Objective To explore the effectiveness and safety of topical phenytoin for wound healing. Methods We searched MEDLINE (1966 to Oct. 2002), EMBASE (1984 to 2002), The Cochrane Library (Issue 4, 2002), Biological Abstracts (1993 to 1996), Cancerlit (1997 to Sept. 2002), Life Science Collection (1982 to Mar. 1995), International Pharmaceutical Abstracts (1970 to 2002), and CBMdisc (1978 to Jan. 2003). Controlled trials on topical phenytoin for wound healing were identified. The methodological quality of included studies was assessed, and a descriptive analysis was performed. Results Nine studies (507 cases) including 1 randomized controlled trials (RCT) and 8 non-randomized controlled trials were included. These studies were of poor methodological quality. Because there were a variety of etiology of ulcers, differnet interventions in control groups, and different outcome measures, for which meta-analysis was difficult to perform, a descriptive analysis of the results was presented. Most studies showed that topical phenytoin had better effects on improving healthy granulation appearance, increasing complete recovery rate, reducing time for complete recovery, and positive cases of bacterial culture than those of control groups. Mild side effects were observed in only one study.Conclusions The reviewers think that the inclusion studies less rigorous than randomized controlled trials could result in misleading findings.Some well designed randomized controlled trials of topical phenytoin for wound healing are warranted.
ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the effect of auto adjusted triggering mechanism on the triggering balance of sensitivity and anti-interference in non invasive ventilator field. Methods Taking the breathing simulator as the experimental platform, for the same ventilator, the experiments of "automatic adjustment mode" and "manual adjustment mode" were carried out in a self-control manner, comparing the sensitivity and anti-interference indexes of the experimental group and the control group in the triggering stage. The results were statistically analyzed. Results In case of large air leakage, for ventilator of "A40", the group of "automatic adjustment mode" presented auto-triggered cycle and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 5 to 9 L/min) could provide breathing assistance ventilation. While for ventilator of "VENT", both the group of "automatic adjustment mode" and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 1 to 8 arbitrary unit) appear auto-triggered cycle. In case of medium air leakage, for ventilator of "A40", the trigger delay time, trigger pressure and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 3 to 5 L/min) were significantly less than those of the "automatic adjustment mode" group, and the trigger delay time, trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 8 to 9 L/min) were significantly higher than those of the "automatic adjustment mode" group; While for ventilator of "VENT", compared with the inspiratory trigger sensitivity of the "automatic adjustment mode" group and the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 4 arbitrary unit), the trigger delay time, trigger pressure and trigger work were not statistically significant. In case of small air leakage, for ventilator of "A40", the trigger delay time and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 6 L/min) were significantly less than those in the "automatic adjustment mode" group, and the trigger pressure of "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 5 L/min and 7 L/min) was significantly lower than that of "automatic adjustment mode" group. While for ventilator of "VENT", the trigger delay time, trigger pressure and trigger work of the "manual adjustment" group (the inspiratory trigger sensitivity was adjusted to 1 to 2 arbitrary unit) were less than those of the experimental group, and they were statistically significant. Conclusions In case of large air leakage, ventilator of "VENT" can not provide breathing assistance ventilation no matter which inspiratory trigger mode. While ventilator of "A40" should be used the "manual adjustment mode", and adjust the inspiratory trigger sensitivity to the less sensitive arbitrary unit to increase its performance of anti-interference. In case of medium air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "automatic adjustment" mode for breathing assistance ventilation. In case of small air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "manual adjustment" mode for breathing assistance ventilation and we should adjust the inspiratory trigger sensitivity to the higher sensitive arbitrary without auto-triggered cycle.
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
Objective To explore the effectiveness of conservative dressing change method in treating skin necrosis after open reduction with internal fixation (ORIF) of calcaneal fracture. Methods Between November 2007 and June 2010, 21 cases of skin necrosis after ORIF of calcaneal fracture were treated, including 18 cases of Sanders type II and 3 cases ofSanders type III. There were 20 males and 1 female with an average age of 33.1 years (range, 23-60 years). All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 3-5 days (mean, 4 days) after internal fixation. The interval of internal fixation and conservative dressing change was 3-10 days (mean, 6 days). Of 21 cases, 10 cases had superfacial skin necrosis with a size range of 1-10 cm in length and 0.5-1.5 cm in width, and 11 cases had deep skin necrosis with a size range of 1-8 cm in length and 0.5-1.5 cm in width. The conservative dressing change method was performed. Alcohol (75%) was used at the edge of the zone of skin necrosis, whereas sal ine in the central of the wound every 2-3 days. The necrosed tissue in the wound was reserved as more as possible. No patient was given antibiotic. Results Scab formed and subcrust heal ing was observed after 6-30 days (mean, 16 days) in 20 patients, 1 patient failed for discontinue treatment. No case had deep infection or osteomyl itis. The mean treatment time was 7.8 days (range, 6-14 days) in 10 cases of superfacial skin necrosis, and was 23.1 days (range, 14-30 days) in 10 cases of deep skin necrosis. All cases were followed up 92 days on average (range, 54-123 days). The scar was usually dark red and hard, protruding from the normal skin. No patient had difficulty in weight bearing or walking. Conclusion Skin necrosis after ORIF of calcaneal fracture can be cured by the conservative dressing change method, and this conservative method is effective and economic.
