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BACKGROUND:Acellular vascular scaffolds can mimic the microstructure and function of native blood vessels,but some extracellular matrix loss occurs during their preparation,which affects their hemocompatibility.Therefore,it is necessary to modify them to improve their hemocompatibility. OBJECTIVE:To assess the hemocompatibility of acellular vascular scaffold prepared by Triton-x100/heparin sodium treatment. METHODS:The abdominal aorta was taken from SD rats and randomly divided into control and experimental groups.The control group was treated with Triton-x100 for 48 hours.The experimental group was treated with Triton-x100 for 48 hours and then treated with heparin sodium.The morphology and hydrophilicity of the two groups of acellular vascular scaffolds were detected.The hemocompatibility of the two groups of acellular vascular scaffold was evaluated by recalcification coagulation time test,platelet adhesion test,dynamic coagulation time test,hemolysis test,and complement activation test. RESULTS AND CONCLUSION:(1)Scanning electron microscopy showed that the surface of the two groups of vascular scaffolds was relatively intact,and a large number of fiber filaments appeared on the surface of the scaffolds after decellularity treatment,and the surface microstructure changed significantly.The water contact angle of the two groups of vascular scaffolds was smaller than that of natural vessels(P<0.000 1).There was no significant difference in water contact angle between the two groups(P>0.05).(2)The coagulation time of vascular scaffold was longer in the experimental group than in the control group(P<0.05).The number of platelets attached to the scaffold membrane was less in the experimental group than that in the control group(P<0.000 1).The coagulation index was greater in the experimental group than that in the control group(P<0.01),and the complement level was lower in the experimental group than that in the control group(P<0.001).The hemolysis rate of the two groups was lower than 5%of the national standard.(3)To conclude,acellular scaffold treated with Triton-x100/heparin sodium has excellent hemocompatibility.
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Objective:To explore the role of active screening in the diagnosis and treatment of early lung cancer, and give health management recommendations.Methods:A retrospective study was conducted to collect lung cancer patients who had complete population sociology, clinical information, pathology and imaging characteristics in the Thoracic Surgery in Xiangya Hospital of Central South University from 2016 to 2019. According to different diagnostic modes, they were divided into an active screening group (1082 cases) and a passive case finding group (974 cases), to analyze their differences in demographic sociological, clinical information, pathology and imaging characteristics, and to discuss the key points of population management in the active screening group.Results:From 2016 to 2019, the proportion of lung cancer patients in the active screening group increased from 36.1% to 54.2%, and the proportion of patients found to have lung cancer by CT examination in the active screening group increased from 82.2% to 96.8%. Compared with the passive case finding group, the active screening group had a higher proportion of women, non-smokers, patients with precursor glandular lesions and adenocarcinoma, patients in stage 0 and stage I, patients with lesion diameter (d)≤1 cm and 1<d≤2 cm, patients with sublobectomy and lymph node sampling (46.9% vs 32.9%, 59.2% vs 43.8%, 4.0% vs 2.1%, 80.5% vs 56.8%, 4.0% vs 2.1%, 72.0% vs 56.8%, 14.5% vs 7.6%, 42.5% vs 33.3%, 6.3% vs 2.9%, 2.4% vs 1.0%, respectively, all P<0.05). Conclusion:Active screening is helpful to find early lung cancer, and the health management and physical examination center should pay attention to the management of such physical examination population.
