ABSTRACT
BACKGROUND: At present, there is no consensus on the risk factors for delirium after hip fracture in the elderly, and there is no risk prediction system that can effectively assess the risk of delirium after hip fracture in the elderly. OBJECTIVE: To identify the risk factors of postoperative delirium of elderly hip fracture. METHODS: Studies about delirium of elderly hip fracture patients were retrieved by computer. Quality of the studies was assessed. Analysis of sensitivity and heterogeneity was performed by RevMan 5.3 software and cumulative effects were calculated by either fixed or random effects models. RESULTS AND CONCLOUSION: (1) Totally 15 studies included 872 cases of delirium and 3 221 cases of non-delirium. (2) The results of meta-analysis showed that:univariate analysis indicated that preoperative cognitive dysfunction[pooled OR=4.99,95%CI(2.66,9.37),P=0.000],age[pooled MD=3.60,95%CI(2.21, 5.00),P=0.000],preoperative complications ≥ 3[pooled OR=2.83,95%CI(2.12,3.79),P=0.000],preoperative hemoglobin<100 mg/L[pooled OR=2.09, 95%CI(1.17,3.76),P=0.01],preoperative albumin<35 g/L[pooled OR=2.29,95%CI(1.77,2.97),P=0.01],general anesthesia[pooled OR=2.17,95%CI(1.41, 3.34),P=0.000 4],the type or treatment of hip fracture[pooled OR=1.36,95%CI(1.04,1.78),P=0.02],operation time[pooled OR=2.88,95%CI(1.42,5.82), P=0.003],and intraoperative blood loss[pooled MD=36.97,95%CI(25.74,48.19),P=0.000]were the risk factors of postoperative delirium of elderly hip fracture patients.(3)Multivariate analysis showed that preoperative cognitive dysfunction[pooled=4.94,95%CI(2.23,10.95),P=0.000],age[pooled MD=2.84,95% CI(1.89, 3.78),P=0.000],preoperative complications ≥ 3[pooled OR=3.05,95%CI(2.11,4.41),P=0.000],general anesthesia[pooled OR=4.29,95%CI(1.40,13.14), P=0.01],and operation time ≥ 2.5 hours[pooled OR=2.62,95%CI(1.68,4.08),P=0.000]were independent risk factors for postoperative delirium of elderly hip fracture patients. (4) In conclusion, the independent risk factors of postoperative delirium of elderly hip fracture patients are preoperative cognitive dysfunction, age, preoperative complications ≥ 3, general anesthesia and operation time ≥ 2.5 hours. The type of fracture, preoperative waiting time, and type of operation are not related to postoperative delirium. However, due to the low quantity and quality of the included literature, the conclusion needs the support from many high-quality studies.
ABSTRACT
BACKGROUND: Surgical site infection is the main complication after posterior lumbar surgery, which not only increases the patient's hospitalization time, financial burden and physical pain, but also increases the difficulty for the clinical medical staff, delays the recovery of postoperative patients, even leads to deaths. Therefore, it is important to analyze the factors related to the infection of the surgical site after posterior lumbar surgery. OBJECTIVE: To analyze the risk factors of the surgical site infection after lumbar posterior approach in China. METHODS: Studies about the surgical site infection after lumbar posterior approach were retrieved by computer. The quality of the studies was evaluated by reading the full text. Heterogeneity was analyzed using RevMan 5.3 software. Meta analysis was used to analyze the combined effect. RESULTS AND CONCLUSION: (1) Totally 20 studies with 423 cases of surgical site infection and 13 995 cases of non-infection were included. (2)Meta-analysis univariate analysis results:body mass index ≥ 27 kg/m2[OR=3.82,95%CI(2.47,5.91),P<0.000 01],age ≥ 60 years [OR=1.99,95%CI(1.44,2.76),P<0.000 1],intraoperative blood loss ≥ 300 mL[OR=3.98,95%CI(2.50,6.33),P<0.000 01],subcutaneous fat thickness[MD=5.35,95%CI(3.58,7.12),P<0.000 01],number of segments ≥ 3[OR=3.83,95%CI(2.02,7.26),P<0.000 1],operation time ≥180 minutes[OR=2.96,95%CI(2.06,4.27),P<0.000 01],preoperative serum protein<35 g/L[OR=2.37,95%CI(1.63,3.46),P<0.000 01],and diabetes[OR=2.88,95%CI(2.22,3.74),P<0.000 01]were risk factors for surgical site infection after lumbar posterior approach.(3)Multivariate analysis results:body mass index ≥ 27 kg/m2[OR=3.21,95%CI(1.97,5.22),P<0.000 01],subcutaneous fat thickness[MD=5.35,95%CI(3.58, 7.12),P<0.000 01],preoperative serum protein<35 g/L[OR=3.73,95%CI(2.30,6.04),P<0.000 01],and diabetes[OR=3.35,95%CI(1.75,6.42), P=0.003]were independent risk factors for surgical site infection after lumbar posterior surgery.(4)Results showed that body mass index ≥27 kg/m2, subcutaneous fat thickness, preoperative serum protein < 35 g/L, and diabetes are independent risk factors for surgical site infection after lumbar posterior approach in China. Due to the number of cases of surgical site infection and its methodological quality during the study, the above conclusions still need to be confirmed by more large-scale, high-quality studies to provide reliable evidence for perioperative management.
