ObjectiveTo analyze the death causes of postoperative early-stage after orthotopic liver transplantation (OLT) in rats, and to provide appropriate treatment strategies. MethodsThree hundreds of rat OLT models were performed by modified Kamada two-cuff technique. Operation time of each stage during OLT and postoperative survival time of rats were recorded and analyzed. According to survival time, the rats were divide into 4 groups:intraoperative death group (rats died during operation), < 6 hours group, 6-24 hours group, and > 24 hours group. Then comparison of operation time of each stage during OLT in rats of 4 groups was performed, and reasons of death during 24 hours after OLT were analyzed. ResultsOf the 300 OLT models, 37 rats died during operation (12.33%), 51 rats died within 6 hours after operation (17.00%), 76 rats died during 6-24 hours after operation (25.33%), and 136 rats survived longer than 24 hours (45.34%). The most common death causes of < 6 hours group were as follows:lose too much blood during the operation (27.45%, 14/51), postoperative bleeding (27.45%, 14/51), and vascular embolization (15.69%, 8/51). However, the most common death causes of 6-24 hours group were as follows:angiostenosis (27.63%, 21/76), postoperative bleeding (21.05%, 16/76), and pulmonary edema (19.74%, 15/76). There were significant differences in the cold ischemia time and anhepatic phase among the 4 groups (P < 0.05). The cold ischemia time and anhepatic phase of intraoperative death group were longer than those of other 3 groups (P < 0.05), in addition, the cold ischemia time of > 24 hours group was shorter than those of other 3 groups (P < 0.05). ConclusionsThere are many reasons leading to the early death after OLT. The long time of anhepatic phase and the cold ischemia time, intraoperative and postoperative bleeding, thrombosis, angiostenosis, and pulmonary edema are key factors for the improvement of prognosis in rats after OLT operation. Improvements of the reasons above are helpful to improve the successful rate of modeling and quality of OLT rats.
Thoracic trauma has the characteristics of complexity, specificity, urgency and severity. Therefore, the treatment is particularly important. Thoracic Traumatology Group, Trauma Medicine Branch of Zhejiang Medical Association organized the writing of the thoracic trauma and further optimization consensus of Zhejiang thoracic surgery industry Treatment and diagnosis of rib and sternum trauma: A consensus statement by Zhejiang Association for Thoracic Surgery (version 2021), compiled the popular science book Emergency Treatment and Risk Avoidance Strategy of Thoracic Trauma and Illustration of Real Scene Treatment of Trauma, actively prepared to build the trauma database of Zhejiang Province, and participated in the construction of trauma group in the Yangtze River Delta. Although Zhejiang Province has carried out many related works in the diagnosis and treatment of chest trauma, it is still inconsistent with the development requirements of the times. Standardization of chest trauma treatment, popularization of relevant knowledge, management of trauma big data, grass-roots radiation promotion tour and further optimization of industry consensus are the requirements and objectives of this era.
Compared with traditional medical devices, artificial intelligence medical devices face greater challenges in the process of clinical trials due to their related characteristics of artificial intelligence technology. This paper focused on the challenges and risks in each stage of clinical trials on artificial intelligence medical devices for assisted diagnosis, and put forward corresponding coping strategies, with the aim to provide references for the performance of high-quality clinical trials on artificial intelligence medical devices and shorten the research period in China.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
Objective To explore the clinical value, latest research progress, and clinical controversy of total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC). Method We searched and reviewed on the latest literatures about studies of the clinical research of TNT in LARC. Results TNT could make the tumor downstage rapidly and improve the patients’ treatment compliance. In terms of organ preservation rate, 3-year disease-free survival and pathological complete remission rate, TNT had advantages and was a especial potential treatment strategy compared with traditional methods. Conclusions TNT decreases local recurrence rate and improves the long-term survival. For LARC patients with strong desire for organ preservation, TNT is a good treatment choice and has the value of clinical promotion.
Surgery is the only effective treatment for congenital choledochal cysts, as it allows for the resection of the cysts, the complete relief of cholangitis, and the prevention of canceration of cysts. The key elements of surgery for central choledochal cysts involve the cysts resection, bile-intestinal anastomosis, and biliopancreatic diversion. The difficulty in operating on central choledochal cysts lies in the rational decision making and effective management of cysts in the hilar and pancreatic regions. Depending on the type of central choledochal cysts with different anatomical patterns, a reasonable and feasible individualized surgical management strategy can be established to effectively avoid adverse therapeutic consequences such as postoperative biliary leakage, cholangio-intestinal anastomotic stricture, residual choledochal cysts and its carcinogenesis.
