简介：Objective:Toanalyzeretrospectivelytheclinicalsymptoms,signs,radiologicalfindingsandresultsoftreatmentofposttraumaticsyringomyelia.Methods:Thedataof7patientswithposttranmaticsyringomyeliaconfirmedbycomputerizedtomography(CT)andmagneticresonanceimaging(MRI)inourhospitalbetween1999and2004werereviewedretrospectively.Thepatientsunderwentdecompressivelaminectomyorsyringo-subarachnoid(S-S)shuntingwithmicrosurgery.Long-termfollow-upwasavailable(range:13-65months).Results:Themajorclinicalmanifestationsofposttraumaticsyringomyefiausuallyincludedtheonsetofincreasingsignsandthedevelopmentofnewsymptomsafteranapparentlystableperiod.Theclinicalsymptomsincludedpain,sensorydisturbance,weakness,andproblemsinautonomicnerves.Syrinxexistedmerelyatthecervicallevelin4casesandextendeddownwardtothethoraciclevelsintheother3cases.Onecaseunderwentdecompressivelaminectomy,6casesweretreatedbyS-Sshunting.Duringtheearlypostoperativeperiod,allthepatientsshowedanimprovementofsymptomsofsyrinxwithoutmajorcomplicationordeath.ThedecreasedsizeorcollapseofthesyrinxwasdemonstratedbypostoperativeMRI.Conclusions:Posttraumaticsyringomyeliaisadisablingsequelaofspinalcordinjury,developingmonthstoyearsafterspinalinjury.MRIisthestandarddiagnostictechniqueforsyringomyelia.Thepatientswithposttraumaticsyringomyeliacombinedwithprogressiveneurologicaldeteriorationshouldbetreatedwithoperations.S-Sshuntingprocedureiseffectiveinsomepatientswithposttraumaticsyringomyelia.Decompressiveproceduremaybeanalternativeprimarysurgicaltreatmentforpatientswithkyphosisandcordcompression.

简介：比较在主要debulking外科(PDS)和neoadjuvant化疗之间的幸存和perioperative病态的目的在与先进上皮的卵巢的癌症(EOC)对待病人由间隔debulking外科(NAC/IDS)列在后面。我们回顾地与阶段IIIC或IVEOC考察了67个病人的方法从2006年1月在北京大学癌症医院对待到2009年6月。在那里，37和30个病人分别地经历了PDS和NAC/标志。结果在全面幸存(OS)或没有前进的幸存(PFS)的差别都没在NAC/IDS组和PDS组之间被观察(OS：41.2对39.1个月，P=0.23；PFS：27.1对24.3个月，P=0.37)。最佳的debulking率在NAC/IDS组是60%，它在PDS组(32.4%)(P=0.024)比那显著地高。NAC/IDS组显著地有比PDS的肠的功能的估计的血损失和输送，更低的nasogastricintubation率，和更早的移动和恢复组织的更少的intraoperative(P<0.05)。结论NAC/IDS不比PDS侵略，并且关于最佳的cytoreduction率，intraoperative血损失，和手术后的恢复提供优点，没有显著地损害与在对待有阶段IIIC或IVEOC的病人的PDS相比的幸存。因此，NAC/IDS可以是为EOC病人的一种珍贵治疗选择。

