In order to guide diagnosis and treatment in children with sleep disordered breathing aged 1 to 23 months, the European Respiratory Society(ERS) summarized the evidence and released the European Respiratory Society statement based on clinical experience in 2016. This article aims to interpret the ERS statement. Children with apparent upper airway obstruction during wakefulness and those with SDB symptoms and complex conditions requires treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions. Obstructive SDB in children aged 1 to 23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities.
Objective To study the effects of glucose and lipid metabolism on gallstone formation. Methods Twenty five patients with gallstones and 25 normal volunteer controls were studied from January to April in 1998. The patients were well matched the control with sex and age (1∶1). In the study, Body Mass Index (BMI) and Waist-to-Hip circumference ratio (W/H) were measured. Blood glucose, glucosylated hemoglobin (HbA1C), insulin, C peptide and all parameters of lipids were detected at fasting state. The glucose,insulin, C peptide were detected again at 2-hour after taking 75g glucose orally.Results The result showed there was no difference on BMI and W/H between the patients and controls. HbA1C、mean fasting and 2hour glucose concentration were not in significantly different between the two groups (Pgt;0.05, Pgt;0.2, Pgt;0.1 respectively). There were 10 patients with abnormal glucose metabolism (7 with NIDDM, 3 with IGT), but only 4 controls were abnoumal (one with NIDDM, three with IGT). The difference was significant (Plt;0.05). Furthermore, the mean fasting and 2hour insulin concentration of gallstone group was higher than that of the control (Plt;0.02, Plt;0.05). And the gallstone group had a higher fasting C peptide concentration than control (Plt;0.05). There was no statistical difference on the parameters of plasma lipid between the tow groups. Conclusion The study suggests that diabetes mellious and hyperinsulinemia acted as an important role on gallstone formation.
Objective Choose polylactide-co-glycolide/hydroxyapatite (PLGA/HA) and porous phosphate calcium (PPC) as the object that we will study, compare their degradabality and choose one as a suitable scaffold for rib reconstruction. Methods All the experiments were divided into PLGA/HA group and CPC group. Degradabality experiment in exvivo: put the two scaffold which have the same size into 0.9% NaCl, keep sterile, then put the container into warm cage，get out and weigh them in 2, 4, 8, 12 and 24 weeks, compare the different speed of the two scaffold. Degradability experiment in vivo: put the two scaffold which have the same size under the skin of the rabbit, and weigh them in 2, 4, 8, 12 and 24 weeks, the tissue around the scaffold was examinzed by HE and the scaffold was examined by electron scanning microscope. Results Micro-CT and Scanning electron microscopy shows that CPC group had better structure （1101.2228±0.6184 mg/ccm vs. 1072.5523±0.7442 mg/ccm）and porosity（70.26％±0.45％ vs.72.82％±0.51％）than PLGA/HA group; The result of degradabality experiment in vitro shows that the speed of the two scaffolds was slow. It is at 24 weeks that the degradability is obvious,and the PLGA/HA group degraded a lot which was 60%. The result of degradabality experiment in vivo shows that the speed of degradabality of PLGA/HA group was faster than that is in the 0.9% Nacl, also was faster than that of CPC group which was 96%.The reponse of tissue around the PLGA/HA was more sever than that of CPC group which is in favour of the growth of cells. Conclusion As for the reconstruction of large defect of rib, CPC is more suitable than PLGA/HA.
Objective To summarize the therapeutic efficacy of laparoscope， duodenoscope， and choledochoscopein treatment for elderly patients with common bile duct stones associated with acute severe cholangitis. Methods Eighty-six patients with common bile duct stones associated with severe acute cholangitis from May 2008 to December 2012 in this hospital were chosen. The operation methods and their therapeutic efficacy were analyzed. Results ① Thirty-one patients were performed by laparoscopic cholecystectomy （LC） plus common bile duct discission combined with choledo-choscope for removing the stones， which were completely successful. One case of bile duct perforation happened. The total effective rate was 96.77%（30/31）. The hospital stay was （9.05±2.11） d， the hospital costs was （1.47±0.34） ten thousand yuan. ② Forty-three patients were performed by LC combined with duodenoscopic papillotomy， 42 patients were successful，one patients was turned to the other operation， the retained calculus was found in two patients. The total effective rate was 97.67%（42/43）. The hospital stay was （8.64±1.20） d， the hospital costs was （2.36±0.62） ten thousand yuan. ③ Twelve patients were performed by endoscopic nasobiliary drainage and LC plus common bile duct discission combined with choledochoscope for removing the stones， which were completely successful. The total effective rate was 91.67%（11/12）. The hospital stay was （11.06±2.33） d， the hospital costs was （2.79±0.41） ten thousand yuan. No severe complications such as intestinal perforation， hemorrhea， and severe acute pancreatitis and no death happened. Conclusions Three-endoscopy in treatment for elderly patients with common bile duct stones associated with severe acute cholangitis has a good therapeutic efficacy， a suitable operation is chosen according to the different conditions of the patients， the success rate is high， the complication rate and the mortality rate are low.