Objective To investigate different gases and hematocrits on cerebral injury during deep hypothermic circulatory arrest (DHCA) in a piglet model including monitoring by near-infrared spectroscopy (NIRS). Methods Twenty-four piglets were assigned to 4 groups with respect to different blood gas and hematocrit during DHCA. Group A: hematocrit was maintained between 0.25 to 0.30, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group B: hematocrit was maintained between 0.25 to 0.30 and alpha stat strategy; group C: hematocrit was maintained between 0.20 to 0.25, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group D: hematocrit was maintained between 0.20 to 0.25 and alpha stat strategy. Cerebral oxygenations of piglets were monitored continuously by NIRS. The brain was fixed in situ at 6 hours after operation and a histological score for neurological injury was assessed. Results Oxygenated hemoglobin (HbO2) and total hemoglobin (HbT) signals detected by NIRS were significantly lower in group D than those in group A and group B during cooling (Plt;0.05). Oxygenated hemoglobin nadir time was significantly shorter in group A(Plt;0.05). All piglets with oxygenated hemoglobin signal nadir time less than 25 minutes were free from histological evidence of brain injury. Conclusion Combination of pH-stat strategy and higher hematocrit reduces neurological injury after DHCA.
Turning gait is very common in daily lives. However, study of turning is still limited. For researching the differences of the walking characteristics between straight gait and turning gait and between different turning strategies, and for analyzing the endopathic factor, this study selected 10 healthy young men to perform straight walking and 90° turning using two turning strategies (outside leg turning and inside leg turning). The Vicon capture system and plantar pressure capture system were used to measure gait parameters and plantar pressure parameters at the same time. The study showed that stride velocity reduced while stride time and proportion of stance time increased when turning was compared to straight walking. Inside leg turning strategy needed stronger muscle controlling and could promote turning, while outside leg turning strategy was more stable. This results will offer data for projecting gait of biped robot and provide reference value for walking rehabilitation training design and development of walking assistive equipments, etc.
Abstract： Objective To compare clinical outcomes and postoperative quality of life （QOL） of difference surgical strategies for patients with esophagogastric junction （EGJ） cancer， and investigate the best surgical strategy. Methods A total of 148 patients with EGJ cancer underwent surgical treatment in Xuzhou First People’s Hospital from July 2007 to October 2011. There were 111 male patients and 37 female patients with an average age of 64 （47-77）years. All the patients were divided into 3 groups according to different surgical strategies for them based on their respective preoperative assessment and tumor invasion degree. In group A， 81 patients underwent proximal subtotal gastrectomy and subaortic gastroesophageal anastomosis. In group B， 20 patients underwent total gastrectomy and esophagojejunostomy. In group C， 47 patients underwent proximal subtotal gastrectomy and jejunal interposition. Postoperative mortality and morbidity were compared among the three groups. Cancer metastasis rate and 1-year survival rate were also compared among the three groups. QOL questionnaire （EORTC QLQ C-30 and tumor specific module QLQ-OES24） was used to evaluate patients’ QOL during follow-up. Results There was no statistical difference in postoperative morbidity （P=0.762）and mortality （P=0.650）among the three groups. There was no statistical difference in cancer metastasis rate at 1 year after surgery among the three groups （P=0.983）. One-year survival rate was 100% in all the three groups. At 1 year after surgery， physical functioning score （P=0.037，0.000） and global health score （P=0.035，0.006） of group A and group C were significantly higher than those of group B， and there was no statistical difference in physical functioning score and global health score between group A and group C （P＞0.05）. Emotional function score of group B was significantly lower than that of group C （P=0.015）. Fatigue score （P=0.040，0.006）， anorexia（P=0.045，0.025）， nausea and vomiting symptom score （P=0.033，0.048） of group A and group C were significantly lower than those of group B. Pain score of group A was significantly lower than that of group C （P=0.009）. Insomnia score of group A was significantly higher than that of group C （P=0.028）. Reflux score of group A was significantly higher than that of group B and group C （P=0.025，P=0.021）. Conclusion Postoperative QOL in patients with EGJ cancer who undergo total gastrectomy is comparatively unsatisfactory. Proximal subtotal gastrectomy and jejunal interposition can significantly improve postoperative QOL. Postoperative QOL evaluation is helpful to choose better surgical strategies for patients with EGJ cancer.