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Objective:To investigate the rationality and surgical errors in countermeasures against difficult removal of screws so as to provide reference for standardization of technical procedures.Methods:A retrospective study was conducted to analyze the data of 99 patients who had encountered difficult removal of screws in operative removal of internal fixation at Department of Orthopaedics, Wuxi NO.9 People's Hospital Affiliated to Suzhou University from January 2018 to May 2022. There were 62 males and 37 females with an average age of 38.8±14.7 years. Their internal fixation time ranged from 7 months to 11 years. The irrationality was defined as insufficient preoperative preparation or a countermeasure that failed to follow the surgical indications or scientific principles of minimal injury or priority of simplicity. A surgical error was defined as unnecessary injury, failed removal or complications related to operation. Cases of irrationality and surgical errors were analyzed to find associations between them.Results:The operative removal was successful in 92 cases and failed in 7 cases. Of the patients who experienced difficult removal of screws, irrationality was found in 26.3% (26/99) and a surgical error or errors occurred in 28.3% (28/99). In the patients with countermeasure irrationality, the incidence of surgical errors was 53.9% (14/26) while in those without countermeasure irrationality, the incidence of surgical errors was 19.2% (14/73), showing a statistically significant difference ( χ2=11.360, P<0.001). In the patients with surgical errors, the incidence of countermeasure irrationality was 64.3% (18/28) while in the patients without surgical errors, the incidence of countermeasure irrationality was and 11.3% (8/71), showing a statistically significant difference ( χ2=29.148, P<0.001). In the patients with failed removal, the rate of countermeasure irrationality was 85.71% (6/7) while in those with successful removal, the rate of countermeasure irrationality was 21.7% (20/92), showing a statistically significant difference ( χ2=13.748, P<0.001). Conclusions:Close relationships exist between countermeasure irrationality, surgical errors and failed removal. The higher proportion of countermeasure irrationality, the higher possibility of surgical errors. Therefore, following the rationality principle may avoid or reduce surgical errors in difficult removal of screws.
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OBJECTIVE:To provide reference for improving related policy and list about medical insurance medicines in China. METHODS:The descriptive analysis method was used to compare 2017 and 2009 edition of Medicine List for National Basic Medical Insurance,Employment Injury Insurance and Maternity Insurance in respects of item,medicine classification (including classification code,grading and name),medicine types(including new type,removed type),dosage(including new dosage classification,adjusted dosage form),the limit of payment and use.The trend of its development and the existing problems were discussed. RESULTS:Compared with 2009 edition,2017 edition of medicine list added the item of"drug classification code"and removed the item of"English name". The grading of drug classification code was reduced from six grades to four grades. The code and name of four grades classification were in accordance with the first four grades classification rules of the anatomical-therapeutic-chemistry(ATC). A total of 2 535 types were included in 2017 edition,increasing by 362 types compared to 2009 edition(151 chemical medicines,211 Chinese patent medicines). 15 types of chemical medicines were removed,and 4 types were transferred to Chinese patent medicine list;11 types of Chinese patent medicines were removed,and one type was transferred to chemical medicine list. 2017 edition was actually 20 more dosage forms than 2009 edition,involving 31 types;dosage forms of 231 types were adjusted(143 chemical medicines,88 Chinese patent medicines). Chemical medicines of usage and payment restriction increased from 239 to 302,and Chinese patent medicines increased from 72 to 115,respectively. CONCLUSIONS:2017 edition of list increases the number of medicine,expands the scope of clinical medication and improves the classification structure of the list.The number of medical insurance cost control type shows a growing trend.
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Objective To explore the change rules of peak area ratio of STR loci to Amelogenin (AMEL) locus (STR/A M EL ), a sex-determ ining gene in DNA degradation, and to evaluate the application of STR/A MEL value in the estim ation of DNA degradation degree. Methods DNA w as extracted from iliopsoas, and the variations of STR/A MEL value (Penta E/AMEL, Penta D/AMEL, FGA/AMEL) w ere analyzed after the artificial degradation w as m ade by DNaseⅠ, and the changes of these three ratios of the iliopsoas naturally degraded in an outdoor environm ent w ere also analyzed. The regression curves w ere analyzed using the periods of DNA degradation and outside the body as the independent variable (x) and the STR/A MEL value as the dependent variable (y) and three curve equations under tw o conditions w ere established. Results B oth under the conditions of artificial and natural degradation, STR/A MEL value had a negative relationship w ith the degradation tim e. The relationship betw een STR/A MEL and degradation tim e can be w ell sim ulated by the cubic function. R2 w as over 0.99 under controlled degradation condition and over 0.86 under natural degradation condition. Conclusion The STR/A MEL value (Penta E/AMEL, Penta D/AMEL , FGA/AMEL ) is negatively related w ith the DNA degradation degree, w hich follow s m athem atical regression m odels strictly, and it m ight be applied to evaluate the DNA degradation degree.
