Objective:To investigate the factors influencing the short-term prognosis of patients with acute diquat poisoning (ADQP).Methods:Patients with ADQP admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Occupational Disease Prevention Hospital from August 2015 to July 2022 were retrospectively selected. Patients were divided into survival group and death group according to 30-day survival status after poisoning. The general data and the results of the first laboratory examination after admission were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factors associated with prognosis. And the receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value of risk factors in patients with ADQP.Results:A total of 79 ADQP patients were included in this study, including 40 patients in the survival group and 39 patients in the death group. There were statistically significant differences in the age, poisoning dose, white blood cell, alanine aminotransferase, aspartate aminotransferase, serum creatinine, blood urea, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and systemic immune inflammation index (SII) between survival and death groups (all P<0.05). Multivariate logistic regression analysis showed that the poisoning dose ( OR=1.018, 95% CI: 1.001-1.035, P=0.033), serum creatinine ( OR=1.049, 95% CI: 1.005-1.095, P=0.028), and SII ( OR=1.001, 95% CI: 1.000-1.002, P=0.029) were independent risk factors for the prognosis of patients with diquat poisoning. The areas under the curves of the combined detection of poisoning dose, serum creatinine and SII was 0.968, the sensitivity was 0.949, and the specificity was 0.900, which were higher than those of the single index. Conclusions:The poisoning dose, serum creatinine and SII are independent prognostic predictors of patients with ADQP. The combination of three independent factors has higher sensitivity and specificity in evaluating the prognosis of ADQP, which could be used as a reliable indicator to predict the prognosis of patients with ADQP.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

Objective:To discuss the effect and prognostic factors of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery.Methods:The patients with malignant parotid gland tumor who underwent facial nerve rehabilitation surgery in Peking University School and Hospital of Stomatology from January 2004 to July 2020 were retrospectively analyzed. Their demographic characteristics, preoperative and postoperative facial nerve function according to the House-Brackmann (HB) facial nerve grading system from HB grade Ⅰ to HB grade Ⅵ, injury sites of facial nerve including the trunks injury and branches injury, surgical timing including immediate rehabilitation and elective rehabilitation and rehabilitation methods such as facial nerve anastomosis, nerve transplantation, nerve transfer and muscle flap suspension were recorded. Patients were divided into two groups: satisfactory outcomes with HB grades Ⅰ-Ⅲ and unsatisfactory outcomes with HB grades Ⅳ-Ⅵ, and the factors that may affect the prognosis of facial nerve function were statistically analyzed. T-test was used to compare measurement data, chi-square test or Fisher’s precision probability test was used to compare count data. P<0.05 was considered statistically significant. Results:Eighty-nine patients were included in the study, including 50 males and 39 females, aged 9-82 years, the median age was 49.0 years. Preoperative facial nerve function outcomes were HB Ⅰ ( n=57), HB Ⅱ ( n=5), HB Ⅲ ( n=8), HB Ⅳ ( n=2), HB Ⅴ ( n=15) and HB Ⅵ ( n=2). Fifty-seven patients underwent immediate rehabilitation and 32 patients received elective rehabilitation. In 53 cases, the main trunk and/or the temporal and cervical trunk were injured, and 36 cases were branches injury. Facial nerve anastomosis was performed in 35 cases, 39 cases required nerve transplantation, 12 cases underwent nerve transfer, and 3 cases underwent muscle flap suspension. The follow-up time was 6-72 months. Postoperative facial nerve function outcomes were HB Ⅰ ( n=6), HB Ⅱ ( n=17), HB Ⅲ ( n=26), HB Ⅳ ( n=27), and HB Ⅴ ( n=13). Forty-nine cases were classified as group with postoperative HB grades Ⅰ-Ⅲ, and 40 cases were classified as group with postoperative HB grades Ⅳ-Ⅵ. Statistical analysis showed that there was no significant difference in terms of age and gender between two groups ( P>0.05). Among the patients with postoperative HB grades Ⅰ-Ⅲ, 73.5% (36/49) of the patients had immediate rehabilitation, 36.7% (18/49) of the patients had injury of the nerve trunks, 89.8% (44/49) of the patients had preoperative HB grades Ⅰ-Ⅲ, and 59.2% (29/49) of the patients had nerve anastomosis. Among the patients with postoperative HB grades Ⅳ-Ⅵ, 52.5% (21/40) of the patients had immediate rehabilitation, 87.5% (35/40) of the patients had injury of the nerve trunks, 65.0% (26/40) of the patients had preoperative HB gradesⅠ-Ⅲ, and 15.0% (6/40) of the patients had nerve anastomosis were in the group. There were statistically significant differences between the two groups ( P<0.05 or <0.01). Conclusions:Immediate reconstruction of the facial nerve defect during the operation of malignant parotid gland tumor can obtain better result. Furthermore, injury sites of facial nerve may affect the prognosis of facial nerve function as well.

