Objective To investigate the perioperative analgesic effect of ultrasound-guided bilateral thora-columbar interfascial plane block(TLIPB)in patients with discogenic low back pain(DLBP)undergoing percuta-neous transforaminal endoscopic discectomy(PTED).Methods Fifty-seven patients with discogenic low back pain admitted to the First Affiliated Hospital of Anhui Medical University from January 2022 to April 2022 were randomly divided into group A(control group)with 28 patients and group B(ultrasound-guided bilateral thoracolumbar inter-fascialinterfacial plane block group)with 29 patients.The differences of visual analogue scale(VAS)at rest and turning over were compared between the two groups preoperative(t0),2 hours postoperative(t1),6 hours postop-erative(t2),12 hours postoperative(t3)and 24 hours postoperative(t4).The differences of quality of recovery-15 scores(QoR-15)were compared between the two groups preoperative and 24 hours postoperative.The changes of mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups after entering the oper-ating room(T0),at the time of skin incision(T1),at the time of foraminoplasty(T2),at the time of the most severe pain recognized by the surgeon(T3),and at the end of the operation(T4).Adverse events were recorded during the operation and within 24 hours postoperative.Results All patients successfully completed the operation and ultrasound-guided bilateral TLIPB,without intervertebral space infection,spinal cord,nerve root and vascular injury,and serious complications such as nausea and vomiting.VAS scores at rest and turning over and QoR-15 scores at 24 hours postoperative were significantly lower than preoperative in the two groups(P<0.05).There was no significant difference in VAS scores between the two groups at rest at preoperative and postoperative time points(P>0.05).There were significant differences in VAS scores at 2 hours,6 hours and 12 hours postoperative between the two groups(P<0.05).There were significant difference in QoR-15 scores between the two groups at preoperative and 24 hours postoperative(P>0.05).There was a significant difference in QoR-15 scores between the two groups at 24 hours postoperative(P>0.05).There were significant differences in MAP and HR between the two groups at the time of foraminoplasty(T2)and at the time of the most severe pain recognized by the surgeon(T3)(P<0.05).Conclusions Ultrasound-guided bilateral thoracolumbar interfascial plane block can effectively relieve the pain after PTED,reduce the occurrence of perioperative stress response and adverse events,accelerate the postoperative rehabilitation of patients,and shorten the postoperative duration of hospitalization.

Three cases of lower lumbar nerve root gangliomas with spinal instability or lumbar disc herniation are reported. The first patient was treated for lumbosacral pain and discomfort for more than 10 days. Preoperative diagnosis was L 5S 1 intervertebral instability, L 5 bilateral spondylolysis, and L 5S 1 left intervertebral foraminal space occupying lesions to be investigated, the tumor was removed intraoperatively and sent to pathology. Meanwhile, L 5S 1 posterior interbody bone graft fusion and internal fixation were performed. The second patient presented for 1 month due to left lumbar and leg pain and discomfort. Preoperative diagnosis was L 4-5 intervertebral instability and L 4-5 intervertebral disc herniation. Intraoperative exploration revealed a nerve root mass on the left side of L 5, which was surgically removed and sent to pathology. Meanwhile, posterior decompression of L 4 and L 5 intervertebral bone grafting and internal fixation were performed. The third patient presented for 4 days with right lumbar and leg pain and discomfort. Preoperative diagnosis was L 3-4, L 4-5 and L 5S 1 intervertebral disc herniation. Intraoperative exploration found a right nerve root mass of S 1, which showed invasive growth and was closely surrounded by nerve fibers. Partial resection of the mass was sent to pathology, and posterior decompression and internal fixation of L 4-5 and L 5S 1 bone grafting and fusion were performed at the same time. All 3 patients were confirmed to be ganglion neuroma by postoperative pathological examination. Three patients recovered well after surgery. Spinal ganglion cell tumor is mainly originated from primitive neural crest cell migration differentiation of sympathetic ganglion cells, and can also be derived from the sympathetic nerve and peripheral nerves. It is seen more at retroperitoneal and mediastinal, lumbosacral nerve root ganglion cells tumor is rare. Clinically, it is very close to intervertebral disc herniation and difficult to distinguish, often found during operations and less can be clearly diagnosed before operation. Surgical resection is the main treatment for ganglion cell neuroma.

BACKGROUND: Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM. METHODS: The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated. RESULTS: Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%-12%) and incremental yield of CMA in VM was 11% (95% CI: 7%-16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%-16%), 5% (95% CI: 1%-11%), 3% (95% CI: 1%-6%), and 13% (95% CI: 4%-25%), respectively. CONCLUSIONS Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.
Chromosome Aberrations ; Chromosomes ; Female ; Fetus ; Humans ; Hydrocephalus ; Karyotyping ; Microarray Analysis ; Pregnancy ; Prenatal Diagnosis ; Retrospective Studies ; Ultrasonography, Prenatal

Bypass surgery ( BSX ) and endovascular therapy ( EVT ) are the most important therapeutic method to critical limb ischemia?EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on? Concerning long?term results, BSX is better in reducing long?term mortality and improving long?term patency than EVT group? Therefore, control indications reasonably and select individualized methods, avoid the abuse of EVT are more meaningful for patients.

