[Effect of Ropivacaine Combined with Dexmedetomidine for Serratus Anterior Plane Block Plus Patient-Controlled Intravenous Analgesia on Postoperative Recovery Quality of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer].

Objective: To study the postoperative analgesic effect of ropivacaine combined with dexmedetomidine for serratus anterior plane block (SAPB) under ultrasound visualization plus patient-controlled intravenous analgesia (PCIA) in patients undergoing thoracoscopic radical resection of lung cancer. Methods: A total of 129 patients undergoing elective thoracoscopic surgery were enrolled. The patients were randomly assigned to three groups ( n=43 in each group), a normal saline group (control group), a ropivacaine mesylate group (Group R) and a ropivacaine mesylate combined with dexmetomidine hydrochloride group (Group RD). After operation, ultrasound-guided SAPB was performed and patients in the three groups received the injection of 0 mL of 0.9% normal saline, 25 mL of 0.5% ropivacaine, and 25 mL of 0.5% ropivacaine+1 µg/kg dextrometomidine hydrochloride mixture, respectively. In addition, PCIA was used for all the patients. The button on the PCIA pump was pressed when the postoperative pain visual analogue score (VAS)≥4 on coughing, and rescue analgesic of sufentanil was given intravenously at 2.5 µg/bolus. The primary outcome was the VAS scores at rest and on coughing at 10 min (T 1), 6 h (T 2), 12 h (T 3), 24 h (T 4), and 48 h (T 5) after extubation. The secondary outcomes included hemodynamics, the quality of sleep for the first 3 nights after operation, number of times the button on the PCIA pump was pressed, intraoperative and postoperative opioid dosage, time of first postoperative rescue analgesic, duraion of intubation, length of stay at the hospital, adverse reactions, etc. Results: Compared with those of the control group, the VAS scores of the Group R and Group RD were significantly lower at 10 min, 6 h, and 12 h after extubation ( P<0.05). In comparison with Group R, the number of patients requiring rescue analgesia, the time of first postoperative rescue analgesic, the number of times the button on the PCIA pump was pressed, and the total dose of rescue sufentanil were all significantly lower ( P<0.05) in the Group RD. Patients in the Group RD had better sleep quality in the second and third nights after operation and lower incidence of nausea and vomiting ( P<0.05). Conclusion: 0.5% ropivacaine and 1 µg/kg dexmedetomidine SAPB combined with PCIA can significantly reduce postoperative pain and improve postoperative recovery quality in patients undergoing thoracoscopic radical resection of lung cancer.

Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy.

BACKGROUND: This study aimed to investigate the diagnostic and therapeutic value of a digital single-operator cholangioscope (SOC) system for endoscopic management of acute appendicitis. METHODS: 14 patients with acute uncomplicated simple or supportive appendicitis were evaluated between November 2018 and September 2020. The diagnosis of acute appendicitis was confirmed by direct colonoscopy imaging and cholangioscope. The success rate of digital SOC-assisted endoscopic retrograde appendicitis therapy (ERAT), the procedure time, postoperative length of hospital stay, complications, and recurrence rate were recorded. RESULTS: Technical success rate was 100 %, with high quality imaging of the appendiceal cavity achieved using SOC in all 14 patients. The mean procedure time was 37.8 (standard deviation [SD] 22) minutes. All patients experienced immediate relief from abdominal pain after the procedure. Mean postoperative hospitalization was 1.9 (SD 0.7) days. No recurrence occurred during 2-24 months of follow-up. CONCLUSION: Digital SOC-assisted ERAT provided a feasible, safe, and effective alternative approach for diagnosis and management of acute uncomplicated appendicitis without the need for X-ray or ultrasonic guidance.

Frequency and correlates of violence against patients with schizophrenia living in rural China.

