不同手术方案在无神经损伤椎体骨折患者中的应用

目的 比较经皮椎弓根螺钉内固定术和开放椎弓根螺钉内固定术治疗无神经损伤胸腰段骨折患者的临床疗效.方法 选取2013年1月至2015年5月于我院接受治疗的98例无神经损伤椎体骨折患者为研究对象,按照随机数表法将患者分为对照组和观察组,每组49例.对照组行开放椎弓根螺钉内固定术治疗,观察组行经皮椎弓根螺钉内固定术治疗,比较两组患者的手术切口长度、手术时间、术中出血量、术后引流量、切口愈合时间;比较两组患者治疗后1个月、3个月、6个月疼痛视觉模拟评分(VAS);比较治疗后2周两组患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、血清肌酸激酶活性(CK)的水平;治疗3个月后对患者进行复查,比较两组患者的椎体前缘影像学高度、后凸Cobb角以及椎体矢状面指数.结果 观察组和对照组患者的手术切口长度[(1.83±2.01)cm vs(8.67±1.54)cm]、手术时间[(1.12±0.33)h vs(2.31±0.82)h]、术中出血量[(114.6±20.8)mL vs(276.5±40.8)mL]、术后引流量[(78.3±18.8)mL vs(162.4±45.6)mL]、切口愈合时间[(7.3±2.2)d vs(15.4±4.1)d]比较,观察组均优于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后1个月、3个月、6个月VAS评分分别为(3.01±0.78)分、(2.07±1.04)分、(1.97±0.93)分,均低于对照组的(6.82±1.47)分、(5.83±1.31)分、(3.87±1.07)分,差异均有统计学意义(P<0.05);治疗2周后观察组和对照组患者的血清CRP[(43.1±3.3)mg/L vs(50.3±1.7)mg/L]、IL-6含量[(3.87±0.83)ng/L vs(5.24±0.98)ng/L]、TNF[(178.65±21.44)ng/L vs(193.52±18.76)ng/L]、CK[(54.1±11.1)IU/L vs(74.4±13.6)IU/L]比较,观察组优于对照组,差异均有统计学意义(P<0.05);治疗3个月后观察组和对照组患者椎体前缘影像学高度[(84.3±7.2)%vs(85.1±6.8)%]、后凸Cobb角[(8.23±2.97)°vs(8.27±3.01)°]、椎体矢状面指数[(90.8±15.4)%vs(91.2±14.7)%]比较,差异均无统计学意义(P>0.05).结论 经皮椎弓根螺钉内固定术与开放椎弓根螺钉内定术治疗无神经损伤椎体骨折患者的治疗效果相当,但经皮椎弓根螺钉内固定术手术时间短、愈合时间快且术后炎症反应水平更低,值得临床推广.     

腰椎间盘突出并侧隐窝狭窄症微创开窗减压术保留黄韧带的效果观察

目的 观察腰椎间盘突出症侧隐窝狭窄症患者微创操作下行黄韧带保留腰椎间盘摘除局部"开窗"减压术的效果.方法 选择榆林市第四医院(星元)骨一科2013年1月至2015年12月拟行手术治疗的腰椎间盘突出症侧隐窝狭窄症患者82例,采用随机数表法分为对照组和观察组各41例,对照组于内窥镜下行腰椎间盘摘除局部"开窗"减压术,观察组于内窥镜下行黄韧带保留腰椎间盘摘除局部"开窗"减压术,比较两组患者的手术时间、切口长度、出血量、住院时间;术前、术后6个月、12个月采用日本骨科学会(JOA)评分评价临床症状改善情况.结果 观察组患者的平均手术时间为(119.32±18.27)min,长于对照组的(98.25±12.64)min,差异有统计学意义(P<0.05);两组患者的平均切口长度、术中出血量、平均住院时间比较差异均无统计学意义(P>0.05);观察组患者术后6个月、12个月的JOA评分分别为(28.71±1.52)分、(30.87±1.29)分,明显高于对照组的(23.55±1.52)分、(25.32±1.41)分,差异均有统计学意义(P<00.05).结论 微创操作下行黄韧带保留腰椎间盘摘除局部"开窗"减压术对腰椎骨性结构破坏少,可明显改善患者的中远期症状.     

