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Objective:To collect and summarize evidence for improvement of readiness for hospital discharge of patients after PCI.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) evidence-based health care center database, National Institutes of Health and Clinical Optimization Guidelines Network, Scotland Inter Hospital Guidelines Network, Ontario Registered Nurses Association, International Guidelines Collaboration Network, American Heart Association website, European Heart Association website, Cochrane The literatures about improving the discharge readiness of patients after PCI in library, PubMed, CINAHL, CNKI and Wanfang databases included guidelines, system reviews, best practice information books, evidence summary, expert consensus, and randomized controlled studies. The retrieval time limit was from the establishment of the database to October 2019. Four researchers evaluated the quality of the literature, and extracted evidence from the literature that met the quality standards.Results:A total of 5 articles were included, including 2 guidelines, 2 expert consensus, 1 systematic reviews,3 randomized controlled trials. The best evidence included evaluation of discharge readiness, education of knowledge and skills to patients and caregivers, improvement of self-efficacy of patients and caregivers in disease management, and assurance of social support and health resources for patients and caregivers after discharge.Conclusion:It is suggested that in clinical practice, medical personnel should use the discharge readiness assessment tool to comprehensively evaluate patients after PCI, carry out programmed health education, improve patients' self-efficacy in disease management, and ensure social and medical support for patients and caregivers after discharge as much as possible.
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Objective To study the impact of preoperative nutritional support on the clinical outcomes in patients with malnutrition who underwent transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma.Methods 46 patients with malnutrition underwent TACE after operation for primary liver cancer were randomly divided into the experimental group (n =23) and the control group (n =23).The patients in the experimental group received preoperative nutritional support,but patients in the control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidences of postoperative complication,the liver function,the lengths of hospital stay,the costs of nutrition support and the costs of hospitalization were compared between the two groups.Results On the day before the operation,on postoperative day 1,day 7,and one month,the levels of serum albumin,and on the postoperative day 7 and one month,the levels of pre-albumin were significantly higher in the experimental group than in the control group,and the differences were significantly different [(38.4 ± 1.5) g/L vs.(32.8±0.8) g/L,(37.6±1.3) g/Lvs.(31.4±0.9) g/L,(39.0±1.6) g/L vs.(32.0±0.7) g/L,(39.8±2.2) g/L vs.(33.0±2.0) g/L,respectively,P＜0.05],[(160.0±14.6) mg/L vs.(131.0 ± 16.5) mg/L,(163.0 ± 17.7) mg/L vs.(135.0 ± 17.1) mg/L,respectively,P ＜0.05].The incidences of complication were significantly lower in the experimental group than that of the control group (52.2％ vs.91.3％,P ＜0.05).The length of hospital stay in the experimental group was shorter than that of the control group [(19.9 ± 2.0) d vs.(24.8 ± 2.7) d,P ＜ 0.05].The cost in the experimental group was significantly lower than that in the control group [(20 108.9 ± 1 142.4) yuan vs.(23 174.1 ± 1 128.5) yuan,P ＜ 0.05].The cost in nutrition support in the experimental group was similar to that of the control group (P ＞ 0.05).Conclusions Preoperative nutritional support was helpful in reducing the incidence of postoperative complications,in shortening the length of hospital stay and in reducing medical costs.Nutritional support improved the nutritional status of the patients with primary hepatocellular carcinoma after surgery and TACE.
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Objective: To investigate the effect of silver nanoparticles (AgNPs) on hemichannel activity in human skin keratinocytes (HaCaT) and to explore the role of hemichannel in AgNP-induced anti-proliferative effect on HaCaT cells.Methods: HaCaT cells were exposed to 0, 0.1, 0.2, 1.0, 5.0, 10.0, 15.0 and 20.0 μg/cm2 of AgNPs for 24 h and cell viability was assessed by propidium iodide (PI) staining with flow cytometry.Hemichannel activity was examined by ethidium bromide (EB) uptake experiments in cells exposed to AgNPs with and without hemichannel inhibitor carbenoxolone (CBX).Afterward, HaCaT cells were seeded at a low density of 1×104cell /cm2 or a normal density of 4×104cell /cm2 and cultured for 24 h.Cell proliferation was measured by cell counting kit-8 (cck-8) in low-or normal-density cultured cells exposed to AgNPs for 24 h with and without 100 μmol/L CBX.Results: Cell viability showed no significant differences between the control and AgNP-exposed groups with the concentration less than 10 μg/cm2.Exposure to AgNPs increased EB uptake in a time-and dose-dependent manner in HaCaT cells and EB fluoresce density was increased to 116.67%, 124.85% and 139.53% of the control after exposure to 10 μg/cm2 AgNPs for 2 h, 12 h and 24 h.After being treated with 25, 50 and 100 μmol/L CBX, 10 μg/cm2 AgNP-induced increase in EB uptake was significantly reduced in HaCaT cells (P<0.01).The cellular proliferation rate was increased inlow-and normal-density cultured cells after AgNPs exposure with 100 μmol/L CBX.After being treated with 100 μmol/L CBX, 10 μg/cm2 AgNP-induced anti-proliferation in low-density cultured cells was significantly restrained (P<0.01).Conclusion: AgNPs could enhance hemichannel activity of HaCaT cells.Hemichannel activation was involved in AgNP-induced anti-proliferative effect.
