Objective To evaluate the modified POSSUM surgical scoring system in urologic surgery patients over 70. Methods 180 patients over 70 were retrospectively analyzed with the mo dified POSSUM surgical scoring system.A comparison between the observed and the predicted morbidity was made. Results In the complication group and noncomplication group,the mean age of the patients were 74.9?4.1 and 74.7?3.6,the mean length of stay were (42.1?4.2)d and (28.7? 14.2 )d,respectively.In the complication group,both the physiological scores and the operative severity scores of POSSUM scoring system were significantly higher than the no complication group ( 22.0 ? 4.1 vs 20.1?3.9 in pysiological score and 11.7?4.3 vs 10.3?3.5 in operative severity score, P

Hearing Loss ; complications ; diagnosis ; metabolism ; Humans ; Multiple Acyl Coenzyme A Dehydrogenase Deficiency ; complications ; diagnosis

BACKGROUND: Vascular injuries of the extremitiesy are frequently concomitant with vascular defects and are usually repaired by autologous vessel grafting. However, the source of autologous vessels is limited and the preparation of them is traumatic.OBJECTIVE: To retrospectively evaluate the extremity-preserving efficacy of vascular prosthesis grafting in repairing major vascular injuries of the extremities in 29 cases.DESIGN: A retrospective study.SETTING: Department of Orthopedics and Traumatic Surgery, Center for Battle Wound and Trauma of Chinese PLA, Research Institute of Surgery,Daping Hospital, Third Military Medical University of Chinese PLA.PARTICIPANTS: We selected 29 patients with major vascular injuries of the extremities repaired by vascular prosthesis grafting who received the treatment at the Department of Orthopedics and Traumatic Surgery of the Center for Battle Wound and Trauma of the Chinese PLA of the Research Institute of Surgery of, Daping Hospital of the Third Military Medical University of Chinese PLA between January 1989 and December 2000. There were 23 males and 6 females. Injury sites: 9 cases were at subclavian artery, 6 at axillary artery, 2 at brachial artery, 10 at femoral artery, 1 at femoral vein and 1 at popliteal artery. 11 of these 29 cases (37.9%) were complicated with shock, 8 with fractures and dislocations, 5 with peripheral nerve injuries and 3 with infections.METHODS: The vascular prosthesis was anastomosed end to end with the trimmed culprit vessels. As for the 3 cases with infective arterial injuries,the vessels were placed away from the infected region and were bridged together in a non-inf1ammatory region and then muscles or musculo-cutaneous flaps were used to cover the infected regions.The functions of the extremities of the patients were evaluated according to MAS at week 2 and 1 year after the operation.MAIN OUTCOME MEASURES: The vascular patency rate and the extremity-preserving outcomes..RESULTS: All 29 patients entered the stage of result analysis. Extremitypreserving efficacy: All the patients who underwent vascular prosthesis grafting had their extremities preserved. Only 1 patient had the late sequelae of ulcers in the foot sole due to extended extremity ischemia and nerve damage. The rate of 2-week patency rate of the grafted vessels was 100% and the 1-year rate of patency was 96.5%, as revealed by Doppler blood stream scanning. The excellent and good rate of the function of extremity was 89%.CONCLUSION: Vascular prosthesis grafting is the one of the methods for repairing the major vascular injuries so as to preserve the extremities and their functions.

BACKGROUND: Idiopathic scoliosis is a common spinal deformity in teenagers, which is managed mainly by orthomorphia. However, due to great trauma, long operative duration and large blood loss, a great amount of blood transfusion is needed during the surgery. Allogeneic blood transfusion should be reduced in order to release blood insufficient, decline blood transfusion expense, as well as avoid transfusion diseases. OBJECTIVE: To investigate the value of controlled hypotension combined with autotransfusion in idiopathic scoliosis orthomorphia.METHODS: Intraoperative controlled hypotension was performed during posterior orthomorphia surgery on all the 46 cases of idiopathic scoliosis, 17 cases in which were served as the control group, who underwent allogeneic blood transfusion without autotransfusion, while the other 29 cases were served as the experimental group, who underwent autotransfusion that including reinfusion of preoperative deposited autologous blood and intra-operative salvaged autologous blood. The blood loss volume and transfusion status in two groups were observed. RESULTS AND CONCLUSION: Blood loss volume in the control group was 400-1 000 (867±161) mL, and that in the experimental group was 350-1400 (842±376) mL, There was no marked difference between the two groups (P > 0.05). The volume of allogeneic blood transfusion in the control group was 500-1 800 (845±332) mL, which was greater than that in the experimental group [0-1 300(423±237) mL] (P < 0.01). The results suggested that controlled hypotension reduces intraoperative bleeding, and postoperative autotransfusion minimizes the need of allogeneic blood transfusion.

