ObjectiveTo retrospective summarize the experience of endovascular repair and open surgery in the treatment of renal aneurysms in our single center.MethodsClinical data of 24 patients with renal aneurysm treated in our hospital from August 2012 to May 2018 were analyzed retrospectively. Nine patients undergoing surgical intervention were categorized as the open operation group, and ten patients who received endovascular repair were classified as the endovascular repair group. To compare and analyze the results of the two groups. Five patients who had refused surgery therapy will be analyzed separately.ResultsTwenty-four patients with seventeen females (70.8%) and seven males (29.2%) were enrolled in this study and nineteen patients with twenty-three aneurysms got repaired successfully. The endovascular repair group had shorter hospital stay compared with the open operation group [median: 10.5 (P25 6.3, P75 15.0) d vs. 21.0 (P25 17.0, P75 27.5) d］. One patient in the open operation group developed renal artery stenosis at 11 months after surgery and underwent reoperation by repair by successful stent placement. There were no other significant postoperative complications occurred in the two groups. No abnormal enlargement or rupture of the aneurysms were observed during the follow-up period in 5 unoperated patients.ConclusionsBoth open surgery and endovascular repair are effective means of treating renal artery aneurysms. Once the renal aneurysm ruptures, serious consequences will occur. Once a renal aneurysm is diagnosed, regardless of the size of the aneurysm, active surgical treatment is recommend.
【摘要】 目的 通过观察单肺通气患者术中氧合指数（oxygenation index，OI）、呼吸指数（respiratory index，RI）及动态肺顺应性（dynamic lung compliance，Cdyn）的变化，探讨高渗氯化钠溶液对术中单肺通气患者的肺保护作用。 方法 选择2009年12月-2011年2月完成的美国麻醉师协会分级为Ⅰ~Ⅲ级，心肺功能筛查、血常规、肝肾功能及凝血功能无明显异常，拟在全麻双腔气管插管下行开胸手术，术中需行单肺通气患者60例，随机分为高渗氯化钠组（A组）和对照组（B组），每组30例。A组在开始单肺通气后30 min快速输注7.5%高渗氯化钠溶液2 mL/kg，15 min内输注完毕，B组输注等量生理盐水，分别记录输注前（T1）、输注完毕时（T2）、输注后30 min（T3）、输注后1 h（T4）的OI、RI及Cdyn变化，并比较两组各时间点生命体征变化。 结果 两组患者OI、RI及Cdyn在T1、T2时差异无统计学意义（Pgt;0.05）；两组患者不同时间点平均动脉压、心率、脉搏血氧饱和度、中心静脉压、呼气末CO2分压比较差异无统计学意义（Pgt;0.05）；A组患者在T3、T4时的OI和Cdyn较B组明显升高，RI明显降低（Plt;0.05）；且A组患者在T3、T4时的OI和Cdyn较T1时明显增高，RI明显降低（Plt;0.05）。 结论 高渗氯化钠溶液能改善术中单肺通气患者的OI、RI及Cdyn，对肺功能有一定的保护作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
ObjectiveTo summarize the research progress of the greater tubercle fixation and the rotator cuff repair in humeral head replacement.MethodsThe literature about proximal humerus fracture and humeral head replacement in recent years was extensively consulted and analyzed.ResultsThe greater tubercle fixation and the attached rotator cuff repair have great influence on the function of shoulder joint after humeral head replacement. It is difficult to make an objective comparison because of lack of direct comparison between various methods, unified standards of grading, and limited number of cases.ConclusionIt is an important factor of reduction and fixation of greater tubercle to obtain better effectiveness in humeral head replacement. However, one-stage repair of rotator cuff is more important than greater tubercle fixation for functional recovery of shoulder joint.
With the developing of three-dimensional (3D) printing technology, it is widely used in the treatment of bone tumors in the clinical orthopedics. Because of the great individual differences in the location of bone tumor, resection and reconstruction are difficult. Based on 3D printing technology, the 3D models can be prepared to show the anatomical part of the disease, so that the surgeons can create a patient-specific operational plans based on better understand the local conditions. At the same time, preoperative simulation can also be carried out for complex operations and patient-specific prostheses can be further designed and prepared according to the location and size of tumor, which may have more advantages in adaptability. In this paper, the domestic and international research progress of 3D printing technology in the treatment of limb bone tumors in recent years were reviewed and summarized.
China is the country with high incidence of high myopia in the world. High myopia can cause severe vision impairment. So far, there is no effective treatment for high myopia in clinic. Scleral collagen cross-linking surgery has been proven to be effective in preventing animal eye axial elongation in vitro and in vivo. However, the influence of posterior scleral collagen cross-linking on the deformation of the whole eyeball is still unclear. In this study, finite element simulation were used to analyze the changes of eyeball shape and the position of light casting on the retina after posterior sclera cross-linking, and the mathematical algorithm was written to verify their similarity. The results showed that the shape of the whole eyeball was still very similar before and after cross-linking, and the diopter of the eyeball after cross-linking had little change, which had almost no effect on the position of light projection on the retina. Our results indicate that posterior sclera cross-linking wouldn’t lead to distortion to the optometry, that is, the increase of elastic modulus in local scleral tissue after cross-linking wouldn’t cause new problem of optometry and vision.
Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.
Human society has entered the age of artificial intelligence(AI). Medical practice and education are undergoing profound changes. The government strongly advocates the application of AI in the field of education and it has been incorporated into the national strategy. The integration of medical education and AI technology is changing the paradigm of modern medical education. This paper introduces the current application status of AI in medical education, and analyzes the existing problems and proposes corresponding resolutions, so as to lay a foundation for promoting the integration of medical education and AI.
Objective To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery. Methods A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference (P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed. Results All patients completed the surgery successfully, with no significant difference in surgical time between the two groups (P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences (P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant (P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery (P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups (P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups (P>0.05). Conclusion Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.