Objective To explore surgical technique and clinical outcome of transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal hernia repair (TEP) in inguinal hernia repair. Methods 〗The clinical data of 23 patients underwent laparoscopic herniorrhaphy were retrospectively analyzed. Nine patients were underwent TAPP, and 14 patients underwent TEP. Results 〗None of patients was changed to open operation. Only one patient of TEP was changed to TAPP. Average operative time was (82.1±40.6) min. Blood loss was (5.7±3.0) ml. Disruption of peritoneum happened to 2 patients underwent TEP. The rate of postoperative complications was 21.7% (5/23), which included serum swelling (1 case), scrotal emphysema (2 cases), transient neurapraxia in the area of repair (1 case) and urinary retention (1 case). No chronic pain, foreign body sensation and infection were found. Average hospitalization after operation was (4.3±0.9) d. No recurrence was observed during a follow-up period of 1-15 months. Conclusion 〗Laparoscope herniorrhaphy is safe due to lower recurrence and complications. It also has the advantages of slight pain and rapid recovery.
Objective To study the clinical effect of anterior cruciate ligament(ACL) reconstruction with different grafts under arthroscope. Methods A retrospective analysis was done on 68 cases of ACL injury.ACL reconstruction with bonepatellar tendonbone autograft and interface screw fixation were performed in 26 cases(group A) and quadruple semitendinosus tendon autograft and endobutton plate fixationin in 38 cases (group B). ACL reconstruction with bonepatellar tendonbone allograft cryopreserved and interface screw fixation were performed in 4 cases (group C). Therewere 16 males and 10 females with an average age of 26.4 years (16-45 years) in group A, 24 males and 14 females with an average age of 24.6 years (13-48 years) in group B, and 3 males and 1 female (55-65 years) in group C. The left knee involved in 14 cases, 27 cases and 3 cases, and the right knee involved in 12 cases, 11 cases and 1 case in groups A, B and C, respectively. The disease courses were 1 week to 15 months (group A), 1 week to 16 months (group B) and 2 weeksto 28 months (group C).The intermediate myodynamic recovery, IKDC score and Lysholm score were compared among 3 groups. Results All patients were followed 12-36 months (17.5 months in group A, 18.5 months in group B and 16.5 months in group C). No intra articular infection, phlebothrombosis of leg, vascular injury and nerve injury occurred. Lysholm scores was increased from preoperative 65.3±4.8 to postoperative 95.1±4.3 in group A, from 68.4±5.6 to 93.0±5.9 in group B and from 60.3±6.7 to 92.2±4.3(excellent in 3 cases and good in 1 case) in group C; the excellent and good rates were 88.5% (excellent in 18 cases, good in 5 cases and fair in 3 cases) in group A, 86.8% (excellent in 28 cases, good in 5 cases and fair in 5 cases) in group B, IKDC scores were 93.7±3.8 (group A), 95.7±4.7 (group B) and 94.8±3.6(group C); the knee joint functions were normal in 19 cases(73.1%), in 30 cases (78.9%) and in 3 cases, were fair in 5 cases (19.2%), in 5 cases (13.2%) and in 1 cases in groups A, B and C respectively. Conclusion The transplantation of bonepatellar tendonbone autograft , quadruple semitendinosustendon autograft and bonepatellar tendonbone allograft all can reconstruct and strengthen the stability of knee joint. Bonepatellar tendonbone allograft is better selection for the ACL injury in elder and quadruple semitendinosus tendon autograft is suitable to adolescent patients with disrupted ACL.
