Application of low dose S-ketamine in analgesia of elderly patients with non-traumatic acute abdomen in emergency / 中华急诊医学杂志

Objective:To investigate the efficacy and safety of low dose S-ketamine in analgesia of elderly patients with non-traumatic acute abdomen (NTAA) in emergency department.Methods:This was a randomized controlled trail. From January to August 2021, elderly patients with NTAA in the Emergency Department of the No. 904 Hospital of the Joint Logistic Support Force were selected. Analgesia was administered intravenously with 0.3 mg/kg S-ketamine or 0.1 mg/kg morphine injection for 15 min. Visual analogue score (VAS), respiratory rate, heart rate, non-invasive blood pressure and pulse oxygen saturation were recorded at 15 min, 30 min, 60 min and 90 min. The mini-mental state examination (MMSE) scores were recorded at 90 min after injection. The incidence of salvage analgesia, incidence of adverse reactions and diagnostic accuracy after analgesia were recorded in the two groups. VAS scores and vital signs were compared between the two groups by two-way repeated measures analysis of variance, and multiple comparisons between and within groups were performed.Results:A total of 137 elderly patients with NTAA were selected and randomly divided into two groups: S-ketamine group (SK group, 68 cases) and morphine group (M group, 69 cases). After the exclusion of patients with abscission, 39 cases were included in the SK group and 45 cases in the M group. VAS score of the SK group was significantly lower than that of the M group in 15 min after administration [(3.1±1.8) vs. (4.8±2.2)], and the difference was statistically significant ( P=0.013). There were no significant differences in vital signs and MMSE score between the two groups or within the group at each time point after medication (all P>0.05). However, the incidence of dizziness in the SK group was significantly higher than that in the M group (61.54% vs. 31.11%, P=0.005). Conclusions:Intravenous administration of low dose S-ketamine is not considered to be more effective than morphine in alleviating acute abdominal pain in elderly patients with NTAA. S-ketamine provides not only satisfactory analgesia but also short recovery time and high controllability. S-ketamine is one of the recommended analgesic alternatives of NTAA for elderly patients in emergency.

A rare case of dicentric ring chromosome and derivative ring chromosome Chimera / 中华医学遗传学杂志

OBJECTIVE@#Utilize high-resolution chromosome analysis and microarray detection to determine the genetic etiology of infertility of a 32-year old female patient.@*METHODS@#The peripheral blood of the patient was cultured for high-resolution chromosome G and C banding karyotype analysis, and then 750K SNP-Array chip detection was performed.@*RESULTS@#Karyotype analysis results showed that the patient's karyotype was 45,XX,-13 [7]/46,XX,r(13) (p13q34) [185]/46,XX,dic r(13;13)(p13q34;p13q34) [14]/ 47,XX,+der(13;13;13;13) (p13q34;p13q34;p13q34; p13q34), dic r(13;13) [1]/ 46,XX [3]. The microarray results showed that the patient had a 3.3 Mb deletion in the 13q34 segment of chromosome 13, which may be related to infertility.@*CONCLUSION@#Infertility of the patient reported in this article may be related to the deletion of chromosome segment (13q34-qter).

Disease spectrum and distribution characteristics of pre-hospital emergency patients in Wuxi in 2015-2020 / 公共卫生与预防医学

Objective To provide guidance for pre-hospital emergency treatment by studying the disease spectrum and distribution characteristics of pre-hospital emergency treatment patients in Wuxi area from 2015 to 2020. Methods The medical records of 120 pre-hospital emergency patients in Wuxi area from January 2015 to December 2020 were retrospectively analyzed, and the disease types, gender, age, and seasonal distribution of the pre-hospital emergency patients were statistically analyzed. Results The top five emergency diseases of 16 437 pre-hospital patients were trauma (24.51%), cerebrovascular disease (19.16%), cardiovascular disease (18.33%), digestive system disease (9.70%) and respiratory disease (7.20%). In the distribution of disease types, the proportions of injuries, cerebrovascular diseases, cardiovascular diseases, digestive system diseases, respiratory system diseases, poisoning diseases and urinary system diseases in males were significantly higher than those in females (χ2=4.975, P<0.05). The proportion of male species (9 812/16 437) was higher than that of female species (6 625/16 437). From 2015 to 2020, the age group with high incidence of pre-hospital emergency patients in Wuxi area was distributed in the 50-60 years old (19.30%) and 40-50 years old (16.28%), and the least age group was 0-10 years old (2.60%). The number of pre-hospital emergency patients was 46.60% from 6 to 12 hours per day, and 10.26% from 18 to 24 hours per day. The number of pre-hospital emergency patients was the highest in summer (38.69%), and the lowest in spring (11.87%). Conclusion The pre-hospital emergency diseases in Wuxi area are mainly cardiovascular and cerebrovascular diseases, and the acute and severe diseases show an increasing trend. It is necessary to rationally allocate the pre-hospital emergency resources according to the disease spectrum and the peak months and time periods of different diseases, so as to improve the medical service level in Wuxi.

