Objective To explore the impact of transpedicular screw fixation on bone metabolism and clinical effi-cacy in thoracolumbar fractures.Methods Totally 77 patients with thoracolumbar fractures(T11-L2)treated at the Spinal Surgery Department of Xinxiang Central Hospital from December 2020 to June 2022 were selected as sub-jects.According to different surgical screw placement methods,the patients were divided into the cross-pedicle screw group(group A,n=41)and the transpedicular screw group(group B,n=36).The two groups were com-pared for surgical indicators(operation time,intraoperative blood loss,postoperative drainage volume,hospital stay),hematological indicators[serum alkaline phosphatase(ALP),serum bone glaprotein(BGP)],radiological indicators(anterior vertebral height ratio,correction rate of vertebral Cobb angle),and clinical efficacy indicators(Oswestry Disability Index ODI score,lumbar spine JOA score).Results The operation time of group A was longer than that of group B(P＜0.05).There was no significant differences in intra-operative blood loss,post-operative drainage volume,and hospital stay between the two groups(P＞0.05).At 3 days after surgery,the hematological indicators of both groups were higher than those of before surgery and the data of group A were higher than those of group B(P＜0.05).At 3 months after surgery,the hematological indicators of Group B were higher than those be-fore surgery and those of group A(P＜0.05).The anterior vertebral height ratio of both groups were better than those before surgery at 3 days,3 months,and 1 year after surgery(P＜0.05).At 1 year after surgery,the anterior vertebral height ratio and Cobb angle correction rate of group A were better than those of group B(P＜0.05).The clinical efficacy indicators of both groups were better than those before surgery at 3 days,3 months,and 1 year after surgery(P＜0.05).At one year after surgery,the clinical efficacy indicators of group A were better than those of group B,and the differences were statistically significant(P＜0.05).Conclusions In the treatment of thoracolum-bar fractures,compared with the cross-pedicle screw fixation method,the transpedicular screw fixation method has an early stimulating effect on bone metabolism indicators,speeds up healing of fractures and has more advantages in maintaining spinal correction and improving spinal function.

【Objective】 To explore a RhD negative blood collection and supply mode suitable for Liaocheng area and improve the blood demand satisfaction rate of RhD negative patients. 【Methods】 Under different collection and supply modes (collection mode: in 2020, not advocate walk-in donation by RhD negative repeat blood donors, but in 2021 and 2022 were the opposite; supply mode: in 2020, type A, B, O and AB RBCs were frozen within 6 days of blood collection without inventory, but in 2021 and 2022, they were stored of 2-6 U and the remaining were frozen within 6 days of blood collection), RhD negative blood was divided into Type A, B, O and AB, appointment donation and walk-in donation, first donation and repeat donation, cold storage red blood cells(RBCs), frozen RBCs and frozen thawed deglycerolized RBCs, and the collection and supply data of each observation group from 2020 to 2022 were compared. Based on whether blood demand of RhD negative patients was met, the patients were divided into the group of going to other places for medical treatment, the group of RhD positive blood transfusion and the group of RhD negative blood transfusion to analyze the blood usage. 【Results】 From 2020 to 2022, the proportion of RhD negative blood donated by repeat appointment donors decreased year by year (P<0.05); the proportion of RhD negative blood donated by repeat walk-in donors increased year by year (P<0.05); the proportion of frozen thawed deglycerolized RBCs to RhD negative RBCs increased year by year (P<0.05); the proportion of cold storage RBCs distributed as RhD negative and RhD positive decreased year by year respectively (P<0.05); the proportion of the increase in frozen RBCs inventory to the current year's frozen RBCs inventory decreased year by year (P<0.05). The satisfaction rate of blood demand of RhD negative patients increased year by year (P<0.05), with the number of patients with RhD positive blood transfusion and going to other places for medical treatment decreased year by year respectively(P<0.05). 【Conclusion】 In Liaocheng area, it is appropriate to encourage RhD negative blood donors to donate blood randomly, and A, B, O and AB type cold storage RBCs kept in 2-6 U inventory respectively. When exceeding the inventory, frozen RBCs are prepared within 6 days, which can improve the blood demand satisfaction rate of RhD negative patients and avoid sending excessive RhD negative RBCs to clinical use as RhD positive RBCs.

