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BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.
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Humans , Hepatectomy , Vena Cava, Inferior/surgery , Liver , Laparoscopy , Fluid TherapyABSTRACT
Objective:To figure out the timing of zeroing and the location of the zero line in the central venous pressure (CVP) monitoring and invasive arterial blood pressure (IBP) monitoring, and to provide scientific and accurate data for patients management.Methods:The liquid vessel models were used to simulate the pressure measurement process of the continuous pressure monitoring system. Based on the theory of fluid mechanics and the knowledge of blood pressure physiology and cardiovascular anatomy, the composition and influencing factors of the pressure in the fluid-filled catheter system during the zeroing and placing the transducer in the zero line of CVP and IBP, were analyzed.Results:The pressure in the liquid-filled catheter system was composed of atmospheric pressure, the pressure of pumping bag, the gravity of the water column (the vertical distance between the liquid level of Murphy's dropper and pressure transducer, ΔH), and the resistance of tube wall. This pressure value is set as a pressure of 0 mmHg (1 mmHg ≈ 0.133 kPa). In the process of pressure measurement, when the pressure transducer was placed at a horizontal position of 10 cm below the highest liquid level of the vessel, the pressure measured at different catheter tip positions was all 10 cmH 2O (1 cmH 2O ≈ 0.098 kPa); When the pressure transducer was placed at the horizontal position of the highest liquid level of the vessel, the measured pressure is 0 mmHg. Conclusion:Zeroing should repeatedly be performed only when one or more conditions (atmospheric pressure, pressure of pumping bag, gravity of ΔH water column and resistance of tube wall) are changed. In the measurement process, the pressure transducer should be placed at the zero line position at any time to eliminate the influence of hydrostatic pressure and to ensure the objective and accurate value.
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Objective:To evaluate the effect of paclitaxel on the mast cell-CCL2-macrophage axis in rats with pulmonary hypertension.Methods:Thirty SPF-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 180-220 g, were divided into 3 groups ( n=10 each) using a random number table method: control group (group C), pulmonary hypertension group (group PH), and paclitaxel group (group PTX). The model of pulmonary hypertension was established by subcutaneous injection of monocrotaline 60 mg/kg in rats.At 25 days after establishing the models, paclitaxel 2 mg/kg was injected via the tail vein once every four days, for 4 times in total in group PTX.The equal volume of normal saline was injected in the remaining 2 groups.The mean pulmonary artery pressure (mPAP) was performed at 40 days after establishing the model.The heart was removed and dried, the right ventricle (RV) and left ventricle plus ventricular septum (LV+ S) was weighed, and the Fulton index [RV/(LV+ S)] was calculated.The inferior lobe of left lung was taken, the ratio of media wall thickness of pulmonary vessels was calculated by HE staining, the number of Tryptase + , CD68 + , CD163 + , and Ki67 + cells was recorded by immunohistochemistry, the mean value was calculated, the percentage of Ki67-positive cells in blood vessels was recorded, and the proportion of muscularized blood vessels was calculated.The content of CCL2 was measured by enzyme-linked immunosorbent assay, and the expression of cleaved caspase-3 and Cyclin D1 was detected by Western blot. Results:Compared with group C, the mPAP, Fulton index, ratio of media wall thickness, proportion of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly increased, and the expression of cleaved caspase-3 was down-regulated in PH and PTX groups ( P<0.05), the expression of Cyclin D1 was significantly up-regulated in group PH ( P<0.05), and no significant change was found in group PTX ( P>0.05). Compared with group PH, the mPAP, Fulton index, ratio of media wall thickness, percentage of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly decreased, the expression of CCL2 and Cyclin D1 was down-regulated, and the expression of cleaved caspase-3 was up-regulated in group PTX ( P<0.05). Conclusion:The mechanism by which paclitaxel alleviates pulmonary hypertension is related to inhibiting the mast cell-CCL2-macrophage axis in rats.
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AIM: To explore the effect of single nucleotide polymorphism (SNP) of breast cancer susceptibility gene 1 (BRCA1) on chemotherapy sensitivity and survival prognosis of patients with metastatic esophageal squamous cell carcinoma. METHODS: A total of 153 patients with newly treated metastatic esophageal squamous cell carcinoma who were admitted to Suzhou Science and Technology City Hospital from June 2016 to February 2020 were included and administered with cisplatin combined with capecitabine chemotherapy. Before the first chemotherapy, 5 mL of venous blood was collected to extract DNA, and the TaqMan probe method was used to detect the genotypes of the BRCA1 gene rs8176318G/T, rs799917T/C and rs1799966T/C polymorphic loci. The objective response rate (ORR) and overall survival (OS) of different genotypes were analyzed. RESULTS: Rs799917T/C polymorphism was closely related to the chemosensitivity of metastatic esophageal squamous cell carcinoma. The chemotherapy response rates of TT, TC and CC genotypes increased gradually (TT 22.5%, TC 38.6%, CC 55.3%, χ
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Objective To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.Methods The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed.The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused,intraoperative estimated blood loss,volume of blood transfusion,the dosage of vasoactive drugs,postoperative liver function,inflammation index,the incidence of intraabdominal infection and the length of hospital stay (LOS).Results Patients were divided into infection group (n =39) and non-infection group (n =83).Intraabdominal infection was correlated with preoperative cirrhosis,the elevated direct bilirubin and alanine aminotransferase,the duration of operation,bilioenteric anastomosis or cholangiotomy,the infusion volume of colloid and crystalloid fluid,transfusion volume,direct bilirubin level on the POD 1 (post-operation on day 1) (P ＜ 0.05);Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P ＜ 0.05).Conclusions Intraoperative infused volume of synthetic colloid,along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.
