Comparison of bispectral index value from the tumor side with contralateral position during supratentorial craniotomy / 临床麻醉学杂志

Objective To evaluate the agreement of bispectral index values recorded from tumor side and the contralateral areas during supratentorial craniotomy.Methods Thirty-five patients (16 males, 19 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ) scheduled for supratentorial tumor resection were enrolled in this study.Bispectral index (BIS) sensors were placed at bilateral frontal areas.The patients were anesthetized with propofol.From each BIS monitor, we collected data at each of four time stages: before the induction of anesthesia, before dura opening, removal of tumor and recovery of conscious.These data were compared using Bland-Altman analysis.Results Bland and Altman analysis revealed a BIS negative-bias (limits of agreement) of before induction-0.8(-7.2-5.7), before dura opening 0.6 (-8.3-9.5), and removal of tumor 1.5(-6.9-9.9), recovery of conscious 0.2 (-9.3-9.8).Conclusion There are significant agreement for BIS values between the frontal area of tumor side and the contralateral areas.BIS values can be used interchangeably between bilateral frontal.

Research Progress of the Relationship between SUNDS and OSAHS / 法医学杂志

Sudden unexplained nocturnal death syndrom e (SU N D S ) is alw ays a difficulty in forensic m edicine researches. A lthough the developm ent of m olecular genetics prom otes the etiologic study of SU N D S, the pathogenesis of m ost such cases is still unclear. Sleep apnea syndrom e (SA S) is one of the com m on form s of sleep disorders, and obstructive sleep apnea hypopnea syndrom e (O SA H S ) is the m ost com m on. In recent years, som e dom estic and international researches show that O SA H S is related to the developm ent of cardiovascular disease, w hich m ay cause cardiac arrhythm ia, even sudden death. T his article review s the relationship betw een SU N D S and O SA H S and aim s to provide new ideas for the pathogenesis of SU N D S.

Discussion on Theoretical Origin and Clinical Application of “Jing Jin and Bone Balance-regulating” Manipulation / 中国中医药信息杂志

TCM believes that physical tendons and bone are interdependent, keeping dynamic balance, and they influence each other pathologically. Physical tendons and bone balance is human spine physiological state. Physical tendons and bone imbalance is the important pathogenesis of spine and related diseases. The core of physical tendons and bone balance-regulating theory is the physique homology and syndrome differentiation and treatment. This article expounded from the above aspects in details.

Significance of parathyroid hormone measurement in drainage liquid after thyroidectomy / 中华内分泌外科杂志

Objective To explore the significance of parathyroid hormone (PTH) measurement in drainage liquid after thyroid surgery,and to evaluate its relationship with parathyroid glands in situ.Methods Form Dec.2013 to Aug.2014,166 patients who underwent unilateral thyroidectomy were chosen as the research object.According to the number of parathyroid reserved in situ,patients were divided into group A0,group A1 and group A2.The levels of blood PTH and serum calcium were measured before and after operation,and postoperative PTH in drainage liquid was measured.Results The levels of postoperative blood PTH and serum calcium were lower than those before operation(P＜0.05).The difference of PTH level in drainage liquid in each group had statistical significance(P＜0.05).The level of drainage liquid PTH was highest in group A2,following group A1,and finally group A0.We found a positive correlation between the number of parathyroid glands protected in situ and the level of drainage liquid PTH.Conclusion Drainage liquid PTH measurement can be used to determine whether parathyroid gland is reserved in situ and its secretion function.

Value of bilateral central neck dissection in patients with clinically node-negative papillary thyroid microcarcinoma / 中华内分泌外科杂志

Objective To study the risk factors of lymph node metastasis in the central neck compartment of thyroid carcinoma,and to explore the reasonable range of lymph node dissection in central neck dissection for clinically node-negative papillary thyroid microcarcinoma patients.Methods From Dec.2015 to Dec.2016,a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups according to the registration number:unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery,Fujian Medical University Union Hospital.The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed.Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were ≥0.7 cm in diameter and older than 45 years in age and gender in male.Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm.The positive rate was 22％.The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18,P=0.035,respectively.The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75,P=0,022 respectively.Conclusion In patients with tumor diameter ≥0.5 cm,bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.

