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Objective:To study the factors influencing repeatedly hospitalization in patients with acute pancreatitis (AP), and to analyse the predictive value of triglyceride for repeated hospitalization.Methods:The clinical data of 1 958 patients with AP treated at the First Affiliated Hospital of Anhui University of Science and Technology from January 2012 to April 2022 were analyzed. Of 1 733 AP patients who were enrolled, there were 1 000 males and 733 females, with mean ± s. d age being (49.4±16.4) years. Patients were grouped based on their ID numbers to determine their number(s) of hospitalization. Those who were admitted only once were included in the initial hospitalization group ( n=1 030), and those who were admitted twice or more were included in the repeated hospitalization group ( n=703). The factors influencing repeated hospitalization were analyzed by univariate analysis and multivariate logistic regression analysis. The predictive value of triglyceride for repeated hospitalization was evaluated by receiver operating characteristic (ROC) curve. Results:Multivariate logistic regression analysis showed that hypertriglyceridemia ( OR=1.445, 95% CI: 1.144-1.825, P=0.002) and biliary causes ( OR=3.184, 95% CI: 1.978-5.125, P<0.001) were independent risk factors for repeated hospitalization. When triglyceride <10.9 mmol/L, the prediction of AP patients without repeated hospitalization was 90.6%. The area under the ROC curve was 0.589, and the Yoden index was 0.170. Conclusion:Hypertriglyceridemia was risk factor for repeat hospitalization in AP patients and the efficacy of triglyceride in predicting repeat hospitalization in AP patients was good.
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Objective:To investigate the correlation between preoperative thyroid function and central lymph node metastasis in cN0 unilateral papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 208 patients with cN0 unilateral PTMC admitted to the First Affiliated Hospital of Anhui University of Science and Technology from July 2020 to December 2021 were retrospectively analyzed. The patients were divided into a metastasis group( n=64) and a non-metastasis group( n=144) according to whether there was central lymph node metastasis in postoperative pathology. The preoperative serum free three iodine thyroid gland (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), anti thyroid peroxidase antibody (TPOAb) , anti thyroid globulin antibody (TGAb), paraffin pathological results and general data were compared between the two groups of patients. Statistical analysis was performed using SPSS 19.0 software. The measurement data of normal distribution were expressed by Mean±SD , and comparison between groups was performed by t test. Non-normal distribution measurement data were expressed as [ M( Q1, Q3)], and comparison between groups was performed by Mann-Whitney U test. Enumeration data were represented by n(%), and comparison between groups was performed by chi-square. Multivariate analysis was conducted by binary logistic multivariate regression analysis. Results:In 208 PTMC patients with cN0, the rate of central lymph node metastasis was 30.77% (64/208). The misexcision rate of parathyroid gland was 28.13% (18/64) in the metastatic group, 25.69% (37/144) in the non-metastatic group, and the overall misexcision rate was 26.44%. There were no significant differences in age, tumor subtypes, combined hashimoto′s thyroiditis, multiple lesions, FT3, FT4, TGAb and TPOAb between the metastatic group and the non-metastatic group ( P>0.05). The proportion of male patients in the metastatic group was higher than that in the non-metastatic group (32.81% vs 19.44%, χ2=4.38, P=0.036), the tumor diameter in the metastatic group was larger than that in the non-metastatic group [(0.63±0.23)cm vs (0.49±0.22)cm, χ2=3.99, P<0.001], and the preoperative TSH in the metastatic group was higher than that in the non-metastatic group[2.87(1.92, 4.95) vs 2.04(1.56, 2.84), Z=2.48, P=0.024], and differences between the two groups was statistically significant ( P<0.05). Multivariate logistic regression analysis showed that male, tumor diameter and preoperative TSH were independent risk factors for lymph node metastasis in central region ( P<0.05). Conclusions:The central lymph node metastasis rate of cN0 unilateral PTMC is high. Male, patients with large tumor diameter and high preoperative TSH should be alert to occult lymph node metastasis, and the protection of parathyroid glands should be strengthened during central lymph node dissection.
