ObjectiveTo compare the keyhole approach and traditional craniotomy in the treatment of basal ganglia region hypertension cerebral hemorrhage postoperative epileptic curative effect comparison keyhole approach and traditional craniotomy in the treatment of basal ganglia region the curative effect of hypertensive cerebral hemorrhage postoperative epilepsy. MethodsCollected cases of basal ganglia region admitted in department of neurosurgery our hospital from September 2006 to March 2015, 108 cases of hypertensive cerebral hemorrhage patients, randomly divided into two groups:keyhole approach group (58 cases) and conventional surgery group (50 cases).Two groups of patients with perioperative all use the same management scheme, using statistical methods to analyze clinical data of two groups of patients, such as age, sex, blood loss, postoperative epilepsy, drug efficacy and the incidence of adverse drug reactions, etc. ResultsPostoperative follow-up of 2 years, keyhole approach group 12 cases sufferred postoperative seizure, 1 case of patients with status epilepticus, no death occurred; a total of 10 cases of mono-antiepileptic drug(AEDs) therapy effectively, and 7 cases present adverse drug reactions; Traditional surgical postoperative seizures 22 cases, 9 cases occurred status epilepticus, and five died as a result, only five were effective for single therapy, and 15 cases with adverse drug reactions.Statistical results suggest the incidence of postoperative epilepsy, the incidence of severe epilepsy, prognosis, single drug control and adverse drug reactions between the tuo groups have significant difference (P < 0.05). ConclusionCompared with traditional craniotomy for removal of hematoma, keyhole approach greatly reduce the incidnce of basal ganglia region hypertension cerebral hemorrhage postoperative complications, severe epilepsy and adverse reaction of AEDs.Therefore, keyhole approach in the treatment of basal ganglia region hypertension cerebral hemorrhage is an admirable way of treatment.
ObjectiveTo explore the related risk factors of epilepsy after traumatic skull defect repair.MethodsThe clinical data of 72 cases patients underwent cranial three-dimensional titanium mesh repair in Neurosurgery Department of Sichuan Baoshihua Hospital from February 2010 to December 2017 were collected and followed up for 6 months, retrospectively analysed the causes and operation problems of secondary epilepsy after repair.Results21 casese (29.2%) among the 72 cases patients underwent cranioplasty were found with secondary epilepsy. Univariate analysis showed that the rate of secondary epilepsy in patients with softening lesion of gray matter, no formal antiepileptic treatment after the first operation, suspension of dural during operation and repair time of the trauma >6 months was significantly higher than that in patients without secondary epilepsy (P<0.05). Multivariate Logistic regression was used to correct the results, showing that softening lesion in the gray matter [OR=8.425, 95% CI (2.541, 27.934), P<0.001)], no formal antiepileptic treatment after the first operation [OR=0.160, 95% CI (0.050, 0.518), P=0.002], intra-operative suspended dural [OR=13.306; 95% CI (3.769, 46.976), P<0.001] and repair time of trauma >6 months [OR=6.205, 95% CI (1.705, 22.583], P=0.006] were independent risk factors of secondary epilepsy.ConclusionAfter decompression of bone flap, regular antiepileptic therapy, shortening repair time, and proper peroperative management can reduce the incidence of postoperative epilepsy.
ObjectiveTo summarize the research progress on the impact of postoperative adjuvant chemotherapy on frailty, cognitive function, and quality of life in older patients with breast cancer.MethodCollected literatures about the impact of postoperative adjuvant chemotherapy on frailty, cognitive function, and quality of life in older patients with breast cancer to make an review.ResultsElderly breast cancer patients were likely to benefit from postoperative adjuvant chemotherapy without undergoing significant impairment of frailty, cognitive function, and quality of life. However, postoperative adjuvant chemotherapy might cause an aggravation of the frailty in patients who was already with it.ConclusionWe should develop personalized treatment plans for elderly breast cancer patients after multidisciplinary assessment.
ObjectiveTo summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy (NAC) and to review the impact of NAC on the surgical treatment of breast cancer. MethodRelevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed. The literatures were analyzed, summarized, and discussed. ResultsFollowing NAC, the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy. The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission (pCR) of breast lesions after NAC, potentially allowed some breast cancer patients to undergo only radiation therapy after NAC, thus avoiding breast surgery. For patients with positive axillary lymph nodes, techniques such as dual-tracer, triple-tracer, and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy, provided a safe alternative to axillary lymph node dissection. ConclusionsNAC is an important component of comprehensive breast cancer treatment. However, there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC. Currently, individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice, aiming to achieve the optimal control of local recurrence and survival benefits for patients.
