ObjectiveTo find out the risk factors causing iatrogenic spinal cord injury (ISCI) so as to provide theoretical support for reducing the spinal cord injury during spinal operation. Methods A retrospective study was done on 120 patients undergone cervical or thoracic spinal( C1-T12 ) surgery at Xiangya Hospital of Central South University from January 2002 to January 2009. The patients were randomly divided into injury group (n = 34) and control group (n = 86) and the univariate analysis was used to analyze 30 factors including clinical factors, iconography factors, operation and pathology factors as well as possible protective factors. Then, the factors with statistical difference were analyzed by using the multi-factor unconditioned Logistic analysis.Results The univariate comparison between the two groups showed statistical difference ( P ＜ 0. 05 ) in nine factors including combined hypertension, combined diabetes mellitus, preoperative ASIA grade, spinal canal stenosis rate, ratio of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2WI high signal, bleeding amount during operation, intraspinal prominence adhesion to dura mate of spinal cord as well as intraoperative use of methylprednisolone. The multi-factor Logistic regression analysis revealed that ASIA grade, value of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal and bleeding amount in operation had positive correlation with ISCI. Use of methylprednisolone during operation had negative correlation with ISCI. ConclusionsCombined diabetes mellitus, ASIA grade, spinal cord MRI T2W1 high signal, ratio of spinal cord/vertebral canal area and bleeding amount in operation are the risk factors for ISCI. Use of large dose methylprednisolone exerts preventive effect on ISCI.

Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoper-ative analgesia in patients undergoing thoracoscopic lobectomy. Methods Sixty patients undergoing thoracoscopic lobectomy were randomly divided into the dexmedetomidine group(DS group)and the control group(S group). The two groups were treated with PCIA.The Group DS:dexmedetomidine 2 μg/kg+sufentanil 1.5 μg/kg+ondan-setron 8 mg;and the group S:sufentanil 2 μg/kg+ondansetron 8 mg,in which all drugs were dissolved in 100 mL 0.9 normal saline. Parameters:loading dose 2 mL;infusion speed 2 mL/h;PCA dosage 2 mL each time;lock time:15 min. The mean arterial pressure(MAP),heart rate(HR),resting(VASR)and cough(VASC)VAS score,and Ramsay sedation score were recorded at 2,6,12,24,36 and 48 h after surgery.The number of press analgesic pump,the amount of sufentanil used,the incidence of adverse reactions such as,the nausea and vomit-ing,respiratory depression,bradycardia and so on were recorded within 48 h after operation. Results Compared with the group S,the MAP and HR of patients in the group DS decreased significantly at each time(P < 0.05), the scores of VASR and VASC decreased obviously at 6,12,24 h after surgery(P<0.05),the number of press analgesic pump,the amount of sufentanil used,the incidence of nausea and vomiting decreased obviously within 48 h after operation(P<0.05).Conclusions Dexmedetomidine combined sufentanil administration in PCIA after thoracoscopic lobectomy can obtain satisfactory analgesic effect and more stable hemodynamics,and reduce the dosage of sufentanil,the incidence of nausea and vomiting.

Background::Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.Methods::This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.Results::A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs. 80.9%; χ2 = 4.10; P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43-17.95; P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17-5.76; P = 0.019), and short neck (OR, 2.85; 95% CI: 1.08-7.52; P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups ( P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair. Conclusions::Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

Objective:To explore the clinical characteristics of hemoglobin H (HbH) disease during pregnancy, and evaluate the impact of prepregnant anemia on maternal and fetal outcomes.Methods:Clinical data of 12 pregnant women, who were diagnosed with HbH disease by genetic testing in the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2017, to December 31, 2022, were retrospectively collected. Thalassemia genotypes, general conditions before and during pregnancy, and perinatal outcomes were analyzed using descriptive analysis.Results:The 12 patients were categorized into moderate anemia (Hb<90 g/L, n=5) and mild anemia (Hb≥90 g/L and <110 g/L, n=7) groups according to the level of Hb before conception. In the moderate anemia group, with one deletional HbH disease and four non-deletional type, all had blood transfusion histories, and four developed severe anemia during pregnancy with four cases of fetal growth restriction. The mild anemia group comprised six deletional and one non-deletional genotype, with no severe anemia or transfusion requirement during pregnancy. In terms of maternal and fetal outcomes, two moderate anemia cases opted for pregnancy termination, while three delivered via cesarean section with two preterm infants having mild asphyxia and one full-term. In the mild anemia group, one case terminated due to intrauterine fetal death, and the remaining six continued the pregnancies, including two were delivered normally, one was assisted by forceps, and three through cesarean section. Among the six delivered cases, one was preterm birth, one infant was born with severe asphyxia and four mothers developed postpartum complications such as puerperal infection and postpartum hemorrhage. Conclusions:Clinical manifestations of HbH disease vary greatly. Individualized management should be offered based on the degree of anemia before pregnancy. For women with moderate anemia, close monitoring and appropriate intervention are required during pregnancy to improve both maternal and infant outcomes.

