Objective:To explore the influencing factors for postoperative delirium in General Ward of Neurosurgery and evaluate the influence of serum acetylcholinesterase level in it.Methods:A retrospective study was performed. Two hundred and ninety-eight patients accepted surgery and diverted into General Ward of Neurosurgery in our hospital from January 2021 to July 2021 were chosen in our study. The 4AT delirium scoring tool was used to evaluate whether the patients had delirium, and these patients were, then, divided into non-delirium group and delirium group. The preoperative general data, history of deseases and laboratory results (serum acetylcholinesterase level) were collected. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent factors affecting the occurrence of postoperative delirium, especially the relation between preoperative serum acetylcholinesterase level and postoperative delirium. Receiver operating characteristics (ROC) curve was drawn to evaluate the predictive value of serum acetylcholinesterase in postoperative delirium.Results:The incidence of postoperative delirium in 298 patients in General Ward of Neurosurgery was 24%, including 225 patients into the non-delirium group and 73 patients into the delirium group. There were significant differences between the two groups in the proportions of patients having resuscitation in anesthesia ICU, using postoperative analgesic pump and having alcoholism history, surgical duration, intraoperative bleeding, proportion of patients accepting skull base surgery, proportion of patients remaining awake 2 h after surgery, and incidence of bilateral frontal lobe pneumatosis after surgery ( P<0.05). Preoperative serum acetylcholinesterase level in delirium group ([2.35±0.49] U/mL) was significantly lower than that in non-delirium group ([2.78±0.48] U/mL, P<0.05). Preoperative serum acetylcholinesterase level ( OR=0.116, 95%CI: 0.034-0.394, P=0.001), postoperative resuscitation in anesthesia ICU ( OR=0.043, 95%CI: 0.002-0.878, P=0.041), keeping awake 2 h after surgery ( OR=7.641, 95%CI: 1.675-34.858, P=0.009), surgical duration ( OR=1.887, 95%CI: 1.192-2.987, P=0.007), intraoperative bleeding ( OR=1.010, 95%CI: 1.006-1.014, P<0.001), and skull base surgery ( OR=6.700, 95%CI: 1.907-23.547, P=0.003) were all independent influencing factors for postoperative delirium in patients in General Ward of Neurosurgery. The area under ROC curve for serum AchE level to predict the occurrence of postoperative delirium was 0.735(95%CI: 0.679-0.800, P<0.001); when the cut-off value was 2.67 U/mL, the sensitivity and specificity were 64% and 75%. Conclusions:Skull base surgery, keeping awake 2 h after surgery, long surgical duration and large amount of intraoperative bleeding can promote the occurrence of postoperative delirium; admission to anesthesia ICU after surgery can reduce the occurrence of delirium. When the preoperative serum AchE level is less than 2.67 U/mL, the possibility of postoperative delirium should be warned.

Objective:To investigate the effect of overexpression of leucine-rich repeats and immunoglobulin-like domains 1 (LRIG1) on the proliferation, apoptosis and invasion of glioma cells and its molecular mechanism.Methods:U373 cells were cultured in dulbeeeo modified eagle medium (DMEM) medium and divided into control group and LRIG1 group. Control Group was infected with control lentivirus and LRIG1 group was infected with over-expressed lentivirus. The positive cells were screened after 48 hours. Cell proliferation was detected by cell counting kit-8 (CCK-8) and 5-Ethynyl-2’-deoxyuridine (EdU) staining, cell apoptosis was detected by flow cytometry staining, and cell invasion was detected by Transwell staining. The expression levels of the proteins associated with apoptosis and invasion was analyzed by Western blotting.Results:Compared with control group (1.24±0.21), the expression level of LRIG1 protein in LRIG1 group (2.81±0.30) significantly increased ( t=3.015, P<0.05). Compared with the control group (1.74±0.25), the light absorption value of LRIG1 group (1.12 ± 0.18) significantly decreased ( t=3.641, P<0.05). Compared with the control group [(78.65±10.58)%], the EdU positive rate [(34.02 ± 8.01)%] in LRIG1 group significantly reduced ( t=4.387, P<0.05). Compared with the control group [(5.02±1.81)%], the apoptosis rate of LRIG1 group [(25.49 ± 6.89)%] significantly increased ( t=6.914, P<0.05). Compared with the control group (88.14±9.28), the number of invasive cells (39.48±5.81) in LRIG1 group significantly decreased ( t=5.498, P<0.05). Compared with control group (0.58±0.10), the expression level of cysteinyl aspartate-specific protease (Caspase)-3 protein in LRIG1 group (1.16±0.13) significantly increased ( t=3.001, P<0.05). Compared with control group (1.18±0.18), the expression level of matrix metalloproteinase (MMP)-9 in LRIG1 group (0.44±0.11) significantly decreased ( t=3.482, P<0.05). Conclusion:Over-expression of LRIG1 can significantly inhibit the proliferation and invasion of Glioma cells and promote tumor cell apoptosis.