BACKGROUND: Violence against patients with schizophrenia is very common, however it is rarely studied in China, especially in primary health care institutions of rural areas. Therefore, we investigated the frequency of violence against patients with community-living schizophrenia in rural China and examined its associated factors and impact on quality of life (QoL) and social function. METHOD: A survey was conducted among 487 patients with schizophrenia living in rural communities. Data about violent victimization experiences in the past 6 months, demographic information, and clinical characteristics were collected by questionnaires. RESULTS: We found that 92 (18.9%) of 487 subjects experienced at least one type of violent event in the past 6 months. Logistic regression analysis suggested that a history of conducting dangerous behaviors(OR = 1.702, P = 0.02, 95%CI: 1.05-2.73), higher Brief Psychiatric Rating Scale (anxiety domain) score (OR = 1.15, P = 0.02, 95%CI: 1.01-1.304) and lower hospitalization rates (OR = 0.89, P = 0.04, 95%CI: 0.81-0.99) were significantly associated with violent victimization in patients with schizophrenia. Analysis of covariance showed the victims of violence tended to have worse social function in patients with schizophrenia living in rural communities of China (P = 0.04). CONCLUSIONS: Individuals with schizophrenia living in rural China had a high risk of being exposed to violence and violent victimization of patients with schizophrenia had adverse consequences for social function. More attention is needed for those patients experiencing violent events, because they are simultaneously possible to conduct dangerous behaviors.

[Research on planting area and industrial development strategy of Tibetan medicine].

Appropriate producing areas can guarantee the quality of Tibetan medicine, but research on the suitable ecological factors and suitable producing areas of Tibetan medicinal plants is scarce. This paper used the Geographic Information System for Global Medicinal Plants(GMPGIS) to analyze the ecological suitability of Tibetan medicinal plants nationwide. For the first time, the range of ecological factors and main soil types of Tibetan medicinal plants were extracted, such as the average annual temperature-19.4-24.2 ℃, annual average precipitation 17-4 088 mm, annual average sunshine 124.2-171.6 W·m~(-2). The main soil types were black calcareous soil, thin layer soil, chestnut soil and so on. Based on 337 sampling points, the largest ecological similarity area of Tibetan medicine across the country was obtained through ecological similarity analysis. In addition to Tibet and Qinghai provinces and Tibetan Autonomous Prefectures in Sichuan, Gansu, and Yunnan provinces, Jiuquan city and Linxia county in Gansu province, Panzhihua and Ya'an in Sichuan province, and Xinjiang, Inner Mongolia, and Shanxi provinces also had larger suitable cultivation areas. In addition, by analyzing the current situation of Tibetan medicine industry, the research pointed out that there were some problems such as unreasonable development and utilization of resources, lack of standards and norms, weak basic research and imperfect industrial system, and made corresponding countermeasures for sustainable development of resources, formulation of standards and specifications, promotion of medicine through science and technology, expansion of domestic and foreign markets, etc. This study provided the basis for guiding the rational layout of production bases, introduction and breeding of plant Tibetan medicine nationwide, laying the foundation for the scientific and standardized production of high-quality Tibetan medicine, clarifying the development direction of Tibetan medicine industry, and providing ideas for the development strategy of Tibetan medicine and other national medicine industry.

Systematic review of comparing single-incision versus conventional laparoscopic right hemicolectomy for right colon cancer.

