Objective To compare the clinical effect of arthroscopic single-row and suture-bridge double-row fixation of full-thickness rotator cuff tear.Methods A retrospective study was conducted on 40 patients with full-thickness rotator cuff tear treated by single-row and suture-bridge double-row fixation between May 2010 and May 2012.Single-row rotator cuff repair was performed in 18 patients and doublerow repair in 22 patients.The two techniques were compared in aspects of complications,recovery time to daily life,time to achieve satisfaction score,re-tear rate,pre-and post-operative VAS,University of California at Los Angeles Shoulder Scores (UCLA),and American Shoulder and Elbow Surgeons (ASES).Results Mean period of follow-up was 15.6 months (range,13-24 months).Both treatment were effective in improving VAS,UCLA,and ASES,but the differences were insignificant (P ＞ 0.05).Recovery time to daily life,time to achieve satisfaction score,and large rotator cuff re-tear rate were 69.2 ± 16.6)d,(196.4 ±24.6)d,and 4/5 respectively in single-row fixation,with significant differences from (54.1 ± 13.3)d,(165.0 ±20.6)d,and 1/8 in suture-bridge double-row fixation (P ＜0.05).Conclusion Both treatments are effective for rotator cuff reconstruction,but suture-bridge double-row fixation provides earlier recovery to daily life,shorter time to achieve satisfaction score,and lower incidence of large rotator cuff retear.

Objective To evaluate the early clinical outcomes of arthroscopic suture-bridge repair of media to large full-thickness rotator cuff tear.Methods One hundred patients that underwent arthroscopic suture-bridge (suture-bridge group,n =50) or single-row repair (single-row suture group,n =50) for media to massive full-thickness rotator cuff tear from June 2010 to June 2014 were enrolled in this study.The patients (63 males and 37 females),aged 58.7 years (range,46 to 75 years),were all available to the follow-up.Thirty-one patients were injured in traffic crashes,30 in falls,27 in strains and 12 with no apparent reasons.Early passive activity was allowed in suture-bridge group,while shoulder abduction was maintained for 6 weeks postoperatively in control group.Clinical and functional outcomes were measured using the visual analogue scale (VAS),range of motion,University of California at Los Angeles (UCLA) score,and American Shoulder and Elbow Surgeons (ASES) score.Results Mean duration of follow-up was 16.7 months (range,8 to 24 months).Prior to the surgery,these measurements were similar between the two groups.After a follow-up of 3 months,the differences were significant in suture-bridge group compared to control group:VAS [(1.7 ± 1.5) points vs (3.9 ± 2.1) points],forward flexion [(168.3 ± 30.2)° vs (120.2 ± 51.6)°],external rotation [(47.0 ± 11.0)° vs (31.8 ± 13.8)°],UCLA score [(31.7±4.2) points vs (18.2±4.8) points],ASES score [(86.2±14.6) points vs (35.9 ±17.7) points] (P ＜0.05).No re-tear occurred after operation.Conclusion Arthroscopic suture-bridge repair of moderate to massive full-thickness rotator cuff tear results in significant improvement of function outcomes and clinical results,indicating a reliable and effective treatment technique.

