Three-dimensional laser combined with C-arm computed tomography-assisted puncture of intracerebral hemorrhage.

Background: Intracerebral hemorrhage (ICH) is the deadliest subtype of stroke, with a 30-day case fatality rate of approximately 40%. Timely and accurate treatment is essential to facilitate recovery. The introduction of stereotactic instruments and navigation systems has greatly improved the accuracy of surgical treatment. In this study, we explored the application and effects of a three-dimensional (3D) laser combined with C-arm computed tomography (CT) on ICH puncture. Materials and methods: According to the principle of randomness, 118 patients with ICH were divided into control and experimental groups. The control group was treated with CT-guided puncture, and the experimental group was treated with 3D laser combined with C-arm CT puncture. The hematoma clearance rates at 3, 5, and 7 days after surgery and the prognosis at 1, 3, and 6 months after surgery were compared between the two groups. Results: The hematoma clearance rates of the group using 3D laser combined with C-arm CT at 3, 5, and 7 days after surgery were significantly higher than those of the control group, and the difference was statistically significant (p < 0.05). One month postoperatively, the daily living ability (ADL) grading and recovery of the patients in the test group was significantly better than those of the control group (p < 0.05), but there was no statistically significant difference in ADL 3 and 6 months after surgery (p > 0.05). Conclusion: 3D laser combined with C-arm CT puncture has the advantages of real-time guidance, accurate positioning, and simple operation. It is an effective minimally invasive surgical method that is easy to master.

Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia.

BACKGROUND: Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)-guided stereotactic localization of hematomas in elderly patients diagnosed with ICH. METHODS: The study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups. RESULTS: No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05). CONCLUSIONS: A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.

Laser Navigation Combined With XperCT Technology Assisted Puncture of Brainstem Hemorrhage.

Background: Brainstem hemorrhage has a rapid onset with high mortality and disability rates. In recent years, an increasing number of studies have reported on the surgical treatment of brainstem hemorrhage. The introduction of stereotaxic instruments and navigation systems has improved the accuracy of surgical treatment; however, the popularity of these devices in the primary hospitals is not high. In this study, we introduce laser navigation combined with the XperCT technology to assist in the puncture and drainage of brainstem hemorrhage, aiming to improve surgical accuracy and facilitate the drainage of brainstem hemorrhage in primary hospitals. Material and Methods: A total of five patients (four men and one woman), aged 34-70 years, who underwent hematoma puncture drainage with the assistance of laser navigation combined with XperCT technology at the Binzhou Medical University Hospital, China, between June 2020 and Aug 2021 were included in the study. The brainstem hemorrhages had volumes of 7-18 ml. Statistical analyses of the postoperative puncture deviation distance (distance between the actual puncture end and simulated puncture end) and postoperative improvement were also performed. Results: The operations were successfully completed in all five patients. The puncture deviation distance was <6 mm in all five patients and <2 mm in two patients. The postoperative hematoma clearance rate was about 70%-90%. Among four patients with respiratory failure, three had improved breathing and resumed spontaneous breathing. Out of three patients with high fever, one showed a substantial decrease in body temperature. There were no cases of postoperative infection. Of the five patients, two recovered consciousness, one died, and two voluntarily gave up further treatment and were discharged. Conclusions: Laser navigation combined with the XperCT technology could improve the accuracy of surgical puncture. The technique might be convenient for widespread clinical application because of its low trauma, high precision, short operation time, and low operation cost.

[Abdominal puncture drainage alleviates severe acute pancreatitis in rats by activating Nrf-2/HO-1 pathway and promoting autophagy].

