Objective:To compare the clinical effects between proximal humerus internal locking system (PHILOS) inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods:A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics, The Second Hospital of Fuzhou. The patients were assigned into 2 groups according to different treatment methods. In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted: 20 males and 10 females with an age of (41.5±11.6) years; type A in 5 cases, type B in 14 cases, and type C in 11 cases by AO fracture classification. In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate: 23 males and 12 females with an age of (39.9±11.2) years; type A in 7 cases, type B in 17 cases, and type C in 11 cases by AO fracture classification. The preoperative general data, operation time, intraoperative blood loss, total incision length, fracture healing time, and shoulder and elbow VAS scores, Constant-Murley shoulder function score, Mayo elbow performance score (MEPS), and complications at the last follow-up were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There were no significant differences either in operation time, fracture healing time, or shoulder or elbow VAS pain score, Constant-Murley shoulder function score, or MEPS at the last follow-up between the 2 groups ( P>0.05). The intraoperative blood loss was (59.7±26.6) mL in the observation group and (165.7±86.4) mL in the control group, and the total incision length was (10.7±2.1) cm in the observation group and (18.6±2.7) cm in the control group, showing statistically significant differences between the 2 groups ( P<0.01). There was no injury to the radial nerve or musculocutaneous nerves, incision infection or fracture nonunion in the observation group. There were 4 cases of iatrogenic radial nerve injury, 2 cases of incision infection and 1 case of fracture nonunion in the control group, yielding a complication rate of 20.0% (7/35). The difference in the incidence of complications was significant between the 2 groups ( P<0.01). Conclusion:In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation, PHILOS inverted has advantages of less soft tissue damage, less intraoperative bleeding, and a lower risk of iatrogenic radial nerve injury than the posterior single plate.

Objective     To investigate the effect of intravenous analgesia with a wireless or traditional analgesia pump system in thoracoscopic lung resection. Methods     Patients who used the patient-controlled intravenous analgesia after thoracoscopic lung resection between June 2016 and June 2021 were enrolled in the study. They were allocated into a wireless pump group (a ZigBee-based wireless analgesia pump system collecting data automatically) and a traditional analgesia pump group. Perioperative analgesia management followed the routine standard operation protocol of Shanghai Chest Hospital. The patients’ numeric rating scale (NRS) for pain and postoperative nausea and vomiting (PONV) scores were collected for analysis from the Anesthesia Information Record System. The incidence of postoperative analgesia insufficiency (defined as NRS≥4 points) within 48 h, the incidence of PONV within 24 h, and the 48 h completion rate of analgesia pump infusion were compared. Results    A total of 59 431 patients were collected, including 24 855 males and 34 576 females, 17 209 patients in the wireless pump group, and 42 222 patients in the traditional analgesia pump group. The incidence of analgesia insufficiency within 48 h after operation (3.75% vs. 4.98%, P=0.007), the incidence of PONV within 24 h after operation (13.60% vs. 16.70%, P=0.030) in the wireless pump group were lower than those in the traditional analgesia pump group. The 48 h completion rate of analgesia pump infusion in the wireless pump group was higher than that in the traditional analgesia pump group (83.40% vs. 71.90%, P<0.001). The wireless pump group could monitor the pressing times and use of the analgesia pump, while the traditional analgesia pump group could not record the relevant data. Conclusion    Compared with the traditional analgesia pump, the wireless analgesia management system may be convenient for timely, accurate and individualized management, and has good analgesic effect and low incidence of adverse reactions, and may be more suitable for perioperative analgesia management.