Objective To systematically evaluate the clinical effect of surgery combined with adjuvant therapy (postoperative chemoradiotherapy or chemotherapy) and single surgery for resectable pancreatic cancers.Methods Literatures were researched using PubMed,Embase,Science Citation Index Expanded,Cochrane Central Register of Controlled Trials and China Biology Medicine disc with the key words including "pancreatic cancer,adjuvant therapy,chemoradiotherapy,radiochemotherapy,chemotherapy,radiotherapy,胰腺癌,辅助治疗,化学治疗and放射治疗”from the time of database building to October 2016.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients undergoing surgery combined with adjuvant chemoradiotherapy,surgery combined with adjuvant chemotherapy and single surgery were respectively allocated into the first treatment group,second treatment group and control group.The inverse variance was used for mergering hazard ratio (HR) and related statistic data.HR and 95％ confidence interval (CI) were used for assessing the overall survival time and disease-free survival time.The median survival time and 1-,2-,5-year survival rates were evaluated by the relative risk (RR) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Eleven randomized controlled trials (RCTs) of 9 literatures were retrieved,and the total sample size was 1 482 patients,including 238 patients in the first treatment group,545 in the second treatment group and 699 in the control group.Results of Meta analysis:① overall survival time:there was no significant difference in overall survival time between the first treatment group and control group (HR =0.87,95％ CI:0.56-1.17,P＞ 0.05).There was a significant difference in overall survival time between the second treatment group and control group (HR =0.68,95 ％ CI:0.55-0.80,P＜ 0.05).② Disease-free survival time:there was no significant difference in disease-free survival time between the first treatment group and control group (HR=0.78,95％CI:0.53-1.03,P＞0.05).There was a significant difference in disease-free survival time between the second treatment group and control group (HR=0.56,95％CI:0.45-0.67,P＜0.05).③ Median survival time:there were significant differences in median survival time between the first treatment group and control group (RR=1.82,95％CI:1.35-2.45,P＜0.05) between the second group and control group (RR=1.32,95％CI:1.07-1.62,P＜0.05).④ One-,2-,5-year survival rates:there was no significant difference in 1-,2-,5-year survival rates between the first treatment group and control group (RR=1.24,2.47,1.15,95％ CI:0.72-2.12,0.82-7.41,0.71-1.84,P＞0.05).One-year survival rate in the second treatment group was compared with that in the control group,with no significant difference (RR=1.15,95％CI:0.99-1.34,P＞0.05).There were significant differences in 2-and 5-year survival rates between the second treatment group and control group (RR=1.24,1.73,95％CI:1.01-1.50,1.32-2.27,P＜0.05).Conclusions Compared with single surgery,surgery combined with postoperative chemoradiotherapy cannot significantly improve the overall survival time and disease-free survival time of patients.However,surgery combined with adjuvant chemotherapy can prolong the overall survival time and disease-free survival time of patients.

Objective:To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease, and provide a suitable reference dose for postoperative analgesia in children.Methods:Using a prospective study, 157 patients with congenital heart disease(ASA Ⅱ- Ⅳ) admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group (H1 group, 30 cases): hydromorphone dose ≥2 and <3 μg/(kg·h), hydromorphone medium-dose group (H2 group, 30 cases): hydromorphone dose ≥3 and <4 μg/(kg·h), high-dose hydromorphone group (H3 group, 31 cases): hydromorphone dose ≥4 and ≤5 μg/(kg·h), sufentanil group (S group, 36 cases): the dose of sufentanil was 0.08 μg/(kg·h), morphine group (M group, 30 cases): the dose of morphine was 20 μg/(kg·h). The five groups of children received midazolam 2 μg/(kg·min) intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h, 4 h, 8 h, 12 h, and 24 h after operation.Heart rate, mean arterial pressure, blood glucose, lactate, and serum cortisol levels were also monitored and detected, and the occurrence of adverse reactions, the number of cases requiring additional analgesic and sedative drugs, as well as the duration of mechanical ventilation were compared.Results:(1) There were no significant differences regarding the age, body weight, cardiopulmonary bypass time, pediatric critical illness score and ASA score among five groups (all P>0.05). (2) There was no significant difference in the levels of respiration, heart rate, blood sugar, lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups, but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h( P<0.05). (3) The analgesic satisfaction of H1 group, H2 group and H3 group at 1 h, 4 h, 12 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in analgesic satisfaction among H1 group, H2 group and H3 group at each time point.(4) The sedation satisfaction of H1 group, H2 group and H3 group at 4 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in sedation satisfaction among H1 group, H2 group and H3 group at each time point.(5) There was no significant difference in postoperative analgesia satisfaction and sedation satisfaction between H1 group, H2 group, H3 group and S group.(6) Children in H1 group[1(0, 2)], H2 group[1(0, 2)], H3 group[1(0, 2)] had fewer additional doses within 24 hours than that in M group[2(2, 3)]( P<0.05), and fewer children in H1 group, H2 group and H3 group had been given analgesic sedatives than that in M group ( P<0.05); The extubation time was shortest in H2 group and S group[H2 group(88.3±2.9) h, S group(85.9±3.0) h]. (7) There were no adverse reactions in H1 group, H2 group, H3 group and S group, and there were two cases of apnea in M group. Conclusion:The analgesic effect of hydromorphone in children with congenital heart disease after surgery is better than that of morphine, and the effect of hydromorphone is comparable to that of sufentanil.Hydromorphone 3-4 μg/(kg·h)+ midazolam 2 μg/(kg·min) can achieve satisfactory analgesic and sedative effects in children after congenital heart surgery, with few adverse reactions, safe and reliable, which is an excellent choice for postoperative analgesia and sedation in children.