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Objective:To investigate the efficacy and safety of en-bloc low-power (22.5 W) holmium laser for enucleation of prostate (LP-HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods:The clinical data of 98 patients with BPH who underwent surgical treatment in the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2020 to October 2022 were retrospectively analyzed. They were divided into LP-HoLEP group ( n=53) and TURP group ( n=45) according to different treatment methods. Patients in the LP-HoLEP group were treated with en-bloc holmium laser enucleation of prostate, and patients in the TURP group were treated with transurethral resection of prostate (TURP). Perioperative indexes of the two groups were compared, including operation time, postoperative hemoglobin changes, tissue resection amount, postoperative catheter indentation time, postoperative hospital stay, complications, and international prostate symptom score (IPSS), quality of life (Qol) score, maximum urine flow rate (Qmax), postvoid residual volume (PVR) and other indicators were obtained at 3 and 6 months after surgery. The measurement data were tested by Shapiro-Wilk normality test. The measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups, measurement data of skewness distribution were expressed as median (interquartile distance)[ M( Q1, Q3)], and Mann-Whitney U test was used for comparison between groups. The Chi-square test was used to compare the count data between groups. Results:In the LP-HoLEP group, the operative time was (65.74±22.82) min, the hemoglobin decreased 5.71(3.97, 9.01) g/L, the tissue resection volume was (60.59±24.40) g, and the catheter indinduration time was (3.03±0.91) d. The length of postoperative hospitalization was (4.14±1.05) d. TURP group was (77.04±27.33) min, 11.02(8.89, 16.51) g/L, (39.49±11.32) g, (4.80±0.91) d, (5.98±1.03) d, respectively. All the indexes of LP-HoLEP group were better than TURP group. The differences were statistically significant ( P<0.05). Compared with preoperative, IPSS, Qol score, Qmax and PVR of two groups were significantly improved at 3 months after surgery, but there were no statistical significance between groups ( P>0.05). Conclusion:En-bloc LP-HoLEP is safe and reliable in the treatment of BPH, and has advantages over TURP in terms of tissue resection volume, shortening hospitalization and indwelling catheter time, and reducing intraoperative bleeding.
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Objective:To investigate the clinical effect of repairing postoperative nasal skin cancer defect with subcutaneous pedicle flap based on partition and blood supply.Methods:From March 2018 to September 2020, 39 patients with skin cancer (basal cell carcinoma, Bowen′s disease, squamous cell carcinoma and malignant melanoma in situ) were repaired with kites subcutaneous pedicle flap after extensive resection.Results:Thirty-nine patients were treated with parafasal kite flaps, including 44 cases. The donor sites of the flap were nasal tip in 4 cases, bilateral alar in 7 cases, bilateral nasolabial sulcus in 19 cases, bilateral parasinal in 12 cases and interglabellar in 2 cases. There were no serious complications such as necrosis, hematoma or infection. During the follow-up period of 6 to 24 months, 2 patients complained of occasional tingling in the surgical area, 1 complained of occasional pruritus, and 1 patient had local recurrence of squamous cell carcinoma and underwent surgery again. The scar was evaluated 6 months after surgery, and the scores of Vancouver scar scale and visual analogue scale were 2.42±1.04 and 7.83±1.21, respectively. The skin color of the operation area was similar to that of the surrounding skin without obvious local strain deformation.Conclusions:The subcutaneous pedicle flap designed by considering the nasal division and blood supply has a high survival rate, fewer complications and small local appearance deformation, which is worthy of popularization and application.