Objective:To investigate the effects of miR-4295 on proliferation, invasion and epithelial mesenchymal transition of glioma cells by targeting leucine-rich repeats and immunoglobulin-like domains 1 (LRIG1).Methods:120 cases gliomas and adjacent tissues from June 2018 to April 2020 were selected as the research objects. The expression level of miR-4295 in gliomas and adjacent tissues was analyzed by fluorescence quantitative polymerase chain reaction (PCR). MiR-4295 silencing cell line (experimental group) and control cell line (control group) were established by lentivirus in U251 glioma cell line. The proliferation ability of the two groups was analyzed by cell counting kit-8 (CCK-8). The invasion ability was analyzed by Transwell. The expression of epithelial mesenchymal markers in the control group and the experimental group was analyzed by Western blotting. The miR-4295 gene was analyzed by bioinformatics and double luciferase reporter gene, and the expression level of cell target protein in control group and experimental group was analyzed by Western blotting. T test was used to compare the data between groups, and the difference was statistically significant ( P<0.05). Results:The expression of miR-4295 in gliomas (1.29±0.20) was significantly higher than that in adjacent tissues (2.81±0.19, t=2.809, P<0.05). Compared with the control group (1.07±0.15), the expression level of miR-4295 in the experimental group (0.38±0.11) significantly reduced ( t=2.441, P<0.05). Compared with the control group (1.61±0.25), the 48 h absorbance value (1.22±0.18) of the experimental group significantly reduced ( t=2.091, P<0.05). Compared with the control group [ (89.27±9.10) cells], the number of invasive cells in the experimental group [ (32.49±5.94) cells] significantly decreased ( t=4.109, P<0.05). The expression levels of N-cadherin and Vimentin in the experimental group (0.30±0.11, 0.37±0.12) were significantly lower than those in the control group (1.13±0.13, 1.20±0.19, t=3.091, 2.861, P<0.05). Bioinformatics and double luciferase reporter gene showed that LRIG1 was the target gene of miR-4295. The relative expression level of LRIG1 in the adjacent tissues (1.05±0.22) was significantly lower than of tumor tissues (0.23±0.11, t=3.021, P<0.05). Compared with the control group (0.35±0.13), the relative expression level of LRIG1 in the experimental group significantly increased (0.89±0.17, t=2.198, P<0.05). Conclusion:MiR-4295 regulates the proliferation, invasion and epithelial mesenchymal transition of glioma cells by targeting LRIG1.

背景:临床中对腰椎滑脱患者腰椎稳定性的诊断多借助腰椎侧位屈伸X射线,但该检查存在一定的局限,因此寻找可靠的腰椎稳定性预测指标十分必要.目的:通过回顾患者影像学资料,分析退变性腰椎滑脱患者腰椎椎间小关节积液是否与腰椎稳定性存在相关性.方法:回顾性分析2016年12月至2018年1月在天津市人民医院脊柱外科就诊的L4-5节段腰椎退变性滑脱患者共108例,所有患者对测量方案知情同意,且得到医院伦理委员会批准.根据其滑脱节段的腰椎MRI中是否出现椎间小关节腔内积液将患者分为无积液组55例,有积液组53例,并对2组进行对比分析.对有积液组中的双侧椎间小关节积液宽度和与矢状位椎体动态滑移指数、椎体旋转度、双侧椎间小关节退变指数和及椎间盘退变指数分别进行相关性分析.结果与结论:①无积液组的失稳率低于有积液组,动态滑移量、动态滑移指数及矢状位旋转度均小于有积液组,椎间小关节及椎间盘退变程度均高于有积液组,差异均有显著性意义(P=0.000);②对于有积液组的相关性分析,双侧椎间小关节积液宽度和分别与矢状位椎体动态滑移指数、矢状位椎体旋转度成线性正相关(r=0.710,P=0.000;r=0.452,P=0.001);双侧椎间小关节积液宽度和分别与双侧椎间小关节退变指数和、椎间盘退变指数成负相关(r=-0.630,P=0.000;r=-0.648,P=0.000);③提示退变性腰椎滑脱症患者腰椎MRI上存在椎间小关节积液表现可提示滑脱不稳定,滑脱节段椎间小关节总积液量与腰椎滑移不稳定性、旋转不稳定性成正相关,与双侧椎间小关节退变程度、椎间盘退变程度成负相关.