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Objectives@#To investigate the effect of short-term exposure to ambient NO2 has influence on lung function and fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) patients.@*Methods@#A panel of doctor-diagnosed stable COPD patients (n=33) were recruited and repeatedly measured for lung function and FeNO from December 2013 to October 2014. The patients who lived in Beijing for more than one year and aged between 60 and 85 years old were included in the study. We excluded patients with asthma, bronchial tensor, lung cancer and other respiratory disorders other than chronic obstructive pulmonary disease and occupational exposure and chest trauma surgery patients. Because the frequency of each subject visiting to the hospital was different, a total of 170 times of lung function measurements and 215 times of FeNO measurements were conducted. At the same time, the atmospheric NO2 data of Beijing environmental monitoring station near the residence of each patient during the study period were collected from 1 day to 7 days lag before the measurement. Effects of short-term NO2 exposure on lung function and FeNO in COPD patients were estimated by linear mixed-effects models.@*Results@#The subjects' forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and exhaled NO of subjects were (3.26±0.83) L, (1.66±0.61) L, (4.13±1.77) L/s, and (48.99±14.30) μg/m3, respectively. The concentration of NO2 was (70.3±34.2) μg/m3 and the interquartile range (IQR) was 39.0 μg/m3. Short-term exposure to NO2 resulted in a significant decrease in FVC among COPD patients' which was most obvious in 2 days lag. Every quartile range increased in NO2 (39 μg/m3, 2 day) would cause a 1.84% (95%CI: -3.20%- -0.48%) reduction in FVC. The effects of exposure to higher concentration of NO2 (≥58.0 μg/m3) on FVC estimate was -2.32% (95%CI: -4.15%- -0.48%)(P=0.02). No significant relevance of FeNO and NO2 was observed in this study.@*Conclusions@#Short term exposure to ambient NO2 may bring down pulmonary function in COPD patients.
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As an important immune organ,spleen also plays a crucial role in stabilizing hematologic system.Previous reports support that splenectomy must be performed after the ligation of spleen vessels.At recent time,with the deep knowledge of the anatomy and function of spleen,the surgeons have tried to preserve this organ after the ligation of the vessels.From March 2012 to April 2016,five patients in our hospital have undergone the distal pancreatectomy with spleen preservation after the ligation of splenic vessels,and all the patients' outcomes were satisfactory in the follow-up.This essay aims to discuss the safety and feasibility of preserving spleen after the ligation of the vessels by reporting our own experience and reviewing related literatures on this topic.
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Considerable clinical and experimental evidence supports that liver injury in acute pancreatitis (AP) is a sign for the potential progression to systemic inflammatory reaction.The Kupffer cells,various cytokines and macrophage migration inhibitory factor (MIF) play important roles in the pathogenesis of AP associated liver injury.However,the specific molecular mechanism of the liver damage remains uncertain.Therefore,efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in AP,which could not only identify novel therapeutic targets,but also provide new insight into improving the clinical treatment.Here our review discusses the recent research progress on the etiology,pathology and diagnosis and treatments of liver injury in AP.
