One-time Success Rate Research Articles

Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)—the abdominal end of the VPS device was placed externally—as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.

Blind versus endoscopy-guided postpyloric feeding tube placement in adults with ischemic stroke: A retrospective cohort study.

This study compared the one-time success rate of blind and endoscopy-guided postpyloric feeding tube placement after implementing a comprehensive nursing scheme of intestinal blind placement for patients with ischemic stroke. This retrospective cohort study included 179 patients with blind bedside placement and 118 with endoscopy-guided placement. The primary outcome was the one-time success rate of radiologically confirmed postpyloric placement. The secondary endpoints included the position of the tube tip, length of insertion, time of placement, and expenses. The safety endpoints were the incidence of complications caused by placement. The results showed that the method of tube placement did not significantly affect the outcome of the first tube placement (odds ratio [OR] = 0.41; 95% CI = 0.137-1.207; P = 0.105). Compared with endoscopy-guided placement, blind placement was half the cost. We also found that a history of abdominal surgery (OR = 0.003; 95% CI = 0.000-0.059; P < 0.001) and longer intensive care unit (ICU) days (OR = 0.94; 95% CI = 0.903-0.981; P = 0.004) were inversely associated with the one-time success rate. Our study suggested that blind intestinal feeding tube placement has an equivalent one-time success rate compared with endoscopy-guided placement in hospitalized patients with ischemic stroke if operators can be trained well. However, the expenses of endoscopy-guided placement were twice those of blind bedside methods. We also found that patients with abdominal surgery history and longer ICU stay were more likely to fail at the first placement. Further research is needed to replicate our single-center observations in a larger population of patients.

Safety Analysis of Umbilical Vein Puncture Guided by B-Ultrasound in Prenatal Diagnosis

Objective: To explore the safety of umbilical vein puncture guided by B-ultrasound in prenatal diagnosis. Methods: Patients undergoing prenatal examinations in the Department of Obstetrics and Gynecology from February 2023 to February 2024 were selected as the observational subjects. A total of 90 cases were included. Umbilical vein puncture was performed under B-ultrasound guidance to observe puncture safety. Results: The one-time puncture success rate of umbilical vein puncture under B-ultrasound guidance in 90 patients was 97.78%, with an average puncture time of 8.43 ± 1.04 minutes. Fetal heart rate slowed down in 2 cases during umbilical vein puncture guided by B-ultrasound and in 3 patients after surgery, resulting in an incidence rate of 5.56%. Logistic nonlinear multifactor analysis indicated that puncture time and the number of successful punctures were correlated. Additionally, fetal cardiovascular system abnormalities emerged as an independent risk factor for fetal heart rate slowdown, with a statistical value of P &lt; 0.05. Conclusion: The one-time success rate of umbilical vein puncture guided by B-ultrasound for prenatal diagnosis is high. Early identification of high-risk groups and the implementation of targeted measures can reduce puncture adverse events and ensure the safety of prenatal diagnosis.

Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case-control study.

A novel technique, percutaneous elastic stable intramedullary nail fixation (ESIN), proposed by our team for the treatment of anterior pelvic ring injury. Finite element analysis and retrospective case-control study were used to compare biomechanical properties and clinical outcomes between ESIN and other techniques. Four groups of finite element models of pelvic anterior ring injury were simulated, including ESIN (model A), retrograde transpubic screw fixation (RTSF, model B), subcutaneous internal fixator (model C), and external fixator (model D), and a vertical downward load of 500 N was applied to the S1 vertebral endplate. Stress and displacement distributions of intact pelvis, displacement distributions of pubic fracture fragments, and stress distributions of fixation devices were analysed. Then 31 patients with anterior pelvic ring injury (15 in the ESIN group and 16 in the RTSF group) were reviewed. Clinical outcomes were evaluated at the final follow-up. Postoperative complications were also recorded. Under 500N loading, the intact stability of the pelvis was compared as follows: model B (20.58mm, 121.82MPa), model A (20.80mm, 129.97MPa), model C (22.02mm, 141.70MPa), and model D (22.57mm, 147.06MPa). The regional stability of superior pubic ramus was compared as follows: model B (9.48mm), model A (10.16mm), model C (10.52mm), and model D (10.76mm). All 31 patients received follow-up at least 12 months postsurgery (range 12-20 months). Age, sex, injury mechanism, fracture type, time between the injury and operation, American Society of Anesthesiologists score, intraoperative blood loss, hospital stay, follow-up period, time to union, and Majeed scores did not differ significantly between the two groups ( P >0.05). However, the differences in the duration of unilateral surgery, unilateral intraoperative fluoroscopy and one-time success rate were significant ( P <0.05). With sufficient biomechanical stability and minimally invasive advantage, the percutaneous technique using ESIN can be used to successfully treat anterior pelvic ring injuries. In addition, advantages over RTSF include a shorter duration of surgery, reduced requirement for intraoperative fluoroscopy, and a higher one-time success rate. ESIN therefore constitutes a good alternative to RTSF.