In order to help improving mental attention and sensory integration ability of mental retarded children, this paper proposes an interactive eyes-brain-hands coordination training system. This system realizes the principle of seeing, thinking and moving of hands by an interactive operation between the computer software custom icons and a touch control panel, so it can improve cognitive function and activity of daily living. The results show this training platform has a high degree of application and acceptance, and provides a portable training method for mental retarded children.

Bypass surgery ( BSX ) and endovascular therapy ( EVT ) are the most important therapeutic method to critical limb ischemia?EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on? Concerning long?term results, BSX is better in reducing long?term mortality and improving long?term patency than EVT group? Therefore, control indications reasonably and select individualized methods, avoid the abuse of EVT are more meaningful for patients.

Objective To investigate the efficacy of recombinent human B-type natriuretic peptide (rhBNP) in peripartum cardiomyopathy (PPCM) with refractory heart failure (RHF).Methods From January 2010 to January 2014,a total of 61 patients with PPCM-RHF of the First Hospital of Qinhuangdao were enrolled into this study.All patients were randomly assigned into the rhBNP group (30 cases) and control group (31 cases).rhBNP was given 1.5 μg/kg,2 mim intravenously in rhBNP group and then infused intravenously 0.007 5-0.030 μg/(kg · min) for 24 hours,0.015-0.030 μg/(kg · min) for 24 hours when systolic blood pressure(SBP) ≥ 85 mmHg (1 mmHg =0.133 kPa) and mean brachial arterial pressure (MBP) ≥ 65 mmHg.Routine therapy followed the clinic practice was administrated in control group for 24 hours.Recorded the dyspnea change.Blood samples were collected at different time points to investigate BNP at 6 h,14 d and 30 d.Ultrasonic cardiography (UCG) was performed to evaluate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVEDD) before the initiation of the infusion,at day 1,14 and 30 after the infusion.All patients were followed up for one month to record the main adverse cardiac events (MACE),including heart failure recurrence,cardiac death and ventricular fibrillation and tachycardia.Results The time of dyspnea resolved in rhBNP group was significantly shorter than control group ((1.69 ± 1.07) h vs (2.69 ±1.39) h,P =0.002).Concentration of plasma BNP(6 h:(296.50±123.25) ng/L,14 d:(141.37±69.54) ng/L,30 d:(107.41±33.69) ng/L) was signifisantly reduced in both groups than basic line (727.07 =± 146.84) ng/L,and it was significantly different between two groups.LVEF raised and LVEDD decreased were observed at 24 hours((52.23±4.54) mm),14 d((49.60±4.20) mm) and 30 d((42.59±3.90) mm) in rhBNP group and were significant better than the control group ((56.33 ± 4.38) mm,(53.03 ± 4.95) mm,(48.85±4.96) mm;P ＜0.05).There was no significant difference in term of LVEF between two groups after treatment.However,24 h(4.12±41.13)％,14 d(4.10±43)％,30 d(44.52±3.43)％ were significantly higher than the baseline(36.73±5.82)％ in rhBNP group.MACEs were lower in rhBNP group at 30 dayscontrast to the control(10％ (3/30) vs.42％ (13/31);P =0.005).Conclusion Compared with conventional treatment,rhBNP can effectively improve the heart function in patients with PPCM-RHF,reduce the occurrence of major adverse cardiac events in 30 d,and improve the prognosis of patients.

This report presented a male patient aged 69 years,who was admitted into our hospital for fever,hemoptysis and chest pain.Chest X-Ray showed shadows on the right lung and pleural thickening.The effect of broad spectrum antibiotic therapy was poor.With the disease progressed,pleural effusion appeared on the right side.Blood culture showed methicillin-resistant staphylococcus aureus.Pleural effusion tests indicated pyothorax,but the effects of closed chest drainage and sensitive antibiotic therapy were poor.After disentangling with open thoracic exploration,the right middle lobe was resected and the right lung lobe pathology showed Wegener granulomatosis.His blood antineutrophil cytoplasmic autoantibodies was negative.The paranasal sinus CT scan and renal function showed no abnormalities.The definitive diagnosis was pulmonary limited Wegener granulomatosis.

Objective To summarize our clinical experience of prophylaxis and treatment for complications associated with catheterization of brachial artery. Methods 87 patients underwent endovascular treatment via brachial artery. Complications associated with catheterization of brachial artery were retrospectively analyzed. Results Under ultrasonic guidance the catheterization procedure of brachial artery was successful in all 87 patients. The success rate of cannulation was 100%. In 53 patients(61% ) ultrasonic guided cannulation was successful at the first attempt, the other 35 (39% ) with 2 or more than 2 times puncture. Complications associated with catheterization of brachial artery were detected in 16 cases. The complication rate was 18. 4%. Guidewire insertion into peri vascular compartment took place in 4 cases (4. 6% ). Episodes of local hematomas were noted in 11 cases( 12. 6% ) and in three of the 11 cases nerve injuries were detected (one of which was of late-onset type). Brachial artery pseudoaneurysm was found in 1 case(1.2%). Conclusion Familiarity with the anatomical features of the brachial access, skillful application of the techniques for the catheterization, full understanding of complications and sufficient preparation of treatment strategies can prevent those complications effectively.