Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

OBJECTIVES: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common operative neurocognitive disorders, which places a heavy burden on patients, families and society. Therefore, it is very important to search for preventive drugs. Previous studies have demonstrated that perioperative use of dexmedetomidine resulted in a decrease the incidence of POD and POCD. But the specific effect of dexmedetomidine on elderly patients undergoing hepatic lobectomy and its potential mechanism are not clear. This study aims to evaluate the efficacy of intraoperative use of dexmedetomidine on preventing POD and POCD in elderly patients undergoing hepatic lobectomy and the influence on the balance between proinflammation and anti-inflammation. METHODS: This trial was designed as a single-center, prospective, randomized, controlled study. One hundred and twenty hospitalized patients from January 2019 to December 2020, aged 60-80 years old with American Society of Anesthesiologists (ASA) II-III and scheduled for hepatic lobectomy, were randomly allocated into 3 groups (n=40) using a random number table: A C group, a Dex1 group, and a Dex2 group. After anesthesia induction, saline in the C group, dexmedetomidine [0.3 μg/(kg·h)] in the Dex1 group, and dexmedetomidine [0.6 μg/(kg·h)] in the Dex2 group were infused until the end of operation. The incidences of hypotension and bradycardia were compared among the 3 groups. Confusion Assessment Method (CAM) for assessing POD and Mini Mental State Examination (MMSE) for evaluating POCD were recorded and venous blood samples were obtained for the determination of neuron specific enolase (NSE), TNF-α, IL-1β, and IL-10 at the different time below: the time before anesthesia (T0), and the first day (T1), the third day (T2), the fifth day (T3), and the seventh day (T4) after operation. RESULTS: Compared with the C group, the incidences of bradycardia in the Dex1 group or the Dex2 group increased (both P<0.05) and there was no difference in hypotension in the Dex1 group or the Dex2 group (both P>0.05). The incidences of POD in the C group, the Dex1 group, and the Dex2 group were 22.5%, 5.0%, and 7.5%, respectively. The incidences of POD in the Dex1 group or the Dex2 group declined significantly as compared to the C group (both P<0.05). However, there is no difference in the incidence of POD between the Dex1 group and the Dex2 group (P>0.05). The incidences of POCD in the C group, the Dex1 group, and the Dex2 group were 30.0%, 12.5%, and 10.0%, respectively. The incidences of POCD in the Dex1 group and the Dex2 group declined significantly as compared to the C group (both P<0.05). And no obvious difference was seen in the incidence of POCD in the Dex1 group and the Dex2 group (P>0.05). Compared with the C group, the level of TNF-α and IL-1β decreased and the level of IL-10 increased at each time points (from T1 to T4) in the Dex1 group and the Dex2 group (all P<0.05). Compared with the Dex1 group, the level of IL-1β at T2 and IL-10 from T1 to T3 elevated in the Dex2 group (all P<0.05). Compared with the T0, the concentrations of NSE in C group at each time points (from T1 to T4) and in the Dex1 group and the Dex2 group from T1 to T3 increased (all P<0.05). Compared with the C group, the level of NSE decreased from T1 to T4 in the Dex1 group and the Dex2 group (all P<0.05). CONCLUSIONS Intraoperative dexmedetomidine infusion can reduce the incidence of POCD and POD in elderly patients undergoing hepatic lobectomy, and the protective mechanism appears to involve the down-regulation of TNF-α and IL-1β and upregulation of IL-10 expression, which lead to rebalance between proinflammation and anti-inflammation.
Aged ; Aged, 80 and over ; Bradycardia ; Cognitive Dysfunction/prevention & control* ; Delirium/prevention & control* ; Dexmedetomidine/therapeutic use* ; Humans ; Hypotension/drug therapy* ; Interleukin-10 ; Middle Aged ; Postoperative Cognitive Complications/prevention & control* ; Postoperative Complications/epidemiology* ; Prospective Studies ; Tumor Necrosis Factor-alpha

