Objective To investigate the incidence and causes of medication errors(MEs)related to aspirin in the eld-erly(≥60 years old)of China,to provide data for targeted precautions,and to promote medication safety in the elderly.Methods Reports about aspirin-related MEs in the elderly were extracted from the National Monitoring Network for Clinical Safe Drug Medication from September 22,2012 to September 22,2022.The severity of errors,content of errors,where errors were made,the personnel who made these errors,and causes of errors were analyzed retrospectively and statistically.Results A total of 386 MEs reports were extracted,235 males and 151 females,with a median age of 70(60-98)years old.Regarding the severity of MEs,errors of class B were dominating(314 cases,81.35%).As for the severe MEs(9 cases,2.33%),5 cases of ME were as-sociated with bleeding.There are four patients suffering from gastrointestinal bleeding:one patient took aspirin three times a day,one patient broke off enteric-coated tablets,one patient took aspirin as acarbose mistakenly,one patient took aspirin with Xuesai-tong for long time.One patient had urinary urgency,but did not seek medical attention in time,then developed into visible hema-turia.Two patients missed taking aspirin led to stent thrombosis.One patient suffered from diarrhea after overdosing on 29 pills of aspirin by mistake.One patient with hyperuricemia had gout after taking aspirin.Among these 386 MEs,224(58.03%)cases were triggered by physicians,the first three error factors were frequency(multiple times a day),dosage(the dosage of enteric-coated tablets is not the whole tablet),and variety.Most of these MEs were due to a lack of knowledge or training,and fatigue.Regarding the MEs caused by pharmacists(87 cases,22.54%).Pharmacists identified 274 cases(70.98%)of errors.Conclusion When it comes to aspirin-related MEs,it ought to be noticed that the drug usage and dosage,drug interaction,and selection of drug varieties when combining with other diseases(such as atrial fibrillation and hyperuricemia).It is recommended that information construction be fortified to decrease the ME of the prescription link,and the clinicians be better informed of rational drug use.At the same time,patient medication education should be improved.

Purpose: Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high. Methods: One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods. Results: Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001). Conclusion Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

Objective:To compare the therapeutic results between axis pedicle screwing assisted by intraoperative 3-D navigation and freehand axis pedicle screwing in the treatment of Hangman fracture.Methods:A retrospective analysis was performed of the 64 patients with Hangman fracture who had received posterior axis pedicle screwing at Department of Spinal Surgery, The Sixth Hospital of Ningbo from May 2014 to December 2019. According to the placement methods of axis pedicle screws, they were divided into a navigation group ( n=34, subjected to axis pedicle screwing assisted by intraoperative 3-D navigation) and a freehand group ( n=30, subjected to freehand axis pedicle screwing). Pedicle screw placement time, operation time, intraoperative bleeding, fluoroscopy time, hospital stay, total hospitalization cost and complications were recorded and compared between the 2 groups. The accuracy of axis pedicle screw placement was evaluated according to the postoperative cervical CT and screw grading criteria proposed by Park et al. At admission, 3 months postoperation, and the last follow-up, neurological function of the patients was evaluated by modified Japanese Orthopedic Association (mJOA) score, neck pain was evaluated by visual analogue scale (VAS), and C2/3 vertebral body angulation and C2 forward displacement were measured. The clinical efficacy was evaluated by Moon grading at the last follow-up. Results:The navigation group and the freehand group were comparable due to insignificant differences between them in the preoperative general data ( P>0.05). The accuracy of screw placement in the navigation group (98.2%, 54/55) was significantly higher than that in the freehand group (85.2%, 46/54) ( P<0.05). The screw placement time, operation time, fluoroscopy time and total hospitalization cost in the navigation group were significantly more than those in the freehand group ( P<0.05). Vertebral artery injury occurred in 3 cases in the freehand group. Screw loosening, screw breakage or rod breakage occurred in none of the patients after operation. There was no significant difference between the 2 groups in the intraoperative bleeding, hospital stay or follow-up time ( P>0.05). In both groups, the VAS score, mJOA score, C2/3 vertebral body angulation and C2 forward displacement were significantly improved at 3 months postoperation and the last follow-up compared with those at admission ( P<0.05), but there was no significant difference between the 2 groups in the contemporary comparisons ( P>0.05). At the last follow-up, Moon grading in the navigation group was significantly better than that in the freehand group ( P<0.05). Conclusion:In the treatment of Hangman fracture, compared with freehand screw placement, axis pedicle screwing assisted by intraoperative 3-D navigation can improve accuracy and safety of screw placement and reduce postoperative complications, leading to better clinical efficacy.