Objective:To discuss the effect and prognostic factors of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery.Methods:The patients with malignant parotid gland tumor who underwent facial nerve rehabilitation surgery in Peking University School and Hospital of Stomatology from January 2004 to July 2020 were retrospectively analyzed. Their demographic characteristics, preoperative and postoperative facial nerve function according to the House-Brackmann (HB) facial nerve grading system from HB grade Ⅰ to HB grade Ⅵ, injury sites of facial nerve including the trunks injury and branches injury, surgical timing including immediate rehabilitation and elective rehabilitation and rehabilitation methods such as facial nerve anastomosis, nerve transplantation, nerve transfer and muscle flap suspension were recorded. Patients were divided into two groups: satisfactory outcomes with HB grades Ⅰ-Ⅲ and unsatisfactory outcomes with HB grades Ⅳ-Ⅵ, and the factors that may affect the prognosis of facial nerve function were statistically analyzed. T-test was used to compare measurement data, chi-square test or Fisher’s precision probability test was used to compare count data. P<0.05 was considered statistically significant. Results:Eighty-nine patients were included in the study, including 50 males and 39 females, aged 9-82 years, the median age was 49.0 years. Preoperative facial nerve function outcomes were HB Ⅰ ( n=57), HB Ⅱ ( n=5), HB Ⅲ ( n=8), HB Ⅳ ( n=2), HB Ⅴ ( n=15) and HB Ⅵ ( n=2). Fifty-seven patients underwent immediate rehabilitation and 32 patients received elective rehabilitation. In 53 cases, the main trunk and/or the temporal and cervical trunk were injured, and 36 cases were branches injury. Facial nerve anastomosis was performed in 35 cases, 39 cases required nerve transplantation, 12 cases underwent nerve transfer, and 3 cases underwent muscle flap suspension. The follow-up time was 6-72 months. Postoperative facial nerve function outcomes were HB Ⅰ ( n=6), HB Ⅱ ( n=17), HB Ⅲ ( n=26), HB Ⅳ ( n=27), and HB Ⅴ ( n=13). Forty-nine cases were classified as group with postoperative HB grades Ⅰ-Ⅲ, and 40 cases were classified as group with postoperative HB grades Ⅳ-Ⅵ. Statistical analysis showed that there was no significant difference in terms of age and gender between two groups ( P>0.05). Among the patients with postoperative HB grades Ⅰ-Ⅲ, 73.5% (36/49) of the patients had immediate rehabilitation, 36.7% (18/49) of the patients had injury of the nerve trunks, 89.8% (44/49) of the patients had preoperative HB grades Ⅰ-Ⅲ, and 59.2% (29/49) of the patients had nerve anastomosis. Among the patients with postoperative HB grades Ⅳ-Ⅵ, 52.5% (21/40) of the patients had immediate rehabilitation, 87.5% (35/40) of the patients had injury of the nerve trunks, 65.0% (26/40) of the patients had preoperative HB gradesⅠ-Ⅲ, and 15.0% (6/40) of the patients had nerve anastomosis were in the group. There were statistically significant differences between the two groups ( P<0.05 or <0.01). Conclusions:Immediate reconstruction of the facial nerve defect during the operation of malignant parotid gland tumor can obtain better result. Furthermore, injury sites of facial nerve may affect the prognosis of facial nerve function as well.