简介：AIM:Tocomparethesafetyandefficacyofphacoemulsificationandsmallincisioncataractsurgery(SICS)inpatientswithuveiticcataract.·METHODS:Inaprospective,randomizedmulti-centricstudy,consecutivepatientswithuveiticcataractwererandomizedtoreceivephacoemulsificationormanualSICSbyeitheroftwosurgeonswellversedwithboththetechniques.Aminimuminflammationfreeperiodof3mo(definedaslessthan5cellsperhighpowerfieldinanteriorchamber)wasapre-requisiteforeligibilityforsurgery.Superiorscleraltunnelincisionswereusedforbothtechniques.Improvementinvisualacuitypost-operativelywastheprimaryoutcomemeasureandtherateofpost-operativecomplicationsandsurgicaltimeweresecondaryoutcomemeasures,respectively.Meansofgroupswerecomparedusingt-tests.Onewayanalysisofvariance(ANOVA)wasusedwhenthereweremorethantwogroups.Chi-squaretestswereusedforproportions.KaplanMeyersurvivalanalysiswasdoneandmeansforsurvivaltimewasestimatedat95%confidenceinterval(CI).APvalueof<0.05wasconsideredstatisticallysignificant.·RESULTS:Onehundredandtwenty-sixof139patients(90.6%)completedthe6-monthfollow-up.Sevenpatientswerelostinfollowupandanothersixexcludedduetoeitherfollow-uplessthansixmonths(n=1)orinabilityimplantanintraocularlens(IOL)becauseofinsufficientcapsularsupportfollowingposteriorcapsulerupture(n=5).Therewassignificantimprovementinvisionafterboththeprocedures(pairedt-test;P<0.001).Onfirstpostoperativeday,uncorrecteddistancevisualacuity(UDVA)was20/63orbetterin31(47%)patientsinPhacogroupand26(43.3%)patientsinSICSgroup(P=0.384).Themeansurgicallyinducedastigmatism(SIA)was0.86±0.34dioptres(D)inthephacoemulsificationgroupand1.16±0.28DinSICSgroup.Thedifferencebetweenthegroupswassignificant(t-test,P=0.002).At6mo,correcteddistancevisualacuity(CDVA)was20/60orbetterin60(90.9%)patientsinPhacogroupand53

简介：Objective:Survivalandtreatmentofpatientswithmicroinvasivebreastcancer(MIBC)remaincontroversial.Inthispaper,weevaluatedwhetheradjuvantchemotherapyisnecessaryforpatientswithMIBCtoidentifyriskfactorsinfluencingitsprognosisanddecidetheindicationforadjuvantchemotherapy.Methods:Inthisretrospectivestudy,108patientswithMIBCwererecruitedaccordingtoseventheditionofthestagingmanualoftheAmericanJointCommitteeonCancer(AJCC).Thesubjectsweredividedintochemotherapyandnon-chemotherapygroups.Wecomparedthe5-yeardisease-freesurvival(DFS)andoverallsurvival(OS)ratesbetweengroups.Furthermore,weanalyzedthefactorsrelatedtoprognosisforpatientswithMIBCusingunivariateandmultivariateanalyses.Wealsoevaluatedtheimpactofadjuvantchemotherapyontheprognosticfactorsbysubgroupanalysisaftermedianfollow-uptimeof33months(13-104months).Results:The5-yearDFSandOSratesforthechemotherapygroupwere93.7%and97.5%,whereasthoseforthenonchemotherapygroupwere89.7%and100%.Resultsindicatethat5-yearDFSwassuperior,butOSwasinferior,intheformergroupcomparedwiththelattergroup.However,nostatisticalsignificancewasobservedinthe5-yearDFS(P=0.223)orOS(P=0.530)rateofthetwogroups.Mostrelevantpoor-prognosticfactorswereKi-67overexpressionandnegativehormonalreceptors.Cumulativesurvivalwas98.2%vs.86.5%betweenlowKi-67(≤20%)andhighKi-67(>20%).ThehazardratioofpatientswithhighKi-67was16.585[95%confidenceinterval(CI),1.969-139.724;P=0.010].Meanwhile,ER(-)/PR(-)patientswithMIBChadcumulativesurvivalof79.3%comparedwith97.5%forER(+)orPR(+)patientswithMIBC.ThehazardratioforER(-)/PR(-)patientswithMIBCwas19.149(95%CI,3.702-99.057;P<0.001).SubgroupanalysisshowedthatchemotherapycouldimprovetheoutcomesofER(-)/PR(-)patients(P=0.014),butnotthosewhooverexpressKi-67(P=0.105).Conclusions:PatientswithMIBCwhooverexpressKi-67and