Objective?To systematically evaluate the effects of thoracic epidural anesthesia on outcome after coronary artery bypass surgery. Methods?We searched PubMed, EBSCO, Springer, Ovid, and CNKI databases from 1990 through Oct. 2009 to identify randomized controlled trials (RCTs) about thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone on outcome after coronary artery bypass surgery. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook. The homogeneous RCTs were pooled using RavMan 4.2.10 software. Results?Sixteen RCTs involving 1 316 patients met the inclusion criteria. The results of meta-analyses showed that thoracic epidural anesthesia significantly reduced time to tracheal extubation (MD= –332.43, 95%CI –640.19 to –24.68, P=0.03), visual analog scale (VAS) scores at rest on postoperation day 1 (MD= –1.23, 95%CI –2.19 to –0.27, P=0.01), VAS scores with movement on postoperation day 1 (MD= –2.52, 95%CI –4.65 to –0.39, P=0.02) and day 2 (MD= –1.5, 95%CI –2.56 to –0.43, P=0.006), and incidences of myocardial ischemia (RR=0.53, 95%CI 0.29 to 0.97, P=0.04). There were no significant differences between the two groups in postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. Conclusions?Thoracic epidural anesthesia could reduce postoperative time to tracheal extubation, VAS score, and incidences of myocardial ischemia, but it does not affect postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. More high-quality RCTs are required.
Objective To investigate the levels of IL-6 and TNF-α in children with obstructive sleep apnea syndrome (OSAS) and to determine their clinical significance. Methods One hundred children with OSAS in our department from August 2005 to February 2006, and 40 healthy children were enrolled in the study. The serum levels of IL-6 and TNF-α were measured. Results Serum levels of IL-6 and TNF-α were significantly higher in patients with OSAS than those in the control group (Plt;0.05). Both IL-6 and TNF-α were not correlated with AHI. Conclusion It is concluded that OSAS is a chronic inflammatory process. A close correlation was observed between high levels of IL-6 and TNF-α and OSAS. High levels of IL-6 and TNF-α account for the risk factors in the development of cardiovascular diseases in children with OSAS.
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。
【摘要】 目的 建立血液中乙醇的直接稀释-填充柱气相色谱测定法，将其与现行推荐方法GA/T105-1995进行对比，同时对不同采血管对乙醇含量的影响进行研究。 方法 使用GDX-102填充柱作为分析柱，柱温160 ℃，汽化室190 ℃，检测器（FID）190 ℃；用1 mg/mL正丙醇溶液稀释血液50倍，经离心后，取上清液1 μL进样测定。 结果 本法回收率91.2%~105.7%，与GA/T105-1995推荐方法测定结果最大相对误差为7.1%，血液保存于非抗凝管的血醇浓度比抗凝管稍高。 结论 该法适用于血液中乙醇含量的测定，样品处理更简便。不同采血管对血醇含量有一定影响，综合考虑各因素后建议使用枸橼酸钠抗凝管作为采血管。【Abstract】 Objective To establish a direct dilution-gas chromatographic method for the determination of ethanol in blood, compare the method with GA/T105-1995 recommendation method, and study the effects of blood tubes with different anticoagulants on the ethanol contents. Methods GDX-102 packed column was used as separation column with an oven temperature of 160 ℃, an injector temperature of 190 ℃ and a flame ionization detector temperature of 190 ℃. Normal propanol solution at 1 mg/mL was adopted to dilute the samples with a volume 50 times of the propanol solution. After being centrifuged, 1ul of the supernatant liquid was injected for analysis. Results The recovery rate of the method was between 91.2% and 105.7%. The deviation of the method with GA/T105-1995 recommendation method was less than 7.1%. The concentration of blood ethanol preserved in the non-anticoagulant tubes was a little higher than that preserved in the anticoagulant tubes. Conclusions The method can be used for the determination of ethanol content in blood. Compared with GA/T105-1995 recommendation method, the sample treatment of this method is much simpler. And the blood tubes with different anticoagulants have influences on the ethanol contents. It is recommended that blood tubes with sodium citrate as anticoagulant can be used for blood sampling and preservers.
目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。