【摘要】 目的 评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。 方法 通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。 结果 最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（Plt;0.000 01）。 结论 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。【Abstract】 Objective To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia. Methods The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software. Results Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (Plt;0.000 01). Conclusion Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.
Objective To study the medicine dynamics, distribution in tissue and abdominal cavity fluid concentration of 5-FU after giving intraperitoneal by using a gelatin carrier to be made 5-FU slowing-release microballoons. Methods 5-FU slowing-release microballoons medicine release speed, tissue distributing and the concentration in abdominal cavity fluid were measured by high performance liquid chromatography. Results 5-FU wrapped by gelatin were slowly released. The concentration in abdominal cavity fluid was obviously higher than that in tissue or in blood. Using established standard curve line, it was proved that in body area under curve (AUC) of 5-FU slowing-release microballoons group was obviously higher than that of simple 5-FU injection group, analyzed by 3p97 pharmacokinetic software management. Conclusion 5-FU enwrapped by gelatin can retain an effective anticancer activity concentration in abdominal cavity 7 days after giving intraperitoneal and it is distributed mostly in abdominal cavity.
As the most common primary malignant bone tumor in children and adolescents, osteosarcoma has the characteristics of high malignancy, easy metastasis and poor prognosis. The recurrence, metastasis and multi-drug resistance of osteosarcoma are the main problems that limit the therapeutic effect and survival rate of osteosarcoma. Among them, lung metastasis is often the main target organ for distant metastasis of osteosarcoma. In recent years, people have paid attention to the signaling pathway of the occurrence and development of osteosarcoma and made in-depth studies on its mechanism. A variety of relevant signaling pathways have been constantly clarified. At present, there is still a lack of systematic and multi-directional exploration and summary on the signaling pathway related to the pulmonary metastasis of osteosarcoma. This paper explores the new direction of targeted therapy for osteosarcoma by elucidating the relationship between the signaling pathway associated with osteosarcoma and the pulmonary metastasis of osteosarcoma.
Objective To investigate the status of the knowledge, attitudes and intervention behaviors in medical professionals in the prevention and treatment of deep vein thrombosis (DVT), and explore the weak links in knowledge-attitude-practice of DVT. Methods From December 2017 to February 2018, a convenient sampling method was used to extract 158 medical professionals out of 204 medical professionals from Department of Orthopedics, West China Hospital of Sichuan University. The questionnaire included the general information and basic situation of DVT learning, the knowledge of DVT, intervention attitude and implementation of preventive measures. The survey involved orthopedic doctors, nurses, rehabilitation therapists and nutrition managers. Results A total of 158 questionnaires were distributed and 150 valid questionnaires were completed. The effective questionnaire recovery rate was 94.9%. The mean score of basic knowledge of DVT was 6.45±1.83, the mean score of risk factors was 13.29±3.38, the mean score of intervention attitudes was 9.57±0.78, and the mean score of prevention implementation was 23.33±5.85. Conclusions The knowledge-practice of DVT intervention in orthopedic medical staff is moderate, and the attitude of DVT intervention is better among medical staff. There are various characteristics and weaknesses in knowledge-practice. It is necessary to regularly carry out knowledge about DVT among medical staff to improve the professional level of medical staff to prevent and treat DVT.
Objective To clarify the thin-layer 16-slice spiral CT features of coal worker’s pneumoconiosis and the superior distribution of comorbidities in their staging and lobes and lung field anatomy. Methods Sixty-six patients with coal worker's pneumoconiosis diagnosed by the pneumoconiosis diagnosis and identification group from October 2014 to March 2015 were enrolled. All patients underwent 16-slice spiral CT and thin-layer CT reconstruction with a thickness of 1.5 mm. The thin-slice CT signs and comorbidities of coal workers’ pneumoconiosis were observed, and the superior distribution of CT signs in patients at different stage and different lobes and lung field anatomy were evaluated. Results There were 16 cases of irregular small nodules in the lungs, 22 cases of large shadow fusion, 18 cases of intraocular shadow calcification, 41 cases of emphysema, 21 cases of pulmonary bullae, 21 cases of pulmonary hypertension, and 31 cases of enlarged lymph nodes in the mediastinum and calcified. The above signs were mostly distributed in stage Ⅲ pneumoconiosis (P<0.05). There were 32 cases of regular small nodules, which were mostly distributed in stage Ⅰ pneumoconiosis. In the 16 cases of irregular small nodules, the advantage was distributed in the middle and outer lobes of the double lungs. In the 22 cases of large shadow fusion, the advantage was distributed in the upper and lower lobe of the lungs. In the 16 cases of tuberculosis, the advantage was distributed in the upper lobe of the lungs. In the 21 cases of bullous bullae, the advantage was distributed in the upper lobe of the two lungs, mostly in the right upper lung. Conclusion The thin 16-slice spiral CT signs of coal worker’s pneumoconiosis can reflect the pathological changes, and have a certain correlation with the stage of pneumoconiosis, and have obvious characteristics in the anatomical distribution of lung and lung fields.
