Objective To evaluate risk factors for surgical site infection(SSI) in patients with thoracolumbar fracture,and provide basis for making prevention and control measures.Methods Patients with thoracolumbar fractures operation in the department of spinal surgery of a hospital between January 2010 and March 2015 were monitored through information monitoring system,on-site visit,and telephone follow-up,incidence of SSI was investigated,risk factors were performed univariate analysis.Results A total of 326 patients undergoing thoracolumbar fracture operation were monitored,15(4.60％) had SSI.SSI were high in patients≥60 years old,underwent operation at nonlaminar air flow operation room,didn't receive antimicrobial prophylaxis 30 minutes prior to operation,preoperative hospital stay ＞3 days,operation duration ＞3 hours,as well as with diabetes mellitus and chronic respiratory disease (all P＜ 0.01).Conclusion Risk factors for SSI in patients undergoing thoracolumbar fractures operation were patients with older age,receive operation at non-laminar air flow operation room,didn't receive antimicrobial prophylaxis,long length of preoperative hospital stay and operation duration,as well as combined with diabetes mellitus and chronic respiratory disease,preventive measures should be taken to reduce the incidence of infection.

Objective:To investigate the application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver trans-plantation.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 4 donors and 4 recipients undergoing right lobe living donor liver transplantation in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and 17 donors and 17 recipients undergoing right lobe living donor liver transplantation in the First Affiliated Hospital with Nanjing Medical University from June 2015 to August 2018 were collected. Of 21 donors, there were 10 males and 11 females, aged from 35 to 57 years, with a median age of 46 years. The median body mass of 21 donors were 64 kg, with a range from 56 to 72 kg. Of 21 recipients, there were 16 males and 5 females, aged from 21 to 68 years, with a median age of 42 years. The median body mass of 21 recipients were 63 kg, with a range from 47 to 77 kg. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect graft function, tumor recurrence, vascular graft complications, patency of vascular graft and survival of recipients up to August 2020. All recipients will be followed up for all their lives. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. The Kaplan-Meier method was used to calculate patency rates of hepatic vein outflow tract and survival rates to draw patency curve and survival curve. Results:(1) Surgical and postoperative situations: the operation time, the weight of donor graft, graft to recipient weight ratio and duration of hospital stay of 21 donors were (367±72)minutes, (557±68)g, 0.89%±0.16% and (10+2)days, respectively. No major complication requiring reoperation or intervention occurred in any of the 21 donors. One donor undergoing mild bile leakage preserved peritoneal drainage for one week. All 21 recipients underwent classic orthotopic liver transplantation successfully. The time of hepatic vein outflow tract reconstruction in donor graft, operation time and time of anhepatic phase of 21 recipients were (24±4)minutes, (326±66)minutes and (42±6)minutes, respectively. The number of reconstructed middle hepatic vein in hepatic segment 5 and 8 were 18 and 15, with the diameter of (6.1±1.3)mm and (7.2±1.2)mm, respectively. The number of reconstructed inferior right hepatic vein were 10, with the diameter of (6.3±1.3)mm. The postoperative treatment time at intensive care unit and duration of hospital stay of 21 recipients were (1.5±0.9)days and (22.6±6.7)days, respectively. Ten of 21 recipients underwent postoperative complications. Five recipients underwent graft dysfunction including the level of alanine aminotransferase and aspartate aminotransferase >1 000 IU/L and the level of bilirubin slightly increasing, combined with increased ascites. Enhanced computed tomography scan showed congestion in the right anterior of graft and thrombosis in the middle hepatic vein of hepatic segment 5 and segment 8. All 5 recipients undergoing graft dysfunction recovered with normal liver function and ascites decreasing after symptomatic treatment including liver protection therapy, anticoagulation and albumin infusion. Two recipients underwent inferior vena cava thrombosis and intractable pleural effusion one month after operation. Vena cava venography examination showed thrombosis in the graft vascular. Of the 2 recipients, one case with collateral circulation formation recovered undergoing balloon dilatation and stent placement combined with anticoagulation therapy of warfarin. The other one case recovered after anticoagulation therapy of warfarin. One recipient undergoing bile leakage and abdominal infection with klebsiella pneumoniae recovered after symptomatic treatment. Two recipients undergoing abdominal infection or pulmonary infection recovered after symptomatic treatment. There was no serious complication or death during perioperative period. (2) Follow-up: all 21 recipients were followed up for 10 to 57 months, with a median follow-up time of 38 months. During the follow-up, no recipient underwent graft dysfunction and 2 recipients had tumor recurrence at postoperative 6 months. Six of the 21 recipients died within 2 years after operation including 3 cases dying of tumor recurrence, 2 cases dying of acute hemorrhage and 1 case dying of liver failure. There was no death caused by vascular graft complica-tions. The postoperative 1, 3, 6-month, and 1-year and 2-year potency rates of hepatic vein outflow tract in 21 recipients were 88.4%, 88.4%, 82.4%, 68.0% and 42.1%, respectively. The 6-month, 1-year and 2-year overall survival rates in 21 recipients were 100%, 94.4%, 71.4%, respectively.Conclusion:Application of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver transplantation is safe and feasible.