Practice teaching and supervision has become an important part of hospital social work practice, and the handling and response to internship dilemma is the problem that every institution supervisor needs to think a-bout. Based on qualitative interview and text analysis, starting from the needs of intern, this paper found that students of social work major mainly faced the following dilemma in the process of hospital practice: role adapta-tion, the dilemma of professional practice, the dilemma of ethical relationship and practice burnout and so on. Combined with their own supervision experience, this paper put forward coping methods.

As an important part of the medical supply-side reform, grading diagnosis and treatment is the core objective of various medical services carried out by medical institutions at all levels. This paper proposed that tertia-ry hospitals should promote the construction of grading diagnosis and treatment from three aspects of multi-sited practice of physicians, construction of medical alliance and functional orientation planning. On this basis, this pa-per mainly discussed the service function of medical social work involved in grading diagnosis and treatment mode in tertiary hospitals.

OBJECTIVETo demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.

METHODSA prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.

RESULTSAll patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).

CONCLUSIONSELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Perineum ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Rectal Neoplasms ; surgery ; Treatment Outcome

Objective To report the preliminary result of cylindrical abdominoperineal resection (cylindrical APR) and pelvic reconstruction with human acellular dermal matrix (HADM). Methods Cylindrical APR was performed in 13 consecutive patients with advanced very low rectal cancer between January 2008 and April 2009. The mesorectum was not dissected off the levator muscles at abdominal part of the operation, the perineal part of the operation was done in the prone position. The levator muscles were exposed circumferentiaUy. The coccyx and part of the 5th sacrum were dissected and Waldeyer" s fascia divided. The levator muscles were divided laterally on both sides from posterior to anterior. The remaining pelvic floor muscle fibers were divided just posterior to the transverse perineal muscles and the levator muscles were resected en bloc with the anus and lower rectum. The specimen was cylindrical. The pelvic defects were reconstructed with HADM. Results There was no bowel perforation, and all specimens were proved CMR negative by pathology. Perineal wounds were healed uneventfully. After 8 months" follow-up, no patient developed perineal wound breakdown, bulge or hernia. There was 1 patient developed perineal wound infection; one patient developed seroma and three with perineal pain. Five patients with short-term urinary retention recovered within 10 days. Conclusion Clinical APR and HADM pelvic reconstruction can reduce circumferential margin positive and rectum perforation rate, and made the procedure easier and safer without increasing complications.

Objective To investigate the side effects of a new supramolecular drug-platinum compound CCP on the cardiovascular system,respiratory system and neuropsychological system of healthy rat.Methods After abdominal anaesthesia with 4.0 ml/kg of 10%chloral hydrate.the rats were injected with10,20,40 ms/ks CCP respectively,and then the life indexes,including blood pressure,heart rate,electrocardiogram,respiratory rate and depth were recorded through single femoral and tracheal intubations and so to non-anaesthesia rats.Glucose injection was chosen as negative control and carboplatin(15 mg/kg)as positive control.Results After venous injection with CCP,glucose injection and carboplatin as the dosages as above respectively,the blood pressures of the tested rats are from(57.8±14.1)mm Hg to(86.2±8.1)mm Hg,heart rates are from(250.9±95.4)times/min to(356.7±47.7)times/min,respiratory rates are from(59.3±17.7)times/min to(95.7±26.0)times/min.No obvious changes of blood pressure,heart rate and respiration were observed after drug injection,t values are(0.02～1.96),(P＞0.05).Once of sporadically ventrieular premature beat was recorded in one rat of CCP and earboplatin groups and it is not dosage-dependent.There is no side effect of 40 ms/ks CCP in neuropsychological system and daily activity of non-anaesthesia rats.Conclusion CCP injection is safe in rat and there is no obvious change observed in the cardiovascular system,respiratory system,neuropsyehological system of healthy rat.