The Safety and Efficacy of Using Drainage in Arthroscopic Rotator Cuff Repair

PurposeThis study aimed to evaluate the effects of not using a drain or placing a drain in the glenohumeral (GH) or subacromial (SA) joint spaces on fluid retention and pain in the early postoperative period and late clinical outcomes.MethodsPatients who underwent arthroscopic rotator cuff repair between 2018 and 2020 were included in the study. Before the operation, demographic data, range of motion (ROM), visual analog scale (VAS) scores, Constant–Murley scores has documented. Deltoid muscle diameter (DMD) were measured. The total amount of irrigation used during the surgery and the operation duration were recorded, and the active amount of fluid coming from the drain in patients with a drain was recorded. The first postoperative DMD measure was made in the operating room and accepted as day 0. DMD measurements repeated postoperative first and second day. VAS assessments were performed on the postoperative first and second days. At the outpatient clinic, these measurements were repeated on the first and second weeks after discharge. Functional evaluations were made with ROM and Constant–Murley scores at the final follow-up examination.ResultsThere was no difference in the amount of drainage between the two groups in which a drain was used. When the three groups were compared among themselves regarding preoperative and postoperative VAS scores, Constant–Murley scores, and DMD, no significant difference was found.ConclusionsWe do not recommend the routine use of drains after arthroscopic rotator cuff surgery in terms of cost-effectiveness.Level of evidenceLevel II: Prospective Cohort Study.     

上腔静脉塌陷指数预测机械通气患者容量反应的可行性

目的探索上腔静脉塌陷指数(SVC-CI)对机械通气患者容量反应的预测效果。方法选择择期气管插管全麻机械通气下行腹部手术患者36例,男20例,女16例,年龄18～64岁,ASAⅠ或Ⅱ级,NYHAⅠ或Ⅱ级。所有患者在全麻诱导后至手术开始前,快速输注复方乳酸钠10 ml/kg,输注时间10～15 min。记录补液前后MAP、HR、CVP、心脏指数(CI)、每搏量变异度(SVV),利用经食管超声心动图测量上腔静脉(SVC)内径,并计算补液前后CI的变化值(ΔCI)以及SVC-CI。根据ΔCI将患者分为容量反应组(R组,ΔCI≥15%)和非容量反应组(NR组,ΔCI15%)。采用受试者工作特征(ROC)曲线评估SVC-CI和SVV预测容量反应的效能。结果有20例(56%)患者出现容量反应。R组SVC-CI明显高于NR组(P0.05)。SVC-CI预测容量反应的ROC曲线下面积为0.816(95%CI 0.673～0.958),敏感性85%,特异性75%。SVV预测容量反应的ROC曲线下面积为0.731(95%CI 0.567～0.895),敏感性55%,特异性88%。结论 SVC-CI和SVV均可预测机械通气患者容量反应,而SVC-CI的预测效能优于SVV。     

Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos

ObjectiveTo compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR.DesignRandomized experimental pilot study by groups.SettingOut-hospital care basic life support units on the Island of Mallorca.ParticipantsAdults attended after cardiorespiratory arrest of non-traumatic origin.InterventionsAdvanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring.Main measurementsCapnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions.ResultsTwenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3 mmHg in the control group and 27.4% in the intervention group. 34.8% (n = 8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n = 6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P = .066).ConclusionsThe use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.     

基于32位Windows的双泵复苏装置的控制系统

本文介绍一种新型双泵复苏装置的控制系统。此控制系统采用了上下位机结构，上位机采用奔腾以上的PC机，32位Windows操作系统为工作平台；下位机采用16位的80C196KC单片机，并由两片82C55实现上下位机之间的并行通讯。上位机主要是设置和调节双泵复苏的控制参数，并把设置好的参数通过并行通讯传递给下位机，以实现对下位机的控制，同时对下位机产生的控制脉冲波形进行监测；此外还具有心电等生理信号进行实时的采集、监测、存储和波形回放等功能。下位机主要是根据内置的或上位机传递下来的控制参数，以特定的算法产生双泵复苏所需的控制脉冲序列，去控制气阀的动作实施双泵复苏术。     

