Objective To investigate the feasibility of mono-segment pedicle instrumentation (MSPI)in management of thoracolumbar fracture (AO classification,A1 and A3) by being compared with short-segment(two-segment) pedicle instrumentation(SSPI).Methods Overall 141 patients with tape A1 or A3 thoracolumbar fractures,aged from 20 to 60 years (average,40.5 years),were enrolled in this prospective study.According to a simple randomized method,35 patients with type A1 fracture and 41 patients with type A3fracture were treated with MSPI,while 26 with type A1 fracture and 39 with type A3 fracture were treated with SSPI.Low back outcome score (LBOS) and ASIA2000 were used to evaluate clinical outcome.Eighteenth month postoperatively was assigned as the last follow up period.Wedge index (WI) and sagittal index (SI) of the affected vertebrae on radiography were measured and compared preoperatively,one week postoperatively and at the final follow-up.Results All patients were followed up successfully.The blood loss and duration of operation of MSPI group were significantly less than that of SSPI group,respectively.However,there were no significant differences of clinical outcome between two groups.For type A1 fracture,correction rate and correction loss of WI in MSPI group were better than those in SSPI group.For type A3 fracture,there were no significant differences of correction rate and correction loss of WI and SI between MSPI group and SSPI group; however,the failure rate of MSPI group was significantly higher than that of SSPI group.Conclusion For type A1 and partial type A3 thoracolumbar fractures,MSPI can provide the same or better fixation with less blood loss and operative duration than SSPI.Since MSPI for type A3.2 thoracolumbar fracture has a higher failure rate,the surgical indication should be strictly controlled.

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective thoracoscopic surgery under general anesthesia,were divided into 3 groups (n=20 each) using a random number table method:control group (group C),thoracic paravertebral block (PVB) group (group PVB) and group SAPB.After the patients were turned to contralateral position,thoracic PVB was performed at T4.6 thoracic vertebrae on the affected side under ultrasound guidance,and 0.25％ ropivacaine 20 ml was injected in group PVB.In group SAPB,ultrasoundguided SAPB was performed on the affected side,and 0.33％ ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores＞3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing,total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded,the dose was calculated,and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting,pulmonary infection and chronic pain was also recorded.Results Compared with group C,the consumption,dose and total consumption of sufentanil were significantly decreased,the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased,and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P＜0.05).Compared with group PVB,no significant change was found in the parameters in group SAPB (P＞0.05).There was no significant difference in the incidence of chronic pain among the three groups (P＞0.05),and no patients required additional flurbiprofen axetil.Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects.

Objective:To analyze the advantages and disadvantages of online and offline laboratory medicine continuing education and training, and to discuss the future continuing education and training mode under new technology development and new situation.Methods:A questionnaire was administered to the trainees who participated in the 2019 and/or 2020 national continuing medical education project—Clinical Application and Evaluation of New Technologies and Methods of Laboratory Medicine—sponsored by the Department of Laboratory Medicine, West China Hospital, Sichuan University. One hundred and twenty-four questionnaires were completed for the 2019 offline training, and 503 questionnaires were completed for the 2020 online training. The rank sum test, Fisher's exact test, and chi-square test were performed for statistical analysis with the use of SPSS 26.0.Results:The participants in 2020 were significantly younger and the proportion of female participants in 2020 was significantly higher compared with those in 2019. Intermediate titles or above accounted for 66.93% (83/124) in 2019, and intermediate titles or below accounted for 88.67% (446/503) in 2020. The proportion of people from Sichuan Province was significantly higher in 2019. The proportion of trainees from primary institutions was significantly lower in 2019. In 2019, public institutions were mainly tertiary hospitals (74.31%, 81/109), and the majority of participants from private institutions were from third party testing institutions (60.00%, 9/15). In 2020, the percentage of tertiary hospitals in public institutions decreased to 60.99% (258/423), while the percentage of community medical institutions increased to 10.64% (45/423), and 75.00% (60/80) of trainees from private institutions were from tertiary and secondary medical institutions. Trainees with lower educational levels were more likely to appreciate the value of the training course, especially with higher degrees of satisfaction with improvements in theoretical levels and practical skills, and participants from primary institutions believed that the training course could effectively improve their theoretical and practical levels. The number of participants who provided suggestions on laboratory medicine continuing education and training needs in 2019 (83.75%, 67/80) was higher than that in 2020 (48.51%, 244/503). The overall pass rate of post-training assessment in 2020 was 88.52% (424/479).Conclusions:Online and offline training modes have different audience groups and training effects. Online continuing education can provide training opportunities to more primary care personnel and junior and intermediate professionals, which is conducive to improving the basic professional literacy and testing skills of laboratory personnel on the whole. At the same time, the integration of online and offline modes will promote the development of laboratory medicine continuing education.