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Objective:To explore the correlation between muscle CT measurement parameters, energy expenditure and acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 146 patients with stable COPD from March 2020 to November 2021 in Lu′an Hospital Affiliated to Anhui Medical University (Lu′an People′s Hospital) were retrospectively analyzed. The clinical data were recorded; the lung function was measured by bronchodilator test. The cross-sectional area and CT value of the pectoral muscle were measured by reconstructed CT images of the mediastinum; the total energy consumption was calculated by Weir formula. Acute exacerbations within 3 and 12 months were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for acute exacerbation in patients with stable COPD. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of total energy expenditure, pectoral muscle cross-sectional area and pectoral muscle CT value for predicting acute exacerbation in patients with stable COPD.Results:Among 146 patients with stable COPD, 38 cases (26.03%) developed acute exacerbation within 3 months (acute exacerbation group), and 108 cases (73.97%) did not develop acute exacerbation (non-acute exacerbation group). The proportion of age<60 years old, rate of acute exacerbation within 12 months and rate of pulmonary function grading Ⅲ to Ⅳ in acute exacerbation group were significantly higher than those in non-acute exacerbation group: 71.05% (27/38) vs. 47.22% (51/108), 52.63% (20/38) vs. 30.56% (33/108) and 63.16% (24/38) vs. 37.96% (41/108), the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value were significantly lower than those in non-acute exacerbation group: (2 036.28 ± 163.13) J/d vs. (2 389.59 ± 204.71) J/d, (28.79 ± 3.45) cm 2 vs. (31.61 ± 4.56) cm 2 and (29.79 ± 3.06) HU vs. (34.52 ± 4.38) HU, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that age ≥60 years old, lower total energy expenditure, smaller pectoral muscle cross-sectional area and lower pectoral muscle CT value were independent risk factors for acute exacerbation in patients with stable COPD ( OR = 26.493, 1.015, 1.245 and 1.437; 95% CI 3.745 to 187.405, 1.008 to 1.022, 1.002 to 1.546 and 1.109 to 1.861; P<0.01 or <0.05). The ROC curve analysis result showed that combined prediction of the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value for acute exacerbation in patients with stable COPD had the largest area under the curve (0.962), with a sensitivity of 86.1%, a specificity of 80.8%, and the optimal cutoff values of 2 206.12 J/d, 32.39 cm 2 and 31.63 HU, respectively. Conclusions:The elderly age, smaller pectoral muscle cross-sectional area, lower pectoral muscle CT value and lower total energy expenditure are independent risk factors for acute exacerbation in patients with stable COPD. The combination of pectoral muscle cross-sectional area, pectoral muscle CT value and total energy expenditure has a good predictive effect on the risk of acute exacerbation in patients with stable COPD, and relevant indexes can be paid attention to in clinical treatment.
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Objective:To investigate the therapeutic effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) combined with rigid choledochoscopy in the treatment of benign hepatic bile duct strictures.Methods:The clinical data of 46 patients with hepatic ductal stenosis and stones undergoing PTOBF combined with rigid choledochoscopy at the First Hospital of Guangzhou Medical University between September 2016 and September 2022 were retrospectively analyzed, including 20 males and 26 females, aged (48.5±17.6) years. The location of stones and strictures, stone retrieval rate, postoperative complications, stricture release rate, stone recurrence rate, and reoperation rate were analyzed to access the safety and effectiveness of this procedure.Results:A total of 58 sites of stenoses were found in 46 patients, and PTOBF lithotripsy combined with rigid choledochoscopy were performed for 77 times. The early postoperative complication rate was 19.6% (9/46), and the stenosis release rate was 93.5% (43/46). The mean follow-up time was (28.1±19.6) months, the complete stone retrieval rate was 91.3% (42/46), the stone recurrence rate was 19.6% (9/46), the reoperation rate was 8.7% (4/46), and the long-term postoperative complication rate was 6.5% (3/46).Conclusion:PTOBF combined with rigid choledochoscopic stenoplasty for benign hepatic duct strictures is a safe and feasible procedure to reduce the stone recurrence and long-term postoperative complications.