Robot-assisted versus fluoroscopy-guided pedicle screw fixation of thoracolumbar compression fractures.

The aim of this study is to compare the clinical outcomes and accuracy of robot-assisted (RA) versus fluoroscopy-guided (FG) pedicle screw fixation of thoracolumbar compression fractures. We retrospectively enrolled 85 patients with surgically treated thoracolumbar compression fractures in our study (RA group, 45 patients; FG group, 40 patients). We analyzed the accuracy of pedicle screw placement by using the Gertzbein-Robbins classification, and calculated the one-time success rate (i.e., the rate of screws successfully inserted in the first attempt). We also evaluated volume of blood loss, operative time, visual analogue scale scores for pain, Cobb angle, and postoperative complications. The rates of grade A screw placement (96% vs 68.5%; P < .005), clinically acceptable screw placement (98.2% vs 86%; P < .005), and the one-time success rate (97.3% vs 82.5%; P < .005) were all significantly higher in the RA group than in the FG group. No differences were observed in sex, age, body mass index, volume of blood loss, operative time, visual analogue scale scores, Cobb angle, and postoperative complications between the 2 groups. Compared to FG surgery, RA surgery yielded greater accuracy and one-time success rates of pedicle screw fixation of thoracolumbar compression fractures, with comparable clinical outcomes.

Absorbable Clips Applied in Thoracoscopic Anatomical Lung Resection in Younger Children.

This study aims to evaluate the feasibility and safety of a 5-mm absorbable clips applied in thoracoscopic anatomical lung resection in younger children. Demographic data and intra- and postoperative parameters of the two groups (Abs-o-lock® group and Hem-o-lok® group) were reviewed. In the Abs-o-lock® group, 5-mm absorbable clips were used in thoracoscopic anatomical lung resection on all patients from January 2020 to March 2021. In the Hem-o-lok® group, 5-mm Hem-o-lok® clips were used from January to December 2019. The primary outcomes were the one-time success rate of ligation, major bleeding rate, intraoperative dislodgement rate and operative time, which were compared between the two groups. There were 224 patients involved in this study, of whom 103 were in the Abs-o-lock® group and 121 were in the Hem-o-lok® group. The one-time success rate of ligation was 96.5% in the Abs-o-lock® group and 98.9% in the Hem-o-lok® group (p < 0.05). No major bleeding occurred in either group. The intraoperative dislodgement rate did not significantly differ between the two groups (p = 1.0). The operative time consumed in the Abs-o-lock® group was much longer than that in the Hem-o-lok® group for subgroups of resection of extralobar sequestration (p < 0.05), lobectomy (p < 0.05) and segmentectomy (p < 0.05). Compared to Hem-o-lok® clips, it is feasible and safe to apply 5-mm absorbable clips for vessel sealing during thoracoscopic anatomical lung resection in younger children.