OBJECTIVE: To assess the effect of early abdominal puncture drainage (APD) on autophagy and Nrf-2/HO-1 pathway in rats with severe acute pancreatitis (SAP) and explore the possibile mechanism. METHODS: Thirty-two male SD rats were randomly divided into sham-operated (SO) group, SAP group with retrograde injection of 4% sodium taurocholate, APD group with insertion of a drainage tube into the lower right abdomen after SAP induction, and APD + ZnPP group with intraperitoneal injection of 30 mg/kg ZnPP 12 h before APD modeling. Blood samples were collected from the rats 12 h after modeling for analysis of amylase and lipase levels and serum inflammatory factors. The pathological changes of the pancreatic tissue were observed with HE staining. Oxidative stress in the pancreatic tissue was detected with colorimetry, and sub-organelle structure and autophagy in pancreatic acinar cells were observed by transmission electron microscopy. The expressions of autophagy-related proteins and Nrf-2/HO-1 pathway were detected using RT-PCR and Western blotting. RESULTS: Compared with those in SAP group, the rats with APD treatment showed significantly alleviated pathologies in the pancreas, reduced serum levels of lipase, amylase and inflammatory factors, lowered levels of oxidative stress, and activated expressions of Nrf-2/HO-1 pathway in the pancreas. The ameliorating effect of ADP was significantly inhibited by ZnPP treatment before modeling. APD obviously reversed mitochondrial and endoplasmic reticulum damages and p62 accumulation induced by SAP. CONCLUSION: APD treatment can suppress oxidative stress and repair impaired autophagy in rats with SAP by activating the Nrf-2/HO-1 pathway, thereby reducing the severity of SAP.

Analysis of Efficacy and Safety of Modified Transfrontal Puncture Drainage in Hypertensive Basal Ganglia Hemorrhage Patients.

Objective: The study aimed to explore the efficacy and safety of modified transfrontal puncture drainage in patients with hypertensive basal ganglia hemorrhage. Methods: The study enrolled 102 patients with hypertensive basal ganglia hemorrhage who received treatment at our hospital between April 2020 and June 2020. They were divided into a control group (51 cases, burr hole evacuation of intracranial hematoma) and a study group (51 cases, modified transfrontal puncture drainage) using the random number table method. The operative time, hematoma evacuation rate, time to recovery of consciousness, postoperative Glasgow coma scales (GOS), and the length of hospital stay were compared between the two groups. The postoperative recovery of neurological function in the two groups was observed, and activities of daily living at 3 months postoperatively in the two groups were statistically analyzed. The postoperative complications and recurrent bleeding, as well as prognosis in the two groups, were recorded. Results: The operative time, hematoma evacuation rate, time to recovery of consciousness, postoperative GOS scores, time to extubation, and the length of hospital stay of the two groups were compared postoperatively, and the difference was statistically significant (p < 0.05). The preoperative neurological function of the two groups was compared, and the difference was statistically insignificant (P > 0.05). The postoperative neurological function of the study group was lower than that of the control group, and the difference was statistically significant (P < 0.05). The postoperative incidence of stress ulcer, renal failure, and recurrent bleeding in the two groups was compared, and the difference was statistically insignificant (p > 0.05). The rate of pulmonary infections and gastrointestinal bleeding in the study group was lower than that of the control group, and the difference was statistically significant (P < 0.05). The mortality rate of the study group was 1.96% (1/51) and that of the control group was 3.92% (2/51), and the difference was statistically insignificant (p > 0.05). The activities of daily living in the two groups were compared and the difference was statistically insignificant (p > 0.05). Conclusion: Modified transfrontal puncture drainage can effectively treat hypertensive basal ganglia hemorrhage patients and has relatively good safety.

Abdominal puncture drainage alleviates severe acute pancreatitis in rats by activating Nrf-2/HO-1 pathway and promoting autophagy / 南方医科大学学报

OBJECTIVE@#To assess the effect of early abdominal puncture drainage (APD) on autophagy and Nrf-2/HO-1 pathway in rats with severe acute pancreatitis (SAP) and explore the possibile mechanism.@*METHODS@#Thirty-two male SD rats were randomly divided into sham-operated (SO) group, SAP group with retrograde injection of 4% sodium taurocholate, APD group with insertion of a drainage tube into the lower right abdomen after SAP induction, and APD + ZnPP group with intraperitoneal injection of 30 mg/kg ZnPP 12 h before APD modeling. Blood samples were collected from the rats 12 h after modeling for analysis of amylase and lipase levels and serum inflammatory factors. The pathological changes of the pancreatic tissue were observed with HE staining. Oxidative stress in the pancreatic tissue was detected with colorimetry, and sub-organelle structure and autophagy in pancreatic acinar cells were observed by transmission electron microscopy. The expressions of autophagy-related proteins and Nrf-2/HO-1 pathway were detected using RT-PCR and Western blotting.@*RESULTS@#Compared with those in SAP group, the rats with APD treatment showed significantly alleviated pathologies in the pancreas, reduced serum levels of lipase, amylase and inflammatory factors, lowered levels of oxidative stress, and activated expressions of Nrf-2/HO-1 pathway in the pancreas. The ameliorating effect of ADP was significantly inhibited by ZnPP treatment before modeling. APD obviously reversed mitochondrial and endoplasmic reticulum damages and p62 accumulation induced by SAP.@*CONCLUSION@#APD treatment can suppress oxidative stress and repair impaired autophagy in rats with SAP by activating the Nrf-2/HO-1 pathway, thereby reducing the severity of SAP.

