Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evalu...Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evaluates the efficacy of fully endoscopic MVD for dcTN and presents our early experience.Methods:This retrospective study included patients with dcTN who underwent fully endoscopic MVD in the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University School of Medicine from November 2020 to February 2023.We recorded basic patient clinical information,clinical outcomes,offending vessels,complications,and recurrences,and assessed outcomes via the Barrow Neurological Institute(BNI)pain intensity score and the numeric rating scale(NRS)score.Results:All 42 patients had dcTN with preoperative BNI scores of V and NRS scores of 8e10.Endoscopic visualization enabled the precise identification of neurovascular conflicts,including small and deeply located vessels.Immediately after surgery,90.5%of patients achieved complete pain relief(BNI score of I,NRS score of 0).At the final follow-up,85.7%of patients had complete pain relief.All patients’pain was significantly relieved at immediate after surgery(0 vs.9,p<0.001)and at the final follow-up(0 vs.9,p<0.001),with lower NRS scores.Complications,including vertigo,headache,and transient facial numbness,occurred in 14.4%of patients and were manageable.展开更多
In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)a...In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.展开更多
BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of con...BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.展开更多
Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to...Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.展开更多
Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for...Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for high-temperature superconductors, as both Im3m YH_(6) and Im3m CaH_(6) exhibit similar structures and excellent superconducting properties, while Y and Ca atoms possess close atomic radii and electronegativities.Here, we report the successful synthesis of Im3m(Y, Ca)H_(6) achieving a maximum superconducting transition temperature(T_(c)) approximately 224 K at 155 GPa through five independent high-temperature and high-pressure experiments. Remarkably, the T_(c) of Im3m(Y, Ca)H_(6) remains highly stable(ΔT_(c) ≤ 1 K) during decompression between 148 and 165 GPa, significantly outperforming binary Im3m CaH_(6) and Im3m YH_(6). The enhanced superconducting properties may stem from the cooperative chemical template effect of Y and Ca atoms near the s-d border, which significantly reinforces H lattice stability and thus maintains superior superconductivity.This study highlights the potential of multicomponent cooperative effects in designing hydride superconductors,offering new insights for achieving high-T_(c) hydrides at lower pressures in the future.展开更多
Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to...Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.展开更多
Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral ...Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral head necrosis models of rabbit were established by steroid injection.A total of 48 rabbits(96 femoral head necrosis) were randomly divided into 4groups:Group A,control group with12 rabbits,24 femoral head necrosis;Group B,treated with rhBMP-2/PLCA implantation after core depression,with 12 rabbits,24 femoral head necrosis;Group C,treated with rhBMP-2 implantation after core depression,with 12 rabbits,24 femoral head necrosis;Croup D treated with core depression group without implantation,with 12 rabbits,24 femoral head necrosis.All animals were sacrificed after 12 weeks.The ability of repairing bone defect was evaluated by X-ray radiograph.Bone mineral density analysis of the defect regions were used to evaluate the level of ossification.The morphologic change and bone formation was assessed by HE staining.The angiogenesis was evaluated by VEGF immunohistochemistry.Results:The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation.And the angiogenesis in group B was better than other groups.Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D.Conclusions:The treatment of rhBMP-2/PLCA implantation after core depression can promote the repair of rabbit femoral head necrosis.It is a promising and efficient synthetic bone material to treat the femoral head necrosis.展开更多
AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective revie...AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective review of medical records from patients with sight-threatening TAO [definite or highly suspected dysthyroid optic neuropathy(DON)] treated with iv GC(60 cases) and OD(25 cases) was conducted at the Zhongshan Ophthalmic Center between January 2001 and January 2009. Patients were initially treated with iv GC(iv GC group). If no significant improvement in visual function was obtained, they then received OD surgery(OD group). The pre-versus post-treatment efficacies of either iv GC or OD in these patients were assessed using several indices, including visual acuity, intraocular pressure, ocular alignment, ocular motility, and exophthalmos. RESULTS: Nighty-one eyes had definite DON while 79 were considered to have highly suspected DON. In the iv GC group, 51 individuals(85.0%) eventually demonstrated normal vision, while 10 patients(16.7%) demonstrated a reduction in deviation(P<0.01), and 35 cases(58.3%) showed slight improvements in ocular motility(P<0.01). In OD group, visual acuity improved in 24 cases(96.0%, P<0.01) and all patients showed varying reductions of exophthalmos(mean: 4.35±1.13 mm, P<0.01). Eight cases(32.0%) experienced an 8-15 PD reduction of deviation and ocular motility improved in 12 cases(48.0%), while 3 patients(12.0%) developed new-onset strabismus with diplopia post-surgically(P<0.01). Patients were followed up at an average of 1.55±1.07 y. CONCLUSION: Both iv GC and OD show good therapeutic efficacy in the treatment of sight-threatening TAO. Thepresence of extremely poor eyesight(≥0.5 log MAR) was corrected in some patients with iv GC alone, thus sparing these patients from subsequent OD surgery. In patients who were refractory to steroids, subsequent OD surgery often provided satisfactory outcomes, however, new-onset strabismus with diplopia was observed in 12.0% of these cases.展开更多
AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and...AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.展开更多
BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studi...BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studies,the mechanism of obstruction differs from that in humans.This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting.METHODS:We conducted a 'before and after study' on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression.Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling(TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin(HE) to identify bile lakes.All measurements were independently done by 2 observers.RESULTS:Twenty-one severe obstructive jaundice patients were included.In all patients,excessive hepatocyte apoptosis and bile lakes were apparent.After decompression,the hepatocyte apoptosis index decreased from 53.1(SD 105) to 11.7(SD 13.6)(P<0.05),and the bile lakes from 23.6(SD 14.8) to 10.9(SD 6.9)(P<0.05).CONCLUSION:Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice,similar to the findings in animal studies.展开更多
U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently c...U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.展开更多
AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. M...AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.展开更多
AIM： To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves＇ ophthalmopathy（GO）.METHODS： Totally 170 cases with GO underwent orbital decompression betwee...AIM： To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves＇ ophthalmopathy（GO）.METHODS： Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, mediallateral（balanced）, medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy（DON） were compared between different surgical techniques.RESULTS： The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2 y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values（P〈0.005）. Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups（P=0.181）. CONCLUSION： The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.展开更多
AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction ...AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups.Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other.The duration of the procedure and the success rate for each group were evaluated.RESULTS:A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group(32.6±14.6 min)and the endoscopic group(16.5±7.8 min)among the cases classified as successful(P<0.05).The success rate was significantly different between the groups:88.6%in the fluoroscopic group and 100%in the endoscopic group(P <0.05).CONCLUSION:For patients with adhesive small bowel obstruction,long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.展开更多
Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainst...Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.展开更多
Purpose:To investigate the safety and feasibility of radical total gastrectomy without postoperative gastrointestinal decompression in elderly patients with gastric cancer.Methods:Elderly patients(65e80 years of age)h...Purpose:To investigate the safety and feasibility of radical total gastrectomy without postoperative gastrointestinal decompression in elderly patients with gastric cancer.Methods:Elderly patients(65e80 years of age)hospitalized with gastric cancer from May 2009 to August 2012 were selected to receive radical total gastrectomy with(controls,n=39)or without(n=37)postoperative gastrointestinal decompression.Postoperative recovery conditions and associated complications were observed and compared.Results:In the group without decompression,the first passage of flatus post-operation was significantly earlier,and scores of nausea,pharyngitis,insomnia,and postoperative ambulation limitation were significantly reduced compared to controls(all p<0.01).However,there were no differences in the degree of abdominal distension,time to first anal defecation,or incidence of postoperative complications between the groups.Conclusion:Gastrointestinal decompression is not necessary after total gastrectomy in elderly gastric cancer patients,and may improve patient comfort and recovery.展开更多
A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The ce...A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.展开更多
BACKGROUND： The main clinical treatments for optic nerve injury are optic canal decompression and systemic administration of hormones, but both treatments have disadvantages. OBJECTIVE： To observe the pathological c...BACKGROUND： The main clinical treatments for optic nerve injury are optic canal decompression and systemic administration of hormones, but both treatments have disadvantages. OBJECTIVE： To observe the pathological changes in the retina and growth associated protein-43 （GAP-43） expression, to compare the treatment of optic canal decompression, hormones, and their combination with the intracanalicular optic nerve injury.DESIGN, TIME AND SETTING： A randomized, controlled animal study was performed at the Department of Anatomy, Weifang Medical University, China, from September 2007 to November 2008.MATERIALS： Dexamethasone （Shandong Huaxin Pharmaceutical, China） and rabbit anti-GAP-43 polyclonal antibody （Boster, China） were used.METHODS： All 36 healthy adult rabbits were randomly assigned