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Objective:To investigate the risk factors for anastomotic leakage after laparo-scopic lower anterior resection (LAR) of rectal cancer, and the application value of its risk assess-ment scoring model.Methods:The retrospective case-control study was conducted. The clinico-pathological data of 539 patients who underwent laparoscopic LAR of rectal cancer in 13 medical centers, including 248 cases in Renji Hospital of Shanghai Jiaotong University School of Medicine, 35 cases in Ningbo First Hospital, 35 cases in Changzhou Second People's Hospital, 32 cases in the First People's Hospital of Nantong, 32 cases in Linyi People's Hospital, 31 cases in Changzhou Wujin People's Hospital, 28 cases in Jiading District Hospital of Traditional Chinese Medicine, 27 cases in the First Hospital of Taizhou, 26 cases in Shanghai Pudong Gongli Hospital, 21 cases in the People's Hospital of Rugao, 11 cases in Central Hospital of Fengxian District, 7 cases in Ningbo Hangzhou Bay Hospital and 6 cases in Jiangsu jianhu People's Hospital, from January 2016 to November 2020 were collected. There were 157 males and 382 females, aged (62.7±0.5)years. Observation indicators: (1) follow-up; (2) risk factors for anastomotic leakage after laparoscopic LAR; (3) establishment of risk assessment scoring model for anastomotic leakage after laparoscopic LAR. Follow-up was conducted by outpatient examination or telephone interview. Patients were followed up at 1 week after discharge or 1 month after the operation to detect the anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted usong the Logistic regression model. The area under curve of receiver operating characteristic curve was used to estimate the efficiency of detecton methods. The maximum value of the Youden index was defined as the best cut-off value. Results:(1) Follow-up: 539 patients were followed up at postoperative 1 week and 1 month. During the follow-up, 79 patient had anastomotic leakage, with an incidence of 14.66%(79/539). Of the 79 patients, 39 cases were cured after conservative treatment, 40 cases were cured after reoperation (ileostomy or colostomy). (2) Risk factors for anastomotic leakage after laparoscopic LAR. Results of univariate analysis showed that sex, age, body mass index, smoking and/or drinking, tumor diameter, diabetes mellitus, hemoglobin, albumin, grade of American Society of Anesthesio-logists (ASA), neoadjuvant chemoradiotherapy, distance from anastomotic level to dentate line, the number of pelvic stapler, reinforced anastomosis, volume of intraoperative blood loss, placement of decompression tube, preservation of left colic artery, operation time and professional doctors were related factors for anastomotic leakage after laparoscopic LAR ( χ2=14.060, 4.387, 5.039, 4.094, 17.488, 33.485, 25.066, 28.959, 34.973, 34.207, 22.076, 13.208, 16.440, 17.708, 17.260, 4.573, 5.919, 5.389, P<0.05). Results of multivariate analysis showed that male, tumor diameter ≥3.5 cm, diabetes mellitus, hemoglobin <90 g/L, albumin <30 g/L, grade of ASA ≥Ⅲ, neoadjuvant chemoradiotherapy, distance from anastomotic level to dentate line <1 cm, the number of pelvic stapler ≥3, non-reinforced anastomosis, volume of intraoperative blood loss ≥100 mL and no placement of decom-pression tube were independent risk factors for anastomotic leakage after laparoscopic LAR ( odds ratio=2.864,3.043,12.556,7.178,8.425,12.895,8.987,4.002,3.084,4.393,3.266,3.224,95% confidence interval as 1.279?6.411, 1.404?6.594, 4.469?35.274, 2.648?19.459, 2.471?28.733, 4.027?41.289, 3.702?21.777, 1.746?9.171, 1.365?6.966, 1.914?10.083, 1.434?7.441, 1.321?7.867, P<0.05). (3) Establishment of risk assessment scoring model for anastomotic leakage after laparoscopic LAR. based on the results of univariate analysis, clinicopathological factors with χ2>20, χ2>10 and ≤20 or χ2≤10 were defined as scoring of 3, 2, 1, respectively. The cumulative clinicopatho-logical factors scoring ≥6 was defined as an effective evaluating indicator for postoperative anastomotic leakage. The risk assessment scoring model (6-321) for anastomotic leakage after laparoscopic LAR was established. The cumulative value ≥6 indicated high incidence of anastomotic leakage, and the cumulative value <6 indicated low incidence of anastomotic leakage. Conclusions:Male, tumor diameter ≥3.5 cm, diabetes mellitus, hemoglobin <90 g/L, albumin <30 g/L, grade of ASA ≥Ⅲ, neo-adjuvant chemoradiotherapy, distance from anastomotic level to dentate line <1 cm, the number of pelvic stapler ≥3, non-reinforced anastomosis, volume of intraoperative blood loss ≥100 mL and no placement of decompression tube are independent risk factors for anastomotic leakage after laparoscopic LAR. The risk assessment scoring model (6-321) is established according to the above results.The cumulative value ≥6 indicates high incidence of anastomotic leakage and the cumulative value <6 indicates low incidence of anastomotic leakage.
