Objective To study the feasibility of a new method for the cross-leg position maintained by the Kirschner wire internal fixation after the cross-leg flap procedure. Methods From December 2004 to October 2005, 5 patients (4 males, 1 female; aged 14-52 years) were admitted to our department, who suffered from the tibia exposure or the internal fixation plate exposure after operation because of the tibia fracture by trauma for 1-8 weeks. The soft tissue defects ranged in area from 2.4 cm × 2.0 cm to 4.2 cm × 3.0 cm. The soft tissue around the wound in the leg was too poor in condition to perform an operation of the local flap transplantation, but the wound and the tibia had no obvious infection, so an operation of the cross-leg flap transplantation was performed to cover the wounds. The operation was performed with the routine crossleg flap method introduced in the medical literature. After operation the cross-leg position was maintained through a simple internal fixation with two Kirschner wire, which were inserted through the tibia of the cross region of both thelegs, and layers of dressings were placed as a cushion between the crossed legsin case of the crushing skin ulcer formation. The effect of fixation, blood circulation in the cutaneous flap, and the stress of the pedicle were observed postoperatively. After 3-4 weeks the pedicle of the cross-leg flap was cut off; the crossed legs were detached and the Kirschner wire were pulled out. Results All the flaps survived with a good blood circulation and a low pedicle stress. The patients had a relatively comfortable position because all the areas of the legs could be allowed to make some motions except the cross-area ofthe legs. Another advantage of this fixation method was its convenience for observing the blood circulation of the cutaneous flap and for changing the dressings. Neither infection in the holes of the Kirschner wire nor crushing skin ulcer formation in the area of the cross-leg could be observed. The follow-up for 3-18 months revealed that all the flaps were in good condition with no edema, contracture or skin pigmentation. Conclusion The method of usingthe Kirschner wire to maintain the cross-leg position after the crossleg flapprocedure has more advantages than the plaster fixation. This improved method is simpler, and can achieve a tighter fixation in the crossleg area to maintainthe cross-leg position, allowing a micro-motion in other parts of the legs. The patients can have a relatively comfortable posture, and have a more convenient dressing changes and observation on the blood circulation in the flaps.
Building a harmonious socialist society reflects the inherent requirement of building a prosperous, democratic, civilized and harmonious modern socialist country. Strengthening medical and health services, and improving the level of people's health is one of the most important measures in constructing a socialist harmonious society of the CPC Central committee. Hospital is an important part of medical and health services. Hospital trade union is the bridge and link between the party and workers. Therefore, hospital trade union should give full play to its function and role, actively participate and promote the construction of harmonious hospital. The current hospital trade unions need positioned and explored under the present situation.
ObjectiveTo assess the effect of polyurethane gelatum grommet positioning and Mayfield head holder positioning under suboccipital retrosigmoid approach in acoustic neuroma resection on patients' facial crushing. MethodsRetrospective analysis of the clinical and nursing data of 90 patients treated by microsurgical surgery under the lateral prone position in our hospital from January 2013 to January 2014 was carried out. Patients in group A (n=28) were given grommet positioning, while those in group B (n=62) were given Mayfield head holder positioning, and then we compared the situation of facial crushing between the two groups. ResultsIn group A, 5 patients showed abnormality including 2 cases of skin injury in lower frontozygomatic and mandibular area, 2 cases of lower conjunctival edema and 1 of co-existing skin injury in lower zygomatic area and lower conjunctival edema, and the crushing rate was 17.86% in group A. In group B, the crushing rate was 1.61% with one case of mandibular skin injury. There was a significant difference between the two groups (χ2=5.778, P=0.016). ConclusionUnder suboccipital retrosigmoid approach for acoustic neuroma resection, Mayfield head holder positioning is better to avoid facial crushing.
Hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. Hypertension is common among patients with diabetes. Recently, the American Diabetes Association (ADA) published a new position statement which updated the assessment and treatment for hypertensive patients with diabetes. This interpretation is intended to help Chinese clinicians to understand the new ADA position statement.
