In order to introduce a novel reversed digital artery island flap, it was used in 13 cases involving 17 digital skin defects since 1993, in which digital skin defects were covered by a reversed digital artery island flap, a comparative study was made between the flaps with or without a palmar digital vein. The results showed that the 17 island flaps were all survived, and during the early stage after operation, the incidence of venous crisis in the flaps without palmar digital vein was 87.5% (7/8) while that in the flaps with the vein was only 11.1% (1/9), so, it was concluded that the reversed digital artery island flap containing a palmar digital vein could obviously reduce the incidence of venous crisis and improve the survival of the flap.
【摘要】 目的 探讨甲氨蝶呤(MTX)联合米非司酮治疗早期异位妊娠(EP)的临床效果。 方法 收集2006年2月-2010年2月收治的早期未破裂型EP患者126例，随机分为MTX联合米非司酮组62例，单独应用MTX组64例， MTX治疗采用小剂量分次肌肉注射给药进行。 结果 126例患者中，MTX联合米非司酮组和单独应用MTX治疗组的成功率为分别为88%和65%，两组差异有统计学意义(Plt;0.05)。 结论 MTX小剂量分次给药联合米非司酮治疗早期未破裂型EP效果优于MTX的单独使用。【Abstract】 Objective To observe the therapeutic effect of methotrexate (MTX) combined with mifepristone on early ectopic pregnancy. Methods A total of 126 patients with early ectopic pregnancy diagnosed from February 2006 to Febrary 2010 were randomly divided into two groups. In 126 patients, 62 treated with MTX combined with mifepristone were in the treatment group,and 64 treated independently with MTX were in the control group. MTX was administrated at a low dose in several times. Results In 126 patients,the success ratio of the treatment was 88% in treatment group groups and 65% in the control group; the difference between the two groups was significant (Plt;0.05). Conclusion Low-dose MTX in separate times combined with mifepriston is effective on the early ectopic pregnancy, and the therapeutic effect of the combined administration of MTX and mifepriston is better than that of the single administration with MTX.
ObjectiveTo investigate the application and effectiveness of the biological type acetabular cup (diameter ＜44 mm) in adult Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween April 2001 and August 2013, biological type acetabular cup was used in total hip arthroplasty for the treatment of Crowe type IV DDH in 16 cases (20 hips). There were 3 males and 13 females, aged 31-69 years (mean, 49 years). Unilateral hip was involved in 12 cases, and bilateral hips in 4 cases. The patients showed pain of the hip joint and inequality of lower limb (shortening of affected limb 1.8-6.0 cm in length, 3.5 cm on average). Acetabular deformity, the relationship and the severity of femoral head dislocation were comfirmed on the X-ray films. The preoperative Harris score was 34.0±6.9. ResultsAll patients achieved healing of incision by first intention, with no complication of infection or neurovascular injury. Sixteen cases were followed up 4-12 years (mean, 7.5 years). At 2 weeks after operation, dislocation occurred in 2 cases, and were fixed with plaster for 3 weeks after reduction of the hip. Postoperative X-ray films showed complete reduction of femoral head; the average acetabular coverage of the cup of the weight-bearing area was 98.5% (range, 98.2%-99.1%). The cup from the Ranawat triangle was 4.6-7.0 mm (mean, 5.8 mm) in medial shifting, and was 4.5-7.9 mm (mean, 6.2 mm) in elevation, it located at cup lateral surface area inside the iliopectineal line and the Kohler line (＜40%); the cup abduction angle was (45±5)°, and the anteversion angle was (10±5)°. The other patients had no prosthesis loosening except 1 patient having extensive acetabular prosthesis loosening because of acetabular osteolysis at 12 years after operation. The hip Harris score was significantly improved to 85.0±7.5 at 1 year after operation (t=14.34, P=0.01). ConclusionThe acetabular grinding process to retain enough bone combined with a small cup of biological prosthesis treating adult Crowe type IV DDH has the advantages of satisfactory coverage and initial acetabular fixation, so good early and mid-term effectiveness can be obtained.