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Objective:To investigate the correlation between hyperuricemia and hypertension in hospital employees.Methods:A cohort was constructed from staff participating health checkups at the Xiangya Hospital of Central South University, baseline health examinations and questionnaires were conducted from February 1, 2011, to January 29, 2012; 502 participants were excluded according to the nadir criteria, and 3 525 participants were followed-up from February 1, 2012, to December 31, 2018, according to the results of annual employee checkups. The participants were divided into the normal uric acid (3 232 cases) and hyperuricemia groups (293 cases) according to the baseline examination results. The presence of hyperuricemia was used as an observation index and occurrence of hypertension within 7 years was used as an outcome indicator. Age, sex, body mass index, creatinine, LDL cholesterol, triacylglycerol, HDL cholesterol, fasting glucose, marriage, education, job position, smoking, alcohol consumption, and exercise status were used as confounding factors to construct five Cox regression models and calculate their HR values, adjusted HR values, and 95% CI to analyze the relationship between hyperuricemia and the occurrence of hypertension in the overall population and female and male populations. Results:The follow-up of the study participants was conducted for a period of (6.19±1.25) years, with a total of 21 831 person-years of follow-up. The 7-year cumulative prevalence of hypertension was 16.5% in the total population, 12.5% in the female population, 30.1% in the male population, 14.1% in the normal uric acid group, and 42.0% in the hyperuricemia group. The prevalence density of hypertension was 26.6, 19.6, 53.8, and 22.4 per 1 000 person-years in the total, female, male, and normouricemic groups, respectively. Without adjusting for any confounding variables, the risk of hypertension was higher in the total population, female population, and male population in the hyperuricemia group than in the normal uric acid group [ HR=3.86, 5.69, 1.60, (95% CI: 3.17-4.72, 4.36-7.43, 1.18-2.16)] (all P<0.05); after gradually adjusting for confounders, this correlation was only manifested in the female population [adjusted HR=1.91 (95% CI: 1.08-3.36)] (all P<0.05), and the difference was not statistically significant in the male population ( P>0.05). Conclusion:Among female hospital employees, hyperuricemia is an independent risk factor for the development of hypertension.
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Objective:To explore the efficacy of apatinib combined with S-1 capsule in the treatment of patients with advanced recurrent and metastatic esophageal cancer.Methods:A total of 140 patients with advanced esophageal cancer were selected as test subjects from January 2017 to January 2019 in Shandong Tai′an Cancer Prophylaction-Therapeutic Hospital. These patients were randomly divided into observation group (72 cases) and control group (68 cases) using random number table method. The patients in the observation group were treated with oral apatinib combined with S-1 chemotherapy, and the patients in the control group was only given S-1 chemotherapy. The short-term and long-term efficacy and adverse reactions of the two groups were observed.Results:The objective remission rates of the observation group was 38.9% (28/72), higher than that in the control group (22.1%, 15/68), with a statistically significant difference ( χ2=4.655, P=0.031). The disease control rate of the observation group was 88.9% (64/72), higher than that in the control group (61.8%, 42/68), and there was a significant difference between the two groups ( χ2=13.993, P<0.001). The median progression-free survival of the observation group and the control group was 5.9 months and 2.7 months respectively, the median overall survival was 14.8 months and 7.9 months respectively, and there were significant differences between the two groups ( χ2=5.477, P=0.026; χ2=6.083, P=0.014). The adverse reactions of the two groups were mild, grade 1-2, mainly including fatigue, leukopenia, hand-foot syndrome, hypertension and proteinuria, with incidences of 59.7% (43/72), 50.0% (36/72), 8.3% (6/72), 12.5% (9/72), 9.7% (7/72) in the observation group, and 51.5% (35/68), 57.4% (39/68), 17.6% (12/68), 4.4% (3/68), 4.4% (3/68) in the control group, there were no significant differences between the two groups ( χ2=0.965, P=0.326; χ2=0.760, P=0.383; χ2=2.708, P=0.100; χ2=2.919, P=0.088; χ2=0.794, P=0.373). Conclusion:Apatinib combined with S-1 is effective, safe and tolerable in the treatment of recurrent and metastatic esophageal cancer.