Objective:To explore the influence of childhood psychological abuse, neglect and alexithymia on the boredom proneness of college students.Methods:The boredom proneness scale for college students(BPS), child psychological abuse and neglect scale (CPANS) and the Toronto alexithymia scale (TAS-20) were used to investigate 1 557 college students, and SPSS 22.0 was used for descriptive statistics, correlation analysis and regression analysis.Results:Childhood psychological abuse (26.540±8.985), neglect (32.665±10.651), recognition emotion in alexithymia dimension (19.359±4.835), description emotion dimension (14.173±3.001), extroverted thinking dimension in alexithymia (20.383±3.429) had positive correlation with the total score of boredom tendency (101.109±19.735) and the dimension of external stimulus (66.022±21.079)( r=0.160-0.559, all P<0.01). And there were negative correlations with the internal stimulus dimension (35.132±8.207)( r=-0.302--0.104, all P<0.01). The hierarchical regression analysis showed that after controlling the effects of gender and age, psychological abuse and neglect were the influencing factors of boredom proneness, internal stimulus and external stimulus, which explained 14.3%, 5.1% and 18.2% of the total variation (△ F=130.561, 41.968, 172.711, all P<0.01). Recognition of emotions, description of emotions and extroverted thinking in alexithymia were the influencing factors of boredom proneness, internal stimulus and external stimulus, which explained 17.5%, 9.9% and 25.5% of the total variation (△ F=134.274, 60.696, 234.383, all P<0.01). Conclusion:Childhood psychological abuse, neglect and alexithymia have significant effect on boredom proneness of college students, and mainly on external stimuli of boredom proneness. Among them, alexithymia has the greatest influence and the highest explanatory power.

Objective To investigate the regional cerebral stimulation after central analgesics nasal spray and its mechanism with pharmacological functional magnetic resonance imaging (phfMRI). Methods Eighteen healthy right-handed volunteers participated. Butorphanol tartrate nasal spray was used as the experiment agent. Ethological experiment was carried out to record the participants' subjective feeling and the onset time of the analgesics, followed by the functional MRI (fMRI) scan two weeks later. Block design was adopted. Two phases of fMRI scan were performed at 7 min and 25 min after the nasal spray, respectively. Participants were also given pain stimulation in the dorsum of hand during the fMRI scanning. The data were post-processed with Matlab 6.5 and SPM 2. Results ①Onset time of butorphanol tartrate was 15-35 min after nasal spray administration, which was consistent with its concentration-time curve. ②After nasal spray, activations were observed in the cerebral cortex, including frontal lobe (orbitofrontal gyrus, medial frontal gyrus, superior frontal gyrus), temporal lobe (insula, middle temporal gyrus, inferior temporal gyrus), parietal lobe (precuneal gyrus), limbic system (anterior cingulate gyrus, middle cingulate gyrus, hippocampus, parahippocampal gyrus);subcortical region (globus pallidus) and cerebellum (6-9 of cerebellar cortex, cerebellar peduncle, vermis). ③The number and activation intensity of the second phase were more obvious than those of the first phase (P<0.01). Conclusion The feasibility of phfMRI study on cerebral stimulation and the mechanism of nasal spray is demonstrated. The study of butorphanol tartrate further validates the main distribution of opioid receptors in the central nervous system and the possible mechanism of central analgesia.