Objective     To evaluate the effect of frailty on postoperative complications in elderly patients with esophageal cancer. Methods     We enrolled the patients aged≥65 years and with esophageal cancer who underwent surgical treatment in Shanghai Chest Hospital in 2021. The modified frailty index (mFI) was calculated and the patients were divided into a non-frailty group and a frailty group. The primary outcomes were the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula and chylothorax complications. Secondary outcomes were the time of extubation, the rate of unplanned re-intubation, the length of ICU stay, hospital stay, rate of readmission within 30 days after discharge and the mortality within 30 days after operation. Results     Finally 607 patients were collected. There were 273 patients in the non-frailty group and 334 patients in the frailty group. The non-frailty group had lower rates of complications including pulmonary infection (5.5% vs. 13.5%), arrhythmia (3.7% vs. 9.3%), anastomotic fistula (2.9% vs. 7.5%), and shorter ICU stay [2.0 (0.0, 4.0) d vs. 4.0 (1.0, 6.0) d] and in-hospital stay [11.5 (9.5, 13.0) d vs. 13.0 (11.0, 18.0) d], lower rates of the readmission within 30 days (2.9% vs. 6.6%) and the mortality within 30 days (0.4% vs. 1.2%) compared with the frailty group (P<0.05). Conclusion     Frail elderly patients with esophageal cancer have higher rates of postoperative complications. mFI can be used as an objective index to identify high-risk elderly patients with esophageal cancer.

Objective:To investigate the dose of intravenously infused cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery.Methods:Patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, scheduled for elective thoracic surgery under general anesthesia, were studied.The patients were connected to a muscle relaxation monitor after entering the operating room.After the completion of muscle relaxant calibration and anesthesia induction, cisatracurium was intravenously infused at a constant rate to maintain deep neuromuscular blockade (post-tetanic count [PTC]≤5 ). The infusion rate was calculated by modified Dixon up-and-down method.The first patient received cisatracurium at 0.12 mg·kg -1·h -1.If the PTC was 0 or was maintained≤5 continuously, the infusion rate was decreased 0.01 mg·kg -1·h -1 in the next patient, until PTC was >5 during operation.The mean dose for the patient was used as initial dose.Then the infusion rate was increased/decreased by 0.005 mg·kg -1·h -1.The 95% effective dose of cisatracurium (ED 95) was the median of 6 thresholds. Results:A total of 22 cases completed the study.The ED 95 of continuous intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade was 0.108 mg·kg -1·h -1(95% confidence interval 0.105-0.125 mg·kg -1·h -1). Conclusion:The dose of intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery is 0.108 mg·kg -1·h -1.

Objective To evaluate the effect of epidural block on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia. Methods A total of 348 patients with primary non-small cell lung cancer of both sexes, aged 18-80 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, with body mass index of 18-30 kg∕m2, with International Associa-tion for the Study of Lung Cancer staging criteria stage 1-2, scheduled for elective radical operation for lung cancer under general anesthesia, were divided into 2 groups ( n＝174 each) using a random number table method: general anesthesia plus patient-controlled intravenous analgesia ( PCIA) group ( group G) and general anesthesia plus epidural anesthesia plus patient-controlled epidural analgesia group ( group GE). Anesthesia was induced by target-controlled infusion of propofol and fentanyl and intravenous injection of rocuronium. The patients were tracheally intubated and mechanically ventilated to maintain the end-tidal pressure of carbon dioxide at 30-40 mmHg. Anesthesia was maintained by target-controlled infusion of propofol and intravenous injection of remifentanil. An increment of fentanyl was given immediately after chest opening and closing, and cisatracurium besylate was injected intravenously. In group GE, 0. 375%ropivacaine was epidurally injected in a initial dose of 5-8 ml followed by continuous epidural infusion at 5 ml∕h, and infusion was stopped before closing the chest. Bispectral index value was maintained at 40-60 during operation. PCIA was performed at the end of operation with fentanyl, flurbiprofen, ramosetron or palonosetron hydrochloride, and the PCA pump was set up with a 0. 5 ml bolus dose, a 15-min lockout in-terval and background infusion at a rate of 2 ml∕h in group G. Patient-controlled epidural analgesia was per-formed with 0. 15%-0. 18% ropivacaine 250 ml, and the PCA pump was set up to deliver 2-3 ml bolus dose with a 20-min lockout interval and background infusion at 4-5 ml∕h in group GE. Postoperative analge-sia was performed until 48 h after operation in both groups. Patients were followed up by telephone at half a year and 1 and 2 yr after operation. The 12-item short-form scale was used to evaluate the quality of life. Physical component summary (PCS-12) and mental component summary (MCS-12) scores were calculated. Results PCS-12 and MCS-12 scores were significantly lower at 2 yr after operation than at half a year in both groups (P＜0. 05). Compared with group G, PCS-12 and MCS-12 scores were significantly increased at 2 yr after operation in group GE (P＜0. 05). Conclusion Compared with general anesthesia alone, epi-dural block provides better effect on postoperative long-term quality of life in patients undergoing radical op-eration for lung cancer under general anesthesia.