Despite the continuous improvement in perioperative use of antibiotics and aseptic techniques, the incidence of infection continues to rise as the need for surgery increasing and brings great challenges to orthopedic surgery. The rough or porous structure of the prosthesis provides an excellent place for bacterial adhesion, proliferation and biofilm formation, which is the main cause of infection. Traditional antibiotic therapy and surgical debridement are difficult to determine whether the infected focus have been removed completely and whether the infection will recur. In recent years, nanotechnology has shown obvious advantages in biomaterials and drug delivery. Nano drug carriers can effectively achieve local antimicrobial therapy, prevent surgical infection by local sustained drug release or intelligent controlled drug release under specific stimuli, and reduce the toxic side effects of drugs. The unique advantages of nanotechnology provide new ideas and options for the prevention and treatment of periprosthetic infection. At present, the application of nano-technology in the prevention and treatment of infection can be divided into the addition of nano-drug-loaded materials to prosthesis materials, the construction of drug-loaded nano-coatings on the surface of prosthesis, the perfusable nano-antimicrobial drug carriers, and the stimulation-responsive drug controlled release system. This article reviews the methods of infection prevention and treatment in orthopaedic surgery, especially the research status of nanotechnology in the prevention and treatment of periprosthetic infection.
Objective To summarize the current research advances of colorectal signet-ring cell carcinoma (SRCC). Methods In this paper, the related literatures of colorectal SRCC in recent years were collected and reviewed. Results Colorectal SRCC was a pathological subtype of colorectal adenocarcinoma, with extremely low incidence but high malignancy and poor prognosis. At present, its molecular mechanism was still not very clear and the clinicopathological manifestations were not specific. Surgical treatment was the major treatmen. Conclusions Although we already have a certain degree of understanding about colorectal SRCC, due to the limitations in the results of some related researches because of the small sample size or the single-center study, we still need more researches to improve the cognition of colorectal SRCC.
阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 是心血管疾病的独立危险因素[1,2 ]。睡眠过程中反复发生氧饱和度降低和频繁觉醒是心血管损伤的病理生理基础。OSAHS 血管损害的早期改变可表现为血管僵硬度增加, 对亚临床血管病变患者开展早期动脉弹性功能检测及早进行干预, 可有效预防心血管疾病的发生。本文就常用的无创动脉硬化检测lt;br /gt;技术及其对OSAHS 心血管损伤的评估相关研究进展进行综述。
Objective To investigate the relationship between systolic blood pressure (SBP) and etiological subtype in patients with cerebral infarction. Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018. Patients within 24 h of symptom were included. Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype. Results A total of 944 eligible cases were included, accounting for 37.3% (944/2528) of the total number of registered cases. The mean age was (65.35±14.17) years, and 57.5% (543/944) were male. The median time from onset to admission was 15 h, with 54.7% (516/944) of patients having elevated blood pressure. Among the patients, large artery atherosclerosis, small artery occlusion, cardiogenic embolism, other definite causes and undetermined causes accounted for 24.9% (235 cases), 21.2% (200 cases), 20.0% (189 cases), 1.8% (17 cases), and 32.1% (303 cases), respectively. Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology [odds ratio (OR)=0.987, 95% confidence interval (CI) (0.977, 0.998)]; normal SBP at admission [<140 mm Hg (1 mm Hg=0.133 kPa)] was significantly positively correlated with cardioembolic etiology [OR=2.016, 95%CI (1.211, 3.357)]. Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology, which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.
目的:组织瓣修复缺损是头颈部肿瘤切除术中的重要手段和必要环节。本研究总结65例颊癌和口咽癌不同范围组织缺损用局部带蒂组织瓣的修复方法。方法: 回顾2001~2009年我科65例口腔颊癌及口咽癌切除术后选择腭瓣、颏下瓣、面动脉逆行皮瓣、颊脂垫颊肌复合瓣修复颊部及口咽部组织缺损,病变范围和治疗结果。结果: 65例皮瓣中,17例腭瓣全部成活,29例颏下瓣26例全部成活,2例部分坏死,1例表层皮肤坏死, 7例面动脉逆行皮瓣6例全部成活,1例坏死,12例颊脂垫或颊脂垫颊肌复合瓣全部成活11例,1例部分坏死,总成活率96.9％。31例患者术后有不同程度的张口受限,咀嚼和吞咽功能基本正常。结论: 根据颊癌和口咽癌的病变范围决定采用不同的临近带蒂组织瓣修复缺损,修复效果确切,可以明显减少手术创伤和术后并发症,尤其适用于年老及较多基础疾病患者,仍应作为头颈部肿瘤术后缺损修复的重要方法。