简介：BackgroundVocalcordmovementdisorder(VCMD)isalaryngealdisordercharacterizedbyparadoxicaladductionofthevocalcordsduringininspiration,expirationorboth.ThenursingexperienceofpatientswithVCMDafteraorticdissectionsurgeryislimited.MethodsWeretrospectivelyanalyzedtheclinicaldataandnursingrecordsof269patientsafteraorticdissectionsurgeryinGuangdongGeneralHospitalbetweenMay2010andMay2012.Weobservedthepatients’pronunciation,andjudgediftherewasdysphagiaundergoingwaterdrinkingtesttwohoursafterextubation,toconfirmwhetherpatientshadVCMD.ResultsSeventeenpatientshadVCMDafteraorticdissectionsurgery,ofwhom2sufferedhoarseness,3haddysphasiaand12hadbothhoarsenessanddysphasia.Aftertimelytreatmentandcarefullynursing,allthepatientsrecoveredwell.ConclusionsWiththeenhancedcareofpatientswithaorticdissection,observinghoarsenessappearanceanddrinkingexperimentimmediatelyafterextubationcandetectVCMDassoonaspossible.Furtherrehabilitationtrainingandpsychologycarecanpreventbuckingandaspirationeffectively,andpromotingrecoveryandimprovingpatient’slifequality.

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简介：ObjectivesTotestthefeasibilityoftheuseofhighthoracicepiduralanesthesiaasasoleanestheticinpatientsundergoingoffpumpcoronaryarterybypasssurgery,avoidinggeneralanesthesia.MethodsBetweenOctober2002toApril2003,twentyfivecasesunderwentbeatingheartcoronaryarteryrevascularizationwithoutendotrachealgeneralanesthesia,usinghighthoracicepiduralanesthesiaandanalgesia.Allthepatientsunderwentepiduralcatheterizationontheeveningbeforethesurgery.ResuitsThepatientsinallreceived71grafts(singlen=11,doublen=5,triplen=6,quadruplen=3).Sixpatientsunderwentrepeatcoronaryarterybypass.Exceptonewasconvertedtogeneralanesthesiaandcardiopulmonarybypass,theotherpatientsunderwentoff-pumpcoronaryarterybypassgraftsurgery,2patientsunderwentgraftingvialeftthoracotomy(MIDCAB)andtherestthroughmidsternotomy.Therewasnomortality.Meanlengthofstayintheintensivecareunitwas16.2(4.2hoursandhospitalwas3.0(1.2days.ConclusionsOurexperienceconfirmsthefeasibilityofperformingmuhiplecoronaryarterybypassesinconsciouspatientswithoutendotrachealgeneralanesthesia.

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简介：AbstractBackground:Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO2) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO2 in the forearm and that in the thigh.Results:We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.Conclusion:Muscular tissue desaturation, defined as a baseline SmtO2 < 80% in the forearm, may be associated with an increased risk of POP.Trial registration:No. ChiCTR-ROC-17012627.

简介：AIM:Toidentifyriskfactorsassociatedwithpost-cataractsurgeryendophthalmitis(PCE)intype2diabeticpatients.METHODS:Ahospital-basedretrospectivecase-controlstudywasconductedon194type2diabeticpatientsundergoingcataractsurgeryinRajavithiHospitalfromJanuary2007toDecember2015.FifteenpatientswithPCEwereincludedasthecasegroupand179patientswithoutPCEwereincludedasthecontrolgroup.PotentialfactorsassociatedwithPCEamongbothgroupsincludingdemographics,pre-operativecharacteristics,surgicalsettingsandcomplications,werestatisticallyanalyzedusingChi-squaretestingandalogisticregressionmodel.RESULTS:Withinthecasegroup,53%werefemalesandthemedianagewas68y.Univariateanalysisofpre-operativecharacteristics,surgicalsettingsandcomplicationsrevealedthatrecentpre-operativefastingplasmaglucose,insulintherapy,presenceofdiabeticretinopathy,andseverenon-proliferativeorproliferativediabeticretinopathyweresignificantlyassociatedwithPCE.Inamultivariateanalysisadjustingforbloodglucoselevel,insulintreatmentwastheonlysignificantfactorassociatedwithanincreasedriskofPCE(OR3.9,95%CI1.0-15.0,P=0.04)comparedtopatientswithoutinsulintreatment.Themostcommoncausativeorganismsweregram-positivebacteria(89%).Staphylococcusspeciesrepresentedthemostcommongroup(67%).Medianbestcorrectedvisualacuityat1-monthand3-monthfollow-upwasequalat0.7logMAR(20/100).CONCLUSION:Theauthorsidentifyinsulintreatmentastheonlyriskfactorassociatedwithendophthalmitisaftercataractsurgeryintype2diabeticpatients.Furtherstudieswithserumlevelsofpre-operativeglycatedhemoglobin(HbA1c)andpost-operativefastingplasmaglucoselevelareessentialtotrulydemonstratetheroleofperi-operativeglycemicmarkersasariskfactorforPCE.

