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【Objective】 To compare the efficacy and safety of oxycodone and sufentanil in transition analgesia after radical surgery of cervical cancer under general anesthesia. 【Methods】 A randomized, double-blind study was conducted. We randomly divided 68 patients on radical surgery of cervical cancer under general anesthesia into two groups: Group S (sufentanil in transition analgesia) (n=35) and Group O (oxycodone in transition analgesia) (n=33). Patients in Group S received sufentanil (0.1 μg/kg for endoscopy procedures or 0.15 μg/kg for laparotomy procedures), whereas patients in Group O received oxycodone (0.1 mg/kg for endoscopy procedures or 0.15 mg/kg for laparotomy procedures) 30 min before the end of operation as transition analgesia. We recorded the time of consciousness recovery and extubation, RSS restlessness score, the number of cough times, Ramsay score, Numerical Rating Scale (NRS) at rest in extubation immediately (T0), 30 min after extubation (T1), 1 h after extubation (T2), 2 h after extubation (T3), 4 h after extubation (T4), 12 h after surgery (T5), 24 h after surgery (T6), and the incidence of adverse complications within 24 h after operation. 【Results】 Compared with those in Group S, patients in Group O showed shorter time of consciousness recovery (4.28±3.35 vs. 5.53±2.25, P=0.027), shorter time of extubation (5.92±3.67 vs. 8.09±2.49, P=0.001), lower RSS restlessness score (0.38±0.49 vs. 0.83±0.63, P<0.001), smaller number of cough times (0.96±0.78 vs. 1.34±0.93, P=0.026), lower Ramsay score (2.3±0.58 vs. 2.63±0.85, P=0.017), and lower NRS score at rest in T3 and T4 (2.64±0.63 vs. 3.14±0.66; 2.86±0.81 vs. 3.69±0.75) (P<0.001). The incidence of nausea and vomiting was lower in Group O than in Group S (9.09% vs. 20%; 3.03% vs. 11.43%). 【Conclusion】 Both oxycodone and sufentanil provide adequate pain relief in transitional analgesia after radical surgery of cervical cancer under general anesthesia. However, oxycodone shows longer analgesia, faster recovery, and a lower incidence of side effects than sufentanil.
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Objective:To investigate the clinical significance and correlation between blood glucose variability and cognitive impairment in elderly patients with metabolic syndrome.Methods:A total of 80 elderly metabolic syndrome patients and 50 healthy controls in Chinese People′s Armed Police Corps Hospital in Sichuan Province from December 2017 to March 2019 were selected as study group and control group respectively, and the difference of general data and biochemical indicators between two groups were compared. The cognitive function of the metabolic syndrome patients was measured by Montreal cognitive assessment scale (MoCA) at admission. The patients were divided into cognitive dysfunction group and normal cognition group according to MoCA score. The glycemic variability was detected by 72-h dynamic monitoring of blood glucose started within 24 h after admission, and the difference of average blood glucose (Glu Ave), standard deviation of glucose (Glu SD), mean amplitude of glycemic excursions in 24 h (MAGE), glycemic index (GLI), glucose variability (Glu CV) and other indicators between cognitive dysfunction group and normal cognition group were also compared. Results:The levels of body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterin (LDL-C), glycated hemoglobin (HbA 1c) were significantly increased in the study group [(25.48 ± 3.86) kg/m 2 vs. (22.83 ± 4.60) kg/m 2, (139.09 ± 10.17) mmHg (1 mmHg = 0.133 kPa) vs. (128.12 ± 7.8) mmHg, (73.00 ± 6.65) mmHg vs. (69.90 ± 5.99) mmHg, (9.12 ± 1.54) mmol/L vs. (4.92 ± 0.63) mmol/L, (2.17 ± 0.49) mmol/L vs. (1.70 ± 0.48) mmol/L, (5.32 ± 0.62) mmol/L vs. (4.61 ± 0.45) mmol/L, (3.05 ± 0.79) mmol/L vs. (2.31 ± 0.53) mmol/L, (7.89 ± 1.92)% vs. (5.30 ± 0.56)%], high density lipoprotein cholesterol (HDL-C) were significantly decreased in the study group [(0.98 ± 0.25) mmol/L vs. (1.19 ± 0.43) mmol/L] compared to the control group, and the differences were statistically significant ( P<0.05). The disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV were markedly increased in the cognitive dysfunction group compared to those in the normal cognition group [(7.39 ± 1.87) years vs. (6.50 ± 1.52) years, (8.52 ± 2.21)% vs. (7.32 ± 1.21)%, (11.6 ± 3.35) mmol/L vs. (9.84 ± 2.19) mmol/L, (2.98 ± 0.54) mmol/L vs. (2.17 ± 0.47) mmol/L, (1.19 ± 0.46) mmol/L vs. (0.71 ± 0.28) mmol/L, 95.83 ± 19.77 vs. 86.94 ± 15.22, (27.96 ± 10.38)% vs. (23.02 ± 8.16)%]( P<0.05). Logistic regression model showed that disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV were independent risk factors for the cognitive impairment in elderly patients with metabolic syndrome.In addition, there were positive correlation between MoCA score and disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV ( P<0.05). Receiver operating characteristic curve demonstrated that GluSD>2.56 mmol/L [area under the curve (AUC)=0.897] or (and) MAGE>1.11 mmol/L (AUC = 0.821) may indicated the occurrence of cognitive impairment. Conclusions:Glu Ave, Glu SD, MAGE, GLI and Glu CV are all correlated with cognitive dysfunction in elderly patients with metabolic syndrome, and Glu SD and MAGE may be considered as a potential maker for prediction of cognitive dysfunction.