The purpose of this study is to reveal the protective effect of rib cage on scoliotic spine by comparing the different effect of rib cage on the stability of normal spine and Lenke1 scoliotic spine. Firstly, according to X-ray computed tomography (CT) image data, four spinal finite element models (SFEMs), including normal spine without rib cage (N1), normal spine with normal rib cage (N2), scoliotic spine without rib cage (S1) and scoliotic spine with deformed rib cage (S2), from the first thoracic vertebrae to the sacral vertebrae (T1～S) were established. Secondly, the natural vibration characteristics of the four SFEMs were obtained by modal analysis. Finally, the maximum vibration amplitudes of the four SFEMs under external excitation were obtained by steady-state analysis. As shown in results, compared with N1, the maximum deformation of N2 segment T4～T6 in the X-axis (coronal axis), Y-axis (sagittal axis) and Z-axis (vertical axis) directions decreases by 38.44%, 53.80% and 33.72%, respectively. Compared with S1, the maximum deformation of S2 segment T4～T6 in the X-axis direction, Y-axis direction and Z-axis directions decreases by 44.26%, increases by 32.80% and decreases by 49.23%, respectively. As it can be seen, for normal spine, the rib cage can improve the stability of the whole spine in three directions; for the Lenke1 scoliotic spine, the rib cage can reduce the vibration of the scoliotic spine in the X-axis and Z-axis directions and improves the stability of the whole spine in the two directions, while in the Y-axis direction, for the serious severe anteversion of scoliotic spine, the deformed rib cage exacerbates the vibration of the scoliotic spine in this direction and destroys the stability of the scoliotic spine in the Y-axis direction. This study reveals the biomechanical characteristics of rib caged influence on the stability of the scoliotic spine and it has guiding significance for the study of daily protection methods and protective tools for scoliotic patients.
ObjectiveTo analyze the postoperative drainage volume and its influencing factors in lumbar posterior surgery.MethodsA total of 158 patients undergoing lumbar posterior surgery in West China Hospital, Sichuan University between October 2018 and June 2019 were retrospectively enrolled in this study. The data about general information and perioperative drainage were collected retrospectively according to recording tables and analyzed by SPSS (version 22) software. The drainage volume was presented with median (lower quartile, upper quartile).ResultsThe final average drainage volume was 360 (200, 650) mL, and the length of time for drainage tube placement was from 9 to187 hours with the median (lower quartile, upper quartile) of 61 (40, 86) hours. The result of multiple linear regression showed that immediate drainage volume when returning to the ward [non-standardized partial regression coefficient (b)=0.268, 95% confidence interval (CI) (0.191, 0.345), P<0.001], length of time for drainage tube placement [b=0.554, 95%CI (0.338, 0.769), P<0.001], intra-operative bleeding volume [b=0.161, 95%CI (0.044, 0.277), P=0.007], and surgical methods [Method 3 as the reference, Method 1: b=0.599, 95%CI (0.369, 0.828), P<0.001; Method 2: b=0.574, 95%CI (0.336, 0.812), P<0.001] were the main factors affecting the final drainage volume.ConclusionsThe final drainage volume of lumbar posterior surgery is so large that it should be paid attention to. It is also necessary to take effective interventions according to different surgical methods, intraoperative bleeding, immediate drainage when returning to the ward, length of time for drainage tube placement, and other different circumstances to reduce the drainage to achieve enhanced recovery after surgery.
Objective To explore the correlation between postoperative kinesiophobia and rehabilitation outcome in patients with lumbar disc herniation (LDH). Methods This study was a cross-sectional survey. The patients who underwent lumbar discectomy due to LDH in West China Hospital of Sichuan University between June and October 2019 were included consecutively. According to the Tampa Scale for Kinesiophobia (TSK) score, patients were divided into two groups: the kinesiophobia group and the non-kinesiophobia group. The patients’ scores of the TSK, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association Scores (JOA) at different time points were collected. The relationship between postoperative kinesiophobia, pain, and lumbar function in patients was analyzed. Results A total of 201 patients were included. Among them, there were 128 cases in the kinesiophobia group and 73 cases in the non-kinesiophobia group. The incidence of kinesiophobia was 63.68%. Pearson correlation test analysis showed that TSK score was positively correlated with VAS score (r=0.218, P<0.01) and ODI score (r=0.263, P<0.01) at 24 h after surgery. At one month after surgery, there was a positive correlation with VAS score (r=0.296, P<0.01) and a negative correlation with JOA score (r=−0.182, P<0.05). The results of multiple linear regression showed that postoperative age, pain, lumbar function, and postoperative kinesiophobia were interrelated (P<0.05). Conclusions Patients with LDH had a higher incidence of kinesiophobia 24 h after surgery. Postoperative kinesiophobia was correlated with the recovery outcome of patients with LDH.
In post-coronavirus disease 2019 era, people’s style of work and life have undergone major changes. The sedentary style of work and life, such as long-time office work, online meetings, home eating, online social interactions, and reduced range of activities, affect people’s physical and mental health. Neck and shoulder pain is one of the common symptoms. By combining the clinical practice experience of orthopedic medical experts in West China Hospital of Sichuan University, and reviewing a large number of literatures, this article summarized the definition, incidence, hazards, causes, evaluation and prevention of neck and shoulder pain in post-coronavirus disease 2019 era. It aimed to provide experience for the prevention and treatment of neck and shoulder pain in post-coronavirus disease 2019 era.
In recent years, reports of domestic robot-assisted total knee arthroplasty have gradually increased. In response to problems that may arise during the perioperative period, West China Hospital of Sichuan University has adopted measures such as the establishment of multidisciplinary team, adequate preoperative evaluation, precise intraoperative operations, and whole process optimization management (incision management, pain management, functional exercise and follow-up management). Combined with the actual clinical situation, a domestic robot-assisted total knee arthroplasty management program during the perioperative period was explored and formulated to promote the recovery of patients. This article introduces the above-mentioned program, and aims to provide a reference for the management optimization of domestic robot-assisted total knee arthroplasty during the perioperative period.