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.

BACKGROUND: Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system, comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate. It severely affects the patients' quality of life. AIM: To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage. METHODS: From March 2018 to May 2020, 118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan. The control group used a hard-channel minimally invasive puncture and drainage procedure. The observation group underwent minimally invasive neuroendoscopic surgery. The changes in the levels of serum P substances (SP), inflammatory factors [tumor necrosis factor-α, interleukin-6 (IL-6), IL-10], and the National Hospital Stroke Scale (NIHSS) and Barthel index scores were recorded. Surgery related indicators and prognosis were compared between the two groups. RESULTS: The operation time (105.26 ± 28.35) of the observation group was min longer than that of the control group, and the volume of intraoperative bleeding was 45.36 ± 10.17 mL more than that of the control group. The hematoma clearance rates were 88.58% ± 4.69% and 94.47% ± 4.02% higher than those of the control group at 48 h and 72 h, respectively. Good prognosis rate (86.44%) was higher in the observation group than in the control group, and complication rate (5.08%) was not significantly different from that of the control group (P > 0.05).The SP level and Barthel index score of the two groups increased (P < 0.05) and the inflammatory factors and NIHSS score decreased (P < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group (P < 0.05). CONCLUSION: Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage; however, hematoma clearance is more thorough, and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude.

PURPOSE: Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone. METHODS: From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests. RESULTS: A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ2 = 4.38, p = 0.043). However, there was no significant difference regarding the survival curve between PD + DC group and DC group. The correlation between the time from admission to operation and GOS at 6 months (r = -0.41, R2 = 0.002, p = 0.829) was not significant in the PD + DC group, but significant in the DC group (r = -0.357, R2 = 0.128, p = 0.038). CONCLUSION: PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

Sequential therapy with combined trans-papillary endoscopic naso-pancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts.

BACKGROUND: Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection. AIM: To manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome. METHODS: One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups. RESULTS: The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases). CONCLUSION: Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.

Diagnosis and Treatment of Retroperitoneal Infection.

Background: Retroperitoneal infection is a persistent and widespread infectious disease that is difficult to treat. It is usually caused by secondary complications such as inflammation, damage, or perforation of adjacent organs in the retroperitoneal space. Pathogenic bacteria invade the retroperitoneal space through retroperitoneal and interstitial organs, peripheral tissue, and the blood. As a result, infections mostly arise from severe acute pancreatitis, acute colonic diverticulitis, inflammatory bowel disease, kidney abscess, and biliary tract injury. Initially manifested by the presence of lumbago, this disease spreads easily, is persistent, and is often misdiagnosed. Methods: Review and synthesis of pertinent literature and guidelines pertaining to abdominal infection and retroperitoneal infection. Results: Recent data indicate that mortality rates associated with retroperitoneal infection have been increasing annually. Early diagnosis and treatment have been shown to improve the prognosis. In the early stage, infection is insidious and lacks typical symptoms, and is primarily diagnosed with computed tomography (CT). Strategies that control the source of infection, rational use of antibiotic agents, and nutritional interventions are the primary approaches to treat the infections. Emergence of minimally invasive drainage technologies, including the ultrasound/CT-guided puncture and drainage, percutaneous nephroscope puncture and drainage, and drainage using a catheter through an abdominal puncture device (trocar) have shortened the treatment cycle and disease burden. However, current diagnosis and treatment for retroperitoneal infection are not sufficiently effective because some patients do not show typical clinical manifestations. Moreover, sensitivity and specificity of available auxiliary examination methods are not supported by sufficient evidence-based medical research. Additionally, there are no uniform standards on the timing of surgical intervention and treatment options. Therefore, we summarized the progresses on current diagnosis and treatment approaches for retroperitoneal infection.

The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude / 中华创伤杂志(英文版)

PURPOSE@#Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.@*METHODS@#From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests.@*RESULTS@#A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ@*CONCLUSION@#PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

Application of a 3D-Printed Navigation Mold in Puncture Drainage for Brainstem Hemorrhage.