Objective To access the possibil ity of CPC as a suitable scaffold for tissue engineering artificial rib by morphologic observation, adhesion experiments and cellar prol iferation experiments. Methods The 5 mm × 5 mm × 5 mm CPCs were prepared and the structure and components of CPC were compared with those of the normal human bone by micro-CT and scanning electron microscope. Bone marrow aspirates were harvested from the young pig and monuclear cells were separated. The first passage cells were collected and re-suspended in the culture media at a density of 6 × 105 cells/mL. There was 150 μL suspension which was incoluated on the CPC, and then cells were recollected and counted 4, 12 and 24 hours after inoculation. MTT was used to examine the growth condition of BMSCs on the surface of CPC. The scanning electron microscope was used to observe the CPC scaffold 7 days after inoculation, and comparison was made with CPC and the normal human bone. Results The adhesion rate of CPC was 28.00% ± 0.98%, 46.70% ± 1.14% and 48.50% ± 1.18%, respectively 4, 12 and 24 hours after compound culture. The prol iferation rate of CPC was 1.103 ± 0.214, 1.557 ± 0.322, 1.920 ± 0.178, 2.564 ± 0.226, 2.951 ± 0.415 and 3.831 ± 0.328, respectively 1, 2, 3, 4, 5 and 6 days after compound culture, with an obvious rising trend. The micro-CT demonstrated that the content of hydroxyapatite of porous phosphate calcium was (1 101.222 8 ± 0.618 4) mg/ ccm while that of the normal human bone was (1 072.552 3 ± 0.744 2) mg/ccm, and the porosity of porous phosphate calcium was 70.26% ± 0.45% while that of the normal human bone was 72.82% ± 0.51%, and there was no significant difference (P gt; 0.05). The experiment of cell prol iferation showed that the cell which was cultivated with porous phosphate calcium prol iferated rapidly. Through the inverted phase contrast microscope, it was found that the cells grew well and there was no dead cell, which indicated that the material had no toxicity. The rate of the cell adhesion to CPC was less than 50%. Conclusion The structure and components of CPC are similar to those of the normal human bone, and BMSCs grow well on the surface of it, so it is asuitable scaffold for tissue engineering artificial rib. However, the cell adhesion abil ity is to be further improved.
ObjectiveTo investigate the safety and efficacy of naked eye 3D thoracoscopic surgery in minimally invasive esophagectomy.MethodsClinical data of 65 patients, including 50 males and 15 females aged 47-72 years, with esophageal cancer who underwent minimally invasive thoracoscopic esophagectomy from October 2018 to April 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a naked eye 3D thoracoscopic group (group A: 30 patients) and a traditional 2D thoracoscopic group (group B: 35 patients). The effects of the two groups were compared.ResultsThe operation time in the group A was significantly shorter than that in the group B (P<0.05). The number of dissected lymph nodes in the group A was more than that in the group B (P<0.05). The thoracic drainage volumes on the 1th-3th days after operation in the group A were significantly larger than those in the group B (P<0.05), but there was no significant difference between the two groups on the 4th-5th days after operation (P>0.05). The indwelling time in the group A was longer than that in the group B (P<0.05). Postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic leakage, and recurrent laryngeal nerve injury were not significantly different between the two groups (P>0.05).ConclusionNaked eye 3D thoracoscopic surgery for minimally invasive esophagectomy is a safe and effective surgical procedure. Compared with traditional 2D minimally invasive thoracoscopic surgery, it is safer in operation and more thorough in clearing lymph nodes. The operation is more efficient and can be promoted.
