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BACKGROUND@#At present, an ultrafine chest tube combined with a traditional thick tube were often used after pulmonary uniportal video-assisted thoracoscopic surgery (U-VATS). However, the thick tube was often placed in the incision, which increased the risk of poor wound healing and postoperative pain. The aim of this study is to investigate the feasibility and safety of using two ultrafine chest tubes (10 F pigtail tube) for drainage after pulmonary U-VATS.@*METHODS@#The medical records of patients who underwent pulmonary U-VATS during June 2018 and June 2020 in the department of cardiothoracic surgery of the second affiliated hospital of Soochow university were retrospectively reviewed to compare two different drainage strategies, receiving two 10 F pigtail tubes as chest tube (group A) or one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube (group B).@*RESULTS@#106 patients in group A receiving two 10 F pigtail tubes during June 2019 and June 2020 and 183 patients in group B receiving one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube during June 2018 and June 2019 were included. There was no significant difference between two groups in terms of the postoperative thoracic drainage (mL) (1st: 199.54±126.56 vs 203.59±139.32, P=0.84; 2nd: 340.30±205.47 vs 349.74±230.92, P=0.76; 3rd: 435.19±311.51 vs 451.37±317.03, P=0.70; 4th: 492.58±377.33 vs 512.57±382.94, P=0.69; Total: 604.57±547.24 vs 614.64±546.08, P=0.88), drainage time (d) (upper chest tube: 2.54±2.20 vs 3.40±2.07, P=0.21; lower chest tube: (2.24±2.43 vs 3.82±2.12, P=0.10), postoperative hospital stays (d) (6.87±3.17 vs 7.06±3.21, P=0.63), poor wound healing (0 vs 3.28%, P=0.09), replacement of lower chest tube (0.94% vs 2.19%, P=0.66) and the VAS1 (3.00±0.24 vs 2.99±0.15, P=0.63). Notably, there were significant differences between two groups in terms of the VAS₂ (2.28±0.63 vs 2.92±0.59, P<0.01) and VAS₃ (2.50±1.58 vs 2.79±1.53, P=0.02), as well as the frequency of using additional analgesics (25.47% vs 38.25%, P=0.03) and replacement of the upper chest tube (0 vs 4.37%, P=0.03).@*CONCLUSIONS@#It's feasible and safe to use two 10 F pigtail tubes for drainage after pulmonary U-VATS, which can achieve less postoperative pain and lower frequency of replacement of the upper chest tube on some specific patients.
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Lung cancer leads to the highest cancer-related morbidity and mortality worldwide. With the development of multi-slice spiral computed tomography technology and the implement of lung cancer screening, more and more lung nodules have been discovered, many of which are multiple pulmonary nodules. These pulmonary nodules are usually diagnosed as multiple primary lung adenocarcinomas from a pathological perspective. For multiple nodules with different imaging features, the preferred treatment methods are different, and the treatment of each lung nodule is still controversial. In recent years, the interactions between multiple lesions and the evolution of the lesions as well as the inter-tumoral and intratumoral homogeneity and heterogeneity of the genomics also arouse attention. Our review gathered the research progress in multiple pulmonary nodules from the points of histopathology, genomics and surgical management. .
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Humans , Diagnostic Imaging , Genotype , Multiple Pulmonary Nodules , Diagnostic Imaging , Genetics , TherapeuticsABSTRACT
Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.
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Objective To introduce the methods of performance excellence management model in clinical nursing teaching. Methods A total of 110 clinical nursing interns were selected before and after implementation of performance excellence model, traditional teaching method was used prior to the implementation of performance excellence model. The teaching quality evaluation, teachers teaching level feedback, examination of interns, teachers′ satisfaction degree with nursing work were investigated and compared before and after the implementation of performance excellence model. Results After the implementation of excellent performance management model, the assessment of interns with teaching quality scored from 3.75±0.51 (before the implementation) to 3.98±0.14, t=-6.738, P<0.01. Examination of interns by teachers scored from 92.44 ± 1.44 to 95.01 ± 2.20, t=-7.24, P<0.01. Teachers′satisfaction degree with nursing work scored from 3.91 ± 0.44 to 4.26 ± 0.46, t=-3.006, P<0.01. Conclusions The application of excellent performance management model in the hospital clinical nursing teaching can effectively improve the quality of teaching as well as satisfaction degree of nursing interns, teachers and departments.