Objective To evaluate 3D printing abdominal aortic aneurysm model in analysis of clinical teaching effect for standardized resident doctors in vascular surgery department. Methods 48 resi-dents in vascular surgery department in our hospital from December 2016 to September 2017 were seleeected and randomly divided into control group and the experimental group. The traditional vascular surgical anatomy atlas, ultrasound, CT abdominal blood vessel 3D reconstruction, digital subtraction, video and so on were used by 24 residents in the control group, while in the experimental group, on the basis of the traditional teaching, abdominal aortic aneurysm model of 3D printing, true aortic coated stent delivery system were increased. After the teaching, the theory of evaluation (abdominal vascular anatomical features, morphological characteristics and classification of AAA, measurement of various parameters and key points of operation in the EVAR) and satisfaction questionnaire were adopted to evaluate the effect of two kinds of teaching methods. SPSS 19.0 was used to conduct t test on two groups of physician evaluation data. Results The results of theoretical assessment showed that there was no significant difference between the control group and the experimental group in the abdominal vascular anatomical features, the morphological features and the classification of the experimental group (P>0.05) in the examination of the common AAA cases and the complicated AAA cases. However, the experimental group was higher than the control group in the mea-surement of the parameters of EVAR, and the score of the operation points and the total score, and the difference was statistically significant (t=2.283, t=2.263, P<0.05). The results of the questionnaire showed that the students' satisfaction scores on the teaching satisfaction of the normal and complex AAA cases were better than those of the control group, and the difference was statistically significant (P<0.05). Conclusion The 3D printing model can increase the understanding and mastery of the anatomy and treat-ment of abdominal aortic aneurysm and improve its learning enthusiasm for vascular surgery. We should make full use of the advantages of 3D printing technology on the basis of retaining the advantages of tradi-tional teaching methods and means, and further enhance the teaching effect.

Objective:To investigate the incidence and related risk factors related to early postoperative complications after hepaticojejunostomy surgery for iatrogenic bile duct injury.Methods:A retrospective analysis was made on the data of 110 cases undergoing a hepaticojejunostomy at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 2001 to December 2018. The univariate and multivariate analyses were performed to explore the impact risk factors on the short-term complications.Results:Patients′ median age was 44 years old. The short-term postoperative complication rate was 35.5% and the serious complication rate was 17.3%. Univariate analysis showed that male, a failed repair was attempted before referral, intraoperative bleeding>400 ml, and duration of surgery were significantly related to the occurrence of early postoperative complications (all P<0.05). Multivariate analysis showed that male, pre-referral failed surgical repair, preoperative bile leakage, initially combined with hepatectomy, and intraoperative bleeding>400 ml were independent risk factors for postoperative short term complications (all P<0.05). Univariate and multivariate analysis of early postoperative severe complications(Clavien-Dindo≥Ⅲ) revealed that pre-referral surgical repair, combined liver resection, and intraoperative bleeding>400 ml can significantly affect the occurrence of early postoperative severe complications (all P<0.05) . There was no significant correlation between the timing of biliary repair and the occurrence of complications ( P>0.05). Conclusions:Upon the occurrence of iatrogenic bile duct injury, the surgeon is advised to refrain from doing a repair instead sending the patient to a referral hospital. If bile leakage persists before surgery, sufficient bile drainage should be given priority to control infection.

3D printing technology has been widely applied in the field of clinical education in vascular surgery due to the advantage of 100% reduction of objects. Vascular surgeons with different levels benefit from 3D printing application in anatomy structure, operation plan, skill training with simulator. At present, the application of 3D printing model in vascular surgery is still in the initial stage with some limitations. This paper reviews the application, limitations, and prospects of 3D printing model in clinical teaching of vascular surgery.