术前禁食、输液对剖产母婴血糖的影响

目的：了解术前禁食、输液对剖宫产母婴血糖的影响。方法：将110例健康的剖宫产妇分为3组,A组：术前禁食≥6小时、未输液体;B组：术前未禁食、未输液体;C组：术前禁食≥6小时、输葡萄糖液体5－25g。于术前、术后（手术结束时）采集母体静脉及新生儿脐带静脉血测定其血糖值并进行比较,结果：术前血糖以C组最高,术前低血糖发生率A组达26．7％,明显高于另两组;3组术后血糖均高于其术前平均值;新生儿脐带静脉血糖均值,A、B两组在正常范围内,C组低于正常值,低血糖发生率A组、C组分别达46．7％、60％,明显高于B组,结论：健康产妇在硬膜外麻醉下行剖宫产术,术前禁食时间不宜过长,以不超过6小时为宜,术前输注葡萄糖不宜过多,以不超过25g为宜。     

人性的复苏——解析霍桑《红字》的人物

《红字》表达的深刻含义一直以来都是评论家们争论的焦点。文中从人性这个角度来诠释《红字》中3个主要的人物,探讨在清教的专制统治下,个人在自由与权威中的挣扎以及主人公在此压制下人性的发展,以此揭示作者霍桑本人的内心世界,即内心对爱的欲求以及呼吁人以极大的勇气抛弃虚伪、回归真实的人性。     

Upper airway involvement in Parkinson’s disease resulting in postoperative respiratory failure

A 71-yr-old man with a six-year history of Parkinson’s disease (PD), Type II diabetes mellitus, myocardial infarction, and remote 20 pack-year smoking history, underwent an anterior resection of the rectum for carcinoma. Sixty hours later, the patient suffered a respiratory arrest; his antiparkinsonian medications had not been resumed. Preoperative flow-volume loops showed the characteristic saw-tooth pattern of PD indicating dysfunction of the striated muscle of the upper airway. Although postoperative respiratory distress was managed as lower airway obstruction, at the time of intubation there were no signs of lower airway pathology. Upper airway dysfunction and obstruction secondary to PD is thought to have been a contributing factor to the postoperative respiratory distress and failure. This case is presented to draw attention to the risk of upper airway dysfunction in Parkinson’s Disease, especially with the withdrawal of antiparkinsonian medications. Un homme de 71 ans souffrant d’une maladie de Parkinson depuis six ans, de diabète type II, d’un infarctus du myocarde avec une histoire de tabagisme de 20 années-paquet, subit une résection antérieure du rectum pour un cancer. Soixante heures plus tard, il fait un arrêt respiratoire avant d’avoir recommencé sa médication antiparkinsonnienne. Les courbes débits-volumes préopératoires montraient un tracé en dents de scie caractéristique du dysfonctionnement des muscles striés des voies aériennes supérieures consécutif au parkinsonnisme. Bien que cette détresse postopératoire ait été traitée comme une obstruction des voies aériennes inférieures, on n’a pas observé de signes de cette pathologie à l’intubation. On emit que le dysfonctionnement de voies aériennes supérieures a surtout contribué à la détresse et à l’insuffisance respiratoires postopératoires. Cette observation est présentée dans le but d’attirer l’attention sur le risque de dysfonctionnement des voies respiratoires causé par la maladie de Parkinson, particulièrement après l’arrêt de la médication spécifique.     

快速FLAIR 序列在颅脑MRI 中的应用

探讨快速液体衰减反转恢复序列在脑部疾病中的应用价值。方法对３９例脑部疾病患者同时行常规ＭＲＴ２加权像及快速ＦＬＡＩＲ检查,比较两种序列对病灶的显示情况。结果：ＦＬＡＩＲ共检出病灶３１０个,常规Ｔ２加权像检出２３７个,ＦＬＡＩＲ显示病灶的轮廓更为清晰,病灶与正常脑组织的对比度更高。