Objective To evaluate the effect of auto adjusted triggering mechanism on the triggering balance of sensitivity and anti-interference in non invasive ventilator field. Methods Taking the breathing simulator as the experimental platform, for the same ventilator, the experiments of "automatic adjustment mode" and "manual adjustment mode" were carried out in a self-control manner, comparing the sensitivity and anti-interference indexes of the experimental group and the control group in the triggering stage. The results were statistically analyzed. Results In case of large air leakage, for ventilator of "A40", the group of "automatic adjustment mode" presented auto-triggered cycle and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 5 to 9 L/min) could provide breathing assistance ventilation. While for ventilator of "VENT", both the group of "automatic adjustment mode" and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 1 to 8 arbitrary unit) appear auto-triggered cycle. In case of medium air leakage, for ventilator of "A40", the trigger delay time, trigger pressure and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 3 to 5 L/min) were significantly less than those of the "automatic adjustment mode" group, and the trigger delay time, trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 8 to 9 L/min) were significantly higher than those of the "automatic adjustment mode" group; While for ventilator of "VENT", compared with the inspiratory trigger sensitivity of the "automatic adjustment mode" group and the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 4 arbitrary unit), the trigger delay time, trigger pressure and trigger work were not statistically significant. In case of small air leakage, for ventilator of "A40", the trigger delay time and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 6 L/min) were significantly less than those in the "automatic adjustment mode" group, and the trigger pressure of "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 5 L/min and 7 L/min) was significantly lower than that of "automatic adjustment mode" group. While for ventilator of "VENT", the trigger delay time, trigger pressure and trigger work of the "manual adjustment" group (the inspiratory trigger sensitivity was adjusted to 1 to 2 arbitrary unit) were less than those of the experimental group, and they were statistically significant. Conclusions In case of large air leakage, ventilator of "VENT" can not provide breathing assistance ventilation no matter which inspiratory trigger mode. While ventilator of "A40" should be used the "manual adjustment mode", and adjust the inspiratory trigger sensitivity to the less sensitive arbitrary unit to increase its performance of anti-interference. In case of medium air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "automatic adjustment" mode for breathing assistance ventilation. In case of small air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "manual adjustment" mode for breathing assistance ventilation and we should adjust the inspiratory trigger sensitivity to the higher sensitive arbitrary without auto-triggered cycle.
Objective To explore effectiveness of TiRobot-assisted screw implantation in the treatment of coracoid process fractures of the scapula. Methods A retrospective analysis was conducted on the clinical data from 24 patients with coracoid process fractures of the scapula admitted between September 2019 and January 2024 and met selection criteria. Among them, 12 patients underwent TiRobot-assisted screw implantation (robot group) and 12 underwent manual screw implantation (control group) during internal fixation. There was no significant difference (P>0.05) in baseline data such as gender, age, body mass index, disease duration, cause of injury, coracoid process fracture classification, and proportion of patients with associated injuries between the two groups. The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, coracoid process fracture healing time, and complications were recorded and compared, as well as pain visual analogue scale (VAS) score, and Constant-Murley score at last follow-up. ResultsThe intraoperative blood loss and incision length in the robot group were significantly lower than those in the control group (P<0.05); however, there was no significant difference in operation time and hospital stay between the two groups (P>0.05). All patients were followed up 8-27 months (mean, 17.5 months), and the difference in follow-up time between the two groups was not significant (P>0.05). At last follow-up, the VAS score for shoulder pain in the robot group was signifncatly lower compared to the control group, and the Constant-Murley score was significantly higher (P<0.05). In the robot group, 16 screws were implanted intraoperatively, while 13 screws were implanted in the control group. Radiographic re-evaluation showed that the excellent and good rate of screw implantation was higher in the robot group (93.8%, 15/16) than in the control group (61.5%, 8/13), but the difference in the precision of screw implantation between the two groups was not significant (P>0.05). Four patients in the robot group and 1 in the control group achieved double screws fixation; however, the difference in achieving double screws fixation between the two groups was not significant (P>0.05). All fractures healed in both groups with 1 case of malunion in the control group. There was no significant difference in healing time between the two groups (P>0.05). During follow-up, 1 patient in the control group experienced screw loosening and displacement. There was no significant difference in the incidence of screw loosening and fracture malunion between the two groups (P>0.05). Conclusion Compared with manual screw implantation, TiRobot-assisted minimally invasive treatment of coracoid process fractures of the scapula can reduce intraoperative blood loss, shorten incision length, alleviate pain, and obtain better promote shoulder joint functional recovery.
Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
ObjectiveTo compare the effectiveness of lateral approach minimally invasive plate osteosynthesis (MIPO) and helical plate MIPO in the treatment of proximal humeral shaft fractures. Methods The clinical data of patients with proximal humeral shaft fractures who underwent MIPO via lateral approach (group A, 25 cases) and MIPO with helical plate (group B, 30 cases) between December 2009 and April 2021 were retrospectively analyzed. There was no significant difference in gender, age, injured side, cause of injury, American Orthopaedic Trauma Association (OTA) fracture classification, and time from fracture to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, and complications were compared between two groups. The angular deformity and the fracture healing were evaluated according to anteroposterior and lateral X-ray films postoperatively. The modified University of California Los Angeles (UCLA) score for shoulder and the Mayo Elbow Performance (MEP) score for elbow were analyzed at last follow-up. Results The operation time in group A was significantly shorter than that in group B (P<0.05). However, the intraoperative blood loss and fluoroscopy times presented no significant difference between the two groups (P>0.05). All patients were followed up 12-90 months, with an average of 19.4 months. There was no significant difference in follow-up time between the two groups (P>0.05). In terms of the quality of postoperative fracture reduction, there were 4 (16.0%) and 11 (36.7%) patients with angulation deformity in group A and group B, respectively, and there was no significant difference in the incidence of angulation deformity (χ2=2.936, P=0.087). All fractures achieved bony union, there was no significant difference in fracture healing time between group A and group B (P>0.05); delayed union occurred in 2 cases and 1 case in group A and group B, respectively (healing time was 30, 42, and 36 weeks after operation, respectively). In group A and group B, 1 patient had superficial infection of incision, respectively; 2 patients and 1 patient had subacromial impact after operation, respectively; and 3 patients in group A had symptoms of radial nerve paralysis of different degrees; all of them were cured after symptomatic treatment. The overall complication incidence of group A (32%) was significantly higher than that of group B (10%) (χ2=4.125, P=0.042). At last follow-up, there was no significant difference in the modified UCLA score and MEPs score between the two groups (P>0.05). Conclusion Both lateral approach MIPO and helical plate MIPO can achieve satisfied effectiveness in the treatment of proximal humeral shaft fractures. Lateral approach MIPO may be beneficial to shorten the operation time, while the overall complication incidence of helical plate MIPO is lower.