Indirect Puncture Using a Novel Arc Puncture-Guided Device in Percutaneous Transforaminal Puncture on Goat Lumbar Spine Specimens

To investigate the implication of indirect puncture using a novel arc puncture-guided device in percutaneous transforaminal puncture in improving the puncture accuracy, reducing fluoroscopy times, puncture times and operation time. We have designed a novel arc puncture-guided device which consists of a 90°arc block and a 30°arc block. Punctures were performed on 8 fresh goat lumbar spine specimens. A senior doctor performed indirect punctures on the left side of L2/L3, L3/L4 and L4/L5 level side using the novel device (group A)，and on the right side of L2/L3, L3/L4 and L4/L5 level with conventional method (group B). We recorded the fluoroscopy times, puncture times and operation time. In group A, the first puncture could successfully reach the target after 1-3 punctures, and the one-time success rate of the second needle puncture is 91.67%. The total fluoroscopy times were 14.88±0.99 in group A and 16.08±2.22 in group B (p=0.027). The puncture times were 3.00±0.66 in group A and 6.04±2.13 in group B (P < 0.01). The operation time(s) was 273.75±30.19 in group A and 361.25±69.57 in group B (P < 0.01). There were significant differences in fluoroscopy times，puncture times and operation time between the two groups(P < 0.05). The indirect puncture using the novel arc puncture-guided device in percutaneous transforaminal puncture can significantly improve the puncture accuracy, reduce fluoroscopy times, puncture times and operation time. Indirect puncture using the novel device in percutaneous transforaminal endoscopic discectomy (PTED) is a potential and practical puncture method.

Clinical Analysis of Intranasal Dexmedetomidine Combined With Midazolam in Pediatric Cranial Magnetic Resonance Examinations

PurposeTo observe the efficacy and safety of intranasal dexmedetomidine combined with midazolam in cranial magnetic resonance imaging of children. DesignA prospective, observational, single-arm, one-center study. MethodsA total of 474 children were scheduled for cranial 3.0 T MRI at the first time. All patients were initially given 3 mcg/kg dexmedetomidine combined with 0.15 mg/kg midazolam. The one-time success rate, vital signs before and after treatment, onset time, recovery time, and incidence of adverse reactions were recorded. FindingsThe one-time success rate was 78.1%. There were significant differences in respiration, heart rate, and blood oxygen saturation before and after treatment (P < .001). The onset time was 10 (8-15) minutes. The average recovery time was 2.58 ± 1.10 hours. Only 1.27% (6 cases) of adverse reactions were observed, including bradycardia (3 cases, 0.6%), tachycardia (1 case, 0.2%), and startle (2 cases, 0.4%). No special treatment was needed. The success of the examination was significantly correlated with age (OR 1.320, 95% CI 1.019-1.710, P = .035) and onset time (OR 0.959, 95% CI 0.921-0.998, P = .038). ConclusionDexmedetomidine 3 mcg/kg combined with midazolam 0.15 mg/kg intranasally has a good sedative effect in pediatric cranial magnetic resonance examinations, little impact on breathing and circulation, and few adverse reactions. Age and onset time are related factors affecting the one-time success rate.

Ultrasound- Versus Computed Tomography-Guided Cervical Dorsal Root Ganglia Pulsed Radiofrequencies via Intervertebral Foramen for the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study

BACKGROUND: Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported. OBJECTIVES: The goal of this study was to propose a method for performing US-guided transforaminal PRF on cervical DRG. By comparing the results with those of CT guidance, we also sought to assess the accuracy, safety, and efficacy of this new approach in the treatment of PHN. STUDY DESIGN: A retrospective cohort study. SETTING: The study took place at the department of pain management of a single academic medical center. METHODS: The data of 73 PHN patients receiving 2 sessions of US-guided (US group, n = 26) or CT-guided (CT group, n = 47) cervical DRG PRF were reviewed. US-guided DRG PRF was performed using our proposed protocol. The one-time success rate was used to assess accuracy. The average radiation dose, the number of scans per operation, and the rate of complications were recorded for safety assessment. For the evaluation of pain amelioration, a Numeric Rating Scale (NRS-11), the daily sleep interference score (SIS), and oral medication (i.e., anticonvulsants and analgesics) usage 2 weeks, 4 weeks, 12 weeks, and 24 weeks after treatment were compared to the baseline values and between groups. RESULTS: The one-time success rate in the US group was significantly higher than that in the CT group (P &lt; 0.05). Compared those of the CT group, the mean radiation dose and number of scans per operation were both obviously lower in the US group (P &lt; 0.05). The average operation time was also shorter in the US group (P &lt; 0.05). No obvious serious complications occurred in either group. No obvious between-group difference was found in the NRS-11 score, daily SIS, or rate of oral medications at any of the time points (P &gt; 0.05). The NRS-11 score and SIS significantly decreased after treatment at each follow-up time point (P &lt; 0.05) in both groups. Compared with those at baseline, the use rate of anticonvulsants and analgesics obviously decreased 4 weeks, 12 weeks, and 24 weeks after treatment (P &lt; 0.05). LIMITATIONS: This study was limited by its nonrandomized and retrospective design. CONCLUSIONS: US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time. KEY WORDS: Ultrasound, pulsed radiofrequency, dorsal root ganglion, postherpetic neuralgia, transforaminal

