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Objectives:To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI).Methods:A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding.Results:Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( HR 7.28, 95% CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age ( HR 1.04, 95% CI 1.01-1.07, P<0.01), and low levels of ejection fraction ( HR 0.95, 95% CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO ( HR1.67, 95% CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions:Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.
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Pancreaticoduodenectomy is one of the most difficult abdominal operations, and the difficulty in resection and complicated digestive tract reconstruction have brought great challenges for surgeons. At present, laparoscopic pancreaticoduodenectomy has been widely used in clinical practice, and compared with traditional 2D laparoscopy, 3D laparoscopy has the features of high magnification, high definition, and three-dimensional vision, which enables surgeons to see more clearly and operate more accurately, and thus it has great potential to be widely used in pancreaticoduodenectomy.
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Objective:To study the preliminary clinical results of the No-touch technique in laparoscopic pancreaticoduodenectomy for pancreatic head cancer.Methods:A retrospective analysis was consulted on 11 patients who underwent laparoscopic pancreaticoduodenectomy for pancreatic head cancer at the Pancreas Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from April 2019 to April 2020. There were 5 males and 6 females, with a Mean±SD age of (63.6±12.2) years. Preoperative evaluation showed all patients were diagnosed to have resectable pancreatic head carcinoma with no local invasion into adjacent arteries and veins, and without metastasis. The surgical strategy consisted of no initial Kocher manoeuvre with no flipping or pulling of the pancreaticoduodenal area. Through unwinding of the pancreatic uncinate process, the pancreatic blood vessels, nerves and lymphatic vessels were completely detached to isolate the tumor. Finally, the pancreaticoduodenal area was totally resected and the digestive tract was reconstructed using the Child’s method. The operation time, intraoperative blood loss, postoperative complications, postoperative pathology and follow-up data of the patients were evaluated.Results:All patients completed the laparoscopic operation without any need for conversion to laparotomy. The operation time of the 11 patients was (422.2±102.2) min, and the bleeding volume was (102.7±65.4) ml. There were 2 patients who developed pancreatic fistula, with 1 patient having a biochemical fistula and 1 patient a grade B fistula. There was no grade C fistula. Other complications included 1 patient with delayed gastric emptying. There were no biliary fistula, no postoperative abdominal bleeding, and no perioperative death. Postoperative pathology showed 6 patients had lymph node metastases, with a positive lymph nodes rate of (4.8±4.4)%. All patients had R 0 resection. The follow-up survival data of the 11 patients showed one patient to develop intrahepatic metastasis 1 month after operation and he died 9 months after operation. Another patient developed liver metastases 2 months after operation. The remaining patients were tumor-free. Conclusion:Laparoscopic pancreaticoduodenectomy using the No-touch isolation and resection technique could achieve complete resection of tumors, and it can safely and effectively be applied to patients with pancreatic head cancer.
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BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain. OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty. METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine. RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.