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Objective To investigate the value of continuous renal replacement therapy (CRRT) coupled with minimally invasive ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) for the treatment of severe acute biliary pancreatitis.Methods Hospitalized patients with severe acute biliary pancreatitis were recruited from the intensive care unit (ICU) of the Mfiliated Hospital of Qingdao University from June 2010 to June 2015,and divided into conventional CRRT alone group (n =30) and CRRT + PTGD group (n =30).Comparisons of postoperatively symptoms (time required for abdominal pain relief,time consumed for,gastrointestinal decompression),laboratory findings (WBC,PLT,PCT,CRP,AMS,TBIL,ALT,ALB,Lac) and acute physiology and chronic health evaluation score (APACHE Ⅱ,Balthazar CT,MODS) were carried out between two groups.The occurrence of complications (ARDS,abdominal infection,bile leakage,abdominal hemorrhage,intestinal injury,catheter translocation,catheter dislocation) was observed.The differences in duration of ventilator support,the length of stay in ICU,and fatality rate were compared between the two groups.Results Compared with the conventional CRRT alone group,the postoperative symptoms were significantly relieved,and time required for abdominal pain relief and time consumed for gastrointestinal decompression were evidently shortened in the CRRT + PTGD group (P ＜ 0.05).There were statistically significant differences in laboratory findings (WBC,PLT,PCT,CRP,AMS,TBIL,ALT) between two groups (P ＜ 0.05).The differences in APACHE Ⅱ,Balthazar CT and MODS score between the two groups also presented statistical significance (P ＜ 0.05).The comparisons of the duration of ventilator support [(6.1 ± 1.3) d vs.(9.5 ± 1.4) d] andthe length of stay [(15.7 ± 1.1) dvs.(21.1 ± 2.5) d] between thetwo groups revealed statistical significance (P ＜ 0.05).Conclusions CRRT coupled with PTGD for the treatment of severe acute biliary pancreatitis can effectively eliminate the inflammatory mediators and toxins from patients.On this basis,the coupled therapy with gallbladder puncture and drainage is capable of decompressing the biliary tract,improving liver function,effectively relieving clinical symptoms,minimizing the changes of laboratory findings an,d APACHE Ⅱ score,and thereby optimizing the prognosis of patients.
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Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group (t=2.44-14.70; P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group (t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, IgG and IgM. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; P<0.01) and EN+PN groups (t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5% vs. 47.5%; χ= 8.24, P<0.01), intracranial infection (12.5% vs 32.5%;χ= 6.88, P<0.01) and pyemia (25.0% vs. 47.5%; χ= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia (27.5% vs. 50.0%; χ= 6.39, P<0.05), hypoproteinemia (17.5% vs. 55.0%; χ= 18.26, P<0.01) and diarrhea (20.0% vs. 60.0%; χ= 20.00, P<0.01). The EN+PN group also had significant less length of stay in NICU (t=2.51, 4.82; P<0.05, P<0.01), number of patients receiving assisted mechanical ventilation (χ= 6.08, 12.88; P<0.05, P<0.01) and its durations (t=3.41, 9.08; P<0.05, P<0.01), and the death rate (χ=7.50, 16.37; P<0.05, P<0.01) than those of EN or PN group. Conclusion Early EN+PN treatment could promote the recovery of the immune function, enhance nutritional status, decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.
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Adult , Female , Humans , Male , Middle Aged , Brain Injuries, Traumatic , Allergy and Immunology , Metabolism , Therapeutics , Enteral Nutrition , Nutritional Status , Parenteral Nutrition , Treatment OutcomeABSTRACT
Objective To explore the effect of support with total parenteral nutrition(TPN)or early enteral and parenteral nutrition(EN+PN)on immune function of critically ill neurosurgical patients.Methods In this prospective control study,patients were divided inte TPN group and EN+PN group based on the timing of admission.The changes of immunological indicators including CD3,CD4,CD8,CD4/CD8,CD3/CD25,IgA,IgG,IgM,and serum protein before and after nutritional support were compared.Results The percentage of T lymphocyte subsets CD3,CD4,and CD8,the ratio of CD3+/CD25+,the plasma leveh of IgA,IgM,and IgG,and the serum protein were significantly increased after nutrifional supports(P<0.05,P<0.01).However,compared with the TPN group,the percentages of T lymphocyte subsets(CD3,CD4,and CD8),the ratio of CD4+/CD8+,the plasma levels of IgA,IgM,and IgG,and the serum protein were significantly higher in EN+PN group(P<0.05,P<0.01).Conclusions Both TPN and EN+PN can promote the recovery of immune function,while EN+PN is superior to TPN.Early nutritional support should be provided to critically ill neurosurgical patients.
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<p><b>BACKGROUND</b>Using the most comprehensive available data on lung cancer incidence and mortality in China, the mortality time trends were described and the incidence and mortality profile in 2000 and 2005 were estimated and projected, so as to provide evidence and reference for clinic, basic research and making prevention and control strategy for lung cancer in China.</p><p><b>METHODS</b>The Joinpoint model was used to analyze the lung cancer mortality trends during 1987-1999, based on data reported to WHO from the Ministry of Health in China. Combined with the data from the second national mortality survey in 1990-1992 and the lung cancer incidence and mortality data from several cancer registries in China which involved in Cancer Incidence in Five Continents, the 8th version, using the log-linear model (based on Poisson distribution), the incidence and mortality profile for lung cancer in 2000 and 2005 in China were estimated and projected.</p><p><b>RESULTS</b>The age-standardized mortality rates increased during the study period, especially in rural areas (the expected annual percentage changes were 2.7% in men and 3.6% for women, both were statistically significant) and showed among almost all age groups (above age 15). From 2000 to 2005, there would be 0.101 million more lung cancer deaths (from 327643 in 2000 to 428936 in 2005) and 0.116 million more new incident cases (from 381487 in 2000 to 497908 in 2005).</p><p><b>CONCLUSIONS</b>Due to the double effects from both changes in the risk factors for the disease and the population growth and aging, lung cancer is becoming one of the most common and increasing malignant neoplasmin China . The prevention and control for this disease will be theemphasis for future cancer control strategy of China in which tobacco control is critically important .</p>
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<p><b>OBJECTIVE</b>To assess the impact of stomach cancer on the Chinese population by epidemiological analysis of its mortality distribution.</p><p><b>METHODS</b>1990-1992 data on stomach cancer mortality collected by sampling survey involved one tenth of the total Chinese population.</p><p><b>RESULTS</b>The crude mortality rate of stomach cancer in China was 25.2 per 10(5) (32.8 per 10(5) for males and 17.0 per 10(5) for females), which comprised 23.2% of the total cancer deaths from 1990 to 1992, making stomach cancer the leading cause of cancer death. The stomach cancer mortality rate of males was 1.9 times of that of females. The Chinese mortality rates of stomach cancer adjusted by the world population were 40.8 per 10(5) and 18.6 per 10(5) of males and females, which were 4.2-7.9 (of males) and 3.8-8.0 (of females) times of those in the developed countries. Age-adjusted mortality rates of stomach cancer in China have distinct geographical difference: form the lowest 2.5 per 10(5) to the highest 153.0 per 10(5) in the 263 surveyed localities, 15.3 per 10(5) in urban areas and 24.4 per 10(5) in rural areas giving a difference of 1.9 times.</p><p><b>CONCLUSION</b>The prevention and treatment of stomach cancer in China, especially in the countryside and the under-developed areas in the northwest, should be a long-term focus in control of cancers of the digestive system. Urgent measures for prevention and early detection of stomach cancer should be taken.</p>