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BACKGROUND:Neural stem cel s have multi-directional differentiation potential, self-sustaining and self-renewal capacity as wel as have strong migration ability. Bushen Huoxue Recipe can reduce neuronal damage and promote nerve cel regeneration, to achieve neural function reconstruction. Underlying mechanisms of Bushen Huoxue Recipe combined with neural stem cel transplantation in rats with tinnitus induced by sodium salicylate are yet unclear. OBJECTIVE:To investigate the effects of Bushen Huoxue Recipe combined with neural stem cel transplantation in rats with tinnitus induced by sodium salicylate. METHODS:Sixty Sprague-Dawley rats were randomized into five groups (n=12):normal control group, tinnitus model group, Bushen Huoxue Recipe group, stem cel group and combined treatment group (Bushen Huoxue Recipe combined with neural stem cel transplantation). Animal models of tinnitus induced by sodium salicylate were made in al the groups except for the normal control group. Fifteen days after modeling, rats were given intragastric administration of Bushen Huoxue Recipe water decoction (3 mL, 2.592 g/mL) for consecutive 7 days in the Bushen Huoxue Recipe group, intravenous injection of neural stem cel s (1 mL, 1.0×109/L) in the stem cel group, or their combined treatment in the combined treatment group. RESULTS AND CONCLUSION:Bushen Huoxue Recipe, neural stem cel transplantation and their combination al could effectively promote the recovery of drinking water inhibitory rate that was ranked as fol ows:combined treatment group
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OBJECTIVE@#To study the clinical characteristics of early tinnitus in patients with sudden deafness.@*METHOD@#Forty-seven patients with sudden deafness and early tinnitus recieved subjective review and filled out classified questionnaire of tinnitus. By pure tone audiometry and tinnitus matching test, we obtain the distribution, quantity and matching loudness of tinnitus patients.@*RESULT@#(1) Objective examination: the most common frequencies of tinnitus were 8000 Hz and 4000 Hz. The most common numbers were two frequencies. The matching loudness was (16.63 ± 8.37) dB. (2) Subjective examination: the tinnitus was monotone (74.0%), sustained (89.0%), third level loudness (45.0%), third level annoying (60.0%), high frequency (83.0%), sound of cicadas (66.7%). The most influencing factors were hearing (28.2%) and mood (29.5%). (3) Relationship between tinnitus and pure tone hearing threshold curve: there was a significant correlation between the frequency of pure tone audiometry and the matching loudness of tinnitus (r = -0. 370, P 0.05).@*CONCLUSION@#(1) The results of subjective examination were consistent with those of objective examination. (2) The tinnitus should be considered in the early treatment of sudden deafness.