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Objective:To investigate the correlation between serum uric acid level and non-alcoholic liver disease (NAFLD).Methods:A medical examination cohort of our hospital′s staff was constructed. From February 1, 2012 to January 29, 2013, a total of 3, 479 staff without NAFLD were selected as research subjects, and baseline data were collected through a questionnaire survey, physical examination, abdominal ultrasound examination, blood lipid, blood glucose, liver and kidney function, and other laboratory tests. From February 1, 2013 to December 31, 2018, the patients were followed up during the annual physical examination for six years. The serum uric acid level was used as the observation index and divided into four groups from A to D according to the quartile. With the occurrence of NAFLD as the outcome indicator; the four groups of uric acid as the observation indicator; and age, body mass index, hyperlipidemia, hyperglycemia, hypertension, creatinine, and alanine aminotrans ferase as confounding factors; four Cox regression analysis models were constructed to explore the relationship between groups of different blood uric acid levels and NAFLD. Stratified by gender, three Cox regression analysis models were constructed to investigate the relationship between blood uric acid level grouping and NAFLD between different genders.Results:The six-year cumulative incidence of NAFLD in groups A, B, C, and D was 1.2%, 3.1%, 4.9%, and 12%, respectively (χ 2=114.710, P<0.05). Among the female workers, the six-year cumulative incidence rates in groups A, B, C, and D were 1.0%, 2.9%, 4.1% and 10.9%, respectively (χ 2=71.241, P<0.05). The incidence risk of NAFLD in groups B, C, and D was 2.04 (1.01-4.11), 2.24 (1.13-4.44), and 3.89 (1.94-7.80) times that of group A, P<0.05, respectively. The incidence risk of NAFLD in groups B, C, and D was 2.21 (1.02-4.77), 2.39 (1.10-5.19), and 4.49 (1.99-10.15) times that of group A, all P<0.05, respectively. Conclusion:The risk of NAFLD increased with the increase of serum uric acid level, and this trend was mainly manifested in female employees.
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Objective@#Constructing and applying the multi-module training program for junior midwives to improve the training quality.@*Methods@#The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated.@*Results@#Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P < 0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05).@*Conclusion@#The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.
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Objective Constructing and applying the multi-module training program for junior midwives to improve the training quality. Methods The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated. Results Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P<0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05). Conclusion The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.
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To analyze the incidence and imaging characteristics of pulmonary nodules in a unit staff. Methods: Low-dose spiral CT (LDCT) scan were performed in 1 372 staffs ≥45 years old in a certain unit during the physical examination. The clinical and imaging data were collected to analyze the detection rate, imaging characteristics, and postoperative pathological conditions of pulmonary nodules. Results: The total detection rate for pulmonary nodules was 30.39% (417/1 372). The detected nodules were mainly single (227 cases), solid (343 cases), 0.05). Compared with the Lung-RADS category 3 nodules, the proportions of nodules in subsolid state, with irregular shape, lobulation sign, and vascular penetration in the Lung-RADS category 4 were increased (all P<0.05). Among them, 11 patients received surgical therapy, including 10 women. Postoperative pathology confirmed lung adenocarcinoma in 9 patients (2.16%), including 8 women, all non-smokers. Conclusion: The nodules in subsolid state with vascular penetration, irregular shape and lobulation sign tend to be malignant. Lung cancer screening with low-dose spiral CT in female non-smokers should be emphasized.
Sujets)
Femelle , Humains , Mâle , Adulte d'âge moyen , Dépistage précoce du cancer , Tumeurs du poumon , Imagerie diagnostique , Tomodensitométrie hélicoïdale , TomodensitométrieRésumé
From the two aspects both at home and abroad endowment institutions the elderly family support commonly used assessment tool, this paper introduces the process of development of tools, dimensions, scoring method, and analyze the reliability and validity of the advantages and disadvantages of various assessment tools, aimed at the elderly family support for localization development of our country endowment institutions provide reference for the development and application of assessment tools.