ABSTRACT
BACKGROUND: Because of liver donor deficiency and high incidence of fatty liver, moderate fatty liver as a marginal donor results in a high risk for graft loss after liver transplantation. Therefore, it is imperative to establish a stable rat model by which we can enhance the utilization of these liver donors. OBJECTIVE: To establish a viable and stable model of reduced-size liver transplantation with fatty liver donor in rats. METHODS: Forty pairs of fatty liver donor and recipient rats were randomly chosen. The recipient rats in experimental group received reduced-size liver transplantation and the rats in control group received orthotopic liver transplantation. The breath, heart rate, and vessel filling situation were observed. The postoperative recovery, cause of death, and survival conditions were observed. The operation time was compared between two groups. Besides, the postoperative liver function and pathological changes were assessed. RESULTS AND CONCLUSION: After graft reperfusion, in the control group, the respiratory rate and heart rate were significantly faster than those in experimental group (P < 0.05), but the vessel filling of inferior vena cava was poor. Rats in the experimental group recovered better than those in the control group (P < 0.05). The operation time in the control group was significantly prolonged compared with the experimental group (P < 0.05). The early mortality in the control group was significantly higher than that in the experimental group, which mainly caused by intra-abdominal hemorrhage, air embolism and hypovolemic shock. The survival time, histology and liver function indexes postoperatively did not differ significantly between two groups. To conclude, the rat model of reduced-size liver transplantation is stable, which reveals clear field of operation and stable circulation, so it is a ideal model for liver transplantation with fatty liver donors.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of an adjuvant chemotherapy regimen: XELOX (Capecitabine puls Oxaliplatin) used after curative resection for stage III colorectal cancer.</p><p><b>METHODS</b>From Jan. 1998 to Jan. 2004, 256 cases with stage III colorectal cancer randomized received de Gramont, modified FOLFOX4 (mFOLFOX4) and XELOX regimens. The 3-year disease-free survival (DFS) and overall survival (OS) were compared within the three groups and relative prognosis factors within mFOLFOX4 and XELOX groups. Therapeutic adverse events were recorded and analyzed with Kaplan-Meier test.</p><p><b>RESULTS</b>98, 87 and 71 cases were respectively enrolled in the de Gramont, mFOLFOX4 and XELOX groups, mFOLFOX4 and XELOX had superior efficacy compared with de Gramont regimen. The two former could significantly improve 3-year DFS (79.7% vs. 66.2%, P = 0.015; 81.5% vs. 66.2%, P = 0.004) and medium survival time (40.2 mon vs. 37.8 mon, P = 0.024; 41.4 mon vs. 37.8 mon, P = 0.014). Meanwhile they could respectively decrease the ratio of recurrence risk by 18.0% (P = 0.024) and 21.0% (P = 0.003). The relative benefit of mFOLFOX4 versus XELOX didn't differ for 3-year DFS [hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.79-1.12, P = 0.13] and OS (HR: 0.87, 95% CI: 0.84-1.06, P = 0.54). In the analysis of DFS in relative prognosis factors, XELOX had a better trend of survival advantage. mFOLFOX4 had higher adverse events within these regimens, especially in grade 3 or 4 neutropenia and peripheral neurologic adverse events.</p><p><b>CONCLUSION</b>XELOX maintains its efficacy and safety ratio in advanced colorectal cancer. Patients have good tolerance and compliance. The regiment is deserves to be applied in clinical treatment. Oxaliplatin;</p>