Objective:To explore the clinical treatment of retinoblastoma (RB) after being treated with vitrectomy (PPV) due to misdiagnosis.Methods:A retrospective case study. From July 2015 to July 2018, 5 cases and 5 eyes of RB children diagnosed by pathological examination at the Eye Center of Beijing Tongren Hospital were included in the study. Among them, there were 3 males with 3 eyes and 2 females with 2 eyes; all of them had monocular disease. The average age was 4.8±1.7 years old. At the first visit, the diagnosis was endophthalmitis in 2 eyes (40%, 2/5); vitreous hemorrhage in 3 eyes (60%, 3/5). All were treated with PPV. All children underwent slit lamp microscopy, orbital MRI and CT, and eye color Doppler ultrasound blood flow imaging. If there was no clear extraocular spread, the eyeball removal combined with artificial orbital implantation was performed; if there was clear extraocular spread, the modified orbital content enucleation operation was performed with part of the eyelid preserved. The average follow-up time after surgery was 34.6±7.9 months.Results:Among the 5 eyes, 2 eyes (40%, 2/5) underwent eyeball enucleation combined with stage I artificial orbital implantation, and 3 eyes (60%, 3/5) with modified orbital content enucleation. There were 2 eyes of endogenous type (40%, 2/5), 1 eye of diffuse infiltration type (20%, 1/5), and 2 eyes of mixed type (40%, 2/5). The orbit spread in 3 eyes, the tumor invaded the optic nerve in 1 eye, and regional lymph node metastasis in 2 eyes. All children received systemic chemical therapy (chemotherapy). During the follow-up period, there were no new metastatic diseases and no deaths.Conclusions:After RB misdiagnosis and PPV, surgical treatment should be performed as soon as possible. If there is no clear extraocular spread, eyeball removal or combined stage I orbital implantation should be performed. If there is clear extraocular spread, the orbital contents should be enucleated; Chemotherapy should be combined after surgery.

To observe the safety and impact on the short-term prognosis for patients of stroke volume variation (SVV) goal-directed fluid therapy (GDFT) in laparoscopic precision hepatectomy.
 Methods: A total of 120 patients (18-65 years old) undergoing laparoscopic precision hepatectomy were randomly divided into the fluid therapy group (group S) guided by SVV and the fluid therapy group (group C) guided by central venous pressure group (CVP), with 60 cases in each group. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time: at home calm (T0), the operation started (T1), began to cut the liver (T2), the hepatectomy was acheived (T3), and in the end (T4). The lactic acid was measured at T0 to T4 and 1 day after surgery (T5). The amount of blood loss, urine output and fluid supplement, the incidence of intraoperative hypotension, and the use of neophryn were recorded. The recovery of liver function, Hb, and so on were also recorded.
 Results: Compared with the group C, the number of hypotension cases, the amount of blood loss and the amount of neophryn in the group S were decreased during the operation (P<0.05), while the lactic acid values in the group S were not significantly increased than those in the group C at T3 and T4 (P<0.05) and the elevation of AST, ALT, DBIL and TBIL in the group S was significantly decreased than those in the group C at 1 and 2 d after the operation (P<0.05). Hb and Hct in the group S were higher than those in the group C at 1 d after the surgery (P<0.05). Compared with the group C, the postoperative exhaust time and hospitalization time were shortened in the group S (P<0.05), and the infection rate and ICU admission rate were decreased in the group S (P<0.05).
 Conclusion: SVV-guided GDFT in laparoscopic precise hepatectomy is safe and effective. It reduces intraoperative blood loss and benefits the short-term prognosis of patients after operations. High SVV value (13%-17%) is adopted at the liver resection stage, and SVV value with 8%-12% at the end of trans-section may be used as one of intraoperative liquid therapy in laparoscopic precise hepatectomy.
Adolescent ; Adult ; Aged ; Central Venous Pressure ; Fluid Therapy ; Hepatectomy ; Humans ; Laparoscopy ; Middle Aged ; Stroke Volume ; Young Adult

