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】目的探讨在数字减影 (DSA)透视下,经过鼻腔将胃管、空肠营养管联合置入及其临床应用的范围和价值。方法选择2007年8月23日2009年10月22日期间35例需要行肠内营养的患者,在DSA透视下经鼻腔将胃管以及预先套入的空肠营养管联合置入,置管成功后分别造影,显示胃管位于胃内,而空肠营养管末端位于空肠内。结果35例患者成功置管。置管时间为49～186 min,平均108 min。置管中及置管后未发生严重并发症。置管后营养管在位良好,喂养过程顺利。结论DSA透视下经鼻胃管、空肠营养管联合置入是一种安全、经济、有效的肠内营养途径,同时解决了胃液引流问题,具有一定的临床应用价值。
【摘要】 目的 探讨结膜恶性黑色素瘤的手术治疗方法。 方法 1997年1月-2007年1月收治结膜恶性黑色素瘤48例，均为单眼。肿瘤范围:lt;1/3眼睑长度及结膜14例，gt;1/3眼睑长度，部分穹隆结膜受累19例，上下眼睑及内外眦大部分结膜受累者15例。采用单纯肿瘤切除术、单纯肿瘤切除联合液氮冷冻治疗、眼眶内容物剜除术3种治疗方法。 结果 所有患者均经病理学证实为结膜恶性黑色素瘤 。术后48例进行9个月～5年随访，15例眶内容物剜除术，3例死于肺及颅脑转移；14例单纯扩大肿瘤切除联合液氮冷冻治疗，2例死于肝转移；19例单纯扩大肿瘤切除术，6例分别死于肝、肺及颅脑转移。 结论 早期诊断并选择积极有效的手术治疗是提高患者生存率，改善生存质量的重要手段。手术切除联合液氮冷冻法可有效降低肿瘤复发，避免影响患者视觉质量和外观，是治疗结膜恶性黑色素瘤的一种有效方法。【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.
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.
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 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 探讨颅内动静脉畸形切除术中彩色多普勒超声检查的应用价值与预后的关系。 方法 在显微外科手术的基础上，将65例动脑静脉畸形患者随机分为A、B两组， A组34例动静脉畸形患者在术中接受术中超声检查，确定其畸形血管团的数目、位置、深度、大小、范围及其与周边组织结构的关系，探查供血动脉及引流静脉的数目及走行，以确定动、静脉畸形的位置、手术切除范围及切除术后是否有畸形血管残留；B组31例行常规手术，比较两组之间的差异。 结果 术中彩色多普勒超声能清晰的显示动静脉畸形的情况，两组经手术完整切除动静脉畸形率、再出血率、术后7 d Glasgow昏迷评分及预后差异均有统计学意义（Plt;0.05）。 结论 术中实时彩色多普勒超声能对脑动静脉畸形准确定位，并可判定脑动静脉畸形的血供模式及残余情况，减少脑组织损伤及降低手术并发症的发生，提高了手术安全性及治疗效果。【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.
ObjectiveTo predict the risk factors affecting postoperative recurrence of granulomatous lobular mastitis (GLM) in the mass stage by machine learning algorithm, and to provide a reference for the early identification and prevention of postoperative recurrence of GLM in the mass stage. MethodsThe electronic medical records and follow-up data of patients with GLM in the Department of Breast Disease Unit, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from October 2020 to January 2023 were selected. A total of 340 patients with GLM in the mass stage who met the inclusion and exclusion criteria were selected as the research subjects. According to whether the patients relapsed after surgery, they were divided into recurrence group and non-recurrence group. The collected cases were randomly divided into training set and test set according to the ratio of 7:3. In the training set, the recurrence prediction model was constructed by using traditional logistic regression and three machine learning algorithms: artificial neural network, random forest and XGBoost (extrem gradient boosting). In the test set, the performance of the model was evaluated by sensitivity, specificity, accuracy,positive predictive value, negative predictive value, F1 value and area under the curve (AUC) value. The Shapley Additive exPlanation (SHAP) method was used to explore the important variables that affect the optimal model in identifying postoperative recurrence in the GLM mass phase. The optimal risk cutoff value of the prediction model was determined by the Youden index. Based on this, the postoperative patients in the GLM mass phase of the external test set were divided into high-risk and low-risk groups. ResultsA total of 392 patients who met the GLM mass stage were included, and 52 cases were excluded according to the exclusion criteria, and 340 cases were finally included, including 60 cases in the recurrence group and 280 cases in the non-recurrence group. Based on the results of univariate analysis, correlation analysis and clinically meaningful influencing factors, 12 non-zero coefficient characteristic variables were screened for the construction of the prediction model, and these 12 characteristic variables included other disease history, number of miscarriages, breastfeeding duration of the affected breast, history of milk stasis, lesion location, nipple indentation, fluctuation sensation, low-density lipoprotein, testosterone, previous antibiotic therapy, previous oral hormone medication, and perioperative traditional Chinese medicine treatment duration. The logistic regression prediction model, artificial neural network, random forest and XGBoost prediction models were constructed, and the results showed that the accuracy, positive predictive value and negative predictive value of the four prediction models were all >75%, among which the XGBoost model had the best performance, with accuracy, specificity, sensitivity, AUC, positive predictive value, negative predictive value and F1 values of 0.93, 0.99, 0.65, 0.87, 0.92, 0.93 and 0.76, respectively. SHAP method found that the duration of traditional Chinese medicine treatment during perioperative period, the duration of breast-feeding on the affected side, low density lipoprotein, testosterone and previous hormone drugs were the top five factors affecting XGBoost model to identify postoperative recurrence of GLM in mass stage. ConclusionsCompared with the traditional Logistic regression prediction model, the models based on machine learning for identifying postoperative recurrence in the GLM mass phase showed better performance, among which the XGBoost model performed best. Targeted preventive measures can be given based on the above risk factors to improve the postoperative prognosis of the GLM mass phase.