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Objective To investigate the relationship between hyperlipidemia and hyperuricemia.Methods From February 1,2012 to May 31,2017,a physical examination queue for serving and retired employees in Xiangya Hospital was established.As the survey's baseline,height,weight,waist circumference,blood lipids,blood pressure,blood glucose,creatinine,and serum uric acid were collected.The normal group was the control group,and the dyslipidemia group was the exposure group.The occurrence of hyperuricemia was investigated during follow-up.A multivariate Cox proportional hazards regression model was used to analyze hyperlipidemia.Four different clinical types (hypercholesterolemia,hypertriglyceridemia,mixed hyperlipidemia,and low high-density lipoprotein hyperlipidemia) and hyperuricemia had an incidence of hazard ratio (HR) and confidence interval (95%CI).Results A total of 1 553 people entered the follow-up cohort.A total of 5 297 patients were followed up for an average of 3.4 years.Three hundred and ninety-four cases of hyperuricemia were collected.The density of hyperuricemia was 744/10 000 years.The hyperuricemia group was followed up for 2 509 years,with hyperuricemia occurring in 142 cases,and hyperuricemia in the hyperlipidemia group of 566/million years.The hypercholesterolemia,high triglyceride,mixed hyperlipidemia,and low-density lipoprotein groups were followed up for 1 431,403,580,92 years,respectively,and high uric acid occurred respectively.In 105,64,72 and 11 cases,the incidence of disease was 734/million years,1 588/million years,1 241/million years,1 196/million years;the difference was statistically significant (P< 0.01).Hyperlipidemia and its four clinical types,hypercholesterolemia,hypertriglyceridemia,mixed hyperlipidemia,and hypodic lipoproteinemia,were associated with hyperuricemia.HR (95%CI) was 1.971 (1.604-2.421),1.441 (1.120-1.855),3.103 (2.309-4.169),2.434 (1.833-3.233),2.336,respectively.(1.265-4.316),P< 0.01;after adjusting the influence of age,sex,body mass index,hypertension,hyperglycemia,and hyper creatinine,HR (95%CI) was 1.885 (1.533-2.317),1.450 (1.127-1.866),2.881 (2.141-3.876),2.118 (1.588-2.825),2.451 (1.326-4.528) P<0.01.Conclusions Hyperlipidemia and its four different clinical types (hypercholesterolemia,hypertriglyceridemia,mixed hyperlipidemia,and low-density lipoproteinemia) are all associated with the onset of hyperuricemia.
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Studies have shown that pregnant women due to their specificity and social factors during pregnancy, maternal mortality and postpartum serious complications were significantly higher. Taking effective measures to control maternal mortality and ensuring the safety of pregnant women is an urgent problem to be solved.The first measure to ensure the safety of pregnant women is to use appropriate assessment tools, accurate, dynamic and comprehensive risk assessment of pregnant women. At present, with the start of a comprehensive two-child policy,research related to obstetric early warning scores has become the focus of research in the field of obstetric care.Therefore,this article through the"obstetrics","maternal","risk warning","risk score"as the key word,search Wanfang database,Chinese Journal full-text database(CNKI),Chinese biomedical literature database(CBM);foreign language literature,such as PubMed,Web of Science,Springer,EBSCO and other databases,with"early warning score","risk score","risk score system","Obstetric","Obstetric care"Word for retrieval.So that to provide a comprehensive analysis of the status quo of the use of early risk assessment tools at home and abroad,and to summarize the contents of the assessment tools,and further point out the problems in the current research.
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Health education during pregnancy can reduce the incidence of maternal and child disease and improve their health level. As the implementation of the " universal two-child policy" and the change of the national fertility view, the number of maternal, especially the number of the advanced maternal age, is faster increase.While the health manpower in our country is short, so we need a convenient, fast and safe informationalizedway for maternal health education.This article comprehensive analyze the status of application health education about the form and content in the China and overseas,and discuss the advantages and limitations, in order to establish a scientific, effective, propagable and new model of maternity information health education, to provide experience and enlightenment for our clinical works.