OBJECTIVE: To investigate the pure tone audiometry characteristics and curative effect in sudden hearing loss patients with hypertension. METHOD: One hundred and fifty-seven inpatients (168 ears) with hypertension suffered from sudden hearing loss were included in this study. We retrospectively analyzed the audiological index of these patients by comparing the pure tone audiometry (PTA) among patients in the aspects of gender, age, affected side, duration of hypertension, with or without inducement, concomitant symptoms and other combined diseases. The hearing threshold at different frequency was also compared, as well as the curative effect among patients with diverse audiological characteristics. RESULT: Of the contemporaneous sudden hearing loss patients (874 cases), the prevalence of hypertension was 17.96%, where the male ones accounted for. 28.69% (103/359) and the female ones accounted for 19.42% (54/278) respectively with statistically significant difference between genders (P < 0.01). The prevalence of hypertension in 34-44 years old group, 45-49 years old group, 60-69 years old group and over 70 years old group was 12.69% (25/197), 22.51% (70/311), 47.62% (40/84), 48.89% (22/45) respectively, which were statistically different (P < 0.01). The number of impaired ears with audiogram configuration characterized by rise type, downslope type, flat type and completely deafness type was 18 (10.71%), 61 (36.31%), 41 (24.40%), and 48 (28.57%), respectively. The decrease of hearing threshold in PTA were increasingly severe as the increasing impaired-frequency, and the difference of the degree of hearing impairment among these three types of frequencies was statistically significant (P < 0.01). The hearing threshold means of each frequency had no significant difference among patients with various gender, age and Cardiovascular Risk Stratification (P > 0.05). The hearing threshold means of each frequency of unilateral hearing loss patients was significantly higher than that of bilateral hearing loss patients (P < 0.05). The hearing threshold means at 125 Hz, 250 Hz, 500 Hz and 1 kHz showed significant difference among patients with different duration of hypertension (P < 0.05). The total effective rate of sudden hearing loss in patients with hypertension was significantly lower than that in the sudden hearing loss patients without hypertension (19.64%, 61.57% respectively, P < 0.01). The total effective rate presented significant difference among patients with different duration of hypertension and different Cardiovascular Risk Stratification (P < 0.05). CONCLUSION The prevalence of sudden hearing loss in hypertension patients was higher in male than in female, which rose with age and combined disease. The hearing threshold means at mid-frequency and high-frequency were higher than that at low-frequency. The total effective rate of sudden hearing loss was relatively low in patients with hypertension. The longer the duration of hypertension and the higher the Cardiovascular Risk Stratification, the lower the total effective rate. Comprehensive understanding of audiological characteristics and hypertension condition plays a crucial role in type-specific treatment of sudden hearing loss.
Adult ; Aged ; Audiometry, Pure-Tone ; Deafness ; Female ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; complications ; Hearing Loss, Unilateral ; Hearing Tests ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

Objective:To study the effect of quality control circle(QCC)on the reasonable ratio of clinical prescriptions. Methods:The dispensed prescriptions in orthopedic emergency department were reviewed in our hospital,and the reasons of unreasonable prescriptions were analyzed. According to the QCC technique,the activities were implemented,the standardized work process was made out and the results were studied. Results:After the six-month QCC activities,the unreasonable ratio of emergency orthopedics prescriptions was reduced from 70% to 21% ,and the target yield rate was 140% and the improvement rate was 70% . Conclusion:The QCC has obvious effect on the improvement of reasonable ratio of emergency orthopedics prescriptions.

AIM:To establish and characterize the patient-derived esophageal squamous-cell carcinoma xeno-graft (PDECX) in mice.METHODS:The samples of human esophageal cancer were grafted into severe combined immu-nodeficient ( SCID) mice.The xenografts were transferred to SCID mice when the first passage of xenografts grew up .The growth of tumors in the first, second and third passages was observed .HE staining was performed.The expression of CK5/6, p63 and p40 in the patient samples , and the first and third passages of the xenografts were detected by immunohisto-chemical analysis.The expression of mTOR, p-mTOR, p70S6K, p-p70S6K, Akt1, p-Akt (Ser473), Erk1/2 and p-Erk1/2 were determined by Western blot .RESULTS:The PDECX was successfully established .The positive expression of CK5/6, p63 and p40 in the xenografts was consistent with that in the patients ’ samples.The levels of phosphorylated and total proteins of proliferation-related signaling pathways were different in the xenografts from different patients .CONCLU-SION:The PDECX model adequately reflects the tumal heterogeneity that is observed in the patients .

