Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective analyze the clinical efficacy of percutaneous endoscopic lumbar posterior fusion(PE-PLIF)in the treatment of lumbar spondylolisthesis and evaluate its safety and effectiveness.Methods From January 2018 to December 2021,46 patients with grade Ⅰ degenerative lumbar spondylolisthesis underwent PE-PLIF surgery in the Department of Orthopedics of our hospital.General data such as age,gender,body mass index(BMI),operative time,blood loss and fluoroscopy were collected.Visual analogue scale(VAS)and Oswestry Disability Index(ODI)scores were compared before surgery,3 days and 12 months after surgery to analyze the efficacy.Macnab was used to evaluate patient satisfaction,and Lenke was used to evaluate fusion.Follow-up was 1.2 to 3.3 years.Results The average operative time of the patients was(143.76±34.39)min,the average intraoperative fluoroscopy was(6.98±0.75)times,and the average hospitalization was(9.13±3.68)days.The VAS scores before low back pain ranged from 2 to 9,with an average of(6.14±2.79).The VAS score at 3 days after operation was 0-5,with an average of(2.02±1.52)points,and the difference was statistically significant compared with that before operation(P＜0.05).The VAS score at 12 months after surgery was 0 to 3,with an average of(1.09±0.92)points,which was significantly improved compared with 3 days after surgery,and the difference was statistically significant(P＜0.05).VAS scores of patients before lower extremity pain ranged from 4 to 9 points,with an average of(6.58±2.20)points.The VAS score at 3 days after surgery was 0-5,with an average of(1.72±1.45)points,and the difference was statistically significant compared with that before surgery(P＜0.05).The VAS score at 12 months after surgery was 0～3,with an average of(1.13±0.95),and the difference was statistically significant compared with 3 days after surgery(P＜0.05).ODI score of patients decreased from(77.25±9.82)％before surgery to(15.73±9.86)％after 12 months of follow-up,with statistical significance(P＜0.05).Postoperative complications included cerebrospinal fluid leakage in 3 cases,radiculopathy in 2 cases,incomplete reduction in 1 case,and open surgical revision of internal fixation rupture in 1 case.According to Macnab criteria,27 patients were excellent(58.7％),15 were good(32.6％),and 4 were average(8.7％),with no adverse evaluation.Conclusion The results of this study indicate that PE-PLIF is a safe and effective treatment for mild lumbar spondylolisthesis.

Objective analyze the clinical efficacy of percutaneous endoscopic lumbar posterior fusion(PE-PLIF)in the treatment of lumbar spondylolisthesis and evaluate its safety and effectiveness.Methods From January 2018 to December 2021,46 patients with grade Ⅰ degenerative lumbar spondylolisthesis underwent PE-PLIF surgery in the Department of Orthopedics of our hospital.General data such as age,gender,body mass index(BMI),operative time,blood loss and fluoroscopy were collected.Visual analogue scale(VAS)and Oswestry Disability Index(ODI)scores were compared before surgery,3 days and 12 months after surgery to analyze the efficacy.Macnab was used to evaluate patient satisfaction,and Lenke was used to evaluate fusion.Follow-up was 1.2 to 3.3 years.Results The average operative time of the patients was(143.76±34.39)min,the average intraoperative fluoroscopy was(6.98±0.75)times,and the average hospitalization was(9.13±3.68)days.The VAS scores before low back pain ranged from 2 to 9,with an average of(6.14±2.79).The VAS score at 3 days after operation was 0-5,with an average of(2.02±1.52)points,and the difference was statistically significant compared with that before operation(P＜0.05).The VAS score at 12 months after surgery was 0 to 3,with an average of(1.09±0.92)points,which was significantly improved compared with 3 days after surgery,and the difference was statistically significant(P＜0.05).VAS scores of patients before lower extremity pain ranged from 4 to 9 points,with an average of(6.58±2.20)points.The VAS score at 3 days after surgery was 0-5,with an average of(1.72±1.45)points,and the difference was statistically significant compared with that before surgery(P＜0.05).The VAS score at 12 months after surgery was 0～3,with an average of(1.13±0.95),and the difference was statistically significant compared with 3 days after surgery(P＜0.05).ODI score of patients decreased from(77.25±9.82)％before surgery to(15.73±9.86)％after 12 months of follow-up,with statistical significance(P＜0.05).Postoperative complications included cerebrospinal fluid leakage in 3 cases,radiculopathy in 2 cases,incomplete reduction in 1 case,and open surgical revision of internal fixation rupture in 1 case.According to Macnab criteria,27 patients were excellent(58.7％),15 were good(32.6％),and 4 were average(8.7％),with no adverse evaluation.Conclusion The results of this study indicate that PE-PLIF is a safe and effective treatment for mild lumbar spondylolisthesis.

Liddle syndrome and Gordon syndrome are two rare single-gene inherited hypertension diseases. In patients≤40 years, the prevalence of Liddle syndrome is about 1% and Gordon syndrome is uncertain all over the word, for which is often misdiagnosed and mistreated. The therapies of those diseases are targeted at gene mutation sites, as well as combined with modified lifestyle, and can achieve satisfactory diseases control. This paper reports a patient who is diagnosed with Liddle syndrome and Gordon syndrome at the same time. We aimed to consolidate and improve the diagnosis and accurate treatment of those two diseases by sharing, studying and discussing together with clinical doctors.

OBJECTIVE:To provide reference for further standardizing and perfecting the management of drug unpacking in outpatient pharmacy.METHODS:A total of 6 primary and secondary health institutions (4 community health service centers and 2 secondary hospitals) were selected from 2 districts in Shanghai to conduct a questionnaire survey on the use of their drugs and drug unpacking in outpatient pharmacy.The survey data was analyzed statistically.RESULTS:Totally 6 institution questionnaires and 6 pharmaceutical staff questionnaires were sent out,all were received with recovery of 100％.In 2015,the average number of essential medicines in community health service centers and secondary hospitals were 496.50,542.00,respectively,and the average number of varieties sold were 530.75,1 052.00.In outpatient pharmacy of surveyed community health service center,the number of unpacked drugs was 10-21 which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 5.56-16.70 ten thousand yuan.In outpatient pharmacy of 2 two secondary hospitals,the number of unpacked drugs were 17 and 23,respectively,most of which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 13.19 to 158.06 ten thousand yuan.The proportion of unpacked drugs was less than 5％ of the total number of varieties sold,and the proportion of consumption sum of unpacked drugs was less than 1％ of total consumption sum.Estazolam tablets and Alprazolam tablets took up the top 5 in the list of consumption sum of unpacking drugs in 2 types of intervi ewed instiutions.All the surveyed institutions were not equipped with drug dispensing machine in the outpatient pharmacy,still depended on manually unpacking.There were four institutions to regularly arrange the unpacking,unpacking frequency was usually 1 to 3 times a week,supplemented by the need to arrange unpacking,and another two to implement a daily unpacking.There were 5 institutions to develop a drug unpacking mechanism in the institutions,but the relevant system was not perfect.CONCLUSIONS:The enthusiasm of pharmaceutical saff in primary and secondary health institutions in Shanghai to carry out or engage in unpacking work need to be improved,the instructions for unpacked drugs are not available on request,and the way to unpack drugs still needs to explore.