Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures： Surgical Management and Early Outcome

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report

BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.

Outcome of Early Surgical Decompression in Traumatic Incomplete Spinal Cord Injury

Objectives: Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. Methods: 60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. Results: Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). Conclusions: Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.

Spherical silicon solar cell with reflector cup fabricated by decompression dropping method

A spherical Si solar cell with a reflector cup was successfully fabricated by a dropping method at decompression state. In the dropping method, melted Si droplets were instilled at decompression state (0.5×105 Pa) to reduce crystal growth rate, dominating crystal quality such as dislocation density in crystal grains. Spherical Si solar cells were fabricated using the spherical Si crystals with a diameter of 1 mm and then mounted on a reflector cup. The current-voltage measurement of the solar cell shows an energy conversion efficiency of 11.1% (short-circuit current density (Jsc): 24.7 mA·cm-2, open-circuit voltage: 601 mV, fill factor: 74.6%). Minority carrier diffusion length determined by surface photovoltage method was 98 μm. This value can be enhanced by the improvement of crystal quality of spherical Si crystals. These results demonstrate that spherical Si crystals fabricated by the dropping method has a great potential for substrate material of high-efficiency and low-cost solar cells.

Study on animals' femur blood flow alteration under inadequate decompression with ^(133)Xe isotope washout method

Animals’ regional femur blood (F) alteration was studied under an inadequate decompression by using the inhaled isotope 133Xe washout method. Results showed that the average F on left and right side of minipigs’ femur decreased from 15.4±1.8 and 16 .9±2.0 ml/ (100 g.min) (before exposure) to 10±1.8 and 11.1±1.6 ml/(100mg.min) (after expposure for 1.5 h under the pressure of 0.5 MPa and then decompression to normal with the rate of 0.03~0.04MPa/min), respectively; the blood flow of hematopoietic marrow tissues (f1)on both sides also decreased from 19.3±2.0 and 22.1±1.9 ml/(100mg.min) to 13.9±1.4 and 13.8±1.0 ml/(100 mg.min). The exact same alteration also happened in the experiment on New Zealand rabbits. It indicates that inadequate decompression in hyperbaric exposure can give rise to decrease animals’ bone blood flow and insufficient bone blood supply serves as one of the reasons for causing decompressive osteonecrosis.

Inhibition of inflammatory cytokines after early decompression may mediate recovery of neurological function in rats with spinal cord injury

A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.

Flow Characteristics of Grains in a Conical Silo with a Central Decompression Tube Based on Experiments and DEM Simulations

Grains are widely present in industrial productions and processing,and are stored in silos.In the silo,auxiliary structures are added to achieve efficient production.However,little effort has been devoted to the influence of the internal structure of the silo on the granular flow.In this work,a silo with a central decompression tube is studied through experimental measurements and discrete element methods.Then,the influences of the central decompression tube on the flow behavior of grains and wall pressure are analyzed.Results show that the grains are in mass flow in the silo without a central decompression tube,while the grains are in funnel flow in the silo with a central decompression tube.Moreover,regardless of whether there is a central decompression tube in the silo,the maximum pressure appears at the top of the conical silo.In the lower part of the silo,the wall pressure of the silo with a central decompression tube is lower than that of the silo without a central decompression tube.Therefore,a silo with a central decompression tube is more conducive to grain storage and discharge than a silo without a central decompression tube.

Modified technique of advanced core decompression for treatment of femoral head osteonecrosis

BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.

Desalination of Seawater by Liquid Columns and Decompression Boiling (Recovery of Condensation Latent Heat)

In this study, the concept of a new seawater desalination method and equipment using liquid columns of seawater and desalinated fresh water, decompression boiling and evaporation, condensation, and recovery of condensation latent heat are proposed. The equipment consists of seawater and freshwater columns approximately 10 m high with top spaces. The pressure of the top space, the evaporation and condensation area, of the seawater column, for example, is reduced approximately 30 mmHg (abs.) using the seawater column, after which it is heated from the general seawater temperature of 25°C to 30°C to boil and evaporate the seawater. The vapor is cooled by the seawater at approximately 25°C in a heat exchanger, and then, it is condensed and sent to the fresh water column. At this time, the condensation latent heat is recovered to preheat the newly flowing seawater. The evaporation or condensation rate, namely, the production rate of freshwater, by the new desalination equipment is also estimated by the results of the existing quadruplex effect vacuum evaporator used in the salt production industry. This new desalination method and its associated equipment also can be used to purify polluted water and waste water.

