简介：平坦破裂是的王牌的解剖结构复杂、起作用的暴露和固定是极其困难的。因为那些显然代替了王牌平坦破裂，更靠近的引出被注定引起致丑陋的愈合。有内部固定(ORIF)的开的减小不仅导致解剖减小，而且带复杂并发症。不管哪个方法将被采用，创伤的关节炎或大腿骨的头的脉管的坏死可能发生。以便treatacetabular更有效地断裂，矫形外科医生应该被要求充分为复杂并发症预防掌握theacetabular解剖，简历力学，分类和必要知识。

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简介：客观；在脚关节关节上学习远侧的tibiofibularsyndesmosis的分离的影响并且比较各种各样的起作用的方法以便为分开的远侧的tibiofibular韧带联合发现合适的稳定。方法：从1997年7月到2002年7月，我们对待87个病人(64男性和23女性，变老18-54年)与distaltibiofibular韧带联合的分离，在谁之中，79与踝的骨折被相结合。Manipulativereduction，有cancellous螺丝钉的内部固定和有灰浆支持的外部固定在37个病人，有为腓骨的骨折的板和螺丝钉的固定和固定上被执行为34个病人上的远侧的tibiofibular韧带联合的withcancellous螺丝钉，和有peroneus的腱的distaltibiofibular系带的修理渴望我们，分开的distaltibiofibular韧带联合的减小，和有16个病人上的cancellous螺丝钉的固定。当远侧的tibiofibular韧带联合与cancellous螺丝钉被修理时，脚关节关节是为30°的dorsiflexed。并且cancellous螺丝钉在操作以后在8-10星期被拿出。结果：这些病人被跟随在上面为至少二年。药品效果根据病人的抱怨被估计，脚关节的轮廓，功能和无线电报连接；优秀in55病人(63%)，在14个病人(16%)在18个病人(21%)好、公平。distaltibiofibular韧带联合的分离在为长与peroneus的腱修理远侧的tibiofibular系带经历了一个手术的2个病人复发了我们并且恢复。一个cancellous螺丝钉被折断。没有坏死在脚关节榫眼的前面的皮肤发展了。结论:远侧的tibiofibular韧带联合的分离能与各种各样的合理操作被对待。长与peroneus的腱修理我们能为远侧的tibiofibular韧带联合的完全的分离得到优秀结果。

简介：AbstractThe demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

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简介：Objective:Tosummarizetheperi-operativeexperiencefrom53patientswithtraumaticheadinjurieswithGCSscore3-5.Methods:Fifty-threemostseverelyhead-injuredpatientswithGCSscore3-5wereadmittedtoourdepartmentandtreatedoperativelyfromOct.1994toJun.1998andthedatawereanalyzedretrospectively.Results:Thirty-sevencases(69.8%)survived,amongthem28(52.8%)hadagoodrecoveryormoderatedisability,and9(17%)hadseveredeficits.Theother16(30.2%)diedaftertherapy.Conclusions:Theprognosisofmostseverelyhead-injuredpatientscouldbeimprovedbyperi-operativetreatmentincludingpremedicalcare,earlyevacuationofintracranialhematomawithlargedecompressivecraniectomies,intracranialhypertensionmonitoring,moderatehypothermiatherapy,effectivepreventionandtreatmentofcerebralvasospasmandcomplications.

简介：目的：分析非手术疗法治疗腰椎间盘突出症的近期、远期疗效。方法：将165例腰椎间盘突出症患者按随机和单盲法分为牵引组、推拿组，推拿加功能锻炼组，治疗2个疗程后，评定近期疗效。然后将取得显效的102例患者按区组随机和单盲法分为功能锻炼组和对照组，随访1年观察两组复发率，并分别于治疗后6和12个月进行腰椎功能评定。结果：推拿组和推拿加功能锻炼组较牵引组近期疗效显效率差异有显著性(x^2=8．359，P<0．01)。功能锻炼组1年内的复发率明显低于对照组(x^=12．631，P<0．01)。结论：推拿加功能锻炼是防治腰椎间盘突出症的有效方法。

简介：客观：调查成年钝脾的损害的非起作用的管理的指示。方法：回顾的评论在所有成年病人(年龄>15年)上被执行，钝脾的损害从1999～2003在法国承认了到Pellegrinhospital的脉管的外科的部门。我们不管年龄在所有适当病人non-operatively管理了脾的损害。结果：在4年期间，有钝脾的损害的54个连续成年病人在医院里被对待。有稳定的血液动力学的地位的27个病人的一个总数起初non-operatively被对待，哪个2个病人被辜负到non-operativetreatment。非起作用的管理的成功的百分比是92.6%。在54个病人，比55年老的7个of8病人与非起作用的管理被对待。二个案例developingpostoperatively代替膈的感染被合适的治疗愈合。在系列，没有死亡。结论：低档的非起作用的管理脾的损害能与可接受的低失败的率被完成。如果临床并且对外科医生到困难的实验室参数作决定，他们能取决于Resciniti“获得系统与脾的损伤选择成年人的一个子集的sCT(计算断层摄影术)是non-operativemanagement的试用的优秀候选人。比55年老的病人绝对没被禁止收到non-operativemanagement。

简介：AbstractBackground:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients’ tolerance, and reduce postoperative bleeding.Methods:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients’ tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher’s exact test, and Bonferroni’s multiple comparison tests were used in this study.Results:In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00–26.50 s] vs. 24.00 s [14.50–45.50 s], P = 0.005). Both the AD (99% vs. 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs. 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs. 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients’ tolerance scores.Conclusions:Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.Trial registration:Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321.

