OBJECTIVE: To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). METHODS: Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L _{3, 4} in 4 cases, L _{4, 5} in 5 cases, and L ₅, S ₁ in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. RESULTS: All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. CONCLUSION When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Humans ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Middle Aged ; Female ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Treatment Outcome ; Operative Time ; Pain Measurement ; Length of Stay

PURPOSE: To analyze risk factors for severe trauma and establish a nomogram for early risk prediction, to improve the early identification of severe trauma. METHODS: This study was conducted on the patients treated in 81 trauma treatment institutions in Gansu province from 2020 to 2022. Patients were grouped by year, with 5364 patients from 2020 to 2021 as the training set and 1094 newly admitted patients in 2020 as the external validation set. Based on the injury severity score (ISS), patients in the training set were classified into 2 subgroups of the severe trauma group (n = 478, ISS scores ≥25) and the non-severe trauma group (n = 4886, ISS scores <25). Univariate and binary logistic regression analyses were employed to identify independent risk factors for severe trauma. Subsequently, a predictive model was developed using the R software environment. Furthermore, the model was subjected to internal and external validation via the Hosmer-Lemeshow test and receiver operating characteristic curve analysis. RESULTS: In total, 6458 trauma patients were included in this study. Initially, this study identified several independent risk factors for severe trauma, including multiple traumatic injuries (polytrauma), external hemorrhage, elevated shock index, elevated respiratory rate, decreased peripheral oxygen saturation, and decreased Glasgow coma scale score (all p < 0.05). For internal validation, the area under the receiver operating characteristic curve was 0.914, with the sensitivity and specificity of 88.4% and 87.6%, respectively; while for external validation, the area under the receiver operating characteristic curve was 0.936, with the sensitivity and specificity of 84.6% and 93.7%, respectively. In addition, a good model fitting was observed through the Hosmer-Lemeshow test and calibration curve analysis (p > 0.05). CONCLUSION This study establishes a nomogram for early risk prediction of severe trauma, which is suitable for primary healthcare institutions in underdeveloped western China. It facilitates early triage and quantitative assessment of trauma severity by clinicians prior to clinical interventions.
Humans ; Nomograms ; Male ; Female ; Wounds and Injuries/diagnosis* ; Risk Factors ; Middle Aged ; Adult ; Injury Severity Score ; Risk Assessment ; ROC Curve ; Aged ; Logistic Models ; China ; Glasgow Coma Scale

【Objective】 To investigate the allele frequencies polymorphic distribution of Duffy, Kidd and Diego blood group systems in Dongxiang ethnic group in Gansu Province. 【Methods】 Blood samples of 100 unrelated blood donors were randomly selected from Dongxiang ethnic group in Gansu from January to December 2017. Allelic typing of Duffy, Kidd and Diego blood groups was performed by fluorescence PCR. 【Results】 The allele frequencies of Duffy, Kidd, and Diego blood group systems of Dongxiang ethnic group were 0.835 for Fy^*01, 0.165 for Fy^*02, 0.570 for Jk^*01, 0.430 for Jk^*02, 0.020 for DI^*01, 0.980 for DI^*02, respectively. No Fy(a-b-), Jk(a-b-), Di(a+b-) rare phenotypes were found. The antigen incompatibility rates of Fy^a/Fy^b, Jk^a/Jk^b, Di^a/Di^b of Duffy, Kidd, and Diego blood group systems were 23.76%, 37.01% and 3.84%, respectively. 【Conclusion】 The allele frequencies distribution of Duffy, Kidd and Diego blood group systems in Dongxiang ethnic group in Gansu were polymorphic and has unique ethnic distribution characteristics.

【Objective】 To investigate the resource allocation status of blood testing laboratories in 14 blood stations in Gansu Province, explore the impact of differences in basic conditions on the comprehensive testing ability of laboratories, so as to promote the homogenization and standardization of blood screening capacity in blood stations in Gansu and improve blood safety and effectivenes. 【Methods】 An evaluation index system of laboratory resource allocation was constructed and a question-naire was designed. The data of human resources, infrastructure and key equipment of 14 blood stations were collected. The entropy weight -TOPSIS method was used to evaluate and rank the resource allocation of 14 blood stations. 【Results】 In the comprehensive evaluation of blood testing laboratory resource allocation in 14 blood stations in Gansu, the top three were laboratories A, B and I, and the last three were laboratories G, M and J. On the whole, the main issue was unreasonable structure of human resources: most laboratories had unreasonable age structure; except for Laboratory A, there was no personnel with bachelor's degree or above in laboratories; most laboratories had not established a team with intermediate professional titles. In terms of infrastructure, the size of seven laboratories could not meet the needs of modern laboratory testing, and all eight blood stations had no spare nucleic acid laboratories nor a mutual spare laboratory with other blood stations As for the key equipment, 5 laboratories had no automatic blood grouping diagnostic instrument, 5 laboratories only had one set of enzyme immunoassay detection system, 3 laboratories had no spare equipment for the key equipment, which means if the equipment failure could not be repaired in time, the release of results would be affected. 【Conclusion】 There were significant differences in human resources, infrastructure and key equipment of blood testing laboratories in 14 blood stations in Gansu, which had a great impact on laboratory testing capacity and subsequent development. It is suggested that governments at all levels and health administrative departments optimize the input of laboratory resource allocation according to the blood collection volume of blood stations to gradually narrow the differences in resource distribution between different regions, improve the degree of laboratory automation and optimize the personnel structure, so as to build high-quality and efficient blood testing laboratories and ensure the safety of clinical blood use.