BACKGROUND: Single-incision laparoscopic right hemicolectomy (SILS) has long used in surgery for a long time. However, there is barely a systemic review related to the comparison between the SILS and the conventional laparoscopic right hemicolectomy (CLS) for the right colon cancer in the long term follow-up. Herein, we used the most recent articles to compare these two techniques by meta-analysis. METHODS: We searched PubMed, Web of Science, Cochrane Library and Wanfang databases to compare SILS with CLS for right colon cancer up to May 2019. The operative, postoperative, pathological and mid-term follow-up outcomes of nine studies were extracted and compared. RESULTS: A total of 1356 patients participated in 9 studies, while 653 patients were assigned to the SILS group and 703 patients were assigned to the CLS group. The patients' baselines in the SILS group were consistent with those in the CLS group. Compared to the CLS group, the SILS group had a shorter operation duration (SMD - 23.49, 95%CI - 36.71 to - 10.27, P < 0.001, chi-square = 24.11), shorter hospital stay (SMD - 0.76, 95% `CI - 1.07 to - 0.45, P < 0.001, chi-square = 9.85), less blood loss (SMD - 8.46, 95% CI - 14.59 to - 2.34; P < 0.05; chi-square = 2.26), smaller incision length (SMD - 1.60, 95% CI - 2.66 to - 0.55, P < 0.001; chi-square = 280.44), more lymph node harvested (SMD - 0.98, 95% CI - 1.79 to - 0.16, P < 0.05; chi-square = 4.61), and a longer proximal surgical edge (SMD - 0.51, 95% CI - 0.93 to - 0.09, P < 0.05; chi-square = 2.42). No significant difference was found in other indexes. After we removed a single large study, we performed another meta-analysis again. The operation duration in the SILS group was still better than that in the CLS group. CONCLUSION: SILS could be a faster and more reliable approach than CLS for the right colon cancer and could accelerate patient recovery, especially for patients with a low BMI.

Clinical research on the dexmedetomidine applied for patient-controlled sedation during the lower limbs operation under combined spinal-epidural anesthesia.

To investigate the effect and safety of dexmedetomidine applied for patient-controlled sedation under combined spinal anesthesia. 150 cases who would be implemented lower limbs operations were randomly divided into patient-controlled sedation group (Group PCS) and control group (Group C) and 75 cases for each group. The ages of patients were between 18 and 65 years old and patients were with American Society of Anesthesiologists (ASA) or level. After being implemented combined spinal anesthesia, patients of Group PCS were undergone patient-controlled sedation by using dexmedetomidine (4µg/mL) with 2mL of load quantity, 1.5ml of background infusion quantity, 0.5mL of single dose and 20s of locking time; patients of Group C were constantly infused the normal saline at the rate of 10ml/h by pump injection. HR, MAP, SpO2, Ramsay sedation scores and airway scores before the pump injection (T0), 10 min (T1), 3 min (T2), 5 min (T3), 7min (T4) and 10min (T5) after the pump injection, at the beginning of operations (T6), 10min(T7) after the operations and in the end of operations (T8) of patients of two groups were respectively recorded. At the same time, the pressing numbers and doses of dexmedetomidine of patients of Group PCS were observed. Compared with the HR at T0, HR in Group PCS obviously decreased between T1 and T8 (P<0.05). Compared with HR in Group C, HR in Group PCS obviously slowered between T1 and T8 (P<0.05). Compared with the MAP at T0, MAP in Group PCS gradually increased between T1 and T3 and gradually reduced between T5 and T8 (P<0.05). MAP between T5 and T8 in Group PCS were significantly lower than those in Group C (P<0.05). Between T3 and T7, there were 51, 72, 74, 73, 72 patients in Group PCS whose Ramsay scores were from 3 to 4 points respectively. During the process of patient-controlled sedation of patients in Group PCS, the pressing times were 112.10±65. 79 times. The effective pressing numbers were 21.00±9. 07times. The patient-controlled dosages were (15.12±3.19) ml; The dosages were 11.29±2.16ml when the level of sedation achieved 3 to 4 scores in Ramsay sedation scores; And the required time to achieve 3 to 4 scores in Ramsay sedation scores was 7.55±1.53 min. In the lower limbs operations, the usage of dexmedetomidine applied for patient-controlled sedation under combined spinal anesthesia can effectively approach to the personalized medicine and is effective in clinical application.

[Role of sliding osteotomy of lateral femur condyle in correcting severe fixed valgus deformity in total knee arthroplasty].

