The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures.

PURPOSE: Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures. METHODS: This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure ≤90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test. RESULTS: The patients' average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05). After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67). CONCLUSIONS: Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.

[Efficacies of bone-marrow-derived mononuclear cells with a hydroxylapatite composite in the treatment of osteonecrosis of the femoral head].

OBJECTIVE: To evaluate the efficacies of core decompression and implantation of concentrated autologous bone marrow containing mononuclear cells (BMMCs) with porous hydroxylapatite composite in the treatment of osteonecrosis of the femoral head. METHODS: A total of 35 patients with 57 osteonecrosis hips with ARCO stage I, stage II and stage IIIA disease were treated by BMMCs with a porous hydroxylapatite composite. The mean age at surgery was 39.4 (26-58) years and the mean period of follow-up 28 (12-40) months. In the control group, cell-free porous hydroxylapatite composite was implanted into 17 patients (27 hips) with osteonecrosis of the femoral head and the outcomes were compared. RESULTS: At the last follow-up, postoperative Harris hip scores significantly increased in both groups (P < 0.0001). The magnitude of increase was significantly greater in the BMMCs group compared with the control group (28.3% ± 0.9% vs 18.4% ± 1.7%, P < 0.01). Postoperative visual analog scale (VAS) scores significantly decreased in both groups (P < 0.01). The magnitude of decrease was significantly greater in the BMMCs group compared with the control group (-70.2% ± 2.1% vs -51.7% ± 2.9%, P < 0.001). The clinical success rate was significantly higher in the BMMCs group compared with the control group (75.4% vs 37.0%, P < 0.01). The radiological success rates were similar between the BMMCs and control groups (59.6% vs 40.7%, P = 0.1046). CONCLUSION: The combined regimen of core decompression and implantation of concentrated autologous BMMCs with porous hydroxylapatite composite appears to confer benefits in the treatment of in stages I-IIIA osteonecrosis of the femoral head.

Early effect of standalone oblique lateral interbody fusion vs. combined with lateral screw fixation of the vertebral body on single-level lumbar degenerative disc disease: A pilot study.

BACKGROUND: For the treatment of single-level lumbar degenerative disc disease (DDD), oblique lateral interbody fusion (OLIF) has clinical advantages. Whether internal fixation needs to be combined for treatment has been the subject of debate. OBJECTIVE: To compare the early clinical effects of standalone oblique lateral interbody fusion (S-OLIF) versus OLIF combined with lateral screw fixation of the vertebral body (F-OLIF) on single-level lumbar DDD. METHODS: A retrospective analysis was performed on the data of 34 patients for whom the OLIF technique was applied to treat single-level lumbar DDD from August 2018 to May 2021. Patients were divided into the S-OLIF (n= 18) and F-OLIF groups (n= 16). Intraoperative blood loss, operative time, and length of hospital stay were recorded. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) before and after the operation were evaluated. The disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), cage subsidence, and fusion by CT examination were measured before and after the operation. RESULTS: The S-OLIF group experienced a shorter operative time and less intraoperative blood loss than the F-OLIF group, and the differences were statistically significant (p< 0.05), but the difference in the length of hospital stay was not statistically significant. The postoperative VAS score and ODI of the two groups were significantly lower than those before the operation, but the postoperative differences between the two groups were not statistically significant. Differences were not statistically significant in postoperative FH, DH, FSL and LL of the two groups. Both groups were followed up for no less than 12 months. In the two groups, fusion was achieved at the last follow-up visit. CONCLUSION: According to short-term follow-up results, both S-OLIF and F-OLIF can achieve reliable and stable fusion and good clinical effect in the treatment of single-level lumbar DDD.

Estimation of sample size and testing power (part 6).

The design of one factor with k levels (k ≥ 3) refers to the research that only involves one experimental factor with k levels (k ≥ 3), and there is no arrangement for other important non-experimental factors. This paper introduces the estimation of sample size and testing power for quantitative data and qualitative data having a binary response variable with the design of one factor with k levels (k ≥ 3).

Estimation of sample size and testing power (Part 4).

Sample size estimation is necessary for any experimental or survey research. An appropriate estimation of sample size based on known information and statistical knowledge is of great significance. This article introduces methods of sample size estimation of difference test for data with the design of one factor with two levels, including sample size estimation formulas and realization based on the formulas and the POWER procedure of SAS software for quantitative data and qualitative data with the design of one factor with two levels. In addition, this article presents examples for analysis, which will play a leading role for researchers to implement the repetition principle during the research design phase.

Estimation of sample size and testing power (part 5).