Objective To assess the effectiveness and safety of Shenfutuodu capsule in the treatment of opioid withdrawal syndrome. Methods We searched The Cochrane Library （Issue 1 , 2005 ） , MEDLINE （1966 -2005） , EMBASE （1974-2005） , and some Chinese databases for additional articles （CBMdisc, CMCC, VIP, CNKI ） （1980-2005 ）. The quality of included randomized controlled trials was evaluated and meta-analysis was performed.Results Our initial search identified just three studies involving 293 patients met the inclusion criteria and were of higher quality. There was a statistical difference between Shenfutuodu capsule and clonidine groups on the fifth day in withdrawl symptom score with weight mean difference （WMD） -3.14 and 95% confidence interval （CI） -6.28 to -0.01. And no statistical difference was detected between the two groups in withdrawal symptom score on the 0th-4th day and the 6th-10th daywith WMD 58.45（95% CI 53.88 to 63.02）, -1. 15 （95% CI -5.69 to 3.40） , -0.42（95% CI -4.55 to 3.70）, -0.77（95%CI -4.37 to 2. 84）, -1.54（95%CI -4.78 to 1.69）, -1.76（95%CI -4.25 to0.74） , -1.74（95%CI -3.89 to0.41）, -1.24（95%CI -3.28 to0.80）, -0.52（95%CI -1.96 to0.92 ） and -0.27（95% CI -1.64 to 1.11 ） respectively. There was no statistical difference on effectiveness between the two groups on the third day with WMD 1.52, （95% CI 0.79 to 2.95）. There was no statistical difference between the two groups in HAMA score on the first , fifth and tenth day with WMD -0.55（95% CI -3.74 to 2.64） , 0.34 （95% CI -2.02 to 2.70） , 0. 63 （95% CI -0.21 to 1.47 ） respectively. There was a statistical difference between the two groups in dizziness rate with RR 0.73 （95% CI 0.62 to 0.87 ） . No statistical difference was detected between the two groups in dry mouth with RR 1.11（95% CI 0.95 to 1.29） , somnolence with RR 0.99（95% CI 0.82 to 1.21） , and blurred vision with RR 0.92（95% CI 0.70 to 1.19）. Statistical difference was detected between the two groups in side effect score on the second day with WMD -1.26 （95% CI -2.40 to -0. 12 ）. No statistical difference was detected between the two groups in side effect score on the first day, the third to tenth day with WMD -0.55 （ 95% CI -1.48 to0.38）, -0.63 （95%CI -1.67 to0.42）, -0.84 （95%CI -1.77 to0.09）, -0.29 （95%CI -1.09 to 0.51）, 0.15 （95% CI -0.52 to 0.81）, 0. 22 （95% CI -0.22 to 0.67）, 0.09（95% CI -0.25 to 0.44）, 0.03 （95% CI -0.21 to 0.27） , -0.03 （95% CI -0.33 to 0.26） respectively. Conclusions Based on the current evidence, Shenfutuodu capsule may be an effective and safe drug or abstinence of drug addiction. More well designed randomized controlled trials are required .
Objective To analyze the risk factors of hospitalized children with acute asthma exacerbation in Chongqing region. Methods A total of 193 cases were randomly selected from the hospitalized children with acute asthma exacerbation in Chongqing Children’s hospital and Jiangjin District People’s Hospital from January 2009 to December 2009. A self-designed questionnaire was used to collect data. A control group of children were randomly selected from the out-patients who received regular maintain therapy without asthma attacks for more than 3 months. Results The first independent risk factor of asthma hospitalization was respiratory infection ( 85. 5%, 165 /193) . Irregular use of control medications was the second important factor for the acute exacerbation. There were 75% ( 138 /193) patients didn’t take controlmedications regularly, includes 102 undiagnosed and 36 pre-diagnosed cases which was more common than that in regular maintain therapy group ( 21/110, 19. 1% ) . A variety of allergen-induced acute exacerbation of asthma was also common, which accountted for 9. 3 % ( 18/193) . There were more boys than girls ( M/F:124 /69) and no significant difference in the family history of allergic diseases ( P gt; 0. 05) . Conclusion Respiratory infection, under-diagnosis of asthma, and irregular use of the control medications are risk factors of acute exacerbation in children with asthma in Chongqing region. Meanwhile allergen exposure warrantsmore attention.
