目的 研究腦電雙頻指數（BIS）在小兒麻醉中的應用，為BIS在小兒臨床麻醉上的廣泛應用及提高小兒麻醉的安全性提供依據。 方法 2011年1月－3月擬行腹部外科手術的患兒60例，男39例，女21例；年齡1～4歲，美國麻醉醫師協會分級Ⅰ～Ⅱ級，隨機分為兩組，每組各30例。S組：七氟醚、瑞芬太尼和維庫溴銨維持麻醉；P組：丙泊酚、瑞芬太尼和維庫溴銨維持麻醉。采用BIS監測麻醉深度，將BIS控制在50 ± 5，記錄麻醉誘導前到手術探查期間不同時點的血流動力學參數及蘇醒、拔管時間。 結果 手術過程中P組血壓及心率明顯低于麻醉前水平（P＜0.05）。S組蘇醒迅速、完全，蘇醒時間與P組比較差異有統計學意義（P＜0.05）。S組的血流動力學穩定性優于P組，蘇醒時間、拔管時間相對較短。麻醉誘導前兩組的BIS值均為97 ± 1，意識消失時的BIS值為71 ± 2。BIS值為50 ± 5時，結果顯示手術過程中（T4、T5、T6、T7）兩組的心率、血壓都很平穩。 結論 BIS作為小兒麻醉鎮靜深度的監測指標有臨床意義。
Objective To investigate inpatient disease constitution in Traditional Chinese Medicine (TCM) Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2010, in order to provide baseline data for medicine allocation of hospitals in western China and development of TCM hospitals. Methods A questionnaire combined with a subject interview was carried out, and the case records of inpatients from 2008 to 2010 were collected. The diseases in discharge records were classified according to International Classification of Diseases (ICD-10) based on the first diagnosis. Data including general information of the inpatients, discharge diagnosis etc. were rearranged and analyzed by Excel software. Results a) The top four systematic diseases seen commonly from 2008 to 2010 were as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases were hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. Respiratory system diseases ranked the third in 2009 and 2010 from the fourth in 2008, and circulatory system diseases had ranked the first during the past three years; b) The following diseases as hypertension, bronchial emphysema and other chronic obstructive pulmonary diseases, diabetes, fractures, airway (bronchus, lung) cancer, and viral hepatitis were commonly seen in males rather than in females. By contrast, intervertebral disc disease, gallstone disease and cholecystitis, and anemia were commonly seen in females; and c) Hypertension was commonly seen in the aged above 60 years old; intervertebral disc disease mainly focused on the patients at the age of 15 to 59; and bronchial emphysema and other chronic obstructive pulmonary diseases, airway (bronchus, lung) cancer involved in the patients who were mostly over 60 years old. Conclusion a) The top four systematic diseases seen commonly from 2008to 2010 are as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases are hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. So these diseases should be taken into well consideration when making development plans by hospital and complementing essential drugs list by local development; b) Chronic diseases become the main disease for troubling Xinjiang population; and c) Male and female are susceptible to different diseases which should be rationally avoided in order to prevent the induced occurrence.
ObjectiveThis study aimed to compare the effects of aerobic training, resistance training, and aerobic training combined with resistance training on blood lipid levels for patients with hypertension using network meta-analysis. MethodsWe searched the CNKI, VIP, WanFang Data, PubMed, Web of Science, The Cochrane Library, and EMbase databases to collect randomized controlled trials (RCTs) on the effects of exercise on blood lipid levels among patients with hypertension from inception to September 16th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Stata 15.1 software and RevMan 5.0 software were then used to perform network meta-analysis. ResultsA total of 29 RCTs involving 2 519 patients were included. Compared with the control group, aerobic training (MD=?0.47, 95%CI ?0.62 to ?0.319, P<0.001), resistance training (MD=?0.37, 95%CI ?0.63 to ?0.11, P<0.05), and aerobic training combined with resistance training (MD=?0.61, 95%CI 0.88 to ?0.34, P=0.005) reduced total cholesterol levels; aerobic training (MD=0.14, 95%CI 0.08 to 0.20, P<0.001), resistance training (MD=0.10, 95%CI 0.02 to 0.19, P<0.05), and aerobic training combined with resistance training (MD=0.12, 95%CI 0.02 to 0.23, P=0.038) increased high-density lipoproteins; aerobic training (MD=?0.32, 95%CI ?0.48 to ?0.15, P=0.001), resistance training (MD=?0.19, 95%CI ?0.48 to ?0.01, P<0.05), and aerobic training combined with resistance training (MD=?0.40, 95%CI ?0.70 to ?0.11, P<0.05) reduced low-density lipoproteins. The SUCRA probability sorting results showed that aerobic training had the most significant effect on the improvement of systolic blood pressure and diastolic blood pressure; aerobic exercise combined with resistance training had the largest effect on total cholesterol, triglycerides, low-density lipoproteins, and high-density lipoproteins. ConclusionsAerobic training combined with resistance training is the most effective exercise method to improve blood lipid levels for patients with hypertension. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To employ spinal virtual surgery system (SVSS) for preoperative planning of thoracolumbar pedicle screw fixation, and to establ ish the measurement method for pedicle screw-related parameters. Methods Eight thoracicand lumbar spine specimens (T11-L3) were selected. First of all, SVSS was used for the preoperative planning of pedicle screw and the parameters of both sides of pedicle were measured in every vertebral segment, including angle of axial view (Aa), angle of sagittal view (As), x-direction entrance (XE), total pedicle length of axial view (TLa), total pedicle length of sagittal view (TLs), pedicle height (PH), pedicle width (PW), and pedicle spongy width (PSW). Then the corresponding parameters of the right and left pedicle screws of the specimens were measured actually. Finally, its accuracy was verified by comparing the data by virtual measurement and actual measurement. Results There was no significant difference in the parameters of virtual measurement (Aa, As, TLa, TLs, XE, PW, PSW, and PH) and actual measurement (Aa, As, TLa, XE, PW, PSW, and PH) between the right and left sides (P gt; 0.05). Except XE of the L3 vertebral segment and PSW of T11 and T12 vertebral segments (P lt; 0.05), the differences in other parameters of other segments were not significant (P gt; 0.05). Conclusion After statistical analysis and comparison, the feasibil ity of preoperative planning of thoracolumbar pedicle screw fixation and the accuracy of the measurement of the SVSS is verified.
Objective To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.
Objective To investigate the feasibil ity of replacing urinary epithel ial cells with oral mucosa cell to reconstruct tissue engineered urethra by being seeded on bladder acellular matrix graft (BAMG). Methods Eighteen male New Zealand rabbits, aged 10 weeks, weighing 0.3-0.5 kg, were used in this study. Oral mucosa cell of 12 rabbits were isolated and seeded onto a culture dish with a feeder layer of 3T3 and a culture dish without 3T3, respectively. The morphologic change and growth condition of oral mucosa cells were observed by inverted phase contrast microscope after 2 days of seeding. The quantity of oral mucosa cells was counted using cell counting meter; the cell growth curve was drawn and the immunofluorescence staining with broad-spectrum keratin antibody was carried out. The bladders taken from the rest 6 rabbits were decelluled to make BAMG and the tissue of 1 cm × 1 cm was randomly selected to observe the effect of acellularization. The second passage oral mucosa cells cultured with 3T3 were appl ied to steril ized BAMG to obtain a issueengineered mucosa. The tissue-engineered mucosa was assessed using HE staining and scanning electron microscope after being cultured for 1 week. Results Oral mucosa cells seeded onto a feeder layer of 3T3 could be passaged for 7 or 8 generations with homogeneous forms and full function. Oral mucosa cells cultured without 3T3 could only be subcultured for 2 generations before aging and had multiple shapes and different sizes. Oral mucosa cells cultured by the two methods both started logarithmic growth on the 8th day and reached the peak value on the 14th day, which was indicated by the cell growth curve. However, more cells could be obtained through oral mucosa cells cultured with 3T3 than those cultured without 3T3. Oral mucosa cells manifestated green colour fluorescence cultured with or without 3T3. After the cells were removed, the BAMG presented as a porous membrane. The HE staining showed that the effect of acellularization was good and there were no cells at BAMG. The second passage oral mucosa cells cultured with 3T3 were expanded and seeded onto steril ized BAMG to obtain a tissue-engineered mucosa. Good compatibil ity of the compound graft was assessed using HE staining and scanning electron microscope. HE staining and scanning electron microscope showed that oral mucosa cells had good biocompatibil ity with BAMG after the tissue engineered mucosa was cultured for 1 week. Conclusion Oral mucosa cells of rabbit can be cultured in vitro and attain magnitude quantities. Oral mucosa cell also have good biocompatibil ity with BAMG and the compound graft could be a new material for urethral reconstruction.