Subject(s)
Humans , Audiometry, Pure-Tone , Hearing Loss, Sudden , Pathology , Tinnitus , PathologyABSTRACT
BACKGROUND:Positive total knee replacement surgery greatly improved the quality of life in patients with knee joint degenerative disease, but widespread perioperative acute pain increases the probability of complications and hinders the rehabilitation exercises of patients; therefore perioperative pain processing has become an important topic of the current knee replacement. OBJECTIVE:To compare the efficacy and safety of preemptive analgesia of parecoxib sodium, periarticular analgesia and their combination in the total knee arthroplasty, and explore reasonable and effective analgesic scheme. METHODS:60 patients undergoing knee replacement were randomly selected in Xuzhou Central Hospital from May 2012 to December 2014, and then they were divided with a random number table into four groups: preemptive analgesia with parecoxib sodium, periarticular analgesia, combination and blank control, with 15 cases in each group. Different programs were used in each group during total knee arthroplasty. RESULTS AND CONCLUSION:At 6, 12, 24 and 36 hours after operation, rest pain scores, activity pain scores and drug dose were significantly lower in the combination group than other three groups (P < 0.05). Time interval of anesthetic use was significantly longer in the combination group than other three groups (P < 0.05). At 3 days after replacement, active leg-raising time and active genuflex 90° time were significantly shorter in the combination group than other three groups (P < 0.05), and range of motion of the knee was good. The incidence of adverse reaction was lowest in the combination group (P < 0.05). These results indicate that preemptive analgesia of parecoxib sodium combined with periarticular analgesia is a safe and effective analgesic option, can obviously reduce pain after replacement, the amount of anesthetics and adverse reactions, improve range of motion of the knee and promote early rehabilitation of patients.
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The anti-fatigue ability decline is one of the most important clinical symptoms of chronic exertional compartment syndrome (CECS). The percentage change of type-I and II skeletal-muscle fiber is an important reason for anti-fatigue ability decline after intracompartmental pressure increase. There is a close relationship between CaN-NFAT or PPAR/PGC-1 signaling pathways and muscle fiber type conversion. Studies have confirmed that Traditional Chinese medicine can protect the body tissue by activing CaN-NFAT or inhibiting PPAR/PGC-1 signaling pathways. Therefore, we wrote the review in order to better analyze the research progress in this field.
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Objective To study the curative effect of limited-acupotomy therapy on chronic lumbosacral osteo-fascial compartment syndrome. Methods 59 patients were randomly recruited into a control group (with 29 patients) and a treatment group (with 30 patients). The control group was treated with general-acupotomy therapy, and treatment group was treated with limited-acupotomy therapy. Evaluate the curative effects before the first and the second therapy, and 3 months after the therapy respectively, as well as VAS pain, JOA and CODI scores. Results The curative effect was 96.56% and 100% respectively in the control group and the treatment group 3 months after the treatment. The difference between the two groups was not statistically significant(χ2＝0.19,P＞ 0.05). As to VAS pain scores, JOA and CODI scores, the difference among the three stages of the treatment were significant (in control group F＝165.70, 99.90, 106.60 respectively, in treatment group F＝279.76, 154.34, 67.36 respectively, P＜0.01)in both groups respectively, but the difference between the two groups were not significant(P＞0.05) in each stage. Conclusion Limited-acupotomy therapy was safe and effective in treating chronic lumbosacral osteo-fascial compartment syndrome.
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Objective To explore the effects of Sanchi gel on MMP-1 and TIMP-1 expression in epidural adhesion after laminectomy. Methods Laminectomy model was set up in SD rats. 72 SD model rats were divided randomly into Saline group, Zhanlp group, Carbopol Gel group and Sanchi Gel group, with 18 rats in each group. On 7, 14 and 21 days after the laminectomy, immunohistochemistry (method of S-P) was adopted to detect the expression of TIMP-1 and MMP-1. Results Different treatments had different influence on TIMP-1 and MMP-1 expression in epidural adhesion. The expression of TIMP-1 increased gradually on 14 dand 21 d after operation, and Sanqi Gel group showed weaker expression than the other groups (P＜0.05), but the number of positive cells decreased gradually. As to the expression of MMP-1, there was no difference among each group at the end of the second week (P＞0.05). There was a difference between Sanchi Gel group and the other groups at the end of third week (21 d) (P＜0.05) after operation. Sanchi Gel group showed higher expression of TIMP-1 than the other groups. The number of positive cells sharply decreased from 14 d to 21 d after operation. Conclusion Sanchi Gel has a significant preventive effect on fibrous scar formation after laminectomy. The possible mechanism of preventing epidural adhesion after laminectomy by Sanchi Gel could be its regulating and controlling the expression of TIMP-1 and MMP-1 in epidural tissue.