Objective To evaluate the effectiveness of inguinal hernia treated by tension-free hernioplasty in adult. Methods Electronic databases were searched including CNKI (1993 to 2003), MEDLINE (1993 to 2003) and OVID (1993 to 2003). Personal contact with experts in the field of tension-free hernioplasty was performed to identify potentially relevant trials. Randomized controlled trials of plug amp; Mesh versus Mesh only repair and laparoscopic versus open Mesh hernia repair in recurrence, peri-operative complication or long term postoperative complication were included. Data related to the clinical outcome were extracted by two reviewers independently. Statistical analysis was performed by using RevMan 4.2 software. Results Twenty one studies involving 4 154 patients met the inclusion criteria from 1993 to 2003. Compared with Mesh only repair, plug amp; Mesh repair had no significant difference in recurrence rate (OR 1.14, 95%CI 0.37 to 3.47, P=0.82), preoperative complication rate (OR 1.01, 95%CI 0.63 to 1.63, P=0.95) and long term postoperative complication rate (OR 0.46, 95%CI 0.18 to 1.16, P=0.1). Compared with open Mesh hernioplasty, transabdominal preperitoreal repair (TAPP) group had no significant difference in recurrence rate (OR1.24, 95%CI 0.65 to 2.36, P=0.52), preoperative complication rate (OR 0.89, 95%CI 0.65 to 1.22, P=0.46) and persistent pain (OR 0.76, 95%CI 0.48 to 1.19, P=0.22); totally extrapevitoreal repair (TEP) group had no significant difference in recurrence rate (OR1.07, 95%CI 0.51 to 2.24, P=0.70) or persistent pain (OR 0.95, 95%CI 0.55 to 1.65, P=0.86), and had lower tendency persistent pain (OR 0.50, 95%CI 0.34 to 0.73, P=0.000 4) with statistical significance. Conclusion Current evidence suggests that there is no significant difference between anterior approach plug amp; Mesh repair (Rutkow’s repair) and the Mesh only repair (Lichtenstein’s repair). TEP of Laparoscopic hernioplasty is superior to open Mesh hernia repair in preoperative complication. More researches are needed for recurrence rate, persistent pain.
【摘要】目的探討在數字減影 (DSA)透視下,經過鼻腔將胃管、空腸營養管聯合置入及其臨床應用的范圍和價值。方法選擇2007年8月23日2009年10月22日期間35例需要行腸內營養的患者,在DSA透視下經鼻腔將胃管以及預先套入的空腸營養管聯合置入,置管成功后分別造影,顯示胃管位于胃內,而空腸營養管末端位于空腸內。結果35例患者成功置管。置管時間為49～186 min,平均108 min。置管中及置管后未發生嚴重并發癥。置管后營養管在位良好,喂養過程順利。結論DSA透視下經鼻胃管、空腸營養管聯合置入是一種安全、經濟、有效的腸內營養途徑,同時解決了胃液引流問題,具有一定的臨床應用價值。
Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.
【摘要】 目的 探討結膜惡性黑色素瘤的手術治療方法。 方法 1997年1月-2007年1月收治結膜惡性黑色素瘤48例，均為單眼。腫瘤范圍:lt;1/3眼瞼長度及結膜14例，gt;1/3眼瞼長度，部分穹隆結膜受累19例，上下眼瞼及內外眥大部分結膜受累者15例。采用單純腫瘤切除術、單純腫瘤切除聯合液氮冷凍治療、眼眶內容物剜除術3種治療方法。 結果 所有患者均經病理學證實為結膜惡性黑色素瘤 。術后48例進行9個月～5年隨訪，15例眶內容物剜除術，3例死于肺及顱腦轉移；14例單純擴大腫瘤切除聯合液氮冷凍治療，2例死于肝轉移；19例單純擴大腫瘤切除術，6例分別死于肝、肺及顱腦轉移。 結論 早期診斷并選擇積極有效的手術治療是提高患者生存率，改善生存質量的重要手段。手術切除聯合液氮冷凍法可有效降低腫瘤復發，避免影響患者視覺質量和外觀，是治療結膜惡性黑色素瘤的一種有效方法。【Abstract】 Objective To investigate the surgical therapeutics for malignant melanoma of eyelid conjunctiva. Methods A total of 48 patients with monocular malignant melanoma of eyelid conjunctiva from January 1997 to January 2007 were collected. The scope of the melanoma involved lt;1/3 eyelid length and conjunctiva in 14, gt;1/3 eyelid length and part of conjunctival formix in 19, and upper and lower eyelid and most of the conjunctiva of medial and lateral canthus in 15. Eye socket exenteration,tumor resection combine with eyelid reconstruction, tumor resection were used. Results All of the patients were diagnosed as malignant melanoma of eyelid conjunctiva by pathological examination. The follow-up period was 9 months-5 years. Among the 15 patients who had undergone eye socket exenteration,3 died. Among the 14 patients who had undergone expand tumor resection combine with liquid nitrogen frozen, 2 died. Among the 19 patients who had undergone tumor resection combine with eyelid reconstruction, 6 died. Conclusion Tumor resection combine with liquid nitrogen frozen is effective on malignant melanoma of eyelid conjunctiva.