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Objective:To explore the pathogenesis of primary hemophagocytic syndrome with UNC13D and MYO5A gene mutations.Methods:A case of adult hemophagocytic syndrome with gene mutation of UNC13D and MYO5A admitted to The 940th Hospital of the Joint Logistic Support Force of the PLA on January 28, 2022 was retrospectively analyzed in terms of laboratory examination, gene atlas of its close relatives and prognosis, and related literature was reviewed.Results:The patient was finally diagnosed with primary hemophagocytic syndrome, and chemotherapy was performed twice with hemophagocytic lymphohistiocytosis(HLH)-2004 regimen. The HLA matching of his cytoplasm was semi-compatible. Considering that his cytoplasm carried blood-macrophage related genes, it was not suitable to be selected as a donor, and there were no other suitable relatives. He was transferred to another hospital for allogeneic hematopoietic stem cell transplantation, but failed to receive allogeneic hematopoietic stem cell transplantation during telephone follow-up, and died.Conclusion:The gene mutation of primary hemophagocytic syndrome is the gold standard for the diagnosis of primary HLH. There may be dual gene inheritance pattern in primary HLH, and the combination of immune disorder caused by viral infection and genetic factors may lead to the pathogenesis of primary HLH.
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Acid sphingomyelinase deficiency (ASMD), also known as type A and B Niemann-Pick disease, is a group of intra-lysosomal lipid storage diseases caused by mutations in the SMPD1 gene that decrease acid sphingomyelinase activity or even cause deletion, resulting in abnormal deposition of sphingolipids. This disease can be diagnosed by bone marrow aspiration, pathological biopsy, acid sphingomyelinase activity measurement and SMPD1 gene testing. In recent years, with the rapid progress of molecular diagnostic techniques, new insights have been gained in the laboratory diagnosis of ASMD by means of molecular genetic tests, biomarkers and acid sphingomyelinase activity assay. This article will review the diagnostic progress of ASMD, aiming to reduce the misdiagnosis and leakage of the disease and improve the clinicians′ understanding of the disease.
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Objective:This study aimed to translate the development of a delirium knowledge test for intensive care nurses (DKT-ICN) and test its reliability and validity.Methods:The DKT-ICN was translated and adapted according to Chinese culture following the translation, back translation and culture adaptation of DKT-ICN using Brislin′s translation model. The Chinese version of DKT-ICN was tested among 316 nurses conveniently sampled in the First Affiliated Hospital of Zhengzhou University from September to December 2021, the reliability and validity of the scale were evaluated by cross-sectional survey method.Results:The scale-content validity index was 0.98, and the item-content validity index ranged from 0.83 to 1.00, the Cronbach′s α for the total scale was 0.884, and the Cronbach′s α for five dimensions ranged from 0.608 to 0.679. The test-retest reliability was 0.753 for the overall scale, and 0.880-0.978 for each domain.Conclusion:The Chinese version of DKT-ICN has acceptable reliability and validity. The DKT-ICN is a valid and reliable instrument for evaluating the knowledge level of ICU nurses in China.
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Liver cancer is one of the most common cancers in China. In recent years, liver cancer tends to be treated with comprehensive therapies, including surgery, ablation, interventional embolization, radiotherapy, chemotherapy, targeted therapy, immunotherapy, and liver transplantation. At present, the low surgical resectionrate is one of the main factors affecting the prognosis of liver cancer patients. Preoperative neoadjuvant therapy or conversion therapy for liver cancer can maximize the rate of surgical resection and improve the prognosis. With the rapid development of radiotherapy and immunotherapy in the comprehensive treatment of liver cancer, it has been gradually confirmed that the unique effects of preoperative radiotherapy and immune therapy for liver cancer can improve the prognosis of the patients. Therefore, this paper reviewed the research progress in the preoperative radiotherapy and immunotherapy for liver cancer by searching relevant literature and reports at home and abroad.