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Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.
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Objective To prepare PTD4-Cu,Zn-SOD fusion protein.Methods The recombinant plasmid of pET 1 6b-Cu,Zn-SOD and pET16b-PTD4-Cu,Zn-SOD was transformed into Escherichia coli BL21 (DE3).Isopropyl β-D-1-thiogalactopyranoside was then added at a final concentration of 0.84 mmol/L,and the cells were incubated for 4 h to induce the expression of Cu,Zn-SOD and PTD4-Cu,Zn-SOD fusion protein.Lysozyme and ultrasound were used to lyse the bacteria,the supernatant was collected for 15％ SDS-PAGE to analyze the expression of the target protein.Ni-NTA His bind resin was used to purify Cu,Zn-SOD protein and PTD4-Cu,Zn-SOD fusion protein under natural conditions.Western blot was used to identify the target protein.Results The results of Western blot showed that the purity of the target protein was about 90％,and the Cu,Zn-SOD protein with a molecular weight about 19 kDa and the PTD4-Cu,Zn-SOD fusion protein with a molecular weight about 20 kDa were found.Conclusion PTD4-Cu,Zn-SOD fusion protein is prepared successfully.
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Objective To discuss the operative strategies for cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis.Methods Retrospectively analyzed 21 cases of cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis,who underwent surgeries from January,2007 to August,2014.Twenty males and 1 female were included.Mean age was (48.6±7.5) years (range,36-65 years).The preoperative American Spine Injury Association (ASIA) classification distribution:2 cases of Grade A,6 cases of Grade B,7 cases of Grade C,5 cases of Grade D,and 1 case of of Grade E.The investigative surgical methods including posterior cervical open reduction,internal fixation and bone graft fusion;posterior cervical open reduction/decompression,internal fixation and bone graft fusion;or combined posterior and anterior cervical decompression,bone graft fusion and instrumentation.The operative time and blood loss were recorded,the clinical therapeutic effect was evaluated by visual analogue scale (VAS) score,ASIA grade improvement,cervical curvature (the angle between a line drawn parallel to the inferior endplate of C2 and a line drawn parallel to the inferior endplate of C7 in the lateral plane of an X-ray image) and radiological assessment (including bone graft fusion condition and internal fixation position).Results One case died from severe pulmonary infection and respiratory failure at the 45th day after operation.All the other 20 patients obtained complete follow-up with a mean time of (39.4±8.76) months (range,25-59 months).7 cases received posterior cervical open reduction,internal fixation and bone graft fusion,average operative time was (92.1±5.4) minutes and average blood loss was (96.1+23.7) ml.9 cases received the posterior cervical open reduction and decompression,internal fixation and bone graft fusion,mean operation time was (121.4± 14.0) minutes and blood loss was (250.0±38.9) ml.3 cases experienced combined posterior and anterior cervical decompression,bone graft fusion and fixation,average operative time was (222.4± 14.9) minutes and average blood loss was (354.3+46.7) ml.Mean of VAS scores at the 3th month postoperatively was 2.76±0.46,significantly lower than the preoperatively VAS scores (8.95±0.36).Mean of VAS scores at the 24th month postoperatively was 1.77±0.39,significantly lower than those at the 3th month postoperatively.The neurological function of spinal cord achieved significant improvement after operations and continued recovered gradually in the subsequent follow up.ASIA Classification distribution at the 24th month postoperatively was:0 case of Grade A,0 case of Grade B,3 cases of Grade C,8 cases of Grade D,9 case of Grade E.Mean of the cervical curvature after operation was-7.1°± 1.9°,significantly higher than preoperatively(-13.4°±3.3°) and did not have any loss of Cobb's angles at 24th month after operation.All the surviving cases achieved solid bone graft fusion.Mean bone graft fusion time was 5.8 months (range,4-9 months).There was no internal fixation loose,fracture and dislocation occurred during follow up.Conclusion All procedures can significantly relieve the painful symptoms,effectively restore the normal cervical alignment and stability,and remarkably improve the neural function of the patients suffering cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic junction kyphosis.