OBJECTIVE: To explore the surgical techniques and clinical efficacy of sliding osteotomy of lateral femur condyle in severe fixed valgus deformity during total knee arthroplasty (TKA). METHODS: A total of 11 consecutive patients (11 knees) undergoing primary TKA for severe valgus deformities were recruited between November 2007 to November 2009. There were 2 males and 9 females with an average age of 67 (58-76) years. The follow-up period was 12-61 months. Primary TKA was performed via a medial parapatellar approach. And conventional osteotomy and soft tissue release were performed. Sliding osteotomy of lateral femur condyle was performed in all cases. Posterior stabilized prosthesis was employed and clinical outcomes were evaluated by the relevant parameters. RESULTS: The knee society score improved from 51.5 ± 7.8 to 89.9 ± 2.8 and functional score increased from 40.4 ± 7.3 to 84.2 ± 5.9. The tibiofemoral angle changed from a preoperative value of (161.4 ± 4.4)° to a postoperative value of (172.8 ± 1.0)°. Patella dislocation was not reported. And no other complications occurred during the follow-up. CONCLUSION: Sliding osteotomy of lateral femur condyle is effective for fixed valgus knee deformity during TKA. Improvement of joint function may be achieved significantly with satisfactory clinical outcomes.

Iatrogenic Pseudoaneurysm with Acute Arterial Thrombosis in Multiple Branches of the Lower Limbs Treated by Ultrasound-guided Thrombin Injection: A Case Report.

INTRODUCTION: With the development of vascular intervention, pseudoaneurysm complications are increasing. Ultrasound-guided thrombin injection (UGTI) is currently the treatment of choice for pseudoaneurysm, but the pharmacological properties of thrombin may trigger acute thrombosis within the vessel lumen. Despite a very low incidence, this type of primary arterial thrombosis is a serious complication of UGTI, and cases involving multiple branches of the lower limb arteries are particularly rare. CASE PRESENTATION: Here, we report a case of a 65-year-old male who underwent UGTI for the treatment of an iatrogenic pseudoaneurysm of the femoral artery complicated by acute thrombosis of multiple arteries in the lower limbs, and the patient ultimately underwent a successful thrombectomy. CONCLUSION: We reviewed the case and analyzed the possible etiologic causes, providing a reference for future clinical work.

School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial.

Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: -0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children's sleep-wake patterns and sleep problems.

Effectiveness of combining plasma exchange with continuous hemodiafiltration on acute Fatty liver of pregnancy complicated by multiple organ dysfunction.

Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic complications that induce significant maternal risk. The application of combining plasma exchange (PE) and continuous hemodiafiltration (CHDF) is a novel concept for patients with AFLP. Since 2002, we have utilized the combination of PE with CHDF as adjunctive medical therapy for 11 AFLP patients with multiple organ dysfunction. Before PE and CHDF initiation, four patients had signs and symptoms of encephalopathy, four required ventilatory support, and all 11 were developing liver failure, significant renal compromise, and coagulopathy. PE combined with CHDF for patients was initiated a mean of 2 days postpartum (range, days 0-3). Daily or every other day PE combined with CHDF was undertaken on two to eight occasions for each of the 11 patients. Ten patients responded with composite clinical and laboratory improvement and were discharged to the ward, then cured and discharged from hospital; one patient died of septic shock. Average duration of hospitalization was 17 days (range, days 9-38) from time of admission to discharge; the average duration of intensive care unit was 10 days (range, days 4-23). No significant PE- and CHDF-related complications occurred. These results indicate that combing PE and CHDF in a series-parallel circuit is an effective and safe treatment for patients with severe AFLP. This finding may have important implications for the development of an effective treatment for patients with AFLP suffering multiple organ dysfunction.

Role of the PI3K/Akt signaling pathway in liver ischemia reperfusion injury: a narrative review.

