Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease

Purpose

To identify the relationship between depression measured by Zung depression rating scale (ZDRS) and postoperative outcomes (including the patients reported outcomes [PRO] and clinical outcomes) two years after short-segment fusion surgery for degenerative lumbar spinal disease in older patients (aged 75 years and older).

Methods

We enrolled patients who underwent short-segment fusion surgery for lumbar degenerative disease from May 2018 to June 2020. All patients were assessed for depression using the ZDRS. Patients were included in the depression group and not-depressed group based on their scores. Preoperative baseline data were collected on characteristics, comorbidities, laboratory data, pain levels (visual analogue scale [VAS]), functional status (Oswestry Disability Index [ODI]), and surgery-related variables. The primary outcomes were PRO measures, including VAS, ODI and satisfaction two years after lumbar fusion surgery. Other outcomes included postoperative complications, the length of stay, and reoperation. Univariate and multivariate analyses were performed to identify the risk factors for poor satisfaction.

Results

A total of 231 patients (201 in not-depressed and 30 in depressed group) were enrolled in this study. There were no significant differences between the two groups for baseline data. Depressed group had higher rates of choices for dissatisfaction (36.7% vs. 14.0%, p = 0.015), higher VAS scores of low back pain (2.8 ± 2.3 vs. 1.6 ± 1.7, p = 0.012), and worse functional status (31.5 ± 22.5 vs 21.8 ± 19.9, p = 0.015) than the not-depressed group. Depressed patients reported significantly higher rates of postoperative complications and readmissions. Multivariate regression analysis revealed that depression (p = 0.001) was independently associated with postoperative dissatisfaction.

Conclusion

Preoperative depression was a risk factor for postoperative dissatisfaction, worse functional status, readmission, and complications in older patients undergoing lumbar fusion surgery. Preoperative screening using the Zung depression scale helps inform decision-making when considering fusion surgery for patients aged 75 and older.

     

星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响

目的 观察超声引导下右侧星状神经节阻滞（SGB）对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐（PONV）的影响。
方法 选择择期行腹腔镜全子宫切除术患者98例,年龄42～74岁,BMI 19～25 kg/m ²,ASAⅠ或Ⅱ级。采用随机数字表法分为两组：全身麻醉联合SGB组（S组）和全身麻醉组（GA组）,每组49例。S组于麻醉诱导前在超声引导下行右侧SGB,注入 0.2%罗哌卡因5 ml,GA组不行SGB。两组采用相同的全身麻醉方法和麻醉药物。记录术前1 d、手术当日、术后1 d的匹兹堡睡眠质量指数（PSQI）。记录术后24 h PONV分级和止吐药补救情况。记录术后24 h活动时VAS疼痛评分、镇痛药补救情况、术后首次下床活动时间和术后住院时间。记录局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症发生情况。
结果 与GA组比较,S组手术当日、术后1 d PSQI评分、POSD发生率明显降低（P＜0.05）,PONV 0级、1级发生率明显升高,PONV 2级、3级、4级发生率、止吐药补救率明显降低（P＜0.05）,术后24 h活动时VAS疼痛评分明显降低（P＜0.05）,术后首次下床活动时间明显缩短（P＜0.05）。两组补救镇痛情况、术后住院时间差异无统计学意义。S组无一例出现局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症。
结论 右侧星状神经节阻滞可有效改善腹腔镜全子宫切除术患者的术后睡眠质量,降低术后恶心呕吐的发生率及严重程度,减轻术后疼痛。     

Prediction of outcomes for symptomatic spinal cavernous malformation surgery: a multicenter prospective clinical study

Purpose

Clinical outcome of spinal cavernous malformation (SCM) varies because of its unclear natural history, and reliable prognostic prediction model for SCM patients is limited. The aim of the present study was to investigate potential factors that predict one-year neurological status in postoperative patients with SCM.

Methods

This was a multicenter prospective observational study in consecutive patients with SCMs. SCMs treated microsurgically between January 2015 and January 2021 were included. Outcome was defined as the American Spinal Injury Association Impairment Scale (AIS) grade at one year after operation. Multivariable analyses were used to construct the best predictive model for patient outcomes.

