BACKGROUND:Deep vein thrombosis is a common complication following bone surgeries,so its prevention and treatment become critical.However,there are few studies on the incidence of deep vein thrombosis after spine surgery in the elderly.OBJECTIVE:To explore the diagnosis of deep vein thrombosis after spine surgery in the elderly and its incidence after intervention with low-molecular-weight heparin.METHODS:All patients undergoing spine surgery were randomly divided into experimental and control groups.Patients in the experimental group were subjected to the subcutaneous injection of 0.4 mL of low-molecular-weight heparin (4 100 IU) at 12 hours postoperatively,once daily for 7-14 days from the next day.Those received no intervention served as controls.The thromboplastin time,thrombin time,activated partial thromboplastin time,and level of plasma fibrinogen were detected before and after treatment.Color Doppler ultrasound results of the lower extremity vessel before and after treatment and postoperative drainage volume were recorded.RESULTS AND CONCLUSION:(1) In the experimental group,the lower level of plasma fibrinogen and slightly prolonged thromboplastin time,thrombin time and activated partial thromboplastin time were observed,but all were within the normal range.(2) The incidence of deep vein thrombosis in the experimental group (0％) was significantly lower than that in the control group (5％,P ＜ 0.05).(3) To conclude,low-molecular-weight heparin therapy significantly reduced the incidence of deep vein thrombosis after spine surgery.

BACKGROUND:With more and more elderly patients suffering lumbar degenerative disease undergoing internal fixation, infection after spinal internal fixation is a common complication in orthopedic surgeries, but its treatment strategy remains controversial.OBJECTIVE: To explore the curative efficacy of incision infection after internal fixation in the elderly with lumbar degenerative disease.METHODS: 197 patients with lumbar degenerative disease undergoing internal fixation and followed up for more than 2 years admitted in Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2012 to January 2015, were analyzed retrospectively. The follow-up time was 2-4.9 years. There were 97 cases of lumbar stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis and 21 cases of lumbar compression fractures.RESULTS AND CONCLUSION: (1) Eleven patients experienced incision infection, including ten acute, and one delayed infection. (2) Among acute infected cases, three were superficial infection in three cases and seven had deep infection,who characterized as exudation (10/10), local pain (8/10) and fever (9/10). Acute infected cases received bacterial culture, drug sensitive test, antibiotic therapy, and debridement of the infected wound, and leaving all internal fixators in situ in all but one case. (3) For delayed infection, one patient had local pain, incision exudation, and intermittent fever,and then the internal fixators were removed. (4) Pseudarthrosis was not founded during 2-year follow-up in all patients.(5) These results suggest that for the elderly patients suffering lumbar degenerative disease with infection after internal fixation, intravenous antibiotics, debridement plus drainage are recommended, but without internal fixator removal, and repetitive debridement and drainage is a rational choice if necessary.

Objective To study the influence of pharmacy intravenous admixture servers(PIVAS)on human resource prioritized allocation.Methods We compared the time consumption and efficiency of drug dispensing as well as the human resource allocation before and after the establishment of PIVAS.The influence of PIVAS on the human resource allocation of nursing and pharmacy staff and work efficiency were analyzed.Results Nursing human resource were economized and we realized human resource prioritized allocation after the establishment of PIVAS.Conclusions Establishment of PIVAS facilitated the human resource prioritized allocation of nursing and pharmacy staff.It can promote the development of nursing cause and possesses wide application value.