Clinical significance of the right side lymph node dissection behind recurrent laryngeal nerve in papillary thyroid carcinoma / 中华内分泌外科杂志

Objective To assess clinical significance of the right side lymph node dissection behind recurrent laryngeal nerve (RLN) in papillary thyroid carcinoma (PTC).Methods Clinical data of 111 cases of PTC adimitted in our hospital (Department of Vascular and Thyroid Surgery,the Union Hospital of Fujian Medical University) from Feb.2013 to Mar.2014 were retrospectively analyzed.Central lymph node metastasis was analyzed.Univariate and multivariate analysis were made to analyze relations between the right side lymph node (Ⅵ b2) metastasis behind RLN and gender,age,tumor size,capsule infiltration and so on.Results Among 111 cases of PTC,71 had central lymph node metastasis (63.96％).Total metastasis number of the right side lymph node behind recurrent laryngeal nerve (Ⅵ b2) was 2.720±2.037,and the transfer rate was 27.03％ (30/111) (P＜0.05),all lower than those of Ⅵ bl.The one-way ANOVA results showed that metastasis of the right side lymph node behind RLN (Ⅵ b2) was related with age,lateral neck dissection,and Ⅵ b1 lymph node metastasis (P＜0.05) while Ⅵ bl lymph node metastasis was the only independent risk factor for metastasis of the right side lymph node behind RLN(Ⅵ b2) in PTC.Conclusion For patients with right PTC,the metastasis rate of Ⅵ b2 is high,thus dissection of this area is favorable and can accurately reflect lymph node metastasis and further to guide tumor staging and postoperative treatment.

Clinical utility of needlescopic in hemithyroidectomy and central neck dissection through bilateral breast approach / 中华外科杂志

<p><b>OBJECTIVE</b>To study application of needlescopic assisted hemithyroidectomy and central neck dissection using bilateral breast approach.</p><p><b>METHODS</b>Totally 145 cases of papillary thyroid cancer patients received endoscopic hemithyroidectomy in Fujian Medical University Union Hospital were randomized to needle assisted endoscopic group (NE group, n=81) and conventional endoscopic group (CE group, n=64). The average age of the patients was 35.9 years and 11 patients were male.All patients underwent hemithyroidectomy and central neck dissection through bilateral breast approach, the NE group additional used the MiniLap-assisted intraoperation.The operative time, postoperative complications and cosmetic results were analyzed by t-test and χ(2) test.</p><p><b>RESULTS</b>The operation time of thyroid gland in NE and CE Group was (42±7) min and (31±7) min(t=9.082, P=0.000), respectively. The operation time of central neck dissection was (33±6) min and (26±3) min (t=9.050, P=0.000), respectively.There were 4 cases occurs transient recurrent laryngeal nerve paralysis in CE group and no case occur in NE group(χ(2)=5.206, P=0.036). There was no significant different in other postoperative complications and cosmetic results.</p><p><b>CONCLUSIONS</b>Hemithyroidectomy and central neck dissection using bilateral breast approach and needlescopic assisted technique isa safe and reliable approach, with high cosmetic effect. Application needle assistive devices can shorten the operation time while no significant increase trauma in patients, it will makes endoscopic thyroid surgery easier to promote.</p>

Encephalo-duro-myo-synangiosis for the treatment of children w ith moyamoya disease:long-term angiography and clinical outcome / 国际脑血管病杂志