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Objective To evaluate the clinical effect of clopidogrel combined with low molecular weight heparin (LMWH) on chronic pulmonary heart disease in patients with acute exacerbation.Methods Eighty cases of patients with chronic pulmonary heart disease with exacerbation were randomly divided into treatment group (40 cases) and control group (40 cases).Patients in control group were administrated with conventional treatment including infection control,cough,phlegm,relieving spasm and asthma,persistent low flow oxygen,maintain airway patency,strong heart,diuresis,anti arrhythmia.Patients in treatment group were treated with subcutaneous injection of low molecular weight heparin and oral clopidogrel therapy beside routine treatment.Plasma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time (TT),fibrinogen(Fb) and pulmonary function(FEVI) were measured.Results (1) After treatment,Fb in treatment group and control group were (3.92 ± 1.11) g/L,(4.54 ± 1.41) g/L respectively.While PT,APTT,TT and FEVI in treatment group were (13.02 ± 1.52) s,(33.21 ± 4.03) s,(14.03 ± 2.52) s,(45.73 ± 7.38) ％ respectively,significantly higher than the control group ((11.31 ± 2.01) s,(30.13 ± 3.59) s,(12.88 ± 2.11) s and (40.12 ± 6.99) ％,P ＜0.05).(2) In control group,FEVI after treatment significantly improved than that of before treatment (t =4.821 ; P ＜ 0.05),while PT,APTT,TT were no significant changes (P ＞ 0.05).PT,APTT,TT,FEVI in treatment group were significantly improved after treatment than that of before treatment(P ＜ 0.05).(3) The clinical effective rate in treatment group was 80.0％ (32/40),higher than that in control group (65.0％(26/40) x2 =4.815; P ＜0.05).Conclusion The therapy scheme of clopidogrel combined with low molecular heparin calcium is proved to be an efficacy method for reducing sputum viscosity,antiinflammatory,anti allergic effect,platelet aggregation,increasing pulmonary blood flow,improving the condition of patients with pulmonary heart diseasethe.And its clinical effect is significant,worthy to promote and apply.
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Objective To explore the effects of mulitinational united medical transport of emergency and critical patients in Indonesia after earthquake tsunami disaster.Method Various factors,which affected mulitinational united medical transport in Indonesia after earthquake tsunami disaster were analyzed.Results All of the 217 emergency and critical patients were successfully transported to the destination.Conclusion Mulitinational united medical rescue had advantages on integrating medical resources and improving efficiency.During mulitinational united medical transport,the tasks should be distributed rationally,and self-protection of medical workers was the basis of accomplishing medical rescue.
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0.05);the difference on d3 with that on d9 was significant(P0.05);the difference on d3 with that on d7 and d9 was significant(P
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Hijack terror is one of the most common terror attacks. In this paper, the definition, the present condition and future development of hijack terror are elucidated. Hijack terrorism may seriously endanger human lives, result in great economic loss, create social panic and political tumult. The medical succor for hijack terror includes treatment and transportation of the wounded, sanitation for epidemic prevention, protection from harmful agents, and medical health care. The challenges confronting medical support for hijach terror are its unexpectedness and abruptness, complexity, and arduousness in its implementation. In order to negotiate these challenges, it is imperative that a flawless counterplan should be worked out, a highly efficient counterterrorism medical organization should be established, intense emphasis should be paid in the studies of anti-neuclear, antimbiological and anti-chemical warfores, and education for psychological prepuredness should be stressed.