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OBJECTIVE:To provide a reference for the management of the facilities and equipment of the pharmacy intrave-nous admixture service(PIVAS). METHODS:The experience in the management of the facilities and equipment of PIVAS in our hospital was introduced in respect of system establishment,archives management and the maintenance of important equipment,and the performance of core purification equipment was tested to evaluate management effect. RESULTS & CONCLUSIONS:The PIV-AS in our hospital established a practical system by developing and improving 7 management systems,9 sets of operational proce-dures and 5 contingency plans,increased the awareness of archives management by perfecting 27 archive files and standardized and conducted the maintenance of key equipment. In 2014 and 2015,after implementing management,the passing rates of all test items of the purification equipment were 100%. It is suggested that facilities management should focus on active preparation of an intelli-gent monitoring system,the improvement of the information system and the training of professional management personnel.
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Objective To evaluate the clinical efficacy of percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic vertebral compression fractures (OVCF).Methods Clinical datas of 90 cases patients with postmenopausal suffered single segment vertebral compression fracture who were treated in Beijing ShiJingshan Hospital of Capital Medical University from March 2010 to March 2013 were retrospectively analyzed.The patienrs were randomly divided into three groups according to the different treatment methods,20 patients receivedbed rest treatment as conservative group,40 patients were undergone percutaneous kyphoplasty as operation group,30 patients were given percutaneous kyphoplasty combined with zoledronic acid as combination group.Visual analogue score (VAS) were recorded before treatment and 1 week,6 months after treatment,and lumbar vertebrae bone mineral density (BMD) was measured before treatment and 2 years after treatment.The subsequent fracture of the vertebrae was analyzed after 2 years of treatment.Results There were 4 patients were not followed up.Three patients in conservative group suffered complications,but no complications were observed in operation group and combination group.The VAS score of the combination group and operation group at 1 week after treatment was significantly different compared with conservative group((3.0± 1.4) points vs.(3.2± 1.2) points vs.(8.0± 1.1) points,P<0.05).At the 6 months after treatment,there were no significant differences among the 3 groups on VAS score (P >0.05).Lumbar vertebrae BMD of combination group increased at 2 years after treatment,compared with conservative group and operation group the difference were significantly((-1.8±0.6) vs.(-3.1±0.5) vs.(-2.7±0.3),P <0.05).The incidence of the subsequent fracture of the vertebrae reduced of combination group,compared with conservative group and operation group the difference were significantly (3.3% (1/30) vs.27.8% (5/18)vs.21.1% (8/38),P< 0.05).Conclusion Percutaneous kyphoplasty combined with zoledronic acid for the treatment of OVCF-patients with postmenopausal and single segment fracture is not only safe,effective,but also can obviously relive pain and reduce the risk of subsequent fracture of the vertebrae.
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Objective To compare the clinical effects of conservative therapy and radiofrequency ablation in the treatment of cervical spondylotic radiculopathy,to analyze the reason and discuss the surgical indications.Methods Fifty-five patients with cervical spondylotic radiculopathy treated in Shijingshan Hospital from May 2013 to May 2016 were selected and retrospectively analyzed,including 30 patients received conservative treatment (conservative group),25 patients undergone radiofrequency ablation (operation group).Visual analogue score (VAS) was used to assess the degree of pain relief in the two groups before treatment and 1 week,1 month after treatment.The side effects in the two groups and the postoperative complications of the patients were observed.Results The VAS score of the operation group and the conservative group in 1 weeks after treatment were (3.2±0.5) points,(5.2±0.7)) points,1 months (2.8±0.3) points,(5.8±0.4) points,respectively,the degree of pain were lower than those collected before treatment (8.0±0.9) points,(7.6±0.8) points,separately,the differences were statistically significant (P<0.05),and the degree of pain relief in the operation group was more obvious than that in the conservative group,there was significant difference between the two groups (P<0.01).Two groups of patients were treated with medication without any obvious discomfort.The surgery of the operation group was successful,and no complications such as nerve and spinal cord injury,vascular injury,local hematoma,puncture needle breakage and intervertebral space infection were found.Conclusion Radiofrequency ablation is more effective for the treatment of cervical spondylotic myelopathy in the short term than conservative treatment,and radiofrequency ablation treatment is a recommended choice for patients with no surgical contradiction.