Advanced Pneumonic-type Lung Carcinoma: A Retrospective Study of Clinical-radiological-pathological Characteristics with Survival Analysis in A Single Chinese Hospital / 中国肺癌杂志

BACKGROUND@#Pneumonic-type lung carcinoma is a special type of lung cancer both clinically and radiologically. Here we present our experience on pneumonic-type lung carcinoma in an attempt to investigate the clinical, radiological and pathological features, diagnostic procedures, treatment, and prognosis of this type of tumor.@*METHODS@#Pathologically confirmed lung cancer with a chest CT characterized by ground glass opacity or consolidation was defined as pneumonic-type lung carcinoma. Cases with advanced pneumonic-type lung carcinoma admitted to Peking Union Medical College Hospital (PUMCH) from January 1, 2013 to August 30, 2018 were enrolled. Retrospective analysis of clinical data and survival follow-up of these patients was conducted.@*RESULTS@#A total of 46 cases were enrolled, all of which were adenocarcinoma. Cough (41/46, 89.1%) and expectoration (35/46, 76.1%) were the most prominent symptoms. The most frequent chest CT findings were ground glass attenuation (87.0%), patchy consolidation (84.8%), and multiple ground-glass nodules (84.8%). Multiple cystic changes (40%) and cavitation (13%) were also quite frequent. Ipsilateral and contralateral intrapulmonary metastasis were noted in 95.3% and 84.8% of cases respectively. The median duration from symptom onset to diagnosis was 214 days (95%CI: 129-298). Both surgical lung biopsy and CT-guided percutaneous lung biopsy had a diagnostic yield of 100%. Transbronchial lung biopsy (TBLB) combined with bronchoalveolar lavage (BAL) had a diagnostic yield of 80.9% (17/21). Sputum cytology had a diagnostic yield of 45% (9/20). Twenty-six cases were invasive mucinous adenocarcinoma (26/46, 56.5%) and the remainder were unable to identify pathological subtypes due to lack of adequate biopsy sample size. EGFR mutation was detected in 15.8% (6/38) of patients and ALK rearrangement was detected in 3.0% (1/33) of patients. The median overall survival for these patients was 522 d (95%CI: 424-619). In patients without EGFR mutation or ALK rearrangement, chemotherapy significantly improved survival (HR=0.155, P=0.002,2). The median overall survival was 547 d (95%CI: 492-602 d) with chemotherapy and 331 d (95%CI: 22-919) without chemotherapy.@*CONCLUSIONS@#Diagnosis of pneumonic-type carcinoma is usually delayed due to clinical and radiological features mimicking pulmonary infection. TBLB combined with BAL has a quite high diagnostic yield. The most frequent histological type is invasive mucinous adenocarcinoma. The incidence of EGFR mutation or ALK rearrangement is low in pneumonic-type carcinoma. For patients without cancer driver genes, chemotherapy is recommended to improve overall survival.

Diagnosis and treatment of anterior pilon fracture / 中华创伤杂志

Objective To investigate the diagnosis,operation characteristics and clinical effect of anterior Pilon fracture.Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014.All had fresh closed fracture.Mean age was 39.8 years (range,18-61 years).Injury resulted from high falls in 11 patients and falls in 2 patients.According to the preoperative imaging manifestations and four column fracture classification,the fracture type was mainly anterior column fracture.All underwent open reduction and internal fixation with buttress plates,and allograft bone was performed in 8 patients.At the last followup,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were employed for clinical evaluation.Results Mean period of follow-up was 15.7 months (range,12-30 months).Mean AOFAS score was 91.38 points (range,74-100 points).Excellent results were found in 10 patients,good in 2 and fair in 1,with the excellent-good rate of 92％.Mean VAS score was 1.08 points (range,0-3 points).Traumatic arthritis occurred in 1 patient.Skin necrosis occurred in 1 patient,and was cured by dressing change.There were no complications such as infection,refracture or implant failure.Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position.Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia,which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture.The fracture is the result of high energy injury,and can be diagnosed by mechanism of injury and imaging manifestations.Through anterior approach,open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes.