Objective To compare the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery using different anesthetic methods in a large sample clinical trial.Methods A total of 1 380 patients of both sexes,aged 60-80 yr,with body mass index of 16-33 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical operations for lung or esophageal cancer,were divided into 3 groups (n =460 each) using a random number table:general anesthesia group (group G),general anesthesia combined with paravertebral block group (group GP),and general anesthesia combined with epidural block group (group GE).After induction of anesthesia,an epidural catheter was placed at T4-7 interspace on the operated side,and 0.375％ ropivacaine 8 ml was administrated via the catheter in group GP.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated,and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in the 3 groups.Maintenance of anesthesia was as follows:propofol was given by target-controlled infusion with the target plasma concentration of 2.5-4.0 μg/ml in the 3 groups;intermittent iv boluses of sufentanil 10 μg were given,and the total dosage was not expected to exceed 1.0 μg/kg in group G;sufentanil 10 μg was injected intravenously when necessary in group GP;0.25％ ropivacaine 5 ml was injected epidurally every 1.5 h in group GE;bispectral index value was maintained at 40-60;rocuronium was injected intravenously according to the condition in the 3 groups.The development of intraoperative atrial fibrillation was recorded.Results The incidence of intraoperative atrial fibrillation was 6.1％,3.7％ and 2.2％ in G,GP and GE groups,respectively.Compared with group G,the incidence of intraoperative atrial fibrillation was significantly decreased in group GE (P＜0.05),and no significant change was found in the incidence of intraoperative atrial fibrillation in group GP (P＞0.05).Conclusion Compared with general anesthesia,general anesthesia combined with epidural block can decrease the development of intraoperative atrial fibrillation,it is more suitable for this type of patients,however,general anesthesia combined with paravertebral block produces no improvement in the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery.

Objective To investigate the causes of recurrent hemoptysis one week after interventional treatment.Methods 56 patients with massive hemoptysis were included in this study.All patients underwent emergent interventional therapy, including angiography and embolization therapy of bronchial artery, intercostal artery, internal thoracic artery, external thoracic artery and phrenic artery via femoral artery puncture.Results 6 cases had rebleeding within one week after interventional therapy,including 2 cases with primary lung cancer,1 case with bronchiectasis,1 case with pulmonary tuberculosis,1 case with esophageal cancer after surgery,1 case with esophageal cancer after radiotherapy.Then, these patients once again underwent angiography and embolization therapy of bronchial artery,intercostal artery,internal thoracic artery,external thoracic artery and phrenic artery.Conclusion The use of vasoconstrictive drugs before intervention, diversification of pulmonary feeding artery, wide range of lesions, inappropriate embolic material and poor image quality can lead to recurrent hemoptysis after interventional treatment.