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Objective:To investigate the safety and efficacy of individualized transperineal prostate biopsy based on the segmentation of PI-RADS v2 for mpMRI.Method:The clinical data of patients undergoing prostate biopsy in Beijing Friendship Hospital from December 2018 to November 2021 were analyzed retrospectively . A total of 228 patients with a median age of 65(49-83)years underwent biopsy. There were 102(44.7%) with tPSA <10 ng / ml, 108(47.4%) with tPSA 10-20 ng /ml, and 18(7.9%) with tPSA >20 ng /ml, with the median tPSA of 9.87(4.1-89.0)ng /ml. There were 42(18.4%) cases without MRI results, and 32(14.0%)cases with PI-RADS score of 1-2, 47(20.6%)cases of PI-RADS 3, 66(28.9%)cases of PI-RADS 4 and 41(18.1%)cases of PI-RADS 5, respectively.Transrectal ultrasound-guided transperineal prostate targeted biopsy (TB) and systematic biopsy (SB) were performed under local anesthesia or intravenous anesthesia. SB was performed for those without MRI and PI-RADS score of 1-2 (SB group), and TB and SB were performed for those with PI-RADS score of 3-5 (TB+ SB group). Prostate image under ultrasound was cognitively fused according to PI-RADS v2. One needle per area was distributed in 10 areas of each layer(the transition zone anterior and posterior sectors, the peripheral zone anterior, lateral, and medial sectors or central zone in left and right lobe). For those whose prostate length was less than 3cm, 10 needles were punctured, and two needles were added to each lateral lobe of the apex with a total of 14 needles. For those whose prostate length was from 3 to 6 cm, selected two layers with a total of 20 needles. For those with a length greater than 6cm, selected three layers with a total of 30 needles. If there was a suspicious lesion with PI-RADS score of 3-5, two needles were targeted for each lesion.The detection rate and complication rate of prostate cancer and clinically significant prostate cancer (csPCa) in the overall samples were observed, and the difference of the detection rate of prostate cancer and csPCa between the two groups was compared.Results:Of the 228 cases, there were 46 cases undergoing biopsy of one layer, 148 cases of two layers, and 34 cases of three layers, detecting 131 prostate cancer (PCa) diagnosed by pathology, with a detection rate of 57.5%, including 40 cases (17.5%)of clinically insignificant PCa and 91 cases(39.9%)of csPCa. The detection rate of PCa in TB+ SB group was 61.0%(94/154), which was higher than that in SB group, but there was no significant difference ( P=0.114). However, the detection rate of csPCa in TB + SB group was higher than that in SB group, which was 46.8%(72/154)vs. 25.6%(19/74), respectively ( P=0.002). In the combined TB and SB group (TB + SB group), the detection rate of csPCa by TB was 44.8% (69/154), which was higher than that of 33.8%(52/154)by SB( P=0.047). In the TB+ SB group, 7(4.5%) PCa were missed by SB, which was less than 18 cases (11.7%) missed by TB( P=0.022), but csPCa were missed by SB more than that missed by TB( P<0.001). There were 37 cases suffered from complications, with Clavien Dindo classification grade 1 of 29 cases (12.7%), grade 2 of 7 cases (3.1%), and grade 3 of 1 case(0.4%). Conclusions:Individualized transperineal prostate biopsy based on the segmentation of PI-RADS v2 for mpMRI is safe and reliable. Target biopsy by cognitive fusion can improve the detection rate of significant PCa. Systematic biopsy is also an important and essential supplement, which can detect prostate cancer missed by TB. Combined TB and SB are the best choice.
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Objective:To determine the clinical effect of sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser for hypertrophic scar. Methods:A total of 80 hypertrophic scar patients, including 45 male and 35 female, in our clinic were randomly divided into test ( n=40) and control ( n=40) groups from March 2019 to May 2020. Patients aged from 18-42 years with average age 28.1. Patients in test groups were treated with triamcinolone acetonide and lattice CO 2laser sequentially. After final treatments, third-party blind evaluation, Vancouver scar scale, visual analog scale and dermatology life quality index were performed. Results:Test group acquired more satisfied result in third-party blind evaluation (82.5% vs. 52.5%, χ2=8.216, P<0.05). Vancouver scar scale, visual analog scale and dermatology life quality index were not significantly different before treatment for both groups while test group acquired better improvement after treatment ( P<0.05). Conclusions:Sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser is effective for hypertrophic scar and worths wide application in the clinic.