Objective To investigate the long -term angiography and clinical outcome of encephalo -duro-myo-synangiosis (EDMS) for the treatment of children w ith moyamoya disease. Methods The clinical and imaging data of before and after procedure in children w ith moyamoya disease treated w ith EDMS w ere analyzed retrospectively. Results A total of 21 children w ith moyamoya disease w ere enroled, including 13 females and 8 males, aged 4 to 16 years. The initial symptom: transient cerebral ischemic attack in 15 cases, ischemic stroke in 4 cases, and hemorrhagic stroke in 2 cases. Matsushima clinical classification: type Ⅰ in 8 cases, type Ⅱ in 7 cases, type Ⅳ in 3 cases, type Ⅴ in 1 case, and type Ⅵ in 2 cases. Suzuki stage: stageⅡ in 4 cases, stage Ⅲ in 11 cases, stage Ⅳ in 5 cases, and stage Ⅴ in 1 case. Ten children underw ent bilateral operation and 11 underw ent unilateral operation (a total of 31 sides). They w ere folow ed up for 13 to 91 months (mean 39.8 months). Three children had transient ischemic attack, 2 had cerebral infarction, 7 had facial edema, and none of them died during the perioperative period. The clinical symptoms w ere improved significantly in 14 sides (45.2%), good in 13 sides (41.9%), and general in 4 sides (12.9%) 1 year after operation. The proportion of children w ith modified Rankin Scale (mRS) score 0-2 after operation w as significantly higher than that before procedure (95 .2% vs.71.4%; χ2 = 4.29, P = 0.041). The middle meningeal artery and deep temporal artery participated in the blood supply of cerebral cortex in different degrees w ere observed by cerebral angiography again for 31 sides, excelent in 25 (80 .6%) and fair in 6 (19.4%). Conclusions The long-term angiography and clinical outcome in children w ith moyamoya disease treated w ith EDMS is good.

Academic thoughts of "pushing meridians to treat viscera diseases" in LIU' s infantile tuina in Xiangxi area / 中国针灸

As one of the most important schools of Chinese infantile tuina, the main academic thoughts of LIU's infantile tuina in Xiangxi area ware "pushing the meridians". In clinical treatment; he focuses on zang-fu syndrome differentiation and meridians tropism treatment, and based on the generation-inhibition of five elements as well as the infantile physiological and pathological characteristics, the "pushing meridians to treat viscera diseases" was gradually developed, which has enriched the academic connotation and performed a better guide for clinical pediatric treatment.

Retrospective study for the risk factors of the early complication after carotid endarterectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To review the influencing factors of the early complication after carotid endarterectomy (CEA).</p><p><b>METHODS</b>Retrospective analysis of clinical data of 509 cases received CEA in Xuan Wu Hospital of Capital Medical University, Liaocheng People's Hospital and Dalian Central Hospital from January 2001 to December 2011. There are 422 male patients and 72 female patients among the 494 patients, 15 patients underwent CEA by stages. The patients were between 35-84 years old,and the mean age was (64 ± 9) years. The complications within 30 days after CEA were analyzed, and find the risk factors for the major adverse events. Chi-square analysis was performed to analyze the correlation between the each variable of the basic characteristics of population, clinical features and intraoperative data and early adverse events after CEA. Logistic regression analysis was used to assess the relationship between a variety of factors and the postoperative complications within 30 days.</p><p><b>RESULTS</b>Technical complete rate of 98.6%, 7 cases of near-total occlusion patients could not been recanalized. Major complications in 30 days after CEA occurred in 20 cases (3.9%), including 6 cases of deaths (1.2%), 9 cases of cerebral infarction (1.8%) and 5 cases of cerebral hemorrhage (1.0%). Secondary complications occurred in 120 cases (23.6%). Univariate analysis showed modified Rankin scale (mRS) ≥ 3 on the incidence of early postoperative complication had significantly difference (χ² =20.517, P < 0.01), multivariate logistic regression analysis revealed that smoking (OR=2.667, 95% CI: 1.048-6.791, P=0.040) and mRS ≥ 3 (OR=8.690, 95% CI: 3.279-23.031, P=0.000) were the significant predictors of 30 days of the end event.</p><p><b>CONCLUSION</b>The complications after CEA are uncommon, the security is proved. Smoking and mRS ≥ 3 can increase the risk of CEA.</p>

Impact of orotracheal intubation by Macintosh laryngoscopy versus Shikani optical stylet on blood pressure and heart rate / 实用医学杂志