OBJECTIVE: To explore the role of phosphatidylinositol-3-kinase/protein kinase B and alpha serine/threonine protein kinase PI3K/PKB (also known as PI3K/Akt) signaling pathway in liver ischemia reperfusion injury. BACKGROUND: The PI3K/Akt signaling pathway is one of the major signal transduction pathways that regulates numerous cellular activities in vivo. The main functions of this pathway include induction of stem cell differentiation and metastasis, promotion of cell proliferation, inhibition of apoptosis, and regulation of tissue inflammation, tumor growth, and invasion. Liver ischemia reperfusion injury is an inevitable clinical problem that can occur during liver transplantation, liver resection, and various circulatory shock events, and it is one of the primary reasons for postoperative liver dysfunction, and poor disease outcome and patient prognosis. In recent years, it has been found that PI3K/Akt signaling pathway is closely related to liver ischemia reperfusion injury. METHODS: In this review, a large number of relevant literatures were collected to explain the biological basis of PI3K/Akt signaling pathway and its role in liver ischemia reperfusion injury. The review was based on a PubMed search using the terms "liver ischemia reperfusion injury", "PI3K/Akt signaling pathway", and "PI3K/Akt signaling pathway AND liver ischemia reperfusion injury", so as to understand the complex interaction between them. CONCLUSIONS: Activated PI3K/Akt signaling pathway can exert anti-inflammatory, antioxidant stress, anti-apoptosis and autophagy regulation effects through downstream related targeted pathways and proteins, thus alleviating liver ischemia-reperfusion injury. Therefore, the regulation of PI3K/Akt signaling pathway is expected to become an effective targeted pathway for clinical prevention and alleviation of liver ischemia reperfusion injury.

[Evaluation on the effectiveness of community intervention on hypertension related knowledge in mid-western rural area of Shandong province].

OBJECTIVE: To evaluate the intervention effect of health education on hypertension knowledge in mid-western rural area of Shandong province. METHODS: A project was launched on chronic disease control in mid-western rural area of Shandong province from 2007 to 2010. The baseline survey was performed using multi-stage random sampling method in 8 counties of mid-western rural area of Shandong province in April, 2007. A total of 20 087 participants aged 25 and above were recruited in the survey to study the relationship between awareness of hypertension and diet, smoking, obesity. Health education focusing on balance diet, physical activity promotion and tobacco control was performed among intervention population. The final evaluation survey using same questionnaire was performed in 2010, classified in intervention (4071 participants) and control (2145 participants) group. Control group was selected from non-intervention town in same county. Intervention and control group shared the same baseline data in 2007 for evaluation. By comparing the changes of hypertension knowledge before and after intervention, the intervention effect was evaluated. RESULTS: Awareness of the relationship between hypertension and diet rose from 34.0% (6830/20 087) at baseline in 2007 to 69.3% (2821/4071) (χ(2) = 1757.30, P < 0.01) of intervention group and 44.8% (961/2145) (χ(2) = 99.30, P < 0.01) of control group in 2010. Awareness of hypertension associated to smoking rose from 25.6% (5142/20 087) at baseline in 2007 to 55.2% (2247/4071) (χ(2) = 1396.59, P < 0.01) in intervention group, 30.9% (662/2145) (χ(2) = 27.83, P < 0.01) in control group in 2010. Awareness of hypertension related to obesity rose from 37.2% (7472/20 087) of the baseline in 2007 to 68.3% (2780/4071) (χ(2) = 1339.27, P < 0.01) in intervention group, 45.1% (967/2145) (χ(2) = 51.14, P < 0.01) in control group in 2010. CONCLUSION: Community comprehensive intervention showed significant effects on hypertension related knowledge improvement in mid-western rural area of Shandong province.

[Effect of intervertebral position on range of motion after artificial lumbar total disc replacement and clinical management].

