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简介：AbstractBackground:No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects.Methods:Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported.Results:A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001).Conclusions:The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.

简介：让S是包含一刺x的Riemann表面。让是S上的简单关上的geodesics的收集，并且让表示在S上在对身份同位素的S上印射班的集合{x}。关于曲线c由tc表示积极Dehn扭曲。在这份报纸，作者学习形式的产品(tbmtn)fk一，b和f。如果，看见那是容易的=b或一，b是S上的刺穿x的柱体的边界部件，那么，一个人可以发现一个元素f以便顺序(tbmtn一)fk无穷地包含Dehn扭曲的许多力量。作者证明converse陈述仍然保持真，也就是说如果顺序(tbmtn)fk无穷地包含Dehn扭曲的许多力量，那么一，b一定是S上的刺穿x的柱体的边界部件，f是旋转地图tb的力量1t一。

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简介：目的：察浅刺多针法与常规针刺法治疗单纯性肥胖症的临床疗效。方法：本按照循证医学的原则，40例单纯性肥胖患者随机分为浅刺多针法治疗组20例，常规针刺法治疗组20例。治疗每目1次，20次为观察疗程，在治疗前后分别记录体重、标准体重、体重指数、脂肪百分率、胸围、腰围、臀围，对所得相关资料进行分析。结果：两组经20次治疗体重、腰围等均有明显改变，两组疗效比较，浅刺多针法治疗组明显优于常规针刺法治疗组（P〈0．05）。结论：刺多针法对单纯性肥胖有较好的临床疗效，其效果优于常规针刺组。

简介：ObjectivesTodeterminethesafetyandvalueofesophagealradiographyasameansoflocatingtransseptalpuncture.Methods486patientswhounderwenttransseptalpuncturewererandomizedintotwogroups.Anesophagusradiographicmethodoflocatingtansseptalpuncturesitewasappliedinthestudygroup(n=243)andmodified-Rosslocatingmethodwasusedinthecontrolgroup(n=243).Aftersuccessfullocation,transseptalpuncturewasmade.Weobservedthesuccessrateandincidencecomplicationsinthe2groups.ResultsLeftatriumimpressioninthestudygroupwasclearlyseen.Nonethelessin120casesofcontrolgroup,theleftatriasilhouettewasnotclearlyvisualised.Thesuccessrateoflocatingtransseptalpuncturesiteinthestudygroupandcontrolgroupwere100%and50.6%respectively(P<0.001).Thesuccessrateoftransseptalpunctureinthestudygroupandcontrolgroupwas99.6%and45.7%respectively(P<0.001).Therewerenocomplicationsassociatedwithpunctureinthestudygroupandpericardialtamponadeoccurredin1controlpatient.ConclusionsTheesophagusradiographicmethodoflocatingtransseptalpuncturesiteisaccurate,safeandsimpletoperform.Transseptalpuncturehasahighsuccessratewithfewcomplications.

简介：ObjectiveToevaluatereliabilityandsafetyofAngio-sealhemostasisdeviceappliedtothefemoralarterialpuncturesiteafterpercutaneouscoronaryintervention(PCI).MethodsIn40patientsafterPCIinourinstituteduringtheperiodbetweenMay2002andDecember2003,Angio-sealdevicewereusedtosealthefemoralarterialpuncturesite.ResultsAlltheAngiosealdevicesweresuccessfullydeployedin40patients(successfulrate;100%);themeantimetohemostasiswas45±12sec;themeantimetoambulateafterangiosealclosurewas1.9?.5hours.Nomajorgroinandsystemiccomplicationwasobserved.Therewasminorgroinoozingin2casesandsmallhemotomain1patient.ConclusionsAngio-sealclosuredeviceofthefemoralarterypuncturesiteafterapercutaneouscoronaryprocedureissafe.Itcanshortenthetimetohemostasis,leadstoearlymobilization,andreducegroincomplication.Thedisadvantageisrelativelyexpensive.

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简介：AbstractPurpose:Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone.Methods:From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests.Results:A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6%); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4%); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5%), 4 moderate disability and 4 good recovery (good outcome 23.5%). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z=-1.993, p = 0.046; χ2= 4.38, p= 0.043). However, there was no significant difference regarding the survival curve between PD + DC group and DC group. The correlation between the time from admission to operation and GOS at 6 months (r=-0.41, R2= 0.002, p= 0.829) was not significant in the PD + DC group, but significant in the DC group (r=-0.357, R2= 0.128, p= 0.038).Conclusion:PD+ DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.

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