The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis

Introduction: Urolithiasis is one of the most common diseases in the world, and at present, ureteroscopy (URS) is the first choice for its treatment. Although the effect is good, there is a risk of insertion failure of ureteroscope. Tamsulosin, as an α-receptor blocker, has the function of relaxing ureteral muscles, and can help stones to be discharged from ureteral orifice. In this study, we aimed to determine the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. Methods: This study was conducted and reported according to the meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed and Embase databases were searched for studies. Data were extracted according to the PRISMA principles. We collected and combined randomized controlled trial and researches in reviews of preoperative tamsulosin to explore the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. A data synthesis was performed using RevMan 5.4.1 software (Cochrane). Heterogeneity was mainly evaluated with I2 tests. Key metrics include: success rate of ureteral navigation, time of URS, stone-free rate, and postoperative symptoms. Result: We summarized and analyzed 6 studies. We noted a statistically significant improvement in the success rate of ureteral navigation (Mantel-Haenszel [M-H], odds ratio [OR]: 3.78, 95% confidence interval [CI]: [2.34, 6.12], p < 0.01) and stone-free rate (M-H, OR: 2.25, 95% CI: [1.16, 4.36], p = 0.02) with tamsulosin preoperatively. At the same time, we also observed that postoperative fever (M-H, OR: 0.37, 95% CI: [0.16, 0.89], p = 0.03) and postoperative analgesia (M-H, OR: 0.21, 95% CI: [0.05, 0.92], p = 0.04) were also reduced because of preoperative tamsulosin. Conclusion: Preoperative tamsulosin can not only increase the one-time success rate of ureteral navigation and the stone-free rate of URS but also reduce the incidence of postoperative adverse symptoms such as postoperative fever and postoperative pain.

Noncontact Manipulation of Intracellular Structure Based on Focused Surface Acoustic Waves

Cell orientation is essential in many applications in biology, medicine, and chemistry, such as cellular injection, intracellular biopsy, and genetic screening. However, the manual cell orientation technique is a trial-and-error approach, which suffers from low efficiency and low accuracy. Although several techniques have improved these issues to a certain extent, they still face problems deforming or disrupting cell membranes, physical damage to the intracellular structure, and limited particle size. This study proposes a noncontact and noninvasive cell orientation method that rotates a cell using surface acoustic waves (SAWs). To realize the acoustic cell orientation process, we have fabricated a microdevice consisting of two pairs of focused interdigital transducers (FIDTs). Instead of rotating the entire cell, the proposed method rotates the intracellular structure, the cytoplasm, directly through the cell membrane by acoustic force. We have tested the rotational manipulation process on 30 zebrafish embryos. The system was able to orientate a cell to a target orientation with a one-time success rate of 93%. Furthermore, the postoperation survival rate was 100%. Our acoustic rotational manipulation technique is noninvasive and easy to use, which provides a starting point for cell-manipulation-essential tasks, such as single-cell analysis, organism studies, and drug discovery.

Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial

BackgroundTo evaluate the safety and effectiveness of different dosages of intranasal Dexmedetomidine (DEX) in combination with oral midazolam for sedation of young children during brain MRI examination.MethodsIncluded in this prospective single-blind randomized controlled trial were 156 children aged from 3 months to 6 years and weighing from 4 to 20 Kg with ASA I-II who underwent brain MRI examination between March 2021 and February 2022. Using the random number table method, they were divided into group A (using 3 ug/kg intranasal DEX plus 0.2 mg/Kg oral midazolam) and group B (using 2 ug/kg intranasal DEX plus 0.2 mg/Kg oral Midazolam). The one-time success rate of sedation, sedation onset time, recovery time, overall sedation time, and occurrence of adverse reactions during MRI examination were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP), and percutaneous SpO2before and after drug administration were observed in both groups. Differences in sedation scores between the two groups were compared before intranasal drug administration (T0), 10 min after drug administration (T1), at the time of falling asleep (T2), at the end of examination (T3), and at the time of recovery (T4).ResultsThe one-time success rate of sedation in group A and B was 88.31% and 79.75% respectively, showing no significant difference between the two groups (P>0.05). The sedation onset time in group A was 24.97±16.94 min versus 27.92±15.83 min in group B, and the recovery time was 61.88±22.18 min versus 61.16±28.16 min, both showing no significance difference between the two groups (P>0.05). Children in both groups exhibited good drug tolerance without presenting nausea and vomiting, hypoxia, or bradycardia and hypotension that needed clinical interventions. There was no significant difference in the occurrence of abnormal HR, MAP or other adverse reactions between the two groups (P>0.05).Conclusion3 ug/kg or 2 ug/kg intranasal DEX in combination with 0.2 mg/kg oral Midazolam both are safe and effective for sedation of children undergoing MRI examination with the advantages of fast-acting and easy application.Trial registrationIt was registered at the Chinese Clinical Trial Registry (ChiCTR1800015038) on 02/03/2018.

In-plane guided upper arm arteriovenous fistula cannulation with color ultrasound.

The blood vessel in the upper extremity arteriovenous fistula (AVF) is deep in the tissue, and cannulation in AVF is frequently associated with blood oozing, hematoma, or aneurysm. This study evaluated the performance of color ultrasound in-plane guided cannulation technique during upper extremity high-AVF cannulation in patients with hemodialysis. A total of 40 patients with hemodialysis who needed cannulation in upper extremity AVF were recruited in the study, and the patients were randomly divided into observation group and control group. Color Doppler ultrasound was used to guide cannulation in the observation group and in the control group blind cannulation method was applied. The success rate of one-time cannulation, the incidence of subcutaneous hematoma, oozing, and pain caused by incorrect fistula cannulation as well as the satisfaction score of the patients were compared to evaluate the effect and advantages of color ultrasound-guided cannulation. The one-time success rate of internal fistula cannulation in the observation group (98.71%) was significantly higher than that in the control group (88.27%). The incidence rates of hematoma, oozing, pain, and total failure events were significantly reduced in the observation group. The average satisfaction degree in the observation group was also significantly higher than that of the control group. Ultrasonic-guided cannulation effectively enhances the success rate of cannulation in upper extremity AVF, reduces the incidence of cannulation failures, and improves the satisfaction level in the patients.

Comparison of the Jcerity Endoscoper Airway with the LMA supreme for airway management in patients undergoing cerebral aneurysm embolization: a randomized controlled non-inferiority trial

BackgroundJcerity Endoscoper Airway is a new back-open endoscopic laryngeal mask airway device with a unique design. Our study sought to compare the implantation, ventilation quality and complications of JEA (Jcerity Endoscoper airway) versus LMA (Laryngeal Mask Airway) Supreme in the procedure of cerebral aneurysm embolization.MethodsIn this prospective, randomised clinical trial, 182 adult patients with American Society of Anesthesiologists class Ι-II scheduled for interventional embolization of cerebral aneurysms were randomly allocated into the Jcerity Endoscoper airway group and the LMA Supreme group. We compared success rate of LMA implantation, ventilation quality, airway sealing pressure, peak airway pressure, degree of blood staining, postoperative oral hemorrhage, sore throat and other complications between the groups.ResultsThere were no significant differences between the groups in terms of one-time success rate of LMA implantation, ventilation quality, airway sealing pressure or airway peak pressure. However, LMA Supreme group showed a higher degree of blood staining than the JEA group when the laryngeal mask airway was removed (P = 0.04), and there were also more oral hemorrhages and pharyngeal pain than JEA group (P = 0.03, P = 0.02). No differences were observed between groups in terms of other airway complications related to the LMA.ConclusionsThe JEA could not only achieve comparable one-time success rate of implantation and quality of ventilation as the LMA Supreme, but also have lower blood staining degree of mask and less sore throat in patients undergoing perioperative anticoagulation for cerebral aneurysm interventional embolization.Trial registrationChinese Clinical Trial Registry, ChiCTR2100044133; Registered 11/03/2021.Statement: This study adheres to CONSORT guidelines.