Objective To investigate the effect of the position of pancreatic duct in pancreatic section on postoperative pancreatic fistula. Methods The clinical data of patients undergoing pancreaticoduodenectomy admitted to the pancreatic surgery department of our hospital from September 2018 to August 2020 were retrospectively collected. The consistency between intraoperative pancreatic section data and preoperative CT cross-sectional images of pancreatic duct was compared, and the occurrence of postoperative pancreatic fistula was analyzed by univariate analysis and multivariate logistic regression model analysis, to determine whether the position of pancreatic duct on pancreatic section during pancreaticojejunostomy had an impact on the occurrence of postoperative pancreatic fistula. Results A total of 373 patients were included in this study. In 44 cases, the ratio of the thickness of the short distance from the center of the pancreatic duct to the edge of the pancreas at the pancreatic section was 0.41±0.09, and the imaging measurement value was 0.40±0.10. The interclass correlation coefficient detection value of the two measurement methods was 0.916 (>0.75), P<0.001, this had high consistency. Patients had a high BMI [OR=1.276, 95%CI (1.154, 1.411), P<0.000 1] and soft pancreatic texture [OR=2.771, 95%CI (1.558, 4.927), P=0.001] were independent risk factors for postoperative pancreatic fistula, while the risk of postoperative pancreatic fistula decreased with the increased proportion of pancreatic duct thickness from center to edge [OR=0.875, 95%CI (0.840, 0.911), P<0.000 1]. Conclusions Patients with high BMI and soft pancreas are independent risk factors for postoperative pancreatic fistula, and the risk of postoperative pancreatic fistula is reduced when the center of pancreatic duct is far from the edge of pancreas. The ratio of short distance from the center of pancreatic duct to the edge of pancreas to the total thickness of pancreas measured by preoperative imaging can be used to evaluate the risk of postoperative pancreatic fistula.
In order to address the issues of spatial induction bias and lack of effective representation of global contextual information in colon polyp image segmentation, which lead to the loss of edge details and mis-segmentation of lesion areas, a colon polyp segmentation method that combines Transformer and cross-level phase-awareness is proposed. The method started from the perspective of global feature transformation, and used a hierarchical Transformer encoder to extract semantic information and spatial details of lesion areas layer by layer. Secondly, a phase-aware fusion module (PAFM) was designed to capture cross-level interaction information and effectively aggregate multi-scale contextual information. Thirdly, a position oriented functional module (POF) was designed to effectively integrate global and local feature information, fill in semantic gaps, and suppress background noise. Fourthly, a residual axis reverse attention module (RA-IA) was used to improve the network’s ability to recognize edge pixels. The proposed method was experimentally tested on public datasets CVC-ClinicDB, Kvasir, CVC-ColonDB, and EITS, with Dice similarity coefficients of 94.04%, 92.04%, 80.78%, and 76.80%, respectively, and mean intersection over union of 89.31%, 86.81%, 73.55%, and 69.10%, respectively. The simulation experimental results show that the proposed method can effectively segment colon polyp images, providing a new window for the diagnosis of colon polyps.
Objective To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis. Methods The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis, including 7 males and 29 females, aged from 50 to 79 years (mean, 63.9 years), were retrospectively analyzed. Lesion segments included 2 cases of T11, 12 cases of T12, 2 cases of T11, 12, 4 cases of T12 and L1, 12 cases of L1, 2 cases of L2, 1 case of L2, 3, and 1 case of L3. The disease duration ranged from 4 to 120 months, with an average of 19.6 months. Surgical procedures included Smith-Petersen osteotomy in 4 cases, Ponte osteotomy in 6 cases, pedicle subtraction osteotomy in 2 cases, and improved fourth level osteotomy in 18 cases; the remaining 6 cases were not osteotomized. The bone mineral density ranged from −3.0 to 0.5 T, with a mean of −1.62 T. The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured, including local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and PI and LL mismatch (PI-LL). The kyphotic flexibility=(preoperative standing LKCA−preoperative prone LKCA)/preoperative standing LKCA×100%. Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation, and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation. ResultsWhen the position changed from standing to prone, LKCA and TK decreased significantly (P<0.05), while SS, LL, PT, and PI-LL had no significant difference (P>0.05). Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions (P<0.05), and the correlation strength between LL and SS in prone position was higher than that in standing position. In the standing position, LKCA was significantly correlated with SS and PT (P<0.05). However, when the position changed from standing to prone, the correlation between LKCA and SS and PT disappeared, while PT and PI-LL was positive correlation (P<0.05). The kyphotic flexibility was 25.13%-78.79%, with an average of 33.85%. Conclusion For the patients of old traumatic spinal fractures with kyphosis, the preoperative LKCA and TK decrease significantly from standing position to prone position, and the correlation between spinal and pelvic parameters also changed, which should be taken into account in the formulation of preoperative surgical plan.