Objective To explore the therapeutic effects of pure collagenase injection and collagenase combined with herniation injection of ozone on the treatment of lumbar disc herniation(LDH).Methods According to the principle of randomized controlled double blind, 100 patients with LDH were divided into 2 groups:pure collagenase group and combined treatment group.Changes of NRS value and Macnab score were observed and recorded at multiple time points after operation.The difference of the effect of the two kinds of operation was analyzed.Results Among the 50 patients in the simple treatment group,3 patients were lost to follow-up.Among the 50 patients in the combined treatment group,2 patients were lost to follow-up,and open surgery in 2 patients because of poor efficacy after the injection of 3 months and 6 months respectively.By analyzing the change of NRS value and Macnab score of 2 groups patients,there was no significant difference in the short-term and long-term efficacy between the 2 groups(P>0.05);The symptoms of the 2 groups were improved after operation.The curative effect was positively correlated with the recovery time, and the difference was statistically significant (P<0.05).Conclusion The curative effect of pure collagenase injection and the combined with herniation injection of ozone are both significant, and there is no significant difference in the clinical efficacy between the 2 kinds of operations.

Objective To observe the clinical efficacy of L-carnitine combined with trimetazidine in the treatment of chronic heart failure.Methods The clinical data of 700 patients with chronic heart failure were retrospectively analyzed.According to different treatment methods,they were divided into four groups:A,B,C,D.181 cases of A group used L-camitine combined with trimetazidine treatment on the basis of routine treatment.177 cases of B group received L-carnitine treatment on the basis of routine treatment.175 cases of C group received trimetazidine treatment on the basis of routine treatment.167 cases of D group received conventional treatment.Then,the clinical efficacy of the four groups was compared.Results The total effective rates of A,B,C,D groups were 83.43％,76.84％,73.71％,62.28％,respectively.The total effective rate of A group was obviously higher than the other groups,the difference was statistically significant(x2 =22.40,P ＜0.05).There was no significant difference in total effective rate between B group and C group (x2 =0.46,P ＞ 0.05),but both B and C groups were obviously better than group D (x2=4.37,5.13,all P ＜ 0.05).The data before and after treatment in four groups were significantly improved,such as 6MWT,NT-proBNP,LVEF and FS(A group:t =33.856,37.474,17.722,31.250,B group:t =27.328,31.559,6.863,25.581,C group:t =23.430,32.640,9.524,16.923,D group:t =15.863,9.602,3.061,10.169,all P ＜ 0.01).In the above four indicators,those in A group were obviously better than B group,C group and D group (F =5.884,38.621,4.357,13.770,all P ＜ 0.01).Conclusion L-carnitine combined with trimetazidine can improve the abnormal metabolism of myocardium,optimize the energy metabolism pathway of myocardium,improve the short-term cardiac function of patients markedly.L-carnitine combined with trimetazidine is worthy of promoting joint use.

Objective: To develop a new rat model for studies of enteral nutrition support.Methods: After acute pancreatitis models induced by laparotomy,32 SPF rats were put a catheter always used for epidural anesthesia, through pylorus to 5 cm of jejunum below Treitz ligament, and sutured and fixed apart at the entrance, stomach, peritoneum, neck, and the tail, which then connected to an one-time infusion tube. By regulating the infusion tube on the pulley, the enteral nutrition input was kept uniform.Results: The routes All rats were successfully built in all rats for TEN, with an average input time of 7days in which rats well tolerated without diarrhea. All rats got positive nitrogen balance after TEN for 3-4 days. No extrusion, bending, or leakage of the infusion tubes happened.Conclusion: This rat model of enteral feeding had advantages of simplicity, firmness, reliability and cheapness, which could be used in large-scale and fulfill the need of experimental EN study in small animals like rats.

Objective To observe the clinical effects and safety of radiofrequency thermocoagulation in treating the lumbar intervertebral disc protrusion.Methods Thirty patients with lumbar intervertebral disc protrusion,whose diagnoses were confirmed by clinical manifestations and CT findings,were involved in this study.The needle was punctured to the target point of the diseased intervertebral space under C-arm fluoroscopic guidance.After the testing of sensory nerve,motor nerve and temperature was made,the target needles were heated until the nerve radiofrequency temperature meter reached the point of 92℃.This point of temperature was held for 100 seconds and the procedure was repeated for four cycles.Results Six months after the treatment,all patients showed an obvious improvement in VAS,which decreased from 7.83±0.33before operation to 2.37±0.48 after treatment(P＜0.05).According to the modified Macnab therapeutic evaluation criteria,excellent result was seen in 9,good result in 12,fair result in 5 and poor result in 4cases,with a total effective rate of 86.7%.No serious complications occurred in all patients.Conclusion Radiofrequency thermocoagulation is an effective and safe method for the treatment of lumbar intervertebral disc protrusion.

Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch
SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P<0.05) , and the clinical duration was significantly prolonged, the recovery index was increased ( P<0.05) , and no sig?nificant change was found in the onset time in group NHL ( P>0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P<0.05), and no significant change was found in the onset time in group HL ( P>0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.