Can simulation impact on first year diagnostic radiography students' emotional preparedness to encounter open wounds on their first clinical placement: A pilot study

IntroductionThis study reports on the use of moulage within a simulation to introduce first year diagnostic radiography students to open wounds in preparation for clinical practice.MethodologyA mixed-method quasi-experimental design was used. Visual Analogue Scales were used to capture state feelings at the point of seeing open wounds. Interpretative Phenomenological Analysis was used to draw themes from focus groups and an interview following clinical placement.ResultsThe simulation reduced negative feelings whilst emotional preparedness, distraction and excitement increased. Five major themes were identified including emotional engagement, engagement with wound, building relationships, developing professional self and simulation impact.ConclusionThe use of moulage and a simulation provides an opportunity to explore initial reactions. Students actively reflect on this experience during clinical practice changing practice. The impact of open wounds can be long lasting and support from radiographers should allow these new experiences to be processed reducing the risk of burnout.     

Effects of neonatal treatment with 5,7-dihydroxytryptamine or 6-hydroxydopamine on the ontogenetic development of the audiogenic immobility reaction in the rat

The ontogenetic development of the audiogenic immobility reaction (freezing) was studied in rats given intracisternal injections of the neurotoxins 5,7-dihydroxytryptamine (5,7-DHT), 25 g, or 6-hydroxydopamine (6-OHDA), 100 g, neonatally (Day 1). The duration of the freezing response was strongly reduced in the 5,7-DHT-treated rats between 20–30 days of age, when normal animals show very prolonged responses. During the same period increased motor activity was observed in the 6-OHDA-treated rats while only a slight reduction of the freezing response was noted. Biochemical analyses performed on brains from animals 35 days of age showed a selective reduction (about 50%) of whole brain levels of serotonin in the 5,7-DHT-treated rats, while the noradrenaline levels were selectively reduced by about 60% in the 6-OHDA rats. A longitudinal investigation on the effects of neonatal treatment with 5,7-DHT showed a persistent selective reduction of the whole brain level of serotonin up to at least 90 days of age. Since 5,7-DHT mainly affects the serotonergic pathways, the results suggest that the disturbances noted in the ontogeny of the freezing response may be due to interference with the developing serotonergic system.     

Differences in fear motivated behaviors among inbred mouse strains

The behavioral performance of inbred mouse strains was examined in animal models of anxiety to evaluate the potential contribution of genetic factors to fear-motivated behaviors. The preference that randomly bred mice and rats exhibit for the enclosed as opposed to the open arms of an elevated maze has been considered a fear-motivated behavior. Pronounced differences were observed in this measure among 16 inbred mouse strains. An estimate of the proportion of the variance attributable to between-strain differences, ², revealed that 78% and 69% of the variance in time and number of entries in the open arms of an elevated maze, respectively, can be attributed to genetic factors. In contrast, only 27% and 42% of the variance could be attributed to between-strain differences in ambulatory activity in the open field and elevated maze, respectively. Furthermore, performance in the elevated maze was predictive of behavior in other animal models of anxiety. Thus, significant negative correlations were observed among inbred mouse strains between the percent time spent in the open arms of the elevated maze and amplitude of an acoustic startle response (r _s=–0.88mP<0.01) or latency to initiate chow consumption in a hyponeophagia paradigm (r _s=–0.71,P<0.05). These results indicate that genetic factors substantially contribute to fear motivated behaviors in these animal models of anxiety. The use of such inbred mouse strains may provide a novel approach to investigate the biochemical and genetic bases of fear.     

Low peripheral perfusion: The cause of pressure sores in patients after open-heart surgery

Summary Pressure sores occurring in patients undergoing open-heart surgery have been accepted as accidental diathermy burns. This etiologic factor is an incorrect explanation. The mechanism must be similar to the one causing urethral strictures in these patients, namely, low peripheral perfusion during pump time. Statistical workup is not available to determine the exact magnitude of the problem, but there seems to be a difference in incidence in various cardiac surgery units. Most of the sores heal spontaneously. Prevention is strongly advocated.     