Objective To discuss the clinical characteristics, mechanism, and treatment of odontoid fracture combined with lower cervical spinal cord injuries without fracture or dislocation. Methods According to the inclusion and exclusion criteria, 7 male patients aged 37-71 years (mean, 51.4 years), suffered from odontoid fractures combined with lower cervical spinal cord injuries without fracture or dislocation were analyzed retrospectively between June 2007 and October 2015. The trauma causes were traffic accidents in 2 cases, fall in 2 cases, and hit injury in 3 cases. The time from injury to admission was 2 hours to 3 days with an average of 9 hours. According to Anderson-Grauer classification of odontoid fracture, 1 case of type IIA, 3 cases of type IIB, 2 cases of type IIC, and 1 case of shallow type III were found. The cervical spinal cord injuries affected segments included C4, 5 in 1 case, C4–6 in 2 cases, and C5–7 in 4 cases. All the cervical spine had different degenerative changes: 2 of mild, 3 of moderate, and 2 of severe. The lower cervical spinal cord injury was assessed by Sub-axial Injury Classification (SLIC) with scoring of 4-6 (mean, 5.1). The visual analogue scale (VAS) score was used to evaluate the occipital neck pain with scoring of 7.8±1.0; the neurological function was assessed by American Spinal Injury Association (ASIA) as grade B in 1 case, grade C in 4 cases, and grade D in 2 cases; and Japanese Orthopedic Association score (JOA) was 9.2±3.9. For the odontoid fractures, 4 cases were fixed with anterior screw while the others were fixed with posterior atlantoaxial fixation and fusion. For the lower cervical spine, 4 cases were carried out with anterior cervical corpectomy and titanium fusion while the others with anterior cervical disecotomy and Cage fusion. Results The operation time was 178-252 minutes (mean, 210.2 minutes); the intraoperative blood loss was 60-140 mL (mean, 96.5 mL) and with no blood transfusion. All incisions healed primarily. All the patients were followed up 12-66 months (mean, 18 months). There was no direct surgical related complications during operation, and all bone grafting got a fusion at 6-9 months (mean, 7.7 months) after operation. There was no inter-fixation failure or loosening. At last follow-up, the VAS score declined to 1.7±0.7 and JOA score improved to 15.1±1.7, showing significant differences when compared with preoperative ones (t=18.064, P=0.000; t=–7.066, P=0.000). The neurological function of ASIA grade were also improved to grade D in 5 cases and grade E in 2 cases, showing significant difference (Z=–2.530, P=0.011). Conclusion Complex forces and degeneration of lower cervical spine were main reasons of odontoid fracture combined with lower cervical spinal cord injuries without fracture or dislocation. The type of odontoid fracture and neurological deficit status of lower cervical spinal cord were important to guide making strategy of one-stage operation with a satisfactory clinic outcome.
目的 研究自體動靜脈內瘺全程規范化護理的可實施性及優勢。 方法 制定自體動靜脈內瘺全程規范化護理工作流程及標準，將2011年6月－8月經自體動靜脈內瘺行維持性血液透析患者隨機分為觀察組（125例）和對照組（115例），分別予以全程規范化護理和普通護理，對比分析兩組之間內瘺不良事件發生率、患者滿意度、護士認同度等指標的差異。 結果 兩組內瘺不良事件發生率分別為8.0%和21.0%，患者滿意度分別為98.4%和84.3%，差異均有統計學意義（P＜0.05）；兩組護士對本組護理模式認同度均為90.0%，差異無統計學意義（P＞0.05）。 結論 自體動靜脈內瘺全程規范化護理模式能有效降低內瘺不良事件發生率并顯著提高患者滿意度，值得臨床推廣。
Objective To explore the effect of self-designed early rehabilitation procedure of frozen shoulder incorporating high-frequency ultrasound technology in the outpatient treatment of patients with early frozen shoulder. Methods One hundred and eighty-two consecutive patients who attended the outpatient clinic of the Department of Rehabilitation Medicine of the First Affiliated Hospital of Xinjiang Medical University and were diagnosed with frozen shoulder between January 2018 and May 2021 were selected and randomly divided into the trial group and the control group, with 91 patients in each group. Patients in the trial group received early rehabilitation procedures for frozen shoulder, and patients in the control group received conventional physiotherapy. The Visual Analogue Scale (VAS) (including VAS score for resting pain and VAS score for active motion), active range of motion of the shoulder joint (external rotation, forward flexion, and abduction), Shoulder Pain and Dysfunction Index (SPADI) (including pain subscale score, dysfunction subscale score, and total score) were compared between the two groups before treatment (Week 0) and 4 and 8 weeks after the start of treatment (Week 4 and 8). Results A total of 143 patients (74 in the trial group and 69 in the control group) completed the study. There was no significant difference in any assessment index between the two groups in Week 0 (P>0.05). The results of the within-group