OBJECTIVE: To analysis the characteristics of sudden sensorineural hearing loss (SSHL) patients with tinnitus, and explore the relationship of characteristics of tinnitus and audiology. METHOD: Patients diagnosed as SSHL with tinnitus were studied in the research. All patients' clinical features were analyzed, such as tinnitus frequency, pure tone audiometry, tinnitus, hearing loss degree, results of residual inhibition test. RESULT: Thirty cases were identified as mild degree hearing loss, 13 cases as moderate degree, 28 cases as severe degree and 34 cases as profound degree. And hearing impaired frequency of 13 cases was ascertained at low-frequency, 39 cases at middle-high-frequency, and 53 cases at full-range-frequency. The incidence of patients with low-frequency was about 41. 9% (44/105), and it was about 21. 9% (23/105) in those with middle-frequency. And it was 36. 2% (38/105) in cases of high-frequency tinnitus. The chi-square test show statistically significant differences between patients with the low-frequency, middle-frequency and high-frequency of the hearing loss (P<0. 05). In tinnitus residual inhibition test, positive rate of convergence type masking curve was about 72.0%, tinnitus separated type masking curve 20.0%, overlapping type was 57.9%, and the spacing type was 43.5%. There was a statistically significant difference among cases with different type masking curve (P<0. 05)with the spacing residual inhibition test positive rate. CONCLUSION There are individual differences of clinical characteristics among SSHL patients with tinnitus. Tinnitus frequency is consistent with the frequency of hearing loss. Patients had the more serious the degree of hearing loss, who had more serious tinnitus grading. Cases with the converged type curve will be fit for tinnitus masking. Therefore, combining the tinnitus detection with the audiological tests, we could obtain the clinical characteristics of SSHL patients with tinnitus.
Audiometry, Pure-Tone ; Deafness ; Hearing Loss ; Hearing Loss, Sensorineural ; complications ; pathology ; Humans ; Tinnitus ; complications ; pathology

Objective: To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Methods: Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Patients were followed clinically every 3 months within one year after procedure. Immediate electrocardiogram was performed in patients with palpitation or choking sensation in chest. The end point of the study was recurrence of any atrial tachyarrhythmia lasting >30 seconds in device interrogation, 24-hour Holter monitoring or 12-lead electrocardiogram after a single procedure. After the ablation procedure, a blanking period of 3 months was allowed according to the guidelines. Procedure time, radiofrequency time, fluoroscopy time, the detection of paroxysmal supraventricular tachycardia, the success rate and the complications were compared between the two groups. Results: There was no difference in the baseline characteristics between the two groups, such as age, gender, BMI, complications, LVEF, LAD (all P>0.05). The duration of procedure ((117.8±51.7)minutes vs.(115.4±36.9)minutes, P=0.79), duration of fluoroscopy((12.5±11.2)minutes vs. (10.4±10.2)minutes, P=0.35), duration of radiofrequency((40.1±12.9)minutes vs. (48.6±44.3)minutes, P=0.48) were similar between the two groups (P>0.05). Compared with S group, discovery of the frequency of atrioventricular node reentrant tachycardia (AVNRT) was significantly lower in GA group (0 vs. 3.6%(10/278), P<0.01), but the difference disappeared with repeat electrophysiological examination when patients become conscious from GA(3.2%(7/220) vs. 3.6%(10/278), P=0.311). The difference of atrioventricular reentrant tachycardia (AVRT) was similar between the two groups(0.9%(2/220) vs. 0.7%(2/278), P=0.841). Compared with S group, reflection of vagus nerve was less in GA group (1.4%(3/220) vs. 8.6%(24/278), P=0.026). After following up of (356±92) days, freedom from atrial fibrillation/atrial flutter/atrial tachyarrhythmia was similar between the two groups(77.9%(162/208) vs. 79.9%(215/269), P=0.818). Conclusion General anesthesia is a promising method to atrial fibrillation ablation, in view of stable patient status and safety for the procedure. There is no difference in complications, recurrence of arrhythmia between the two groups, but detection rate of AVNRT is lower in GA group.