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Objective@#To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after surgery for stomach cancer.@*Methods@#A total of 684 patients with gastric cancer who underwent surgery for stomach cancer from Jan. 1, 2010 to Dec. 31, 2014 in Tai′an Tumor Prevention and Treatment Hospital, including 475 males and 209 females, with an average age of 59.9 years were identified and included in this study. There were 206 cases of gastric cardia and gastric fundus cancers and 478 cases of gastric antrum cancer. 206 cases underwent proximal radical subtotal gastrectomy and D2 lymph node dissection, 478 distal radical subtotal gastrectomy, 206 residual esophagogastric anastomosis, 311 Billroth-Ⅰ anastomosis, 99 Billroth-Ⅱ anastomosis, and 68 Billroth-Ⅱ plus Roux-en-y anastomosis. The incidence and risk factors of PGS were analyzed.@*Results@#All of the 684 patients were successfully operated.Among them, 48 (7.0%)encountered PGS. The univariate analysis showed that age, smoking index, alcohol consumption index, HP infection, scores of anxiety, preoperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level, abdominal cavity infection, and usage of postoperative analgesia pump were related to the occurrence of PGS (P<0.05 for all), while sex, hypertension, diabetes, perioperative hemoglobin level, perioperative electrolyte imbalance, operation duration, intraoperative blood loss, size of gastric remnant and number of dissected lymph nodes were not significantly related to the occurrence of PGS(P>0.05 for all). The multivariate binary logistic regression analysis showed that age, HP infection, scores of anxiety, perioperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level and abdominal cavity infection were risk factors for PGS (P<0.05 for all); while the age (<67 years old), perioperative albumin level (>35 g/L) and preservation of the vagus nerve trunk were protective factors of PGS (P<0.05 for all).@*Conclusions@#The occurrence of PGS is affected by many factors. Detailed evaluation of patients′symptoms and physical signs before operation and rectifying and eliminating risk factors are important to prevent and reduce the occurrence of PGS in patients with gastric cancer.
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Objective To survey aesthetics cognition for smiling beauty in young people smile. Methods Smile model was established. The middle incisor width/length ratio, lateral incisor and middle incisor width ratio, difference of lateral incisor and the middle incisor gingival level, gingiva exposure, buccal corridor width and smile line radian were used as variable values to change respectively. A total of 200 young people were selected to evaluate results. The differences in index of ideal value and acceptable range between different dender groups were calculated. Results The ideal value of middle incisor width/length ratio was 0.75, and acceptable range was 0.65-0.85. The ideal value of lateral incisor and middle incisor width ratio was 0.618, and acceptable range was 0.518-0.718. The ideal value of lateral incisor and the middle incisor gingival level difference was-0.5 mm, and the acceptable range was-1-0 mm. The ideal value of gingiva exposure was 0 mm, and the acceptable range was 0-2 mm. The ideal value of buccal corridor was 0.09, and the acceptable range was 0.05-0.21. Coordinate smile was ideal smile line (value=1), and the acceptable range was 0.5-1. There were no statistically significant differences in smile esthetics of six ideal value indicators and acceptable ranges between different gender groups. Conclusion The ideal values and acceptable ranges of six indexes of quantitative criteria can be used for clinical treatment.
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Objective To observe the clinical efficacy of medicinal moxibustion plus oral administration of Chinese medication in treating chronic eczema.Method Seventy patients with chronic eczema were randomized into a treatment group and a control group, 35 cases in each group. The treatment group was intervened by medicinal moxibustion plus oral administration of Chinese medication, while the control group was by conventional moxibustion plus Chinese medication. The Scoring Atopic Dermatitis Index (SCORAD) was observed before and after treatment, and the clinical efficacies were compared.Result The total effective rate was 72.7% in the treatment group versus 56.3% in the control group, and the difference was statistically significant (P<0.05). The SCORAD scores were significantly changed after treatment in both groups (P<0.05). After treatment, the SCORAD score of the treatment group was significantly different from that of the control group (P<0.05).Conclusion Medicinal moxibustion plus oral administration of Chinese medication is an effective method in treating chronic eczema.