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Objective:To investigate the safety and feasibility of early operation for acute calculous cholecystitis with elevated liver enzymes.Methods:The clinical data concerned about 39 patients with acute calculous cholecystitis complicated with elevated liver enzymes in The First Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology between January 2018 to December 2018 were analyzed retrospectively.There were 14 males and 25 females, the age was(57.59±15.30) years(range 29 to 84 years). All patients were given hepatoprotective therapy and antibiotic therapy, A total of 18 patients received early surgical treatment within 7 days (surgical group), 21 patients who received only hepatoprotective therapy and antibiotic therapy(control group). Observation indicators: (1)Total bilirubin, white blood cells and pancreatin in both groups at admission; (2)Data of liver enzyme indexes (ALT, AST, GGT) of the two groups at admission and 3 days after admission; (3)The length of hospital stay in the two groups, and gallstone-related events after discharge(the incidence of gallstone-related emergency, the rehospitalization rate). Normally distributed measurement data were expressed as mean±standard deviation( ± s), and comparison between groups were analyzed using t test; Non-normal distribution measurement data were represented by M( Q1, Q3), and comparison between groups were analyzed using Mann-Whitney U test. Comparison between groups were analyzed using chi-square test or Fisher method of count data. Results:There was no statistical difference between the two groups in terms of total bilirubin, white blood cells and pancreatin( P>0.05). There was no significant difference in liver enzyme indexes (ALT, AST, GGT) between the two groups when they were admitted to the hospital ( P>0.05) and 3 days later ( P>0.05). Before treatment, ALT、AST、GGT in surgical group were 161.00(83.75, 237.75) U/L, 63.50(49.50, 257.75) U/L, 245.50(66.75, 549.75) μmol/L, ALT, AST, GGT in control group were 187.00(64.00, 335.50) U/L, 104.00(53.50, 355.00) U/L, 299.00(136.50, 455.00) μmol/L, after 3 days antibiotic therapy and hepatoprotective therapy, ALT, AST, GGT in surgical group were 77.50(52.00, 111.00) U/L, 41.50(33.00, 53.75) U/L, 190.50(65.00, 372.00) μmol/L, ALT, AST, GGT in control group were 67.00(23.50, 129.50) U/L, 37.00(26.00, 61.50) U/L, 187.00(90.50, 337.00) μmol/L, levels of the two groups decreased significantly( P<0.05). There was no statistically significant difference in the length of hospital stay between the surgical group and the control group[(12.89±3.41) d vs (11.05±4.57) d, P>0.05]. After 12 months of follow-up, Gallstone-related events after discharge, the incidence of gallstone-related emergency in the surgical group was lower than that in the control group (5.6% vs 33.3%), the rehospitalization rate in the surgical group was significantly lower than that in the control group (5.6% vs 42.9%), there was statistically significant difference between the two groups ( P<0.05). Conclusion:Hepatoprotective therapy and antibiotic therapy and can effectively reduce the liver enzyme indexes of such patients in a short period of time, early surgical treatment after liver enzymes has decreased is a complete and safe option.
