老年腹股沟疝行开放修补手术后并发症的相关因素分析

目的探究老年腹股沟疝行开放修补手术后并发症发生的原因和预防措施,旨在降低手术并发症。方法选取2016年8月至2018年2月郑州人民医院收治的100例行开放修补术的老年腹股沟疝患者。根据文献资料和临床经验总结归纳患者手术后并发症的影响因素,对患者性别、年龄、疝的类型、疝的大小、体重指数(BMI)、麻醉方式及补片类型等进行分析。结果术后发生并发症与未发生并发症患者性别、疝的类型比较,差异无统计学意义(P>0.05);而年龄、BMI、疝的大小及疝环粘连程度比较,差异有统计学意义(P<0.05)。将患者年龄、BMI、疝的大小及疝环粘连程度等代入Logistic回归分析模型中,结果显示年龄>70岁、BMI>24 kg/m2、疝的直径>5 cm和重度疝环粘连是患者术后并发症发生的独立危险因素(P<0.05)。结论老年腹股沟疝行开放修补手术后患者并发症的危险因素较多,应做好术前评估,及时采取干预对策,积极预防术后并发症的发生。     

A gender-based comparison of academic rank and scholarly productivity in academic neurological surgery

The number of women pursuing training opportunities in neurological surgery has increased, although they are still underrepresented at senior positions relative to junior academic ranks. Research productivity is an important component of the academic advancement process. We sought to use the h-index, a bibliometric previously analyzed among neurological surgeons, to evaluate whether there are gender differences in academic rank and research productivity among academic neurological surgeons. The h-index was calculated for 1052 academic neurological surgeons from 84 institutions, and organized by gender and academic rank. Overall men had statistically higher research productivity (mean 13.3) than their female colleagues (mean 9.5), as measured by the h-index, in the overall sample (p < 0.0007). When separating by academic rank, there were no statistical differences (p > 0.05) in h-index at the assistant professor (mean 7.2 male, 6.3 female), associate professor (11.2 male, 10.8 female), and professor (20.0 male, 18.0 female) levels based on gender. There was insufficient data to determine significance at the chairperson rank, as there was only one female chairperson. Although overall gender differences in scholarly productivity were detected, these differences did not reach statistical significance upon controlling for academic rank. Women were grossly underrepresented at the level of chairpersons in this sample of 1052 academic neurological surgeons, likely a result of the low proportion of females in this specialty. Future studies may be needed to investigate gender-specific research trends for neurosurgical residents, a cohort that in recent years has seen increased representation by women.     

脑出血微创置管吸引术对老年脑出血患者血清IL-6TNF-α和hs-CRP的影响

目的 探讨脑出血微创置管吸引术对老年脑出血患者血清IL-6、TNF-α和hs-CRP的影响.方法 选择2010-01-2013-03我院接诊的的80例老年脑出血患者,随机分为实验组和对照组各40例.实验组采用脑出血微创置管吸引术治疗,对照组采用传统的保守治疗.结果 术前和术后2 d、7 d 2组神经功能评分比较无显著差异,术后15 d、30 d实验组神经功能评分明显低于对照组.术后7 d、15 d及30 d实验组血清炎性因子水平明显低于对照组,2组比较差异有统计学意义（P＜0.05）.结论 脑出血微创置管吸引术治疗老年脑出血患者的效果良好,明显优于传统的保守治疗手段.     

Intrahepatic Glissonian approach and outflow vascular occlusion during partial hepatectomy

Under ultrasound guidance, a blunt suture needle was inserted around the Glissonian pedicle and then sutured. This technique significantly reduced the blood loss and facilitated the procedure of partial hepatectomy. We applied this technique in 182 patients who needed partial hepatectomy. We concluded that this method is simple and easy to occlude the vascular inflow and outflow, and allows an accurate delineation of the anatomic zone and therefore, simplifies the procedure of partial hepatectomy.     

Surgeons often underestimate the amount of blood loss in replacement surgeries

Objective：To assess the accuracy of the clinically estimated blood loss （EBL） when compared with the actual blood loss （ABL） in replacement surgeries.Methods：This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013.Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits.Exclusion criteria were intake of antiplatelet drug or anti-coagulant,bleeding disorders,thrombotic episode,and haematological disorders.There were 65 men and 75 women.In this study,the consultants were free to use any clinical method to estimate the blood loss,including counting the blood-soaked mops and gauze pieces （estimating the volume of blood carded in all the mops and gauzes）,measuring blood lost to suction bottles and blood in and around the operative field.The ABL was calculated based on a modification of the Gross＇s formula using haematocrit values.Results：In 42 of the 140 cases,the EBL exceeded the ABL.These cases had a negative difference in blood loss （or DIFF-BL＜0） and were included in the overestimation group,which accounted for 30％ of the study population.Of the remaining 98 cases （70％）,the ABL exceeded the EBL.Therefore they were put into the underestimation group who had a positive difference in blood loss （DIFF-BL＞0）.We found that when the average blood loss was small,the accuracy of estimation was high.But when the average blood loss exceeded 500 ml,the accuracy rate decreased significantly.This suggested that clinical estimation is inaccurate with the increase of blood loss.Conclusion：This study has shown that using clinical estimation alone to guide blood transfusion is inadequate.In this study,70％ of patients had their blood loss underestimated,proving that surgeons often underestimate blood loss in replacement surgeries.     

进一步重视特殊部位与特殊原因深度烧伤创面的美容修复

Along with the vigorous development of medical science and other related subjects,a lot of new techniques,concepts,materials,and methods continuously sprung up.The techniques of plastic and cosmetic su...