to control group （n = 4）, simple injury group （n = 20）, and treatment group （n = 12）. Intracanalicular optic nerve injury models were established using the metal cylinder free-fall impact method. The control group was left intact. The treatment group （four rabbits in each subgroup） was treated by optic nerve decompression, dexamethasone treatment （1 mg/kg daily via two intravenous infusions, 1/5 total dose reduction every 3 days, for 14 days）, and simultaneously giving surgery and hormone treatment.MAIN OUTCOME MEASURES： Pathological changes in the retina were determined using hematoxylin-eosin staining. GAP-43 expression was detected using immunohistochemistry in the retina.RESULTS： Retina injury induced obvious pathological changes in the retina. With prolonged time after optic nerve injury, the number of retinal ganglion cells was gradually decreased, and reached the minimum on day 14 （P〈0.01）. All three treatments increased the number of retinal ganglion cells （P〈0.01）, but surgery ＋ hormone treatment was most effective. No GAP-43 cells were present in the normal retinal, but they appeared 3 days after injury, peaked 7 days after injury, and then began to decline.CONCLUSION： Intracanalicular optic nerve injury induced obvious pathological changes in the retina, including increased GAP-43 expression. Optic canal decompression and hormones improved nerve repair after injury, and their combination produced better outcomes.展开更多
Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE...Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.展开更多
BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and H...BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging(MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging(HR T2WI) is considered to be a more effective method to detect NVC.AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I_(2) statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO(registration No. CRD42022357158).RESULTS Our search identified 595 articles, of which 12(including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval(CI): 0.92-0.98] and 0.92(95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4(95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04(95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283(95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98(95%CI: 0.97-0.99). The studies showed no substantial heterogeneity(I2 = 0, Q = 0.001 P = 0.50).CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.展开更多
基金supported by financial assistance from the Zhejiang Provincial Natural Science Foundation of China under Grant No.LY18H160020.
文摘Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evaluates the efficacy of fully endoscopic MVD for dcTN and presents our early experience.Methods:This retrospective study included patients with dcTN who underwent fully endoscopic MVD in the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University School of Medicine from November 2020 to February 2023.We recorded basic patient clinical information,clinical outcomes,offending vessels,complications,and recurrences,and assessed outcomes via the Barrow Neurological Institute(BNI)pain intensity score and the numeric rating scale(NRS)score.Results:All 42 patients had dcTN with preoperative BNI scores of V and NRS scores of 8e10.Endoscopic visualization enabled the precise identification of neurovascular conflicts,including small and deeply located vessels.Immediately after surgery,90.5%of patients achieved complete pain relief(BNI score of I,NRS score of 0).At the final follow-up,85.7%of patients had complete pain relief.All patients’pain was significantly relieved at immediate after surgery(0 vs.9,p<0.001)and at the final follow-up(0 vs.9,p<0.001),with lower NRS scores.Complications,including vertigo,headache,and transient facial numbness,occurred in 14.4%of patients and were manageable.
文摘In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.
文摘BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.
基金the National Natural Science Foundation of China(Nos.82330063 and M-0019)the Interdisciplinary Program of Shanghai Jiao Tong University(Nos.YG2022QN056,YG2023ZD19,and YG2023ZD15)+2 种基金the Cross Disciplinary Research Fund of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYJC202115)the Translation Clinical R&D Project of Medical Robot of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.IMR-NPH202002)the Shanghai Key Clinical Specialty,Shanghai Eye Disease Research Center(No.2022ZZ01003)。
文摘Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.
基金supported by the National Key R&D Program of China (Grant No.2022YFA1405500)the National Natural Science Foundation of China (Grant No.52372257)。
文摘Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for high-temperature superconductors, as both Im3m YH_(6) and Im3m CaH_(6) exhibit similar structures and excellent superconducting properties, while Y and Ca atoms possess close atomic radii and electronegativities.Here, we report the successful synthesis of Im3m(Y, Ca)H_(6) achieving a maximum superconducting transition temperature(T_(c)) approximately 224 K at 155 GPa through five independent high-temperature and high-pressure experiments. Remarkably, the T_(c) of Im3m(Y, Ca)H_(6) remains highly stable(ΔT_(c) ≤ 1 K) during decompression between 148 and 165 GPa, significantly outperforming binary Im3m CaH_(6) and Im3m YH_(6). The enhanced superconducting properties may stem from the cooperative chemical template effect of Y and Ca atoms near the s-d border, which significantly reinforces H lattice stability and thus maintains superior superconductivity.This study highlights the potential of multicomponent cooperative effects in designing hydride superconductors,offering new insights for achieving high-T_(c) hydrides at lower pressures in the future.