Neonatal desipramine or zimeldine treatment causes long-lasting changes in brain monoaminergic systems and alcohol related behavior in rats

To study the relationship between neonatal antidepressant administration, active (REM) sleep and adult alcohol-related behavior, rat pups were treated daily with 5 mg/kg despramine (DMI) or 25 mg/kg zimeldine SC from the 6th to the 19th postnatal days. Movement sensitive mattress (SCSB) measurements showed that zimeldine treatment suppressed active sleep throughout the whole treatment period, but DMI was more effective during the first 8 days than during the last treatment days. At the age of 70 days, the zimeldine-treated rats expressed a selective increase of some components of activity in the open field test, and the DMI rats had a higher defecation score compared to the controls. Furthermore, the zimeldine-rats responded with a decrease in ambulation in the open field to an alcohol dose which generally stimulates locomotion in rats. At the age of 3 months the DMI and zimeldine rats showed increased voluntary intake of 10% (v/v) alcohol. Measurement of brain monoamines revealed that the neonatal treatment with DMI or zimeldine interfered with the normal development and function of the monoamine neuronal systems: the concentrations of noradrenaline, dopamine and 5-hydroxytryptamine (5-HT), and their metabolites were altered in several brain regions. The results thus suggest that neonatal treatment with DMI or zimeldine suppresses active sleep and has an influence on later alcohol-related behavior, possibly due to a long-lasting defect in brain monoaminergic transmission.     

腹腔镜与开腹手术治疗老年胃癌患者效果及CRP、PCT与术后肠道功能的关系研究

目的探讨腹腔镜与开腹手术治疗老年胃癌患者效果及CRP、PCT与术后肠道功能的关系。方法选取60例老年胃癌患者并且按照随机数字表法分成腹腔镜组与开腹手术组,每组各30例,各组均采取全麻及相关手术治疗,比较两组患者术后康复情况、手术前后血清CRP与PCT变化情况及术后并发症情况。结果腹腔镜组在肠鸣音恢复、初次排气、初次排便、下床活动及住院时间指标上均较开腹手术组短,差异有统计学意义(P <0.05);在术后1 d、3 d两组血清CRP与PCT水平均较术前升高,但开腹手术组升高较腹腔镜组显著(P <0.05),术后5 d各指标对比差异无统计学意义(P> 0.05);腹腔镜组术后并发症总发生率为6.67%,明显低于开腹手术组的26.67%,差异有统计学意义(P <0.05);术后CRP、PCT明显升高者在肠鸣音恢复时间、初次排气时间及初次排便时间上较不明显升高患者长,差异有统计学意义(P <0.05)。结论对老年胃癌患者而言,腹腔镜手术较开腹手术优势明显,术后血清CRP、PCT值越低,胃肠功能恢复越快。     

Open abdominal aortic repair in the current era has more complications for occlusive disease than for aneurysm repair

BackgroundEndovascular intervention has become the first-line treatment of patients with abdominal aortic aneurysms (AAAs) or aortoiliac occlusive disease (AIOD). However, open abdominal aortic repair remains a valuable treatment option for patients who are younger, those with unfavorable anatomy, and patients for whom endovascular intervention has failed. The cohort of patients undergoing open repair has become highly selected; nevertheless, updated outcomes or patient selection recommendations have been unavailable. In the present study, we explored and compared the characteristics and postoperative outcomes of patients who had undergone open abdominal aortic repair from 2009 to 2018.MethodsPatients who had undergone open AAA (n = 9481) or AIOD (n = 9257) repair were collected from the National Surgical Quality Improvement Program database. The primary outcome was the 30-day mortality. The secondary outcomes included 30-day return to the operating room, total operative time, total hospital stay, and postoperative complications. Unmatched and matched differences between the two groups and changes over time were analyzed. Univariate and multivariate regression analyses were conducted to assess the risk factors predicting for 30-day mortality.ResultsAfter propensity matching (n = 4980), those in the AIOD group had had a higher 30-day mortality rate (5.1% vs 4.1%; P = .021), a higher incidence of wound complications (7.4% vs 5.1%; P<.0001) and an increased 30-day return to the operating room (14.2% vs 9.1%; P < .0001). More open AIOD cases (P = .02) and fewer open AAA cases (P = .04) had been treated in the second half of the decade than in the first. The factors associated with an increased odds of 30-day mortality included advanced age, American Society of Anesthesiologists score ≥III, functional dependence, blood transfusion <72 hours before surgery, weight loss in previous 6 months, and a history of chronic obstructive pulmonary disease.ConclusionsFrom 2009 to 2018, the number of open AAA repairs decreased and the proportion of open abdominal AIOD cases increased. Open AIOD surgery was associated with higher 30-day mortality, increased return to the operating room, and increased wound complications vs open AAA repair. Multiple risk factors increased the odds for perioperative mortality. Thus, open abdominal aortic repair should be selectively applied to patients with fewer risk factors.