The purpose of this paper was to investigate the effects of wearable lower limb exoskeletons on the kinematics and kinetic parameters of the lower extremity joints and muscles during normal walking, aiming to provide scientific basis for optimizing its structural design and improving its system performance. We collected the walking data of subjects without lower limb exoskeleton and selected the joint angles in sagittal plane of human lower limbs as driving data for lower limb exoskeleton simulation analysis. Anybody (the human biomechanical analysis software) was used to establish the human body model (the human body model without lower limb exoskeleton) and the man-machine system model (the lower limb exoskeleton model). The kinematics parameters (joint force and joint moment) and muscle parameters (muscle strength, muscle activation, muscle contraction velocity and muscle length) under two situations were compared. The experimental result shows that walking gait after wearing the lower limb exoskeleton meets the normal gait, but there would be an occasional and sudden increase in muscle strength. The max activation level of main lower limb muscles were all not exceeding 1, in another word the muscles did not appear fatigue and injury. The highest increase activation level occurred in rectus femoris (0.456), and the lowest increase activation level occurred in semitendinosus (0.013), which means the lower limb exoskeletons could lead to the fatigue and injury of semitendinosus. The results of this study illustrate that to avoid the phenomenon of sudden increase of individual muscle force, the consistency between the length of body segment and the length of exoskeleton rod should be considered in the design of lower limb exoskeleton extremity.
ObjectiveTo compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. MethodsA total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. ResultsCompared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). ConclusionCompared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.
ObjectiveTo summarize the treatment results of double aortic arch (DAA) by minimally invasive surgical technique. MethodsWe retrospectively analyzed the clinical data of DAA patients who underwent minimally invasive surgeries in our center between October 2016 and August 2021. ResultsThere were 11 males and 4 females with a mean age of 3-61 (20.00±18.80) years. There were 8 patients of DAA and 7 patients of DAA complicated with distal left-sided aortic arch atresia and ligamentum connection. All patients received operations through minimal subaxillary incision, 13 patients were through left side and 2 patients were through right side. One patient with ventricular septal defect was performed operations concurrently under the cardiopulmonary bypass through right minimal subaxillary incision. All patients had symptom improvement without surgery related complications or death in postoperative period. The duration of operation was 30-192 (61.93±40.19) min and mechanical ventilation time was 2-9 (5.33±2.53) h. The length of ICU stay was 18-124 (51.00±38.07) h and hospital stay time was 8-21 (12.67±3.42) d. All patients had symptomatic relief with good growth and exercise tolerance during the follow-up of 6 (3, 9) months. ConclusionMinimally invasive surgical technique is a safe, effective and cosmetic approach with good results for DAA treatment.
Objective To explore the effects of narrative intervention and different intervention models on children at risk for developmental language disorders (DLD). Methods Using a random number table method, thirty children at risk for DLD in Yuhua District, Changsha City, were selected from September to December 2024 and randomly assigned to three groups: individual group (n=10), peer group (n=10), and control group (n=10). The individual and peer groups (2-3 children per peer group) received a 20-hour narrative intervention, while the control group did not receive any intervention. The Little Frog, Where Are You? test was used to assess the children’s narrative abilities, and both global and local coherence error rates were analyzed. Results A total of 24 children were enrolled in the final analysis, including 7 in the individual group, 9 in the peer group, and 8 in the control group. Compared with pre-intervention levels, in the individual group, within-group differences in global and local coherence error rates at 1 week and 3 months post-intervention were statistically significant (all P<0.05) with large effect sizes (Cohen’s |d|>1); in the peer group, only the within-group difference in local coherence error rate at 1 week post-intervention reached statistical significance (P<0.05), with a large effect size (Cohen’s |d|>1); in the control group, within-group differences in global coherence error rate were statistically significant at both 1 week and 3 months post-intervention (both P<0.05), with large effect sizes (Cohen’s |d|>1). Between-group comparisons revealed that at 1 week post-intervention, statistically significant differences in local coherence error rates were observed between both intervention groups and the control group (both P<0.05), with large effect sizes (Cohen’s |d|>1); 3 months post-intervention, the difference in global coherence error rate between the individual group and the control group was statistically significant (P<0.05) and exhibited a large effect size (Cohen’s |d|>1); no statistically significant intergroup differences were identified in any other pairwise comparisons (all P>0.05). Conclusions Early narrative intervention has a preliminary positive effect on enhancing the narrative coherence in children at risk for DLD. In clinical practice, either individualized intervention or peer participatory intervention can be used independently, or the advantages of both approaches can be integrated by alternating individual and peer collaborative interventions.