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Objective To investigate the value of intravoxel incoherent motion (IVIM)and three-dimensional arterial spin labeling (3D-ASL)technique in preoperative grading diffuse gliomas.Methods Thirty-one patients with diffuse gliomas proved by pathology were enrolled,including 12 cases with low grade gliomas and 19 cases with high grade gliomas.All patients underwent 3D-ASL and IVIM examination before operation.Original dates were disposed in particular software,then the images of cerebral blood flow (CBF), D? and D were obtained,and ROI were selected and relevant parameter values were calculated.The parameter values were analyzed in SPSS,and unpaired two-tailed student t test were performed to compare parameter values between two groups.P＜0.05 was regarded as statistically significant. ROC analysis curves were performed to acquire optimum threshold value,sensibility and specificity of each parameter.Finally,the sensibility and specificity of the associating screening of 3D-ASL and IVIM were obtained.Results The CBF and relative CBF(rCBF) values of high grade gliomas group [(103.89±27.00)mL/min?100 g and (4.28±0.63)mL/min?100 g]were significantly higher than those of low grade gliomas group [(63.96±22.17)mL/min?100 g and (2.72±0.84)mL/min?100 g];The D? and relative D?(rD?) values of high grade gliomas group [(3.82 ± 0.60 )mm2/s and 1.9 5 ± 0.30 ]were significantly higher than those of low grade gliomas group [(2.54±0.50)mm2/s and 1.28±0.14],the D and relative D (rD)values of high grade gliomas group [(0.58±0.12)mm2/s and 2.40±0.49]were significantly lower than those of low grade gliomas group [(0.75±0.12)mm2/s and 3.1 1±0.42](P＜0.05). Statistical analysis in ROC demonstrated AUC value of 0.879 and 0.917 for CBF and rCBF,optimum threshold value of 79.24 mL/min?100 g and 2.85,sensibility of 84.2% and 100%,specificity of 83.3%and 83.3%;AUC value of 0.925,0.846,0.956 and 0.882 for D?,D ,rD? and rD ,optimum threshold value of 2.95 mm2/s, 0.63 mm2/s,1.40 and 2.95,sensibility of 94.7%,91.7%,94.7%and 75%,specificity of 83.3%,73.3%,91.7% and 94.7%.The sensibility and specificity of the associating screening of 3D-ASL and IVIM were 100% and 9 1.7%.Conclusion IVIM and 3D-ASL can be used to grade diffuse gliomas,and the values of rCBF,rD? and rD are optimal indicator.Combination of IVIM and 3D-ASL can improve the sensibility and specificity of grading diffuse gliomas.
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OBJECTIVE: To explore the status of occupational stress and its influencing factors in medical radiation workers using two occupational stress measurement models. METHODS: A total of 632 medical radiation workers from Guangdong Province were selected as the study subjects using cluster sampling method. Chinese version of Job Content Questionnaire and Effort Reward Imbalance Questionnaire were used to assess occupational stress with job demand-control( JDC) and effort-reward imbalance( ERI) models. RESULTS: The rate of occupational stress in the study subjects was 43. 8%( 277/632) using the JDC model. The rate of occupational stress was 38. 6%( 244/632) using the ERI model. The multivariate logistic analysis results showed that the risk of JDC occupational stress was higher in workers with more than 8 hours work daily and more than 40 hours weekly( P < 0. 01). The risk of ERI occupational stress was higher in the workers with age of30. 0-40. 0,public medical institutions,daily work more than 8 hours and weekly work more than 40 hours( P < 0. 01).CONCLUSION: Under the two theoretical models,medical radiation workers have a certain degree of occupational stress. The age,medical institution type,daily and weekly work hours are the main factors affecting occupational stress.