【摘要】 目的 應用受試者工作特征曲線（receiver operating characteristic curve，ROC曲線）探討α-L-巖藻糖苷酶（AFU）對惡性腹水和非結核良性腹水的診斷價值。 方法 2004年7月—2008年1月對213例診斷明確的良、惡性腹水（其中良性腹水117例、惡性腹水96例）AFU活性進行檢測。采用ROC曲線評價AFU的診斷靈敏度、特異度、準確性、陽性預測值、陰性預測值、陽性似然比、陰性似然比及Youden指數，評價其診斷效率。 結果 惡性腹水組AFU水平（164.96±87.72） μmol/（L?h），良性腹水組（104.02±62.07） μmol/（L?h），兩者比較差異有統計學意義（Plt;0.01）。AFU診斷惡性腹水的ROC 曲線下面積為0.754±0.034，最佳分界值101.95 μmol/（L?h）。以AFU≥101.95 μmol/（L?h）來預測惡性腹水，其診斷的靈敏度為82.3%，特異度為63.2%，準確性為72.8%、陽性預測值為65.3%、陰性預測值為83.1%、陽性似然比為2.23、陰性似然比為0.28及Youden指數為0.455。 結論 腹水AFU活性檢測有助于惡性腹水和非結核良性腹水的鑒別診斷，是一個比較理想的實用指標，適合于基層醫院的臨床應用。【Abstract】 Objective To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. Methods Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. Results The average level of AFU in the malignant group [(164.96±87.72) μmol/(L?h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L?h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L?h). When an AFU level equal to or higher than 101.95 μmol/(L?h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.
Objective To evaluate the ability of inductive osteogenesis of allgraft demineralized bone containing basic fibroblast growth factor (bFGF/ALB) in repairing bone defect. Methods Thirty-two New Zealand white rabbits were randomly divided into four groups (groups A,B,C and D, n=8). A segmental bone defect of15 mm inlength was made on the bilateral radius respectively and the defects filled with ALB/bFGF in group A, with ALB in group B, with bFGF in group C and without any materials in group D serving as blank control. At 2, 4, 6 and 8 weeks after operation, all restored bones were evaluated by roentgenography, histological observation and Ca2+detection of osteotylus. Results The X-ray films showed that groups A and B had a little shadow of bone formation at 2 weeks, while groups C and D had transparent shadow; that group A had denser shadow and new bone formation at 4 weeks and 6 weeks, groups B and C had a little increase of shadow and group D had little shadow at fractured ends; and that group A had formation of bone bridge at 8 weeks, the new formed bone in fractured ends of group B closed with each other, the gap still existed in group C, and the defects filled with the soft tissue in group D. The Ca2+content of group A was higher than that of groups B, C and D at 4 weeks (Plt;0.05) and 8 weeks (Plt;0.01). The histological observaton showed that the degree of bone restoration of group A was superior to that of groups B, C and D. Conclusion bFGF/ALB is a good material to improve bone restoration.
ObjectiveTo explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF).MethodsThe clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation.ResultsThe operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores (P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation (P<0.05); but no significant difference was found between at 6 months and at last follow-up (P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones (P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days (P<0.05).ConclusionThe allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.
Objective To analyze the data from patients with pathologically proved granulomatous lung disease, including etiology, clinical, radiological features and laboratory results. Methods 36 patients with granulomatous lung disease confirmed by lung biopsy in Shanghai First People’s Hospital of Shanghai Jiao Tong University from January 2008 to June 2012 were retrospectively reviewed. The clinical presentation, radiological features and laboratory results were collected and statistically analyzed.Results After haematoxylin and eosin stain combined with special stain, the diagnoses were comfirmed, ie.13 cases of mycobacterial infection, 5 cases of aspergillar infection, 4 cases of cryptococcal infection, 6 cases of sarcoidosis, 4 cases of Wegener’s granulomatosis, 4 cases of unknown causes. Cough was the most common clinical symptom, followed by expectoration. Some patients also developed fever, chest tightness and weight loss. The lesions were widely distributed, of which the right upper lung was the common lesion of mycobacterial infection, inferior lobe of right lung was the common lesion of aspergillar infection. The common lesion of cryptococcal infection was uncertain. The common lesions of sarcoidosis and Wegener ’s granulomatosis were in left upper lung. Small nodule was the most common shapes of lesion, while mass and consolidation were present sometimes. Cavity, air bronchogram, pleural effusion, hilar and mediastinal lymph node enlargement could be found in the chest CT. Interferon gamma release assay, galactomannan antigen assay and latex agglutination test were helpful in the diagnosis of mycobacterial infection, aspergillar infection and cryptococcal infection induced granuloma. Conclusions The clinical presentations and radiological features of granulomatous lung disease are nonspecific. Histopathology obtained through biopsy is the key for the diagnosis. Immunological examination, test of new antigens to microorganism and clinical microorganism detection are valuble in the diagnosis and differential diagnosis of granulomatous lung disease.