文摘Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.
基金supported by Shandong Province Natural Science Foundation of China:sd2018762872
文摘Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral head necrosis models of rabbit were established by steroid injection.A total of 48 rabbits(96 femoral head necrosis) were randomly divided into 4groups:Group A,control group with12 rabbits,24 femoral head necrosis;Group B,treated with rhBMP-2/PLCA implantation after core depression,with 12 rabbits,24 femoral head necrosis;Group C,treated with rhBMP-2 implantation after core depression,with 12 rabbits,24 femoral head necrosis;Croup D treated with core depression group without implantation,with 12 rabbits,24 femoral head necrosis.All animals were sacrificed after 12 weeks.The ability of repairing bone defect was evaluated by X-ray radiograph.Bone mineral density analysis of the defect regions were used to evaluate the level of ossification.The morphologic change and bone formation was assessed by HE staining.The angiogenesis was evaluated by VEGF immunohistochemistry.Results:The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation.And the angiogenesis in group B was better than other groups.Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D.Conclusions:The treatment of rhBMP-2/PLCA implantation after core depression can promote the repair of rabbit femoral head necrosis.It is a promising and efficient synthetic bone material to treat the femoral head necrosis.
基金Supported by the National Natural Science Foundation of China (No.81670885)the Science and Technology Program of Guangdong Province, China (No.2013B020400003)the Science and Technology Program of Guangzhou, China (No.15570001)
文摘AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective review of medical records from patients with sight-threatening TAO [definite or highly suspected dysthyroid optic neuropathy(DON)] treated with iv GC(60 cases) and OD(25 cases) was conducted at the Zhongshan Ophthalmic Center between January 2001 and January 2009. Patients were initially treated with iv GC(iv GC group). If no significant improvement in visual function was obtained, they then received OD surgery(OD group). The pre-versus post-treatment efficacies of either iv GC or OD in these patients were assessed using several indices, including visual acuity, intraocular pressure, ocular alignment, ocular motility, and exophthalmos. RESULTS: Nighty-one eyes had definite DON while 79 were considered to have highly suspected DON. In the iv GC group, 51 individuals(85.0%) eventually demonstrated normal vision, while 10 patients(16.7%) demonstrated a reduction in deviation(P<0.01), and 35 cases(58.3%) showed slight improvements in ocular motility(P<0.01). In OD group, visual acuity improved in 24 cases(96.0%, P<0.01) and all patients showed varying reductions of exophthalmos(mean: 4.35±1.13 mm, P<0.01). Eight cases(32.0%) experienced an 8-15 PD reduction of deviation and ocular motility improved in 12 cases(48.0%), while 3 patients(12.0%) developed new-onset strabismus with diplopia post-surgically(P<0.01). Patients were followed up at an average of 1.55±1.07 y. CONCLUSION: Both iv GC and OD show good therapeutic efficacy in the treatment of sight-threatening TAO. Thepresence of extremely poor eyesight(≥0.5 log MAR) was corrected in some patients with iv GC alone, thus sparing these patients from subsequent OD surgery. In patients who were refractory to steroids, subsequent OD surgery often provided satisfactory outcomes, however, new-onset strabismus with diplopia was observed in 12.0% of these cases.
文摘AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.
文摘BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studies,the mechanism of obstruction differs from that in humans.This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting.METHODS:We conducted a 'before and after study' on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression.Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling(TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin(HE) to identify bile lakes.All measurements were independently done by 2 observers.RESULTS:Twenty-one severe obstructive jaundice patients were included.In all patients,excessive hepatocyte apoptosis and bile lakes were apparent.After decompression,the hepatocyte apoptosis index decreased from 53.1(SD 105) to 11.7(SD 13.6)(P<0.05),and the bile lakes from 23.6(SD 14.8) to 10.9(SD 6.9)(P<0.05).CONCLUSION:Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice,similar to the findings in animal studies.
文摘U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.
基金Supported by the Natural Science Foundation of China(No.81371028)Natural Science Foundation of Zhejiang Province,China(No.LY12H12006)the Guided Innovation Project of the Eye Hospital of Wenzhou Medical University(No.YNCX201104)
文摘AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.
文摘AIM： To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves＇ ophthalmopathy（GO）.METHODS： Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, mediallateral（balanced）, medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy（DON） were compared between different surgical techniques.RESULTS： The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2 y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values（P〈0.005）. Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups（P=0.181）. CONCLUSION： The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.