Objective: To observe the safety and efficacy of fecal microbiota transplantation (FMT) in treatment of Parkinson′s disease (PD) with constipation. Methods: From September 2017 to April 2019, 22 PD patients with serious constipation in the Department of Neurology, the Affiliated Huaian No. 1 People′s Hospital of Nanjing Medical University were treated with FMT and followed up for 12 weeks. Spontaneous bowel movement (SBM) per week and scores of Wexner Constipation Scale (Wexner), Constipation Quality of Life Scale (PAC-QOL) and Parkinson′s Disease Quality of Life Questionnaire (PDQ-39) were recorded before and after transplantation. Results: Compared with the number of independent defecation and scores before treatment, the number of independent defecation per week (4.63±2.25, 5.38±1.23, 5.75±1.29, 5.54±1.30 vs 1.57±0.74), Wexner score (7.92±2.61, 5.67±1.78, 5.08±1.83, 4.92±1.78 vs 16.67±4.31), PAC-QOL score (62.3±3.2, 58.8±2.8, 57.1±3.9, 59.6±4.4 vs 110.3±14.7) and PDQ-39 score (44.8±14.8, 37.8±12.8, 32.8±12.3, 31.9±9.2 vs 58.7±16.7) were significantly improved by FMT treatment at two, four, eight and 12 weeks (P<0.01). After 12-week treatment, the effective rate was 100% (22/22), and the clinical cure rate was 86% (19/22). No serious adverse reactions occurred during treatment. Conclusion FMT is effective and safe in treating PD with constipation.

Objective To analyze the causes of revision surgery after percutaneous transforaminal endoscopic discectomy (PTED) for lumbar spinal stenosis,and to provide references for indications and operative methods.Methods From January 2015 to October 2017,206,491 and 60 patients of lumbar spinal stenosis were treated with PTED in Tianjin Hospital,Shanxi People's Hospital,Ningbo Sixth Hospital,respectively;among them,4,10 and 4 cases received revision surgery.Another 13 patients of lumbar spinal stenosis were treated with revision surgery due to poor results after PTED in other hospitals.Among 31 cases of reoperation,there were 16 males and 15 females,aged 27-82 years (average,66.2±12.7 years).The lesion segments included 1 case of L3,4,23 cases of L4,5,5 cases of L5S1,1 cases of L3-L5,and 1 cases of L4-S1.Patients were followed up after reoperation from 3 to 24 months (average,12.1 months).The causes of poor result and revision surgery were analyzed according to preoperative,intraoperative and postoperative data.Results All of 757 cases of lumbar spinal stenosis were treated with PTED in three hospitals,of which 18 cases (2.4％) were re-operated.The causes of reoperation included:bone slice displacement in 1 case;nerve injury in 4 cases;lumbar instability in 4 cases;disc protrusion in 10 cases (residual or recurrence);insufficient decompression in 21 cases;planed staging operation in 4 cases with bilateral or two-level stenosis.32 revision surgeries were performed for 31 patients,including PTED in 15 cases,microendoscopic discectomy (MED) in 1 case,mobile MED (MMED) in 5 cases,MMED assisted fusion in 2 cases,transforaminal lumbar interbody fusion (TLIF) in 4 cases,Minimally invasive TLIF (Mis-TLIF) in 2 cases,and open decompression and fusion in 3 cases.All patients experienced relieve of symptoms after revision surgery.At final follow-up,VAS leg pain deceased form 7.1±3.9 before revision surgeries to 1.9±1.2,VAS low back pain decreased form 6.3±3.2 to 1.8±1.3,ODI score decreased from 35％± 14％ to 7.6％±5％.According to the MacNab score,the result was excellent in 11 cases,good in 16 cases,and fair in 4 cases.Conclusion The treatment of lumbar stenosis with PTED has high technical requirements,the indications of PTED for lumbar stenosis should be strictly controlled according to technical conditions,and appropriate operative methods should be chosen according to the specific conditions of the lesions.Insufficient decompression,disc protrusion,lumbar instability and nerve injury are the common causes of reoperation.Suitable indications and proper operation should be selected.