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Objective:To explore the safety of clinical application of liver cysts under the mode of ambulatory surgery.Methods:Retrospective analysis of the data of 84 patients with liver cysts admitted to the Huainan First People′s Hospital, the Fourth Affiliated Hospital of Bengbu Medical College from January 2017 to December 2019, they were divided into study group ( n=42) and control group according to the random number table method ( n=42). The control group adopted the traditional perioperative management method, and the research group adopted the day surgery treatment mode. The two groups of patients were evaluated for their hospitalization days, total cost, satisfaction, activity of daily living (ADL) score of 7 days after surgery, temporary cancellation rate, unplanned readmission rate, total postoperative complications and other indicators. Normally distributed measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t test was used for comparison between groups. Enumeration data was expressed as a percentage (%), and comparison between groups was performed by chi-square test. Results:The length of stay in the study group and the total cost of hospitalization were (1.76±0.82) d and (0.55±0.10) ten thousand yuan, respectively. The control group were (5.33±1.69) d and (0.90±0.22) ten thousand yuan, respectively. The study group was lesser than In the control group, the differences between the two groups were statistically significant ( P<0.001). The patient satisfaction score of the study group was (4.20±0.64) points, and the control group was (3.20±0.92) points. The study group was higher than the control group. The difference between the two groups was statistically significant ( P<0.001). The postoperative ADL score, temporary cancellation rate, unplanned readmission rate, and total postoperative complication rate in the study group were (46.45±9.75) points, 4.76%, 7.14% and 9.52%, respectively. The control group were (45.57±7.02) points, 2.38%, 4.76% and 7.14%, there was no significant difference between the two groups ( P>0.05). Conclusions:Ambulatory laparoscopic fenestration of liver cysts is safe and effective for the treatment of patients with liver cysts. Compared with traditional in-patient surgery, it can reduce the length of stay and the cost of hospitalization and increase the satisfaction of patients.
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Objective:To explore the influence of the timing of the drainage tube removal on the clinical pathway after radical resection of papillary thyroid carcinoma.Methods:The clinical data of 64 patients with radical resection of papillary thyroid carcinoma discharged to the department of general surgery, First Affiliated Hospital of Anhui University of Science and Technology from December 2019 to May 2020 were retrospectively analyzed. There were 14 males and 50 females, aged (45.8 ± 11.7) years and ranging from 23 to 73 years. According to the amount of postoperative drainage fluid, decide whether to extubate and divide the patient into a study group and a control group, there were 37 cases in the study group and 27 cases in the control group. The extubation indication in the study group was 24 hours of drainage fluid volume <20 mL, the control group was 24 hours of drainage fluid volume <10 mL. The differences in operation time, intraoperative blood loss, tumor diameter, number of lymph node dissection, extubation time, postoperative complications, hospitalization cost, postoperative hospitalization time, total hospitalization time, and clinical path completion rate were compared between the two groups. The measurement data of normal distribution were expressed as mean±standard deviation ( Mean± SD), and the t test was used for comparison between groups, the measurement data of non-normal distribution were measured by M ( P25, P75), and the Mann-Whitney U test were used for comparison between groups.Counting data were expressed as percentages(%), and chi-square test was used in comparison between groups. Results:There were no significant difference between the two groups in the operation time, total intraoperative blood loss, tumor diameter, number of lymph node dissections, postoperative complications and hospitalization costs( P>0.05). The extubation time, postoperative hospitalization time, hospitalization time and clinical path completion rate of the study group were 2.9(2.5, 3.5) d、3.0(3.0, 3.5) d、7.0(7.0, 8.5) d and 70.3% (26/37), vespectively. In the control group, they were 4.5(3.8, 5.5) d、5.0(4.0, 6.0) d、11.0(10.0, 13.0) d and 11.1% (3/27), respectively. The difference between the two groups were statistically significant ( P<0.05). Conclusion:After radical resection of papillary thyroid cancer, taking the 24 h drainage volume <20 mL as the timing of extubation does not increase the incidence of postoperative complications, which can significantly shorten the extubation time, postoperative hospitalization time and total hospitalization time and improve clinical path completion rate.