Objective To compare the hemodynamic response to orotracheal intubation by Macintosh laryngoscopy (MAC) with Shikani optical stylet (SOS). Methods Forty neurosurgical patients, ASA physical status Ⅰ~Ⅲ, were prospectively randomized to MAC group (n = 20) and SOS group (n = 20) according to the method of orotracheal intubation. Heart rate (HR) and invasive systolic blood pressure (SBP) were recorded at pre- and post-intubation. Results The intubation time was significantly longer in SOS group than in MAC group [(22 ± 8) s vs. (17 ± 8) s, P < 0.05]. SBP in both groups decreased significantly after induction (P < 0.05) and increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ at 3, 4 and 5 min. HR in both groups did not differ significantly between the SBP after induction. HR in both groups increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ markedly at 3, 4 and 5 min after induction. There were no significant differences in the peak SBP and HR between the two groups. Conclusion MAC and SOS cause similar hemodynamic responses to orotracheal intubation.

Construction of teaching case base in forensic toxicology / 中华医学教育探索杂志

At present, the theory and experiment teaching of forensic toxicology are faced with difficulties such as lake of practical cases and toxic types, content being abstract and difficult to un-derstand. On that account, we collected and collated many typical cases from Public Security Bureau and our school's medico legal expertise center, and then a relatively systematic and complete teaching case base in forensic toxicology has been constructed, and will be supplement constantly, so as to pro-vide extensive teaching resources and improve the teaching quality of forensic toxicology.

Reverse trendelenburg position can alleviate postoperative nausea and vomiting in thyroid surgery: from Logistic multivariate analysis / 中华内分泌外科杂志

Objective To assess the clinical significance of reverse trendelenburg position in preventing postoperative nausea and vomiting(PONV)in thyroid surgery.Methods 110 patients with papillary thyroid carcinoma(PTC) admitted from Feb.2013 to Mar.2014 were prospectively divided into experimental group and the control group according to whether reserve trendelenburg position was adopted.Univariate and multivariate method were used to analyze relations between PONV and surgical position,gender,age,body mass index,hypertension,surgical time,ASA classification,anesthesia,and motion sickness.Results Of the 110 cases of PTC,the incidence of PONV was 16.28％ (7/43) in the experimental group while it was 37.31％ (25/67) in the control group.The difference had statistical significance(P ＜ 0.05).Statistical analysis showed that PONV was related to patients'gender,surgical position,surgical time,and motion sickness,while only surgical position and motion sickness was the independent risk factors.Conclusion Reverse trendelenburg position surgery can help to prevent PONV and promote recovery.

Effect of kinking on internal carotid artery hemodynamics / 中国综合临床

Objective Colour ultrasound was used to detect the hemodynamic changes in patients with internal carotid artery kingking,in order to investigate the relationship between the carotid distortion angle and blood flow changes and to explore the assessment of severe internal carotid artery twist operation indications.Methods Forty-five patients with carotid artery kingking hospitalized in the Brain Hospital of Liaocheng were performed colour ultrasound to detect systolic blood flow velocity (PSV), end-diastolic velocity EDV) and to measure the angle of carotid artery kingking.Results According Metz classification, of the 45 patients, Ⅰ level 17 cases, Ⅱ level 17 cases, Ⅲ level 11 cases.With the decrease of carotid distortion angle,the influence on hemodynamics was more and more obvious, especially while the angle less than 30 degrees, the carotid artery blood flow was severely affected.The difference of PSV before and after Kinking was statistically significant in patientes of Metz Ⅲ level (Z=-2.934,P=0.003) and Metz Ⅱ level (Z=-3.053,P=0.002), but was statistically no significant in patientes of Metz Ⅰ level (Z=-0.382, P=0.702).There was a negative correlation between the ratio of the twist angle and PSV before kinking/PSV after kinking (rz =-0.842, P ＜0.05),that was, with the decrease of the twist angle, PSV before kinking/ PSV after kinking increase accordingly.Conclusion Kinking seriously affect the carotid artery blood flow dynamics.Ultrasound can accurately detect distortions arterial hemodynamics

Therapeutic Observation of Ultrastructural Dense Acupotomy Treatment for Lumbar Intervertebral Disc Herniation / 上海针灸杂志