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BACKGROUND:Previous studies designed and made titanium metal rubber cervical disc prosthesis, and performed feasible studies on its effect on movement and stress distribution by replicating intervertebral discs. OBJECTIVE:To further observe the changes in the stability of goat cervical vertebra after metal rubber cervical disc replacement. METHODS:Nine goats were randomly divided into experimental group (n=6) and normal control group (n=3). Goats in the experimental group received metal rubber cervical disc replacement at C4/5segment. Goats in the normal control group did not receive any treatment. Radiographic data at anteroposterior and lateral position, hyperextension and excessive flexion were taken to measure intervertebral height, range of motion and intervertebral angle at C4/5 segment before operation, immediately, 4, 8, 12 weeks after operation. Subsequently, slicing and embedding of hard tissue at surgical segment, picric acid-acid fuchsin staining and scanning electron microscopy were conducted.RESULTS AND CONCLUSION:No significant difference in the intervertebral height and spinal range of motion at C4/5 segment at different time points was detected between postoperative results in the experimental group and preoperative results in the experimental group, normal control group. The intervertebral height at C4/5 segment was higher immediately, 4 and 8 weeks after surgery than preoperative result in the experimental group (P < 0.05). No significant difference in intervertebral angle at C4/5 segment was detectable between 4, 8 and 12 weeks postoperatively in the experimental group and normal control group (P < 0.05). At 4 weeks after surgery, bone did not contact with the edge of the prosthesis in the experimental group. At 8 weeks, the gap between bone and the prosthesis became smal, and some new bone attached to the edge of the prosthesis. At 12 weeks, a few osteoblasts were observed on the surface of the prosthesis. New osteogenic tissue grew into the prosthesis. Results suggested that metal rubber cervical disc replacement in the intervertebral space could maintain intervertebral height and range of motion in a short period, and tightly bind to the vertebral body.
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Objective To summarize the clinical efficacy of suture anchors in repairing the delayed Achilles tendon rupture.Methods From January 2010 to December 2013,23 patients with delayed Achilles tendon rupture were treated using the suture anchors.There were 19 males and 4 females,at mean age of 43 years (range,35-53 years).Injury on the left side occurred in 5 patients and right side in 18 patients.Mean time from injury to operation was 26.3 days (range,21-40 days).Ten patients were diaguosed by ultrasound and the other by MRI.All patients underwent suture anchor fixation without external support.Functional training started at the early stage.Incision complications were detected.Ankle flextiou-extension range,American Orthopedic Foot and Ankle Society (AOFAS) score,maximum bilateral leg circumference,tendon rerupture and walking posture were recorded at postoperative 6,12,18 and 24 months.Achilles tendon muscular strength was measured with the Lunsford-Perry heelrise test.Results Follow-up was 24 months.All incisions healed by first intention without sural nerve injury,adherence with skin and deep infection.Six months after operation,the ankle range of motion was dorsiflexion 10.8° (range,9-15°) and plantar flexion 43.8° (range,40-48°),with no significant difference in comparison to the health side (P ＞ 0.05).AOFAS score differed significantly before and after operation (P ＜ 0.01).Maximal leg circumference was 38.2 cm in the health side versus 35.8 cm in the injury side (P ＜ 0.05),but the difference was no more than 3 cm.All patients completed 25 times heel raising without difficulty.Four patients walked with a slight limp and recovered from the limp 12 months after operation.No Achilles tendon ruptured again during the follow-up time.Conclusions Repairing the old Achilles tendon rupture with suture anchors can supply strongly strain between broken ends of the tendon,and the outer cast is not needed after operation.Complications are less and functional practice can be commenced in the early postoperative period for better function restoration.
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ObjectiveTo summarize the application experience of laparoscopic totally extraperitoneal prosthetic(TEP) for inguinal hernia in grass-root hospitals.MethodsThe clinical data of 63 cases of inguinal hernia treated by TEP were retrospectively analyzed,and operation scheme suited to the actual conditions of grass-root hospitals was summed up.ResultsAmong the 63 cases,5 cases were treated by transabdominal preperitoneal repair of inguinal hernia(TAPP) to complete the operation because of relatively serious peritoneal rupture.No case was converted to open surgery.11 cases were subjected to continuous epidural anesthesia and the other cases to endotracheal anesthesia.17 cases gained satisfactory result withoutstapling fixation.Among them,a few people had postoperative complications:3 cases of pneumoscrotum,1 case of hematoma of scrotum and 2 cases of early groin pain.No case recurred.ConclusionTEP is a safe and effective operation method in grass-root hospital for inguinal hernia repair.A reasonable selection can be taken according to the individual condition of patients including operation,anaesthesia,mesh style and stapling fixation,to ensure the operation quality,to reduce the medical wst and to reduce the economic burden of the patients.
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Objective To evaluate a surgical approach and anastomosis for the treatment of carcinoma of the gastric cardia. Methods Transabdominal intramediastinal esophagogastric anastomosis covered by sero-muscular flap of gastricwall for cardial carcinoma in 187 cases. Results The method reached the satisfactory surgical result in terms of tumor free cut edge on esophagus end of the resected samples. And the morbidity rate was 5.8%. Conclusion The technique enables lymphadenectomy within the lower mediastinum and a sufficiently long enough resection of esophagus. Transabdominal incision of the crus dextrum of the diaphragm makes a clear operative field for the purpose of radical operation for carcinoma of the gastric cardia. The anastomosis effectively prevents anastomotic leakage. This procedure is indicated for cardial carcinoma cases in which the esophaged involvement is within 2cm.