Results

We identified 268 eligible SCM patients. Neurological outcome had worsened from preoperative baseline in 51 patients (19.0%) at one year. In the multivariable logistic regression, the best predictive model for unfavorable outcome included symptom duration ≥ 26 months (95% CI 2.80–16.96, P < 0.001), size ≤ 5 mm (95% CI 1.43–13.50, P = 0.010), complete intramedullary (95% CI 1.69–8.14, P = 0.001), subarachnoid hemorrhage (95% CI 2.92–12.57, P < 0.001), AIS B (95% CI 1.91–40.93, P = 0.005) and AIS C (95% CI 1.12–14.54, P = 0.033).

Conclusions

Admission size of the lesion, morphology, symptom duration, AIS grade and the presence of subarachnoid hemorrhage were strong outcome predictors regarding prognostication of neurological outcome in postoperative patients with SCMs. A decision to surgically remove a symptomatic SCM should be justified by systematic analysis of all factors potentially affecting outcome.

     

关节镜下肩袖修补术后感染的危险因素分析

目的:探讨关节镜下肩袖修补术后感染的危险因素,为降低感染发生提供依据。方法:对2019年1月至2022年1月采用关节镜下肩袖修补治疗的2 591例肩关节镜下肩袖修补术后患者的临床资料进行回顾性分析,其中男1 265例,女1 326例;年龄25～82(51.5±15.6)岁。按照术后是否发生感染分为感染组(n=18)和未感染组(n=2 573),记录两组患者性别、年龄、是否吸烟、有无糖尿病、身体质量指数、术前1个月内是否进行局部封闭、手术时间、是否预防性使用抗生素、是否有内固定置入等,应用单因素Logistic回归分析筛选出术后感染的危险因素,再将有统计学意义的危险因素纳入多因素Logistic回归分析,筛选出关节镜下肩袖修补术后感染的独立危险因素。结果:本组2 591例患者中,术后发生感染18例,感染率为0.69%,单因素分析结果显示性别、年龄、手术时间、预防性使用抗生素、内固定置入是关节镜下肩袖修补术后患者发生感染的危险因素。多因素Logistic分析显示男性(OR=14.227)、年龄≥65岁(OR=34.313)、手术时间≥2h(OR=15.616)、未预防性使用抗生素(OR=4...     

局部脑氧饱和度和肠道血氧饱和度对新生儿坏死性小肠结肠炎早期预警及手术治疗时机的指导价值

目的 研究局部脑氧饱和度(rcSO₂)和局部肠道血氧饱和度(rintSO₂)与新生儿坏死性小肠结肠炎(NEC)病情程度的关系,探讨rcSO₂和rintSO₂对NEC早期预警及手术干预时机的指导意义。方法 回顾性分析2021年3月至8月96例胎龄<32周早产儿临床资料,根据是否发生NEC分为三组：对照组49例,未发生NEC;疑似组14例,疑似发生NEC;NEC组33例,患有NEC。其中NEC组再根据是否手术分为两个亚组：手术组19例,非手术组14例。观察三组不同临床分期早产儿的rcSO₂和rintSO₂水平变化,Spearman相关性分析其与Bell分期的关系;利用受试者工作特征(ROC)曲线分析rcSO₂、rintSO₂预测NEC发生和手术时机的价值。结果 (1)疑似组和NEC组rcSO₂及不同监测部位rintSO₂水平均较对照组明显降低,NEC组降低幅度较为显著...     

