Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.
Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.
Objective To evaluate the efficacy of light cured composite resin and glass ionomer cement for wedge shaped defect filling. Methods PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CNKI, CBM, VIP and WanFang Data were searched from inception to April 5th 2016, to collect randomized controlled trials (RCTs) of light cured composite resin versus glass ionomer cement for wedge shaped defect filling. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. Results A total of 12 studies, involving 3 744 cases of teeth were included. Meta-analysis results showed that there was no significant difference in the two groups on the shedding rate after 2 years (OR=1.19, 95%CI 0.70 to 2.02,P=0.53). But the wear rate of the light cured composite resin group was significantly lower than that of the glass ionomer cement group (Peto OR=0.31, 95%CI 0.22 to 0.44,P<0.000 01). The light cured composite resin group had higher rate of micro leakage or secondary caries rate (OR=1.83, 95%CI 1.11 to 3.01,P=0.02) and incidence of endodontic or periapical lesions (Peto OR=2.84, 95%CI 1.82 to 4.45,P<0.000 01) than the glass ionomer cement group. Conclusion Glass ionomer cement for filling wedge-shaped defects of 2 years after the wear degree is higher than the light cured composite resin, but the occurrence probability of micro leakage or secondary caries and stimulation to pulp are lower than the light cured composite resin. Because of the limitations of the quality of the included studies, the above conclusion still needs to be verified by more high-quality studies.
This is the first successful case expriences,a method of the procurement of the fetal cadavertic multiple argans for transplantation of the pancreas and thyroid-pararthyroid glands was produced. The liver,pancreas,duodenum,spleen,and both kidneys were harvested en bloc by a group of surgeons,and the right hem-ithyroid-parathyroid glands with pedicle of thd blood vessels wre removed by another group.The pancreas together with the spleen were transplanted to a patient having diabetes mellitus. The thyroid-parathyroid glands were given to another case with bypothyroidism and hypoparathyroidism.Both cases had good results.This method had dicreased the warm ischemia of the transplants,and could provide liver,pancreas,spleen,kidneys and thyroid-parathyroid glands to solve the problem of shortage of fetal organs.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
ObjectiveTo explore the method for establishing a pig left lung orthotopic transplantation model. MethodsDetailed surgical procedures, including animal anesthesia, tracheal intubation, donor lung retrieval, and recipient transplantation, were thoroughly reported. By examining the histological morphology and blood gas analysis of the transplanted lung 2 hours after reperfusion, the histological changes and function of the transplanted lung were assessed. ResultsThis method was applied to four male Yorkshire pigs with an average weight of (40.0 ±2.5) kg for left lung in situ transplantation, effectively simulating conditions relevant to human lung transplantation. Two hours after the transplantation, arterial blood gas analysis showed PaO2 was 155.4-178.6 mm Hg, PaCO2 was 53.1-62.4 mm Hg, and the oxygenation index was 310.8-357.2 mm Hg. Hematoxylin and eosin staining indicated a low degree of pulmonary edema and minimal cellular infiltration. ConclusionThe pig left lung orthotopic transplantation model possesses strong operability and stability. Researchers can replicate this model according to the described methods and further conduct basic research and explore clinical translational applications.
摘要:目的:探讨慢性硬膜下血肿(chronic subdural hematoma, CSDH)钻孔冲洗引流术后的复发因素。方法：回顾性分析165例CSDH钻孔冲洗+闭式引流术的治疗效果,并结合患者年龄、术后引流量、血肿腔是否有间隔、血肿厚度、引流管安放方向等因素进行相关分析。结果:本组治愈151例,血肿复发14例。〖HTH〗结论〖HTSS〗:患者年龄、术后引流量、血肿腔是否有间隔、血肿厚度、引流管安放方向是影响复发的主要因素。Abstract: Objective: To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient’s age,drainage volume,thickness of hematoma, septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence. Conclusion : Age, drainage volume, thickness of hematoma, septal hematoma cavity and direction of drain pipe would affect the prognosis.
At present, the most commonly used nucleoside (acid) anaog (NAs) treatment regimen in clinical practice cannot completely cure chronic viral hepatitis B (CHB). However, although the polyethylene glycol interferon treatment regimen is superior to the NAs regimen in terms of immune mechanism, it has the disadvantage of low hepatitis B virus DNA response rate. In recent years, the cure of CHB is being studied all over the world. Various mechanisms and drug targets are being explored, and diversified therapeutic strategies are also being used. Clinical cure of hepatitis B is possible, but it is still in the early stage, and many potential drugs and better therapeutic strategies are still being tested. This article mainly reviews the latest progress in the treatment of CHB based on the recent research achievements in direct antiviral drugs and host immunotherapy as well as the research progress in combination therapy.
Objective To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery. MethodsA clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators. ResultsCompared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank. ConclusionCompared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.
Recently, an editorial in Cell Research illuminated the concept of the curative time window for lung adenocarcinoma. Within this window, patients could achieve 100.0% 5-year or 10-year post-operative recurrence-free survival. Adenocarcinoma in situ and minimally invasive adenocarcinoma in pathology, as well as pure ground-glass opacity in radiology could be regarded as the curative time window. However, not all the patients can catch this time window. A precise understanding of this concept helps elevate the curative rate for lung cancer patients and mitigate the risks of overdiagnosis and overtreatment. This article delves into the accurate comprehension of the surgical curative time window for lung adenocarcinoma, proposed a clinical strategy for early-stage lung adenocarcinoma, and introduced clinical procedures comprising of this time window. It offers fresh insights into the timing of surgical interventions for lung adenocarcinoma.