Observation and Nursing of Adverse Reactions in Severe Patients with Enhanced MRI.

In order to explore the observation and nursing of adverse reactions in severe patients with enhanced magnetic resonance imaging, a family nursing service model was proposed in patients with enhanced magnetic resonance imaging. 150 patients who underwent enhanced magnetic resonance imaging in a hospital were selected as the research objects. The patients were divided into two groups by random number table method. 75 patients in the control group received routine nursing intervention and 75 patients in the observation group received family nursing service intervention. The anxiety score, depression score, examination time, one-time success rate, comfort score, incidence of adverse reactions, excellent image quality rate and nursing satisfaction were compared between the two groups. The results showed that the anxiety score and depression score of the observation group were lower than those of the control group (P < 0.05), the examination time of the observation group was significantly shorter than that of the control group (P < 0.05), and the comfort score and one-time success rate of the observation group were significantly higher than those of the control group (P < 0.05). The incidence of adverse reactions was significantly lower than that in the control group (P < 0.05), the excellent and good image quality rate (95.00%) and nursing satisfaction (97.22%) were significantly higher than those in the control group (83.00%, 86.56%). This shows that the application effect of family nursing service mode in magnetic resonance enhanced scanning is remarkable. Therefore, the use of family care mode in MRI patient examination can effectively reduce patients' anxiety and depression scores, shorten examination time, reduce adverse reactions, improve the success rate of one-time examination, improve patients' comfort during examination and patients' evaluation of nursing services. The effect is ideal and worthy of clinical research and promotion.

Neomodified Koyanagi technique for severe hypospadias with one-stage sealed Y-shaped penis foreskin vascular protection surgery.

Proximal hypospadias defects represent the most challenging aspect of maintaining blood supply to the flap, which eventually leads to a high rate of complications. We modified a sealed Y‐shaped penis foreskin vascular protection technique, which can repair the urethra in a single stage. The inner plate of the foreskin was cut along the coronal sulcus, and both sides of the urethral plate were cut as deep as Buck's fascia. The "Y"‐shaped foreskin flaps on both sides of the mouth that are continuous with the urethral plate were sutured to form a new urethral skin tube. The urethral skin tube was turned to the ventral side, and the foreskin was reshaped and sutured. A total of 89 children had their urinary catheters removed 4 weeks after the operation. All children were evaluated at least once a year for 3 consecutive years. There were 11 patients with urine leakage that occurred after the operation. These children, diagnosed with urine leakage, underwent successful repair after the leakage occurred. There were no urethral strictures after the operation. The one‐time success rate of this operation was 87.6% (78/89), and the incidence of urethral fistula was 12.6% (11/89). The results showed that sealed Y‐shaped penis foreskin vascular protection surgery was safer and had a higher operation rate than the traditional hypospadias repair technique. Modifying Koyanagi repair by our improved Koyanagi hypospadias repair is an excellent technique with relatively low complication rates.

Error propagation model and optimal control method for the quality of remanufacturing assembly

In order to improve the quality of remanufacturing assembly with uncertainty for the sustainability of remanufacturing industry, an error propagation model of the remanufacturing assembly process and its optimal control method are established. First, the state space model of error propagation is established by taking the work-in-process parameter errors of each process as the initial state of the procedure and the parameters of remanufactured parts and operation quantities as the input. Then, the quality control issue of remanufacturing assembly is transformed into a convex quadratic programming with constraints based on this model. Finally, the proposed method is used to control the remanufactured-crankshaft assembly quality. The experimental results show that the axial-clearance consistency and the crankshaft torque are improved, and the one-time assembly success rate of a remanufactured crankshaft is increased from 96.97%to 99.24%. This study provides a theoretical model and method support for the quality control of remanufacturing assembly and has a practical effect on improving the quality of remanufactured products.

