Endovascular treatment of delayed arterial hemorrhage after radical operation for hilar cholangiocarcinoma

Radical operation for hilar cholangiocarcinoma(HCCA)is the most effective treatment,but high rates of severe postoperative complication and death remain concerns due to the complexity of biliary and vascular anatomy of the hepatobiliary region.De-layed arterial hemorrhage(DAH)occurring>24 h postoperatively usually causes life-threatening bleeding,and relaparotomy for DAH would be difficult and hazardous because of postoperative adhe-sions and critical general condition.As endovascular technique is less invasive and has improved over the recent decades,clini-cians have begun to prefer endovascular treatment(EVT)to surgi-cal treatment of DAH after hepatobiliary pancreatic surgery.How-ever,to our knowledge,a relatively large series of patients dealing with the outcomes of EVT of DAH after surgery for HCCA has not been reported.Herein,we analyzed the technical and clinical out-comes of EVT in 17 patients to evaluate the efficacy and safety of EVT.

Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.

THE OPERATIVE TREATMENT OF SPINAL FRACTURE-DISLOCATION WITHOUT NEUROLOGIC DEFICITS

To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fractures, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results.The average period of follow up was 4.4 years with a range of 11 months to 13 years. All the patients returned to full time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4 cases, and no progressive kyphosis was noted. There was no operation related complication. The averaged post operative hospitalization time was 13 days. Conclusions. Despite the rare incidence of spinal fracture dislocation without neurologic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal alignment and the stability of the spine.

Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients

BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.

Peri-operative Treatment for Pheochromocytoma

The perioperative management of 81 cases with pheochromocytoma was reviewed including blood pressure and arrhythmia control, blood volume expansion, patient′s general condition improvement and vital signs monitoring. It was stressed that pre and intra operative management was of prime importance in the treatment of pheochromocytoma.

Non-operative management of isolated liver trauma

Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

Emergency Treatment of Testicular Torsion and Postoperative Follow-up: A 71 Case Report

This study presented our experience in the treatment of testicular torsion,which may help achieve early diagnosis and improve therapeutic effects.A retrospective analysis was conducted in 71 patients with testicular torsion who were treated in our hospital from October 2007 to April 2011.The age of the patients ranged from 16 days to 34 years.All the patients had unilateral testicular torsion,which took place on the left side in 43 cases and on the right side in 28 cases.The course of the disease varied between three hours to 30 days.Post-operative follow-up was conducted until October 2011.Items examined included signs and symptoms at their first clinical visit,ultrasound findings,treatment in emergency surgery,and post-operative follow-up.In this study,the 71 patients were diagnosed with testicular torsion by color Doppler sonography,7 had testicular fixation,63 patients received orchiectomy,while 1 patient did not undergo surgery due to pressure from family members.Post-operative follow-up showed that the one patient’s testicle,which had been reserved,atrophied,while all the other survived.No recurrence was found during the follow-up visits.It is concluded that an early diagnosis and surgery is important in improving the survival rate of testicular torsion,and the diagnosis and treatment by the first attending clinician is of critical importance.

Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia

AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.

Acupuncture Treatment for the 88 Cases of Retention of Urine After Surgical Operation

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Discussion on the Operation of Urban Domestic Sewage Treatment Facilities: A Case Study of Guangdong Province

Urban sewage treatment facility is an important ways to control polluted domestic water. The operation of urban sewage treatment facilities is good or not, and whether the effectiveness of pollutant emission reduction can be exerted play a significant role in reducing the pollution of living sources. Nowadays the operation of urban sewage treatment facilities is mainly evaluated by the load rate. However, due to the failure to fully implement the reformation of the rainwater and polluted water in Guangdong Province, the domestic sewage is mixed with rainwater during the rainy season and is included in the treatment of urban sewage treatment facilities. Therefore, it is not objective to evaluate the operation of sewage treatment facilities using only the load rate of sewage treatment. According to the situation of Guangdong Province, the load rates of COD, ammonia nitrogen and total phosphorus in domestic sewage and load rate of sewage treatment were included in the evaluation, and 20 urban sewage treatment facilities were selected as research objects. The operation situations and emission reduction benefits of urban sewage treatment facilities in different regions of Guangdong Province were roughly evaluated.