Objective To evaluate the short-term clinical efficacy and safety of 10-Hydroxy-camptothecin （10- HCPT ） chemotherapy on gastrointestinal carcinoma. Methods We searched electronic database including CNKI （ 1995 - 2005 ）, MEDLINE （ 1995 - 2005 ） and The Cochrane Library （ Issue 1, 2005 ）. More related research data were odtained by cantacting with researchers. Randomized controlled trials of gastrointestinal carcinoma chemotherapy comparing only or including 10-HCPT chemotherapy with normal chemotherapy on efficacy rate, digestive and hematology system toxicity were included. Data related to the clinical outcome were extracted by two reviewers independently. Statistical analysis was performed by using RevMan4. 2.2. Results Twenty-five trials including 1 881 patients met the inclusion criteria. The results of meta-analysis were hsted as follows： 10-HCPT could significantly improve the short-term chemotherapy efficacy for colorectal cancer （ RR. 1.62, 95% CI 1.37 to 1.92） and gastric cancer （RR 1.48, 95% CI 1.18 to 1.85）in chemotherapy curative efficacy in short-term. 10-HCPT induced severe toxicity of lower digestive system（RR. 0.96,95% CI 0.62 to 1.50 ） without statistical significance, while severe toxicity of hematology system was significantly higher than that of control with RR 1.27,95% CI 1.02 to 1.58. Conclusions Current evidence suggests that 10-HCPT can improve hematology system short-term chemotherapy efficacy for gastrointestinal carcinoma and increase the incidence of severe toxicity. Further research is needed to value its influence on the prognosis of gastrointestinal carcinoma.
【摘要】 目的 探討顱內動靜脈畸形切除術中彩色多普勒超聲檢查的應用價值與預后的關系。 方法 在顯微外科手術的基礎上，將65例動腦靜脈畸形患者隨機分為A、B兩組， A組34例動靜脈畸形患者在術中接受術中超聲檢查，確定其畸形血管團的數目、位置、深度、大小、范圍及其與周邊組織結構的關系，探查供血動脈及引流靜脈的數目及走行，以確定動、靜脈畸形的位置、手術切除范圍及切除術后是否有畸形血管殘留；B組31例行常規手術，比較兩組之間的差異。 結果 術中彩色多普勒超聲能清晰的顯示動靜脈畸形的情況，兩組經手術完整切除動靜脈畸形率、再出血率、術后7 d Glasgow昏迷評分及預后差異均有統計學意義（Plt;0.05）。 結論 術中實時彩色多普勒超聲能對腦動靜脈畸形準確定位，并可判定腦動靜脈畸形的血供模式及殘余情況，減少腦組織損傷及降低手術并發癥的發生，提高了手術安全性及治療效果。【Abstract】 Objective To explore the application of the colored Doppler ultrasonography in the excision of intracranial arteriovenous malformation (AVM) to determine the location of the lesion and the completeness of the resection, and to evaluate the clinical value of intraoperative ultrasonography in the diagnosis, treatment and the relation to the prognosis of patients. Methods A total of 65 patients with brain AVM were randomly divided into group A and B. The microsurgery was perfromed on the patients. Intraoperative ultrasound was performed on the 34 patients in group A to the numbers, location, depth,size of different malformation vascular clumps relationship of the arteriovenous malformation with surrounding tissues. While the pateints in group B underwent the routine surgery. The difference between the two groups were compared. Results The condition of the AVM were clearly revealed by intraoperative ultrasonography. All of the intracranial AVM in group A were completely removed. The difference in rehaemorrhagia and postoperative Glasgow coma scale score of seven day between the two groups were statistically significant (Plt;0.05). Conclusions Intraoperative color Doppler ultrasounography in the resection of intracranial AVM could accurate localize the lesions, identify vascular anatomy of the AVM vascular balls and the completeness of resection. The parameters including resistance index of the vessels may identify the abnormal vessels and reduce the operative complications and brain tissue damage, which improve the safety and efficacy of the therapeutic effect.