BACKGROUND: Brainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. MATERIAL AND METHODS: The present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print-assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. RESULTS: In all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. CONCLUSIONS: Use of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.

Ultrasound-Guided Needle Aspiration of Peritonsillar Abscesses: Utility of Transoral Pharyngeal Ultrasonography.

A peritonsillar abscess is a common deep infection that is usually related to acute tonsillitis. Needle aspiration is often performed for diagnosis and treatment, but several complications, including puncture of the carotid artery, may occur, even when performed by properly trained physicians. The utility of transoral pharyngeal ultrasonography (TOPU) equipped with a biopsy adaptor for safe and full aspiration is presented. A 19-year-old man was admitted to our hospital because of a peritonsillar abscess. TOPU showed the abscess and a branch of the carotid artery, and an otolaryngologist performed puncture through the biopsy adaptor with the aid of the ultrasound image. Needle aspiration was accomplished by avoiding arterial puncture and monitoring the shrinkage of the abscess. TOPU-guided needle aspiration is useful in the safe drainage of peritonsillar abscesses.

The effect of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection: Two cases' report.

The aim of this study was to discuss the clinical significance of perirenal puncture and drainage with urokinase treatment of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi. Two cases of perirenal hematoma complicated by infection following surgery for upper urinary tract calculi in 2017, and later received perirenal puncture and drainage of perirenal hematoma with urokinase treatment were selected. Puncture and drainage of perirenal hematoma with urokinase treatment were performed without the occurrence of severe complications such as sepsis, septic shock, or secondary bleeding. Both the renal morphology and functions were well restored. Puncture and drainage with urokinase treatment had definite efficacy in the treatment of perirenal hematoma complicated by infection.

Utility of transoral pharyngeal ultrasonography for puncture drainage of peritonsillar abscess.

Puncture drainage is usually needed to treat peritonsillar abscess. However, inadvertent carotid artery puncture may result in devastating complications. Preoperative transoral carotid ultrasonography (TOCU) is useful to delineate the anatomical relationship between the abscess and carotid artery. We present a case of peritonsillar abscess illustrating the utility of TOPU for safe drainage.

Comparison of two different models of sepsis induced by cecal ligation and puncture in rats.

BACKGROUND: The present study was designed to explore the difference between two rat models of sepsis and to establish a more stable rat model. MATERIALS AND METHODS: Sprague-Dawley rats were randomly divided into three groups: sham operation group, simple cecal ligation and perforation group (SCLP), and cecal ligation perforation plus drainage group (CLP-DS). The general condition of the rats was observed, and the time of death and survival rate at 72 h were recorded. The arterial blood and lung tissue were obtained 9 h after the operation. RESULTS: The mortality of the CLP-DS group was significantly higher than that of the SCLP group. The limitation package, intestinal adhesion, and poor drainage were detected in the SCLP rats, whereas intestinal edema and hyperemia, bloody water in the abdominal cavity, but no inflammatory package were observed 24 h after the operation in the CLP-DS rats by autopsy. There were significant differences in interleukin-6 and tumor necrosis factor-alpha levels between the SCLP group and the CLP-DS group. Severe pulmonary septal thickening, alveolar wall vascular congestion, and protein debris deposition in the alveolar cavity were observed in the SCLP group, whereas pulmonary bullae were observed in the CLP-DS group using light microscopy, and there were significant difference among groups in Smith lung injury score. CONCLUSIONS: These results suggested that the cecal ligation combined with puncture drainage model of sepsis is more stable than that of the simple cecal ligation and puncture model of sepsis in the rat, which resolved the problem of puncture wrapped in the traditional CLP model of sepsis in rat.

Endoscopic hematoma evacuation and soft channel drainage for hypertensive intracerebral hemorrhage / 中国内镜杂志