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Objective@#To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.@*Methods@#The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed. The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused, intraoperative estimated blood loss, volume of blood transfusion, the dosage of vasoactive drugs, postoperative liver function, inflammation index, the incidence of intraabdominal infection and the length of hospital stay (LOS).@*Results@#Patients were divided into infection group (n=39) and non- infection group (n=83). Intraabdominal infection was correlated with preoperative cirrhosis, the elevated direct bilirubin and alanine aminotransferase, the duration of operation, bilioenteric anastomosis or cholangiotomy, the infusion volume of colloid and crystalloid fluid, transfusion volume, direct bilirubin level on the POD 1(post-operation on day 1) (P<0.05); Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P<0.05).@*Conclusions@#Intraoperative infused volume of synthetic colloid, along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.
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Objective: To analyze and compare the efficacy of laparoscopic modified Soave operation and open radical resection in the treatment of Hirschsprung's disease
Methods: Two hundred and sixteen children who suffered from Hirschsprung's disease and were admitted into the hospital from June 2015 to December 2016 were selected as research subjects. They were grouped into an observation group in which patients were treated by laparoscopic modified Soave operation and open radical resection and a control group in which patients were treated by open radical resection. The clinical efficacy and complications of the two groups were observed, and the defecation function was also evaluated
Results: Operation indicators such as the operation time, time to recovery of intestine peristalsis, intraoperative blood loss and pain score of the observation group were superior to those of the control group, and the difference had statistical significance [P<0.05]. The mean arterial pressure [MAP] and heart rate [HR] of the observation group were lower than those of the control group at all time points after operation, and the difference suggested statistical significance [P<0.05]. The postoperative complications of the observation group were less than those of the control group. The follow-up results demonstrated that the excellent and good rate of Kelly score of the observation group was 81.5%, higher than 61.1% in the control group
Conclusion: Laparoscopic modified Soave operation has definite efficacy in the treatment of Hirschsprung's disease, and the treatment is featured by high safety and few complications, which is beneficial to the recovery of defecation function; hence laparoscopic modified Soave operation is worth clinical promotion
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ObjectivesTo study the effect of community interventions and management on asthma in children and its impact on knowledge, attitude, and practice (KAP)of parents and the home environment.MethodsAn asthma health management profile of 0 to 14-year-old asthmatic children (n =93 ) in Sanlitun and Liulitun communities in Chaoyang District in Beijing was established.The children were randomly divided into a management group ( n =49) and control group ( n =44 ) based on community.Community-integrated management,such as regular follow-up,condition monitoring and health education,was implemented in the asthmatic children in the management group but not in the control group.The parents' KAP and the household environment in the two groups were compared after 1 year based on the changes shown in the health management profile.ResultsThe asthma relapse rate decreased to 27.9％ (12/43) in the management group.Compared with the control group,the rates of hospitalization (x2 =8.174,P =0.004) and school absences ( x2 =4.962,P =0.026) significantly decreased.The KAP level of parents increased to 67.4％ ( 29/43 ) in the management group and 20.4％ (9/44) in the control group,and the difference was statistically significant (x2 =19.517,P ＜0.01 ).Knowledge improved the most and showed a significant difference from the control group ( x2 =19.517,P ＜0.01 ).Home environment in the management group improved to 76.7％ (33/43).The number of indoor pets ( x2 =3.906,P =0.048) and indoor cockroaches ( x2 =4.962,P =0.026 ) reduced and showed significant differences between the two groups.In addition,children's allergy-related symptoms decreased to 30.2％ ( 13/43 ) in the management group compared with 9.1％ (4/44) in the control group,which was a significant difference ( x2 =6.183,P =0.013).ConclusionsParents' knowledge of asthma,compliance behaviors,and home environmentwere effectively improved through community-integrated management.This management technique can reduce the allergy-related symptoms of asthmatic children,improve asthma severity,and reduce the influence of asthma on children's daily lives.
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ObjectiveTo investigate the risk factors of upper gastrointestinal hemorrhage in elder patients with lung cancer after operation,providing the basis for clinical prophylaxis and treatment of complications.Methods360 elder patients with lung cancer in department of thoracic surgery of our hospital were enrolled from Jun 2005 to Dec 2010,the complications after operation were reviewed retrospectively.ResultsAfter investigation,we found that only 10 patients(2.8％ ) had upper gastrointestinal hemorrhage.6 cases of them were fluid and electrolyte imbalance,8 cases of them were hyoxemia,3 cases of them was hypotension after operation.8 cases of them were older than 70 years old.There was significant difference between older and smaller than 70 years old.ConclusionThe incidence of postoperative upper gastrointestinal bleeding in elderly patients with lung cancer was 2.8％,which was a relatively uncommon condition in clinic.Its major risk factors were age,fluid and electrolyte imbalance,hypotension and hyoxemia caused by operation.
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Objective To investigate correlation between post-stroke depression (PSD) and multiple factors during onset of acute cerebral infarction. Methods Depression was measured with Hamilton Depression Rating Scales (HAMD) in 58 patients with acute cerebral infarction, and their neurological function were evaluated by neurological function defect (NFD) score. Their immunoglobulin G (IgG) index was calculated and level of nitric oxide (NO) in cerebrospinal fluid (CSF) was measured. Lesion and nature of cerebral infarction in 58 patients with acute stroke were located by CT. All the data were statistically analyzed with student-t test and ? 2 test, as well as linear regression model. Results Seventeen of 58 patients of stroke appeared PSD with an occurrence rate of 29.3%. Occurrence rate of PSD was significantly higher in patients with cerebral infarction than in those with cerebral hemorrhage 2=4.86, P