Objective To observe the therapeutic efficacy of ultrastructural dense acupotomy treatment in treating lumbar intervertebral disc herniation (LIDH). Methods Seventy-two LIDH patients were randomized into a treatment group and a control group, 36 in each group. The treatment group was intervened by ultrastructural dense acupotomy treatment, while the control group was by conventional acupuncture. The therapeutic efficacy was evaluated after a course of treatment. The visual analogue scale (VAS) was adopted for assessing pain, and the Japanese Orthopaedic Association (JOA) score for estimating the symptoms, signs, and functional activities. Results The VAS and JOA scores were significantly changed in both groups after intervention (P＜0.01). There were significant differences in comparing the changes of VAS and JOA scores between the two groups (P＜0.01, P＜0.05). The total effective rate was 97.2% in the treatment group versus 80.6% in the control group, and the difference was statistically significant (P＜0.05). Conclusion Ultrastructural dense acupotomy treatment is an effective approach in treating LIDH.

Effects of repetitive transcranial magnetic stimulation on cognitive function in patients with mild cognitive impairmen / 临床神经病学杂志

Objective To explore the effects of repetitive transcranial magnetic stimulation ( rTMS ) on cognitive function in patients with mild cognitive impairmen ( MCI).Methods Fifty patients with MCI were randomly divided into rTMS treatment group ( rTMS group ) and piracetam treatment group ( control group ) , 25 patients in each group .The stimulated point of rTMS treatment were in the bilateral prefrontal area , for one time a day, continuous treatment for 6 d as a courses in rTMS group patients .Two courses of treatment was interval of 3 weeks, a total of 4 courses.The patients of control group were treated with piracetam 0.8 g, 3 times a day, for taking 16 weeks.Before and after treatment, the event-related potentials P300 and Montreal Cognitive Assessment (MoCA) scale examination were taken in two group respectively .Results Compared with before treatment , the P300 latency significant was significantly shortened and amplitude increased , scores of MoCA scale and delay memory were significantly increased (P<0.05-0.01) after treatment in the rTMS group.Compared with the control group, the difference of those had statistical significance ( all P<0.05 ) .The difference of those had no statistical significance before and after treatment in control group .Conclusion rTMS treatment can improve memory and cognitive in patients with MCI .It can delay the progress of dementia to some extent .

The Treatment of Severe Intraventricular Hematoma through Midfrontal Keyhole Approach / 天津医药

Objective To evaluate the clinical value of midfrontal keyhole approach for the treatment of severe intra-ventricular hematoma. Methods The clinical data of 21 cases of severe intraventricular hemorrhage through midfrontal key-hole approach were analyzed retrospectively. Results Both inside and outside intraventricular hematoma were satisfied cleared. The GCS score and intraventricular hemorrhage Graeb score were improved. There were complications after opera-tion including 1 patient with diffuse brain swelling, 3 patients with cerebral vasospasm, 1 patient with intracranial infection, and seven patients with pulmonary infection. Follow-up schedules included 1-6 months. According to ADL score, 5 patients recovered well, 9 patients were moderately disabled, 3 were severely disabled, 1 was in a vegetative state and 3 died. Conclu-sion The intraventricular hematoma can be removed through midfrontal keyhole approach. The obstructive hydrocephalus can be relieved, the secondary brain damage was reduced and the prognosis was improved in patients.

Clinical analysis of 32 patients with symptomatic carotid stenosis treated by eversion carotid endarterectomy / 中国医师进修杂志

Objective To review the experience and early clinical results of eversion carotid endartotectomy (eCEA) in treatment of patients with symptomatic carotid stenosis. Methods eCEA were performed on 32 patients who suffered from the extracranial carotid stonosis. The treatment results were retrospectively reviewed. Results Thirty-two patients were successfully treated with eCEA. The symptom in 17 patients with transient ischemia attach (TIA) admitted to hospital did not recurrence, the other original symptoms of the patients had different degrees of improvement or disappeared. Two patients had TIA during 72 h after surgery, but 24 h repeatedly CTA examination without infarcts oecurring, and recovered after the treatment of small doses of urokinase. Two cases of severe swelling appeared tracheal shift incision, and went smoothly through edema by treatment of tracheal intubatian. In 4 patients headache reliefed in 2-3 d after medical treatment of the dehydration. Seven patients appeared different degree of hoarseness, and got recovery through neurotrophic medication for 1 month. No other serious complication occurred. Follow-up by 6 months, no CTA carotid artery stenosis appeared again. Conclusion eCEA is an effective method to treat symptomatic carotid stenosis.