The application of Chaperon guiding catheter system in endovascular treatment of intracranial aneurysms / 介入放射学杂志

Objective To discuss the application of Chaperon guiding catheter system in endovascular treatment of intracranial aneurysms. Methods A total of 20 patients with intracranial aneurysms were enrolled in this study. The patients hadⅡorⅢtype of aortic arch (n=11) or sclerotic plague at the orifice of internal carotid or vertebral artery (n = 9). Endovascular embolization of the intracranial aneurysm was carried out in all patients. By using Cordis guiding catheter system the catheter was placed into the target artery. Chaperon guiding catheter system was used during the procedure in order to determine whether the Chaperon guiding catheter could be smoothly placed into the target artery or not. Results When the Chaperon guiding catheter system was employed in the endovascular procedure, the difficulties of catheterization caused by the distortion of the aorta or by the plagues on the walls of arteries could be basically overcome. The Guiding catheter could be smoothly placed into the target arteries. Conclusion The Chaperon guiding catheter system can be successfully used in the endovascular treatment for the intracranial aneurysms, especially when the patient has tortuous aorta or there is sclerotic plague on the artery wall. (J Intervent Radiol, 2014, 23:281-283).

Selective innervation of sacral nerve roots to bladder / 中国组织工程研究

BACKGROUND: The selective innervation of different sacral nerve roots on bladder in SD mice is still uncertain.OBJECTIVE: To study the selective innervation of sacral nerve roots to bladder in order to provide evidence for rebuilding bladder function after spinal cord injury and establishing experimental animal model of artificial bladder.DESIGN: Randomized and controlled study.SETTING: Department of orthopaedics in two universities and physiological department of a medical university.MATERIALS: The experiment was conducted in the Key Laboratory of Hand Function Reconstruction of Ministry of Public Health in Medical College of Fudan University from October 2000 to June 2002. Totally 10 male SD mice of clean class with body mass between 250 and 300 g were chosen.INTERVENTIONS: The mice were randomly divided into two groups of which one used left side as experimental side and the other used right side. Extradural electric stimulation was conducted to St -4 nerve roots of SD mice after spinal cord injury.MAIN OUTCOME MEASURES: To record the change of action potential of cystic nerve plexus and compound muscle action potential of bladder smooth muscle, and insert the pressure monitor into bladder to record internal pressure of bladder by pressure transducer.RESULTS: S1 -4 nerve all participate the innervation of bladder in SD mice,among them, the S2 nerve is the most important one, next with S1, S3 and S4is the minimum one.CONCLUSION: Different sacral nerve roots have different dominative effects to bladder smooth muscle. It is meaningful for patients of spinal cord injury to improve their urination function by performing artificially electric stimulation for emiction through the main nerve roots controlling of bladder or rebuilding artificial bladder reflex arc by neurorrhaphy

Surgical management for sciatic nerve injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To summarize surgical treatments and their corresponding curative effects on sciatic nerve injuries.</p><p><b>METHODS</b>Surgical treatments on sciatic nerve injury were performed in 28 patients from January 1990 to July 2000. The treatments included neurolysis, neurolysis plus partial nerve anastomosis, nerve anastomosis and nerve transplantation. The curative effect was evaluated according to Sunderland criteria.</p><p><b>RESULTS</b>Of 28 cases, 22 patients were followed up with a follow-up period of 13 months to 5 years (average 30 months). Of 22 nerves, 7 were excellent, 5 good, 7 fair and 3 poor, with an excellence rate of 54.5%.</p><p><b>CONCLUSIONS</b>The fair results of sciatic nerve injury are related to its structural character. Surgical exploration should be performed if nerve function does not recover 3 months after primary operation and if Tinel's sign and electromyogram show no signs of nerve regeneration. Electrophysiological monitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosis.</p>