comparison after treatment showed that the VAS score for resting pain (F=44.359, P<0.001), VAS score for active motion (F=158.458, P<0.001), anterior shoulder flexion (F=123.334, P<0.001), abduction mobility (F=117.539, P<0.001), total SPADI score (F=133.814, P<0.001), SPADI pain subscale score (F=74.093, P<0.001), and SPADI dysfunction subscale score (F=145.336, P<0.001) in Week 4 and 8 were better than those in Week 0, and the assessments in Week 8 were better than those in Week 4 in each group (P<0.05); in the control group, there was no statistically significant difference in the external rotation mobility of the shoulder in Week 4 compared with that in Week 0 (P=0.599), and the external rotation in Week 8 improved significantly compared with that in Week 0 (P<0.001), whereas the external rotation of the shoulder in Week 4 and 8 in the trial group improved significantly compared with that in Week 0 (P<0.001). The results of the between-group comparison after treatment showed that the two groups had statistically significant differences in resting shoulder pain VAS score (F=93.712, P<0.001), active motion VAS score (F=103.565, P<0.001), external shoulder rotation (F=13.388, P<0.001), anterior shoulder flexion (F=66.375, P<0.001), abduction mobility (F=110.253, P<0.001), total SPADI score (F=7.917, P=0.006), and SPADI pain subscale score (F=39.091, P<0.001); the SPADI dysfunction subscale score was lower in the trial group than that in the control group in Week 4 (P=0.002), but by Week 8 there was no statistically significant difference between the two groups (P=0.352). Conclusion The early rehabilitation program for frozen shoulder incorporating high-frequency ultrasound technology is more effective than conventional physiotherapy in the intervention of patients with early frozen shoulder, and may provide a referenceable example for the combined application of high-frequency ultrasound technology and physiotherapy.
ObjectiveTo investigate the effectiveness of digital three-dimensional (3D) printing osteotomy guide plate assisted total knee arthroplasty (TKA) in treatment of knee osteoarthritis (KOA) patients with femoral internal implants. Methods The clinical data of 55 KOA patients who met the selection criteria between July 2021 and October 2023 were retrospectively analyzed. Among them, 26 cases combined with femoral implants were treated with digital 3D printing osteotomy guide plate assisted TKA (guide plate group), and 29 cases were treated with conventional TKA (control group). There was no significant difference in gender, age, body mass index, side, Kellgren-Lawrence classification, preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, knee range of motion, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, incision length, postoperative first ambulation time, surgical complications; VAS score, knee HSS score, knee range of motion before operation, at 1 week and 3 months after operation, and at last follow-up; distal femoral lateral angle, proximal tibial medial angle, hip-knee-ankle angle and other imaging indicators at last follow-up were recorded and compared between the two groups. ResultsThe operation time, incision length, intraoperative blood loss, and postoperative first ambulation time in the guide plate group were significantly lower than those in the control group (P<0.05). In the control group, there were 1 case of incision rupture and bleeding and 1 case of lower limb intermuscular venous thrombosis, which was cured after symptomatic treatment. There was no complication such as neurovascular injury, incision infection, or knee prosthesis loosening in both groups. Patients in both groups were followed up 12-26 months, with an average of 16.25 months. The VAS score, HSS score, and knee range of motion improved at each time point after operation in both groups, and further improved with time after operation, the differences were significant (P<0.05). The above indicators in the guide plate group were significantly better than those in the control group at 1 week and 3 months after operation (P<0.05), and there was no significant difference between the two groups at last follow-up (P>0.05). At last follow-up, the distal femoral lateral angle, the proximal tibial medial angle, and the hip-knee-ankle angle in the guide plate group were significantly better than those in the control group (P<0.05). Conclusion The application of digital 3D printing osteotomy guide plate assisted TKA in the treatment of KOA patients with femoral implants can simplify the surgical procedures, overcome limitations of conventional osteotomy guides, reduce surgical trauma, achieve individualized and precise osteotomy, and effectively restore lower limb alignment and knee joint function.