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Hepatolithiasis refers to a disease with stones located in bile ducts above the bifurcation of the left and right hepatic ducts. It is a common benign biliary duct disease. Hepatolithiasis is often associated with intrahepatic bile duct strictures. Due to its complex etiology and pathological changes, its treatment remains a hot topic for debate and research in biliary surgery. In recent years, new treatments have been introduced, but they are all faced with problems such as high recurrence rate, postoperative restenosis rate and reoperation rate. This article reviews the recent progress of surgical management of biliary strictures in the treatment of hepatolithiasis, including the use of hepatectomy, biliary plastic surgery, choledochoenterostomy, choledochoscopy and endoscopic retrograde cholangiopancreatography biliary stent placement to provide a up-to-date view surgical treatment of hepatolithiasis associated with biliary strictures.
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Objective:To study the correlation between biliary angle and hepatolithiasis in liver segment Ⅵ.Methods:A retrospective analysis of the clinical data of 46 patients with liver segment Ⅵ bile duct stones treated at the First Affiliated Hospital of Guangzhou Medical University from January 2017 to January 2021 was carried out. There were 18 males and 28 females, with the age of (55.7±10.5) years. During the study period, 50 patients with cholecystitis were enrolled to form the control group, which consisted of 19 males and 31 females, with the age of (57.4±14.4) years. The angles of the right hepatic duct and the bile duct in segment Ⅵ were measured by the 3D hepatic visualization model. Univariate and multivariate logistic regressions were used to analyze factors correlated with formation of segment Ⅵ bile duct stones.Results:The angles of the segment Ⅵ bile duct (124.5±23.1)° and the right hepatic duct (83.5±14.4)° in the study group were significantly larger than the control group(111.8±27.7)°, (76.9±14.8)°. The difference was significant ( t=2.44, 2.10, P=0.017, 0.039). Analysis showed that the angles of segment Ⅵ bile duct ( OR=1.024, 95% CI: 1.006-1.042, P=0.010) and right hepatic duct ( OR=1.035, 95% CI: 1.005-1.065, P=0.020) correlated with bile duct stones in segment Ⅵ, with greater the angles, greater were the rates of bile duct stones in segment Ⅵ. Receiver operating characteristic curve showed that stones were more commonly formed when the angle of bile duct in segment Ⅵ was over 102.295°. The sensitivity, specificity and area under the curve were 91.3%, 34.0% and 0.631 respectively. Conclusion:The angles of segment Ⅵ bile duct and right hepatic duct were risk factors associated with segment VI bile duct calculi.
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Hepatolithiasis is a common biliary surgical disease. The traditional treatment using laparotomy is highly invasive and risky. In recent years, rapid developments in endoscopic surgical technology in biliary surgery using percutaneous hepatobiliary lithotomy, especially using the percutaneous transhepatic one-step biliary fistulation technique has gradually been widely adopted in clinical practice because of its minimal invasiveness. The complexity and extensive distribution of intrahepatic bile duct stones have resulted in a lot of controversies in preoperative planning, use of intraoperative ultrasound, management of biliary bleeding and biliary stenosis, and postoperative management. There is a lack of universally agreed standards. Based on the author's clinical experience, this article briefly reviewed and focused to discuss on the above-mentioned controversial points.
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Objective To explore the application effect of Thymalfasin for injection in the treatment of chro-nic obstructive pulmonary disease.Methods Clinical data of 80 patients with chronic obstructive pulmonary disease were retrospectively analyzed.According to different treatment methods,they were divided into the treatment group and control group,40 cases in each group.The control group was given routine treatment,the observation group were given Thymalfasin for injection with thymus method on the basis of conventional treatment.The treatment effect,improve pul-monary function,blood gas and TLC immune function of the two groups were observed.Results The total effective rate of the observation group was 95.0%,which was significantly higher than 82.5% of the control group(χ2 =5.274 5, P <0.05);After treatment in patients with pulmonary function,blood gas to improve the situation and TLC were better than those of the control group(all P <0.05);The rate of adverse reactions of the observation group was 5.0%,which was significantly lower than 20.0% of the control group(χ2 =4.114 3,P <0.05).Conclusion Thymalfasin for injection with thymus method in chronic obstructive pulmonary disease treatment has good effect,high cure rate,less adverse reaction.
