Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mor...Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.展开更多
Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. T...Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on improving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai（CV6）, Zhongwan（CV12）, Danzhong（CV17）, bilateral Zusanli（ST36）, and bilateral Xuehai（SP10） acupoints was performed once a day（1-day rest after 6-day treatment） for 14 consecutive days. Senescence-accelerated mouse prone 8（SAMP8） mice without acupuncture and senescence-accelerated mouse resistant 1（SAMR1） mice were used as normal controls. After 14 days of treatment, spatial learning and memory ability of mice was assessed in each group using the Morris water maze. Dendritic changes of pyramidal cells in the hippocampal CA1 region were analyzed by quantitative Golgi staining. Our results showed that acupuncture shortened escape latency and lengthened retention time of the former platform quadrant in SAMP8 mice. Further, SAMP8 mice exhibited a significant increase in the number of apical and basal dendritic branches and total length of apical and basal dendrites after acupuncture. These results suggest that acupuncture improves spatial learning and memory ability of middle-aged SAMP8 mice by ameliorating dendritic structure.Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on im- proving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai （CV6）, Zhongwan （CV 12）, Danzhong （CV17）, bilateral Zusanli （ST36）, and bilateral Xuehai （SP10） acupoints was performed once a day （1-day rest after 6-day treat- ment） for 14 展开更多
Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), wit...Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.展开更多
Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health ...Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.展开更多
BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features o...BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.展开更多
Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery...Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery;however, the compromised and comminuted bones in osteoporotic fracture sites are not conducive to optimum reduction and rigid fixation. In addition, these patients always exhibit accompanying aging-related disorders, including high inflammatory status, decreased mechanical loading and abnormal skeletal metabolism, which are disadvantages for fracture healing around sites that have undergone orthopedic procedures. Since the incidence of osteoporosis is expected to increase worldwide, orthopedic surgeons should pay more attention to comprehensive strategies for improving the poor prognosis of osteoporotic fractures. Herein, we highlight the molecular basis of osteoimmunology and bone mechanosensation in different healing phases of elderly osteoporotic fractures, guiding perioperative management to alleviate the unfavorable effects of insufficient mechanical loading, high inflammatory levels and pathogen infection. The well-informed pharmacologic and surgical intervention, including treatment with anti-inflammatory drugs and sufficient application of antibiotics, as well as bench-to-bedside strategies for bone augmentation and hardware selection, should be made according to a comprehensive understanding of bone biomechanical properties in addition to the remodeling status of osteoporotic bones, which is necessary for creating proper biological and mechanical environments for bone union and remodeling. Multidisciplinary collaboration will facilitate the improvement of overall osteoporotic care and reduction of secondary fracture incidence.展开更多
Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult...Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effectivetreatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.展开更多
Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity.Although many ofthese complications remain uncommon,the range of possible mo...Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity.Although many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ systems.Perioperative visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral cortex.Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery.Peripheral nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative events.Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit rarely.Other uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been reported.Many of these are well-understood and largely avoidable through thoughtful attention to detail.Other complications,such as POVL,remain incompletely understood and thus more difficult to predict or prevent.Here,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.展开更多
目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL...目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL的临床对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率及围手术期并发症发生率的数据并进行Meta分析。结果最终纳入18项研究,共2696个病例,Meta分析显示改良仰卧位组的手术时间较俯卧位组缩短(WMD=-19.24,95%CI:-29.09^-9.39,P<0.01),两组在住院时间(WMD=-0.81,95%CI:-0.85~0.41,P=0.59)、结石清除率(OR=0.95,95%CI:0.76~1.19,P=0.65)和围手术期并发症发生率(OR=0.77,95%CI:0.59~1.01,P=0.06)方面差异无统计学意义。结论改良仰卧位行PCNL安全有效,可缩短手术时间,值得推广应用。展开更多
Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The ...Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2<sup>nd</sup> and 3<sup>rd</sup> waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO<sub>2</sub> showed improvement with significant associations with SpO<sub>2</sub> at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extrem展开更多
Steel mesh is used as a passive skin confinement medium to supplement the active support provided by rock bolts for roof and rib control in underground coal mines. Thin spray-on liners(TSL) are believed to have the po...Steel mesh is used as a passive skin confinement medium to supplement the active support provided by rock bolts for roof and rib control in underground coal mines. Thin spray-on liners(TSL) are believed to have the potential to take the place of steel mesh as the skin confinement medium in underground mines.To confirm this belief, large scale laboratory experiments were conducted to compare the behaviour of welded steel mesh and a TSL, when used in conjunction with rock bolts, in reinforcing strata with weak bedding planes and strata prone to guttering, two common rock conditions which exist in coal mines. It was found that while the peak load taken by the simulated rock mass with weak bedding planes acting as the control sample(no skin confinement) was 2494 kN, the corresponding value of the sample with 5 mm thick TSL reinforcement reached 2856 kN. The peak load of the steel mesh reinforced sample was only2321 kN, but this was attributed to the fact that one of the rock bolts broke during the test. The TSL reinforced sample had a similar post-yield behaviour as the steel mesh reinforced one. The results of the large scale guttering test indicated that a TSL is better than steel mesh in restricting rock movement and thus inhibiting the formation of gutters in the roof.展开更多
Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is...Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.展开更多
Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significan...Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significance of this knowledge, a comprehensive quantification of the influence of regional topographical and geological factors on the spatial heterogeneity of debris-flow-prone areas has been lacking. This study selected the Hengduan Mountains, an earthquake-prone region characterized by diverse surface conditions and complex landforms, as a representative study area. An improved units zoning and objective factors identification methodology was employed in earthquake and fault analysis to assess the impact of seismic activity and geological factors on spatial heterogeneity of debrisflow prone areas. Results showed that the application of GIS technology with hydrodynamic intensity and geographical units analysis can effectively analyze debris-flow prone areas. Meanwhile, earthquake and fault zones obviously increase the density of debrisflow prone catchments and make them unevenly distributed. The number of debris-flow prone areas shows a nonlinear variation with the gradual increase of geomorphic factor value. Specifically, the area with 1000 m-2500 m elevation difference, 25°-30° average slope, and 0.13-0.15 land use index is the most favorable conditions for debris-flow occurrence;The average annual rainfall from 600 to 1150 mm and landslides gradient from 16° to 35° are the main causal factors to trigger debris flow. Our study sheds light on the quantification of spatial heterogeneity in debris flow-prone areas in earthquake-prone regions, which can offer crucial support for post-debris flow risk management strategies.展开更多
Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data o...Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.展开更多
文摘Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.
基金supported by the National Natural Science Foundation of China,No.81603686,81603684the High School Science and Technology Fund Planning Project of Tianjin of China,No.20120211+1 种基金the Natural Science Foundation of Tianjin of China(Key Program),No.15JCZDJC36700,16JCZDJC37500the Natural Science Foundation of Tianjin of China,No.17JCYBJC26200
文摘Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on improving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai（CV6）, Zhongwan（CV12）, Danzhong（CV17）, bilateral Zusanli（ST36）, and bilateral Xuehai（SP10） acupoints was performed once a day（1-day rest after 6-day treatment） for 14 consecutive days. Senescence-accelerated mouse prone 8（SAMP8） mice without acupuncture and senescence-accelerated mouse resistant 1（SAMR1） mice were used as normal controls. After 14 days of treatment, spatial learning and memory ability of mice was assessed in each group using the Morris water maze. Dendritic changes of pyramidal cells in the hippocampal CA1 region were analyzed by quantitative Golgi staining. Our results showed that acupuncture shortened escape latency and lengthened retention time of the former platform quadrant in SAMP8 mice. Further, SAMP8 mice exhibited a significant increase in the number of apical and basal dendritic branches and total length of apical and basal dendrites after acupuncture. These results suggest that acupuncture improves spatial learning and memory ability of middle-aged SAMP8 mice by ameliorating dendritic structure.Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on im- proving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai （CV6）, Zhongwan （CV 12）, Danzhong （CV17）, bilateral Zusanli （ST36）, and bilateral Xuehai （SP10） acupoints was performed once a day （1-day rest after 6-day treat- ment） for 14
文摘Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.
文摘Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.
基金supported by the National Natural Science Foundation of China(grant number 81501654)Natural Science Foundation of Shanghai(grant number 14ZR1433700)
文摘BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.
基金supported by the National Natural Science Foundation of China (81772369, 81401809, 81373150)CAMS Innovation Fund for Medical Sciences (CIFMS, 2017-I2M-3-001)+1 种基金supported by the Beijing Nova program (Z171100001117110)supported by the Beijing Natural Science Foundation (7192127)
文摘Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery;however, the compromised and comminuted bones in osteoporotic fracture sites are not conducive to optimum reduction and rigid fixation. In addition, these patients always exhibit accompanying aging-related disorders, including high inflammatory status, decreased mechanical loading and abnormal skeletal metabolism, which are disadvantages for fracture healing around sites that have undergone orthopedic procedures. Since the incidence of osteoporosis is expected to increase worldwide, orthopedic surgeons should pay more attention to comprehensive strategies for improving the poor prognosis of osteoporotic fractures. Herein, we highlight the molecular basis of osteoimmunology and bone mechanosensation in different healing phases of elderly osteoporotic fractures, guiding perioperative management to alleviate the unfavorable effects of insufficient mechanical loading, high inflammatory levels and pathogen infection. The well-informed pharmacologic and surgical intervention, including treatment with anti-inflammatory drugs and sufficient application of antibiotics, as well as bench-to-bedside strategies for bone augmentation and hardware selection, should be made according to a comprehensive understanding of bone biomechanical properties in addition to the remodeling status of osteoporotic bones, which is necessary for creating proper biological and mechanical environments for bone union and remodeling. Multidisciplinary collaboration will facilitate the improvement of overall osteoporotic care and reduction of secondary fracture incidence.