Objective To compare the early and mid-term results between Fontan operation and anatomic correction for congenitally corrected transposition of the great arteries (ccTGA). Methods The clinical data of 53 patients with ccTGA who underwent anatomic correction and Fontan operation from January 2009 to September 2021 in our hospital were reviewed, including 41 males and 12 females with a mean age of 55.02 (3-168) months. They were divided into an anatomic correction group (16 patients) and a Fontan operation group (37 patients) according to the operation. The hospitalization mortality, survival rate, postoperative complications, and free rate from re-intervention between the two groups were compared. Another 180 healthy children were recruited as a control group, and 14 children were matched with the propensity score matching method as a Fontan control group. The results of cardiopulmonary exercise testing (CPET) between the Fontan operation group and the Fontan control group were compared. Results There were 2 (12.5%) early deaths and 3 (18.8%) early re-intervention in the anatomic correction group, while 1 death and 2 re-intervention in the Fontan operation group. In addition, there were 9 patients (56.3%) in the anatomic correction group and 6 (16.2%) patients in the Fontan operation group suffering from arrhythmia after operation, respectively. Compared with the anatomic correction group, cardiopulmonary bypass time, aortic cross-clamping time, intubation time and ICU stay were significantly shortened in the Fontan operation group (P<0.05). CPET results showed that, percent predicted max VO2 in the Fontan operation group was lower than that in the Fontan control group (0.84±0.11 vs. 0.99±0.12, P＜0.05). The patients were followed up for 0.5-126.0 months. Two patients were lost in the Fontan operation group. There was no death and 1 re-intervention in the anatomic correction group, while no death or re-intervention in the Fontan operation group. The 1-year, 5-year and 10-year transplant-free survival rate of the anatomic correction group and the Fontan operation group was 87.5%, 87.5%, 87.5% and 97.3%, 97.3%, 97.3%, respectively (P＞0.05). The 48 patients were classified as grade Ⅰ-Ⅱ in cardiac function in the last follow-up. Conclusion There is no statistical difference in the transplant-free survival rate between the anatomic correction and the Fontan operation group. The postoperative complications in the Fontan operation group are decreased than those in the anatomic correction group. The Fontan operation is also a good choice, even though the patients with ccTGA meet the condition of the procedure of anatomic correction.
ObjectiveTo systematically review the efficacy of exercise intervention in adolescents with mild to moderate idiopathic scoliosis (AIS). MethodsPubMed, Web of Science, The Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of exercise intervention in adolescents with mild to moderate AIS from inception to November 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software. ResultsA total of 11 RCTs involving 638 patients were included. The results of meta-analysis showed that exercise intervention significantly improved the Cobb angle of the spine in patients with AIS (MD=−1.65, 95%CI −2.63 to −0.68, P<0.01), reduced the angle of trunk rotation (ATR) (MD=−0.68, 95%CI −0.96 to −0.40, P<0.01), and increased their forced vital capacity (FVC) (MD=0.63, 95%CI 0.10 to 1.15, P=0.02). However, there was no statistically significant improvement in the forced expiratory volume in the first second (FEV1) or the ratio of FEV1/FVC between the two groups. ConclusionCurrent evidence shows that the exercise intervention could improve the Cobb angle of the spine, reduce ATR and enhance FVC. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
The scalp-recorded auditory steady-state response (ASSR) is a periodically evoked potential in response to the stimulation with the acoustical property in the same period. The ASSR can be readily induced in comparison with transient responses for specific conditions. The clinical utility of ASSR may be unjustified for the ambiguity of the genesis. With the advance of relevant research, it is considered that the main generation hypotheses of the ASSR are conceived to be pertinent with the linear superposition or neural entrainment mechanism. Based on current findings and our contributions in this field, we introduce recent progresses of the two mechanisms with comments, and suggest the benefit of the rapid stimulation technology in this regard.
Objective To develop an innovative recognition algorithm that aids physicians in the identification of pulmonary nodules. MethodsPatients with pulmonary nodules who underwent thoracoscopic surgery at the Department of Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School in December 2023, were enrolled in the study. Chest surface exploration data were collected at a rate of 60 frames per second and a resolution of 1 920×1 080. Frame images were saved at regular intervals for subsequent block processing. An algorithm database for lung nodule recognition was developed using the collected data. ResultsA total of 16 patients were enrolled, including 9 males and 7 females, with an average age of (54.9±14.9) years. In the optimized multi-topology convolutional network model, the test results demonstrated an accuracy rate of 94.39% for recognition tasks. Furthermore, the integration of micro-variation amplification technology into the convolutional network model enhanced the accuracy of lung nodule identification to 96.90%. A comprehensive evaluation of the performance of these two models yielded an overall recognition accuracy of 95.59%. Based on these findings, we conclude that the proposed network model is well-suited for the task of lung nodule recognition, with the convolutional network incorporating micro-variation amplification technology exhibiting superior accuracy. Conclusion Compared to traditional methods, our proposed technique significantly enhances the accuracy of lung nodule identification and localization, aiding surgeons in locating lung nodules during thoracoscopic surgery.