Combined Endovascular and Surgical Treatment for Brain Arteriovenous Malformations in Biplanar Hybrid Operating Room

Objective Combined surgical and endovascular treatment for vascular disorders has become prevalent in recent years.However,reports on one-session hybrid surgery for arteriovenous malformations(AVMs)are relatively rare.The safety and efficiency of combined treatment for brain AVMs were analyzed in biplanar hybrid operating room(OR)at one stage.Methods We retrospectively analyzed 20 patients with AVMs undergoing combined surgical and endovascular treatment from October 2015 to June 2018.The data for resection rate,microcatheter adhesion,surgical position and postoperative outcomes were analyzed.Total resection or near-total resection was achieved in all cases.Results A total of 13 patients were under combined endovascular and surgical procedures,and 7 experienced surgery with intraoperative digital subtraction angiography.Sitting position was applied in 3 of them;2 niduses in cerebellum,and 1 in parietal lobe.Compared with admission modified Rankin Scale(mRS)in all patients,postoperative 12-month mRS showed a significant decline.Besides,3 patients experienced microcatheter adhesion after endovascular embolization,thereafter underwent surgical adhesion removal while nidus resection was done.Conclusion Combined endovascular and surgical modality in a hybrid OR at one stage provides a safe strategy for the treatment of AVMs.The biplanar hybrid neurointerventional suite is endowed with unconstrained operating angle which enables combined endovascular and surgical treatment in sitting position.It also reduces the risk of microcatheter adhesion,which enables interventional radiologists to perform aggressively.

Causal Analysis on the Lining Exfoliation and Treatment Design of an Operational Tunnel

According to the actual situation of the secondary lining of a expressway tunnel in Chongqing,this paper analyzed the specific reasons for lining exfoliation with corresponding test reports.According to this,a quick treatment scheme for lining exfoliation is proposed,which can make the treatment timely and effective,and suggestions for treating similar diseases in tunnels are put forward,which can provide reference for similar projects.

Conventional operation and laser therapy in the treatment of varicose veins

Objective:To evaluate the effectiveness of endovenous laser therapy and conventional thera- py on the varicose of great saphenous vein.Methods:Thirty-two patients received endovenous laser thera- py and 32 patients were operated by conventional therapy(high ligation and stripping).The observation results of great saphenous vein(GSV)were recorded by clinical evaluation and duplex ultrasound examina- tion.And the operating time,intraoperative blood loss,time to become moveable,duration of hospitaliza- tion and degree of feeling pain were compared between the two groups.Results:Compared with conven- tional therapy,laser therapy had good curative effect with less complications and no scars and no pains. There were significant differences between the two groups(P<0.01).Conclusion:Laser therapy for varicose of great saphenous vein is better than the conventional therapy.It deserves to be widely used in clinical treatment.

Modified Foerster-Dandy 's operation for treatment of spasmodic torticollis under endoscope-assisting

Objective To study microsurgical effectiveness Foerster-Dandy’s endoscope-assisted operation for treatment of spasmodic torticollis. Methods 183 cases of spasmodic torticollis patients were treated by microsurgical modified Foerster-Dandy’s operation from July 2001 to June 2009,which was randomly

Technical operation specification for pricking-cupping therapy

Pricking-cupping therapy is a Traditional Chinese Medicine(TCM)nursing technology that can adjust the viscera of the human body,make the meridians smooth,and Yin and Yang balanced mainly by means of relieving heat and detoxification,harmonizing Qi and blood,promoting blood circulation and removing blood stasis,dredging meridians and activating collaterals,reducing swelling and pain,purging heat and calming shock,clearing heat,and opening orifices.Pricking-cupping therapy has a long history and wide application.After thousands of years of development,it has made great progress.They are widely used to treat lumbar disc herniation,herpes zoster,acute arthritis,migraine,and other diseases in China.Through the clinical practice and theoretical exploration of physicians of past dynasties,the therapeutic mechanism and application scope of pricking-cupping therapy have been greatly enriched.Modern TCM practitioners have conducted in-depth researches on the operation norms of the therapy on the basis of the ancients,hoping to grasp the essence of the disease more accurately and make the rational use of the operation technology of the therapy.

多灶性肝母细胞瘤手术切除的单中心研究

目的探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。方法本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及远期预后等资料,并与同期收治的58例中高危单灶性HB患儿进行疗效对比。结果21例多灶性HB患儿中,11例为2个瘤灶,4例为3个瘤灶,1例为5个瘤灶,5例肝内瘤灶超过5个且无法明确计数。21例均接受肿瘤切除手术,其中9例行解剖性肝切除术,11例行不规则肝切除或瘤灶剜除术,1例行联合肝脏离断及门静脉结扎的分次肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)。20例为R0切除,1例为R1切除,术后无一例发生严重并发症。本组多灶性HB患儿接受手术联合化疗的多学科综合治疗后,中位随访时间57个月,18例患儿无瘤生存,3例死亡。本组多灶性HB患儿3年无事件生存率(event-free survival,EFS)为57.58%,3年总生存率(overall survival,OS)为82.00%,局部进展累积发生率(cumulative incidence of local progression,CILP)为38.00%。同期收治的单灶性中高危HB患儿上述指标分别为91.84%、74.96%、20.04%。两组数据对比,差异无统计学意义(P>0.05)。结论多灶性HB经规范外科手术切除辅助术前、术后化疗,可以获得较为满意的预后。