ObjectiveTo investigate the safety and efficacy of 3D thoracoscopic surgery in uniportal lobectomy.MethodsClinical data of 248 patients with lung cancer who underwent uniportal thoracoscopic lobectomy in our hospital from September 2018 to May 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods, a 3D thoracoscopic group (76 patients, including 52 males and 24 females with an average age of 58.59±7.62 years) and a 2D thoracoscopic group (172 patients, including 102 males and 70 females with an average age of 57.75±8.59 years). Statistical analysis of clinical and pathological data, lymph node dissection, surgical complications, postoperative hospital stay, etc was performed.ResultsCompared with the 2D thoracoscopic group, the 3D thoracoscopic group had shorter operation time, more lymph nodes dissected and pleural effusion on the first day after operation (P<0.05). There was no significant difference in the postoperative chest tube duration, postoperative hospital stay, incidence of pulmonary infection, arrhythmia, bronchopleural fistula, or recurrent laryngeal nerve injury between the two groups.ConclusionCompared with the traditional 2D thoracoscopic minimally invasive surgery, uniportal lobectomy with 3D thoracoscopic surgery is safer and more efficient during operation, and lymph node dissection is more thorough, which is worth promoting.
ObjectiveTo introduce the application of mixed reality technique to the preoperative and intraoperative pulmonary nodules surgery.MethodsOne 49-year female patient with multiple nodules in both lobes of the lung who finally underwent uniportal thoracoscopic resection of superior segment of left lower lobe and wedge resection of left upper lobe was taken as an example. The Mimics medical image post-processing software was used to reconstruct the patient's lung image based on the DICOM data of the patient's chest CT image before the surgery. The three-dimensional reconstructed image data was imported into the HoloLens glasses, and the preoperative discussions were conducted with the assistance of mixed reality technology to formulate the surgical methods, and the preoperative conversation with the patients was also conducted. At the same time, mixed reality technology was used to guide the surgery in real time.ResultsMixed reality technology can clearly pre-show the important anatomical structures of blood vessels, trachea, lesions and their positional relationship. With the help of mixed reality technology, the operation went smoothly. The total operation time was 49 min, the precise dorsal resection time was 27 min, and the intraoperative blood loss was about 39 mL. The patient recovered well and was discharged from hospital smoothly after surgery.ConclusionMixed reality technology has certain application value before and during the surgery for pulmonary nodules. The continuous maturity of this technology and its further application in clinics will not only bring a new direction to the development of thoracic surgery, but also provide a wide prospect.
ObjectiveTo investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.MethodsClinical data of 28 patients, including 25 males and 3 females, aged 51-76 years, with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group (3D group, 10 patients) and a 2D mediastinoscopic group (2D group, 18 patients). The perioperative outcome of the two groups were compared.ResultsCompared with the 2D group, the 3D group had shorter operation time (P=0.017), more lymph nodes resected (P=0.005) and less estimated blood loss (P=0.015). There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting (P>0.05). The other aspects including the indwelling time, postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic fistula, recurrent laryngeal nerve injury were not statistically significant between the two groups (P>0.05).ConclusionThe 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer, which optimizes the surgical procedures of 2D, is safe and feasible, and is worthy of clinical promotion in the future.
ObjectiveTo systematically review the risk factors leading to postoperative persistence of children diagnosed with obstructive sleep apnea (OSA) after adenoidectomy and tonsillectomy. MethodsPubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, VIP, WanFang Data and SinoMed databases were electronically searched to collect case-control studies and cohort studies related to risk factors for postoperative persistence of OSA in children from inception to July 2019. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 12 cohort studies involving 1 659 OSA patients were included. Meta-analysis results showed that the risk of postoperative persistence of OSA in children with preoperative obesity was 3.47 times higher than that in non-obese children (RR=3.47, 95%CI 2.04 to 5.92, P<0.000 01). Compared with normal-weight children, obese children had 4.11 times higher risk of postoperative residual OSA (RR=4.11, 95%CI 1.68 to 10.07, P<0.000 01).ConclusionsPreoperative obesity is a risk factor for postoperative persistence of OSA in children. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verity the above conclusions.