不断推进中国腹腔镜减重与代谢手术规范化

近年来我国减重与代谢外科发展快速,越来越多的医院和医生开展本学科,年手术量快速增长,因而,在学科发展的关键时期不断推进本学科临床医疗的规范化显得愈加重要。现阶段,需要加强和完善对减重与代谢外科医生和个案管理师进行系统的规范化培训,在临床操作层面严格把握手术适应证,基于临床证据合理选择手术方式,做好患者术后规范化随访和临床资料的科学管理,是推动减重与代谢手术规范化的重要举措。     

经腋窝入路免充气腔镜甲状腺手术在中老年患者中的应用价值

背景与目的：近年来随着微创技术的不断更新以及人们对生活质量要求的不断提高,腔镜甲状腺手术逐渐普及应用,尤其受到年轻女性患者的青睐。对于中老年患者,临床上仍以开放手术为主,较多患者术后会出现皮瓣下垂,吞咽联动,异物感等情况,严重影响患者的生活。经腋窝入路免充气腔镜手术利用颈部肌肉的自然间隙建腔,在颈前带状肌深面显露甲状腺并进行手术操作,对颈部功能影响较小,而且不需要CO2,对心肺影响较小。本研究探讨经腋窝入路免充气腔镜甲状腺手术在中老年患者中的疗效及安全性,为其在中老年患者中的应用提供参考。方法：回顾性分析2021年1月—2022年6月江苏省宿迁市第一人民医院甲乳外科收治的56例中老年甲状腺癌患者的临床资料。其中,26例接受经腋窝入路免充气腔镜下甲状腺手术（观察组）,30例接受传统开放手术（对照组）。比较两组患者手术指标、疼痛状况、颈部损伤指数、吞咽障碍指数、并发症及预后。结果：56例患者均顺利完成手术。观察组手术时间长于对照组,术后引流量多于对照组（均P<0.05）。两组患者术中出血、呼吸困难、声音嘶哑、手足麻木、饮水呛咳、皮下血肿等并发症,中央区清扫淋巴结数,住院时间差异均无统...     

简易支撑架联合一针缝合法在直肠癌末端回肠造口中的应用

目的：探讨低位直肠癌病人保肛根治手术中,应用简易支撑架联合一针缝合行末端回肠双腔造口的可行性及效果。方法：回顾性分析2019年12月至2021年5月我院普外科有术后吻合口漏高危因素的直肠癌病人。病人行腹腔镜辅助低位直肠癌根治术和末端回肠双腔造口术。分为简易支撑架联合一针缝合造口组35例,传统缝合造口组35例。术前、术后资料行统计学分析。结果：两组病人一般资料及术后造口相关并发症发生率差异无统计学意义(P>0.05)。所有病人住院期间均未出现严重并发症。所有病人末端回肠造口均成功还纳。简易支撑架联合一针缝合造口组病人一期造口时间[(13.77±2.02) min比(22.66±3.64)min(P<0.001)];二期造口还纳时间[(88.14±28.03) min比(103.29±30.96) min(P=0.04)]和术后总住院时间[(14.54±2.32) d比(17.34±4.57) d(P=0.002)];以及一期手术住院费用[(42 057.98±4 938.69)元比(44 728.46±5 223.62)元,(P=0.03)]和二期造口还纳手术出血量[(17....     

骨质疏松症关键基因的筛选及生物信息学分析

目的通过生物信息学的方式筛选骨质疏松症关键基因,并进一步分析其与骨质疏松症的联系及作用机制。 方法从公共基因表达数据库下载基因表达谱数据集,通过R软件筛选差异表达基因并进行功能与通路分析。使用在线工具String构建蛋白质互作网络,导入cytoscape软件筛选关键基因并构建集簇模块。 结果共筛选出1 334个差异表达基因,其中上调基因722个,下调基因612个。GO分析显示功能主要富集在细胞外基质结构成分,信号受体激活剂活性,跨膜转运蛋白结合及细胞因子结合等方面。KEGG通路富集中显示差异基因主要参与PI3K-Akt信号通路、MAPK信号通路、Rap1信号通路以及Ras信号通路等通路。根据蛋白质互作网络筛选出AKT1、EGF、VEGFA、PROM1、TP53、NES、CD21、SNAI1、FGF13、LIF共十个关键基因,以及一个集簇模块。 结论筛选并分析了关键基因与集簇模块的功能、作用及其与骨质疏松可能存在的联系,为揭示骨质疏松症潜在的的分子机制和药物靶点提供新的思路。