Postoperative pain is an important factor which affects patients'postoperative rehabilitation training.With the application of ultrasound guided nerve block and multimodal analgesia,the quality of postoperative pain management has improved obviously among patients after foot and ankle surgery.The study has reviewed the related research.

Objective To investigate the clinical efficacy of 90Sr-90Y applicator combined with propranolol (inderal) treatment for infants with large areas of cutaneous hemangiomas.Methods Thirty-nine infants with large areas of cutaneous hemangiomas were randomly divided into two groups:study group (n =18) treated with 90Sr-90Y applicator in conjunction with propranolol,and control group (n =21) treated by 90Sr-90Y applicator only.The results of curative effects between the two groups were analyzed using rank sum test and x2 test.Results The cure rate,remission rate and effective rate for the study group were 44.4％(8/18),55.6 ％ (10/18) and 100.0％ (18/18),respectively,and the corresponding rates for the control group were 14.3％ (3/21),52.4％ (11/21) and 66.7％ (14/21),respectively.The effective rate in the study group was significantly higher than that in the control group (Z =-2.861,P ＜ 0.05).The adverse reaction rates in the study and control groups were 66.7％ (12/18) and 19.0％ (4/21 ;x2 =9.084,P ＜0.05),respectively.Conclusion Combined propranolol with 90Sr-90Y treatment for large infantile hemangiomas is clinically effective,but its side effects should be closely monitored.

Objective To explore and evaluate the changes of hemorheology and fracture healing in patients undergoing spinal operation with intraoperative autologuous blood transfusion.Methods A total of 80 patients underwent internal fixation of spine in our hospital from January 2012 to December 2014 were selected in this study.Digital random table method were utilized for dividing them into two groups.Autologous blood transfusion was used in group A,allogeneic blood transfusion was applied in group B.Blood viscosity,plasma viscosity,hematocrit,fibrinogen,erythrocyte sedimentation rate (ESR) and the level of sICAM-1,sVCAM-1 were collected and compared 1,4,8,12 weeks after the operation.Fesults Concentrated red cell and plasma volume infusion in group A was lower than that in group B,the level of sICAM-1,sVCAM-1 1,4,8,12 weeks after operation in group A were significantly lower than that in group B.There was no delayed fracture healing patients in group A,but there was 3 patients with delayed fracture healing in group B (P＜0.05).Blood viscosity,plasma viscosity,hematocrit,fibrinogen,erythrocyte and ESR 1,4,8,12 weeks after the operation compared in both group were not statistically significant (P＞0.05).Conclusion Autologous blood transfusion is not only a safe and effective method for blood transfusion,but also can improve the tissue blood supply,reduce inflammation,and conducive to fracture healing.

Objective To compare the function and influence of magnetic resonance cholangiopancreatography (MRCP) and T tube cholangiography before pulling out T tube after biliary tract surgery. Methods Clinical data from 248 patients with T tube drainage after biliary tract surgery bewteen January 2009 and June 2011 were retrospectively analyzed.Among them, the T tube cholangiography group was 195 cases, and MRCP group was 53 cases.Analyzed the function, the toxic side reaction and effect of prolonged hospitalization time of T tube cholangiography group and MRCP group,and discussed the diagnostic effect of MRCP before pulling out T tube after biliary tract surgery.Results Two groups of patients got distinct and integrated image of the bile ducts all.Compared with T tube cholangiography group, all 53 cases patients of MRCP group got accurate of diagnosis results, no fake positive results and adverse reaction occurred, and no prolonged hospitalization. Conclusion MRCP can replace T tube cholangiography as a means of diagnosis before removal of T tube.

Objective To evaluate the effect of intercostal nerve cryoanalgesia for post-thoracotomy pain control and the chronic discomfort of the incision.Methods A prospective analysis was carried out in 200 patients after standard posterolateral thoracotomy.Then the patients were randomly divided into five groups after gender stratification,each group with 40 patients.Group A was the control group,which was received no advanced method to prevent the pain after operation,only with Pethidine injected while patient require.Group B was PCIA group.Group C was PCEA group.Group D was cryoanalgesia group.Group E was cryoanalgesia and PCEA group.VAS score was used in the consecutive 7 days after operation.And we recorded the doses of pethidine injected in the 7 days,as well as the complications and the side effects.On the third and sixth month,patients were followed up by telephone or clinic review for their pain control and discomfort of the incision.Results The VAS score and the average doses of using Pethidine were lower in group D and group E than that in other groups.Group D had a lower ratio of nausea,vomiting,pruritus and lethargy than any other group.Group A,group D and group E had a higher ratio of pain of incision and other adverse reactions than group B and group C.Conclusion Intercostal nerve cryoanalgesia could effectively relief the postoperative pain,reduce the ratio of traumatic stress reaction and side effect.Cryoanalgesia may be a factor that could add the chronic discomfort of the incision.

