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Objective:To explore whether renal artery involvement is an independent risk factor of acute renal injury (AKI) KDIGO stage 3 after moderate hypothermic circulatory arrest in patients with acute Stanford type A aortic dissection.Methods:From December 2015 to October 2017, 492 consecutive patients with acute Stanford A-type aortic dissection received surgical treatment, 486 of them were included in the study. All patients underwent aortic CTA to determine the extent of aortic dissection and renal artery involvement. According to the standard of Improving Global Outcomes (KDIGO), the renal function of patients after operation was graded. The risk factors of AKI KDIGO stage 3 were analyzed.Renal artery involvement and other risk factors were included in univariate analysis, and significant variables in univariate analysis were included in multivariate logistic regression analysis.Results:In 492 patients, 40 (8.13%) died in hospital, of which 6 died of severe bleeding during operation or failed to wean from cardiopulmonary bypass which lead to unable to leave the Weaning from cardiopulmonary bypass and these 6 patients were excluded in the research. Among 486 patients included in the study, 251 (51.64%) had AKI. Among them, 83 (17.08%) were in the KDIGO stage 1, 56 (11.52%) in stage 2 and 112 (23.05%) in stage 3.The results of univariate analysis showed that there were significant differences in renal artery involvement, age, time from onset to operation, D-dimer, leukocytes and platelets in peripheral blood, creatinine clearance rate, time of cardiopulmonary bypass during operation and aortic cross-clamping time( P>0.05). The above risk factors were included in multivariate logistic regression. The results showed that preoperative renal artery involvement ( OR=1.94, P=0.02), age ( OR=1.03, P=0.02), creatinine clearance rate<85 ml/min ( OR=2.28, P=0.001), and intraoperative cardiopulmonary bypass time ( OR=1.01, P=0.02) were independent risk factors. The incidence of AKI in patients with renal artery involvement was 54.65%, significantly higher than 41.98% in patients without renal artery involvement ( P>0.05). Conclusion:Renal artery involvement is an independent risk factor of AKI KDIGO stage 3 after moderate deep hypothermic circulatory arrest of acute Stanford type A aortic dissection.
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@#AIM: To evaluate the different surgical methods on the function of tear film after pterygium surgery.<p>METHODS: A retrospective case series study, a total of 106 pterygium patients(106 eyes)were randomly divided into two groups, 50 patients(50 eyes)received pterygium excision combined with amniotic membrane transplantation served as membrane group, 56 patients(56 eyes)received pterygium excision combined with autologous limbal stem cell transplantation served as stem cell group. Respectively before surgery and 1mo, 3mo after surgery, the BUT, SⅠt, OSDI were checked. The data were compared and analyzed.<p>RESULTS: There were significant differences in different times of two groups.(1)Compared between groups, before operation and 1mo after surgery. There were no significant differences among BUT, SⅠt and OSDI(<i>P</i>>0.05). But 3mo after surgery, BUT and SⅠt of the stem cell group was higher than the membrane group(<i>P</i><0.05). OSDI of the stem cell group was better than the membrane group(<i>P</i><0.05).(2)Compared within group, BUT, SⅠt and OSDI were no significant differences between before operation and 1mo after surgery(<i>P</i>>0.05), but there were significant differences between 3mo after surgery and 1mo after surgery, before operation(<i>P</i><0.05).<p>CONCLUSION: The function of tear film was restored by pterygium excision combined with amniotic membrane transplantation or combined with autologous limbal stem cell transplantation, and the later was better than the former in effect.
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AIM:To evaluate the clinical value of retinal nerve fiber layer (RNFL) thickness, optic disc parameters and macular thickness by optical coherence tomography (OCT) in early diagnosis of primary open angle glaucoma (POAG). METHODS: Sixty-five patients (eighty-five eyes) were selected as a study group and fifty-two normal people (seventy-eight eyes) were selected as a control group. The retinal nerve fiber layer thickness, optic disc parameters, including cup/disc(C/D) rate, cup area (CA), cup volume (CV), disc area (DA), rim area (RA) and rim volume(RV),and macular thickness were detected by Cirrus HD-OCT. The data were compared and analyzed. RESULTS: The retinal nerve fiber layer thickness of superior, inferior, temple, nasal and average in the study group were all significantly thinner than those of the control group (P<0.001). The cup area, cup volume and cup/disc ratio in the study group were significantly higher than those of the control group (P<0.001); while the rim area and rim volume in the study group were significantly lower than those of the control group (P<0 001). But the disc area was not significantly different between two groups(P>0.05). The macular thickness of superior, inferior, temple and nasal in the study group were all significantly thinner than those of the control group (P<0.001). CONCLUSION: OCT can detect the change of retinal nerve fiber layer thickness, optic disc parameters and macular thickness, it is helpful for early diagnosis of POAG.
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Objective To describe the change of practice of ICU advanced practice nurses after attending ICU Clinical Nurse Specialist(CNS) training program in Shanghai. Methods A purposive sampling method was used to recruit 15 ICU advanced practice nurses and semi-structured interviews were conducted. Thematic analysis was used for data analysis. Results Four themes regarding practice change were extracted,including extension of scope of practice,transformation of emphasis in work,promotion of clinical reforms and improvement of self-development. Conclusion The practice of ICU advanced practice nurses has changed after training,while the degree of change varies in different themes. Further quantitative researches should be conducted to provide more information for the development of ICU advanced practice nurses.
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Proteinase activation receptor-2 (PAR-2) is one of the G protein coupling receptor family members.It exists in all over the epithelial cell surface of gastrointestinal tract,and is easy to expose to the proteinase that can activate it.It is a direct exocrine regulator of many digestive glands,and directly affects the capability of gastrointestinal tract.At present,the PAR-2's unique activation way,its wide distribution in digestive system and its complicated physiological functions,especially the relation between PAR-2 and the gastrointestinal movement and perception,are being highly concerned.