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Objective To analyze the cases of anaphylactic death cases and explore the standards of judi-cial expertise of anaphylactic death for providing evidence for judicial expertise. Methods Fifty-nine cas-es death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postm ortem exam ination findings were review ed for all cases. Results In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were an-tibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic sym ptom s were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 m in to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/m L . The results of clinical manifestation and pathological anatomy had obviously changes. Conclusion B ased on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cas-es including clinical history, exposure to allergens, and clinical manifestation play an im portant role in diagnosis of anaphylactic death.
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OBJECTIVE: The objective of this study was to retrospectively study the outcomes of large vestibular schwannoma resection through the suboccipital retrosigmoid keyhole approach and emphasize technical details and advantages of surgical resection of large vestibular schwannomas via this approach. METHODS: From January 2010 to September 2012, 37 consecutive patients (16 men and 21 women) with vestibular schwannoma, 4 cm or greater, received surgical resection through the suboccipital retrosigmoid keyhole approach in our department. Clinical records, radiographic findings, operative summaries, and follow-up data were analyzed retrospectively. RESULTS: The mean age of these patients was 45.1 ± 11.6 years. Thirty-six patients underwent primary keyhole surgical removal, and 1 underwent surgery for residual tumor after gamma knife. Gross total tumor removal was accomplished in 35 patients (94.6%), near total resection in 1 (2.7%), and subtotal resection in 1 patient (2.7%). The facial nerve was anatomically intact in all 37 patients (100%). Facial nerve function was assessed in 6 to 12 months after operation. Good function (House-Brackmann facial nerve grade I-II) was present in 81.1% of the patients, whereas acceptable function (grade III) was present in 11.1%. Cerebrospinal fluid (CSF) leakage that required surgical intervention occurred in only 5.4% of the patients, and meningitis occurred in 8.1%. In addition, 3 patients (8.1%) had hydrocephalus requiring a temporary ventricular diversion. There were no deaths. CONCLUSIONS: The suboccipital retrosigmoid keyhole approach is a valid choice for removing large vestibular schwannomas. Through this approach, cerebellopontine angle can be effectively exposed. Skills to protect facial nerve and extensive experience in microsurgical techniques can significantly improve the total resection rate and postoperative facial nerve function. The authors recommend this approach for patients with vestibular schwannomas larger than 3 to 4 cm.
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Craneotomía/métodos , Nervio Facial/cirugía , Neuroma Acústico/cirugía , Hueso Occipital/cirugía , Adulto , Anciano , Ángulo Pontocerebeloso/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
Objective To explore the relationship between the expression of EIIIA + fibronectin in incised wound of rat’s skin and injury time. Methods The wounding model was established by cutting the dor-salskin of 48 adult SD rats. The rats were sacrificed atthe pre-setinjury time as immediately, 0. 5h, 1h, 2 h, 3 h, 4 h, 6 h, and 8 h. The skin sam ples were taken at the m argin of wound. The expression of the EIIIA + fibronectin was detected by im m unohistochem istry and W estern blotting and the relationship be-tween its expression and injury time was observed. Results The expression of EIIIA + fibronectin was not observed im m ediately. The basal cell of skin began to showpositive expression 0. 5 h after injury. W ith the extension of injury time, positive staining became stronger. The value of relative optical density was gradually increased with prolonged injury time by the W estern blotting analysis. Conclusion The expres-sion of EIIIA + fibronectin could be used for estimation of injury time in the early stage of skin injury.
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Objective: To study the effects of triptolide-medicated serum on secretory function of adrenocortical cells isolated from rats. Methods: Thirty SD rats were randomly divided into control group, prednisone group, and low-, medium- and high-dose triptolide groups. Rats were administered with normal saline, prednisone and low-, medium- and high-dose triptolide respectively by gastrogavage to prepare sera containing drugs. Primary adrenocortical cells were isolated from normal male rats and cultured with sera containing drug for 48 hours. Expression of proliferating cell nuclear antigen (PCNA) was observed by immunohistochemical method and number of PCNA-positive cells was counted. Ultrastructure of adrenocortical cells was observed under a transmission electron microscope. Content of corticosterone in supernatant of adrenocortical cell culture was detected by enzyme-linked immunosorbent assay, and real-time fluorescence quantitative polymerase chain reaction (PCR) was employed to investigate the expression of 3beta-hydroxysteroid dehydrogenase (3beta-HSD) mRNA. Results: As compared with the control group, content of corticosterone in supernatant of adrenocortical cell culture and expression of 3beta-HSD mRNA were significantly increased in the triptolide-treated groups, and the numbers of PCNA-positive cells were increased in the medium- and high-dose triptolide groups, however, they were decreased in the prednisone group. Conclusion: Triptolide-medicated serum can increase the secretion of corticosterone in rat adrenocortical cells in vitro.