Objective To evaluate the effects of Xuebijing injection on inflammatory mediators of patients with severe acute pancreatitis. Methods Using double blind method, 80 cases with severe acute pancreatitis were randomly divided into two groups, with 40 cases in each group. The control group was treated with conventional therapy such as: fasting, fluid replacement, acid inhibition and anti-infection, combined with the continuing injection with the growth hormone release inhibiting 6 mg, ulinastatin 200000u for 7 days. Based on the control group's treatment, the other group was added with Xuebijing injection 50 ml, twice a day for 7days. The plasma levels of prostaglandin Ⅰ2 (PGI2), thromboxane A2 (TXA2), tumor necrosis factor α (TNFα),interleukin-1,6,8 (IL-1,6,8) were compared before and after the treatment in each group and between two groups.Results Compared with the control group, Xuebijing injection group had marked effects on modulating the levels of inflammatory mediators. The levels of PGI2 and PGI2/TXA2 were increased significantly and the levels ofTXA2, TNF2, IL-1,6 and 8 were deceased(P＜0.05)sharply after the treatment. Conclusion Combined with conventional western medicine therapy, Xuebijing injection has the effects of inhibiting and controlling the release of inflammatory mediators on patients with severe acute pancreatitis.

Objective To discuss the prevention and management method for chylous fistula after neck lymph node dissec‐tion .Methods Totally 1 793 cases of neck lymph node dissection in this department from January 2005 to September 2014 were retrospectively analyzed .The clinical data in the cases of chylous fistula occurred after operation were summarized .Results Twenty one cases of chylous fistula occurred ,accounting for 1 .17% ,in which 13 cases were cured by the local compressed bandaging and continuous negative pressure drainage;5 cases adopted the conventional method for 2-3 d ,but under the ineffective condition ,then they were treated by combining with somatostatin pumping (somatostatin 6 mg+0 .9% normal saline 48 mL ,2 mL/h ,lasting for 24 h ,for successive 2-3 d) and finally cured;3 cases were cured after reoperation .Conclusion Prevention is the best treatment for chylous fistulas ,local compression bandage plus continuous negative pressure drainage is the main method for treatment of chylous fistulas after neck dissection .The combined therapy with somatostatin can increase the close rate of chylous fistulas;for the patients with long persistent time ,large drainage volume and invalid conservative therapy should adopt the remedial measure of operation .

Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

Objective:To investigate the long-term efficacy and the adverse reactions of uterine artery embolization with polyvinyl alcohol granules in the treatment of adenomyosis.Methods:Sixty patients with adenomyosis who received treatment in The Second People's Hospital of Qinzhou from January 2009 to February 2017 were retrospectively included in this study. They were divided into an observation group ( n = 31) and a control group ( n = 29) according to different treatment methods. The observation group was treated by embolization of the uterine artery with a polyvinyl alcohol granule. The control group was treated with a levonorgestrel-releasing intrauterine system. After treatment, all patients were followed up for 2-5 years. The long-term efficacy was evaluated, including the symptoms of dysmenorrhea, average menstrual fluid volume, sex hormone, and change in uterine size. Results:After 2 years of treatment, the response rate in the observation group was 93.5% (29/31), which was significantly higher than 72.4% (21/29) in the control group ( χ2 = 4.81, P = 0.028). After 5 years of treatment, the response rate in the observation group was 93.5% (29/31), which was significantly higher than 65.5% (19/29) in the control group ( χ2 = 7.35, P = 0.007). After treatment, the improvements in uterine size, menstrual fluid volume, and visual analogue scale score were greater in the observation group than those in the control group (all P < 0.05). After treatment, all patients were followed up for 5 years. There was no significant difference in the incidence of long-term adverse reactions between the observation and control groups [3.2% (1/31) vs. 6.9% (2/29), P > 0.05]. The recurrence rate in the observation group was 3.45% (1/29), which was significantly lower than 23.81% (5/21) in the control group ( χ2 = 4.78, P = 0.029). After 2 and 5 years of treatment, ovarian function was not affected in both groups of patients. Conclusion:Uterine artery embolization with polyvinyl alcohol granules for the treatment of adenomyosis has identified long-term curative effects, is safe, and has a low recurrence rate.