OBJECTIVE: To discuss the effect of SB Charité lumbar artificial disc position on intervertebral range of motion (ROM) and clinical management. METHODS: Between 2004 and 2007, 30 discogenic low back pain patients confirmed by discography underwent 1/2-level total disc replacement (TDR) implantation with 32 prostheses. There were 12 males and 18 females with a mean age of 44 years old (range: 28-55). All indexed levels were inserted between L4-S1 involving L4-5 (n = 9), L5S1 (n = 19) and L4-S1 (n = 2). The clinical outcome was measured by Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic outcome measures included flexion/extension ROM, restoration of operative level intervertebral disc height, maintenance of disc height at the final follow-up. A technique previously described by McAfee was used to evaluate TDR position in three groups. Paired t test was used to compare the preoperative and postoperative ROM and clinical ODI, VAS scores. RESULTS: Twenty-eight patients were followed-up for 24-60 months with an average of 38 months. All the prostheses were solidly immobilized with the vertebral endplate. No disc prosthesis rupture, dislocation, subsidence or heterotopic ossification was observed. Preoperative ODI, VAS back pain and VAS leg pain scores were 70.34 ± 9.21, 7.46 ± 2.65, 4.81 ± 2.75;and postoperative corresponding scores 7.65 ± 8.61, 0.68 ± 0.69, 0.35 ± 0.32 respectively. The positions of disc prostheses were graded as Group I, excellent, n = 17; Group II, suboptimal, n = 6; Group III, poor, n = 5. Preoperative mean intervertebral flexion/extension ROM (degree) of Group I to Group III were 9.75 ± 2.80, 10.30 ± 1.20 and 10.08 ± 2.43 respectively. The postoperative mean intervertebral flexion/extension ROM (degree): 6.68 ± 3.83, 4.22 ± 3.51 and 3.48 ± 3.56 respectively. Postoperatively all clinical outcome scores were lower than preoperative ones. Disc height was significantly restored. Mean intervertebral ROM decreased versus preoperative. Although there was a tendency of mean intervertebral ROM increasing with a better disc position, no statistical difference was observed. CONCLUSION: The mid-term clinical outcome of TDR is generally satisfactory. The TDR position influences intervertebral ROM to some extent. Efficient clinical management can reduce prosthetic malposition.

Thirty-two cases of vascular headache treated by acupuncture combined with Chinese herbal decoction.

OBJECTIVE: To compare the acupuncture plus oral administration of Chinese herbal decoction with simple oral administration of Chinese herbal decoction in the treatment of vascular headache. METHODS: Sixty two patients were randomly divided into a treatment group (32 cases) and a control group (30 cases). Acupuncture at Baihui (GV 20), Fengchi (GB 20), Shuaigu (GB 8), Xingjian (LR 2), Neiguan (PC 6), Sanyinjiao (SP 6) and Ashi points combined with oral administration of Chinese herbal decoction, was applied in the treatment group, and simple oral administration of Chinese herbal decoction was applied in the control group. RESULTS: The total therapeutic effect in the treatment group was better than that in the control group (P < 0.05). After treatment, the frequency, and duration of the attacks were reduced and shortened, and headache greatly alleviated in both groups (P < 0.01). The alleviation in the treatment group was more obvious than that in the control group (P < 0.05). CONCLUSION: Acupuncture combined with oral administration of Chinese herbal decoction provided remarkable therapeutic effects in treating vascular headache.

Chondromalacia patellae treated by warming needle and rehabilitation training.

OBJECTIVE: To observe the effect of warming needle combined with rehabilitation training on chondromalacia patellae in a randomized controlled trial. METHODS: The 92 cases were randomly divided into a treatment group treated by warming needle plus rehabilitation training (47 cases) and a control group treated by medication plus rehabilitation training (45 cases), and the therapeutic effect was compared after 20 sessions. RESULTS: The pain was relieved more obviously in the treatment group than in the control group (P < 0.05), and the total effective rate was 91.8% and 71.1% respectively (P < 0.01). CONCLUSION: Warming needle plus rehabilitation training was superior in the therapeutic effect and duration of producing relief of pain to medication plus rehabilitation training in treating chondromalacia patellae.

[Qualitative research on the family management and family needs of children with asthma].

