Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.
Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero-lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and January 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years (mean, 43 years). The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, falls in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days (mean, 7 days). Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months (mean, 13 months). The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular injury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery (HSS) knee function score was 94 (range, 89-97) at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.
ObjectiveTo investigate the classification and clinical value of unilateral cervical lateral mass fracture (C3-7).MethodsFrom January 2008 to December 2017, 68 patients with unilateral cervical lateral mass fracture who had received treatment in Affiliated Hospital of Southwest Medical University, were included. According to the position of fracture, the fractures were classified into three types: articular process fractures (type A), isthmus fracture (type B), and comminution (type C). Two subtypes of articular process fractures were type A1 and type A2. Type A1 refered to articular process fracture with no or slight displacement. Type A2 refered to articular process fractures result in foraminal stenosis and nerve root compression. Single-level anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) or conservative treatment was used in type A1. Posterior decompression, fixation and fusion or the method of posterior decompression associated with ACDF were suited to A2. Single-level ACDF was used in type B as well. Type C underwent two-level ACDF or ACCF or posterior procedure.ResultsThere were 35 cases of Type A1, of which 31 patients underwent single-level ACDF, 2 patients underwent ACCF, and 2 patients received conservative treatment, but one of the two underwent ACDF due to delayed cervical instability. Among the 7 cases of type A2, 4 underwent posterior foraminal decompression and posterior fusion with pedicure screw fixation, 2 underwent single-level ACDF and posterior decompression, and 1 underwent single section ACDF and posterior decompression combined with pedical screw fixation. Type C accounted for 21 cases of all targets. Fourteen performed two-level ACDF, 6 performed ACCF, and 1 performed posterior fixation with pedicure screw and expansive open-door laminoplasty. Six patients showed postoperative complications, including C5 root palsy in one case, incision hematoma in two and pulmonary infection in three. There were no case with incision infection or aggravating nervous injury. Sixty-two patients (91.2%) were followed up with a mean duration of 14 months. All the patients obtained bony fusion and no internal fixation failure or kyphosis was found.ConclusionsAccording to fracture position and CT, the unilateral cervical lateral mass fracture can be classified as type A1, type A2, type B, and type C. A satisfied clinical result can be obtained when choosing an appropriate treatment in accordance with different fracture types.
ObjectiveTo observe the clinical effect of unilateral puncture percutaneous kyphoplasty (PKP) through transverse process-pedicle approach (TPA) for the treatment of lumbar osteoporotic vertebral fractures (OVF).MethodsFrom January 2014 to June 2019, a total of 220 OVF patients (321 fractured vertebral bodies) were enrolled, and PKP was performed by unilateral TPA puncture. The distribution of bone cement in vertebral body exceeding the midline of vertebral body was defined as the success of puncture, and the success rates of puncture of different vertebral bodies were recorded. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior and middle heights of the vertebral body, and the local Cobb angle were compared between three time points namely before operation, 1 day after operation, and 6 months after operation. Surgery-related complications were recorded.ResultsThe 220 patients included 57 males and 163 females, with a mean age of (70.3±6.5) years, a mean course of disease of (18.7±17.7) d, and a mean bone mineral density of −3.3±0.6. The success rate of puncture from L1 to L5 was 81.7% (85/104), 95.2% (80/84), 100.0% (69/69), 97.6% (41/42), and 72.7% (16/22), respectively. The mean volume of bone cement injected into the vertebral bodies was (5.8±0.9) mL. Two patients were followed up for less than 6 months because of death or loss to follow-up, and the other 218 patients were followed up for 6-57 months, with an average of (19.6±8.7) months. Before surgery, 1 day after surgery, and 6 months after surgery, the median (lower quartile, upper quartile) of VAS scores was 6 (6, 8), 1 (1, 2), and 2 (1, 2), respectively, with statistically significant differences in all the two-two comparisons (P<0.017). At the three time points, the median (lower quartile, upper quartile) of ODI was 61% (54%, 66%), 26% (22%, 30%), and 25% (24%, 31%), respectively, the mean height of anterior vertebral body was (18.3±2.8), (22.6±3.0), and (22.6±3.1) mm, respectively, the mean height of middle vertebral body was (17.8±2.2), (22.9±2.8), and (22.9±2.7) mm, respectively, the mean local Cobb angle was (19.9±2.6), (14.4±2.8), (14.4±2.8)°, respectively, and the values at 1 day and 6 months after surgery all differed from those before surgery (P<0.017). A total of 32 cases (42 vertebrae) had bone cement leakage, of whom 4 cases had related symptoms. There were 32 re-fractures of the vertebral bodies, including 18 adjacent vertebral body fractures, with an incidence rate of 5.6%. There were 3 vertebral infections after operation, the incidence was 0.9%.ConclusionPatients with OVF of the lumbar spine undergoing unilateral TPA puncture for PKP surgery have a high success rate, definite clinical effect, and satisfactory correction of local deformities.
ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
Objective To review the research progress in the treatment of high-grade spondylolisthesis (HS), in order to provide a reference for clinical treatment decision-making. Methods The literature related to the treatment of HS at home and abroad in recent years was widely reviewed. The methods of conservative treatment, in situ fusion, and spondylolisthesis reduction were analyzed and summarized. Results Surgical treatment is the main treatment of HS, but which method is the best is still controversial. The advantages, disadvantages, and applicability of various operations are also different, so individualized analysis is needed in clinic. Conclusion The treatment plan of HS needs to be considered comprehensively according to the individual condition of the patient. It will be an important research direction to further compare the existing treatment methods and develop more safe and effective new technology.
To explore the expression of Wnt-1 during the process of inducing neural stem cells (NSCs) into neurons by using all-trans-retinoic acid (ATRA) in vitro and the effect of Wnt-1 on NSCs differentiation. Methods NSCs isolated from cerebral cortex of SD rat embryo (12-16 days’ gestation) were cultured. The concentration of cells at passage 3 were adjusted to 1 × 106 cells /mL and treated with ATRA at 0.5, 1.0, 5.0 and 10.0 μmol/L, respectively. Differentiation ratio of NSCsinto neurons in each group was detected by double-labelling immunofluorescence technique and flow cytometry, and 1.0 μmol/ L was selected as the best concentration for ATRA to promote NSCs differentiation. In experimental group, NSCs at passage 3 were cultured with ATRA at 1.0 μmol/L in vitro, and expression of Wnt-1 was detected by immunocytochemistry staining, realtime flurescent quantitive PCR and Western blot at 3, 5, 7 and 9 days after culture, respectively. The cells at passage 3 receiving no ATRA served as control group. Results Immunocytochemistry staining: in the control group, there was l ittle Wnt-1 protein expression; in the experimental group, peak expression of Wnt-1 and numerous positive cells occurred at 3 days after culture, the positive expression of Wnt-1 was still evident at 5 days after culture, and there was significant difference between two groups in integrated absorbance (IA) value at 3 and 5 days after culture(P lt; 0.05), obvious decrease of positive expression of Wnt-1 was evident, and no significant difference was evident between two groups in IA value at 7 and 9 days (P gt; 0.05). Real-time fluorescence quantitative PCR: the relative expression of Wnt-1 mRNA in the control group was 0.021 7 ± 0.072 1; the relative expression of Wnt-1 mRNA in the experimental group at 3, 5, 7 and 9 days was 0.512 2 ± 0.280 0, 0.216 4 ± 0.887 0, 0.038 5 ± 0.299 4 and 0.035 5 ± 0.309 5, respectively, indicating the value decreased over time, and there were significant difference between two groups at 3 and 5 days (P lt; 0.05), and no significant difference at 7 and 9 days (P gt; 0.05) . Western blot detection: specific and visible staining band was noted; in the control group, Wnt-1 protein expression was 0.005 1 ± 0.558 3; in the experimental group, Wnt-1 protein expression at 3, 5, 7 and 9 days was 0.451 7 ± 0.071 3, 0.311 7 ± 0.080 5, 0.007 3 ± 0.052 7 and 0.004 7 ± 0.931 4, respectively, suggesting the value decreased over time; there were significant differences between two groups at 3 and 5 days (P lt; 0.05), and no significant differences at 7 and 9 days (P gt; 0.05). Conclusion With the induction of ATRA at 1.0 μmol/L, Wnt-1 and NSCs differentiation in early stage are positively correlated. Its possible mechanism may rely on the activation of such signals as classic Wnt-1 signal pathway, indicating Wnt-1 relates to the differentation of NSCs into neurons.