简介：Hearinglossisaconditionaffectingmillionsofpeopleworldwide.Conductivehearingloss(CHL)ismainlycausedbymiddleeardiseases.ThelowfrequencyareaisthepivotalpartofspeechfrequenciesandmostfrequentlyimpairedinpatientswithCHL.AmongvarioustreatmentsofCHL,middleearsurgeryisefficienttoimprovehearing.However,variablesuccessratesandpossibleneedsforprolongedrevisionsurgerystillfrustratebothsurgeonsandpatients.Nowadays,increasingnumbersofresearchersexplorevariousmethodstomonitortheefficacyofossicularreconstructionintraoperatively,includingelectrocochleography(ECochG),auditorybrainstemresponse(ABR),auditorysteadystateresponse(ASSR),distortionproductotoacousticemissions(DPOAE),subjectivewhispertest,andopticalcoherencetomography(OCT).Here,weillustrateseveralmethodsusedclinicallybyreviewingtheliterature.

简介：AbstractThe philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%—90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.

简介：通过分析加拿大百年理工学院的"Co-operativeEducation"实习教育模式,了解了"CO-OP"项目的具体运作方式。加拿大高职实习教育重视政府职能的参与,强调学校、企业和学生的三方合作,通过"COOP"项目实现三方共赢,其模式值得我们借鉴。

简介：Cochlearimplantationisauniquemethodtore-constructauditionforpatientswithseveretoprofoundhearingloss.Withincreasingclinicalapplicationofthistechnique,itsrehabilitativeeffectsinpatientshasbecomeanimportanttopicofhearingandspeechrehabilitationresearch.Thisarticleisanoverviewofhearingandspeechrehabilitativetraining,rehabilitativeefficacyevaluationandfactorsaffectingrehabilitationefficacyfollowingcochlearimplantation.

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简介：AbstractBackground:Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.Methods:We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.Results:POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011).Conclusions:Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.

简介：AbstractBackground:Although the impact of tumor complexity on peri-operative outcomes has been well established using several nephrometry scoring systems, the impact of adherent perirenal fat remains poorly defined. This study aimed to develop a novel nephrometry scoring system for predicting the peri-operative outcomes of laparoscopic partial nephrectomy (LPN) by integrating and optimizing the RENAL score (RNS) and Mayo adhesive probability (MAP) score.Methods:We retrospectively evaluated 159 patients treated with retroperitoneal LPN. The patients’ demographic parameters, RNSs, and MAP scores were evaluated as potential predictors of perioperative outcomes, including operation time, estimated blood loss (EBL), and margin, ischemia, and complication (MIC) achievement rate. The independent predictors were used to develop a novel nephrometry scoring system. The predictive value and inter-observer agreement for the novel nephrometry scoring system were evaluated.Results:Tumor radius (R score), nearness to the renal sinus or collecting system (N score), and posterior perinephric fat thickness were independent predictors of peri-operative outcomes and were used to develop the RNP score. The univariate analysis revealed that the RNP score was significantly associated with operation time, EBL, and MIC achievement rate (P < 0.050). The RNP score was an independent predictor of operation time (P < 0.001), EBL (P = 0.018), and MIC achievement rate (P = 0.023) in the multivariate analysis. The RNP score was not inferior to RNS in the area under the curve for predicting peri-operative outcomes and performed better in inter-observer agreement (76.7% vs. 57.8%) and kappa value (0.804 vs. 0.726).Conclusion:The RNP score, combining the advantages of the RNS and MAP score, demonstrated a good predictive value for the peri-operative outcomes of retroperitoneal LPN and better inter-observer agreement.

简介：AbstractBackground:Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.Methods:A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.Results:A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).Conclusions:Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.Trial Registration:ChiCTR.org.cn, ChiCTR-ONRC-14005096

简介：AbstractBackground:Obstetric hemorrhage is a major cause of maternal death during cesarean delivery. The objective of this retrospective observational study was to evaluate the efficacy and safety of intra-operative cell salvage (IOCS) in cesarean section.Methods:We included a total of 361 patients diagnosed with central placenta previa who underwent cesarean section from May 2016 to December 2018. In this study, 196 patients received autologous transfusion using IOCS (IOCS group) and 165 patients accepted allogeneic blood transfusion (ABT group). Propensity score matched analysis was performed to balance differences in the baseline variables between the IOCS group and ABT group. Patients in the IOCS group were matched 1:1 to patients in the ABT group.Results:After propensity score matching, 137 pairs of cases between the two groups were successfully matched and no significant differences in baseline characteristics were found between the IOCS group and ABT group. Patients in the IOCS group were associated with significantly shorter length of hospital stay, compared with ABT group (8.9 ± 4.1 days vs. 10.3 ± 5.2 days, t= -2.506, P = 0.013). The postoperative length of hospital stay was 5.3 ± 1.4 days for patients in the IOCS group and 6.6 ± 3.6 days for those in the ABT group (t = -4.056, P < 0.001). The post-operative hemoglobin level in the IOCS group and ABT group was 101.3 ± 15.4 and 96.3 ± 16.6 g/L, respectively, which were significantly different (t= 2.615, P= 0.009). Allogeneic red blood cell transfusion was significantly lower at 0 unit (range: 0–11.5 units) in the IOCS group when compared with 2 units (range: 1–20 units) in the ABT group (P < 0.001).Conclusions:This retrospective observational study using propensity score matched analysis suggested that IOCS was associated with shorter length of postoperative hospital stay and higher post-operative hemoglobin levels during cesarean delivery.

简介：AbstractPurpose:Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE.Methods:A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs; studies reported NOM complications together with those post-intervention; case reports; studies including less than 5 cases; studies not written in English; and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test.Results:A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%.Conclusion:NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.