OBJECTIVE: A qualitative research was conducted to investigate the problems on the family management of asthmatic children and the needs for family health services in order to provide basis for family-centered care. METHODS: Fifteen caregivers of children with asthma were interviewed with open-ended questions. The collected data were studied using Colaizzi's seven-step method of phenomenological analysis. RESULTS: The problems of family management and the needs for family health services were shown as follows: insufficient knowledge to prevention and treatment of asthma, poor compliance, ignoring psychological effects of asthma on children, a family's failure to cope with the distress and financial burden. CONCLUSIONS: It is important to provide asthma education and prevention program for caregivers and encourage them to participate in the design of medical program for asthmatic children. Individual asthma education and guides are also necessary for caregivers.

[Efficacy of bilateral sagittal cross percutaneous kyphoplasty for preventing recurrent fracture of the cemented vertebrae].

OBJECTIVE: To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP) for preventing recurrent fracture of the cemented vertebrae. METHODS: From January 2017 to June 2017, 85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs) were treated by bilateral sagittal cross PKP(cross group). There were 35 males and 50 females with an average age of (70.1±8.3) years old in cross group. Another 85 patients with single-segment OVCFs were treated by traditional PKP (traditional group). There were 37 males and 48 females with an average age of (73.3±9.5) years old in traditional group. The cement distribution condition, recurrent fracture of the cemented vertebrae, the anterior vertebral body height and sagittal Cobb angle, visual analogue scale(VAS) were observed in two groups. RESULTS: All patients underwent operation successfully. The follow-up time were (11.8±4.5) months in cross group and (12.1±3.7) months in traditional group. In cross group, all patients' bone cement touched the upper and lower endplates of the vertebral body while 67 cases (78.8%) in traditional group did with significant difference between two groups (P<0.05). No patient in cross group suffered recurrent fracture of the cemented vertebrae while 10 cases (11.8%) in traditional group did with significant difference between two groups(P<0.05). The anterior vertebral body height, sagittal Cobb angle and VAS in both groups were obvious improved at 2 days after operation (P<0.05) and there were no significant difference between two groups at 2 days after operation and the final follow-up(P>0.05). CONCLUSIONS: Bilateral sagittal cross PKP was a simple, safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body, thus preventing the recurrent fracture of the cemented vertebrae.

[Digital modeling and analysis of the applicability of backward rotation method in lumbar kyphoplasty with unilateral puncture].

OBJECTIVE: The 3D model of lumbar spine was established by using Mimics software. To observe the applicability and needling parameters of lumbar vertebral kyphoplasty with unilateral puncture by backward rotation method using simulated puncture. METHODS: Twenty-four patients (12 males and 12 females) with osteoporotic thoracic fracture in the first time and no signs of lumbar misalignment and bone destruction were scanned by spiral CT on the lumbar spine. The original DICOM file was modeled in 3D with Mimics software, and the vertebral bodies were separated. After being imported into 3-matic software, the posterior wall of the vertebral body was restrained for standardized measurement. A sketch perpendicular to the mid-section of the pedicle and the posterior wall of the vertebral body was drawn. The simulated puncture was performed on the sketch. The angle and distance parameters of the range of motion of the puncture needle were recorded, and the puncture needle was recorded at the top. The crossing points of the anterior, middle and posterior zones of the tangential line of the vertebral body were located at the high extraversion angle, and the results were compared and analyzed. RESULTS: All the data in the left and right sides had no significantly differences(P>0.05). Data of different segments in different gender were significantly differences(P<0.05). The maximal extraversion angle in lumbar spine increased gradually from (33.41±1.31) degree to (56.53±4.71) degree in males, as same as in females from(28.58±2.55) to (53.86±2.68) degree. There was no crossing point in area A, 3.3% of males and 26.67% of females in area B, rest in area C. The distribution areas on gender showed statistically significance (P<0.05). CONCLUSIONS: Backward rotation method can theoretically meet the requirements of puncture point for vertebral compression fracture, especially for males and lower lumbar spine. The determination of the maximum inclination angle is of guiding significance to the backward rotation method.