AIM:To assess the clinical efficacy of 5-fluorouracil(5-FU)and bandage contact lens in the pterygium excision combined with autogenous limbal stem cell transplantation(ALSCT)in treating patients with pterygium.METHODS:Random controlled clinical trial. A total of 71 patients(71 eyes)of pterygium who treated at the department of ophthalmology in Qinhuangdao Haigang Hospital between May 2021 and November 2022 were included. They were divide into three groups, including 23 eyes received pterygium excision combined with ALSCT in group A, 24 eyes that were administered with 5-FU intraoperatively and postoperatively in group B, and 24 eyes that received both bandage contact lens and 5-FU in group C. Furthermore, comfort levels at 1, 3, 7, 14d postoperatively, corneal epithelial healing at 1, 3, 7, 14d and 1mo postoperatively, treatment outcomes and complications at 3～6mo postoperatively were compared among the three groups of patients.RESULTS:The comfort levels at 1, 3 and 7d postoperatively and corneal healing at 1 and 3d postoperatively of the group C were better than those of the groups A and B. There were no statistical significant differences in the comfort levels at 14d after surgery and corneal healing at 14d and 1mo after surgery among the three groups of patients. Over a 3～6mo follow-up period, group A experienced recurrence in 3 eyes, group B had 1 recurrence, while group C had no recurrence. There were no statistically significant differences in complication rates among the three groups of patients.CONCLUSIONS: The application of 5-FU combined with bandage contact lens can enhance postoperative comfort levels, promote corneal epithelial healing, and improve the success rate in pterygium excision combined with ALSCT.

Objective To study the effect of soluble amyloid precursor protein α (sAPPα) on nerve cell apoptosis and neurological function in subarachnoid hemorrhage (SAH) rats.Methods Sixty male SD rats were randomly divided into control group (n=20),SAH+saline group (n=20) and SAH+sAPPα group (n=20).A SAH model was established by injecting autologous blood into cistern magna in rats.After a SAH model was established for SAH + saline group and SAH + sAPPα group by injecting saline and sAPPα respectively into the cistern magna of rats,the apoptotic cells were detected by immunofluorescene with TUNEL staining and the neurological function was scored in 10 rats from each group on day 3 after injection of sAPPα and saline.Results The number of apoptotic cells in brain tissue was significantly greater in SAH+saline group than in control group (P＜0.05) and was significantly smaller in SAH+sAPPα group than in SAH+ saline group (P＜0.05).The neurological function score was 26.7±0.5,13.9±0.7 and 23.0±0.8 respectively in control group,SAH + saline group and SAH + sAPPα group.Conclusion sAPPα alleviates secondary damage of neurological function by inhibiting the apoptosis of nerve cells in rats after SAH and can thus improve their neurological function.

Objective To explore the effect of sodium valproate (SV) on reducing high-sensitivity C-reactive protein (hsCRP) and attenuating cerebrovascular spasm damage in rats after subarachnoid hemorrhage (SAH).Methods Seventy-two male rats,weighting 300-400 g,were randomized to following experimental groups:sham-operated group,SAH group,SAH+saline treatment group,and SAH+SV treatment group (n=18).The SAH models in the later three groups were induced by injection of autologous blood into the cistern magna.Saline or SV (2 mg/100 g) was given to the rats in the SAH+saline treatment group and SAH+SV treatment group every day via intraperitoneal injection.Serum hsCRP level was measured on 1,3,5 and 10 day.Neurological deficit scale scores were assessed on 3 and 5 day.Results On 1,3,5 and 10 day,HsCRP level in the sham-operated group was (0.09± 0.02) mg/L,(0.09±0.02) mg/L,(0.09±0.02) mg/L and (0.09±0.01) mg/L;that in SAH group was (0.29± 0.01) mg/L,(0.32±0.02) mg/L,(0.35±0.02) mg/L and (0.32±0.02) mg/L;that in SAH+saline treatment group was (0.28±0.02) mg/L,(0.31 ±0.02) mg/L,(0.34±0.02) mg/L and (0.31 ±0.02) mg/L;that in SAH+SV treatment group was (0.15 ±0.02) mg/L,(0.21 ±0.02) mg/L,(0.24±0.02) mg/L and (0.15 ±0.03) mg/L;HsCRP level in the SAH group and SAH+saline treatment group was significantly higher than that in the sham-operated group (P＜0.05);HsCRP level in the SAH+SV treatment group was significantly increased as compared with that in the sham-operated group,but significantly decreased as compared with that in the SAH+saline treatment group and SAH group (P＜0.05).The neurobehavior scale scores on 3 and 5 day in SAH+SV treatment group (23.0±0.8 and 21.8±1.4) were significantly increased as compared with those in the SAH group (14.1±0.8 and 11.9±0.9) and SAH+saline treatment group (13.9± 0.7 and 11.1±1.4,P＜0.05);those in the SAH+SV treatment group (23.0±0.8 and 21.8±1.4) were significantly decreased as compared with that in the sham-operated group,but significantly increased as compared with that in the SAH+saline treatment group and SAH group (P＜0.05).Conclusion SV decreases the inflammatory injury by reducing the hsCRP level and improve the neurological outcome in SAH rat models.