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Objective:To explore the application effect and value of enhanced recovery after surgery(ERAS) in acute appendicitis.Methods:The clinical data of 70 cases of adult acute appendicitis in the Department of General Surgery, First Affiliated Hospital of Anhui University of Science and Technology from July 2017 to June 2018 were analyzed retrospectively, including 35 males and 35 females, aged (41.4 ± 14.6) years and ranging from 18 to 70 years. According to the different perioperative management methods, the study group was divided into study group ( n=35) and control group ( n=35). The study group adopted systematic and orderly intervention measures guided by ERAS during the perioperative period, and the control group adopted the traditional perioperative management scheme. The differences in the preoperative white blood cells, operation time, intraoperative bleeding, the first time of get out the bed, the time of anus ventilation, the 24 hour postoperative pain score, the hospital days, postoperative complications, leukocyte examination 72 days after operation and total cost were compared between the two groups. Measurement data were expressed by mean±standard deviation ( Mean± SD). T test was used for comparison between groups. Counting data were expressed by percentages, and chi-square test and Fisher test were used in comparison between groups. Results:In the study group, the leukocytes before operation, operation time, intraoperative blood loss, hospital stay and leukocyte examination 72 days after operation were respectively (13.3±4.7)×10 9/L, (66.5±18.7) min, (11.7±6.6) mL, (5.8±1.6) d, (7.5±2.6)×10 9/L; while the control group were respectively (13.3±3.5)×10 9/L, (71.9±21.7) min, (12.5±7.1) mL, (7.3±2.7) d, (7.9±2.4)×10 9/L. There was no significant difference between the two groups ( P> 0.05). In the study group, the first time to get out of bed, the time of anal ventilation, the 24 hour postoperative pain score, the total cost of hospitalization and postoperative complications were (8.3±1.4) h, (21.6±3.6) h, (2.3±0.5) scores, (7 058.0±1 329.9) yuan, 2 csaes; while the control group were respectively (11.1±2.8) h, (35.0±5.3) h, (3.4±0.8) scores, (8 621.3±2 625.6) yuan, 9 cases; The difference between the two groups was statistically significant ( P<0.05). Conclusions:The application of ERAS in the perioperative management of acute appendicitis is safe and effective. It can accelerate the anal ventilation, reduce postoperative pain, reduce postoperative complications, reduce the total hospitalization costs, and have significant social and economic benefits.
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Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones.Methods From June 2017 to December 2017,94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively.All patients were included in clinical pathway management.According to whether the perioperative period was combined with ERAS,there were 45 cases in the study group and 49 cases in the control group.The study group was combined with ERAS during perioperative period,while the control group received traditional perioperative management.The preoperative hospitalization days,operative time,intraoperative bleeding volume,total hospitalization days,postoperative complications,hospitalization costs,postoperative hospitalization days,clinical pathway completion rate and positive and negative variation rates were compared between the two groups.The measurement data were expressed by (Mean ± SD),and the comparisons between groups were performed by t test;Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Results Preoperative hospitalization days,operation time,intraoperative bleeding volume,total hospitalization days and postoperative complications in the study group were (3.3 ± 1.2) d,(63.1 ± 24.3) min,(9.4 ± 3.9) ml,(7.1 ± 1.5) d and 1 case respectively,while those in the control group were (3.2 ± 1.5) d,(68.4 ± 25.4) min,(9.5 ± 2.9) ml,(8.4 ± 1.8) d and 2 cases respectively,and the differences between the two groups ware not statistically significant (P ＞ 0.05).Postoperative hospitalization days,hospitalization expenses and shortened hospitalization days in the study group were (2.9 ± 0.8) d,(9 407.2 ± 500.9) yuan and 64.4％ (29/45) respectively,while those in the control group were (4.5 ± 1.1) d,(10 594.9 ±792.3) yuan and 36.7％ (18/49) respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay,reduce hospitalization costs,increase the positive variation rate of clinical pathway without increasing postoperative complications.