Objective To evaluate the effect of domestic wire-reinforced epidural catheter on the occurrence of adverse events during epidural block.Methods Three hundred ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 41-78 kg,scheduled for elective operations under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =100 each):polyvinyl chloride epidural catheter group (group A),imported wire-reinforced epidural catheter group (group B) and domestic wire-reinforced epidural catheter group (group C).Combined spinal-epidural anesthesia was performed routinely.The corresponding epidural catheter was inserted in each group.The catheterization without difficulty,paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,intravascular catheter insertion,injection obstruction,easiness during removal of the catheter,bleeding after removal,postoperative paresthesia and epidural hematoma within 1 week after operation were recorded.Results Compared with A group,the incidences of paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,injection obstruction and postoperative paresthesia were significantly decreased (P ＜ 0.05),and no significant change was found in the other parameters in B and C groups (P ＞ 0.05).There was no significant difference in all the parameters between B group and C group (P ＞ 0.05).Conclusion Domestic wire-reinforced epidural catheter can decrease the occurrence of catheterization-induced damage to the nerve and blood vessels and the efficacy is comparable with that of imported wire-reinforced epidural catheter.

Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.

Objective To investigate the clinical application of interventional combination embolization of spleen and kidney in treating traumatic splenic and renal hemorrhage. Methods Since Jan. 2010 to early 2014, a total of 24 patients with traumatic splenic and renal hemorrhage were admitted to authors’ hospital. After angiography, super-selective embolization with Gelfoam particles was employed to occlude the bleeding arteries. The results were analyzed. Results Technical success with single procedure was achieved in all the 24 patients. All 24 patients survived the trauma. The complication was mild. Follow-up examination showed that the embolization results were perfect. Conclusion For the treatment of traumatic splenic and renal hemorrhage, interventional combination embolization of spleen and kidney is safe and effective with reliable clinical results, and this technique can reduce visceral function damage to the greatest possible advantage.

Objective To evaluate the efficacy of the combination of percutaneous transhepatic embolization of gastroesophageal varices (PEGV) and partial splenic embolization(PSE) for the treatment of variceal bleeding. Methods Fifty patients with cirrhosis who fit in with the requirements of the study were randomly divided into dual-interventional group and surgical group. The patients in dual-interventional group were treated with PEGV together with PSE, and the patients in surgery group were treated with Hassab's operation. After the procedure all the patients in two groups were followed up periodically. The endoscopy, B ultrasonography, liver function tests and hematologic examinations were performed 24 months after the therapy, and the results were statistically analyzed. Results Fifty patients were enrolled in this study. The procedures of embolization and surgery were successful in all patients. In dual-interventional group, the whit eblood cell and platelet counts were (2.33±0.65) 10~9/L and (3.63±1.05) ×10~9/L respectively before the treatment and were (7.98±3.0) ×10~9/L and (163±91)× 10~9/L respectively 24 months after the treatment (P<0.05). The diameter of theportal vein was (1.47±0.25) cm before the treatment and was(1.31±0.23) cm 24 months after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 11 patients, and from grade Ⅱ to lower grade Ⅰ in 6 patients 24 months after procedure. Portal thrombosis occurred in 1 case. The recurrent bleeding rate was 16% (4/25) 24 months after treatment. Three patients died of the recurrent bleeding, one patient died of hepatic failure. In surgical group, the white blood cell and platelet counts were (2.2±0.60) ×10~9/L and (41±12.5) ×109/L before treatment, and were (9.3±2.56)×10~9/L and (321±12.5)×10~9/L 24 months after treatment (P<0.05). The diameter of the portal vein was (1.43±0.22) cm before the treatment and was (1.28±0.18) cm after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 13 patients, and from grade Ⅱ to lower grade Ⅰ in 7 patients. Four patients developed portal thrombosis after the procedure. The recurrent bleeding rate was 20%(5/25), 2 patients died of hepatic failure after the surgery, 2 died of recurrent bleeding. Conclusion In treating patients with cirrhosis, the combination of PGEV and PSE, regarded as dual-interventional therapy, is very effective, especially in controlling recurrent bleeding and in improving white blood cell and platelet counts.

Objective Toinvestigatethethrombusclinicalcurativeeffectandpracticalvalueintreatmentofdeepveinthrombosis (DVT)byusingmodifiedaspirationcatheter.Methods Atotalof35patientswhometthediagnosticcriteriaofDVTwererandomly assignedintoexperimentalandcontrolgroups.Afterasufficientpreoperativepreparation,thepatientsweredividedintotheexperimentalgroup (n=18,usingmodifiedaspirationcatheterwithsubsequenturokinasethrombolysisandconventionalanticoagulationtherapy)andthe controlgroup [n=17,usingthe8Fvascularsheaths (COOK,USA)duringtheprocedure,subsequenturokinasethrombolysisand conventionalanticoagulationtherapy].Thepatencyofvessels,theperimeterdifferenceandthecomplicationweredocumented.Theresultswere comparedbetweenthetwogroups.Results Inexperimentalgroup,thrombusremovalofgradeⅣ (removalratelessthan0%)was 0%in0case,gradeⅢ (removalratelessthan50%)was5.56%in1case,gradeⅡ (removalrategreaterthan50%)was94.44%in ncontrolgroup,thrombusremovalofgradeⅣwas23.53%in4cases,gradeⅢwas52.94%in9cases,gradeⅡwas23.53%in4cases. Thedifferencesofthelegcircumferenceoftheaffectedextremitiesat15cmaboveandbelowthekneejointattimeofdischargewere alllessthanthoseatadmission.Thedifferencesinbothpreoperativeandpostoperativedatabetweenthetwogroupswerestatistically significant(bothP<0.05).Noseriouscomplicationswerefoundintwogroups.Conclusion UsingmodifiedaspirationcathetertreatingDVTisa safeandeffectivemethod,whichhashighsuctionefficiencyandfewcomplications.Therefore,itisworthytoberecommended. 17casesI.