Surgical decompression in acute spinal cord injury： A review of clinical evidence, animal model studies, and potential future directions of investigation

The goal for treatment in acute spinal cord injury （SCI） is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potential new therapies for the treatment of acute SCI, outcomes and management protocols aimed at ameliorating neurologic injury in patients remain ineffective. More recent clinical and basic science research have shown surgical interventions to be a potentially valuable modality for treatment; however, the role and timing of surgical decompression, in addition to the optimal surgical intervention, remain one of the most controversial topics pertaining to surgical treatment of acute SCI. As an increasing number of potential treatment modalities emerge, animal models are pivotal for investigating its clinical application and translation into human trials. This review critically appraises the available literature for both clinical and basic science studies to highlight the extent of investigation that has occurred, specific therapies considered, and potential areas for future research.

Impact of parenchyma-preserving surgical methods on treating patients with solid pseudopapillary neoplasms:A retrospective study with a large sample size

BACKGROUND Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare neoplasm that mainly affects young women.AIM To evaluate the impact of parenchyma-preserving surgical methods(PPMs,including enucleation and central pancreatectomy)in the treatment of SPN patients.METHODS From 2013 to 2019,patients who underwent pancreatectomy for SPNs were retrospectively reviewed.The baseline characteristics,intraoperative index,pathological outcomes,short-term complications and long-term follow-up data were compared between the PPM group and the conventional method(CM)group.RESULTS In total,166 patients were included in this study.Of them,33 patients(19.9%)underwent PPM.Most of the tumors(104/166,62.7%)were found accidentally.Comparing the parameters between groups,the hospital stay d(12.35 vs 13.5 d,P=0.49),total expense(44213 vs 54084 yuan,P=0.21),operation duration(135 vs 120 min,P=0.71),and intraoperative bleeding volume(200 vs 100 mL,P=0.49)did not differ between groups.Regarding pathological outcomes,tumor size(45 vs 32 mm,P=0.07),Ki67 index(P=0.53),peripheral tissue invasion(11.3%vs 9.1%,P=0.43)and positive margin status(7.5%vs 6%,P=0.28)also did not differ between groups.Moreover,PPM did not increase the risk of severe postoperative pancreatic fistula(3.8%vs 3.0%,P=0.85)or tumor recurrence(3.0%vs 6.0%,P=0.39).However,the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group(21.8%vs 3%,P=0.024).CM was identified as an independent risk factor for pancreatic exocrine insufficiency(odds ratio=8.195,95%confident interval:1.067-62.93).CONCLUSION PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.

Surgical organ displacement: what is the best “materials and methods” for proton radiotherapy?

In the mid 1940s, Robert Wilson （1） hypothesized that a highly localized deposition of energy from a proton beam could be used to increase the radiation dose to tumors while minimizing radiation to adjacent normal tissues. The depth- dose distribution of a proton beam differs significantly from that of a photon beam. Protons show increasing energy deposition with penetration distance, reaching a maximum- named the Bragg peak-near the end of the range of the proton beam. In front of the Bragg peak, the dose level is modest compared to photon beams; beyond the Bragg peak, the dose decreases to nearly zero. By choosing the appropriate proton beam energy, the depth of the Bragg peak can be adjusted to match the depth and extent of the target volume. Therefore, excellent conformality can be achieved, in contrast to conventional or intensity-modulated radiotherapy （IMRT）.