Objective To identify the reasons and treatment strategies of epidural fluid collection (EFC) secondary to cranioplasty in patients with traumatic brain injury after decompressive craniectomy.Methods From June 2013 to July 2017,a retrospective analysis was performed on clinical data of 150 patients with traumatic brain injury after decompressive craniectomy in our hospital.A total of 47 patients experienced EFC following cranioplasty and 103 not.Risk factors of EFC after cranioplasty were analyzed by multiple factor Logistic regression.Results For the 47 EFC patients,32 patients had no obvious clinical symptoms and EFC was absorbed gradually through conservative therapy;15 patients had clinical symptoms,such as mental deterioration,headache,or limb weakness.EFC disappeared through vacuation in 4 patients and subcutaneous drainage in 11.The proportions of patients with skull defect＞80 cm2,dural defect and dural calcification in patients with EFC were significantly higher as compared with those without EFC (P＜0.05).Multiple factor Logistic regression analysis showed that skull defect＞80 cm2 and dural mater calcification were independent risk factors for EFC after cranioplasty.Conclusions Patients with large skull defect＞80 cm2 and dural calcification are prone to have EFC after cranioplasty.Careful evaluation of imaging data,good surgical skills and strengthening postoperative management can reduce incidence of EFC after cranioplasty.

Objective:To investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.Methods:A retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip, who had undergone Bernese periacetabular osteotomy. Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%, 20%, 50%, and 100% of the patient's weight. The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions, including whether the acetabular bone block and the ilium were in contact, whether 3 or 4 screws were used, and whether a graft (including fibular cortical bone and PEEK grafts) was used.Results:The structural stiffness of the pelvis fixed with four screws increased by 67%-94% compared to that with three screws. After using a graft, the structural stiffness of the pelvis increased by 50%-83%. As the load increased, the maximum equivalent stress on the screws also increased. When the acetabular bone block and the ilium had no contact, no graft was used, and only three screws were used for fixation, the maximum equivalent stress could reach 518.9 MPa, while this value dropped to 61% when four screws were used (318.7 MPa). When the acetabular bone block and the ilium were in contact, the maximum equivalent stress was about 12% of that when there was no contact, regardless of the number of screws used. When a cortical bone graft or a PEEK graft was used, the maximum equivalent stress could drop to 21%-26% of that without a graft. When the screw strength was 130 MPa, a load of 20% of body weight was applied, and only three screws were used without a graft, the equivalent stress could exceed the strength of the screw; if four screws were used, the equivalent stress was slightly higher than the strength of the screw when a load of 50% of body weight was applied. However, when a graft was used (either cortical bone or PEEK), even when a load of 100% of body weight was applied, the equivalent stress was slightly lower than the strength of the screw.Conclusion:Absorbable screws can provide sufficient stability for Bernese periacetabular osteotomy. The contact between the acetabular bone block and the ilium, an increase in the number of screws, and the use of grafts (cortical bone and PEEK grafts) can further improve stability. Therefore, absorbable screws have broad application prospects in Bernese periacetabular osteotomy.