Objective To evaluate the feasibility of sentinel lymph node(SLN) mapping with CT lymphography (CT-LG). Methods Twenty-five patients with confirmed breast cancer and no palpably axillary lymph node underwent CT-LG examination. The first one or more lymph nodes along the lymph duct draining from the injection sites to axilla were defined as SLNs, and then the LG results were compared with sentinel lymph node biopsy (SLNB). The over- and underestimation of LG were evaluated. The quality of LG imaging was classified Grade Ⅰ and Ⅱ according to lymph duct appearance on volume rendering (VR). The body mass index (BMI) ＞ 25 was considered obesity. Fisher exact test was used for the statistics. Results (1)Of 25 patients, 5 had local mastectomy history. BMI ＜ 25 was found in 20 cases, and ≥25 was in 5 cases. (2) All SLNs were showed by CT-LG, and Grade Ⅰ and Ⅱ imaging quality were achieved in 21 cases ( 84. 0% ) and 4 cases ( 16. 0% ), respectively. The obese patient tended to have a poor imaging quality ( P ＜ 0. 05 ). (3) Fifty-six SLNs and 45 lymph ducts in all 25 patients were identified on CT-LG. Compared with the results of SLNB, 7 cases ( 28. 0% ) and 9 cases ( 36. 0% ) were over- and underestimated respectively by CT-LG due to obesity and local mastectomy ( P ＜ 0. 05 ). (4) Fifty-two negative SLNs in 18 patients and 15 positive SLNs in 7 patients were confirmed by pathology through SLNB, while 56 SLNs were delineated on CT-LG with 43 negative and 13 positive. The shape in 32. 6% of the negative SLNs (14/43) and 76. 9% of the positive SLNs (10/13) was round,the difference was significant (P＜0. 05). The filling defect on the center in 9.3% of negative SLNs (4/43) and 23. 1% of positive SLNs (3/13) was demonstrated, and irregular filling defect on the margin was found only in 30.8% of positive SLNs (4/13). 3 SLNs in 2 patients combined with small satellite lymph nodes on CT-LG were also confirmed to have tumor infiltration. Conclusion CT-LG can clearly demonstrate the breast lymphatic pathway and may potentially be used for breast SLN mapping, while the imaging quality can be influenced by the obesity and local mastectomy.

Objective To observe any effect of hyperbaric oxygen therapy on cognitive dysfunction caused by traumatic brain injury,and to explore possible neural mechanisms.Methods Sixty-four patients with cognitive impairment after a traumatic brain injury were randomly divided into a hyperbaric oxygen group (n =32) and a control group (n=32) using a random number table.Both groups accepted routine medical therapy and cognitive rehabilitation training,but the hyperbaric oxygen group additionally received hyperbaric oxygen treatment.Both groups' cognitive functioning was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) before and after the treatment.Fifteen patients were randomly selected from both groups to receive T1WI and diffusion tensor imaging scans.The correlation between the two evaluation resuhs was analyzed.Results After the intervention,improvement was observed in the average MMSE and MoCA scores of both groups,with the improvement in both average scores in the hyperbaric oxygen group significantly greater than among the control group.There was no significant correlation between the fractional anisotropy (FA) values of damaged white matter and the average MMSE or MoCA score in the controi group,but in the hyperbaric oxygen group there were significant positive correlations between the FA values of the corpus callosum,the anterior limb of the internal capsule and the left superior longitudinal fasciculus and the average MMSE and MoCA scores.Conclusions Hyperbaric oxygen therapy combined with rehabilitation training can further improve cognition after a traumatic brain injury.This is probably due to its adjusting the structure and function of the corpus callosum,of the anterior limb of the internal capsule and of the left superior longitudinal fasciculus.

Brain ; pathology ; China ; Humans ; Organ Preservation ; standards ; Tissue Banks ; ethics ; standards