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Objective To compare the efficacy of intra?articular dexmedetomidine or morphine mixed with ropivacaine for postoperative analgesia after arthroscopic knee surgery?Methods Sixty ASA physical status I or II patients scheduled for elective arthroscopic knee surgery were randomly assigned into 3 equal groups using a random number table?The group R received 0?25% ropivacaine, and the group RD received 1 μg/kg dexmedetomidine and 0?25% ropivacaine,and the group RM received 2 mg morphine and 0?25% ropivacaine intraarticularly in a total volume of 20 ml?Visual analogue scales( VAS) scores when the patients actively flexed the operated knee to 90° were recorded at 2, 4, 8, 12, 18 and 24 h after surgery?The analgesic duration and consumption of fentanyl at 24 h after surgery were recorded?The complications such as bradycardia,hypotension, nausea,vomit,cutaneous pruritus and uroschesis were followed up?Results At 8 and 12 h after surgery,VAS scores were significantly lower in group RD ( ( 3?23 ± 0?45 ) points, ( 3?18 ± 0?47 ) points ) and RM ( ( 3?20 ±0?46) points,(3?13±0?45) points) than in group R((4?01±0?74) points,(3?93±0?71) points),and at 18 and 24 h after surgery,they were significantly higher in group R((3?85±0?62) points,(3?72±0?57) points) and RD((3?83±0?57) points,(3?71±0?55) points) than in group RM((3?07±0?43) points,(3?02±0?41) points),and there was significant difference(F between groups=124?65,P=0?021,F inner grouP=11?65,P=0?004,F across groups=67?65,P=0?024)?The analgesic duration was significantly different in three groups (F=45?78,P<0?001),and in group RD((668?3±133?4) min) and RM((1 412?8±275?67) min) was significantly longer than in group R(402?3±81?5) min,P<0?05),and the group RM was longer than the group RD( P<0?05)?The consumption of fentanyl at 24 h after surgery was significantly different in three groups ( F=34?47,P<0?001),and it was significantly lower in group RD((32?6±7?3) μg) and RM((12?8±3?7) μg) than in group R((151?3±28?5) μg,P<0?05),and the group RM was lower than the group RD(P<0?05)?No significant side effects were found?Conclusion Intra?articular dexmedetomidine or morphine all can improve the efficacy of ropivacaine for postoperative analgesia after arthroscopic knee surgery,while morphine is superior to dexmedetomidine.
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Objective To summarize the clinical outcomes of pectoralis major myocutaneous flap for repairing large defects in oral and maxillofacial area after resection of malignant tumor. Methods The clinical data of 27 patients underwent resection of malignant tumor in oral and maxillofacial area and reconstructed with pectoralis major myocutaneous flap were collected in our hospital from August 1998 to January 2015. The pectoralis major myocutaneous flaps were harvested with sizes ranging from 6 cm × 4 cm to 11 cm × 9 cm. The major myocutaneous flaps were used to reconstruct the defects of oral mucosa in 26 cases, and flap was used to reconstruct the defect of facial skin in 1 case. Seventeen major myocutaneous flaps reached the neck via the subclavicular tunnel, the other 10 were transferred over the clavicle. Results After surgery, 20 flaps (74.1%) were survived completely, 6 were partial necrosis (22.2%) and one was total necrosis (3.7%). Thirteen cases showed postoperative complications (48.1%), in which 10 cases were wound infection (37.0%), including 8 patients with infection at the recipient site and 2 patients with infection at the donor site. The wound infection was found in all of 7 patients with flap necrosis. The other complications included wound dehiscence in 1 patient (3.7%), neck hematoma in 1 patient (3.7%), and lung infection in 1 patient (3.7%). Conclusion In order to avoid the flap necrosis and reduce wound infection at the recipient site, the major myocutaneous flap should be designed based on the characteristics of blood supply, and the vascular pedicle should be protected carefully in the operation.