,P =0.006) occlusion and parenchymal hematoma (33.3％ vs.4.1％;P=0.011) were significantly higher than the poor outcome group.Multivariate logistic regression analysis showed that diabetes (OR 5.898,95％ CI 1.699-20.479;P=0.005),baseline NIHSS score (OR 1.167,95％ CI 1.011-1.347;P =0.035),and parenchymal hematoma (OR 1.295,95％ CI 1.099-1.875;P=0.028) were the independent risk factors for poor outcomes.Conclusions Atrial fibrillation is an independent predictor of HT risk in patients with acute ischemic stroke after mechanical thrombectomy.Diabetes mellitus,higher baseline NIHSS score,and concurrent brain parenchymal hematoma are the independent predictors of poor outcomes.Therefore,the risk of HT and adverse outcomes should be fully assessed before mechanical thrombectomy in patients with acute ischemic stroke.
ABSTRACT
Objective:To compare the outcomes of guide bone regeneration by calcined bovine bone and Bio-Oss graft material in alveolar ridge preservation after tooth extraction.Methods:280 patients were divided into two groups randomly.Each patient had single tooth extracted.The sockets were filled with calcined bovine bone in 140 patients and Bio-Oss graft in another 140 patients. After shaping,all the sockets were covered with Bio-Gide membrane.Buccal mucoperiosteal flap was released and sutured to close the alveolar sockets.The patients were regularly examined at the 1st,12th and 24th week after surgery.Physical examination and X-ray evaluation were applied to compare the outcomes of the two materials in alveolar ridge preservation.Results:No infection and re-jection occurred.The radiographic results showed the width and height of the alveolar bone were preserved well at the 12th and 24th weeks.No statistically difference was found in the two groups at the 1st and 24th weeks(P>0.05).Conclusion:The two graft ma-terials can effectively preserve alveolar bone after tooth extraction.
ABSTRACT
<p><b>OBJECTIVE</b>The aim of this retrospective study is to present the long-term effects of open healing of keratocystic odontogenic tumors (KCOTs) in the mandible.</p><p><b>METHODS</b>A retrospective case series study was conducted on 41 patients with large KCOTs (the maximum diameter of the tumors exceeded 5 cm) treated at our institution between September 2003 and April 2011. A conservative surgical treatment was applied. The treatment involved enucleation of the primary lesion through narrow unroofing and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regenera- tion and surgical complications were observed. The long-term effects of the treatment were followed up.</p><p><b>RESULTS</b>The inferior alveolar nerve was exposed in the KCOT bone cavity in all cases, and some nerves adhered to the tumor tightly. The post- operative follow-up time was 81.5 months on the average (36 to 127 months). The packing gauze was changed every two weeks after enucleation, and the total duration time for packing was 8.9 months on the average (3 to 15 months). Notable bone regeneration and satisfactory secondary healing were observed clinically and radiographically. The KCOT-affected teeth were reserved, and their chewing functions were restored. Two cases presented recurrences after the initial treatment. The recurrence rate was 4.9% (2/41). No serious complications were observed.</p><p><b>CONCLUSION</b>Enucleation associated with subsequent open packing is a reliable treatment for patients with large KCOTs in the mandible.</p>
Subject(s)
Adult , Female , Humans , Male , Bone Regeneration , Mandible , Mastication , Neoplasm Recurrence, Local , Odontogenic Tumors , Retrospective StudiesABSTRACT
Objective To compare total gastrectomy jejunal loop P-type esophagus jejunum Roux-en-Y anastomosis(PRY) and non-type esophageal transection of the jejunum improved Roux-en-Y anastomosis(URY) two different digestion Road reconstruction on the nutritional status of patients and gastrointestinal symptoms. Methods 152patients with total gastrectomy required of gastric cancer patients immediately divided into two groups ,76 patients in each group ,respectively PRY and URY surgical reconstruction of digestive tract, were followed up for 12 months, two groups were compared on nutritional status and gastrointestinal symptoms. Results PRY operation time and postoperative complication rate we re more than URY group(all P ＜0.05) ;two groups 12 months after the mortality and weight changes, hemoglobin, total protein, albumin, and all reflux esophagitis the incidence rate was no significant difference (all P ＞ 0.05); after 3 months and 6 months in both groups food intake ＜ 300ml/second person, eating frequency ＞5 times/d and the difference in the incidence of RSS had statistical significance (all P ＜ 0.05). Conclusion URY surgical reconstruction of digestive tract and maintain the continuity of muscle conduction,and the surgical procedure was simple,a good prognosis and relatively PRY more reasonable in terms of surgical procedures.
