ABSTRACT
BACKGROUND:One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases,but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation. OBJECTIVE:To observe the position relationship of nerve roots,intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology,and to provide a basis for the clinical operation of one-hole split endoscope surgery. METHODS:Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan.Mimics 17.0 software was imported to measure the related imaging parameters of L1/2 to L3/4 segments:(1)Measurement of vertical distance:In coronal view,the distance(a)from the intersection point of the medial facet of the superior articular process and the superior endplate(N)to the apex of the articular process(S);in the coronal view,the distance(b)from the sagittal intersection(M)of N and the inferior endplate to the apex of the inferior articular process(X).(2)Measured horizontal distance:the distance(c)between the cross-section of N and the lower edge of the outlet nerve root(N2);distance(d)between the cross-section of N and the intersection point of neural tissue(N1);N1 to N2 distance(e);distance(f)between the cross-section of M and the lateral edge of the nerve tissue(M1);M to M cross-section and exit nerve root intersection(M2)distance(g);distance(h)from M1 to M2;distance(i)from M2 to N1;distance(j)from the posterior edge of the articular surface(R)to M2 in sagittal view of the superior articular process. RESULTS AND CONCLUSION:(1)With the decrease of the segment,the distances a and b gradually increased,and the distance j gradually decreased.There was no significant difference between L1/2 and L2/3 segments(P>0.05).(2)With the decrease of the segment,distance d first decreased and then increased;distance f gradually decreased;distances c,e,g,h and i gradually increased;and there was no significant difference between L2/3 and L3/4 segments(P>0.05).(3)Distance i was the shortest distance without pulling nerve roots in the natural state,and the area of the safety zone was between four points M1,M2,N1,and N2.The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X,respectively,to expose the intervertebral space,and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots.(4)In conclusion,the upper lumbar vertebrae have unique anatomical characteristics.Based on the relevant measurements of nerve roots,spinal dura and intervertebral space,the parameters of the one-hole split endoscope technique are more accurate and safe during operation.
ABSTRACT
Objective To investigate the epidemiological characteristics of chronic obstructive pulmonary disease (COPD) in patients aged 65 years and above in Liaoning Province. Methods Between January 2019 and December 2020, a cluster random sampling method was used to investigate residents ≥ 65 years old in Sujiatun Community, Shenyang City, Liaoning Province. The pulmonary function tests of the selected residents were conducted. Questionnaire surveys were carried out and 5738 questionnaires with complete data were analyzed. Results A total of 620 COPD cases were diagnosed among 5738 people investigated in the present study, with a total prevalence rate of 10.81%, of which the prevalence rate in men was 12.58% (371/2950), and the prevalence rate in women was 8.93% (249/2950). According to the GOLD classification of lung function, 620 patients can be divided into 186 (30.49%) cases of grade I, 266 (43.61%) grade II, 118 (19.34%) grade III, and 50 (8.20%) cases of grade IV. The problem with lung function in males was more serious than that in females, which increased gradually with age (P<0.05). Multivariate logistic regression analysis showed that gender, age, BMI, smoking, childhood respiratory history, family history, occupational exposure, indoor oil fume and use of polluted fuel for heating were independent risk factors affecting the onset of COPD (P<0.05). Conclusion The prevalence of COPD in patients aged 65 years old and above in Liaoning is relatively high. Gender, age, BMI, smoking, childhood respiratory history, family history, occupational exposure, indoor oil fume, and use of polluted fuel for heating are related to the onset of COPD. Clinical attention should be paid to early screening and prevention of COPD in those populations to reduce the prevalence of COPD..
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Objective To determine the important functional units of medical endoscopes and provide a theoretical basis for improving the maintenance and repair of hospital medical equipment.Methods The units of medical endoscopes were analyzed by the failure mode effects and criticality analysis (FMECA) method to determine the important functional unit.The maintenance methods of the important functional units were proposed and compared with those obtained by a medical equipment repair company.Results According to the risk priority number (RPN) score＞ 36,the important functional units of the medical endoscope were determined as electrical interface,water bottle interface,suction interface,housing,chain,pliers pipeline,water gas pipeline,jacket,charge coupled device (CCD) glass,guided beam glass and nozzles.These units require clinical operators to focus on and perform regular maintenances.Compared with the results obtained by the company,human factors were considered as a greater impact on the reliability of medical endoscopes.Conclusions For clinical operators,the operation training of medical endoscopes should be strengthened to avoid human-induced failures.
ABSTRACT
Under normal conditions,insulin secreted by the pancreas enters the liver through the portal vein,forming a difference in insulin concentration above the peripheral circulation.Subcutaneous administration of insulin forms a portal-peripheral concentration gradient of insulin above the liver,which is inconsistent with normal physiological conditions.Intraperitoneal insulin administration has been extensively investigated because that is closer to physiological state.In this paper,the pharmacokinetic and pharmacodynamic studies of insulin intraperitoneal administration were reviewed.Compared with the conventional subcutaneous delivery,intraperitoneal insulin administration can not only reduce the incidence of hypoglycemia,but also has the advantage of correcting abnormal lipid metabolism.This means that intraperitoneal administration of insulin has a positive effect on the prevention and treatment of diabetic complications.Therefore,it is necessary and feasible to develop a safe,low-cost,and easy-to-use percutaneous intraperitoneal insulin delivery device.