In recent years, a rapid development in non-invasive brain stimulation (NIBS) techniques have been witnessed in the field of rehabilitation. These techniques have gained significant attention from researchers in the field of brain dysfunction rehabilitation, holding great promise as a therapeutic modality to alleviate impairments in brain function. However, the efficacy of most NIBS treatment protocols often falls short of patients’ expectations in clinical practice. To address this gap, further research and practical efforts are necessary to delve into the mechanisms underlying NIBS effectiveness, devise strategies for enhancing efficacy, and address safety concerns associated with its application. This article provides a comprehensive review of recent research advancements of NIBS in the context of brain dysfunction. Moreover, it offers insights into future development trends, intending to serve as a valuable reference for studies investigating the effectiveness and safety of NIBS, while guiding appropriate clinical practices in rehabilitation.
ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.
Surgical treatment is an important treatment for spontaneous pneumothorax, which can remove the gas in the pleural cavity, relieve symptoms, promote lung recruitment, moreover, prevent future recurrence. The surgical modalities included video-assisted thoracoscopic surgery (VATS) and non VATS treatment. Nowadays, the treatment of spontaneous pneumothorax has entered a minimally invasive era. With the development of minimally invasive techniques in recent years, as the representative of minimally invasive surgery, the surgeon techniques of VATS has developed to diversity, including three-port VATS, two-port VATS, uniportal VATS, subxiphoid uniportal VATS, 3D VATS, robotic-assisted VAT and cervical uniportal VATS. Each technique has its own advantages and limitations, and individual choices should be made.
ObjectiveTo compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision (R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision (L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus ［(3.28±1.64) d vs. (6.01±2.77) d, P<0.001］, the time to the first postoperative oral fluid intake ［(4.46±1.62) d vs. (6.28±2.74) d, P<0.001） and the length of hospital stay ［（11.20±5.80）d vs. (14.72±6.90) d, P=0.023］ of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention (2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group ［(175.06±110.77) mL vs. (123.91±99.61) mL, P=0.031, ）. The operative time, number of lymph nodes harvested and distal margin were similar intergroup（P>0.05）. The total cost was higher in the R-TME than in the L-TME group ［(85 623.91±13 310.50) CNY vs. (67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. ConclusionsCompared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type III humeral supracondylar fracture in children. Methods From September 2002 to July 2009, 189 patients with Gartland type III humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning. There were 137 males and 52 females, aged from 1 to 13 years (6.2 years on average). Injury was caused by sports in 173 cases, by traffic accident in 9 cases, by fall ing from height in 5 cases, and by earthquake in 2 cases. All fractures were closed fractures, compl icating others fracture in 11 cases, radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases, and brachial artery injuryin 2 cases. The time from injury to hospital ization was 1 hour to 10 days. Neurovascular repair was performed at the same period. Results All incisions healed by first intention, no related compl ications occurred. A total of 143 patients were followed up 5 months to 5 years (12 months on average). X-ray films showed fracture healed within 2-4 months (2.5 months on average). Cubitus varus occurred in 6 cases, but the functions of elbow flexion and extension were good; 2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training. According to the Flynn et al criteria, the results were excellent in 121 cases, good in 15 cases, and fair in 7 cases; the excellent and good rate was 95.1%. Only a small incision scar was found, the function returned to normal in the cases compl icated by nerve and blood vessel injury. Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type III humeral supracondylar fracture in children is a safe and effective surgical procedure, which has minimal trauma, short surgery time, quick recovery, simple operation, and can be effective in reducing the compl ications.
Objective To investigate the safety of high fraction of inspired oxygen (FiO2)during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and carbon dioxide (CO2)retention. Methods Fifty-six AECOPD patients with CO2 retention admitted between March 2013 and August 2015 were recruited in the study.All patients received noninvasive ventilation treatment with FiO2<0.5.After stabilization of acute respiratory crisis,FiO2 was increased to 1.0 and lasted for 40 minutes.The changes of tidal volume,respiratory frequency,minute volume,Glasgow coma score,arterial blood gas and SpO2 were observed before and after the FiO2 reset. Results The mean PaO2 increased from (83±14)mm Hg to (165±41)mm Hg and the mean SpO2 increased from (92.4±3.1)% to (97.8±1.9)% significantly (both P<0.001).The mean PaCO2 did not changed obviously from (72±15)mm Hg to (72±14)mm Hg (P=0.438).There were also no significant changes in any of the other parameters. Conclusion During noninvasive ventilation with an FiO2 sufficient to maintain a normal PaO2,an increase in FiO2 does not further increase PaCO2 level in AECOPD patients with CO2 retention.