OBJECTIVE:To study the effects of Dianxianqing granule on the interleukin(IL-6)content and glial fibrillary acid-ic protein(GFAP),ionized calcium linker molecules 1(Iba-1)expressions in hippocampus tissue of rats with kainate-induced epi-lepsy,and explore its mechanism of preventing and treating epilepsy. METHODS:Rats were randomly divided into sham operation group (distilled water),model group (distilled water),phenytoin group (0.03 g/kg,positive control) and Dianxianqing granule low-dose,medium-dose,high-dose groups(4.74,9.47,18.94 g/kg,calculated by crude drug),20 in each group. Rats were intra-gastrically administrated once a day,for 7 d. After 1 h of last administration,except for sham operation group,rats in other groups received single injection of kainite in hippocampus CA1 of left side to induce the epilepsy model. Behavioral changes and death of rats were observed. After 24 h of modeling,enzyme-linked immunosorbent method was used to detect the IL-6 content in hippocam-pus tissue of rats,Nissl staining was used to count the hippocampus neurons,and immunohistochemistry was used to detect the GFAP,Iba-1 expressions in hippocampus tissue of rats. RESULTS:Compared with sham operation group,rats in model group had obvious epilepsy symptoms after modeling,and parts of rats died;IL-6 content and number of neurons in hippocampus tissue were obviously decreased (P<0.01), while GFAP, Iba-1 expressions were obviously enhanced (P<0.01). Compared with model group,epilepsy symptoms and death in each administration group had improved,while IL-6 content in hippocampus tissue were in-creased to varying degrees,with no statistical significance (P>0.05). The numbers of neurons in phenytoin group,Dianxianqinggranule medium-dose, high-dose groups were obviously in-creased(P<0.01);GFAP expression was obviously decreased (P<0.01). Iba-1 expressions in hippocampus tissue in phenyt-oin group,Dianxianqing granule high-dose group were obvi-ously decreased (P<0.01). CONCLUSIONS:Dianxianqing granule can play the role in preventing and treating epilepsy by inhibiting GFAP,Iba-1 expressions in hippocampus tissue and in-creasing the number of neurons in hippocampus tissue.

Objective To evaluate the effect of dexmedetomidine on spinal p38 mitogen?activated protein kinase ( p38MAPK) expression during remifentanil?induced hyperalgesia in rats with incisional pain. Methods Forty?eight healthy male Sprague?Dawley rats, aged 6 weeks, weighing 220-250 g, were ran?domly divided into 4 groups ( n= 12 each) using a random number table: control group ( group C) , inci?sion pain group ( group IP ) , incision pain + remifentanil group ( group IP+R ) , and incision pain +remifentanil + dexmedetomidine group ( group IP+R+D) . After successful establishment of the model of in?cisionsal pian, remifentanil 1?0μg∕kg was infused for 4 h via the tail vein in group IP+R; remifentanil 1?0μg∕kg was infused for 4 h via the tail vein, and dexmedetomidine 10μg∕kg was simultaneously infused for 4 h via the jugular vein in group IP+R+D; the equal volume of normal saline was infused for 4 h via the tail and jugular veins in C and IP groups. The mechanical paw withdrawal threshold ( MWT) was measured at 24 h before operation ( T0 ) , and at 4, 6, 24 and 48 h after the end of drug infusion ( T1?4 ) . After meas?urement of MWT at T4 , the expression of p38MAPK was determined using immuno?histochemistry. Results was up?regulated at T4 in IP and IP+R groups ( P<0?05) , and no significant change was found in the MWT and expression of p38MAPK in group IP+R+D (P>0?05). Compared with group IP, the MWT was signifi?cantly decreased at T1?4, and the expression of p38MAPK was up?regulated at T4 in group P+R, and the MWT was significantly increased at T1?4, and the expression of p38MAPK was down?regulated at T4 in group IP+R+D (P<0?05). Compared with group IP+R, the MWT was significantly increased at T1?4, and the expression of p38MAPK was down?regulated at T4 in group IP+R+D ( P<0?05) . Conclusion The mecha?nism by which dexmedetomidine reduces hyperalgesia induced by remifentanil is related to down?regulation of spinal p38MAPK expression in the rats with incisional pain.

Purpose:To investigate the indications, operational method and effect of TURBt.Methods:From June of 1989 to June of 1999, 94 cases of patients with bladder tumors were admitted , of which 70 were treated by transurethral resection with simple electrical cuff, and 24 were treated by transurethral resection with vaporizing electrical cuff.Results:86 cases had been followed up for0.5～10 years, 39 had recurrence.4 of them recurred with hither grade. There is no obvious difference of the recurrence rate between patients with partial cystoectomy and those with TURBt.Conclusions:There are many advantages such as simpler operation, less lesion, less blood loss and faster recovery. The operation method can reserve good bladder function and even may replace the partial cystoectomy.