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In recent years medical rebates suspected of illegal and criminal cases frequently appeared in the media and newspaper, triggering the public continuous attention to the problems of commercial bribery in the field of medicine. Starting from the definition of medical rebates concept, this paper deeply analyzed the deep cause of medical rebates, jumped out of the existing countermeasures and suggestions framework, and starting from the inter-nal supervision and restriction approach of discipline inspection and supervision, discussed the solution from four aspects of cultural atmosphere, interests chain, management process, self-supervision, in order to provide refer-ence for the comprehensive treatment of medical rebates.
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Objective To investigate the association of serum fibroblast growth factor 21(FGF-21)with coronary heart disease(CHD)and biochemical indexes. Methods Serum FGF-21 expression was detected by ELISA.310 healthy control subjects and 310 CHD patients were recruited.Basic information was obtained by clini-cal questionnaires. Venous blood was tested for serum lipid,fasting glucose,and C-reactive protein(CRP). All the data were analyzed with the SPSS 19.0. Results There were no significant differences in gender and age be-tween CHD and controls(P > 0.05). FGF-21 level was significantly higher in CHD patients than in the controls (P<0.05).Univariate analysis showed serum FGF-21 was a risk factor of CHD.The group of higher score for FGF-21 had a 5.20-fold risk of CHD than the group of lower score without adjustment for confounding factors(95% CI:4.23~8.42).After control of the confounding factors,the group of higher score had a 7.21-fold risk of CHD(95% CI:3.78~13.67)than the group of lower score,it remains the significant difference(P<0.05).Conclusion Ele-vation of serum FGF-21 was closely associated with initiation and development of CHD.
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Objective To evaluate the association between preoperative fasting and postoperative delirium in elderly hip fracture patients. Methods A total of 120 hip fracture patients were divided into the experiment group and the control group with 60 cases each by random digits table method. The experiment group was recommended a 2-3 h preoperative fast for clear fluids and a 6-8 h fast for solids in elective patients. The control group received a 4 h preoperative fast for clear fluids and a 12 h fast for solids in elective patients.Adverse effects of fasting and variation of prevalence of postoperative delirium were compared. Results The incidence rate of hypoglycemi,hunger,anxiety were 18.3%(11/60),63.3% (38/60),16.7%(10/60)in the control group and 3.3%(2/60),36.7%(22/60),5.0%(3/60)in the experiment group, there were significant differences between the two groups(χ2=6.988,8.533, 4.227, P <0.05). There was no significant differences in thirst between the two groups(P>0.05). The incidence rate of postoperative delirium in the experiment group and the control group was 6.7%(4/60)and 21.7%(13/60), there was significant differences between the two groups(χ2=5.551,P<0.05).There was a linear correlation between fasting prohibition and postoperative delirium (r =0.215). Conclusions The new preoperative fasting method is safety and can reduce the incidence of delirium.
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Objective To study the willingness and influence factors related to "centralized slaughtering,fresh poultry listing and marketing" strategy,among the household chefs,and provide reference for government to adjust and optimize the strategy on avian influenza prevention.Methods According to the geographical characteristics and regional functions,6'monitoring stations' were selected from 12 residential districts of Guangzhou,respectively.Another 21 meat markets which selling live poultry,were selected in each station and 5 household chefs of each market were invited to attend a face to face interview.Basic information,personal cognitive,willingness and influencing factors to the policy were under study.Univariate and multivariate logistic regression methods were used.Results A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering,fresh poultry listing and marketing" strategy was 44.6％ (296/664).Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618,95％ CI:1.156-2.264,P=0.005),having received higher education (OR=1.814,95％ CI:1.296-2.539,P=0.001),or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918,95％CI:1.341-2.743,P＜0.001) were factors at higher risk.These household chefs also intended to avoid the use of live poultry stalls (OR =1.666,95％CI:1.203-2.309,P=0.002) and accept the "centralized slaughtering,fresh poultry listing and marketing" strategy.Conclusion Detailed study on this subject and,setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the'freezing-fresh poultry'policy.