Effect of PDCA Evidence-Based Nursing Practice on Arterial Blood Gas Analysis in the Respiratory Department

<i>Objective</i> To explore the effect of PDCA evidence-based nursing intervention on arterial blood gas analysis in the respiratory department. <i>Methods</i> Sixty patients who underwent blood gas analysis in our hospital from February 2021 to March 2021 were selected as the control group; while the same number of patients who underwent blood gas analysis from July 2021 to August 2021 were selected as the observation group to implement PDCA evidence-based nursing practice. The effects of one-time success rate, qualified specimen rate, incidence of redness, swelling and ecchymosis at puncture point, sample turnover time and nurses' knowledge level were compared between the two groups. <i>Results</i> The success rate of one-time puncture and the qualified rate of specimens in the observation group were higher than those in the control group (P < 0.05). Meanwhile, the incidence of redness, swelling and ecchymosis at the puncture point and the turnover time of specimens in the observation group were lower than those in the control group (P < 0.05). After the implementation of the improvement plan, the nurses' knowledge levels in the observation group were significantly increased compared with the control group (P < 0.05). <i>Conclusion</i> PDCA evidence-based nursing practice can effectively improve the knowledge level of nurses, shorten the sample turnover time, increase the success rate of one-time puncture and the qualified rate of samples, reduce the incidence of adverse events such as redness, swelling and ecchymosis at the puncture point, and improve the quality of clinical nursing.

Application of 3D-printed navigation plate in pulsed radiofrequency therapy of dorsal root ganglion in thoracic postherpetic neuralgia

Objective: To evaluate the accuracy, efficacy and safety of 3D-printed personalized navigation template in the treatment of thoracic postherpetic neuralgia (PHN) with dorsal root ganglion pulsed radiofrequency (DRG-PRF). Methods: A total of 63 patients with thoracic PHN from March 2019 to December 2020 in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled and randomly divided into study group (n=31) and control group (n=32) by random number table method. The study group received DRG-PRF treatment assisted by 3D-printed navigation template, while the control group received DRG-PRF treatment guided by conventional CT. The one-time success rate of puncture, the incidence of puncture times ≥3, the number of punctures, puncture time, visual analogue scale (VAS) score and surgical complications between the two groups were compared. Results: The one-time success rate of puncture in study group was 84.9% (79/93), which was higher than that of control group [30.2% (29/96)] (P<0.001). The incidence of puncture times ≥3, the number of punctures, puncture time in study group were 4.3% (4/93), 1 (1, 1) and 2.9 (2.8, 3.0) min, respectively, which were lower than that of the control group [21.9% (21/96), 2(1, 3), 9.0 (4.5, 12.9) min, respectively] (all P<0.01). No difference was found in VAS score at each time point before and after surgery between the two groups (all P>0.05). There was one case of pleura puncture in the control group, but no other complications such as straying into vertebral canal, hematoma, spinal cord injury, limb movement disorder, infection were found in the two groups. Conclusions: 3D-printed personalized navigation template is an effective method to guide DRG-PRF for the treatment of thoracic postherpetic neuralgia. It can significantly improve the surgical efficiency of DRG-PRF, but has no significant effect on the surgical efficacy.

The curative effect analysis of peripherally inserted central venous catheter catheterization for tumor patients under the guidance of new medical guide wire

ObjectiveTo report a method of PICC catheterization with the aid of a new medical guide wire, and to discuss the curative effect.MethodsFive hundred and thirteen patients who visited our hospital from January 2013 to December 2019 for PICC catheterization were selected as study subjects. Random number method was used to group patients. General information was recorded for both groups. Patients in the observation group received catheterization with the aid of a new medical guide wire. The control group received catheterization via conventional guide wire. The success rate of the first catheterization, the success rate of the catheterization, the timing of the catheterization, the complications and the position of the catheter end were compared between the two groups.ResultsThere was no significant difference in general information between the two groups. After analyzing the puncture situation of the two groups, it was found that the average catheterization time of the observation group was shorter than that of the control group, and the difference was statistically significant. Patients in the observation group had higher success rate of one-time catheterization and catheterization success rate, and the difference was statistically significant. The incidences of occult thrombosis, phlebitis and catheter blockage in the observation group were lower than those in the control group, and the difference was statistically significant. The incidence of dominant thrombosis and bleeding at puncture point in the observation group was also lower than that in the control group, but the difference was not statistically significant.ConclusionThe new type of medical guide wire component is effective for PICC catheterization and worthy of further promotion.