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Objective To explore the application effect of the concept of accelerated rehabilitation surgery in elderly patients with choledocholithiasis.Methods A total of 28 patients with choledocholithiasis were treated in Department of General Surgery,Huainan First People's Hospital of Anhui Province in recent years.According to different interventions during perioperative period,they were divided into group ERAS (n =15) and control group (n =13).In group ERAS,systematic and orderly intervention was guided by the concept of rapid rehabilitation during perioperative period,while the control group adopted traditional perioperative management plan.Postoperative anal ventilation time,first out of bed time,postoperative hospital stay,postoperative complications,postoperative leukocyte and albumin differences between the two groups were compared.Measurement data were expressed by (-x ± s).T test was used for comparison between groups.Comparison of counting data were analyzed using Fisher exct probability between groups.Results The anus ventilation time after operation in group ERAS was (37.5 ± 3.7) h,the first time to get out of bed was (14.2 ± 4.1) h,and the number of days after operation was (8.7 ± 4.6) d,while the time of anus ventilation in the control group was (46.1 ± 3.2) h,and the first time to get out of bed was (21.4 ±4.2) h,and the number of days after operation was (13.8 ±7.2) d,and the difference of two groups was statistically significant (P ＜ 0.05).In group ERAS,albumin was (34.3 ± 1.7) g/L for the first time after operation,while (29.5 ± 2.0) g/L in control group.The difference between the two groups was statistically significant (P ＜ 0.05).However,the complications and first reexamination of leukocyte in the two groups were no difference.Conclusion The application of ERAS in the operation of choledocholithiasis in elderly patients with choledocholithiasis can accelerate the anal ventilation,shorten the days of hospitalization,reduce postoperative complications,and improve the postoperative recovery.
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Objective To investigate the effects of painless ward standardized pain management on pain control and postoperative recovery of patients with inguinal hernia after surgery.Methods From January 2015 to January 2016,44 cases of inguinal hernia in Department of General Surgery,First People's Hospital of Huainan,control group (22 cases) and observation group (22 cases) were retrospectively studied.The patients in observation group underwent painless ward standardized pain management and those in control group underwent traditional pain mnanagement model.Pain score after surgery,time for get out of bed after surgery,postoperative intestinal exhaust time,duration of night sleep,and satisfaction degree for pain-control were comparrd between two groups of patients.Results For pain score after surgery,the observation group 3 h after operation,postoperative 1 d,2 d pain score respectively (3.46 ± O.56),(2.72 ± O.21),(2.20 ± O.43) points,the control group 3 h after operation,postoperative 1 d,2 d pain score respectively (4.48 ± 1.52),(3.55 ± 0.40),(2.80 ± 0.40) points,there were significant difference between two groups (P ＜ 0.05).For sleep time,the observation group on the day of surgery,postoperative 1 d,2 d sleep time respectively (5.23 ± 0.98) h,(6.57 ± 0.54) h,(7.50 ± 0.54) h,the control of sleep time of 2 d group on the day of surgery,postoperative 1 d,respectively (4.35 e 1.28) h,(5.17 ± 0.45) h,(6.72 ± 0.61) h,there were significant difference between two groups (P ＜ 0.05).The satisfaction rate of pain control in the observation group was 86.3％,which was higher than that of the control group 50.0％ (P ＜ 0.05).The observation group first ambulation time,anal ventilation time,hospital stay were (10.5 ± 2.0) h,(16.8±2.1) h,(6.6±1.4) d,the control group for the first time,ambulation time,anal ventilation time,hospital stay were (15.9 ± 3.O) h,(22.6 ± 3.3) h,(7.5 ± 1.2) d,there were significant difference between two groups (P ＜ 0.05).However,there was no difference between the two groups in the total cost of hospitalization.Conclusions Application of painless ward standardized pain management for patients with inguinal hernia after surgery can shorten time for get out of bed after surgery,postoperative intestinal exhaust time,prolong duration of night sleep,improve satisfaction degree for pain-control during hospitalization.
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Gene associated with retinoid-IFN-induced mortality-19(GRIM-19)is originally isolated as a growth suppressive gene using a genetic screen.GRIM-19, initially found in nucleus and mitochondria, is essential for the assembly and functioning of mitochondrial complex I.GRIM-19 involves the regulation of cell proliferation and apoptosis, and low expression or mutation of GRIM-19 contributes to abnormal proliferation.During viral oncogenesis, GRIM-19 may be a general target protein similar to other cellular tumor suppressors.GRIM-19 plays an important role in tumor formation and apoptosis inhibition, and may be as a new tumor marker to early cancer screening.