Objective?To compare the clinical efficacy and prognosis of neural endoscopic intracranial hematoma evacuation (NEIHE) and soft channel puncture drainage (SCPD) in treatment of hypertensive intracerebral hemorrhage (HICH).?Methods?106 HICH cases from January 2015 to December 2016 were divided into endoscopic group (51 cases, NEIHE scheme) and drainage group (55 cases, SCPD scheme) according to random number, operation and complications indicators were recorded, variations on peripheral inflammatory factors and NIHSS neurological deficit score were compared, meanwhile, clinical efficacies were determined.?Results?Though the endoscopic group with operative time (108.5 ± 33.8 vs 85.8 ± 25.4) min and intraoperative blood loss (54.2 ± 17.7 vs 42.6 ± 14.5) ml were significantly higher than drainage group (P < 0.05), the endoscopic group associated with a higher hematoma clearance 48 h post operation (85.8 ± 7.8 vs 74.7 ± 9.2) % (P < 0.05) and lower overall complication rate (13.7% vs 29.1%) (P < 0.05). After 14 d, the endoscopic group with the decreased value of peripheral blood TNF-α (129.5 ± 33.7 vs 107.8 ± 29.5) pg/ml, IL-6 (74.3 ± 22.8 vs 56.7 ± 18.2) pg/ml, hs-CRP (32.6 ± 7.5 vs 27.2 ± 6.6) mg/L were all significantly higher than the drainage group (P < 0.05). After 14 d, endoscopic group with decreased value of NIHSS score was significantly higher than the drainage group (13.0 ± 3.8 vs 10.3 ± 3.5) (P < 0.05). 6 months after operation, the increased Barthel index in the survivors of endoscopic group was significantly higher than the drainage group (44.8 ± 9.7 vs 39.5 ± 11.2) (P < 0.05).?Conclusion?Though the NEIHE is more complicated than SCPD in treatment of HICH, the hematoma clearance is more complete, the complications are less, and the short-term efficacy and prognosis with obvious advantages.

Modified scleral puncture drainage in 23G vitrectomy for patients with coexisting rhegmatogenous retinal detachment and choroidal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe and analyze the safety and clinical efficacy of full-thickness scleral incision and <i>in situ</i> paracentesis in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment using minimally invasive vitrectomy. <p>METHODS: From April 2015 to April 2017, 20 patients(20 eyes)with coexisting rhegmatogenous retinal detachment and choroidal detachment who were treated in Department of Ophthalmology, Jiangsu Province Hospital were enrolled in this retrospective analysis. All patients received modified scleral puncture drainage combined with 23G minimally invasive vitrectomy. This study analyzed and compared intraoperative paracentesis success rate, the incidence of intraoperative, postoperative visual acuity, intraocular pressure, and postoperative retinal reattachment rate. <p>RESULTS: Suprachoroidal fluid from all patients were drainaged successfully. Compared with preoperative conditions, the postoperative visual acuity was significantly improved(<i>P</i><0.01). There was a significant difference in average intraocular pressure(IOP)between preoperative one and postoperative one(7.00±2.05mmHg and 15.38±2.66mmHg respectively, <i>P</i><0.01). The origin retinal reattachment rate was 90%(18/20), and the final retinal reattachment rate was 95%(19/20). <p>CONCLUSION: The modified scleral puncture surgery in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment in 23G vitrectomy has great clinical effects. It not only simplifies the procedure of operation, but also reduces the difficulty and complication of operation.

Treatment efficacy and safety of ultrasound-guided puncture combined with surgical resection for liquefied cavitary hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective To study the safety and efficacy of ultrasound-guided puncture combined with surgical resection for liquefied cavitary hepatic alveolar echinococcosis (HAE).Methods A retrospective study was conducted on 17 patients who had liquefied cavitary HAE and were treated at the Affiliated Hospital of Qinghai University from January 2014 to August 2016.Ten patients were treated with ultrasound-guided puncture combined with surgical resection (the case group),and 7 patients were treated with resection (the control group).The basic characteristics,operation time,blood loss during operation,preoperative and postoperative laboratory tests and complications were compared between the 2 groups.Results There were no significant differences between the 2 groups in basic characteristics,such as age,gender,and lesion diameter (P ＞ 0.05).The operation time and blood loss during operation showed significant differences between the 2 groups,(308.0 ± 23.0) min (389.0 ± 95.7) min and (1 360.0 ± 182.9) ml vs.(1 607.1 ± 205.0) ml,respectively (all P ＜ 0.05).The prothrombin time (PT) after day 3 of operation and alanine aminotransferase level after day 5 of operation showed significant differences between the 2 groups,(13.8 ±0.9) s vs.(15.5 ±1.7) s and (81.9 ±20.9) U/L vs.(108.1 ±29.5) U/L,respectively (all P ＜ 0.05).There was no significant difference in postoperative complications between the 2 groups.Conclusions Ultrasound-guided puncture combined with surgical resection shortened the operation time,reduced blood loss and avoided serious complications after surgery.This treatment is efficacious and safe for liquefied cavitary HAE.