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简介：AbstractBackground:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0-120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

简介：ObjectivesToevaluateretrospectivelythepotentialbenefitsofcombinedutilizationofvariousassistedcirculationdevicesincardiacarrestpatientswhodidnotrespondtoconventionalcardiopulmonarycerebralresuscitation(CPCR).MethodsAssistedcirculationdevices,includingemergencycardiopulmonarybypass(ECPB),intra-aorticballoonpump(IABP),andleftventricularassistdevice(LVAD),wereappliedto16adultpatientswhohadcardiacarrest82min-56hafteropenheartsurgeryanddidnotrespondto20minorlongerconventionalCPCR.ECPBwasappliedto2patients,ECPBplusIABPto8patients,ECPBplusIABPandLVADto6patients.ResultsOnepatientrecoveredfullyandonepatientdied.Oftheother14patients,13resumedspontaneouscardiacrhythmandonedidnot;noneofthemcouldbeweanedfromECPB.Furthertreatmentofthe14patientswithcombinationsofassistedcirculationdevicesenabled6patientstorecover.Oneofthe7recoveredpatientsdiedofreoccurringcardiacarrestafter11days;theother6weredischargedingoodconditionandwerefollowedupfor3-49months(mean=22months).Ofthe6dischargedpatientsonesufferedcerebralembolismduringLVADtreatment,resultinginmildlimitationofmobilityoftherightlimbs;theother5nevermanifestedanycentralnervoussystemcomplications.Therewasnolatedeathsgivinga37.5%(6/16)long-termsurvivalrate.ConclusionsECPBcouldeffectivelyreestablishbloodcirculationandoxygensupply,rectifyacidosis,andimproveinternalmilieu.ThecombinedutilizationofECPB,IABP,andLVADreducesthedurationofECPB,improvestheincidenceofrecovery,andoffersbeneficialalternativestorefractorycardiacarrestpatients.

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简介：AbstractEnhanced recovery after surgery (ERAS) protocols have been developed in numerous surgical specialties as a means of systematically improving patient recovery, functional outcomes, cost savings, and resource utilization. Such multidisciplinary initiatives seek to minimize variability in several aspects of perioperative patient care, helping to reduce inpatient length of hospital stay, complications, and the overall resource and financial burden of surgical care. Head and neck oncology patients stand to benefit from the implementation of comprehensive ERAS protocols, as these patients have complex medical needs that may dramatically impact multiple aspects of their recovery, including breathing, eating, nutrition, pain, speech, swallowing, and communication. Implementing ERAS protocols for head and neck cancer patients may present unique challenges, and require significant interdisciplinary coordination and collaboration. We therefore sought to provide a comprehensive guide to the planning and institution of such ERAS systems at institutions undertaking care of head and neck cancer patients. Key elements to consider in the implementation of successful ERAS protocols for this population include organizing a team consisting of frontline leaders such as nursing staff, medical specialists, and associated health professionals; designing interventions based on systematically evaluated, high-quality literature; and instituting a clear methodology for regularly updating protocols and auditing the success or potential limitations of a given intervention. Potential obstacles to the success of ERAS interventions for head and neck cancer patients include challenges in systematically tracking progress of the protocol, as well as resource limitations in a given health system.