Estimation of sample size and testing power is an important component of research design. This article introduced methods for sample size and testing power estimation of difference test for quantitative and qualitative data with the single-group design, the paired design or the crossover design. To be specific, this article introduced formulas for sample size and testing power estimation of difference test for quantitative and qualitative data with the above three designs, the realization based on the formulas and the POWER procedure of SAS software and elaborated it with examples, which will benefit researchers for implementing the repetition principle.

Estimation of sample size and testing power (Part 3).

This article introduces the definition and sample size estimation of three special tests (namely, non-inferiority test, equivalence test and superiority test) for qualitative data with the design of one factor with two levels having a binary response variable. Non-inferiority test refers to the research design of which the objective is to verify that the efficacy of the experimental drug is not clinically inferior to that of the positive control drug. Equivalence test refers to the research design of which the objective is to verify that the experimental drug and the control drug have clinically equivalent efficacy. Superiority test refers to the research design of which the objective is to verify that the efficacy of the experimental drug is clinically superior to that of the control drug. By specific examples, this article introduces formulas of sample size estimation for the three special tests, and their SAS realization in detail.

Estimation of sample size and testing power (Part 1).

This article introduces the general concepts and methods of sample size estimation and testing power analysis. It focuses on parametric methods of sample size estimation, including sample size estimation of estimating the population mean and the population probability. It also provides estimation formulas and introduces how to realize sample size estimation manually and by SAS software.

Estimation of sample size and testing power (part 2).

This article introduces definitions of three special tests, namely, non-inferiority test (to verify that the efficacy of the experimental drug is clinically not inferior to that of the positive control drug), equivalence test (to verify that the efficacy of the experimental drug is equivalent to that of the control drug) and superiority test (to verify that the efficacy of the experimental drug is superior to that of the control drug), and methods of sample size estimation under the three different conditions. By specific examples, the article introduces formulas of sample size estimation for the three special tests, and their SAS realization in detail.

Lumbar Fusion for Spondylolisthesis: A Bayesian Network Meta-analysis of Randomized Controlled Trials.

STUDY DESIGN: This was a Bayesian network meta-analysis. OBJECTIVE: We aimed to assess the comparative efficacies of the 5 most commonly used procedures for spondylolisthesis in a Bayesian network meta-analysis. SUMMARY OF BACKGROUND: Lumbar fusion procedures are the backbone for the surgical treatment of spondylolisthesis. However, the current evidence has only considered head-to-head comparisons of different fusion procedures and failed to definitively favor one fusion procedure over another. MATERIALS AND METHODS: A Bayesian random-effects model was used, and radiographic fusion and complications were assessed by risk ratio with a corresponding 95% credible interval; Oswestry Disability Index (ODI) scores were assessed by mean difference and 95% credible interval. Furthermore, with respect to each endpoint, ranking probabilities for each fusion procedure were evaluated using the value of the surface under the cumulative ranking curve. RESULTS: In all, 12 studies were identified. Significant differences in associated complications were found between minimally invasive transforaminal lumbar interbody fusion (MTLIF) and each of the other 4 fusion procedures. Surface under the cumulative ranking curve results suggested that for the most effective radiographic fusion, open transforaminal lumbar interbody fusion (OTLIF) had the maximum probability of being successful (76.6%), followed by MTLIF (70.4%) and open posterior lumbar interbody fusion (OPLIF, 48.7%). In terms of ODI scores, OTLIF might be the best intervention (70.5%), followed by MTLIF (68.8%) and then OPLIF (44.0%). However, MTLIF is ranked the safest (99.8%) regarding associated complications, followed sequentially by OTLIF (57.1%) and posterolateral fusion (30.1%). CONCLUSIONS: OTLIF for spondylolisthesis was found to be the more efficient procedure in terms of radiographic fusion and ODI scores. Importantly, MTLIF is most likely to have a lower associated complication rate compared with other fusion procedures.

[Typing of hemorrhagic fever with renal syndrome by cluster analysis].

OBJECTIVE: To make an inquiry into method of typing of hemorrhagic fever with renal syndrome (HFRS). METHOD: Average monthly rates were calculated on the basis of data from 1995 to 1999, then cluster analysis was carried out to type out endemic areas. RESULTS: Compared with the results of 36 surveillance spots from 1980 to 1992, twenty-four surveillance spots had the same results (66.7%). Twenty-three surveillance spots had the same results with the original data in 1999 (82.1%). CONCLUSION: HFRS incidences increased in spring or in summer, but decreased in autumn or in winter. Cluster analysis seemed to be a supplementary method in distinguishing the epidemic types for HFRS.