OBJECTIVE: To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. METHODS: Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. RESULTS: All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. CONCLUSION The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
Male ; Female ; Humans ; Child ; Child, Preschool ; Calcium Sulfate ; Humerus ; Humeral Fractures/surgery* ; Plastic Surgery Procedures ; Fracture Fixation, Internal/methods* ; Bone Wires ; Fracture Healing ; Treatment Outcome ; Range of Motion, Articular

Objective:To evaluate the clinical effects of conjoint fascial sheath suspension and frontalis muscle flap suspension in correction of severe blepharoptosis.Methods:The databases of China National Knowledge Infrastruction (CNK), WANGFANG DATA, VIP, PubMed, Cochrane Library and Web of Science (SCIE) databases were searched. All relevant studies were collected from February 2002 to April 2019, and the clinical effects of conjoint fascial sheath suspension and frontalis muscle flap suspension in correction of severe blepharoptosis were studied. The correction effective rate, complication rate and recurrence rate between two operations were Meta analyzed.Results:A total of seven randomized controlled trial studies including 387 eyes of 315 patients were subject to final analysis. The conjoint fascial sheath suspension group had 158 patients (192 eyes) and frontalis muscle flap suspension group had 157 patients (195 eyes). The results showed that the correction effective rate of conjoint fascial sheath suspension was higher than frontalis muscle flap suspension. There were statistically significant difference between the two groups ( P<0.05). The rate of complication and recurrence were lower. There were statistically significant difference between the two groups ( P<0.05). Conclusions:The clinical effects of conjoint fascial sheath suspension are better than frontalis muscle flap suspension in correction of severe blepharoptosis.

Objective:To search, evaluate and integrate the best evidence for alleviating intraoperative pain in patients undergoing local anesthesia, so as to provide a basis for formulating intraoperative pain control plan for patients undergoing local anesthesia.Methods:Evidence-based questions were built based on the PICO model. BMJ Best Practice, UpToDate, US Guidelines, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Joanna Briggs Institute Evidence-based Health Care Center, Cochrane Library, MedlinePlus, PubMed, CINAHL, Medlive, CNKI and Wanfang Database were searched for guidelines, expert consensus, evidence summary, systematic review and other evidence on alleviating intraoperative pain in patients undergoing local anesthesia. The search time was from the establishment of the database to March 30, 2020. Two researchers with evidence-based nursing knowledge independently evaluated the quality of the literature and the level of evidence.Results:A total of 7 articles were included, including 1 guideline, 1 clinical decision and 5 systematic reviews. The 16 best evidences were summarized from 5 aspects, such as preoperative evaluation, pain recognition, intraoperative pain intervention measures, surgical pain evaluation and health education.Conclusions:This study summarizes the current best evidence for reducing the pain during local anesthesia in patients undergoing local anesthesia and provides evidence-based evidence for the selection of intraoperative pain control programs for local anesthesia in related departments.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Objective To discuss the effect of preposition of intravenous thrombolysis from ward to emergency in the treatment for patients with acute ischemic stroke. Methods A total of 392 patients with ischemic stroke in Xuanwu Hospital Capital Medical University from June 2014 to December 2016 were selected in the study. The control group contained 150 cases treated from June 2014 to June 2015, while the experimental group included 242 cases treated from July 2015 to December 2016. Patients in the control group were given intravenous thrombolysis in the ward, and patients in the experimental group received intravenous thrombolysis in the emergency. The Door-to-Needle Time (DNT) were compared between two groups. Results The DNT were (49.74±12.61) min in the experimental group and (114.95±29.48) min in the control group. The difference between two groups was statistically significant (t=16.659,P< 0.001). Conclusions The preposition of intravenous thrombolysis from ward to emergency can shorten the DNT.

Objective To know the situation of time delay from the patients with ischemic stroke arrived the emergency to accepted the thrombolysis treatment, and analyze the related factors in order to put forward effective process optimization measures. Methods Totally 122 patients with acute ischemic stroke admitted into a Beijing grade A tertiary hospital who needed receive thrombolysis treatment from June 2014 to June 2015 were selected as the research object according to the purpose sampling method. Then we recorded the time in the whole process which were devided into 4 steps ( arrived at the emergency department- obtained consultation of stroke physicians;obtained consultation of stroke physicians- arrived in CT chamber; arrived in CT chamber- got CT scan results; got CT scan results- accepted thrombolysis therapy ) . Results The time delayed in hospital of intravenous thrombolysis group and artery thrombolysis group were (114.95±29.48)min and (171.22±50.10)min. The step of biggest delta-T between the actual time and standard time of two groups were both from getting a CT scan results to accepting thrombolysis therapy.Conclusions The delay after getting a CT scan results is the most important reason of delay in hospital. Shorten the time of blood test, optimize the hospital management and perfect the construction of the green channel, can promote the situation of the delay in hospital, and, improve the efficiency of thrombolysis treatment.