文摘AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups.Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other.The duration of the procedure and the success rate for each group were evaluated.RESULTS:A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group(32.6±14.6 min)and the endoscopic group(16.5±7.8 min)among the cases classified as successful(P<0.05).The success rate was significantly different between the groups:88.6%in the fluoroscopic group and 100%in the endoscopic group(P <0.05).CONCLUSION:For patients with adhesive small bowel obstruction,long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.
文摘Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.
基金This project was supported by the Natural Science Foundation of Anhui Province,China(1408085MH154).
文摘Purpose:To investigate the safety and feasibility of radical total gastrectomy without postoperative gastrointestinal decompression in elderly patients with gastric cancer.Methods:Elderly patients(65e80 years of age)hospitalized with gastric cancer from May 2009 to August 2012 were selected to receive radical total gastrectomy with(controls,n=39)or without(n=37)postoperative gastrointestinal decompression.Postoperative recovery conditions and associated complications were observed and compared.Results:In the group without decompression,the first passage of flatus post-operation was significantly earlier,and scores of nausea,pharyngitis,insomnia,and postoperative ambulation limitation were significantly reduced compared to controls(all p<0.01).However,there were no differences in the degree of abdominal distension,time to first anal defecation,or incidence of postoperative complications between the groups.Conclusion:Gastrointestinal decompression is not necessary after total gastrectomy in elderly gastric cancer patients,and may improve patient comfort and recovery.
基金supported by a grant from the Anhui Provincial Health Department-Funded Medical Research Project in 2009 in China,No.09C33a grant from the Key Scientific Research Project of Cultivating Fund of Wannan Medical College in China,No.WK2014ZF14
文摘A variety of inlfammatory cytokines are involved in spinal cord injury and inlfuence the recov-ery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompres-sion surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factorα immunoreactivity and apoptosis were quantiifed in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factorα and signiifcantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. De-compression at 8 hours resulted in signiifcantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factorα.
基金the Educational Commission of Shandong Province of China,No. J06L23
文摘BACKGROUND： The main clinical treatments for optic nerve injury are optic canal decompression and systemic administration of hormones, but both treatments have disadvantages. OBJECTIVE： To observe the pathological changes in the retina and growth associated protein-43 （GAP-43） expression, to compare the treatment of optic canal decompression, hormones, and their combination with the intracanalicular optic nerve injury.DESIGN, TIME AND SETTING： A randomized, controlled animal study was performed at the Department of Anatomy, Weifang Medical University, China, from September 2007 to November 2008.MATERIALS： Dexamethasone （Shandong Huaxin Pharmaceutical, China） and rabbit anti-GAP-43 polyclonal antibody （Boster, China） were used.METHODS： All 36 healthy adult rabbits were randomly assigned to control group （n = 4）, simple injury group （n = 20）, and treatment group （n = 12）. Intracanalicular optic nerve injury models were established using the metal cylinder free-fall impact method. The control group was left intact. The treatment group （four rabbits in each subgroup） was treated by optic nerve decompression, dexamethasone treatment （1 mg/kg daily via two intravenous infusions, 1/5 total dose reduction every 3 days, for 14 days）, and simultaneously giving surgery and hormone treatment.MAIN OUTCOME MEASURES： Pathological changes in the retina were determined using hematoxylin-eosin staining. GAP-43 expression was detected using immunohistochemistry in the retina.RESULTS： Retina injury induced obvious pathological changes in the retina. With prolonged time after optic nerve injury, the number of retinal ganglion cells was gradually decreased, and reached the minimum on day 14 （P〈0.01）. All three treatments increased the number of retinal ganglion cells （P〈0.01）, but surgery ＋ hormone treatment was most effective. No GAP-43 cells were present in the normal retinal, but they appeared 3 days after injury, peaked 7 days after injury, and then began to decline.CONCLUSION： Intracanalicular optic nerve injury induced obvious pathological changes in the retina, including increased GAP-43 expression. Optic canal decompression and hormones improved nerve repair after injury, and their combination produced better outcomes.
文摘Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.
基金Supported by the Key Research and Development Plan of Shaanxi Province,No.2021SF-298.
文摘BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging(MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging(HR T2WI) is considered to be a more effective method to detect NVC.AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I_(2) statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO(registration No. CRD42022357158).RESULTS Our search identified 595 articles, of which 12(including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval(CI): 0.92-0.98] and 0.92(95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4(95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04(95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283(95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98(95%CI: 0.97-0.99). The studies showed no substantial heterogeneity(I2 = 0, Q = 0.001 P = 0.50).CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.