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Objective To study the willingness and influence factors related to "centralized slaughtering,fresh poultry listing and marketing" strategy,among the household chefs,and provide reference for government to adjust and optimize the strategy on avian influenza prevention.Methods According to the geographical characteristics and regional functions,6'monitoring stations' were selected from 12 residential districts of Guangzhou,respectively.Another 21 meat markets which selling live poultry,were selected in each station and 5 household chefs of each market were invited to attend a face to face interview.Basic information,personal cognitive,willingness and influencing factors to the policy were under study.Univariate and multivariate logistic regression methods were used.Results A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering,fresh poultry listing and marketing" strategy was 44.6％ (296/664).Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618,95％ CI:1.156-2.264,P=0.005),having received higher education (OR=1.814,95％ CI:1.296-2.539,P=0.001),or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918,95％CI:1.341-2.743,P＜0.001) were factors at higher risk.These household chefs also intended to avoid the use of live poultry stalls (OR =1.666,95％CI:1.203-2.309,P=0.002) and accept the "centralized slaughtering,fresh poultry listing and marketing" strategy.Conclusion Detailed study on this subject and,setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the'freezing-fresh poultry'policy.
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Objective To explore the effect of teach-back on the health education of osteoporosis knowledge in diabetic patients. Methods A total of 152 cases of diabetic patients hospitalized in endocrinology department, the Second Affiliated Hospital of Xi′an Jiaotong University were recruited. The study subjects were divided into control group and experimental group according to the admission date, 76 cases in each group respectively. Intervention was conducted using a unified set of publicity materials and slides of osteoporosis knowledge. The routine health education was applied in the control group, and the experimental group was carried out the teach-back health education. The effect of health education was evaluated by the Osteoporosis Knowledge Test (OKT) before intervention, 1 day after intervention, and 3 months after intervention. Results Before intervention, the OKT score of two groups were not statistically different (t=0.071, P=0.943). The OKT score of the control group was (19.21±3.91) points for 1 day after intervention and (16.95 ± 4.14) points for 3 months after intervention. The OKT score of the experimental group was (21.61 ± 2.59) points for 1 day after intervention and (20.54 ± 3.09) points for 3 months after intervention. After intervention, the OKT score of the experimental group was higher than that of the control group, and the results were statistically different (t=4.455, 6.057,P<0.01). Repeated measures analysis of variance revealed that there were significant differences in OKT score between the two groups (P<0.01). Conclusion Teach-back health education is more beneficial for diabetic patients to understand and remember the knowledge of osteoporosis and is worth further research and application.
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OBJECTIVE: To explore the effect of occupational stress on the level of salivary cortisol in electronic manufacturing workers. METHODS: Two hundreds and forty workers were selected as study subjects by cluster sampling method. The Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire were used to investigate the level of occupational stress in the job demand control( JDC) model and effort reward Imbalance( ERI) model. The saliva samples of workers were taken to determine the cortisol levels. RESULTS: Among the 240 workers,172( 71. 7%) showed occupational stress based on JDC model and 59( 24. 6%) showed occupational stress based on ERI model. The level of salivary cortisol of the workers in the high occupational stress group of JDC and ERI model were higher than those of the low occupational stress group( P < 0. 01). The level of salivary cortisol was positively correlated with the score of job demands,external costs and internal inputs( P < 0. 01),and it was negatively correlated with score of return dimension( P < 0. 01). In the occupational stress of JDC model,job requirements and autonomy entered the regression equation( P < 0. 05),that explained the 14. 0% of the total variation of the equation. In the occupational stress of ERI model,job pay and return dimension entered the regression equation( P < 0. 05),that explained the 13. 0% of the total variation of the equation. CONCLUSION: There is a correlation between occupational stress and level of salivary cortisol in the electronic manufacturing workers. Salivary cortisol can be used as an indicator of occupational stress.