文摘Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effectivetreatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.
文摘Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity.Although many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ systems.Perioperative visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral cortex.Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery.Peripheral nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative events.Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit rarely.Other uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been reported.Many of these are well-understood and largely avoidable through thoughtful attention to detail.Other complications,such as POVL,remain incompletely understood and thus more difficult to predict or prevent.Here,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.
文摘目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL的临床对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率及围手术期并发症发生率的数据并进行Meta分析。结果最终纳入18项研究,共2696个病例,Meta分析显示改良仰卧位组的手术时间较俯卧位组缩短(WMD=-19.24,95%CI:-29.09^-9.39,P<0.01),两组在住院时间(WMD=-0.81,95%CI:-0.85~0.41,P=0.59)、结石清除率(OR=0.95,95%CI:0.76~1.19,P=0.65)和围手术期并发症发生率(OR=0.77,95%CI:0.59~1.01,P=0.06)方面差异无统计学意义。结论改良仰卧位行PCNL安全有效,可缩短手术时间,值得推广应用。
文摘Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2<sup>nd</sup> and 3<sup>rd</sup> waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO<sub>2</sub> showed improvement with significant associations with SpO<sub>2</sub> at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extrem
文摘Steel mesh is used as a passive skin confinement medium to supplement the active support provided by rock bolts for roof and rib control in underground coal mines. Thin spray-on liners(TSL) are believed to have the potential to take the place of steel mesh as the skin confinement medium in underground mines.To confirm this belief, large scale laboratory experiments were conducted to compare the behaviour of welded steel mesh and a TSL, when used in conjunction with rock bolts, in reinforcing strata with weak bedding planes and strata prone to guttering, two common rock conditions which exist in coal mines. It was found that while the peak load taken by the simulated rock mass with weak bedding planes acting as the control sample(no skin confinement) was 2494 kN, the corresponding value of the sample with 5 mm thick TSL reinforcement reached 2856 kN. The peak load of the steel mesh reinforced sample was only2321 kN, but this was attributed to the fact that one of the rock bolts broke during the test. The TSL reinforced sample had a similar post-yield behaviour as the steel mesh reinforced one. The results of the large scale guttering test indicated that a TSL is better than steel mesh in restricting rock movement and thus inhibiting the formation of gutters in the roof.
文摘Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.
基金supported by the Hubei Provincial Engineering Research Center of Slope Habitat Construction Technique Using Cement-based Materials Open Research Program (Grant No. 2022SNJ112022SNJ12)+4 种基金National Natural Science Foundation of China (Grant No. 42371014)Hubei Key Laboratory of Disaster Prevention and Mitigation (China Three Gorges University) Open Research Program (Grant No. 2022KJZ122023KJZ19)CRSRI Open Research Program (Grant No. CKWV2021888/KY)the Key Laboratory of Mountain Hazards and Earth Surface Processes, Chinese Academy of Sciences (Grant No. KLMHESP20-0)。
文摘Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significance of this knowledge, a comprehensive quantification of the influence of regional topographical and geological factors on the spatial heterogeneity of debris-flow-prone areas has been lacking. This study selected the Hengduan Mountains, an earthquake-prone region characterized by diverse surface conditions and complex landforms, as a representative study area. An improved units zoning and objective factors identification methodology was employed in earthquake and fault analysis to assess the impact of seismic activity and geological factors on spatial heterogeneity of debrisflow prone areas. Results showed that the application of GIS technology with hydrodynamic intensity and geographical units analysis can effectively analyze debris-flow prone areas. Meanwhile, earthquake and fault zones obviously increase the density of debrisflow prone catchments and make them unevenly distributed. The number of debris-flow prone areas shows a nonlinear variation with the gradual increase of geomorphic factor value. Specifically, the area with 1000 m-2500 m elevation difference, 25°-30° average slope, and 0.13-0.15 land use index is the most favorable conditions for debris-flow occurrence;The average annual rainfall from 600 to 1150 mm and landslides gradient from 16° to 35° are the main causal factors to trigger debris flow. Our study sheds light on the quantification of spatial heterogeneity in debris flow-prone areas in earthquake-prone regions, which can offer crucial support for post-debris flow risk management strategies.
文摘Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.