Selection of surgical methods for thoracic ossification of ligamentum flavum combined with cervical spondylotic myelopathy

Objective To investigate the difference between different surgical methods for thoracic ossification of ligamentum flavum(OLF) combined with cervical spondylotic myelopathy(CSM) . Methods From January 1991 to January 2003,56 cases

New Method of Reconstruction from Nonparallel Stereo and Application to Surgical Navigator

A new method to reconstruct 3D scene points from nonparallel stereo is proposed. From a pair of conjugate images in an arbitrarily configured stereo system that has been calibrated, coordinates of 3D scene points can be computed directly using the method, bypassing the process of rectifying images or iterative solution involved in existing methods. Experiment results from both simulated data and real images validate the method. Practical application to surgical navigator shows that the method has advantages to improve efficiency and accuracy of 3D reconstruction from nonparallel stereo system in comparison with the conventional method that employs algorithm for standard parallel axes stereo geometry.

Embryo Transfer by Surgical Method with Landrace as Receptor Sow

[ Objective] The paper was to test the feasibility of embryo transfer technique in pig production. [ Method ] Twenty-four estrus muhiparity Landraee sows provided by Longjing Agricultural Science and Technology Institute were performed embryo transfer surgery, and postoperative effects were observed. [ Result] Totally 11 out of 24 receptor sows were pregnant ; pregnant sows delivered 67 cloned piglets, and the average farrowing rate of sows was approximately 6 piglets/sow. There were 22 mortalities of newborn piglets because of various reasons. [ Conclusion] Embryo transfer technique is an indispensable link in pig production, and an important means of pig breeding and improvement.

Modified surgical method of supra-and infratentorial epidural hematoma and the related anatomical study of the squamous part of the occipital bone

BACKGROUND Supra-and infratentorial acute epidural hematoma(SIEDH)is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone(SOB).Traditionally,surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.AIM To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.METHODS Skull computed tomography(CT)scan data from 32 adult patients were collected from January 1,2019 to January 31,2020.On the median sagittal plane of the CT scan,the angle of the SOB(ASOB)was defined by two lines:Line A was defined from the lambdoid suture(LambS)to the external occipital protuberance(EOP),while line B was defined from the EOP to the posterior edge of the foramen magnum(poFM).The operative angle for the SIEDH(OAS)from the supra-to infratentorial epidural space was determined by two lines:The first line passes from the midpoint between the EOP and the LambS to the poFM,while the second line passes from the EOP to the poFM.The ASOB and OAS were measured and analyzed.RESULTS Based on the anatomical study,a single supratentorial craniotomy was performed in 8 patients with SIEDH.The procedure and the results of the modified surgical method were demonstrated in detail.For males,the ASOB was 118.4±4.7 and the OAS was 15.1±1.8;for females,the ASOB was 130.4±5.1 and the OAS was 12.8±2.0.There were significant differences between males and females both in ASOB and OAS.The smaller the ASOB was,the larger the OAS was.The bone flaps in 8 patients were designed above the transverse sinus intraoperatively,and the SIEDH was completely removed without suboccipital craniotomy.The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines.The OAS was negatively correlated with the ASOB.CONCLUSION The single supratentorial craniotomy for SIEDH is reliable and effective.

Application Effect of Informationized Teaching Method Based on Evidence-based Nursing in Surgical Nursing Teaching

Objective:The study was to analyze the application effect of informationized teaching method based on evidence-based nursing in surgical nursing teaching.Methods:From December 2019 to December 2020,60 students were selected as the research objects and randomly divided into two groups,each with 30 students in the teaching group.The observation group applied informationized teaching based on evidence-based nursing method,and the control group used the traditional teaching model.The teaching effect was evaluated.Results:The test scores of subjective theoretical knowledge and objective theoretical knowledge of the observation group were significantly higher than those of the control group,and the comprehensive ability evaluation of the observation group was also higher(P<0.05).The majority of students accepted the informationized teaching method based on evidence-based nursing,and a few held a neutral or disapproval attitude.Conclusion:Informationized teaching method based on evidencebased nursing can improve students'theoretical and practical levels in surgical nursing teaching,and most students also accept this teaching method,which has application value.

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.