Experiment of skeletal muscle regeneration using autologous fascia as scaffold / 中国组织工程研究

BACKGROUND: There is nearly no muscle tissue with satisfactory function and appearance applying in clinical repair and construction of injured muscles to date. OBJECTIVE: To investigate the feasibility of applying autologous fascia as a scaffold to construct muscle in vivo. DESIGN, TIME AND SETTING: The randomized, self-matched control experiment was carried out between January 2004and June 2006 at Department of Burns & Plastic Surgery, Second Hospital of Shenzhen, Shenzhen, Guangdong Province, China MATERIALS: Twenty-eight healthy New Zealand rabbits, weighing (1.7±0.5) kg, without sex restriction, establishing middle part defect model of anterior tibial muscle of rabbit hind legs. METHODS: One hind leg of each rabbit was randomized to the experimental group (n=28), the other hind leg was assigned to one of 3 control groups, scaffold-connected group (n=10), muscle particle implant group (n=10) and blank control group(n=8). In experimental group, the defect was connected with an autologous fascial scaffold and filled with the mutilated muscle particles, and subcutaneous tissue and skin were sutured in situ. In scaffold-connected group, the treatments were same to the experimental group only except muscle particle implantation. In muscle particle implant group, the defect was filled with muscle particles but without fascial scaffold and other treatments were same to the experimental group. The defect in blank control group received no treatment. MAIN OUTCOME MEASURES: The success rate of muscle transplantation, histological and ultra structural observation,and immunohistochemical identification of desmin were observed at 2, 3, 4, 6 and 9 weeks after operation. The middle parts of samples were also harvested for relative quantitative analysis of α-actin cDNA using reverse transcription-polymerase chain reaction in the experimental group and scaffold-connected group.RESULTS: In experimental group, 1 muscle broke near the proximal junction, the other 27 succeeded and the appearance of healed defects became near normal gradually. In scaffold-connected group, 4 muscles broke, 6 muscles still depressed in defect area; in muscle particle implant group and blank control group, the defects had no change. In experimental group, a large quantity of skeletal muscle satellite cells proliferated, which reached peak at 2-3 weeks, cells attached to the ends of fibrous connective tissue; in scaffold-connected group only fibrous connective tissue was seen. lmmunohistochemistry showed that 85% cells in experimental group were desmin-positive, while the positive rate in scaffold-connected group was < 25%. The relative quantitative analysis of α -actin cDNA showed that there were significant differences between the experimental group and scaffold-connected group at different time points(P < 0.05).CONCLUSION: The success rate of repairing muscle defect with autologous fascial scaffold reached 93.33%, which indicates that it is feasible to promote muscle regeneration with autologous fascial scaffold.

Quantitative Eschar Shaving with Epidermal Sheet Graft for DeepⅡ Burns in Hands / 昆明医科大学学报

Objective Introducing a technique of quantitative eschar shaving with great sheet of epidermal grafting for deep Ⅱdegree burns in hands.Method 148 hands from 112 patients were treated with this methods.From Jan.2001 to Jane 2004,patients who suffered from deep Ⅱdegree burn injuries was quantitatively eschar shaving using electrical or air power dermatome which was fixed at scale mark from 0.012 inc 、0.016 inc to 0.02inc(from 0.3mm 、0.4mm to 0.5mm) according to the burn injury extents,the wounds were divided into three groups just depends on the injury extents,also the wounds was covered with the different thickness of great sheet of epidermal grafting,which was obtained using the electric or air dermatomes.Results There were 148 hands of 112 cases were treated with this technique within 2h.to 72h after injury.The scar thickness was ranged from 0.4mm to 0.8mm,the function of these hands was good,and the shape of hands looks good.Conclusion Good results was obtained with this methods,the wounds covered with the large sheet of epidermal grafting harvested by the quantitative eschar shaving is recovered uneventful.The thickness of the grafting was according to the increasing skin thickness after burns.