单侧肾母细胞瘤新辅助化疗后保留肾单位手术的初步疗效分析

目的探讨新辅助化疗后保留肾单位手术(nephron sparing surgery,NSS)治疗单侧肾母细胞瘤的初步疗效。方法回顾性分析2014年1月至2020年12月复旦大学附属儿科医院收治的7例单侧肾母细胞瘤患儿临床资料,均行新辅助化疗及NSS。收集患儿生存率、肾功能以及肿瘤复发情况,并与同期行根治性肿瘤切除术(radical nephrectomy,RN)的患儿进行疗效比较。结果7例中,男4例、女3例,发病年龄(38.86±18.23)个月,无一例合并肿瘤相关综合征或半侧肢体肥大;肿瘤位于肾脏一极1例,肾脏中央6例。7例经新辅助化疗后,肿瘤体积缩小(66.4±18.6)%。1例肿瘤位于肾脏一极的患儿行部分肾切除术(partial nephrectomy,PN),6例肿瘤位于肾中央的患儿行肿瘤剜除术(tumor enucleation,TE),术后病理检查结果提示镜下肿瘤切缘阳性2例。儿童肿瘤国际协会(International Society for Pediatric Oncology,SIOP)分期:Ⅱ期4例、Ⅲ期3例。随访时间(38.42±10.17)个月,无一例失访或死亡。无瘤生存6例,带瘤生存1例。NSS后出现肿瘤复发2例。NSS后复发率(28.6%)及5年生存率(100%)与同期行RN的患儿复发率(13.3%)和5年生存率(86.9%)相比,差异均无统计学意义(P>0.05)。结论单侧肾母细胞瘤通过合理的术前评估和新辅助化疗,可以增加NSS的机会,并取得与RN相似的治疗效果。

稳定型胸腰椎爆裂骨折非手术治疗失败率和预测因素

目的探讨稳定型胸腰椎爆裂骨折(thoracolumbar burst fractures,TBF)非手术治疗的失败率和预测因素。方法选择2015年1月~2020年12月在该院接受非手术治疗的稳定型TBF患者资料进行回顾性分析,记录患者非手术治疗失败率。观察非手术治疗失败和非手术治疗成功患者的性别、年龄、体质量指数(body mass index,BMI)、个人史、伴随疾病、损伤原因、损伤椎体、疼痛视觉模拟评分(visual analogue scale,VAS)、椎体压缩率(vertebral body compression rate,VBCR)、椎体前缘高度压缩百分比(percentage anterior high compression,PAHC)、Cobb角、椎弓根间距(interpedicular distance,IPD)和椎管压缩程度,采用Logistic回归分析确定影响非手术治疗效果的独立因素。结果71例患者有21例非手术治疗失败,发生率29.58%。非手术治疗失败患者年龄、BMI、糖尿病、VBCR、PAHC、Cobb角、IPD、椎管压缩和VAS均高于非手术治疗成功患者(P<0.05)。多因素Logistic回归分析结果显示,年龄和IPD是影响非手术治疗效果的独立风险因素(P<0.05)。年龄预测非手术治疗失败的灵敏度、特异性、截断值和AUC分别为71.40%、86.00%、47岁、0.811,IPD预测非手术治疗失败的灵敏度、特异性、截断值和AUC分别为71.43%、88.00%、16.7%和0.771。结论年龄和IPD是影响稳定型TBF患者非手术治疗失败的风险因素,对预测手术失败具有一定临床价值。

新线引入既有客运专线车站软土地基加固技术

以新线引入既有客运专线车站软土地基加固工程为依托,开展布袋注浆桩试桩研究,分析不同浆液配比布袋注浆桩复合地基加固效果,对布袋注浆桩施工工艺、质量检验进行了研究。结果表明:布袋注浆桩机械设备高度低,对既有线影响小,对于空间受限的邻近营业线地基加固工程适用性强;提高单位面积布袋质量、采用桶式钻头引孔等可解决碎石成分类填土地基应用布袋注浆桩技术时遇到的布袋破裂、塌孔等问题。浆液质量配比水泥∶水∶粉煤灰=0.70∶0.55∶0.45时桩身无侧限抗压强度平均值9.6 MPa,加固效果优于高压旋喷桩;采用低应变反射波法检测桩体完整性效果较差,工程应用中应加强桩身取芯检测。

泛血管医学时代“脑心同治”手术与展望

“脑心共病”逐渐受到国内外神经外科和心血管内外科医师的重视,并着手开展“脑心同治”手术互为保障,“泛血管医学”概念提出多学科交叉、跨学科整合的研究模式和发展理念。泛血管医学思想对“脑心同治”手术具有重要指导意义,“脑心同治”手术又使“泛血管医学”概念更加完整与深化。现阶段坚持以动脉粥样硬化性疾病为基础进行手术实施设计,“脑心同治”手术将在未来突破传统的颈动脉与冠状动脉同期手术范畴,过渡到以血管重建为中心的发展方向,从外科手术角度扩大“泛血管医学”概念的内涵。