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Objective To analyze the risk factors for lower limb venous thromboembolism of patients undergoing hip fractures operation, reduce the incidence of VTE, improve the prognosis of patients. Methods From February 2016 to February 2017, 508 patients with hip fractures were involved in the study from Sino Japanese Union Hospital of Jilin University. The patients were divided into VTE group and VTE-free group. The data were analyzed concerning general clinical information, combined with other systemic diseases, smoking, operation-time, duration from injury to operation, fracture type, anesthetic techniques and so on. The risk factors of VTE were determined using Logistic regression analysis. Results The overall incidence of VTE in this cohort was 25.4％ (129/508). Multi-factor Logistic regression analysis revealed the following risks related to VTE:age 40-59 years(OR 25.986,95％CI 4.552-148.342)and age over 60 years (OR 66.672,95％CI 11.458-387.967 ), concomitant disease (OR 0.228,95％CI 0.105-0.495 ), smoking (OR 3.070, 95％CI 1.647-5.722 ), non-usage of prophylactic anticoagulants(OR 0.069, 95％CI 0.030-0.159), duration from injury to operation≥3 days(OR 9.966,95％CI 4.791-20.733). Conclusions Age, presence of concomitant disease, smoking, non-usage of prophylactic anticoagulants, duration from injury to operation are the risk factors for VTE in patients with hip fracture.
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Objective To research the efficacy and safety of sequential rivaroxaban use in reducing blood loss after applying tranexamic acid(TXA)in total hip arthroplasty(THA).Methods According to the design by the random control principle,150 pa tients undergoing unilateral primary THA from September 2012 to June 2015 were selected and randomly divided into the group A,B,C,D and E (n=30).The group A did not use TXA,the group B received intravenous drip of 10 mg/kg TXA at 10 min before skin incision,the group Creceived intravenous drip of 15 mg/kg TXA at 10 min before skin incision,the group D respectively received intravenous drip of 15mL/kg TXA at 10 min before skin incision and after 3 h,the group E received intravenous drip of 15 mL/kg TXA at 10 min before skin incision and articular cavity use of 1 g TXA before closing the incision.Oral 10 mg rivaroxaban was given at postoperative 6-12 h when the drainage volume was less than 30 mL/h and then the conventional dose was used until postoperative 35 d.The intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate,postoperative anticoagulation time,time of removing drainage tube,postoperative prothrombin time on postoperative 1 d,activated partial thromboplastin time,descend value of hemoglobin,and occurrence rates of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) were observed in the group A,B,C,D and E.Results The intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate and descend value of hemoglobin on postoperative 1 d had statistical differences among 5 groups(P＜0.05).The are significant differences between the group D and A in the intraoperative blood loss,postoperative drainage volume,hidden blood loss,blood transfusion rate,descend value of hemoglobin on postoperative 1 d,postoperative anticoagulation time and removal drainage tube time(P＜0.05).All cases had no symptomatic DVT and PE during the perioperative period and postoperative 3-month outpatient or telephone follow-up.Conclusion Sequential rivaroxaban use after applying TXA during THA perioperative period is safe and effective.Moreover intravenous drip of 15 mL/kg TXA at 10 min before skin incision and after 3 h has most significant effect in reducing bleeding volume during THA perioperative period.
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Objective To observe the value of non-invasive positive pressure ventilation for the overlap syndrome complicated with pulmonary encephalopathyt.Methods Fifty-six patients with the overlap syndrome complicated with pulmonary encephalopathy were divided into the experinental group and the controlled group.The experimental group was treated with non-invasive positive pressure ventilation and conventional clinical therapy (drugs and oxygen).The controlled group was treated with conventional clinical therapy.Results The experimental group was better than tche Controlled group in blood gas analysis (PH、PaCO2) in the second hour and the twentyfourth hour after treatment (P ＜ 0.05).The experimental group was more than the controlled group in the improvement of consciousness disorder (P ＜ 0.05).The experimental group was less than the controlled group in tracheal intubation (P ＜ 0.05).Conclusion Non-invasive positive pressure ventilation could improve consciousness disorder of the overlap syndrome complicated with pulmonary encephalopathy,and reduce tracheal intubation.