Bladder controller in bladder function reconstruction of paraplegic dogs / 中华外科杂志

<p><b>OBJECTIVE</b>To observe whether bladder controller can restore bladder function in paraplegic dogs.</p><p><b>METHODS</b>Four dogs were studied after their T(10) spinal cord was transected. Electrodes implanted around S(2) bilaterally were connected to subcutaneous recievers. Microsurgical techniques were employed in dorsal rhizotomy at S(1 - 3) intradural segment. After daily stimulation, the results of bladder controller were evaluated by micturition and vesicography.</p><p><b>RESULTS</b>Micturition was given under electrical stimulation with a urine volume of 80 - 140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography showed that the bladder was filled and bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15 - 20 ml.</p><p><b>CONCLUSION</b>Bladder controller together with a sacral deafferentation procedure can restore bladder function of paraplegic dogs.</p>

CLINICAL STUDY OF ARTIFICIAL BLADDER REFLEX ARC ESTABLISHED BY ACHILLES TENDON REFLEX / 解放军医学杂志

To explore the possibility of bladder reinnervation and artificial triggering voiding established by Achilles tendon reflex after spinal cord injuries above cone. Bilateral anterior roots of S 1 and main bladder innervating roots (S 2 or S 3) in 8 patients were severed intradurally and then anastomosed to establish artificial reflex arc of "Achilles tendon spinal cord bladder". After followed up for an average of 2 8 years, it was found that the patients were free from nocturnal incontinence, with micturition frequency of 5～6/d, and the urinary volume varied from 250 to 500 ml each time. The results suggested that artificial reflex arc of "Achilles tendon spinal cord bladder" could restore bladder function in patients with spinal cord injuries above cone

LONG-TERM EFFECT OF STIMULATOR OF ANTERIOR ROOT OF SACRAL NERVE IN RESTORATION OF BLADDER FUNCTION IN SPINAL CORD INJURIES / 解放军医学杂志

The first domestic patient who had received implantation of a stimulator of anterior root of sacral nerve was followed up for 42 months. The result showed that the patient regained control of micturition and absolute continence under electric stimulation. Life quality was improved apparently. No signs of sacral nerve root injury were found. In conclusion, stimulator of anterior root of sacralnerve (SARS) implantation is a safe and effective procedure and can be used in such patient for a long term. A test of the exterior parts of an indigenous stimulator shows that it is comparable to imported ones

Establishing an artificial reflex arc restore controlled micturition of flaccid bladder after spinal cord injury: a preliminary report / 中华显微外科杂志

Objective To explore the establishment of an new artificial bladder reflex arc for controlled micturition function in the conical spinal cord injury(SCI). Methods One conical SCI patients were included by lateral microanastomosis of the L6 ventral root to S2 ventral root. After several months of axonal regeneration, the function of bladder were examined clinically and urodynamically. Results Stimulation of the new artificial reflex are could inuduce controlled voiding, and could cause detrusor contraction when following 55 months of one patient. Conclusions Establishing of an new artificial reflex arc may effective for controlled micturition in conical SCI.

A comparative study of biodegradable and metallic fixation for the treatment of dislocation of acromioclavicular joint / 中华骨科杂志

Objective To compare the results of treatment with biodegradable ligaments and metallic fixation for total acromioclavicular joint dislocation. Methods Twenty eight patients with total acromioclavicular joint dislocation were treated with two different materials, 1) by Kirschner pin and steel wire or screw and steel wire tension band (MF group,16 cases), and 2) reconstructed by artificial coracoclavicular ligament and coracoacromial ligament (BF group,12 cases). There were 17 males and 11 females. All patients had acute dislocation. The time from injury to hospital admission varied from 0-8 days (average, 1.5 days). Results All patients were availble for an average duration of follow up of 39.5 months (range,8-70 months). The results were evaluated by radiographic representations and joint function according to Lazcano's standards. In BF group, 10 patients were assesed as good and 2 as fair. In MF group, 13 patients were assesed as good, 2 as fair and 1 as poor. There were no statistic differences between these two methods. Conclusion Biodegradable ligament fixation is believed to be a good simple method for the treatment of acromioclavicular joint dislocation without the necessity of a second operation for removal of implants.