目的:探索负压吸引联合钉皮器在腹部外科中应用的安全性和有效性.方法:回顾性研究结直肠癌手术513例,根据关腹方法的不同分为2组,观察组在关腹过程中采用关闭前鞘或白线后皮下留置负压吸引器,钉皮器直接钉合皮肤的方法,对照组在关腹过程中采用关闭前鞘或白线后间断丝线缝合皮下组织和皮肤的方法.结果:观察组的切口并发症(切口感染、脂肪液化、切口裂开、皮下血肿)发生率小于对照组(1.1％vs 13.1％,P<0.05),切口美观度优于对照组(4.6％vs 15.9％,P<0.05),住院总费用无显著差异(5.7万元vs 5.6万元,P>0.05).结论:负压吸引联合钉皮器在腹部外科中应用时具有安全性高、切口并发症发生率低、切口更美观等优点.

BACKGROUND:Pelvic floor peritoneum reconstruction is a key step in various standard resections for open radical rectal cancer. However, during endoscopic surgery, most surgeons do not close the pelvic floor peritoneum. This study aims to evaluate the efficacy of pelvic peritonization during laparoscopic Dixon surgery using an observational study.METHODS:A total of 189 patients, who underwent laparoscopic Dixon surgery at Tianjin Union Medical Center, China, were analyzed retrospectively. All of the cases were divided into two groups according to the differences of surgical procedure. The 92 patients in Group A (observation group) underwent pelvic peritonization and the 97 patients in Group B (control group) did not undergo this procedure. Postoperative complications were observed in the two groups, compared, and analyzed using the Chi-square or Fisher's exact test.RESULTS:The incidence of anastomotic leakage was significantly lower in Group A than in Group B (P = 0.014). A significant difference was found in the postoperative short-term (P = 0.029) and long-term (P = 0.029) ileus rates between the two groups, with Group A exhibiting a lower rate than Group B. Patients in Group A had significantly lower rates of postoperative infections than those in Group B (χ2 = 7.606, P = 0.006; χ2 = 4.464, P = 0.035). Patients in Group A had significantly lower rates of deep venous thrombosis than those in Group B (χ2 = 8.531, P = 0.003).CONCLUSIONS:Pelvic peritonization effectively reduces postoperative complications, such as anastomotic leakage, which warrants its increased use in laparoscopic surgery.

肠脂垂是有蒂的袋状脂肪组织,从结肠外表面突向腹膜腔,被裹腹膜.每个肠脂垂由1或2根结肠边缘血管的终末动脉供血和l根静脉回流;有蒂及充分的活动性导致肠脂垂易扭转而发生缺血性或出血性梗死以及炎性改变,即肠脂垂炎(epiploicappendagitis,EA)[1].肠脂垂炎包括原发性和继发性两种类型:原发性肠脂垂炎(primary epiploicappendagitis,PEA)指肠脂垂自身或者周围炎症;继发性肠脂垂炎(secondary epiploicappendagitis,SEA)一般由邻近的炎性疾病引起,如阑尾炎、憩室炎和胆囊炎.本文回顾性分析2014年1月至2017年12月天津市人民医院收治的11例EA的临床资料,总结其诊治经验.现报告如下.

Objective:To evaluate the clinical efficacy and safety of prophylactic ilioinguinal neurectomy in open tensionfree inguinal hernia repair.Methods:The randomized controlled trials estimating the clinical significance of prophylactic ilioinguinal neurectomy publically published before March 2017 were searched in several national and international databases.A meta-analysis was performed on the extracted data.Results:A total of 13 studies were included,involving 2 033 patients with 1 007 cases in nerve excision group and 1 026 cases in nerve preservation group.In nerve excision group compared nerve preservation group,the shortand mid-term postoperative pain (SMD=-0.54,95％ CI=-0.85--0.23;SMD=-0.25,95％ CI=-0.40--0.10) were significantly reduced (both P＜0.05),but the long-term postoperative pain (SMD=-0.21,95％ CI=-0.47-0.05)showed no significant difference (P＞0.05);all the short-,mid-and long-term rates of postoperative numbness (RD=0.00,95％ CI=-0.06 0.07;RD=0.01,95％ CI=-0.03 0.06;RD=0.00,95％ CI=-0.03-0.02) and sensory disturbance (RD=0.05,95％ CI=-0.03-0.12;RD=0.02,95％ CI=-0.02-0.06;RD=0.01,95％ CI=-0.02-0.04)showed no significant difference (all P＞0.05);the incidence of minor postoperative complications (RR=0.71,95％ CI=0.48-1.06) also showed no significant difference (P＞0.05).Conclusion:Prophylactic ilioinguinal neurectomy in open inguinal hernia repair can effectively reduce the shortand mid-term pain,with no increase of risk of abnormal sensations in the inguinal area.