Objective To evaluate the ventilation modes and factors influencing the tidal volume(VT)in the nonventilated lung during one-lung ventilation(OLV)in patients undergoing thorascopic surgery using electrical impedance tomography.Methods Thirteen American Society of Anesthesiologists physical statusⅠ or Ⅱ patients of both sexes,aged 45-64 yr,weighing 45-80 kg,undergoing elective pulmonary surgery performed via video-assisted thoracoscope,were enrolled in the study.After anesthesia induction,a double lumen tube was placed,and correct tube placement was confirmed with a fiberoptic bronchoscope.Two-lung ventilation and OLV were performed sequentially when in supine position with a fixed VT of 8 ml/kg and respiratory rate(RR)of 12 breaths/min.When the patients were turned to lateral position(with the operated lung on the upper side),correct placement of the tube was reconfirmed with a fiberoptic bronchoscope.Bilateral lungs were ventilated with VT of 8 ml/kg and RR of 12 breaths/min,and unilateral lungs were then ventilated in the following modes in sequence:VT 8 ml/kg and RR 12 breaths/min for the lung on the upper side;VT 8 ml/kg and RR 12 breaths/min for the lung on the lower side;VT 8 ml/kg,RR 12 breaths/min and positive end-expiratory pressure(PEEP)4 cmH2O for the lung on the lower side;VT 6 ml/kg and RR 16 breaths/min for the lung on the lower side;VT 4 ml/kg and RR 24 breaths/min for the lung on the lower side.Each ventilation mode stabilized for 2 min.At 2 min of OLV in each mode,electrical impedance tomography was used to record the ventilation mode in the nonventilated lung,anesthesia machine was used to record VT in the nonventilated lung,and the percentage of VT on nonventilated side in VT on ventilated side(VT-non/VT-ven%)was calculated.When the unilateral lung on the lower side was ventilated in lateral position,logistic regression analysis was used to analyze the correlation between VT on ventilated side(no PEEP)and that on nonventilated side.Results Opposite ventilation was found in the nonventilated lung during OLV.VT-non/VT-ven% was significantly higher in lateral position than in supine position(P<0.05).VT-non/VT-ven% was significantly higher when the lung on the lower side was ventilated than that when the lung on the upper side was ventilated(P<0.05).Four cmH2O PEEP exerted no effect on VT-non/VT-ven%.When the lung on the lower side was ventilated in lateral position,there was a linear positive correlation between VT on ventilated side(no PEEP)and that on nonventilated side(r=0.899,P<0.05).Conclusion During OLV in patients undergoing thorascopic surgery,there is opposite ventilation in the nonventilated lung,and VT is influenced by body positions and VT in contralateral lungs.

Objective To screen the risk factors for postoperative residual neuromuscular blockade (RNMB) in the patients undergoing thoracic surgery.Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia,without neuromuscular disease,skin temperature ≥32 ℃,were transferred to the postanesthesia care unit (PACU) after surgery and given synchronized intermittent mandatory ventilation.Neuromuscular blockade was monitored immediately after admission to the PACU,and the occurrence of postoperative RNMB was defined as a train of four (TOF) ratio ＜90％ at the time of extubation.The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred.Each parameter of baseline patient characteristics,complications,sites and methods of surgery,anesthesia time,requirement for muscle relaxants during surgery,TOF ratio on arrival to the PACU,requirement for muscle relaxant antagonists in the PACU,and extubation time were recorded.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB.Results A total of 385 patients developed postoperative RNMB,and the incidence was 52.5％.The results of multivariate logistic regression analysis showed that complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium ≥ 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min were independent risk factors for postoperative RNMB (P＜0.05).Conclusion Complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.

Objective To evaluate the effects of different doses of compound Xuelian capsule on bone cancer pain (BCP) in rats.Methods Fifty pathogen-free adult female Sprague-Dawley rats,weighing 200-220 g,aged 7-8 weeks,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S),group BCP,and compound Xuelian capsule 50,100 and 200 mg · kg-1 · d-1 groups (group CX50,group CX100 and group CX200).BCP was produced by injecting Walker256 mammary gland carcinoma cells into the intramedullary space of the right femur bone.At 11-21 days after inoculation of the tumor ceils,normal saline containing compound Xuelian capsule 50,100 and 200 mg · kg 1 · d 1 was injected through a tube into stomach once a day in CX50,CX100 and CX200 groups,respectively.The mechanical paw withdrawal threshold (MWT) and limb use score were measured at 1 day before inoculation of the tumor cells (baseline) and 4,7,11,14,17,19,and 21 days after inoculation of the tumor cells.Results Compared with group S,the MWT at 4-21 days after inoculation of the tumor cells was significantly decreased,and limb use score was significantly decreased at 11-21 days after inoculation of the tumor cells in BCP,CX50,CX100 and CX200 groups (P＜0.05).Compared with group BCP,the MWT was significantly increased at 19-21 days after inoculation in group CX50,at 17-21 days after inoculation in group CX100 and at 14-21 days after inoculation in group CX200,and limb use score was significantly increased at 14-21 days after inoculation in group CX100 and at 17-21 days after inoculation in group CX200 (P＜0.05).Conclusion Compound Xuelian capsule 50,100 and 200 mg· kg 1 · d 1 (for 11 consecutive days) can reduce BCP in a dose-dependent manner in rats.