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Objective To investigate the influences of pain on early neonatal neurobehavioral development Methods 65 newborn infants admitted to the Neonatal Intensive Care Unit( NICU )of our hospital from October,2009 to March,2010 were randomly chosen as the objects of this study.In light of Neonatal Behavioral Neurological Assessment( NBNA) revised by Professor Bao Xiulan,examinations were carried out before and after pain stimulation,and a statistical analysis of the results of the examinations was conducted.Results The total scores of NBNA before and after the pain stimulation were (36.49±1.73) vs.(34.80±1.79) respectively,demonstrating a significant difference.Specifically,after the pain stimulation,the scores of behavioral ability and active muscle tension decreased,with a very significant difference.However,there was no significant difference in terms of the scores of passive muscle tone,primitive reflexes and common reactions.Conclusions Neonatal pain exerts influences on early neurobehavioral development,particularly on behavioral ability and active muscle tension.The training of neonatal health care professionals in the management of and the intervention in neonatal pain should be strengthened in order to decrease the adverse effects of pain on neonates.
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Objective To understand the level of neonatal pain knowledge and attitudes of neonatal and obstetric department nurses, in order to supply the clinical basis for neonatal pain management. Methods Self-designed questionnaires to fill out on-site were distributed to 107 neonatal and obstetric department nurses (of which 40 were from neonatal department, 67 from obstetric department) for neonatal pain knowledge and attitudes. Results About question of neonatal pain, the average percentage of correct answers in the neonatal group was 75.5%, higher than 66.3% of the obstetric group, in the neonatal group, correct rate of seven questions was more than 80%,while in the obstetric group the correct rate of only one question was more than 80%, and 5 questions correct response rate was significantly lower than that of the neonatal group, the difference was significant. All nursing staff considered it essential or necessary to carry out the nursing knowledge of pain-related training. 95.0%(38/40) of neonatal nurses believed that they could properly assess the extent of neonatal pain, but only 83.6% (56/67) for the obstetric group, the difference between the two groups was significant. 97.5% (39/40) of neonatal nurses believed that they could make the right judgments on neonatal crying, and only 85.1%( 57/67) in the obstetric nurses, the difference between the two groups was significant.Conclusions Neonatal pain has gradually been recognized and paid attention to by the clinical front-line medical staff, they believe that it is necessary to receive training on neonatal pain, knowledge of neonatal pain of neonatal nurses is better than obstetric nurses.
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Objective To investigate the influencing factors of pain and the changes of vital signs in newborn infants. Methods Forty two newborn infants were rated by the behavioral scale of acute pain in newborn infants. The scores of pain were compared among infants with different gender,gestational age,birth weight,birth age,type of puncture and whether by vaginal birth or not. At the same time,the respiration rate,heart rate,blood pressure and oxygen saturation (SO2)were dynami-cally recorded by the multi-function monitor in the process of puncture. Results The average score of pain was 7.6. There was no significant difference among newborn infants with different gender,gestational age,birth weight and type of puncture(P> 0.05),while significant differences among infants with different birth age and whether by vaginal birth or not (P=0.015 and 0.043 respectively). In the process of puncture,the SO2 was significantly decreased,while the respiration rate,heart rate,sys-tolic and diastolic blood pressure were significantly increased. Conclusions Pain is prevalent in newborn infants and accom-panied by obvious changes of vital signs. The means of childbirth and birth age have significant influence on the neonatal pain. It is suggested to pay close attention to the neonatal pain and take effective interventions.