ABSTRACT
Objective:To study the feasibility of extraction of impacted mandibular wisdom teeth using turbine drill and new instruments. Methods: 600 patients with impacted mandibular third molars were divides into 2 groups. A group used turbine drill and new instruments to extract the impacted mandibular third molar. B group used the dental chisel to extract the impacted mandibular third molar. The operation time, intraoperative and postoperative complications were recorded to assess the effects of the methods. Results: The operation time of group A and group B was (22.285±12.025 01) min and (16.115±12.078 62) min respectively. The operation time of group A was shorter(P<0.05). The intraoperative and postoperative complication incidence rate was lower(P<0.05). Conclusion: Turbine drill and new instruments method is superior to dental chisel method in the extraction of impacted mandibular wisdom teeth.
ABSTRACT
Objective: To observe the behavior therapy efficacy in dental fear patients for dental extraction using video eyewear and N_2O inhalation. Methods: 100 patients were divided into two groups, one group only used N_2O and other group used N_2O with video eyewear. Compared two groups′ Frankl behavior rating scale and Houpt scale after dental extraction. The HR and SpO_2 were measured during dental extraction. Results: Using video eyewear and N_2O showed a significant good sedative effect on patients with dental fear. There were statistical difference in the Frankl behavior rating scale and Houpt scale between experiment group and control group(P<0.01). There were no significant changes in heat rate and SpO_2 before and after in two groups. Conclusion: Video eyewear and N_2O inhalation sedation is good for dental fear patient during dental extraction.
ABSTRACT
We report the treatment process of a patient with acute vertebral artery occlusion complicated by top of the basilar artery syndrome after arterial thrombolysis.The top branches of vertebral artery and basilar artery were patent after the mechanical and drug thrombolysis again. The prognosis of the patient was good. The modified Rankin scale score was 1. It suggested that in addition to the arterial local thrombolysis was effective to the lesions themselves, it also had good efficacy for the newly developed embolic complications during the process of thrombolysis.
ABSTRACT
BACKGROUND:TiNi shape memory alloy(TiNi-SMA)distractor can be buried completely,there is no time delay and it is different from other distractors previously used.Therefore,it is necessary to reevaluate the osteogenetic time and quality.OBJECTIVE:To investigate the quality of the alveolar ridge augmented by TiNi-SMA distractor by bone mineral density (BMD)and biodynamics tests of new-formed bone.DESIGN:Randomized controlled observation.SETTING:Department of Stomatology of General Hospital of Chinese PLA.MATERIALS:Twelve healthy adult male mongrel canines(ranged from 21 to 26 kg)were provided and bred by Medical Experimental Animal Center of General Hospital of Chinese PLA.All the animals were accorded with the requirements of the quarantine and animal ethnics.Self-made distractors were used in the study.XR-36 Dual Energy X-Ray Absorptiometry (Norland,USA)and 858 Mini Bionix Ⅱ Biomaterial Testing Machine(MTS,USA)were used in the study.METHODS:The experiments were performed at the Medical Experimental Animal Center of General Hospital of Chinese PLA from July 2000 to May 2004.The animals were grouped into group Ⅰ(3 months group)and group Ⅱ(6 months group)randomlv with 6 animals in each group.The left mandible was used as experimental side and the right was used as COntrol side.The canines were kilied after anaesthesia at 3 or 6 months later in both groups.After the mandible samples were cut,the BMD of three points in the distraction gap,above the distraction gap and below the distraction gap were measured by dual energy X-ray.Compressive biomechanics test was performed in the middle of the distraction area of the experimental side and the corresponding area of the control side to detect compressive stress and the modulus of elasticity.MAIN OUTCOME MEASURES:①BMD of the distraction area of the experimental side and the control side in the group Ⅰand group Ⅱ.②Compressive strength and modulus of elasticity of the mandibles of the experimental side and the control side.RESULTS:All of the 12 experimental canines were included in the final analysis,no drop-out.BMD determination:BMD was lower in above the distraction gap of the mandibles of the experimental side than in the control side in the group Ⅰ (t=-2.898,P＜0.05).There was no significant difference in BMD between both sides in the group Ⅱ(P＞0.05).Compressive biomechanics test:Compressive stress and the modulus of elasticity of the mandibles on the experimental side were lower than on the control side in the group Ⅰ(t=-3.274,-3.534,P＜0.05).All indexes increased by some degree in the group Ⅱ compared to the group Ⅰ (P＞0.05).CONCLUSION:The new bone is strong enough for later repair such as implantation after distraction osteogenesis using TiNi-SMA distractor.