简介：Objective:Cancerisoneofthemostcommondiagnosesinelderlypatients.Ofalltypesofabdominalcancer,colorectalcancer(CRC)isundoubtedlythemostfrequent.Medianageatdiagnosisisapproximately70yearsoldworldwide.Duetothemultiplecomorbiditiesaffectingelderlypeople,frailtyevaluationisveryimportantinordertoavoidover-orundertreatment.Thispilotstudywasdesignedtoinvestigatethevariablescapableofpredictingthelong-termriskofmortalityandlivingsituationaftersurgeryforCRC.Methods:Patientswith70yearsoldandolderundergoingelectivesurgeryforCRCwereprospectivelyenrolledinthestudy.Thepatientswerepreoperativelyscreenedusing11internationally-validated-frailty-assessmenttests.Theendpointsofthestudywerelong-termmortalityandlivingsituation.ThedatawereanalyzedusingunivariateCoxproportional-hazardregressionanalysistoverifythepredictivevalueofscoreindicesinordertoidentifypossibleriskfactors.Results:Forty-sixpatientswerestudied.Themedianfollow-uptimeaftersurgerywas4.6years(range,2.9-5.7years)andnopatientswerelosttofollow-up.Theoverallmortalityratewas39%.Fourofthepatientswhosurvived(4/28,14%)losttheirfunctionalautonomy.ThepreoperativeimpairedTimedUpandGo(TUG),EasternCooperativeGroupPerformanceStatus(ECOGPS),InstrumentalActivitiesofDailyLiving(IADLs),VulnerableEldersSurvey(VES-13)scoringsystemsweresignificantlyassociatedwithincreasedlongtermmortalityrisk.Conclusion:Simplifiedfrailty-assessingtoolsshouldberoutinelyusedinelderlycancerpatientsbeforetreatmentinordertostratifypatientrisk.TheTUG,ECOG-PS,IADLsandVES-13scoringsystemsarepotentiallyabletopredictlong-termmortalityanddisability.Additionalstudieswillbeneededtoconfirmthepreliminarydatainordertoimprovemanagementstrategiesforoncogeriatricsurgicalpatients.

简介：Objective:Tocomparativelystudythedifferenteffectsofopenheartsurgeryonbraintissuesofpatientswithcongenitalandrheumaticheartdisease.Methods:Fortypatientswithcongenitalheartdisease(CHD,CHDgroup,n=20)orrheumaticheartdisease(RHD,RHDgroup,n=20)underwenton-pump(cardiopulmonarybypass,CPB)heart-beatingopenheartsurgery.BloodsamplesbeforeCPB,and20minutes,1hour,24hoursand7daysafterCPBwerecollected,andthelevelsofneuron-specificenolase(NSE)andproteinS-100bintheplasmaweredeterminedwithenzyme-linkedimmunoadsorbentassay(ELISA),respectively.Allthepatientswereexaminedwithelectroencephalogram(EEG)beforeand1weekafteroperation.ThechangesofNSE,S-100bandEEGcomparedtoverifythedifferenceofpostoperativecerebralinjurybetweenCHDcasesandRHDcases.Results:TheplasmalevelofS-100bincreasedsignificantly20minutesafterCPBandwasstillhigherthanthepreoperativelevelat24hoursafteroperationinbothgroups(P<0.01).TheplasmalevelofNSEincreasedmoresignificantlyintheCHDgroupthanintheRHDgroup20minutesafterCPBanditreturnedtothenormallevel24hoursafterCPBintheCHDgroupbutremainedatahighlevelintheRHDgroup(P<0.01).ThelevelsofNSEandS-100breturnedtothenormallevelsonthe7thdayafterCPB.AbnormalEEGwasfoundin75%ofthepatientsintheCHDgroupand60%intheRHDgroup.Conclusions:On-pumpheart-beatingopenheartsurgerycancausecertaincerebralinjuryinthepatientswithCHDorRHD.TheinjurywasmoresevereandrecoveredmorequicklyintheCHDgroupthanintheRHDgroup.