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Objective To investigate the effects of preoperative nutrition support on postopreative clinical outcome in patients with nutritional risk with pancreaticoduodenectomy.Methods Forty six patients with pancreaticoduodenectomy complicated with malnutrition from June 2011 to September 2013 in Department of Hepatobiliary and Lapoaroscopic Surgery of People's Hospital of Wuhan University were randomly divided into experimental group (n =23) and control group (n =23) with random number table,patients in experimental group received preoperative nutrition support,but patients in control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidence of postoperative complications,the length of hospital stay,and the cost of hospitalization in the two groups of patients was compared.Results In terms of intra-operative blood loss and the operative time,experimental group was significantly lower than those in control group [(340 ±90)min vs (420 ± 104)min,(761 ± 100)ml vs (901 ± 150)ml,P＜0.01],on the 1st day of preoperation,the 1st day,7th day and 14th day of post operation,the levels of serum albumin was significantly higher than those in control group [(30.6 ± 1.8) g/L vs (24.6±2.2) g/L on the,P＜0.05];and on the 1st day of pre-operation,the 1st day,7th day of post operation,the levels of transferrin were significantly higher in experimental group than in control group [(3.23 ± 0.65) g/L vs (2.38 ± 0.49) g/L on the,P ＜ 0.05);the rate of post operative complication were significantly lower in experimental group than that in control group (52.2％ vs 21.7％,P=0.000);the postoperative anal exhaust time was earlier in experimental group than that in control group [(6.4 ± 0.6) d vs (9.5 ± 0.6) d,P =0.000),and the length of hospital stay was shorter in experimental group [(20.1 ± 6.5) d vs (26.7 ± 9.5) d,P =0.014),and the cost in experimental group was lower [(99 ± 13) thousand yuan vs (115 ± 13) thousand yuan,P =0.000),however,the cost of nutrition support between the two groups was not significantly different (P =0.210).Conclusions Preoperative nutrition support is helpful to reduce the incidence of postoperative complications,shorten the length of hospital stay,to save medical costs for patients with pancreaticoduodenectomy.
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Objective To analyze the impact of obesity on short-term prognosis in patients who underwent surgery for cirrhotic portal hypertension with hypersplenism.Methods The clinical data of 310 patients with cirrhotic portal hypertension who underwent splenectomy and portaazygous devascularization between Apr.2002 and Jue.2012 were prospectively analyzed.According to the body mass index (BMI),these patients were divided into the non-obesity group (BMI ＜ 28 kg/m2) and the obesity group (BMI ≥28 kg/m2).There were 78 patients in the obesity group (male:female 56:22; mean age 48.7 ± 8.3years).There were 232 patients in the non-obesity group (male:female 166:66; mean age 46.3 ± 6.9years).The postoperative outcomes in the two groups were analyzed.Results When compared with the nonobesity group,there were significant differences in age (48.7 ± 8.3 in obesity group vs 46.3 ± 6.9 years in non-obesity group),perioperative blood transfusion (400 ± 100 vs 200 ± 100 ml),intraoperative blood loss (370 ± 110 vs 240 ±60 ml),operation time (180 ±40 vs 150 ±35 min),serum albumin level after surgery (28.1 ±2.6 vs 31.2 ±2.3 g/L),drainage volume (280 ±70 vs 230 ±60 ml) and hospital stays (10.5 ±3.0 vs 8.5 ± 2.5 days) in the obesity group (P ＜ 0.05).However,there were no significant differences in gender,preoperative level of liver function,platelet counts (preoperative and postoperative) and postoperative deaths (P ＞ 0.05).Conclusion BMI was a significant independent prognosis risk factor for patients with cirrhotic portal hypertension undergone splenectomy and portaazygous devascularization.
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Objective To investigate the effects of low carbohydrate diet in treating non-alcoholic fatty liver disease (NAFLD) patients.Methods 58 male NAFLD patients selected in Renmin Hospital of Wuhan University from September 2010 to October 2012 were divided with random number table into low-carbohydrate diet group (L group,n =31) and medium-carbohydrate diet group (M group,n =27).Waistline,weight,serum glucose level,insulin secretion,glutamic-pyruvic transaminase (ALT),aspartate transaminase (AST)、high-density lipoprotein (HDL),low-density lipoprotein (LDL),total cholesterol (TC),and triglyceride (TG) of the patients were measured.Results Six patients were excluded from this research,2 in L group and 4 in M group.After 6-week's dietary intervention,blood glucose level and insulin secretion were significantly lower in L group than in M group [(4.3±1.4) mol/Lvs.(5.0±0.9) mol/L,P=0.004; (6.1 ±1.5) U/mlvs.(8.9 ± 1.4) U/ml,P =0.001].The levels of ALT and AST in L group were significantly lower than those in Mgroup[(30.23±3.34) U/Lvs.(42.33±4.46) U/L,P=0.003; (31.19±4.13) U/Lvs.(45.21±3.73) U/L,P =0.001].The levels of LDL and TG in L group were also significantly lower than those in M group [(1.13±0.22) mmol/Lvs.(2.71±0.67) mmol/L,P=0.001; (0.99±0.74) mmol/Lvs.(1.42±1.06) mmol/L,P =0.001].Conclusion In NAFLD patients,low-carbohydrate diet can improve blood glucose level,insulin secretion,liver function,and lipid metabolism disorders.