ABSTRACT
To evaluate the incidence of sub-clinical neck metastasis and its surgical treatment in patients with oral squamous cell carcinoma (OSCC) without clear evidences for lymph nodes metastasis, a total of 205 patients with OSCC in N0 and N1 stage(UICC 1987′s classification) were included in the study.Their clinical and histopathological files were retrospectively studied and patients were followed up after operation. Histopathological positive lymph nodes were found in 10.8%(13/120) of patients,and postoperative lymph nodes metastasis occurred in 16.5%(14/85) of patients without neck dissections.There were no significant differences between N0 and N1 groups.Neck recurrence occurred in 11.9%(5/42) of patients after functional neck dissections.The rate was higher in patients with bucal lesions.Patients undergoing radical neck dissections also had neck recurrence with an incidence of 6.4%.But most of them occurred on contralateral side. It suggested that subclinical metastasis of OSCC with clinically negative neck lymph nodes could not be neglected.Functional neck dissection should include the lymph nodes of level Ⅲ,especially for cancers located on bucca mucosa and tongue.Bilateral neck dissection is necessary for large primary lesions spreading to the contralateral side.
ABSTRACT
Objective:To develop an automatic and continuous distraction osteogenesis technique by using totally embedded distractor of nickel titanium (Ni-Ti) shape-memory alloy for the reconstruction of mandibular ramus. Methods:16 adult New Zealand rabbits were used in the experiment. Mandibular ramus and condyle on one side was removed to create a 1.5 cm segmental defect. A transport disc was created by "L" shape osteotomy at the end of the remnant ramus and Ni-Ti distractor was fixed and totally embedded in tissues. The rabbits were sacrificed 2 months after operation and the mandibles were harvested.The bone reconstruction were studied with radiographic and histological examination. Results: 2 months after operation all the animals were alive and mandible function kept well.The Ni-Ti distractors were self-activated and performed distraction osteogenesis automatically. The mandibular ramus achieved preliminary reconstruction. Histological examination showed bone regeneration in the distraction area. Conclusions: Ni-Ti distractor can fulfill automatic and continuous distraction osteogenesis.
ABSTRACT
To evaluate the incidence of sub clinical neck metastasis and its surgical treatment in patients with oral squamous cell carcinoma (OSCC) without clear evidences for lymph nodes metastasis, a total of 205 patients with OSCC in N0 and N1 stage(UICC 1987′s classification) were included in the study.Their clinical and histopathological files were retrospectively studied and patients were followed up after operation. Histopathological positive lymph nodes were found in 10 8%(13/120) of patients,and postoperative lymph nodes metastasis occurred in 16 5%(14/85) of patients without neck dissections.There were no significant differences between N0 and N1 groups.Neck recurrence occurred in 11 9%(5/42) of patients after functional neck dissections.The rate was higher in patients with bucal lesions.Patients undergoing radical neck dissections also had neck recurrence with an incidence of 6 4%.But most of them occurred on contralateral side. It suggested that subclinical metastasis of OSCC with clinically negative neck lymph nodes could not be neglected.Functional neck dissection should include the lymph nodes of level Ⅲ,especially for cancers located on bucca mucosa and tongue.Bilateral neck dissection is necessary for large primary lesions spreading to the contralateral side.