Objective To investigate the diagnostic value of MR imaging in cervical spinal canal stenosis combined with spinal cord injury. Methods From August 1998 to May 2008, 41 patients with cervical spinal canal stenosis and spinal cord injury were treated, including 34 males and 7 females aged 32-71 years (average 53.4 years, 27 patients being older than 60 years). Patients’ MRI data were retrospectively analyzed. Injury was caused by fall ing from height in 8 cases, traffic accidentin 19 cases, crush due to heavy objects in 3 cases and other reasons in 11 cases. The time from injury to operation ranged from 2 hours to 3 years. There were 12 cases of anterior spinal cord injury syndrome, 23 of central spinal cord syndrome and 6 of Brown-Sequard syndrome. JOA score of spinal cord function was 3-11 points (average 6.6 points). Results MR imaging diagnosis before operation showed abnormal signal changes within the spinal cord in 37 cases (41 sites), anterior and posterior longitudinal l igaments and discs (APLLD) injury in 28 cases (30 sites) and signal of edema and hematoma signals in anterior surface of cervical spines (EBC) in 34 cases (36 sites). Diagnosis during operation revealed edemas braises, contusions tears of posterior soft tissue in 18 cases (20 sites), appendix fracture in 6 cases (7 sites), formation of EBC in 20 cases (23 sites), APLLD injury in 34 cases (44 sites), intervertebral instabil ity without the rupture of l igament and intervertebral disc in 7 cases (10 sites). Significant difference was evident between the MRI diagnosis before operation and the intraoperative discoveries (P lt; 0.05). Conclusion The MR imaging diagnosis before operation do not correspond to the intraoperative discoveries, indicating that MRI diagnosis fails to make a relatively comprehensive and accurate diagnosis. So it is advisable to make a diagnosis based on cl inical symptoms.
目的 探讨后腹腔镜手术治疗肾盂输尿管连接部梗阻(ureteropeluic junction obstruction, UPJO)的手术技巧和临床效果。 方法 回顾性分析2006年7月-2009年10月59例采用后腹腔镜手术治疗UPJO患者的临床资料。后腹腔镜下行UPJO周围压迫组织松解术18例，Y-V成形术25例，离断成形术16例。 结果 术后随访3～36个月。所有患者手术均顺利完成。静脉肾盂造影均提示造影剂通过良好，肾积水均得到明显改善。 结论 后腹腔镜治疗UPJO创伤小，患者术后痛苦小、恢复快、住院时间短、疗效显著，可作为UPJO治疗的首选治疗方法。
The central aim of this experiment was to compare the articulatory and acoustic characteristics of students with normal hearing (NH) and school aged children with hearing loss (HL), and to explore the articulatory-acoustic relations during the nasal finals. Fourteen HL and 10 control group were enrolled in this study, and the data of 4 HL students were removed because of their high pronunciation error rate. Data were collected using an electromagnetic articulography. The acoustic data and kinematics data of nasal finals were extracted by the phonetics and data processing software, and all data were analyzed by t test and correlation analysis. The paper shows that, the difference was statistically significant (P<0.05 orP<0.01) in different vowels under the first two formant frequencies (F1, F2), the tongue position and the articulatory-acoustic relations between HL and NH group. The HL group’s vertical movement data-F1 relations in /en/ and /eng/ are same as NH group. The conclusion of this study about participants with HL can provide support for speech healing training at increasing pronunciation accuracy in HL participants.